It is uncertain by whom these Notes were taken
for Dr Richard Tutt was a graduate of the
Baltimore School and could not, I think have
attended the lectures of Dr Chapman in Philadelphia
I can testify however to the correctness
of the report, because I heard Dr C deliver the
same lectures in the University of Pennsylvania in 
1839 & 1840




These notes were taken by Doctor
Robert M. Tutt at Philadelphia in 
1828 He died a few years after of 
consumption. He was the son of 
Col John Tutt of Fauquier County
Virginia
Edward, son of Benjamin Tutt, also 
a medical student met a similar fate
about the same time
Dr Saml J. Tutt, the brother of this, graduated 
in medicine at Philadelphia in 
1841 & heard Dr Chapman deliver the 
lectures herein recorded. He is the
son of Dr Gabriel Tutt of Rappahannock
Co Va & cousin to the young 
men above named.
Nov 20th Kirkwood Mo 1893




Notes taken from the Lectures 
of Nathaniel Chapman
Professor of Practice in 
the University of Pennsyla
Belonging to R. M. Tutt
Augt 30th 1828




1
Gentlemen We now enter on the Practice of Medicine
which has been defined, the art of distinguishing
discovering, preventing and curing diseases. In discerning
and distinguishing diseases, we are guided by the condition 
of the Pulse, Skin, respiration, Countenance,
State of mind, Secretions, and Exertions. The Pulse
has been called an index to the morbid condition of 
the system, but is more properly an auxiliary to 
other symptoms. The Natural Pulse is soft, open
and vigorous, free from all feeling of resistance
ad its stroke recur at regular intervals. Age influences
the pulse very much. At birth it beats 140 strokes
in the minute, at the end of the first year, 120, at the end 
of the second year, 100, at the end of the third 90, and 
from the termination of the third year until the 12th 
it gradually descends to the adults standard of 75
strokes, in the minute. In old persons the pulse
becomes irregular & slower about the age of 70 it
generally [internects]. The pulse is also influenced by 
sex. The Pulses of Women are quicker by 10 strokes in 
the minute than those of men. Different conditions 
of the female system, influence the Pulse very remarkably: 
it is more active about the commencement of
menstruation and during Pregnancy, than at any 
other time: The pulse is fuller and more active, in the 
sanguine; than the Phlegmatic temperament. It is slower 
on tall men than those of lower stature. It is quicker 





2
in the erect posture, and slower when in the recumbent.
When we are lying it is at 64, sitting at 68, and 
standing 75. During sleep the pulse is slower, by 10 or
15 strokes, when it is otherwise it may be attributed
to the warmth of the bed clothes, a hearty supper or
agitating dreams. Darkness has a similar influence 
Motion accelerates the pulse, even getting out of bed
quickens and disturbs it. Difference in diet has also
considerable influence. Heat excites the arterial
system. Cold when long continued acts as a sedative
to the system and of course reduces the Pulse. The state 
of the mind affects the pulse. Conversation has a very 
considerable influence on the pulse and is thought improper
in Fever. Different conditions in life have a 
very considerable influence a civilized man has 
a quicker pulse than a savage: because by civilization 
the number of points of susceptibility is greater increased.
Idiosyncrasies should be attended to. The 
time of day has been observed to affect the pulse.
It was formerly taught that the arterial system 
was feeble in the morning, and gradually increases 
in action until evening. But precisely the reverse 
has been told us, by an ingenious author, whose name
is Knox, and with whom I agree. He says that the 
pulse is most frequent in the morning & gradually 
diminishes its frequency, until evening when it is 
slower by 8 or 10 strokes. All the important functions 
are performed with most vigor in the morning; Thus
it is with Respiration, Digestion, and Circulation
The pulse is as various as are the wrong actions
to which the system is liable; and upwards of 
1—pulses have been enumerated, but for practical 





3
purposes, the following division is perhaps sufficient
1st Synocha pulse, which is full, frequent, and tense
with hardness and contraction of volume. 2nd Synochus
which is full round and vigorous it is softer
more open and of larger volume than the preceeding
3rd Synochula, which is quick, tense and chorded, occurring
in the protracted cases of Phlegmasia. 4th Typhoid: 
quick with some tension and of small volume
5th Typhus: small, weak, very quick and readily compressible. 
Dr Rush’s soap bubble pulse is a modification
of the synochus and does not admit of bleeding
The oppressed pulse is distinguished from that of
debility, by its occurring in the primary stages of disease,
in Malignant Fevers; and in inflammations
of the Alimentary Canal & Brain it is also slower & 
jerks, hobbles or intermits. In examining the pulse
apply at least 3 fingers to the artery; let the arm be 
free from pressure; examine in both arms and be not
precipitate in forming your opinion. Never feel
the pulse when you first enter the room, but wait 
until the agitation, which your entrance may have
occasioned, is calmed. Leaving now our description 
of the pulse; we come to treat of the countenance, as
one of the diagnostics in disease. The Heeled Countenance
is marked by a circumscribed redness of 
the cheek; and a sparkling eye, without much appearance
of distress. Pestilential fever is marked by 
the following appearance of the features a red & 
suffused & muddy eye, a contracted brow, a polished & 
glazed face which last is a fatal symptom. The countenance 
in Inflammatory fever is red and anxious





4
the breathing hurried and the Alae Nasi greatly 
agitated during respiration. Typhus is marked by 
a dejected look, and eye half closed and weak voice
In mania the countenance is [illegible] and furious
eyes red and pupils sometimes contracted.
The Hippocratic Countenance is known by hollow
eyes, high cheek bone, sharp nose and cadaverous
appearance of the skin. A natural countenance 
in a malignant fever, is an unfavourable symptom 
The Risus Sardonicus or smile accompanied by supercilious 
looks and contracted brow; occur most frequently 
in diseases of Gastric or Intestinal origin.
Weeping when involuntary is unfavourable. The appearance 
of red particles, or sparks floating before
the eyes indicates excitement of the Brain. Sleeping
with eyes half closed is of unfavourable import it 
indicates irritation of the stomach or bowels.
The diagnostic symptoms afforded by the tongue 
are considerable in diseases of the stomach & Bowels
particularly. The white tongue of Phlegmanae does not
appear in Bilious fever. In Bilious fever the tongue is
generally yellowish, and [loaded]; with bitterish taste and
foetid breath. The Pulmonary tongue is clean and florid
When the stomach is implicated in the disease we 
find the tongue loaded. In the Cold stage of Intermittents
the Tongue is clammy, in the Hot stage is
dryer and loaded in the sweating stage. AT the commencement
of Typhus it is dry and white subsequently 
becoming tremulous In Scarlatina the tongue is 
covered with a white crust, through which the papilla
being elongated, project.




5
Dryness of the tongue indicates the approach of 
Typhus when there is an inability to put the tongue
beyond the teeth great danger may be apprehended.
Whenever the tongue becomes moist after having
been dry or clean after having been foul, we may 
consider that there has been a favourable change
in the disease. Cleansing of the Tongue generally 
commences at the edges. The lips afford us a criterion
in some cases, a falling pendulous lip is unfavourable.
Pouting of the lips indicates the existence
of Considerable cerebral disturbance. in all miasmatic
fevers, or other affections attending irritation
of Primae Viae, scaly eruptions are favourable
when about the lips. The Respiration is varied in 
different conditions of the system: it is always hurried
in excitement. In Typhus when the Brain is 
affected it is slow, deep, and laborious. In Apoplexy 
it is stertorous. In Hydrocephalus it is marked with 
sighing and suspension. In acute pulmonary inflammation, 
the breathing is very difficult and laborious 
attended with retraction of the sternum and protrusion 
of the abdomen. These symptoms are greatly augmented,
when effusion takes place. In Asthma in spiration 
is performed quick, but expiration is 
long and wheezing. In inflammation of the abdominal
viscera, the Diaphragm remains almost in 
a state of rest; whilst the lungs heave violently 
The abdomen does not move as in common breathing, 
so that a return of the motion is considered
an evidence of returning health.




6
of Cough as a diagnostic. In cynanche the Cough is 
of a peculiar barking kind. In Pleurisy it is confined & 
restricted; The patient can’t cough. There is a hollow
Sepulchral Cough, which attends persons who have
abscesses in the Lungs. In deciding on the nature
of Cough, we are assisted by examining the matter expectorated.
To be serviceable the matter must be 
concocted, according to the Language of the Ancients, or 
completely elaborated of a thick, yellow and ropy 
appearance. In Pleurisy or Catarrh, we perceive
no alleviation of the Symptoms; until the matter
after having been white & frothy, becomes such as 
above described. When the sputa are tinged with 
dark blood, accompanied by heavy laborious breathing
it is a very unfavourable symptom. It sometimes 
occurs in Pneumonia Typhoides Pneumonia Notha
when they are coloured with florid frothy blood
although it not a favourable, it is not accompanied
with much danger, provided the quantity
be small. When inflammation continues unsubdued 
a pureform matter is secreted and subsequently 
genuine pus. This is very inauspicious, but 
it does not certainly indicate the formation of 
an abscess as has been supposed. There are differences
in the appearance of Pus which give rise
to different prognosis. when it is of a light cream
colour, of equal consistence and without odour, it 
is regarded as most favourable but when it is thin
and mucid with gramous blood it is unfavourable
pus has been distinguished from mucous, by its being 






7
composed of Semiopaque globules floating in a transparent 
lymph, by it being miscible with warm
water, and not with cold.
Healthy Pus is readily wiped from the surface of
a sore; but unhealthy discharges adhere very closely. The 
Ancients paid great attention to Decubitus, or to the
particular attitude of the patient in bed. An inability
to like on either side is an evidence of visceral inflammation.
A disposition to lie on the Belly is generally 
to painful affections of the bowells: but in Inflammation 
of the Intestines or Peritoneum; the patient lies upon 
his back and draws up his feet and Legs to relax the 
muscles. Iactitation is always an unfavourable symptom
Sliding down in the bed is an evidence of prostration 
of Muscular power, and is very unfavourable. If the
Patient after having been in the habit of sliding in 
the bed, began to move his arms, lay them quietly over
the bec clothes or attempt to replace himself, it is 
favourable. Unequal Temperature is unfavourable
cold wrists and warm hands, in an acute disease is
a fatal symptom. Cold feet denote danger though
not so much as the preceding. Cold breath is alarming
natural temperature in Malignant
fevers Is unfavourable redness of the hands and 
feet is very inauspicious, when the skin is dry 
without heat, or is soft and swollen, pithy on pressure,
it denotes a feeble circulation in the Capillaries
and is unfavourable. Catching at motes or pecking
at the bed clothes, is a bad symptom. Lividness of the 
nails, in an advanced stage of fever is generally fatal
[unique] mucae, or crooked nails, constitutes a bad or fatal symptom





