Jackson Jany 25 1836
Hearing. sometimes so acute that the 
slightest noise produces the greatest agony.
It is often perverted, sometimes false, so 
that during high excitement, they hear language
addressed to them, reproaching them,
also other delusory sounds. One case relieved by 
Camphor, [illegible] 30 grs. per day for 4 months.
Also used [co??i???t], externally for long time.
This illusion somet. exists in persons of great
mental power, so that they are mono-maniacal 
on this sense. Thus Luther [M??t??]
thought he had a constant controversy with 
Satan, describing voice, etc. 
Vision. Errors may arise from defects
of the Dioptic Instrument, of the Retina,
Nerves, Thalamic & Brain. Somet. the sensibility
is augmented by Neuralgia of 5th Pair.
Remarkable acuteness of vision.
Case in which Touch supplied vision.
Diminution of Sight occurs.
Hallucinations, as Nyctolopia, see at night
Hemeralogia, see in day. Lateral Vision
Perverted, hence superstitious stories. Case
of Nicolet, delusions in fevers, in mania
Inst. of Lord Littleton, a lady’s appearance
predicted the day & hour of his death, & 
at the appointed time, in the midst of a 
joyous festival, he fell dead. Fear probably 
was the cause from its depression.



Case of a student at Heidelberg, deceived
by retarding the clock, & afterwards recovered.
Pathological condition of Int. Sensations.
The two principal are those of Thirst & Hunger
seated in the Fauces & Stomach.
Thirst exists in febrile diseases & in Dropsy
showing that the bloodvessels require some
fluid to fill them up. Somet. it appears 
in last stages of Consumption, it may be
a nervous affection, result from fear, from 
wounds, on field of battle. This should be 
kept in view in treatment of children, 
convulsions even from Thirst, & relieved
by a portion of Cold Water.
Jany 26. Very intense & unquenchable
thirst is a very unfavourable symptom in acute
forms of Fever. In chronic diseases, it often
accompanies them.
This sense is sometimes very acute, so that cases
are recorded of 400 pts taken in 24 hours.
Sometimes a total absence of it for months.
Perversion of it is probably a frequent cause
of Interm. This is somet. acquired, somet.
paroxysmal, & somet. nervous perversion of 
thirst. Case of Paroxysmal Intemp
Case of Lawyer of eminence, who from excitement 
of Brain was driven to it when 
ardently engaged in Court.


It is a morbid perversion of the Perceptive 
Sensation of Thirst.
Hunger also is sometimes perverted.
Thus somet. a morbid appetite in Cancer
of the Stom. prob. it is partially owing 
to the Erosion mistaken for Hunger.
Somet. from Position of Stomach, & there 
is then a sense of Faintness always after
any exertion, relieved by taking food.
Case of Voracity in French Army & after
death, stomach found a large sac occupying
nearly the whole cavity. This to a 
less extent in certain individuals, as one 
who ordered a dinner for four usually.
These patients digest well. But there
is another class, who eat much, but 
reject it soon after. Case of [illegible] lady whose 
whole lie was spent in eating, vomiting
& evacuating. Sometimes no desire
for food, especially in nervous affections,
case of lady for 5 or 6 ms. on Sugar & Water
another 2 or 3 teasp. of Jelly in 24 hours,
but these recover, when nervous affection 
is cured. But if this disgust for food, 
occurs from some organic [illegible], it is 
a fatal symptom.
In acute diseases, a destruction of appetite 


is salutary.
Perversion often occurs, as craving for 
chalk etc. for which you had better substitute 
Pap of flour, Starch etc.
Maniacs somet. present it. Also longings 
of Pregnant Women
Somet. this can be allayed by opium,
& somet. Ard. Spts. so that the lower classes
indulge it to destroy appetite. Case of 
family, lived on it, & destroyed by Cholera.
Pressure around waist by Girdle somet.
makes persons to sustain it, as shipwrecks
Acids increase it & hence probably Earths
which neutralise it
But the mode of treatment must be 
founded principally upon experiment.
The Visceral Funct. Diseases of Nervous
Character. The Viscera are supplied
from Ganglionic & Sympathetic system.
We may have Nervous affection of single
organs or apparatus or expressions in 
one organ of affections of some distant part. 
Visceral Nervous Derangements are very 
common, & apt to be confounded.
Semper Neurosis known by general & 
local. General, no Fever no general 
derangement of the system, & often organs
performing their functions regularly 


Local symptoms, are simple disturbance 
of function, without any change of structure, 
ascertain by percussion etc.
Jany 27
Modifications of voice of nervous character 
relieved by Antispasm. & counter irritation
between the shoulders
Of Respiration. Case of child, in which 
it became only a voluntary act; with 
some pain about the heart etc. relieved by 
Cups between the shoulder, & blister to spin,
 a relapse occurred, & treated by Homeopath.
OF Digestive apparatus, Sensation most
painful, so that in attempting to Swallow
a peculiar feeling & loss of sensation ensues, 
Relieved by any stim. as Wine Brandy Ether etc.
Nervous Dyspepsia is accom. with [illegible]
acid & flatulence, so that if wind is not
discharged, the diaph. is [obstenated]. Was
punching of Halstead cured these cases.
Recognised by absence of thirst, no furred & 
pointed tongue, no fever, no pain upon 
pressure, no bad taste in the mouth, & the
uneasiness does not take place immediately 
after food, but in irrit. stom. the digestion
produces great irrit. of [mind] immed.
Cardialgia accomp. nervous & sometimes the
Inf. form.
Nervous affection of color, producing great 




Perversion of Sympathies may perhaps 
be illustrated by affections of Uterus
followed by vomiting etc. So also in 
Pregnancy. Jany 28th 1836
Treatment of Hysteria of tow Kinds.
1. Find the location of the affection
& it is either usually of stomach or uterus.
When gastric irritation is exciting cause,
it is accomp. with great thirst for Cold
drink, & they may be indulged; then 
the stimuli aggravate the symptoms, & 
cold W. is very soothing & beneficial.
Address the excit. to skin, by Sinapisms 
to stom. ankles, anus, etc. also to Rectum 
by strong solutions zi to ziv Assaf in Muc 
[illegible] with 5 to 20 gtt Laud. and Enema.
If patient has not great thirst, you 
may give diff. stim. as Ether, carefully 
mixed with thick mucil, Syrup. Dose
3 [illegible] to zi & repeat 15 or 20 min till relieved
Hoff. Anod. Aq. Ammo. with Syr.
Tr. Assaf. teaspoon every 15 or 20 min.
but if these remedies produce thirst,
address to skin & to lungs by inhaling Ether
from teaspoon.
Valerian Oil, 2 to 5 gtt with Sugar, & may be
given also dissolv. in Ether or Hoff. Anodyne
When the Paroxysms occur daily for 
a long time, we may suspect organic


functional derangement of the Uterus, 
& most commonly examination will show
that Prolapsus has taken place. Very slight
will somet. produce very violent pain.
Patients complain of Pain in Back, or at point 
of Coccyx. Pessary often relieves it But 
if there be Heat & morbid discharges in Vagin
we may suspect Chronic Inf. & apply Leeches
to Neck of Uterus, ½ dozen gives great reliev.
Spine & Ganglionic become involved secondarily,
& external Irrit. are often Serviceable, & 
it must often be long continued, from 6 to 18 mo.
Somet. Hyst. depends upon Dyspep. syrup.
then Tonics & Laxatives, Alkaline remedy
Rx Gential zi
Cascaril. zfs.
Rhei zi or ii
Bicarb Soc. zii
Sem. [Fe??c] ziv 
Infuse in oii boiling 
W 3 or 4 days 
add 1 gill Brandy
decant & give zfs or 
zi 2 or 3 times per day
Diet must be restricted, without Coffee,
Green Tea or Wine.
Derangements of Motility
Muscles are mere passive agents, & we must
look to the Nerves as the original seat.
Local Spasmodic Diseases, as Wry Neck.
This may be natural, or irritated as from air
blowing upon one side. Apply local heat by 
smoothing iron, or along spine, & Purgatives
Give Wine, Colc 10 gtt & Black Drop 5 gtt, 3 the day [illegible][illegible]



[Trismus] is another local affection, somet.
accompanies Tetanus. somet. occurs in Infants
within first 14 days. Appears to be
connected with Gastric derangement, & purgation
are most effectual. May arise from Cold,
& then treated by Gen. & local Bleeding, cups & 
Blisters to Mastoid & Neck, & Revulsives by 
Purges 
Jany 29. 1836
General Spasmodic Diseases.
Permanent rigidity of muscles & joints is 
owing to Inf. of Corp. Striat. & Infer. of Brain.
It occurs somet. in Typhoid Fevers, & is a 
dangerous, but not a fatal symptom.
But if the rigidity comes on gradually without
Fever, it is a fatal symptom, & shows
that Softening of Brain is progressing. But
that is not a spasmodic disease.
Tetanus from 2 causes, Predisp. & Exciting
Predisp. are nervous Temperament, Hot Weak
& climate, from cold, [worms] etc.
Hence it is Idiopathic & Traumatic,
the first most easily cured, the latter, hazardous
The structural condition of Nervous system 
in this disease is unknown.
Symptoms of approach should be carefully 
watched. Punctured & lacerated wounds are
most apt to occasion it. Hoarseness & 



difficulty of swallowing.
Exciting causes are some local irritation & 
often a considerable time elapses, before the
impression disturbs the nervous centre.
Somet. no local irrit. perhaps owing to some
irrit. of internal surfaces.
Symptoms are premonitory, as Uneasy
sensation in part & in Nerves extending from it,
& pain from pressure along its course, then 
leeches, Poultices & Anod. along it.
Uncomfort, feeling at back of Neck, round
jaw, & at end of Sternum, then active
measures must be immed. used.
somet. Trismus is [comm????]
The muscles affected are different, either
flexors or extensors. Patient bent forwards
in Emprosthotonos, or backw. opisthot.
If all muscles, he is rigid, Tonic Tetanus
also one side affected
Cramps for a few minutes, violent pain,
increase in frequency, till at last violent
spasm produces suffocation. Mind is often 
perfect, or that Brain & Senses do not
suffer, but merely motional power
circul, & skin natural, except in Parox.
or in Sweat of Agony
Treatment not settled. opposite & various,
Canth. V.S. Merc. Revuls. upon Spine, Antispasm.
as opium in large doses, Liquid prep. is better than solid.
The Brain does not feel the narcotic effect


Intoxication by diffus. Stim. to produce relaxation 
has been attempted.
Likewise Tobacco has been recommended,
& the safest method is as Suppository.
The most successful treatment is 
Local depletion by covering Spine, with Cups
& Leeches, op. internally, & Calomel
Follow local dep. by Moxa, Caustics etc.
Convulsions. differs from Spasm in having
the senses destroyed during the Paroxysms, 
rom having irreg. muscular action, instead
of fixed spasm. The whole of the Brain & 
nervous centre appears to be involved.



collection of flatus, producing pain, borborygmus 
etc. Relieved by Tonic & [Ca???]
Inject. as Bark & Fennel or Chamomile.
More common in Females than Males, 
& with it we have great torpor of Bowels,
& the best remedies are those addressed to 
the Spine.
Nervous affection of Secretory organs, particularly 
of Urinary organs, increasing the 
discharge enormously, during Paroxysms.
The derangements of Sympathy next
demand attention, & may be of 3 kinds
Augmented, Diminished or Perverted
Under the first, is comprehended Hysteria
& the local excitement inf Females is usually 
the Uterus. The only means to be relied
upon for cure, is to equalise the 
nervous stimulation. It commences generally 
in abdom. visc. unpleas. feeling
from lower part of abdomen, rolls upwards
& forms Globus Hyst. & we often have associated
with it, derangements of function 
of Lungs, Heart, Viscera etc. It seems to 
belong to Symp. System only, because all 
the functions are disturbed temporarily only.
Second. Paralysis is one of the worst forms
of [illegible] sympathy. It must be cured
by Fever, which is a healthy recuperative
powers, depending upon movement of nervous
system.