8
Subsultus Tendinum evinces an alarming state
of the nervous system, but is less alarming in drunkards.
A spasmodic state of the tendons which 
prevents your feeling the pulse of the Radial Artery
is fatal. A voice fierce and bold from a mild man
loquacity from a silent or Taciturnity from a talkative
man denote danger. Trembling of the voice is bad
when the voice remains natural we may hope, amid
all the gloom of alarming symptoms. Blindness or 
depravation of vision is always alarming, though less
so when depending on irritation of the Primae Viae.
Deafness in Malignant Fevers is very alarming
Tinniutus aureum is unfavourable, but a revival of
hearing is favourable. Bitter Taste denotes Bile
Sweet, Gastric or Hepatic diseases, saltish, pulmonary
irritation, particularly from Turbercles. The return of 
taste particularly for Tobacco; is very favourable.
The want of sensation, as well as preternatural sensibility
is unfavourable. The restoration of Sensibility after it has
been lost is favourable it is indicated by the patient
complaining of pain when he turns in bed. by 
susceptibility to the action of blisters, after this has
been lost. Delirium is an unfavourable symptom, as
is a partial alienation shown by a carefulness about the
result of the disease; and a want of solicitude 
concerning family or affairs. On the contrary when the 
patient is anxious about his situation and concern
for his family; it is favourable The mind being
gloomy with foreboding of death is very unfavourable
but petulance is favourable.





9
Certain discharges afford us the criteria for judging
of disease. In autumnal Fevers, we frequently have
copious discharges of Yellow Green or Black bile by 
vomiting; of these the first is most favourable, and 
the last least is. The Black vomit which is a vitiated
Secretion from the capillaries of the Stomach, is 
according to my experience, fatal. Of the Faeces 
watery stools denote relaxation, or a high degree of 
irritation in the bowels. Slimy, bloody stools, evince
Inflammatory action. Dark stools in Bilious Fever
generally accompany a favourable change in the 
disease. Green Colour of the stools is dependent 
on contact of the Atmosphere. Clayey or Ash coloured
stools denote a want of bile. A mixture of Food
with the Stools denotes gastric irritation and a 
depraved condition of the digestive organs.
Perspiration. An undue sweat on a critical
day is favourable, if attended with a natural warmth
Cold sweats and pallid surface are alarming.
Partial sweats particularly about the head & neck augur
along and obstinate disease. An acid sweat is 
favourable, but a foetid Cadaverous perspiration is
otherwise Perspiration in drops like dew is inauspicious. 
The Urine in dropsies of excitement
coagulates by heat In cases connected with 
visceral disease it is Scanty and high coloured
In atonic dropsy it is scanty and pale. when 
is in excess and of a pale colour, it denotes great
relaxation of the Kidneys, connected with sonal affixation 





10
of the brain and nervous Copious discharges of
urine indicate convalescence, in Gout, Rheumatism,
Intermittents etc. but they indicate danger in Cerebral
affections. In Calculous affections the presence of 
red sand in the urine, informs us of the presence of 
uric acid; which requires for its cure the exhibition of 
the Alkalies. A milky appearance is peculiar to phosphoritis 
and should be treated with acids.
As the coagulation of the blood deprives it of its vitality,
we may suppose that the degree of health is 
proportional to the tardiness of the Seperation of its
parts. Dissolved blood is an evidence of an exceedingly 
enfeebled system and therefore is unfavourable.
In Phlegmasia we frequently find that
the blood is Scarlet, after the first bleeding without
a seperation of its parts but assumes the sizy
appearance on a repetition of the bleedings.
I have now concluded what I had to say concerning
the signs by which we distinguish diseases
and judge of their terminations. To the appearance 
of diseases, the term Physiognomy has been applied
of all physicians Hippocrates had the most
accurate knowledge of this department.
Notwithstanding a close attention to all the Signs
enumerated we shall sometimes be mistaken in 
our prognosis. it is to post mortem examinations 
that we are to look for a confirmation or a refutation 
of our opinions: these constitute a court
of errors in which decisions made elsewhere
are confirmed or reversed.




11
In the technical arrangements of the Schools, symptoms
have been divided into proper and common, primary 
and secondary and diagnostic and Pathognomonic.
The proper Symptoms are such as are peculiar in the
disease thus a pain in the side is a proper symptom
of Pleurisy; but the general excitement attending
it is common to the other Phlegmasia.
The primary symptoms are those that first occur
the secondary those that follow.
Diagnostic symptom are those by which we
judge of the disease Pathognomonic are the
same as proper.
The ravages of morbid action are well
known they consist in the various disorganizations
from the simplest lesion to the formation of Scirrus
and Cancer. Diseases according to the
venerable Sydenham consists in the confused and
irregular operation of disordered and debilitated
nature. Amidst a thousand diversified chains 
or morbid excitement, some permanent forms 
may be recognized, as Irritation, Inflammation,
Spasm, and oppression. The primary effects of all 
morbid agents, is to produce an impression on the 
Nerves of a part to which they may be applied: 
thus if occasioning sensation is irritation, which 
may continue according to circumstances. it generally 
invites an afflux of blood by diminishing the 
Strength of the vessels these fill with blood and
inflammation to the result with this local disease 


nosology should be founded only on the 
remote causes which produce the disease
none of the nosological writers have 
made this their basis and therefore they 
are all in error. Nosological tables cannot
ever be correct until men have the
same temperaments, are on the same
diet in the same climate and [alike] 
in every thing then we may [have]
diseases alike.


12
the system sometimes sympathizes, producing
general fever. If irritation continue without being
subdued or bringing on inflammation, more or less
spasm is produced. The oppressed or Suffocated state
of the whole or a part of the system, in which action 
is suspended or improperly developed, in consequence 
of the force of the remote cause results from the loss
of Elasticity, by which the system is deprived of the 
power of reacting. Diseases have been divided into
Acute and chronic; Epidemic, Endemic & sporadic
and intermittent. Epidemic diseases are such as 
arise from a general Cause Endemic from Causes 
peculiar to the place in which they exist.
In entering on the Practice of Physic the first question
which presents itself is, how shall we classify
diseases? They have been grouped together in 
systems of Nosology, which are marked with the 
greatest incongruities. Dr Cullen’s is probably the
best system; except that of Dr Horack of New York
which has fewer false collections than any other
Dr Brown in that spirit of innovation, which 
was peculiar to himself, rejected every preexisting
Nosological arrangement, and established his own 
with the simplicity of which you are all acquainted.
Our own school has also furnished an
instance of intrepid generalization, which is 
certainly stamped with the appearance of enthusiasm.
As some classification is necessary, I 
have thought it best to arrange how according 





13
to the different systems, which they attack.
1st The Circulatory, comprehending the heart & blood vessels
2nd Digestive including the Stomach and Chylopoetic 
viscera; 3rd The Respiratory embracing the
lungs and their appendages. 4th The Absorbent, which 
include the Lymphatic & lacteals. 5th The Secretory the
Glands; 6th The Sensitive The organs of sense, the
Brain & Nerves. 7th The Muscular The muscles,
Tendons, and aponeuroses. 8th Cutaneous the skin
9th osseous the bones. 10th Generative the organs 
of generation in both sexes. Under these heads
all the diseases to which we are liable may be 
comprehended. According to the arrangement which 
I have adopted, we shall commence with the diseases 
of the circulatory system, and firstly of Fever.
These are by far the most common complaints of our 
nature; and as they afford general principles, on which 
the treatment of other diseases; must be founded. I shall 
dwell on them at some length, and with more than
ordinary minuteness. It is computed that more than 
one half of the deaths of the human species are 
produced by febrile affections alone. What is the
nature of Fever? Ever since the dawn of Medical 
Science, the question has been proposed and still
remains unanswered. The febrile affections are
so numerous, diversified and fluctuating, and are
so much under the influence of those causes
which modify diseased action that they perpetually 
shift their character and render any description 




14
inapplicable to the whole. Cullen which is chiefly 
followed on this subject, defines Pyrexia to consist
in increased heat and frequency of pulse
Common on after shivering with a disturbance of many 
of the functions, and diminution of strength, Especially 
in the limbs. Although this definition is as unexceptionable
as any that has been advanced, it will not be 
difficult to show that hardly one of the symptoms
which has been mentioned is an universal attendant.
That increased heat is not a patholognomonic
sign of fever, is conceded by all.  There are not indeed
many cases, in which in animal temperature
rises much above the natural standard, and we often
see instances in which it is lower. Nor is chilliness
an invariable Symptom: it appears to precede those
fevers occasioned by Miasmata or Contagion.
As it regards the pulse, there is very good variety, as
a general rule, it is more frequently than natural in 
fever, but the exceptions are numerous. Thus in certain 
affections in which the Brain is concerned, it links
to one half of its natural Standard. That a disturbance
of functions and lassitude occurs in fever is 
not denied: but these also occur in many other diseased
Conditions of the System. Hence it follows that no one of the preceding symptoms, is sufficient
of itself to point out the Existence of Fever, but to 
arrive at any satisfactory conclusion, they must 
be considered together




15
Not the least of the absurdities of Nosology, is the 
diversion of fevers into Idiopathic and Symptomatic.
Fever is always symptomatic of some local irritation
and its symptoms are modified by the peculiarities of
the irritated part. Directed by this fact we have frequently 
arrived at useful practical inferences
Contagion, Miasmata etc. are entangled with the
saliva and swallowed, where they produce an impression 
on the sentient extremities of the nerves of the
Stomach, which being extended to the Sensorium
Commune, produces a degree of general depression 
proportional to the force of the remote cause: to 
this, reaction of the system succeeds. This is much 
influenced by the force of the remote cause. If the
latter should have been great, the fever will be 
Typhoid or Congestive if inconsiderable Inflammatory
Fever will likely ensue.
Fevers may be divided into Intermittent and continued
By Intermittent Fever, is meant that form, in what
there is a succession of paroxysms; between each of 
which a perfect and distinct suspension of febrile
Symptoms takes place. The time intervening between
the commencement of one paroxism and beginning
of the next is called an interval: that between the
termination of one paroxism and the beginning of
the next an intermission, or in pathological language
the Apyrexia. Different names have been given to 




16
the Fever according to the length of the interval. Thus
when the Paroxism returns every 24 hours, the disease
is called Quotidian; when it occurs every other day, or 
the interval is 48 hours, it is called Tertian; and when
it occurs on the first and fourth days, making an 
interval of 72 hours, it is called Quartan. we have
also the double Tertian, having a paroxism every day 
the alternate ones being equal or having two paroxysms 
every other day. As a general the fits of the Quotidian
are in the morning, the Tertian at Noon, and the Quartan
in the Evening. but there are many exceptions. Of each
of the primary forms, many modifications have been 
enumerated by different authors. As the double Tertian
double Quartan etc. By some of the ancient authors
it is indeed asserted, that cases occurred in which the 
interval was of eight days length. This was affirmed 
by Hippocrates and corroborated by the authority of 
Boerhave. There have not been wanting, writers
who have extended the period to one month, two months
and even a year. Conferring on these cases the terms
Menstrual, Bimenstrual and Annual. Whether these
peculiarities ever take place I will n either affirm
nor deny. If they do they must be considered as anomalous
cases deviating from the general character of
the disease, and therefore deserving but little attention 
When these diseases are arrested they have a disposition
to return on the 7th, 14th & 21st days the practical inference
from which is that you should administer
Bark in anticipation of these periods




17
It has been observed that persons who suffer with Intermittents
during the fall are very apt to have a return
of the disease the next spring or fall.
The fever generally makes its attack in about 7 days
after exposure to the carrier, but the period is sometimes
much longer. I think that all Vernal
Intermittents are dependent on Miasmata received during
the fall, the action of which is Suspended by the
Cold of Winter, and breaks out in the Spring.
The 3 primary forms of Intermittent are all that need
be recollected. Of these the Tertian is most frequent
and easiest to Cure. Next to this in both respects is
the Quotidian. The Quartan occurs less frequently 
than either, and is more difficult to cure. Cullen
says the last mentioned is more common than the 
Quotidian whether this is so or not in Edinborough
I can’t say; but it certainly is not so in the U.S.
The Quartan is seldom seen in this City; and when 
it does occur, arises in general out of a protracted
Tertian or Quotidian. Nothing is more curious
or inexplicable than the periodical nature of this
disease I need not inform you that in the present
state of Knowledge, no explanation can be 
offered. In a remote and darker age, it was supposed 
to depend on planetary influence to which 
might be added other notions equally absurd.
Of late it has been attributed to a temporary exhaustion
and reaccumulation of excitability But 
why is not this the case in other fevers?




18
Each Paroxysm of an Intermittent Fever is divided
into the Cold, Hot, and Sweating stages. The cold
stage is ushered in by languor and sluggishness 
in motion [horripelation] or cold creeping sensations
running over the body, yawning, stretching and some
nausea; anorexia great thirst and sometimes
vomiting of bile. The face becomes cold the features
Shrink, and the skin over the whole body is constricted, 
as if by the action of cold. In consequence
of the blood’s deserting the surface, and determining
towards the viscera, superficial Tumours shrink
and ulcers become dry., Not long after the appearance 
of these symptoms, universal rigors come on, accompanied
by pain in the head, back, loins and extremities 
These are sometimes so great that a constand and 
convulsive motion of the extremities takes place
which cannot be restrained. The respiration now
becomes short and distressing, and the pulse is
small and sometimes very irregular. Copious
discharges of pellucid urine are usual at this
juncture The bowels remain unmoved.
In some cases either from previous debility of the
patient, or the violence of the remote cause, the
system does not react and congestion or engorgement
of some of the viscera is the consequence. Those
which are the more liable are the Brain Lungs, Liver,
and Spleen. If it be the first of these we have 
coma or a disposition to apoplexy; if the second
Pneumonia Notha, & in the 3rd a dull heavy pain in the 





19
right or left Side. The first stage continues from
one to 5 hours, when the symptoms gradually abate
and the second stage comes on. This marked by a diffusion
of Heat over the surface of the body, redness of the
Face, throbbing of the temples, pain in the head, anxiety
and restlessness and some tendency to delirium
The Stomach is generally harrassed, the bowels continue
unmoved and the urine is high coloured. The pulse
slowly rises, until at length it become strong voluminous
and exceedingly vehement. This stage 
lasts from 4 to 4 or 10 to 12 hours, and is then followed
by moisture first appearing on the forehead. Succeeded
by a general sweat. The heat then abates, the thirst
ceases, the respiration becomes free; the circulation 
tranquilized and the functions generally restored to their 
healthy condition The urine now becomes turbid and 
the tongue is loaded. The ordinary length of a paroxysm
is 12 hours but it is sometimes extended to 18 
There are many anomalies, in the appearance of the 
Paroxysm. The Cold stage is sometimes wanting
constituting what is called Durub Ague. The Hot stage
is sometimes wanting in which case the sweating
immediately succeeds the cold stage; and is very profuse.
The Hot stage has in some cases preceded the
cold. The attack sometimes goes off by urine or
stool without sweating
Intermittents have been Known to restrict their
attacks to particular parts of the body and  go through 
the different stages regularly. I have known it to attack 
the Eye, Abdominal Muscles etc when thus limited the 





20
disease is generally thus manifested by a feeling of 
Coldness and pain. No disease is more frequently 
disguised it appears in the form of Dysentery 
Diarrhoea, Colic, Rheumatism, Gout, Dropsy, Hysteria,
Convulsions etc.
As regards the cause of Intermittent Fever much 
difference of opinion has existed. It is now generally 
admitted, that the most common cause is march
exhalation, emitted chiefly from vegetable matter
in a state of putrefaction. Antecedently to the
commencement of the last Century; miasmata 
were unknown; [Lamsisci] was the author who Spoke 
of the. The production of marsh miasmata is
not confined to marshes they may arise in any 
Argillaceous sail covered by woods. Cold weather 
arrest the action of miasmata. a patient may be 
exposed to the action of the miasmata late in the fall
cold weather coming on soon after the disease is 
suspended, and makes the appearance in the Spring
Typhus Contagion on the contrary is suspended by 
warm weather. The effluvia from animal matter
if noxious at all, are supposed to produce Typhus
Whatever depresses the body so as to cause extreme
debility, as poor diet, a great fatigue, mental anxiety
excessive evacuations etc, are Known to excite Intermittents
Heat has been the cause of Intermittent as was Known 
in this City in the Summer of 1823. Cold has been
productive of the same effect particularly when combined 




21
with moisture. Intermittents sometimes prevail
epidemically, depending on a cause as yet enveloped in 
obscurity they are the more malignant and obstinate
In forming our Diagnosis in disguised cases we must
have reference to the season of the year; and the nature
of the prevailing diseases, the manner of attack and
subsequent symptoms. It is apt to be confounded
with hectic; but the paroxysms of Hectic are seldom 
uniform for any number of days together, but come
on at any hour of the day or night There are also 
generally 2 paroxysms in 24 hours but this is not
always the case. 2nd In Hectic Fever the paroxysm
is sometimes not preceded by a Chill in other cases
there are several rigors, without the hot or sweating
stages. 3rd it is not relieve by perspiration. 4th 
The paroxysm of Hectic by circumscribed redness of 
the cheeks, in the Hot stage without headach
5th The Joints are sometimes affected with swelling
and acute pain in Hectic the pulse continues
quick and irritable after the subsidence of the 
Paroxysm 6th The tongue is clean, florid, and 
polished 7 The appetite and digestion are unimpaired 
8 The urine is turbid during the Paroxysm
and clean in the intermission 9 The mind 
is cheerful and full of hope
Our Prognosis must depend chiefly on the Paroxysms
and tiem of their continuance. If the Apyrexia be free 




22
and distinct and the interval become greater under
the use of remedies, the Event will generally prove
favourable The Treatment divides itself
into tow Kinds. 1st That which is proper during the
paroxysm and 2nd That which is required during the
Intermission; taught by the example which nature
affords we should endeavour to bring on Perspiration
as soon as possible. Called in the Cold stage, we should
immediately resort to the remedies, which are best calculated
to produce this effect. We should have the patient
placed at once in a warm bed; and direct that
warm bricks or bottles filled with warm water should 
be applied to the extremities. warm beverages are
now to be administered. Herb Teas or Hot lemonade or
if any thing more stimulating be required; wine 
whey will answer very well or Aether Carb Ammon
Brandy, or Camphor. Opium has been found particularly 
useful. It has been stated on the authority
of Trotter, that one or two grains of opium administered
at this time, have the effect of removing the headach
and rigors, of exciting an universal glow, followed
by perspiration, and thus producind a solution 
of the cold stage. To the efficacy of this plan I 
can bear ample testimony. of all the remedies which 
I have seen employed in this case, opium is followed 
by the never agreeable consequences. when the cold
stage is very violent menacing fatal consequences
one of the best remedies, is an Emetic. It generally 
puts an end to the cold stage as soon as it operates
I would not however employ it in common cases 