Canula of Belloque




Olfactory 1st Pair Corp. Striata
Optic 2nd Pair Thal. [Testis] & [C???] [Co???]
Mot. Oc 3d Int. Surf. of Cons [Cere?n]
Trochlearis 4th Valve of Brain
[Ingen???us] 5th  Corp. [Restifo???] & emerges
from junct of Pons & [Cons] Cerebelli
Mot. Externus 6th  Corp. Pyram.
(Facial) Portio Dura corp. [oliv] & [P??s] Corp. Rest. & Surface of
Pars Media 7th  4th Ventricle.
(Audit.) Portio Mollis
Glosso-Pharyn. Fissure between olivare
& Restiforme
(Carda Pneumon Gastric) Par Vagum 8th 
Spin.Accessory medul. Spin, as low down
as 5th or 7th Cervical Nerve
Hypo-Glossal 9th  Between Pyram. & Olivar.
3. Thro. Sphenoid Fissure. to muscle except Obliq. Sup. & R. Externus
4. Same. Ext to former to Troch. or Sup. [ob.]
6. Also thro Cav. Sinus, sends fil. to Int. carotic. rad. of Syrup, then it [passes]
thru Sphen. Fiss. to Rect. Externus.
5. Plexus at point of Petious Bone, canal of Dura Mater & [forms] [Gag]
of [Gasser], ([co??s??]) & then 3 branches 1. Opth, thro [Sphear] Fissure
2. Sup. Max. thro For. Rotund. 3. Inf. Mad thro. For. ovale
1. Nasal, Frontal & Lachrymal
Nasal fil. to [Lentic] Ganglion. then divides into 2. one goes to ext Nasal sub.
canthus, other (Int. Nasal) thro Ant. [Eth??] For. & out thro. Ant. [Crib.] to Top etc.
Lentic Ganglion of this [fi?] & from 3rd send 20 Ciliary Nerves.
Frontal Int. & Ext.


2. Sup. Max. passes thro Pterygomax. Fiss. sends forwards
Infra orb. which branches also to the Teeth. I
Forms spheno Pal. Gan. & thence go Palatine, spheno. Pal
to Nose, & Pterygoid. Pter. divided into Superfic & Deep
[Petions], which with [rec??ent] of 6 forms Syrup
Muscles of Mastication, Sup. Temp. with Temp. [A?t?rg.]
Next Inf Dent. to Post Dent For. & there sends Mylo Hyoid, 
Lingual & Inf. Dent. go between Pterygoid muscles
Ling. in Gustatory Nerve & receives the Deep [petions] or Ch. Tymp.
7. Thro [?eat] Sut P. Dura in front winds round into Stylo Mas. [illegible]
For enters Parot. & divides into Facial or [Pos] Anserina.
8. Spin. Ac. thro Post. For. Lac. to Sterno [Cl??] muscle
Glos Phary (along Stylo Phar. muscle behind this & between it & Stylo Gloss
to Tongue & Glottis
9. Hypo Glos. below former thro’ Ant. Con. For. to muscles 
passes above Os Hyoides over [con?tids] sends down from its
[Curve] Descend. [No??] in front of vessels of Neck to 
Sterno hy. thy. & Omolyoid
Par Vagum, thro’ Post. For. Lac. sends off Sup & Inf. Pharyng.
[illegible]. Laryn in Thorax. Inf. Laryng. or [Recument].
then [??ngs] behind Bronch. down Esoph. (plexus) to the
stom. Right in Posterior & Left Anterior.
Sup. Laryng. goes between os Hyoid, & Thyroid behind [Illegible] [Lig.]
[Recu??] Inf. Laryng. left, from front of aorta, up Esoph. to Larynx
right, behind subclav. & [prim.] carot.
Outside of 
Prim Carot.



1
Jackson Jany 25 1836
Vital Phenomena are results of different causes, & 
external agents are absolutely necessary for them, as
Caloric, Air, perhaps Light.
Between Life & these external agents there is an eternal
conflict, & the latter sometimes prevail.
1. Vitality is incessant activity or movement.
2. Movement owing to Ext. agents.
3. Reaction between these causes Life, or vital phenom.
Vital movements which take place in Organized 
matter are various, & may be arranged into those 
of relation, or nutrition, & digestion, absorption, circulation,
respirations, terminating in Nutrition & Secretion
We have also movement, of sensation, of voluntary 
& involuntary motion, of perception.
Every movement has some specific agent to effect it.
First causing Life by Excitability, Contractility etc.
1. That it is generated in Nervous System.
2. That force of life is essentially connected with organisation,
is a property belonging to it


Formerly Life was thought to be owing to Anima or
Soul, & this has been variously modified since the time
of Stahl. Hoffman thought that the force causing
these movements was caused into oxygen Lungs & thence produced
its effects Cullen took somewhat the same view.
Jany 26. 1836.
The objection to the doctrine of Stahl is that if the nervous
system is the exciting power of vital actions, what is 
it that excites the nervous system?
Doctrine of Glisson is that Life is an inherent property 
of organised matter, & this proper of Irritability,
he divided into Natural, Sensitive & Animal.
This doctrine was obscured by Haller, because he
limited it to that tissue alone which contract when 
Irritants are applied.
By vital actions we now mean the reactions which 
takes place in organic matter between it & the external
agents, peculiarly modified according to each tissue,
& that there is but one vital force, acting upon 
the organised matter. The structure is constantly 


3
changing, & hence the effect of the reaction must be constantly 
vary & no individ. remains the same for 24 hrs.
Hence the importance of examining the forces of the
diff. organs, so as properly to adapt our remedies.
So also those who have been accustomed to the use of 
Ardent Spts. or opium, they acquire a new vitality
& the immed. return to a state of health is fatal.
Chronic diseases require the same modification of the life
of the individual to suit his diseased organs. Case 
of Dropsy of 9 yrs. standing, treated for cure by another
physician & she died in 3 weeks
Absorption. Upon this movement of [inbibition] depends
some of the most important functions of the Economy 
Formerly it was thought to be owing to a particular set
of vessels, but now thought to be a property of all organic
& inorganic matter, & that there is a kind of chemical
affinity between these tissues & the matter absorbed.
If the economy can reduce it to its own nature, it does 
so, but if not, a conflict takes place & diseases 
of various kinds result.


Jackson. Jany 28 1836.
Movement of Circulation, or distribution of nutriment
to every portion of the body. This takes place on in the 
higher order of animals, in the lower order we have a movement
of inbibition.
The Heart & Arteries are the powers propelling the
blood, & the column of blood distending the elastic coat
of the arteries gives origin to the pulse; but when the
column is so diminished as not to fill up the calibre of
the arteries, we find no pulse. The Forces returning
the blood to the Heart are yet unknown, it cannot 
be the mere Vis a Tergo of the Heart, but perhaps the
suction of the Rt. side may have some influence
Besides Venous & arterial, we have the Capillary or Interstitial
circ. the most important to the physician.
This movement does not take place by mechanical,
but by vital forces, as shown in congestion, irritation etc.
Hence the totally distinct principle of action of blood
taken from the arm & blood taken from the capillary 
system by leeches or cups.


5
Another Phenomena which probably acts upon circulation 
is similar to that of vegetables, in which the sentiment rises
thro’ the woody fibre, from the vacuum produced by Evapor.
from Leaves. So in human body, we have numerous extended
surfaces folded up economically, as in Lungs, in which 
the blood is spread out to the thinness of red globules, & from 
this a constant evap. is kept up, so also the surfaces 
of other organs & parts of the body.
Jany 29. 1836
Movements of Respiration. Before [nutriment] becomes
fit blood for the economy, it must be exposed to atmospheric
air, & arterialised. Venous blood is fatal to the
Brain whenever it enters it. The presence of Oxygen is
rather inferred than demonstrated in Art blood, & likewise 
the existence of Carbonic Acid in Venous blood,
this has been recently shown by means of a serous membrane
stretched as a partition between Blood & Lime Water.
Any foreign body which cannot be assimilated, if it
can be divided sufficiently minutely, is eliminated by 
the Lungs. Some medicines have peculiar tendency 


6
to Lungs, thro Arteries is eliminated in that way,
& it may be a question whether Arsenic does not produce
a tendency to Tubercles. So also Mercury, & from 
this we account for increase of Tuberc. Consumption.
In summer & hot climates, the skin eliminates it, but
in Winter, the Lungs, & hence great caution for those who
have been thro a course of Mercury.
Movements of Nutrition & Secretion, occur in the
very interior structure of the economy, & we know but little
about them. They are constantly changing.
Movements of Sensation & of the Nervous System generally,
we only know as a fact, the cause & manner is beyond 
our conception. Pressure upon them, arrest their function.
Nervous Parenchyma presents 2 forms Pulpy & [Fibrinary], 
the former ash-coloured or darkens, the latter white.
They are diff. arranged in diff. parts of the body, & rom 
these proceed [illegible] chords or nerves, terminating on
surfaces, & from the sensitive Surfaces We shall commence
with the Spinal Marrow, which may be divided 
into 6 portions. 


Jackson. Feby 1st 1836
The White or Medullary portion of the nervous System
merely transmits impressions, while the cortical
cineritious originates the forces of the Nervous System
We shall follow Bellinger, an Italian anatomist
There are 6 strands of Medullary matter in the Spinal
marrow. 2 Ant. 2 Post. & 2 Lateral.
1. The 2 Ant. are connected with Cerebrum.
2 The Post. with the Cerebellum
3. The Lateral with the Corp. Restiform
1. Produce motion 2. Sensation, & 3 Superintend
the Organic & Instinctive action of the Individual
We believe that the Ganglia are formed on the Nerves
from the Lateral strands, & not on the Posterior.
Post. roots have 3 origins, one from Lateral strands, and
then from the Cineritious portions & a third from the 
cerebellic strands.
Hence Bellinger concludes that the Ant. portion 
gives origin to flexion, the Lateral, to organic action, the Post. to 
extension, & the Cineritious to Sensation.


8
Sensibility is divided into organic & Functional.
Organic is formed when Brain does not perceive any 
impression, as in Apoplexy, or in musc. tissue removed
from the body, which contracts, if irritated.
Besides this, to perfect Sensation, we must have the 
Brain to perceive the action of external agents.
We have 5 External senses, from imitation of ext. agents.
Internal, arising from some modification of mucous
membranes lining the diff. cavities & organs.
Three things are essential to Animal Sensation.
1. An impression or modif. of recipient surface,
2. Nerves to transmit the impression,
3. Organ to receive the impression & appreciate it.
There must be an absolute connexion between 
the various parts contributing to sensation, or the 
function will be completely destroyed. Hence
disease either of the recipient surface, of the transmitting
nerves, or of the Brain, may destroy the
proper exercise of any of the Sensations. p. 11


9
Chapman. Feb. 1st 1836.
Cullen pronounces Hydrothorax generally incurable,
& when it occurs from organic lesion, or in broken
down constitutions, it probably is so, but if from 
[simple] Pleurisy, prognosis is favourable.
Post mortem exam. shows Pleurisy altered by Inf. or structural 
lesions of the Thoracic or Abdominal Viscera.
Fluid is found in Pleural Sac, compressing the Lungs.
Somet. in the Pericardium; & Edema of cell. tissue of Lungs
Treatments. In the early stage, they are generally Inf.
shown by blood, pain in side, etc. hence commence 
with V.S. & repeat while active pulse etc. demand it.
Top depletion, by cups to Back & Blist. to Breast
Nitre, alone or with Tart. Emetic, Squill & Calomel,
Digitalis, in which at present but little confidence,
Colchicum. Dr Ferrie’s experiments resulted in the
following combination as most efficient
Ext. [Ecat??] gr i
[Illegible] Spt Nit zii
Tr.Scill
[Ol] Colch aa zfs
Syr Rham zi
Dose zi every 3 or 4 hours.