23
as the remedies already mentioned, are adequate to the 
end proposed when the system refuses to react, we
have venous congestion in important organs, which are 
very apt to terminate fatally. To arouse the energies
of the system, we should as already mentioned, first
resort to Emetics. 2nd Rubefacients; as Spts Terebinth
Cayenne Pepper in brandy etc. to the surface. 3rd Sinapisms
to the feet and Epigastrium. 4 Stimuli, particularly opium
when there are local determinations in consequence of 
a want of reacting power of the system. use Leeching,
Cupping, and if admissible V.S. The only apoplectic
case of this Kind, I ever knew cured was
treated by copious bleeding (30 or 40 z). Great care
must be used in resorting to this remedy draw
a small quantity at first & observe its effects If the 
pulse rises, go on until relieve is obtained; but if it
Sink, you must not venture further.
The indications in the management of 
the system Hot Stage are 1st to remove irritation
2nd To induce perspiration
The irritation is generally occasioned by bile in the 
Stomach, and in such cases; we should have no 
hesitation in resorting to an Emetic. But if
vomiting have already occurred, or if there be much 
Nausea, all that is necessary is to assist nature
by the administration of warm beverages, as
Chamomile Tea, warm water etc. To meet the
second indication, we must resort to the class 






24
of medicines called Diaphoretics. By all the European
writers and especially those of Great Britain, James
Powder is most highly recommended, but in this
country it is rarely obtained pure, and has on that
account been abandoned Antimonial wine and
small doses of Emetic Tartar, are very commonly 
used. It is very common in this country to administer
an infusion of Eupatorium Perfoliatum, for 
the purpose of bringing on perspiration. On the 
authority of Dr Lynd opium has been much used
in the hot Stage. It is alledged by this Gentleman
that it produces a solution of the paroxysm,
prepares the system for the use of the bark, diminishes
the danger of Congestion in the viscera; and thus
prevents schirrus and ulceration. When given to 
robust and vigorous patients, opium always 
increases the head ach, heightens and protracts the
fever, and renders the patient restless; but in 
relaxed and irritable habits, I have found great 
advantage from the Practice. I prefer administering
it however in the form of Dovers Powder
The best diaphoretic in these cases, is the Spts
Mindereri or Acetate of Ammonia It is more
prompt and certain in its effects than any 
other, and it is moreover very grateful to the
stomach. It will be retained when most of the
other Kindred articles would be rejected. The dose
is a Tablespoonfull of the saturated spirit to be repeated 





25
if necessary. The Spirit of Nitre is also used in this
case. If nausea exist the best remedy is the alkaline
mixture Rx Potash zi Gum Arabic zi
Oil of Mint 10 drops, Laudanum 30 drops, water ziv
Dose a teaspoonfull every 10 or 15 minutes. The 
Practice above detailed is applicable to ordinary cases
but Intermittents are sometimes of a highly inflammatory 
nature; in which case, the Paroxysm
requires a place of treatment somewhat different
They generally adopt this character during the prevalence
of inflammatory Epidemics. When the fever is of the Type
alluded to, the pulse is strong and vigorous, the face is 
exceedingly flushed, the respiration difficult and laborious
with acute pain in the head, sides or chest.
When the Paroxysm is attended with these symptoms
it is necessary to bleed Copiously. The Alimentary 
Canal should also be evacuated by emetics and powerful 
Cathartics. Intermittents, in some cases
assume a Typhus instead of an Inflammatory character.
When these cases occur (as they often do in 
Hospitals or crowded places and during the prevalence
of Typhoid Epidemics) a different treatment is required
The paroxysm is to be treated by stimulating and cordial 
drinks, and by all the remedies, which are
best calculated to support the strength of the 
Patient and to arrest the Typhoid tendency. 
We now come to treat the disease in the 
Apyrexia of all the remedies the Peruvian bark 




26
is most important. Little diversity of sentiment
now exists, with regard to its administration, although 
no point in medicine was formerly more unsettled
Amongst the early notions on this subject the absurd
one, was entertained, that in Intermittent fever sometime
should be permitted to elapse before giving
the Bark; that the morbific matter might be 
thrown out of the system, by the Paroxysms. This was
advocated by Boerhaave, who said that the Bark’
was to be given “cum morbus aliquo tempore
durabit” Van Sweetan his commentator united
with him in this sentiment, which was also
supported by Sydenham and all the eminent
practitioners of that period. Directly the reverse 
is now generally admitted, and the fact is fully 
established, that the earlier we commence with 
the Bark, the more speedy and prompt will 
be the Cure. The only circumstance which 
warrants the slightest delay, is the condition 
of the Alimentary Canal, and perhaps of the
system generally. Doubts are entertained by 
some whether it is really necessary to prepare
the system in any way for the exhibition of
the bark; and I am acquainted with some 
practitioners, who act on the supposition of its
total inutility. But this is by no means the
common opinion, or the established practice. 




27
It is pretty generally that though the Bark, may effect
a cure without previous evacuation, it is hazardous as a 
general rule to manage the disease on this plan. It is
customary to evacuate previously either by puking or 
purging. For these purposes Emetic Tartar and Calomel
are preferred. Emetics in modern times and more especially 
in this part of the U.S. have given way to purging
this generally answers very well, but cases of an intractable
nature, often occur in which emetics can 
hardly be dispensed with. They operate in such cases 
not only as evacuants of the Alimentary Canal; but
also by making a powerful impression on the stomach
which breaks down and dissolves the chain of wrong
and perverted action, on which Intermittents and
other periodical diseases, seem chiefly to depend.
Of the efficacy of Emetics, my own observation 
has afforded abundant and conclusive evidence
But besides these Evacuations, V.S. is sometimes
required. In the commencement Intermittents are
always more or less inflammatory, and this diathesis
is Kept up with considerable pertinacity
Without the loss of blood pretty copiously, the bark
would be rejected from the Stomach; and of course
do no good; or if it were retained its only effect
would be to aggravate the Symptoms, which it
was intended to remove. My rule is never
to resort to the bark, until I have prepared the
System, by some Evacuation, so that it may 
receive the proper impression from this invaluable 





28
medicine. By pursuing this course adapting the
remedy to the state of the system, I can pronounce that
the certainty of its effects are such as almost to entitle
it to its former rank of a specific in Ague & fever
This species of fever is not unfrequently associated
with obstructions of the viscera, and when
this is the case Bark has been held as inadmissible
“That cases of the nature” says Dr Cullen, “do exist,
wherein it is improper to give B ark, & have not
sufficient Experience to determine; but I am 
well aware that it is dangerous to adopt any 
particular rule on this subject.” The practice
with regard to this point may be readily adjusted
In visceral obstruction when no inflammation 
exists, I would not hesitate to employ the Bark
In other cases where there is pain in the viscera or 
activity of the Pulse indicating some local inflammation,
the Bark so far from doing good is
eminently mischevious. We should here resort to 
vesicatory applications, and a slight Salivation
which will most commonly cure the obstruction’
and fever; but if there should be considerable pain
and the case decidedly inflammatory VS should be 
used. As perhaps you all Know there was at one
time much dispute whether the Bark should 
be given immediately preceding the Paroxysm.
Cullen and Heberden were decidedly in favour
of the practice; but I think they were wrong.
Home, thought it immaterial, whether it was given 




29
towards the close of at the commencement of the apyrexia.
I have no doubt but what it is more effectual
when given in the latter part of apyrexia
Determining from my own experience I should
avoid administering it at the moment of the 
anticipated attack. As I have found it to aggravate
the paroxysms by increasing the fever and 
depressing the Stomach. Some practitioners go so
far as to contend that there should be no remission
in it, but that it should be employed in every 
stage of the Paroxysm itself. Dr Clarke who 
wrote with great ability on the fevers of Tropical
Climates, is among those who most strenuously 
recommends the practice. As yet I have
not been induced to [immutate] it, because I have
always, where Bark is given at the time, when 
the disposition in Fever is but slight, that it 
never fails to do mischief. It is a rule established
by the consent of the ablest physicians, that
when there is an indication of the accession 
of the paroxysm; the Bark should be discontinued.
The ordinary mode of administering
it is in substance with water, Milk, Wine
Diluted Spirits, an infusion of Serpentaria or
what is the best of all a solution of Liquorice
The Dose is zi or zii repeated as often as the Stomach 
will hear, so that zi may be given during the
Apyrexia of at Tertian. It is the practice in the 





30
West Indies, to give zi at a time in the morning and
smit it for the remainder of the day. The late
Mr Dallas who was from that part of the world
brought with him the practice. He took zi
at a time in the morning, which was completely 
successful in 2 or 3 days. Very few Stomachs will
be able to bear so much and the practice therefore
will scarcely be imitated. The fact however is interesting 
and I thought it worthy of notice, as
case may occur in which his method may be 
advantageous. But in some persons the Stomach 
is so irritable, that Bark cannot be retained even
in the most minute dose. In such cases we resort
to the decoction or Infusion, either by itself
or conjoined with aromatics, as Cloves, Cinnamon
Orange peel or Virginia Snake Root. Black Pepper
or Cream Tart zi to zi, Bark may be used. The Snake 
root is however the best it renders the mixture
pleasant to the taste, comfortable to the stomach 
and greatly increases it efficacy. Combinations
of this sort may employed in some cases when 
bark alone would be forbidden they are particularly 
suited to children and delicate persons
I have derived great advantage from the following 
prescription. Rx Bark zfs Sal. Ammonia zi divided 
into four or five powders, which are to be
taken during the Apyrexia or Bark zi Confect opii
zi, Lemon juice zfs or Elixir vitriol zi Port Wine zviii
Shake them well and give a wine glassful every 3 hours 




31
It has been recently ascertained, that the virtues of the
Bark, depend on an acidifiable base. The substance of 
character yielded by the Pale and Yellow Bark differ
a little That obtained from the Pale Bark is called
Cinchonine from the Yellow Kinine The Red furnishes
both these substances. The Sulphuric Acid
added to these Alkaline bases, forms a neutral salt
of great efficacy. We had heard of the great efficacy 
of this medicine in the hands of the Physicians of
Paris, and resolved to try it in this City. On trial we
found it Superior to every other medicine in the
Treatment of Intermittents. It is given in Pills in
dose of 1 gr (which is equal to zi of bark) or in solution 
as follows Rx Cinamon water zi Sulph Acid
8 drops, Sulph, Kinine 8 grs, dose zi. I once knew 
8 grs to be taken at a time by accident, which 
completely removed the disease and produced no 
bad effects. The pure Alkaline Kinine has been shown
by a London physician to be equal with the sulphat
Dr Jackson has find that the better extract possesses
the same virtue in a similar dose with the sulphate 
Kinine. The better extract is the Carput Mortuum,
after the Seperation of the Kinine, and exists in a 
much larger quantity in the Bark, than the latter
Bark sometimes purges, which prevents its remedial
influence when this happens each dose should
be combined with a small quantity of Laudanum
when it produces Constipation, which it sometimes
does small doses of Rhei should be combined with ‘
the Bark.




32
Now and then Intermittent Fever is connected with great
acidity of the Stomach. it is customary under such 
circumstances to combine with the bark a little
magnesia or a minute quantity of vegetable alkali
Notwithstanding the various means of administering
the bark, it will be rejected too speedily by vomit or
Stool; to produce any salutary effect. In cases o f
this kind it is common to resort to injections but
I have never used them except in cases of Children
Possibly it may be useful, but you will hardly ‘
find an adult who has used it in the form o f
Enema; who will submit to a repetition.
You will be frequently disappointed by the irritation 
of the bowels existing previously or in consequence 
of the sue of the Medicine. When used 
in this way the following should be the form zii 
or ziii of Powdered Bark are to be internally mixed
with some mucilage, common Starch or Flaxsus
Tea, to which a small quantity of Laudanum should 
be added. The quantity of mucilage should be such 
to prevent irritation of the Rectum.
Bark has sometimes been applied to the surface; 
the methods of doing this are Different.
By some it is recommended that Cataplasms or 
Poultice made of this article should be applied
over the pit of the Stomach. By others a warm 
bath of the decoction is preferred. It is stated 
on respectable authority that Intermitttents may be
cured by immersion of the feet in a decoction of the
bark. A general bath is probably more efficacious





33
when I have used the Bath it has been with the design
of restraining violent vomiting, especially in Pestilential
Fevers. under such circumstances it will calm
irritability of the Stomach, as soon as any other
remedy that can be employed. Its modus operandi
is very intelligible: By creating a tonic impression
on the skin, between which and the stomach, there
is a consent of a very intimate nature it imparts
tone to this viscus and thereby restrains its inordinate
actions. Bark has been externally applied in a 
dry state: It is said by Darwin that if the sheets be thickly 
strewed with powdered bark, the person who sleeps 
between them will be cured of Intermittent. To 
believe this, even on the respectable authority of Darwin
requires a considerable stretch of credulity.
When however it is differently applied there can 
be no doubt of its efficacy. When quilled in a jacket 
and worn next the body it acts very beneficially
This mode of using Bark is probably most applicable
to children and delicate women. After all 
however it is of little efficacy when compared
with its internal administration
Next to the Bark as a remedy for ague
and fever, we may rank the Serpentaria The 
mode of using it, originally practiced by Sydenham 
was, with wine. As a general rule he says that
in all cases of Intermittent where wine appears
to be indicated, its effects will be increased by the 
addition of Serpentaria






34
Whether it is adequate to the cure of the more confirmed
cases of the disease, I cannot pronounce with 
certainty. But in the milder shapes or where the
Type is ambiguous, partaking in some degree of the
remitting character, it is very efficacious. One
formula of it which has been called the Ague
and fever powder, has cured the worst cases. It is 
made as follows Rx Cort Peruv zfs. Serpentaria zi
Carb Soda vel Potassae ]?ii]. To be intimately mixed and
divided into 4 powders, one of which is to be taken
every three or four hours. Why the Serpentaria
thus combined with Bark and so small a quantity 
of the vegetable Alkali, should have its powers so
greatly increased is difficult to determine. The preparation 
has been employed for more than half a 
century, and received in its favour; the testimony 
of different practitioners. Nothing is more idle
than a priori speculations concerning the modus
operandi of Medicines.
Of the remedies for Intermittent afforded by our
Country, the Eupatorium Perfoliatum is professed 
of great powers. It may be so prepared and as 
administered, as to prove Diuretic, Diaphoretic,
Emetic and eminently Tonic. It may be employed
in the Cold or Hot stages of the Paroxysm as well
as in the Apyrexia. Its tonic power is best obtained
by administering it in powder or cold decoction
this remedy has been much used in Philadelphia &
my friend Dr Hosack informs me that it has 




35
supplanted the Peruvian Bark and Fowlers solution in 
the practice of several Physicians of New York. The
dose is 20 or 30 grs of the powder or a wine glassful
of the decoction every hour or two
IN our enumeration of articles adapted to the cure of
Intermittent, the Cheronea Angularis is not to be 
overlooked. It is different least in the medical effects
and appearance of the Centaury of the Shops. Like the 
Eupatorium it may be employed under all circumstances 
of the disease, and is sometimes given
with advantage when the Bark is inadmissible
It should be given in Infusion or Decoction in such 
quantities, as the Stomach will hear. Though mostly 
employed by country practitioners, we have used
it in this City, and have had abundant reason to 
be satisfied with its effects. It is now 30 
or 40 years since the Common Poplar, was introduced
as a remedy for Intermittent. I have no
experience with it, but Dr Rush and Barton 
recommend it. The former introduced the remedy 
when ague & fever prevailed amongst our troops in 
the revolutionary war. He considers it as little
inferior to the Peruvian Bark. The Bark of the root
is to be employed in powder or decoction, in the same
does as the Peruvian Bark
Not a little has been said, within the last 20 or 30 
years, of the Angustura, as a remedy in Intermittent
When originally introduced in the management of the 




36
disease, it inspired so much confidence that it was likely 
to supersede the Peruvian Bark & other established medicines.
But though it has been Known for only 30 
or 30 years it has fallen completely in discredit
Recently however it has been revived in Europe. Some
speak so confidently of its powers, that it much have 
been too precipitately rejected. It is highly aromatic & 
cordial as well as astringent and will be best
adapted perhaps to Cases attended with Irritability
of the Stomach and bowels dose from zfs to zi
repeated as Peruvian Bark. Not many years ago 
a species of Mahogany called Swietenia Febrifuga
was recommended very strongly by Dr Rockburn in 
Intermittent. Experiments subsequently made have
verified the statements of that writer. It is possessed 
in some degree of the properties of Angustura, and 
it will be proper perhaps to administer it under 
the same circumstances.
Much has been said of the powers of Kino in this 
disease. It was introduced by Dr Fothergill who though 
generally temperate and cautious in hie recommendations
of Medicines, has in this instance been enthusiastic.
Judging from my own experience I should 
say that Kino is by no means competent to cure intractable
cases. Exhibited however with the bitters
and opium, its efficacy is greatly increased; and in 
some instances when thus combined it has proved
to be a valuable remedy. The following si the best
formula Rx Kino zii Gentian zifs opium grsii to be divided 





37
into 12 powders one of which may be given every 2 hours
It does not appear very clear why this mode of using
it should increase the powers of the medicine; but
of the fact there can be no doubt. The last of the
vegetable remedies which we shall mention is charcoal.
Dr Calcagno of Sicily employed this article
7 or 8 years ago in the treatment of Intermittent.
The Physician to the British forces on that station
was induced to imitate the practice, and accordingly 
to his reports it is a valuable article. He states that
it is particularly adapted to cases connected with bowel
diseases. On the authority of the writer just mentioned
the remedy has been used in this City. Two or three
practitioners have employed it in the Public Institution
with advantage. It has been prescribed by one in no 
great variety of Cases but from what I have seen 
I think it entitled to your confidence. A teaspoonful
should be given every 2 or 3 hours during the Apyrexia
Not the least valuable of the remedies for Intermittent
Fever is sulphur. It has introduced by Dr
Granger about 50 years ago, who prescribed a teaspoonful
at a dose mixed with a little ardent Spirits.
At one time I was disposed to think that its efficacy
depended on the [sp??l] mixed with it: wider experience
however has convinced me that this was not the
case. The powers of Sulphur are not restricted to Intermittents.
No remedy is more efficacious in checking
Hectic Fever. It affords one much pleasure to have 




38
the authority of Dr Physick for the views which I have
presented you concerning the powers of Sulphur
He goes further and declares from his ample experience
that there is no remedy so useful in anomalous 
Fevers of the Paroxysmal Type I believe it would
be useful in most chronic affections of an Intermittent
nature particularly the sick Headach. The mode in 
which I administer it, is in such doses and in such 
intervals, that it may not purge. This end is attained
by giving 30 or 40 grs every 3 or 4 hours. On the authority
of Dr Munroe and one or two others, the Blue vitriol
or Sulphuret of Copper, has been prescribed in Intermittents
It has been alledged by [Dom.] that whilst Physician General
to the British forces in the Netherlands, he as enabled
to arrest Intermittent Fevers by the remedy when all 
others failed. To the same purpose goes the testimony of 
Dr Adair and others. The following is the formula in 
which it was used Rx Sulph Cupri grs 4 Extract Cort
Peruv grs 32. To be made into pills [illegible] one of which 
is to be given every 4 hours. whether this remedy is 
as powerful as represented I cannot readily pronounce
The cases in which I have found it most serviceable
are old Quartans
Dispersed through practical writers some evidence might
be collected of the efficacy of Cuprum Ammoniacum
in this disease nearly on the same footing may 
be placed the several preparations of Zinc they 
have no strong claims to your notice




39
The Sulphate of Alumine or Common Alum has had considerable 
reputation in the treatment of Intermittent. Dr
Darwin thinks it best adapted to three cases which 
are associated with the bowel affections Dose from
5 to 10 grs. Fowlers Solution of Arsenic has gained
much reputation in the management of Ague & fever 
and in the estimation of Practitioners generally stands
next in point of efficacy to the Peruvian Bark.
that it has done good in Intermittent cannot be denied;
but whoever expects uniform success from it, will be
disappointed. In all weak and debilitated states of the 
system, whether of a Typhus or Cachectic nature 
or arising from old age or debauchery, the Arsenic will
always fail. This is precisely what might be expected; 
Bark and many other Medicines employed in 
Intermittent, are tonic in their nature but arsenic
has no such properties, though commonly ranked with 
that class of Medicines. Its principle operation is 
to create nausea weakness of the Stomach and debility
of the system generally which is indicated by a feeble
pulse, cold surface, loss of General Strength and
muscular relaxation.  But even when judicially 
employed it sometimes fails. Compared with bark
it is in my opinion most decidedly inferior and 
should never be employed when that article can be 
obtained. The cases of Intermittent to which it is
best suited are such as occur in Children and persons 