10
Emetics have been highly recommended, but probably 
are useful only to exonerate the Lungs. There use in 
nauseating doses I think acts favorably.
Purging I have found advantageous especially in 
Women, who are much more tenacious of life than men, 
but others do not recommend them. The Drastic articles
are best as Elatin or Croton Oil. The first dose 
of Croton Oil I gave in this Country (gtt i) proved very serviceable
Expectorants may act as palliatives & facilitate the 
discharge of bronchial accumulations, & most of them also 
produce absorption.
For the chronic form, little can be done. Attend 
to invigoration of general system & organic lesions.
Paracent, Thor. may sometimes be tried as a palliative.
Cures have been reported from it, but they are very rare.
The Pericardium has been tapped by a needle with 
success, in one case reported in the Lancet. [La???]
suggests that sternum be first trephined, & expose the
Pericardium to view. See p. 12. 


11
Jackson. Feb 2 1836
Paralysis of Extensor muscles with permanent flexion
of the limbs, showing that the Antagonising power
of the muscles is owing to separate Nerves arising
from distinct portions of the Spinal Marrow.
The Ant. Strands coming from Cerebrum govern
the motion s of Flexors, the Post. from Cerebellum
govern the motions of Extensions.
In the Spinal marrow, the Lateral strands superintend
the Functions of the Viscera, & their derangement
is often the cause of Visceral Disease. This
should be kept steadily in view in anomalous 
affections which appear to be seated in the Viscera.
Inf. of Arach. memb. of Spine is accompanied with 
pricking sensation in limbs, not always pain upon 
pressure, Constipation of Bowels, Irreg. resp. & Palpit.
somet. rigidity of limbs. After death, it is found
thickened, & has cartilaginous & osseous deposits.
Inf. of the Spinal Marrow, is accompanied with 
Formication, & often with Palsy. p. 15



12
Chapman Feb 2 1836
Hydrocephalus Internus, was formerly considered 
merely as effusion under the Scalp.
Divided into Internal & External by Petit etc.
Now divided into Acute & Chronic, or other terms.
Acute. Children are chiefly liable to it.
First stage very insidious, languor, irreg. bowels, collapse 
const. tender scalp, puffy abdomen, epigast. tender 
sleep disturb by moaning, inquietude also in day.
Febrile movement follows. Nausea [illegible] dry 
or moist & coated tongue, headache, or stiff of back 
of Neck, temp. [illegible], noise in Ears, aversion to 
light & sound, sudden starts, screams in sleep.
Next approach of heaviness, scowl, dilat. pupils.
pulse slow & intermitt. bowels disord, clay col. stools.
& covered with oil urine deficient, partial delirium
when roused, tend to syncope when raised up.
Now a dry cough arises.
Pulse becomes weak & thready, strabissimus, rolling
of head, tossing hands about, low delirium 


13
spasms of limbs, diff. deglutition & labor. respiration.
Invol. discharges, Thus it may be several days, emaciated
& suffering, & Death occurs in 10 or 15 days.
Somet. a case occurs without premonition, & dies 
in 2 or 3 days; they are often called Water-strokes.
More commonly result from protracted Fevers.
It occurs somet. from Metastasis.
Its cause cannot be readily explained, probably 
the delicacy of the Arach. is such that no [interss?] Inf.
follows its lesion, but this does in older persons.
There appears to be peculiar susceptibilities to it in Some
families, perhaps connected with Strumous Habit.
Dentition has some influence. The condition of the
Chylopoietic viscera, the irritation of Worms, the sudden 
suppression of acute or chronic eruptions etc. cause it.
Diagnosis somet. is difficult. Previous history, inclination 
to vomit, constip & aspect of stools, urine, aversion 
to light & noise, strabiss. slow irreg pulse, head
& hands deglutition & respiration, & they can [bear]
only the recumbent posture, faint or scream, if roused.


14
Important to determine whether of Cerebral Origin,
by observing the preliminary symptoms.
It is only in the early stage before effusion that
we can be very serviceable. If excited by stom. or 
viscera, it is more manageable, so also acute & Infl.
Unfav. Sump. are Desire to lie still, tinnitus aurium,
or deafness, pupils dilated or contract, pain in Neck,
coma, convulsions, pellucid urine, copious watery
discharges of feces are fatal symptoms.
Fav. are subsid. of cereb. affect. compos. stomach,
nat. evac & urine, soft skin, & defluxions from 
nostrils, which indicate proper secretions.
Post mort. Exam. very various. Substance of Brain
sometimes softened, & parts Hypertroph while the
Fomix is usually wasted, Effus. in Ventricles, between
memb. & convolutions, of fluid of diff. kind & colour
tho’ somet. no effusion could be found, altho’ the 
symptoms during life seem to mark Hydroceph.
Tumours, abscesses etc. are sometimes found.
Derangements of Chylopoietic Viscera


15
February 3d 1836
the Effusion is owing to weak diffused Arachnitis,
but Hydrocephalus is very distinct from the usual acceptation 
of the term Arachnitis. Sometimes it may 
arise from disorder of the Digestive Apparatus.
Treatment. Predisposition must be watched, preceded
by evac. of Al. Canal – mercurials, rest, low diet, etc.
Leeches to part affected with Pain
After Inf. appears V.S. if patient can bear it, which 
is rare, consequently it must be used with great caution.
Leeches may be employed repeatedly, or opening of the 
Temporal Artery, cold to Heat, Stem. to Feet. Much 
depends upon Purging, & I have seen it very beneficial.
Cal. alone or combined, or Spigel, & Senna for worms
Emetics have been too much neglected, for I have seen 
an overloaded stomach produce very similar symptoms.
They also change the capillary action.
Blisters first upon the Nate of Neck, then over the
whole of the top of the Head, the latter to remain for 24 or
36 hours, until suppuration of the scalp is estalished.
Shave the head several hours before its application.


15
At this state, the patient becomes affected with spasms.
Convulsions or Coma etc. owing, I contend, to a collapsed 
state of Brain & Nervous System & not to overexcitement,
hence it is proper to treat it by Stimulants, ad Carb.
Ammo. Op. Wine & even Brandy.
After Effusion, there is but little hope of benefit. The
fairest prospect is held out by Mercury to change the 
[???ning] system. Case with Kuhn, child 6 yrs. covered with 
Merc. Ointment, & used 14 ½ lbs. to produce effect, it
recovered & is still living. See p. 17
Jackson Feb. 4
Affections of Spinal Marrow. The Dorsal portion gives
rise to pain in Back, Palpitation, Einbar, Resp. Pain 
in Side (Left) & in Sternum, Gastralgia. The recumbent
posture in a warm bed increases the pain. We
have also Cramps of stom. relieved by Cups to Spine.
If Lumbar portion Pain there & in Sacrum, somet.
down in [??pogastric] Region, so that it may be mistaken
for Disease of Bladder, Prostate etc. Also
obstinate Constipation often depends upon it.


16
Colica Pict. depends upon Inf. of muc. memb. of Al. Canal
& of Spinal marrow & nerves supplying the Dig. Apparatus
Hence the diversity of treatment according as one or the
other affection gains the ascendency.
Spine subject to Hemor. or Apoplexy, produc. Paralysis,
also to Dropsy, from Acute Arachnitis, & accomp. Hydroenceph.
Spina Bifida, Hypertrophy, Atrophy, Concussion,
Compression from Tumours, or Aneurisms, all producing
disturbance of its functions.
There appears to be also an Epileptic condition of it.
Case of Lad, seised with Intermit. Fever, & after Heat 
regular monthly parox. of cramps of all muscles below
the Neck. continuing for 3 or 4 days at a time. He
was treated by Cups, Leeches, Pustules to Spine etc. & [illegible]
diet, rest etc. appropriate to treatment of Epilepsy.
There may be also a constant Pain in Spinal Marrow,
especially lower portion, lasting for years & then disappears.
If in females, it is often connected with Prolapsus.
Some pathol. regard Intermit. Fevers as arising from 
Spinal Marrow, thus Hoffman, Francke etc. p. 23.


17
Chapman. Feb. 4 1836
Chronic Hydrencephalus, apt to occur in children of
weak & strumous constitutions, or any cachectic condition.
Dry husky skin, depraved appet, disorder of digest, & bowels
tumid abdom & pain, debility & emaciation. Then fever,
Headache, [ingel] or seminal, & other cerebral affections.
V.S. rarely admins. but Leeches & Blist. to Head, Purging
& Mercury, which however may prove injurious.
Somet. this form is Congenital, & may continue many yrs.
The Functions of Brain may be continued, because the 
folds of the Brain are merely unravelled or drawn out into 
a sac, so that there is no loss of substance.
Medicine is useless, Tapping somet. is effectual.
Anasarca. If local, it is called Edema.
It is much modified by circumstances under which it occurs
Generally commences in Feet & Ankles, & gradually proper 
somet. vesicles from on surface, burst & become Gangrenous
Int. cell. tissues may become dropsical, especially of
Lungs. External is occasioned by local irritation
of skin, passing to subcellular tissue, or by interruption


18
of circulation, as in Pregnancy, or from extreme exhaustion.
Somet.  accomp. Ascite, & other forms. Also 
sequellae of Fever, cold, debility from V.S etc.
Diagnosis generally very easy, & particularly by the
indentation upon pressure.
Curability is variable, if suddenly induced from the 
cell. tissue, generally easy, but not if Chronic, or dependent
upon visceral lesion If attack long continued,
cells are enlarged, if recent, they are diminished
Effusion is owing to slight & diffused Inf. of Cell. membrane
& somet. in debility to escape of fluids thro’ relaxed inhalents.
Treatment nearly the same as in other varieties
Mercury is less applic. & Diaphoretics more so, also
warm frictions, enveloping limb in Silk, cabbage leaves,
or Tulip Poplar leaves. Gangrene somet. occurs from 
pressure, & may somet. be arrested by compressing the 
limb above & below with a flannel roller, which imparts 
heat to the skin. Regulus of Dropsy of Cavitie partic.
during febrile state should be very low, Case of Dr Johnson.
If it be of the less active kind, nutritious diet is demanded.
Drinks are allowable, acidulated vegetables, Cider etc.