40
possessing considerable vigour of constitution. It acts 
promptly on the systems of Children and on its being without
taste and of small bulk may be given when other
remedies would be rejected. It has been a subject of debate
whether the use of Arsenic should be continued during
the different stages of the Disease. My own experience
has taught me that there is no precise rule on the subject
The only objection to its employment in the Paroxysm is
the nausea or vomiting, which it is apt to induce especially 
in the Cold Stage. Arsenic is very prompt in its operation;
therefore if no decided advantage is experienced
in 6 or 8 days, it should be discontinued. Longer used
it only debilitates the system, and induces a long
train of unpleasant symptoms; as distress of stomach
pain in the head, and oedomatous swellings of the extremities.
It has lately been alleged by high authority 
that when Arsenic does not succeed by itself, it may 
be rendered very efficacious by combination with 
Peruvian Bark. This is sound practice and I have 
imitated it with advantage. Arsenic has been supposed 
to prepare the system for the bark; and consequently,
it has been recommended that when the
disease does not yield readily to the bark, we should 
use this remedy and afterwards, recur to the Bark
I have not tried this plan, but there is nothing
theoretically incorrect in it the dose is 8 or 10 drops 
3 or 4 times a day. Withing a few years past
the web of the Spider has gained some reputation as  




41
a remedy in this disease; I derived the first hint of its
efficacy from Dr Jackson, Inspector General of the British
Army. This article is undoubtedly sedative, and narcotic
and we have had evidence of its virtues in Intermittent
IT should be given in Pills, in the dose of 2 or 3 grains
It is now 15 or 20 years since the introduction of Gellatin
as a remedy on Ague & fever. The French practitioners 
used common Glue the English Lillies. Dr Griffith of
this City, found great advantage from the use of 
Lillies in the case of his own child I would strongly 
recommend it as an article of diet in this disease
The Prussiat of Iron has been employed by Dr Tolleckoffer
of Maryland in doses of 5 grs,3 or 4 times
a day I have not found any advantage from it
The subnitrat of Bismuth in doses of 4 or 5 grs, several 
times in 24 hours has been employed by Dr Carmichael
of Fredg, Va. The oil of Turpentine has also been used
in doses of a teaspoonful every 2 hrs during the apyrexia
The species have been much employed especially the
Blk Pepper.
In obstinate cases I have prescribed Emetics
for 3 or 4 mornings in succession; and then placed
the Patient under the influence of opium giving of the 
latter, one grain every 6 hrs during the apyrexia, with 
2 grs just before the accession of the Paroxysm.
This disease has been regarded too much a specific
and specific remedies have been trusted too much in its
cure. I hever give Tonics [salary] as the Tongue is
foul or the blood vessels excited. Small and repeated bleedings 




42
will sometimes be necessary to subdue the phlogistic diathesis
and awaken the Susceptibility of the system. After which 
Bark and other remedies have a good effect. In the
Cachectic state succeeding Intermittent, I have found
nothing so good as the Rubigo Ferri in doses of 10 grs
3 times a day
Notwithstanding the
numerous remedies, which have been mentioned for the
cure of Intermittent Fever, it will sometimes baffle all
our best efforts and continued its course in spite of all
our exertions. Cases of this peculiarly obstinate
character, depends most generally on congestion or 
some other disease of the viscera or are vitiated and
confirmed by long habit. It is our duty under such 
circumstances to resort to mercury, gradually introduced
into the system until salivation is induced 
which must be Kept up for 2 or 3 weeks without intermission.
This is properly called a revolutionizing
remedy, by which changes are effected in the system so 
as to do away the preexisting disease. As a substitute
for Mercury, Blisters have been found highly beneficial
they should be applied to the extremities and ought not
to be dried up too hastily. They operate freely much 
on the same principle as Mercury; for by creating
a counter impression they tend to destroy those concatenated
associations on which the disease depends 
when however all these means fail we should 
direct the patient to undertake a protracted journey.
So that exercise, changes of scenery, the novel impressions derived
from a different climate; and other causes may operate 




43
in producing a new train of action, which may suspend
the old. I will now speak of those
remedies, which are proper to meet a second indication
in the apyrexia; viz to suspend or direct the Paroxysm
It is a common practice to order the patient to got to
bed and take opium as Dr Trotter has recommended.
warm beverages are also administered for the purpose
of exciting Diaphoresis. Aether is a prompt powerful
and diffusible stimulant and is well suited to 
this stage. You should warn the patient not to 
overload his stomach at this period as Nausea
& vomiting would be occasioned. Cases are on
record which were cured by 6 or 8 hrs fasting any 
great change in the condition of the stomach will 
answer the same purpose. By some practitioners
a different course is pursued. They make the
strongest possible impression on that viscus by 
stimulating medicines Strong spiritous liquors
either alone or with spices have been used and no
doubt with advantage. In fact whatever makes
a strong impression on the system whether through
the medium of the mind or body will often succeed 
in curing Intermittent. Emetics given before the
Paroxysm have a powerful effect, and Blisters applied
to the Stomach at the same juncture not
unusually ward off the attack.
It is the imperious duty of the physician to endeavour 





44
to cure Intermittent as soon as possible. There is not
disease more disagreeable to the patient and though
not immediately dangerous, it is apt to degenerate
into complaints of a very serious nature. The 
disease is very apt to terminate in Hydrocephalus
in  Children. The more common of the remote consequences
are congestion of the viscera, schirrus indurations,
and Cancer Conjoined with Dropsy and other
depravations of the system. No opinion is therefore more
absurd and mischievous than that which is advocated
by Boerhaave and adapted by many other physicians that
Intermittents are Salutary in their primary operation 
and unless of a malignant type ought not to be too 
suddenly suppressed by artificial means.
Nevertheless it cannot be denied that Intermittents sometimes
supersede other diseases, and those too of a very 
formidable character. Gout, Rheumatism, the Cutaneous
affections, and many of the spasmodic or nervous disorders
as Chorea, Epilepsy, Asthma, Hysteria, Dyspnoea
sometimes yield to attacks of Ague & fever. It has
been ascertained that Intermittents after they are completely 
established sometimes cure Pulmonary 
Consumption. I have already mentioned, that it 
was the practice of an old Physician of this City to 
induce this species of Fever as a remedy for Consumption 
but I will hereafter treat of this more particularly. 
The same effect is sometimes produced by 
it, in Melancholy and the furious forms of Insanity
It was customary with the same Physician to take the 





45
[Maniacs] out of the Hospital and expose them to the
sun and send them to Miasmatic districts, that they 
might be attacked with Ague & Fever. Though this practice
did not always effect cures yet a sufficient
number were relieved by it to show the power of the
Intermittent action over such Cases.
Of Continued Fevers
These run their course without any intermission 
although some degree of remission and exascerbation
takes place daily. It has been held by some
writers that this definition is exceptionable because
Say they a continued Fever consists of a single
paroxysm, Kept up without abatement, until 
the final termination. But I believe that no 
such fever exists and am supported in my opinion 
by the highest authoritys. Except the fever denominated 
ephemera from its short duration
every other Kind of Febrile affection is made 
up of a repetition of paroxysm. It may be
remarked as a general rule that the remissions
and exacerbations take place in the morning
and evening. By consulting Nosological writers 
you will find that the Class of Fevers is variously 
arranged I shall treat of them under the general 
heads of Synocha and Typhus. The different 
forms of continued fever may thus be disposed 




46
of without deficiency of perspecuity or too great
generalization. Synocha as ordinarily defined
I believe has no existence. Every case at least
which has met my observation has been attended w
with some local affection which marked it as
one of the Phlegmasia.
Of Continued Fevers the most common in this
country is the Bilious Inflammatory. This prevails
in the United States to a great extent, but with 
greatest violence to the Sough. It is much 
varied by climate, society etc. Like the fever
already treated of it arises from Marsh Exhalations,
but is produced by other causes.
Considering the close analogy in the origin, symptoms
and mode of cure not to mention other
slight resemblances of Intermittent and continued
Bilious Fever we have good reason to believe that
they are the same disease differing a little in 
type and external phsyiognomy
During the exacerbation an Intermittent is
as similar to an attack of Continued Bilious
Fever that an account of one will answer
equally well for the other, each being ushered 
in by the same train of symptoms and accompanied
by the same set of affections. Discharged
therefore from the necessity of occupying our time 




47
with a recapitulation of what has been said we will 
proceed to the cure of the disease before us.
But can we arrest the progress of Fever after it is once established
This is a question which has been ably discussed by Cleghorn
Hillary, Prengle, and even Fordyce it has been answered
in the negative. It is contended by the last particularly 
that we are not only unable to arrest the career of Fever
but that addition to or subtraction from the cause producing
it, will have not the slightest influence.
In support of this opinion they appeal to Small pox,
Measles, and other diseases in which the fact is undoubtedly 
as stated. Neither of these cases however 
abated in violence, can be cured by artificial means
and neither of them is affected by withdrawing the
further application of the cause. This is particularly
true as it regards the Small Pox, but the reasoning
is fallacious in as much as it is deduced from cases
of disease particular in their nature and governed by 
their own laws. As it respects the common Fevers we
see them daily checked by the remedies usually employed
an it be denied that they are interrupted by a timely 
resort to V.S. evacuants and other similar means?
Most assured we see this happen every day of our 
lives, and our success in arresting the march of fever
constitutes one of the trophies of the profession
We must however concede that there is much difficulty
in many occasions and hence we often must with 
the precept in Practical writers, to attack disease in its
forming state as then victory is easy.