19
Chapman Feb. 5 1836
Diseases of Pulmonary Organs. 1. Catarrh,
an affection of the mucous membrane of the Lungs,
introduced by fullness of Head, [corysa], Hoarseness,
Embar. Resp. Cough & Expect. somet pain in Frontal
Sinus, accomp. with Fever. Terminates by copious 
expect. or by Diarrhea. It is apt to be complicated.
Caused generally by some exposure, by inhalation
of acrid fumes, as of new Paint, flowers, snuff, somet. is
Epidemic (wide-spread), & called Influenza (Italian).
One attack protects the system during its prevalence.
Diagnosis easy, partic. with the Stethoscope, in find the
sibillant [ronchus], & temp. abs. of Respir. murmur,
until after coughing.
Prognosis most unfavorable in early & advanced age.
Thin & [glassy] sputa indicate continuance of Inf. but 
thick & yellow indicate approach of convalescence
Catarrh should not be neglected on acct. of Sequela.
The Upper lobe of one lung is generally all that is affected
Mucous memb. either hard & thick, or soft & puply.


20
Pathology. It is owing to Inflam. of the mucous membrane
extending from Schneiderian membrane down the Trachea.
Treatment. It may often be suppressed by taking an 
Opiate upon going to bed, which acts as a diffus. stim.
Somet. ARd. Spts answer the same purpose. Diaph somet.
act happily, Stim. [pedilus]. Cups to Frontal Juices,
& after these Cal & op. acts well. Lemonade Hot, Molasses
Whey (Milk boiled oi, & molasas gradatim, from Drury
Lane). Egg Tea, Bran Tea etc. somet. Cold Water.
For Diaph. Infus. of Eupat. Inhalation of equal parts
of Hoff An. & Laud. (Physic)
When moves violent, more active treatment, as V.S.
topical bleeding, Saline Purgatives, Calomel sometimes.
Rx Sulph Magnes. zi 
Nit. Potass. zii
Tart. Ant. gri
Aq. Tepid. f zvi
To keep bowels open & give
a tendency to skin, give
it in small & repeated 
doses.
Emetics are suited to relieve pulmose oppression.
Blisters if properly timed are useful, but it must
be in declining stage, where Cough remains & pain 


21
in the chest. Cough Mixtures are abundant, all containing
opium etc.
Rx Ext Glycyr ziii
Aq. Tep. f zii
Swt. Spr. Nit. zii
Ant. Wine
Laud.
Rx Oxyn Scill
Ant Wine
Swt Spt Nit
Laud
Rx Carb Pot.
[sut] wine aa zi
Laud gtt 60
Comp. spt. [Le?] zii
Aqua f ziv
For old persons, Paregoric
is preferable to other
prep. of opium.
Vinegar or Lemonjuice with Brown Sugar.
Diet must be strictly Antiphlogistic.
Vegetable Broth. 2 Turnips, 2 Potatoes, Onion or Celery 
Slice of Bread 3 Pints of Water boil to oi add Salt & 
pour it on piece of Toasted Bread.
Lying in bed sometimes relieves it. Laennet recommends
Spiritous Preparations, just before going to bed.
Sometimes a Paroxysmal Cough remains after the 
Inflam. has been relieved, it may be owing to enlarged
Tonsils, or Uvula, or atonic condition of muc. memb.
They are relieved by an appropriate Garge..


22
Chronic Cattarh, may be either original or follow
an acute attack, & often degenerates into Catarrhal Consump.
Approaches with Pain in Chest & Sore Throat, some Sputa
[glassy], mingled with small yellow bodies from follicles,
it grad. changes, becomes more copious & puruloid.
Large quantities of Pus are somet. secreted without ulceration.
Diagnosis somet.  difficult, as it passes on, it closely 
resembles genuine Tuberc. Consump. Stethoscope 
gives mucous rattle in Catarrh with Resp. murmur, occasionally 
stopped by the Phlegm, removed by coughing.
If permanent cessation, & sibillant ronchus, show the
thick, [illegible] memb. [Pectoloquy], cavernous Resp. etc.
show exist. of Tub.
Post mort. shows somet. Ulceration, Dilat, or Contract
of Bronch Tubes, secretions blocking them up. False adhesions
of Pleura, Dropsy of Heart, & Indurat. of Liver etc.
Treatment First arrest Inf. by gen.  & top. bleeding, Blisters
etc. Tart. Ant. Low diet etc. Then Emetic occasionally 
Balsams of Tolu, Copaiva. Bals of Honey (Tolu & Laud)
Rx Tr Solu zi
Tr Digit
Laud aa zi 
[gtt 40] 3 times per day Terebinth Prep. also
See p. 24


23
Jackson. Feby 8. 1836
Medulla Oblongata is a most complicated structure,
is the centre of the motorial, sensual organic faculties.
The function of most importance is Sensibility, which 
is not fixed, but varies with the structure to which it
is connected. Hence the variety of Sensations, the diversity 
of talents, etc. in different individuals.
Some parts of the human body are highly sensitive,
while others are not, but these latter may undergo
such a modification by disease, as to be sensible.
Sensibility is divided into Organic & Animal.
Organic occurs without Perception or Consciousness.
Case of violent spasms etc. from Wine in Stomach,
cured by Cold Water & Cups to Stom.
Animal requires the Intellect.
Sensations are Org. or Animal, Int. or Ext.
They are very numerous, each part has its own.
They depend upon the activity of Sensibility, & hence
the capacity of exciting them varies exceedingly, & so
also in Pathology, diff. susceptibilities to medicines.


24
Sensations are Active or Passive. Active occur in Hypochondriacs,
whose sensibility becomes so acute that
the mind is fixed upon some organ as a seat of disease.
Thus trifling diseases often become very serious by 
the constant operation of the mind. See p. 27
Chapman Feb. 8.
Acute Bronchitis, formerly called Peripneumonia
Notha. or Catarrhus Nothus or Suffocativus.
It is produced by ordinary causes of Catarrh operating
upon weak or Phthisical Constitutions.
Its aggression is very various generally heavy respiration 
with wheesing or rattling, very seldom acute
pain. Cough dry, or phlegm like white of Egg, no Fever
pulse somet. accel. & fuller, somet. less, pale bloated face
dullness of mind, thirst clammy fauces, & constip.
Somet. more reaction, sense of tightness & suffocation
It rapidly advances, oppression increases, brain 
becomes affected, general prostration, much thin
bronchial secretion & rattling, dyspnea, hoarseness,
inability to endure recumbent posture, or expectorate
& death follows.


25
There are varioius grades of intensity, & secondary lesions
Etiology similar to Catarrh, from Cold & moisture
Diagnosis, in early stage, easy. Wheesing & rattling,
or if after this, use Percussion & Auscultation.
Prognosis unfavourable, if much oppression without
much expect. thin sputa, cold skin, coma, livid
lips & nails, dewy perspiration. The Revers of these 
may be considered as favourable.
Case ends in 3 or 4 days, somet. in a few hours.
Post mortem, Morbid [glairy] secretion in Trachea & 
Bronchia somet. engorgement of vessels & ecchymosis.
Pathology. It is an affection of muc. memb. of Lungs,
seated partic. in Bronchiae, & more of Congestion than
Inflammation, hence Sputa more thin & [glairy].
The secretions block up Bronch. so that the blood can 
not be sufficiently exposed to the air & decarbonised.
Treatment. The subjects are generally so weak that
V.S. is scarcely admissible; Emesis in [commenc.] is 
recommended as highly useful, by Ipecac. or Sulph Zinc
but I prefer combin. of Ip. & Tart. Emetic. Some caution
is necessary in administering them.


26
Cups between Shoulders & on Sides & Blisters to Breast;
Calomel may next be administered, & I have 
found it useful. Then Cal. Ip. & op. in small doses.
Or Expect. as follows Rx Lac Ammon. zi
ox Scill
Paregoric zfs
Rx Decoct Sen zvi
Honey zi
Paregoric zfs
Rx Honey zi
Vinegar zii
Paregoric zfs
Water zvi
Tablespoonful of these
every hour or two.
Spt. Tereb. teaspoonful every hour I have seen useful 
In extremis Carb. Ammo & Wine Whey 
Inhalations or Vinegar & Water, Syr of Tolu & Water etc.
Hoff. Anod. Tar, Turpentine etc.
Chronic Bronchitis. May follow acute or not.
Drunkards are peculiarly liable to it, & probably it
follows disorder of the Abdom. Viscera. Resembles
Ch Catarrh, Sputa at first thin, & gradually becomes
purulent without pain, more wheesing & rattling
feeble pulse, edema of lower Extremities. Life is
very indefinitely protracted & usually suffocation.


27
Post mort. Lungs do not collapse on acct. of mucus
contained, lining memb. thickness & variously deranged
from Inf. So also the Parench of the Lungs
Somet. the lining memb. is pale, & secretes abundantly.
Treatment. Commence with mod. V.S. if [admins]
Cups to Back & Sides. Blisters to Breast. Cal. squills
& Ip. singly or combined. Colchicum has been used
Balsamic Prep. might prob. be beneficial. Also Tonics
But the cases generally terminate fatally. See p. 28
Jackson Feb. 9th 1836
Sensations when very active & long continued, destroy 
the sensibility of the part. They are very variable, & 
cannot remain constant at any one point.
One sensation destroys another of equal intensity.
Very painful sensations often removed by slighter
ones, as Rheumatic by gentle Frictions.
Sensations acquire delicacy & acuteness by exercise.
& become blunted by inactivity.  The loss of one sense 
is somet. supplied by another.
Labourers have sensations much blunted so that they 
complain of little or no pain. Alms House 



28
In the higher orders, their vital powers are expended
upon the nervous system, so that they are constantly 
complaining of aches & pains, without any disease.
Pleasure & Pain are very variable, one often terminates
in the other. Thus Titillation may produce Death.
Pleasure is more lasting by closely adhering to a 
moral course of life, & avoiding all excesses of pleasurable 
indulgences, so that conscience may not check [illegible].
Pain is a powerful stimulant to Brain, & hence when
this organ is acutely inflamed, we must abstain
from painful excitations. p. 33
Chapman. Feb 9. 1836
Tussis vel Catarrhus Senilis. Its subjects are
generally feeble, it attacks somet. paroxysm 2 a day,
surface becomes cold, bluish etc. & sometimes death
from suffocation. Sometimes the attacks continue
during Winter & disappear during summer. Somet. continuous
for several years, with copious bronchial secretions.
General Treatment much the same as for 
former varieties of Bronchitis.



29
Infantile Bronchitis or Cat. Fever. Somet. it appears 
like Bronch. somet. like Catarrh. It occurs generally 
between 2 or 3 yrs. begins like common Catarrh, the
child changes but little, sleeps rather more & perhaps 
more fretful, pulse rather feeble, pallor & cold surface,
impeded respirat. & gen. debility. Next comes the
stage of excitement, more fever, constrict. chest, constip.
abs. of Secretions, Next Collapse ensues, with 
wheesing & rattling, cough suppressed, & occas. delusive
respites, till at length, comatose or suffocates.
Somet. it advances very insidiously. The Inf. may 
be extended to the neighboring tissues, to the mucous
lining of stom. & produces Gastric disorder.
The disease usually prevails in Spring, but may 
occur at any other season. The florid & robust as well as 
the weak & sickly, are subject to it occasionally. It 
somet. prevails epidemically as in 1825, attacking all 
ages, something like Influensa, & in 1831-2 it again 
appeared, attacking the adults, more than Children 


30
Diagnosis By history of disease, by percussion & auscultation,
& from Croup, it is diff. in symptoms.
Favourable. Facil. Resp. Thick copious expect. & defluxions
from Nose, Bilious Discharges.
Unfav. Dry Schneid. memb. & contracted Alae Nasi,
short labor, breathing & [illegible] lips.
Post mortem. Similar to those in adults, but more
commonly pneum. Laryng. & cerebral lesions.
Pathology. Both seated in muc. lining of Lungs. Bron
is Congestion, Cat. Fever is Inflame, both may be mixed
Treatment, commence with Emetic & [?ou?t] [sept.]
when Resp. much oppressed, then purging with Cal. & 
Castor Oil, & continue it as revulsives. It rarely 
admits of V.S. lest great prostration ensue. Top. bleed
aided by blisters, are useful. Excitements to Skin,
by Friction, Warm Bath, Cal. Ip. & op. etc.
When the system becomes much prostrated use Stim.
as Carb. Ammo. Whine Whey, Blisters or Sinapisms to 
Extremities, of which the latter are usually preferable.
Phthisia, a wheesing, rattling of young infants, depends on 
malformation of chest somet. Clothing, Diet, Exercise & Tonics.


31
Cynanche Trachealis or Croup or Hives etc. etc.
Heaving of Lights Trancheitis. etc. etc. etc. etc. etc.
Prof. Holms of Ed. in 1765 first described it, but
I suspect it was known & mentioned long before
Commonly comes on at night without premonition,
with a dry hoarse, stridulous voice, like a wippet bark
The Parox. is apt to return the next night similarly.
Somet. it approaches insidiously like Catarrh, with 
active pulse, flushed face, dry skin, imped. respiration,
sound like breath. thro’ gauze, sonorous dry cough, no 
deflux, & secret. generally interrupted, feeble whispering,
sometimes no voice, cerebral affection & tend. to somnolence,
cop. secret. in Larynx, diff. or no expect. then the 
case rapidly advances, embarrassed Resp. feeble
circ. cold skin, eyes injected & protuberant, lips livid,
face cold & covered with dewy perspiration. Sometimes
the brain remains perfect, & all the senses. Coughing
sometimes produces Convulsions, Constant Senatus 
somet. occurs. Its duration varies from few hours to 
several days. One case I saw terminate in a few minutes.


32
Feb. 10. 1836
Inf. of the mucous memb. may extend downwards from 
simple Catarrh & form Croup. So also Bronchitis may extend.
Causes. Predispos. of childhood, change of the parts at
the age of Puberty, & abund. of lymph in blood of children.
Moist & cold atmosp. in Spring, near Sea Shore etc. Somet.
it is said to occur as Epidemic, but this form & think 
is a modification of Scarlet Fever. It may be Endemic,
as in Leith near Ed. It may arise from irrit. of Alim. 
Canal, from Worms, loaded stomach on going to bed, from 
mental emotions etc. NO reason for suspecting contagion,
but the mistake has been made from Scar. Anginosa
which may occur without efflorescence, the Inf. extending 
from the throat, down the Windpipe.
Diagnosis generally very easy if not complicated, use
Percuss. & auscultation, if necessary, besides the other signs.
Prognosis, in early stage favourable from vig. treatment
but if deferred or far advanced, it is doubtful. Favor.
to [illegible] due Suscep. to Med. subsid. of [stu?], cough restor. of 
nat. breathing, or equability of Temp. more regular pulse.
Unfav. Inc. disturb, heart thumping, abdom. breathing 
& elevation of shoulders.


33
Post mort. Appearances depend upon time of death, treatment
etc. Secretions of ropy mucus, Extrav. of Coag. lymph
forming Membrane, Surface beneath of red or livid hue,
We may also find Congestion & Inf. of Lungs, so as even to 
produce Hepatisation.
Pathology. It has been divided into Spasmodic & Inflam.
At first it must be spasm, & Infl. is afterwards developed.
The diff. of Inf. between this & Catarrh is probably owing
to the diff. of intensity. See p. 34
Jackson Feby 11th 1836
Man has 5 Senses, Touch, Taste, Smell, Hearing & Sight,
by which he acquires all his knowledge, other animals
have other peculiar senses, as the bird, which teaches
it to wing its flight to distant regions in a direct course.
Touch, enables us to know 1. Temperature of Bodies to a 
certain degree but not positively, 2. Consistence & Weight.
3. Form. This sense is divided into Tact & Touch. Tact is
common to the whole body, Touch is most acute at 
the ends of the fingers, & in the Lips. The hand is admirably 
adapted to its purpose.


34
Taste is seated in the Papilla of the upper surface of the
Tongue. By cultivation it is much improved, & becomes
very delicate By disease, it is often much perverted, & 
in chronic cases, a bad taste, or disgust for all food,
is a fatal symptom. It is sometimes totally lost.
See p. 40
Chapman. Feb 11 1836.
Treatment of Croup. We rely principally upon Evacuants, & the practice of using Musk, Op. Assaf. etc. is 
highly injurious. In commenc. use nauseating med.
Sinap. or flannel wet with Spt. Ter. round Throat.
smoke cigar, or Snuff Plaster on Breast Next vomit
freely with Tart. Ant. alone or comb. with Cal. & Ipec.
If it do not act, put Child in warm Bath.
Next bleed, & afterwards again repeat Emetics.
Top. bleed. somet. necessary by Cups to Side or Back of Neck,
or better by Leeches. Blist. Throat. If symp. increase
V.S. ad deliq. generally puts an end to the disease.
Then give a large dose of Cal. to purge speedily & actively.
If cough continues, give the Infus. Sang. as an Expectorant.
Now Sweating is desirable, by Dov. powd. & Vapour Bath for
1 or 3 hours



35
After the disease has continued for 10 or 15 hours, extravasation 
of lymph occurs, in the Windpipe, Lungs, etc.
Then we must endeavour to remove it by placing Child in 
Warm Bath & while there, vomit it actively by Sulph. Zinc.
(Tart. Ant. Ip. & Cal.) or Juice of Garlic.
If the Lungs be much engorged. General or Local Bleed.
must be used accord. to circumstances. Blisters to Breast,
& subseq. Expect. of Ant Wine, Ox Scill, Decoct. Seneg etc.
somet. comb. with Carb. Ammo. Calomel also is useful,
in small doses to act upon mucous membrane
Tracheostomy has been proposed as a last resort, but not 
much can be expected from it [Stei??tatorias] might
sometimes throw off the memb. So also a bougie pushed
down the Trachea, would separate the memb. & the coughing
throw it off in many instances.
In memb. forming after other diseases as Scar. Fever,
it has been proposed to paint the whole of the Fauces
with some stim. lotion, so as to excite a new action
I have found the burnt Alum applied in the same
way more efficient.
Prompt & energetic practice for children.


36
Feb. 12
Cynanche Laryngea or Laryngitis. 1812.
Bailey published an acct of it in 1812; Hick of [Alix.] in 1808.
Commences with chill, dryness of throat, & hawking,
expect. not reg. but by scriatus, resp. imped. painful
constric. of Larynx from Inspir. with whistling, differs
from [sh???], thrilling wind of Croup. No Cough, but
a [gre??l], or grunting noise in Throat, voice hoarse, 
Pain from any effort at [Po??] [Adamis] but very little
tumefaction can be seen in the throat. Diff. of deglution 
slight fever, except when it commences as Tonsillitis.
Somet. approaches as ord. Catarrh, without any appreciable
constit. disturb. for sev. days, then rapidly developes
Condition of primae Via varies, stom. irrit. somet. then
bowels lax, or torpid & almost [ins??]. to ord. impres.
Inf. somet.  extends thro’ the whole of the neighboring parts.
Somet. a pale bloated aspect of the surface, from the serious
effusion in sub-cellular tissue, called Lar. Edematosa.
In its progress, the symptoms increase, pulse
quicks, deglut. very diff. & seems to pass into Trachea, from
inaction & swelling of Epiglottis, dyspnea excessive.


37
Eyes wild & protrud. mouth gasping, livid lips & face.
& why indication of utmost agony. Short respites.
Duration from 2 to 5 days, somet. only a few hours.
It prevails more gen. among males than females, & in 
adults or old age. Washington in 68th yr Dec 13th 1799.
Somet. it occurs in Children.
It arises from cold, & austere atmos. by inhaling vapours
of boiling Water, as in bursting of Steam Boilers,
from extension of Inf. sore Throat,
Distinguish from Crop, by diffus. or partial inflam. Fauces, [tender]
of Larynx, diffic. deglut, intonation of voice, & 
age of their occurrence. In croup, muc. coat is inflam.
& lymph is thrown out in surface, but in Lar. Inf is 
in sub-cellular tissue, & no membrane is thrown out.
Diagnosis between this & Cy. Tons. from these being
in swelling of Tonsils. Pharyngitis, has less disturbance
of resp. functions, but same agony of swallowing
Prognosis It often proves unmanageable, & unless
actively managed in the onset is very apt to terminate
fatally.


38
Post mort Stellated spots upon muc. surface of Larynx
sides of [runaglottis] approx. Epiglot. swollen, vary rarely 
extravas. of memb, if any, very thin, not like Croup.
Fluid found in cell. tissue, Trachea seldom involved.
Bronch. somet. choked up, & Lungs so filled that they do 
not collapse.
Pathology, is yet unsettled, but there is a combination
of Spasm, & Inf. affect. Croup appears to be an affection 
of muc. & musc. tissue, [te???]. by effusion of lymph,
while Laryngitis attacks sub-cell. tissue, & [te???]. by effus.
of serum or pus. hence the Larynx becomes obstructed.
The inf. of the cell. tissue accounts for the intractability 
of the disease, this is diff. to relieve in any part.
Fibrin is more abund. in youth & hence [illegible] in Croup.
Treatment. To overcome suffoc. & prevent effusion
V.S. ad deliq. & much want of success owing to insuffic
bleeding, for here it is more necessary even, than in Croup
Death of Washington was owing to his not having been 
suffic. bled in the commencement. Even in old persons,
there is no substitute, & we had better risk it.


39
Next excite vomiting, by Tart. Ant. Cal. & Ip. assisted by 
Warm Bath, which Armstrong has highly recommended.
Leeches & Blisters to Throat may also be added. To 
prevent Spasms, Op. has been suggested, but I do not admire
the practice. Inhalations & Fomentations.
If effusion has taken place, local deplet. & blisters
may prove serviceable & I should rely chiefly upon a 
combination of Cal. Op & Ip. & Vapour Bath with Dover’s
Powder to produce Diaphoresis profuse.
Laryngotomy has been proposed by some, & must be 
properly timed, there are several modes of performing it,
& notwithstanding the failures of previous trials, I can
still recommend it, & think it more useful than in Croup.
On acct of the intractability of the disease, the operation
should not be delayed, but performed as soon as the first
stage has passed, & take the risk of cure
Chronic Laryngitis is more prevalent than Acute.
the most simple form is called Hoarseness, which 
has little constit. disturbances & may continue for long time.
At first, a feeling of stiffness in Throat, some diff. of deglut.


40
wheesing inspir. somet. pain on pressing Windpipe, & on 
exam. Throat, no Inf. observable, or elong of Uvula somet.
& enlargement of Tonsils. Ext. of the Larynx somet. edematous,
No Fever at first, but symp. grad. increase, diff.
breathing, with shrill, laboured inspir. voice rough or
whispering, impeded resp. sputa of ropy mucus, somet.
pain in chest, followed by Hectic, Emaciation, Purul.
Expect. Night Sweats, Diarrhea, & ends Phthisis Laryngea.
Duration from few weeks to several years.
It occurs in middle & advanced age, more common 
in males than females. Clergymen have been thot.
most liable ot it, but I know no reason for it.
See p. 42
Jackson Feb. 15 1836.
Smell, gives us the property of bodies called Odour, & 
is a species of Touch. The seat of it is the Schneid. memb.
& chiefly on the Sup. Turbinated Bone. It seems placed
as a guardian to what enters in the mouth, & is more
perfect than the sense of Taste in man. But the sense 
is much more perfect in the lower animals, than in 
man, & we often see it strikingly exemplified.