48
The doctrine above alluded to is highly pernicious in its consequences; 
having arisen in the dark ages of medical science,
it has been kept up by too great a respect for authority
It will not fail if credited to take away all the energy
of practice and sink you into irresolution and indecision 
when exertion is most required. According to this motion 
you must remain idle spectators of the ravages of disease 
on the constitution. Could I believe that we are unable 
to arrest the progress of Fever but that we must merely 
look on whilst nature cures the disease, I would instantly
strike the flat of my profession an desert it as
fraudulent and deceptive But this far from being 
the case our means are ample and energetic. Let it
not be believed from what has escaped me that I am
at all disposed to deny that in Fever there is a tendency 
to solution or crisis at particular times. This was early 
noticed by Hippocratesand has been abundantly confirmed
by other physicians. Hence arose the doctrine of critical
days, by which are meant those on which the Fever
is disposed to Solution. These according to Hippocrates
are the 3rdd, 5th, 7th, 9th, 11th, 14th, 17th, 20th, or 21st in which have
been added the 27th, 35th and 42nd. Every practitioner of enlarged
experience must know that there is a tendency
to a remission of the symptoms on some of these days
but such a tendency is not so clearly manifested in our
diseases as in those of the Ancients. The reason is
not obscure. You all know that the climate of Greece
is equable and serene and that the people in the time
of Hippocrates still cherished the simplicity of their
republican habits. Diseases therefore prevailed with 
uniformity of character and were not disturbed as among 




49
us by wide deviations of nature and by the character of our
climate A more powerful reason for this difference 
however is to be found in the energy of our practice.
Attempts have been made to explain the recurrence of Critical
days on the supposition that Intermittents are the primary 
type of all Fevers whether this be admitted or not the 
facts are important. They teach us to watch the efforts 
of nature to bring about a crisis which is marked by 
a remission of the symptoms This is the most favourable 
time for the use of remedies. Disease is most
apt to terminate favourably on the 7th day
Treatment of Synocha
Early in the discussion it was remarked that the Bilious Fevers 
are for the most part inflammatory in their nature. This being
the case the principal indication is very obvious to reduce the arterial
action to the ordinary standard. Confessedly to attain this end no
means are equal to the lancet. Its operation under such circumstances 
is prompt and effectual but in this disease it should be directed
by judgment and tempered by a sound discretion. Do not in any 
instance prescribe for the name of a disease. The same disease may be 
varied (and none more than the one under consideration) by climate
season personal idiosynchrasies, and many other causes. Thus
whilst copious bleeding is our only remedy in this disease the
practitioners in the Southern states never open a vein But no
matter where you settle, do not refrain from depletion by the 
Lancet whenever it is indicated by a strong full pulse, a hot skin
determination to the head or other symptoms of increased arterial 
action. These symptoms whether they occur beneath the burning tropics
or amidst polar Snows; or in the more genial climates of the Temporate 
Zone, may be considered as signals as held out by nature for
succour from the Lancet, and other evacuants, in her difficulties and
oppressions. Nor must the loss of blood be moderate. we must
detract enough at once to arrest the progress of the disease, and protect 




50
the organs from disorganization. I generally bring on a tendency to faintness
or absolute syncope. Next in importance, are those remedies
which produce evacuations from the Alimentary Canal. These are
called for in all Fevers, but especially in this on account of the
large accumulations of Bile which are apt to occur. My general 
practice when I can prevail on the patient to consent is to direct
an Emetic and as I remarked on a former occasion, the antimonial 
preparations are to be preferred. It will be perceived 
that I am an advocate for Emetics in this order of diseases.
My experience has persuaded me of their superior efficacy 
to purging, and I am supported in my opinion by those
Physicians who are acquainted with the most inveterate shapes
of Bilious Fever. But that they may attain their full effects they 
must be repeated, and in some cases for several days together.
A loaded tongue with continued nausea points out the necessity 
for repeating Emetics. There is a fashion in medicine as well as 
in other things. Emetics which were at one time universally 
resorted to and of whose efficacy undoubted testimony was 
afforded in one of those revolutions to which our science is
subject, were suddenly supplanted by purging medicines.
But they have been recently reversed. By consulting the French 
and English authors who wrote on the diseases of their respective 
armies 20 years ago it will be found that the vehement Bilious
Fever of the climate of Egypt refused to submit to other modes
of evacuations. Emetics were therefore adopted by the whole medical
corps of both armies without regard to those habits of Country and prejudice
of Education, which have so much influence in the generality of cases. The 
efficacy of the class of medicine is equally attested by the east and west
India practitioner, as well as by those of our own country, where Bilious
Fevers prevail to a wide extent, and are marked by great violence of 
Symptoms, Determining from my own observations, I should say 
that when early administered they hardly ever fail to check the disease




51
and that in the advanced stage the pulse is reduced the pain in the 
head relieved, Sickness of Stomach quieted, the temperature of the 
surface lowered, engorgement of the viscera removed and diaphoresis 
produced by the operation of the remedies. But when Emetics cannot
be administered wither from the prejudice of the patient or
from the existence of a rupture from a predisposition to apoplexy
or after active vomiting we may with propriety and advantage
recur to Purgatives. Combinations of Calomel with some of the 
drastic Cathartic as Jalap, Rhubarb, or Gambonge, will succeed
best in the commencement of continued fevers. It is a 
favorite practice with some where the Stomach is loaded with 
Bilious accumulations to such emetics with purgatives so as to 
produce an artificial cholera Morbus. of the utility of this
plan there can be no doubt. It has occasionally been resorted 
to in the Bilious Fevers of this City with success and it is more 
employed in the Southern States, where there is a greater necessity
for it, from the superior vehemence of Bilious affections.
Combinations of Calomel with Emetic Tarter, to which some
add Gambonge are occasionally prescribed. The Gambange alone
in the dose of 10 or 12 grs will produce this effect. But to justify the
 use of so violent a remedy; the fever must be of a dangerous
character and the indications of a bilious accumulation strong 
and considerable. In prescribing purges, if delay be at all admissible
it is proper to wait for that period of the Fever when 
a partial remission of the symptoms takes place. Given at this time
they act powerfully and efficaciously. If on the contrary they are 
exhibited during the rage of the Fever, they are either rejected by 
the Stomach or lie inactive. The mercurial purges
are not to be discontinued as soon as the bowels are opened
but their use must be persisted in until dark foetid bilious
stools come away. For this purpose Calomel may be given
in doses from 3 or 4 grs every 2 or 3 hours, until about 20 grs
have been administered and then give a dose of Castor Oil.






52
Combinations of medicines sometimes purge on much smaller doses
than the same articles would before combination. The following
is a very efficient and at the same time a mild medicine
Rx Calomel grs 10, Gambonge grs 3, Jalap & Rhei grs 5 each sol Cinnamon
gutt 2. Divided into 6 pills one of which should be given every 
hour. The alimentary canal being evacuated by the above
measures we are next to resort to saline Laxatives. Employed
in moderate doses, they are beneficial in Keeping the bowels open;
and by their action on the inner surface of the exhalent vessels
of the Intestines, they detract the watery part from the Circulating
fluid, and thus Keep down arterial action. Of the saline
purgatives the best have already been mentioned. A prescription 
very much used by myself and other practitioners of this
City is the following Rx Sulph Soda zi, Emetic Tart 1 gr. Sharp 
Vinegar or Lemon Juice zi, water ziii Dose a Table spoonful 
every two or three hours. It keeps the bowels in a laxative state
produces a mild diaphoresis, subdues arterial action and lessens
the term of the patients suffering. As cooperating remedies Enemata
are not to be overlooked they promote the operation of purges 
and are good substitutes for these medicines when they cannot be
retained or when the alimentary canal has been much evacuated
Several formulae have been used. The Best for common purposes I’
will mention now. Take a pint of water, a table spoonful of
Common Salt, the same quantity of olive or castor oil and molasses
mix them together and inject them. when you wish an Enema 
a little more stimulating, as when there is flatus in the bowels
in the close of a Fever, the Terebinthinal injections are well
adapted to the case. Mix a Tablespoonful of the oil of Terebinth
with the white and yolk of an Egg, and add a pint of water
It relieves flatus more speedily and effectually than any  
other remedy which I have tried
By the combined operating of the remedies already mentioned, the existence 





53
of the system being already sufficiently reduced we are next to resort to
those medicines which are calculated to promote perspiration.
By the vulgar this is esteemed safe and effectual in all occasions
nor is the opinion confined to the low and illiterate orders of mankind
Every class of society acquiesce in the prejudice and entertain the 
same view. It is obvious however that remedies which have so 
powerful an operation on the system as many of the Diaphoretics 
exercise should not be wantonly trifled with or inconsiderately 
employed. On the contrary they should never be used in inflammatory 
fever until arterial action and general excitement are 
reduced by VS. and evacuations from the Alimentary Canal
Diaphoretic then come in with advantage and mitigate the
disease or arrest its further progress. Even here however 
only the milder articles should be used and these should be 
combined with auxiliary means having the same tendency .
As a general precept from which you should never deviate 
it may be stated that we are rather to solicit perspiration by 
lenient means, than to extort it by violent measures.
To bring a continued fever to a crisis the antimonials are now
generally preferred. Early introduced into the practice of medicine
with tis view they were prescribed occasionally with 
variable reports until their efficacy was declared by Hoffman
and their employment sanctioned by the authority of Cullen
and Fordyce. Anitmony affords us a great variety of [preparations]
each of which may be so given as to produce diaphoresis
IN Europe at the present time great confidence is reposed in 
the Celebrated James’ Powder. This is certain an excellent preparation;
but in the state in which we get it, there is too 
much uncertainty in its powers. Prepared as an article of 
commerce in the large bulks, the active ingredient is very measurably 
diffused through the mass, so that in a common dose there 