41
The odour of a savoury dish awakens the Digestive
organs, hence in feeble Digestion, always endeavour to 
give the patient food agreeable to his senses.
This sense undergoes various perversions, & sometimes 
is entirely lost, sometimes becomes very acute.
Hearing, gives us a knowledge of the sonorous properties
of bodies. Sounds differ in force & tone. The [gra??st]
sound we can disting. in 32 vibrations per minute, the
most acute is 8190 per minute.
Feb. 16. The specific uses of the diff. portions of the Ear
are yet totally in doubt. We find the Concha or External
Ear, the Meatus Externus, Memb. Tympani, the Cavity
of the Tympanum, communicating externally thro’ the Posterior 
Fauces by the Eustachian Tubs. The Internal portion 
consists of the Vestib. Cochlea & semicirc. canals, of which 
the Vestib. is most important, filled with Liquor [Cotumnii], in 
which floats the filaments of the Acoustic Nerve
Obscurity of sound may take place from flatness of
Concha against side of Head, from wrong direction 
of Ext. Meatus, from induration of Wax, relieved 



42
by injecting with large syringe, from obstruction of the 
Eustachian Tube, relieved by injecting fluid or air.
When the difficulty is in the Internal Organ, or in the
Nervous Apparatus, the case is almost irremediable.
Music has very striking effect upon the mind.
This sense may become morbidly acute, obtuse, or perverted.
P. 33
Chapman Feb. 17 1836.
IT Occurs in scrofulous & consumptive persons, or in 
bad habits, but I have never seen it from Acute Laryngitis.
Speaking or singing will not produce it unless
there be a predispos. to it. It has been traced to 
exanthemata, to various Inf. & Ulcerations of Fauces
Elong. Uvula. Indication of Tuberc. Phthisis.
Thoracic oppres. Wheesing & Rattling. Colourless
lips in Interval are sings of Bronchitis. Percussion
& Auscultation, Nervous affections may somet.
be mistaken, so also partial Paralysis of Muscles
of Voice. To disting between Laryng. & Trach. affec.
attend to seat of pain, more alternat. of voice in 
former, cough more strid. tickling & brought on by 


43
food or drink in Laryng. not in Tracheitis.
Prognosis very variable, & cure often difficult, & 
if it be strumous or tubercular diathesis, is almost
incurable, so also with other complications.
Postmortem, shows thickening of muc. memb. with 
granulations or small ulcers around the Glottis,
Cartilages converted into calcareous matter.
Subcell. tissue solid, & incorpor. with muc. tissue
Somet. Edema of cell. tissue, or pus. Tubercules.
Pathology. Phlogosis of cell. memb. original or secondary,
with which muc. memb. participates, & effusion 
of liquid takes place, usually serous, somet. pus.
Very generally is connected with Tuberc. Phthisis,
Treatment. First ascertain the cause of the disease
whether from elongated Uvula, Syphilis etc. & vary 
the treatment accordingly. If from Chronic Inf. in
a sound constitution, Gen. & local bleeding. Blisters
Setons, Rigid Diet, Quietude of voice & no exposure
to Cold. Tonic treatment is inadmissible. Cal. Op. * Ip.
have been used, till ptyalism is induced. Discrim. is necessary,
in use of Mercury. Laryngotomy. p. 45


44
Jackson Feb. 18 1836
Vision. performed by an appropriate apparatus,
which gives us the idea of form & colour.
The colour of bodies depends upon the rays of light which 
they reflect, probably owing to the molecules, hence we can
understand how touch can distinguish colour.
Eye composed of 3 parts, Accessory, Globe of Eye, & the
Nerves supplying it.
When Brain or Retina is much inflamed, Iris contracts
& almost completely closes the pupil, but when 
the Brain is in a state of congestion, the pupil dilates.
The Tuberc. [Suadriquina] are the essential organs 
of vision. It is not known whether there is a decussation 
or mere junction of fibres of Optic Nerve.
Two provisions are requisite for Vision, 1. Sufficient
extent of Retina must be occupied. 2. An impression 
must be made upon the Retina, by bodies at a 
proper distance. The manner by which the Eye 
adapts itself to so great diversity of distance is unknown.
Probably it is by the movements of the Pupil.
Myopy & Presbyopy. p. 52


45
Chapman. Feb. 18 1836
Pertussis or Whooping Cough. Tus. convulsiva,
Perennis, Suffocation, Puerilis, Chir cough etc. etc.
Probably of modern date. Occurs principally in 
early life, somet. in adults. May commence like ord.
cold, continues throughout with fever, somet. sudden
& no febrile movement, but whoop first appears.
IT is paroxysmal, preceded by tickling in Larynx, constriction 
of Chest. Then Sonor. expirations, & then deep
convulsive inspir. with hissing & vomiting or disch. of
ropy phlegm. Somet. congestion, suffers of face & even 
gush of blood from mouth, nose, ears or convulsions.
Disease runs on from 1 to 4 mo. is of longer duration 
in Winter, & cold is apt to excite a relapse or complicate 
Popular notion, that it requires 3 wks. to reach its
height, continues 3 wks, & 3 wks. decline.
Has been thought to depend upon Contagion, & generally 
occurs but once, sometimes more. It occurs
as Epidemic somet. sporadically.
Diagnosis not difficult. It differs from Catarrh by 
Parox. cough, no fever, in commencement.



46
It is unfavorable in Infants, so young that they can
not expectorate, in old persons, or complicated with Pulmonary
Affections. Favor. signs are Expect. or vomiting,
shorter parox, sputa, mucus etc. It may terminate by 
spasm of glottis, convulsion, Hydroceph. etc.
Postmortem. Muc. memb. from Larynx thro’ Bronch
highly inflamed, extravasat. of lymph
Pathology By some thought to be Spasmodic, others Inflammatory.
It has its origin in Spasm, irritation, which 
by protraction, produces Phlogosis, & extrav. of mucus
which brings on Cough & Expect. then subsides until 
reproduction & another paroxysm follows. At length
disorgan. follows. or Bronch. closed up, or Glottis closed
by Spasm, or perhaps Brain may become complicated.
The Inf. is of specific kind & hence more diff. to remove.
The upper portion of Spinal marrow is probably either 
the seat or primary complication of the disease. Some
modern writers consider it owing to some irritation of 
Pneumo-Gastric Nerve, & experiments verify it.
The management however is about the same


47
Treatment. Seems to be characterised by more or less 
empiricism, as we have no cure for early stage. It 
will run its course, & we can only palliate it.
Two leading indications by Cullen, to restrain violence,
& overcome the morbid chain it produces.
Bleeding is much relied on by many writers, also topical
Bleed, followed by Blister, & unless otherwise indicated
apply them on back of Neck or between the Shoulders
Also clear al. canal by Emetics & Cathartics. Children
may be vomited once or twice a day, they bear it well.
Small doses of Tart. Ant. or Squill may be given in interval.
Tendency to constipation must be guarded 
against by Calomel. Castor Oil to keep open.
As the disease is generally exhibited. V.S. is rarely 
admissible, & little else is requisite than the exhibition 
of Emetics & Nauseates to promote Expectoration.
After the evacuations, specifics have been recom as
Rx Carb Pot zfs
Cochin 10 grs
Aq. ziv
Sugar zi
Teaspoonful.
I do not place much reliance
upon them. The opiates have
been tried, especially endemically.



48
Digitalis, Belladonna, alternated with Bitters.
Also Stramon. & Prussic Acid, but I distrust them.
Lac assafetida is best of Antispasmodics.
To interrupt the morbid associations, Bark has been 
used, but Sulph. Quinine may be more readily taken
Also Fowler’s Solution has been very useful, united
with Laudanum. As Tonics, the Martial Prep.
have proved most serviceable.
Tinct. Cant. with Land. is cautiously administered
till strangury occurs, & then recovery commences
The best plan, however, is to ascertain the pathologic
condition of each of the organs, & prescrib accordingly 
The Lungs are usually affected, as also Spinal
marrow, especially Cervical portion. Hence Friction 
along Spine with Vol. Liniment. Garlic Juice etc.
Rubefac. plast. between shoulders, as [Beng.] Pitch,
or Warm Plaster is better. The patient should guard
against Cold. If weather be mild & Infl. stage has
past, ride out occasionally & visit seashore.
Vaccination has been proposed as counteragent.


49
Regimen should be low & abstemious, while Inflam.
condition remains.
Asthma. Symptoms are such as precede & attend
the attack, as disorder of Digestive appar. cardialgia
Tend. of Abdomen, Pain, Precursors of attack,
uneas. of head & eyes, drowsiness, fullness of stom.
borboryginus etc. during the night, the attack
comes on with constrict. diff. respir. wheesing, & somet.
with dry cough, or with copious secretions.
Circulation but little affected, somet. weak, surface
cold. If very violent parox. count. purple, & danger
of Suffocation. Towards morn, abates with more
expect, & on the following night, another repetition.
So it continues perhaps for 2 or 3 successive nights
when it passes off with some discharge of urine or
copious expectoration.
Recurrence may be at regular stated intervals, but 
generally is not periodical, & not so strictly pure
Asthma, but some other form of Anhelation
It is difficult to give a strict etiology of this 


50
disease, it occurs most frequently previous to Puberty.
It is hereditary. More direct causes are acrid inhalations
of fumes of Lead, Mercury, & great variety of 
articles, especially Ipecac. [i?e?p.] gases, diff. states of
atmosphere, dry & elevated country air, less friendly to the 
asthmatic than central parts of a city. Even the
different stories of a house make great difference in comfort
of the patient. Case 3d Story. Moral & Mental 
Emotions, recession of Eruptions. suppression of natural
or habitual discharges. metastasis of Gout.
Diagnosis, generally very easy, from sudden & period.
parox. & manner of breathing.
Prognosis in early life is generally favorable, either
from remedies or from Change at Puberty IN later
life, it is of less favorable appear. Its ordinary termination 
is in some organic lesion of Lungs, Heart etc.
or by Diabetes. Somet. death in Paroxysm.
Postmortem varies very much. In recent cases & 
sudden death, no morbid appearances or dissection,
death probably occasioned by spasm.


51
Somet. Phlogosis & copious secretions are found.
Heart has been found much enlarged & dilated,
ossific. of Valves, disease & engorgement of Lungs etc.
Pathology, not well understood, by Cullen & some
others thought to depend upon spasm of muscles of 
Bronchia, but others contend that the invitation is 
produced by serous or other effusion into air-cells.
More recently, vascular engorg. of muc. memb.
has been said to be the cause, but I suspect both 
these latter are rather effects than causes.
Rostan asserts that it depends upon some organic
lesion of Heart or large Bloodvessels, & this may 
be the case in some instances, but not in all.
It appears to me to be a spasm of Bronchial
Structure, & that the effusion, phlogosis etc. are effects
perhaps depending also upon some primary irritation
of Pneumo-Gastric Nerve, & digestive derangement.
I consider it as originating in Nervous Irritation,
followed by Inf. of Pulmon. Structure, & secretions 
producing serious consequences, if not arrested


52
It has generally been divided into 2 kinds, Dry & Humoral
Asthma, but this depends merely upon secretion.
Treatment. After disorganisation, case may be
considered as nearly hopeless. But in curable cases, 
V.S. is first indicated by livid count. labor. resp. etc.
& though it may not always answer our expectations,
it answers well especially in febrile states In Chronic
cases. Top. depletion somet. preferable from Back of Neck
& Shoulders, unless circumst. demand from Epigast. etc.
p. 53.
Jackson Feb. 22. 1836.
The most usual place in which vision occurs is in
the Yellow Spot of [Seru????iny], altho’ the whole Retina 
is capable of receiving a distinct impression.
The simultaneous action of all our intellectual faculties,
& of the double organs, explain the reason why 
we do not see two objects, with our two eyes. This is 
not always so, cases are recorded of the alternate action
of faculties, as in a lady of Meadville, Penn. who 
changed every six months, & maintained two distinct
characters.


53
Strabismus cannot be readily explained, it is probably 
owing to want of antagonism of muscles, thus
it is supposed than in infants lying in cradle, will 
constantly turn their eyes towards light, & hence destroy the 
balance between the muscles. Some suppose
that it is owing to diff. powers of vision of the eyes.
But all attempts to solve the question have proved 
unsuccessful, & hence modus medendi is unknown.
The Eye receives a liberal supply of nerves; Six 
of the Cerebral Nerves go to supply it, 2d, 3d, 4th, part 
of 5th, 6th & part of 7th see p. 55.
Chapman Feb. 22 1836
Blisters must also be applied to Back of Neck or
shoulders, unless other indications.
Emetics have been highly recom. by many, although 
opposed by some. I always prescribe [illegible] in Parox.
& have generally found it successful. Ipecac, prefer.
Squill suitable for old people. Stimulant Expect.
have proved useful. Also Lobelia. I have seen 
great advantage from Tinct. or Juice of Pokeberry. f zii
adult.



54
Purgatives of Calomel have proved useful both for
evac. bowels, & exonerating Lungs.
Bree & others consider opiates injurious, but I think
this owing to improper application, they should not
be given in light of Paroxysm. Also all Narcotics.
Best of them is Paregoric Elixir.
Cold Water somet. relieves Parox. So also Hot W. or
Beverage, Cold Air, or Feet to Fire or Hot Brick.
Alkalies & Acids. All employed imprecisely.
Inhalations of various gases, smoking [Stra??ous] etc. &
Tobacco. & I have never witnessed injury in this disease
from smoking either of them, & do not believe there is.
[Insufflation] of Air by Bellows recom by Italian.
Elect-Magnetism & Galvanism, have all been tried.
In this Interval of Paroxysm, the treatment for
eradication must vary with the State of the System.
Guard the Al. Canal, use Martial Preparations,
if period returns, Sulph Quin. Ars. Sulph Tinc. Cop etc.
if spasm, Valer. Oil, Musk, Assaf. Ol. Succ. Eth etc.
if new irrit. op. Narcotics & Sedatives.


55
if it simulates Bronchitis (chronic). Tar Pill useful,
if any suppression, metastasis etc. remove the cause
Regimen is of most importance. No trespass against
strict diet, bowels reg. warm clothing & 
careful protection of feet, take exercise & [illegible] labour,
& long journeys have improved it, even military life.
Change of residence to situations which experience
finds most agreeable. 
A review shows that the Treatment is empirical, because 
the Etiology & Pathology of it is unknown.
If we can take it in the commencing stage, a perspiration
produced by the stim. pediluvia, Dov. Powd. etc. 
somet. V.S & afterwards Emetics & Diaphoretics.
p. 58
Jackson Feb. 23 1836.
The Diseases of the Eye are numerous, & would prove
sufficient to constitute a separate branch of medicine.
The Sensibility somet. is much increased, & is generally 
connected with partic. states of the Brain.
In [Ama?rosis], the loss is owing to the inability of the
nervous organ to receive impressions.



Double vision & inverted vision often accompany diseases
of the Digestive Apparatus.
Perverted vision is generally connected with some disease 
of the Brain, & somet. even without it, when of highly 
excitable nervous temperament. Hence, we can acct.
for Spectres etc. so often seen by the vulgar. Case of 
Nicolet most interesting. (See Scott on Witchcraft.)
Internal Sensations arise from peculiar condition
of the economy, or of internal surfaces, & not from external
impressions like the external senses. Thus the irritation 
of the lining memb. of the stomach produces the
sensation of Hunger. They may be divided into several
classes, 1. Those attacked to organic functions.
2. Those connected with intellectual & social faculties.
Under the 1. hunger, Thirst, Inspir & Expiration,
Evacuations, Inability to carry on circ. from Congestion
Generation & Reproduction.
Impressions made upon these internal surfaces often
increase existing diseases, or excite others, thus in Convulsions,
Mania, which may be derangement of Sensation


57
seated in Medulla Oblongata, or derang.
of Thought, seated in Cerebrum.
IN treatment of former, the Digestive apparatus becomes
very important to manage, because the impressions
here are immed. transmitted to the Med. Oblong. by 
the [Par Vagum]. Hence in Mania a Potu, attend to it.
Starvation. Wreck of Medusa Frigata.
Voltaire on Defecation. Shakespeare (Coriolanus.)
We shall find that Int. Sensations are a Mentor whose
counsel we should not reject, & often in treatment of 
diseases, we must listen to it altho’ contrary to rules.
The reason why we have not so many specimens
of Cold Plague, the horrible Putrid Fevers etc. as
formerly, is because Physicians attend more to the 
Language of Nature & treat their patients more rationally.
The diseases were not specific in themselves
but were rendered so by close confinement, exclusion
of air, inattention to the obvious language of Nature etc.
p. 62


58
Chapman Feb. 23d 1836.
We now come to diseases of serous & cellular memb.
covering the Lungs. Inflammations of these have given
rise to several names, as Pleuritis, Pleurodyna,
Diaphragmatis, or Paraphrenitis, Peripneumonia etc.
these are now included under Pneumonia Vera.
Pleurisy & Peripneum, are generally combined together,
& we shall treat of it as Pleuro-Peripneumonia
This may be ushered in with chill, or with wandering
pains at length settling in chest, with dull pain, 
which in pure Pleurisy is most commonly in left side,
& generally, when immed. under nipple, we have Peripn.
Pneumon. of rt. side is most frequent.
Resp. usually embarrassed from the pain in motion 
of ribs. hard pulse, hot skin, dry cough & or expect. of 
thin mucus, thirst, furred tongue, vomit irrit. stom. & 
tendon Epig. scanty urine, dyspnea becomes more oppressive,
prostration, cold extreme, coma or delirium,
expect. checked, secretions in Bronch. & wheesing.
somet. the whole disease runs its course without symp.



59
Duration varies, apt to give way on 3d, 5th 9th day etc.
if properly treated. French allow from 7 to 20 days.
Somet. prevails epidemically as in 1813 et seq. when
it was called Pneum. Typhoidis. Cold, [repel?ed] [illegible]
Rheum. & Gout, Metastatic Abscesses, Damp Weather
also in Summer by entering Ice Houses etc. 
The robust & Plethoric are generally the subjects,
attacks all ages & sexes, perhaps more in middle life.
Diagnosis. of Pleuro-Peripneum. generally very easy from 
pulse, breathing, pain etc. 
When Pleurisy alone, pulse hard, corded, accel. & vibrat.
pain sharp [illegible] in side, breath, quick short, cough
dry or glairy sputa. If Diaph. former are aggravated.
inspir embarras. cough convulsion, flushed face,
eyes wild, risus Sardonicus. If Lungs subst. pulse
fuller [illegible] pain with [stre??] epig. or should deep
seated, obtuse, cough less, expect. thick, tenacious,
& looks like Jelly, coma more apt to supervene.
From these signs, many variations, & very often we
cannot distinguish between Pleurisy & Pneumonia.


60
The signs from Percussion & Auscultation also [uncertain]
In Peripneum, the Crep. Rattle appears in first stage.
Flat. Percussion, & at length want of Resp. murmur.
When Pus forms, we have Mucous Rattle, Cavernous
Gurgle, & Pectoriloquy. The same thing somet. occurs
in Emphysema, Hydroth. Phthisis, etc.
Prognosis, in Intemperate is very unfavourable.
Sputa varies in diff. stages, & should be closely watched.
Feb. 24. Postmortem has given us some precise
knowledge of this disease. Pleura inflamed in points
or patches, somet. thickened, somet. no change. Seldom 
Spot of Gangrene. Most common in Coag. lymph which 
is gradually converted into false membrane, Effusions
turbid or scrophulent or limpid, or sang. tinge which 
constit. Sanguine Empyema or Hemorrhagic Pleurisy.
Dry Pleurisy somet. The Pulmonary subst. varies,
deep violet hue dense & heavy, red internally, frothy & crepitant,
or hepatised, with red, white & black spots intern.
or pale yellow int. & pus upon pressure, somet. like small
abscess, but [??nts] the sac lining abscesses.


61
Somet. Gangrene but very rare, offensive odour, & sloughs
out leaving an ulcerated cavity.
These diff. varieties often coexist in same lung.
Both lungs seldom attacked, & the lower portion is generally 
the Seat of the Inflam. somet. the upper.
Pathology Inf. of the Pleura. grad. extends to substance
of Lungs. Hence indication for cure is plain.
Treatment Should be prompt & vigorous. In early stage 
no doubt of copious V.S. from large orifice. “Better 
that the weakened sick be cured, than that the strong 
be permitted to die” ([Dienbracte]) Bleed till relief.
Exception to this rule are aged, or drunkards.
Hot skin, active pulse, constrict. diff. respir. are better
reasons for bleeding than the appear. of blood.
Local depletion by Cups between shoulders, or immediately 
over the seat of pain. Followed by Blisters,
& at what period is a subject of controversy. I postpone
until reduction of vasc. action & excitement. Prior to 
establishment of Inf. it often does much good. Some
substitute local deplet. by Cups for the Blisters.


62
Emetics have been recom. as substitutes for V.S. but
I do not believe they are useful.
Purgatives generally merely to keep the bowels [solu???]
but in [illegible] comb. I think more purging with Merc.
would prove beneficial. There is some danger of [taking]
cold from constant exposure.
Diaphoretics have received much confidence, but except 
in forming or closing stage, they are not useful.
Nitre & Ip. Antim & Calomel. p. 63.
Jackson. Feb. 25. 1836
Medulla oblong. is the seat of the sensations, & 
in this also commences the power of motion. Here 
then is the source of the Spasmodic Diseases.
Doctrine of Phrenology. The Faculties are divided into
2. Propensities & Intellect. Propen. are divided into
Domestic, Presentation, Prudential Sentiments, Moral Sent.
& Governing Power. Intellect. divided into Percep.
Imag. Reflective & Language.
Valedictory.


63
Chapman Feb. 25
Tart. Ant. has lately been highly recom. especially 
by the Italians, who have said to give it in very large
doses without distress. But I do not believe it.
They consider it as contra-stimulant, but no substitute
for bleeding can be found in Pneum. or Pleuritic Infl.
When given in such large doses, irritation & inf. of Stom.
Depression of Nervous System, & even Death.
Opiates are inadmissible until reduction of Inf. by 
depletion, & after that, they may be combined with 
Diaph. & Expect. as in form of Dover’s Powder.
Somet. in old persons, there is in [common] much spasmodic
cough & bronch. irritation, the op. is proper.
When vessels much excited, they pour out lymph,
but when weakened, they pour out [serum], & hence
much judgment is necessary to correct them.
When cough becomes loose, Demulcents & Cough Mixt.
If prostration, use diffus. stim. as Carb. Ammo. Decoct.
Senega, Hot Toddy.


64
Pneumonia Biliosa, most common in Winter & Spring
in marshy & malaria districts. Somet. in this City.
Epidemic somet. Excited by common pulmonary 
injuries, & modified by condition of chylopoeitic visc.
Besides ord. Peripneum. Symptoms, we have dull
pain, expect. tinged with black blood, symptoms of
Autumn Fevers, pain in head, flushed face, yellow
or brown tongue, bitter taste, fullness of [illegible], deficient
[saffron] [mine], pulse full & compressible, slow
& oppressed, hot surface afterwards cold & clammy & 
in 2 or 3 days Typhoid condition, prostration, sensorial
& nervous disturbance.
Diagnosis from common form is very easy.
It is more intractable & more fatal.
Postmortem, precise appearance I do not know, 
probably congestion of lungs & brain.
Treatment. First V.S. but must not be carried
too far lest prostration ensue. Blood is sisy & on
surface loose coat, less firm than ordinary lymph
like Soft Soap, & under it like Molasses & Water.


65
Cups & Blisters to relieve local pain. Evacuate
Al. Canal by Emetic in commencement. Mercurial
Purges of great utility Next Diaph, of which 
Dover’s Powder & Infus. of Eup. Serpentaria etc.
In advanced stage, diffus stimuli.
In every variety of Pneumonic Infl. patient
should be confined to bed with head & shoulders 
raised, room of equable temperature, diet of 
mucilaginous beverage during Inf. stage.
We have also chronic forms of these diseases.
Laennea doubts whether Chronic Inf. can exist
for a long time in an organ so vascular & mobile,
but I think it may occur, although rarely.
It is somet. very insidious in its approach, somet
slight pain, transit stitch, dull sensation somet
increased by exertion or recumbent position.
Then Cough, labor. breathing, sputa [puriform],
pulse quick, hard & febrile. Hectic disorder of
Digestion, init [st?m] or contrary. Diff. breathing
increases, cough & bloody or puriform expectoration,


66
sometimes very abundant. Somet. more masked
& may run thro’ their stages without symptoms.
Case of Boy, treated for Chronic Peritonitis, but after
death, Periton. perfectly sound, but Lungs & Pleura
much deranged & about oiii pus in chest.
Another of young lady, treated for Disease of Ovary.
Causes of Chronic may be result of Acute or
of slow Inf. of the Pulmonary structure.
Diagnosis, from [Tub.] Phthisis, Pleurisy & [Peripis??]
when subst. of Lungs inflamed, pain more dull,
sputa purulent & devoid of garlicky odour which 
is almost [pathogy??morial] of Chronic Pleurisy.
Where Chronic Pleurisy, fluids disturb the Chest or
false memb. thrown out, fluids absorb. & chest contract
Percussion & Auscultation differ but little, unless
a cavity is formed.
Prognosis, must be founded upon the stage & complication
of the disease, upon the age & habits of the
patient etc. Empyema or Tubercular Diathesis are
unfavorable symptoms.


67
Post mortem examinations in simple Pleuritis, exhibit
the Pleura of a deep red, & may be thickened,
it is often covered with a false membrane. Sometimes
then in an effusion of Seropurulent matter, or of pus
having the garlic odour, & lung compressed.
In Pneumonitis we find Hepatisation, often Tubercular
development, & [Vomicae], but abscesses without
Tubercles are exceedingly rare.
Pus is sometimes secreted by the mucous surface of 
the Lungs, in conseq. of the irritation from lesions o f
other portions, & expectorated, while the cavity or Abscess
itself may have no communication with the 
Bronchial Tubes.
Treatment. We must prevent organic lesions by 
general & topical bleeding, blistering, Antimonials & 
Low Diet. After reduction, Mercury may be used if
there be no tuberc, disposition. It arrest chronic Inflammation 
of all the viscera.
Empyema or abscess forming, little is to be done,
somet. the abs. ruptures & is expect. & the cure goes on 


68
if the patient has sufficient strength remaining.
But if Nature fails to remove the matter either
in this way, or by absorption, we have but little
to expect, & our last resort is to the operation of
Paracentesis Thoracis, which most generally affords
merely temporary relief, as the fluid reaccumulates
very rapidly, somet. in 24 or 48 hours. Permanent
benefit & cures have however been reported from the
operation, & hence it is deserving of attention.












8
Cold sponging, cool acidulated drinks, perfect quiet,
dark room, a good nurse & diet of arrow-root & gruel
administered every 2 or 3 hours, all contribute materially 
to the cure of the patient. p. 287.
After the disease has advanced so that stimulants are 
required, the best is Wine or Brandy, & unless these 
produce their effects in a short time, they will not at all p. 292
No opiate proves beneficial while the skin is very 
hot, the tongue very dry & the patient’s actions violent. 293.
For the Cerebral Affections, Blood Letting & the Cold Dash
are the most powerful remedies. p. 295.
For the Thoracic Affections, Tart. Emetic in doses of grs ii
to f zi Water, repeated every 2, 3, or 4 hrs. p. 300.
For the Abdominal, Leeching followed by a Poultice & 
afterwards apply a linen rag wet with Spts Terebinth. p. 300.
Scarlet Fever approaches more nearly to Inflammation & 
hence requires more Bleeding. p. 302
Great care is requisite in treating Convalescent patients,
they become impatient of Confinement etc. p. 312


7
The exciting cause is a poison formed by the decomposition 
of organic matter, of which we know nothing except its
power to strike the human system with sickness & death p. 259.
A predisposing cause is whatever diminishes the vigorous
action of the organs, & thus weakens the general strength of
the system. The most powerful of all is the continued
presence or slow operation of the exciting cause. p. 274.
Treatment. Fever, once established, cannot be cut short
& cured instantaneously. p. 280.
The object to be aimed at in practice is to cure the Inflammation,
the Fever then proceeds mildly & safely. p. 282.
Hence the grand remedy for this purpose is Bleeding, & the 
earlier it is resorted to the more likely will it be to prevent
the occurrence of Inflammation. P. 284.
To reduce this febrile Inf. however, requires the loss of less
blood than for ordinary inf. hence much judgment is necessary
to decide upon the proper quantity. In the early 
stage, very little need be abstracted. p. 286.
After this, it may be proper to purge with Calomel & 
Rhubarb, sufficient to obtain 3 or 4 stools in 24 hours.


6
The Spleen is almost always diseased in Fever & becomes
somewhat after in consistence, while the Pancreas
becomes harder. p. 145.
Tenderness of the abdomen on pressure, with loose
stools, generally mark the disease of the albuminal
viscera in fever. p. 217.
The primary essential event in the morbid series constituting 
Fever is the affection of the nervous system. p. 248.
Instantaneous death never results from the sudden excitement
of Inflammation in any organ or organs,
but Fever, on the contrary, may produce death in less
than a single hour p. 250.
The second event in the series is Inflammation, connected 
with the first p. 252.
The third function deranged is the Respiratory. p. 256
Since Fever then consists of an Inf. modified by the
peculiar & primary affection of the nervous system, the
removal of this Inflam. is essential to, but does not
complete its cure. p. 258.
The causes of Fever are of 2 kinds, exciting & predisposing.


5
Syn. Gravior with acute cerebral affection is characterised
by pain etc. attended with a slow & intermitting
pulse, which should be remembered. The patient also
may be noticed with frequent & deep sighing p. 85.
Typhus. The same organs are affected in this
as in Synochus; the difference is only in intensity. p. 114.
In T. mitior with abdominal affections, hemorrhage
from the bowels most frequently takes place. p. 123.
The notion of Debility existing as the cause of the intense
form of fever is erroneous. It is a congestive state
of the system, which can often be relieved by bleeding. p. 127.
Scarlatina, resembles an Inflammatory affection
The pulse is generally from 120 to 140., & the temperature
of the body rises higher in this than any others fever. p. 129.
The disease is always marked by a peculiar specific
redness of the tongue & throat. p. 131.
Pathology A characteristic of the febrile state
is a specific preternatural redness of the mucous membrane
of the bronchia, especially of the smaller branches p. 141.


4
of the circulating function & 3. Derangement
in the secreting & excreting functions, and these
events must always concur in one invariable order p. 43.
In Inflammation, the order in which these
events take place is different. p. 44.
There is no such thing as Symptomatic Fever, it is an
Inflammation & not a Fever. p. 51
Fevers of all kinds differ only in the intensity of
the affection, but in order to classify them he adopts
the terms Synochus & Typhus. Synochus denotes 
the mild degree of Fever, while the severer form is designated
by Typhus. These may be again subdivided 
into S. mitior & gravior, & T. mitior & gravior.
Eruption diseases are essentially Fevers, modified
only by the eruptions etc. p. 59 et seq.
Synochus gravior with sub acute Cerebral affection is
as often denoted by Giddiness as Pain in the head, & 
the former is as sure a criterion. p. 79.
Nothing is more characteristic of returning health 
than sound, undisturbed sleep. p. 81.



fact what is merely a conjecture, as Cullen’s. 2. From
assigning to the genus what belongs only to the species.
3. From characterising the disease by what belongs
only to a stage of it as in the doctrine of Debility.
4. From mistaking the effect for the cause, as those
who consider it owing to a morbid state of the blood. p. 29
Several things are necessary to be known in order to 
understand what Fever is. We must ascertain the
common phenomena, the invariableness of their occurrence
& their mutual relation. p. 34
Boerhaave said that the only symptoms, in a long 
catalogue, which appeared in all fevers were shivering, 
frequent pulse & heat. p. 39. These, however are not
always found to exist as he asserted.
Cullen made a still more general definition by 
adding to the foregoing: but it was not more correct. p. 40
W. Philip differed but little from Cullen p. 40.
But we define Fever to consist in a certain order
of events which invariably concur, & these are 1. Derangement 
in the nervous & sensorial functions. 2. Derantement


2
sweating stage, it was the least of all p. 19
Stoker differed from Brown only in considering
Typhoid Fever as the consequence of Debility, (hence
he named it Adynamic), while Inflammatory Fever
was owing to an increased action. p. 21.
Burne said the primary cause was the respiration
of a contaminated atmosphere producing a morbid
condition of the blood, while Clanny, not regarding
a vitiated state of the blood as the essence of 
fever, believed the proximate cause to be a want 
of power in the system to form blood. p. 22.
Clutterbuck contends that Fever is merely a secondary 
effect of some local Inflammation, & this 
local Inflam. always exists primarily in the Brain. p. 23
Broussais also contends that Fever is the result o f
topical Inflammation, but that the organ which is
always the seat of it is the stomach or bowels, hence
he has termed it Gastro-Enteritis. p. 26.
The errors for the preceding theories arise from
several different reasons 1. From assuming as a 


1
Notes from “Smith on Fever.”
Hippocrates, Galen & Sydenham considered
that Fever arose from an effort of Nature to expel
the corrupt matter received into or generated in 
the system. p. 14
Cullen thought that the primary effect produced
by cold, miasmata etc. etc. was Debility & that the
succeeding cold & hot stages were the result of this
Debility. The cause of the general Debility was the 
action of these deleterious substances diminishing
the energy of the brain, thereby producing a debility 
in the whole of the functions & particularly in the
action of the extreme vessels. This however proved
an indirect stimulus to the sanguiferous system,
which together with the Vis Medicatrix Natura
caused subsequent reaction. p. 19.
Brown, a pupil of Cullen, attributed all Fever to 
Debility, & asserted that the difference in Fever was
sonly in degree, that during the cold stage, the debility
was greatest, during the hot less, & during the