54
there is sometimes enough of the active principle to occasion death 
whilst at others it is perfectly inert. The Pulvis antimonials or
Xoyde of Antimony, with Phosphat of lime is used under some 
circumstances the dose of either from 4 to 10 grs. The Golden sulpuret
of Antimony has been much used in Europe especially in 
France dose 4 or 5 grs. Tartar Emetic is preferable to them all 
nearly tasteless, and quite inodorous, as well as being quite
minute in its dose it may at all times be conveniently 
administered. It has been a controverted point, whether 
Tart Emet in order to do good should occasion nausea
or not. By Cullen it is maintained that the medicine 
must produce nausea or vomiting in order to be effectual
whilst by Fordyce, it is contended that the power of 
the article is destroyed, if nausea take place.
I believe that antimonials do good in fever by exciting 
their own peculiar action which supplants the disease
and that this effect is prevented if the Stomach be sickened 
just as the specific operation of Calomel is prevented by 
its operation on the bowels. Nausea of itself is not
salutary. The diminution of action which it occasions 
is soon followed by reaction. As a general rule the more
Tart Emetic you can give without sickening the Stomach
the greater will be its effects. The efficacy of Diaphoretic 
medicines, depends not so much on the sweating 
produced as their correcting the morbid action of the
vessels. The most copious transudation sometimes 
takes places place without affording any relief.
when the stomach is so irritable that the Antimonials
cannot be retained the Saline medicine may be prescribed
It is made as follows: Rx Lemon juice or Strong Vinegar zii Sal
Tartaris [?S] ad [Laturand] Loaf Sugar zi water zii dose a table spoonful





55
every hour or two. Sometimes a small quantity of Laudanum
or Spts Nitri may be added, as the symptoms demand. Preparations
of Opium and Ipecacuanha have been used, but I am 
not fond of the prescription. A remedy of great efficacy 
in these cases is Nitre alone or in the following combination 
Rx Nit Potassae zi, Cal grs 10 or 15, Tart Ant 1 gr. To be mixed & 
divided into 8 powders one of which may be given every 
2 or 3 hours. Cold applications have been used in cases of 
Inflammatory action with advantage. The sponge wet
with cold water and applied to the surface where there is 
great action in the pulse with heat, subdues the action,
quiets irritability and promotes diaphoresis. Previous to the 
use of Mercury Blisters to the Extremities should be resorted 
to: if these do not answer however a slight salivation 
is to be induced.
The Capillary vessels circulate their blood, by a power
almost independent of the hearts’ action and according to 
my views of the subject the derangement of that harmony 
which in health subsists between their action and the Arterial 
system generally is the Essential cause of the phenomena 
of Fever. That fever does not exist in simple
excitement of the Arterial system is obvious: for 
if a man exert himself in any way, or drink a glass
of wine; his pulse, respiration and the temperature of his
body are all affected; yet these symptoms [illegible] when l
the causes cease to act. If however the cause continue
to operate until the capillaries become implicated, disordered
secretions with the whole train of morbid Symptoms follow
whilst excitement is confined to the larger vessels evacuation 
by VS. purging, vomiting etc. will cure the disease 





56
but when the Capillaries become affected we must address 
our remedies to them. These are local bleeding, Diaphoretics,
Blisters, and Mercury. 
In placing the system under the revolutionizing effect
of Mercury, this medicine should be gradually introduced
if time permit when however the symptoms are urgent
it should be used freely both externally and internally
In many cases we are unable to induce the mercurial
action in time to save the patient. The quantity of mercury
given in some of these cases has been very great.
There is a very ingenious physician in Kentucky (Dr
Marshall) who has been in the habit of giving Calomel
in Tablespoonfuls. when asked if he was not fearful of 
the consequences of such doses he replied that if the
mercurial action was excited at all it would be the same
whether it was produced by 1 gr or 10,000. But it is not uncommon
for people in that district of Country to lose
their jaws by mortification.
It has been a question whether Bark should be used
in Continued fever, after the reduction of action by evacuants
I believe that we are to trust to the latter, exclusively in 
tis form of the disease; but when it remits or intermits
Bark may be used. It should never be resorted until 
the Tongue is clean and the skin is perspirable.
Having finished our account of the general treatment
of Bilious Inflammatory fever it remains for us to say’
a few words concerning certain local symptoms and
determinations which occur during the progress of the 
disease: 1st Determinations to the head; these should 
be met by V.S. if occurring at that stage of the disease, when 




57
bleeding is admissible. The blood should be drawn from a 
large vein or the Temporal Artery should be opened. Local
applications of cold water should be used. [Illegible] or three leaves
of the Tulip Poplar applied to the head will frequently occasion 
the most sweating and thus relieve it. If these fail apply 
a Blister and Keep in on for 24 hours. 2nd when there is 
restlessness and want of sleep with fever and increased
heat, sponge the surface or immerse the arms up to the 
elbow in water. Opiates though useful in the advanced
stage are seldom employed; Hoffmans anodyne is occasionally 
used for this purpose. When opium is used
I prefer the Blk Drop or the Tartrate of Morphium prepared
as follows. Rx Laudanum zi Tartaric Acid grs 10 
water ziv. Tablespoonful at a dose. This is very composing 
and sedative. 3rd If there be great thirst, clean
the Tongue, Gums and lips, with Vinegar or limon juice
This symptom is generally owing to the vitiated contents 
of the Primae Viae and consequently indicates a continuance 
of evacuants. The mouth should be cleansed with 
Carbonic Acid, in the form yeast or the effervescing
mixture. when thirst depends on deficient secretion 
give ½ gr Calomel every hour, until 4 or 5 grs are down’
and then purge with Epsom salts. Now and then some
acidulated drink, as limonade, vinegar and water,
Apple water, Tamarind water etc. will be useful.
It has been a question much controverted whether the 
patient should be indulged in his ardent desire for 
drink. The physicians of antiquity were much divided
on this subject; whilst one set forbade another 
freely allowed the use of water. It requires little sagacity 




58
to perceive that the brush occupies a medium between 
the two. By denying altogether the use of drinks, we should 
occasion great distress and thus increase the disease;
but by allowing a two free indulgence of water, the 
Stomach would be deluged and nausea and vomiting
occasioned. water should not be taken very cold; for 
it is a precept worthy of your attention that drink
in moderate quantity and moderately warm will 
relieve thirst more than when cold and inordinately
taken. During the Continuance of Fever
the drinks above enumerated will afford sufficient 
nourishment to the patient. It sometimes happens 
that the appetite solicits solid food and the 
demands of the patient for it are clamorous; but
this propensity is always an unfavourable symptom 
and should never be indulged. Every 
practitioner must have seen the Evil consequences
which result from the gratification of this diseased
appetite. Cases have frequently terminated fatally 
from this cause which might have otherwise 
been cured. 4th Gastric distress and vomiting
when arising from Bilious accumulations
Evacuants should be resorted to: when dependant 
on irritability alone; the effervescing draught
will frequently arrest it: or the Potash mixture made
thus: Carb Potassae zi Gum Arabic zi Laudanum 30 gutt





59
oil of [Miat] 10 drops, water ziv give a spoonful every hour
Lime water & milk, a tablespoonful every hour: minute
doses of Calomel and magnesia: Saccharum Saturni i gr every 
half hour: Tinct of Cloves or Capsicum: or an old opium
pill. In addition to these we should use pediluvium with 
mustard in the water, sinapisms & Blisters to the
stomach. Before leaving the subject I will
give you some direction for the management of the
patient during Convalescence. Febrile affection of
every description leave behind them an accumulation
excitability which if not properly regulated may be productive 
of relapse. A condition of things more dangerous
and intractable than the original disease. The first [illegible] to be
when convalescence commences is either to remove the patient 
to another room, or in order all the apparatus of sickness, as
phials, pill Boxes etc. to be taken away. By the sight of these 
a remembrance of the sickness is kept up, and by depressing
the spirits, retard the progress of the cure. He should then 
be shaved and his clothes changed. We should next be
careful to accommodate his diet to the state of the system
It is proper to begin with the farenaceous articles of which 
none are better than Tapioca, Arrow Root, Sago, & Rice.
Next you may allow Eggs and oysters raw or slightly cooked
whatever is taken should be in small quantities and frequently 
repeated. water is for the most part the best drink
but if the condition of the system require something more 
cordial malt liquor and especially Porter should be given.
It is not less important that the patient should return 
gradually to his former pursuits and habits of life. He is 
especially to avoid much exercise of his intellectual faculties.
To prevent this he should be kept from study and
attention to business of every kind. He should not be permitted 





60
to enquire into matters without doors, and company of course
is to be excluded. Be not too precipitate in putting your 
patient to take exercise: There is always much eagerness
on the part of friends, under the idea that it will afford
the patient strength and confirm his recovery. You should
remember that there is great liability to take cold and
in the commencement of convalescence [illegible] the stimulus of riding
instead of strengthening would most probably excite a return
of fever. Even when you allow him to take exercise you 
should direct that he should be warmly clad, and particularly 
enjoin on his attendants that the ride be not so
protracted as to occasion fatigue.
The preceding instructions relate to the management 
of the patient under ordinary circumstances, but occasionally 
certain symptoms arise during the course of medical treatment
which demand particular attention. Sometimes the patient
in convalescence from a long spell of Fever remains very 
feeble and without appetite. In these cases Tonics should 
be given. Among these the Tinct of Bark alone or in 
combination with a small quantity of Gentian is highly 
beneficial. There is a great variety of articles of similar
character which may be used in succession or according to the
circumstances of the case. The leading articles of this kind are
the vegetable bitters, as Columbo, Quassia, Chamomile, Gentian
etc. which should be used in the form of cold infusion.
The Elixir vitriol is also admirably adapted
to these cases and often restores appetite.
Not the least unpleasant affections incident to a state
of convalescence are those of watchfulness. They often
retard recovery and sometimes excite fever. Here small
opiates are useful and the Black drop is to be preferred. 




61
This is a preparation made of acetic acid, which has three times
the strength of Laudanum and has a most powerful anodyne
effect. when opium in this form fails you may resort to the
Tinct of Hap with much advantage. The Camphorated Julep 
sometimes has a good effect watching sometimes proceeds
from an empty stomach. In this case stimulating
food, with Porter is generally effectual. The condition of 
the bowels demands cure: sometimes Diarrhea, though more
frequently constipation attends recovery from disease.
the former will generally yield to some of the Cretaceous preparations.
when there is a tendency to constipation small 
doses of Rhubarb should b given. This whole should be
preffered because it imparts tone to the Alimentary Canal
and when taken by itself, never purges copiously. It is
remarkable that its operation is not effected by opium 
evacuations from the alimentary canal when copious 
during convalescence, sometimes produce an alarming
state of Exhaustion. In the condition of Convalescence there
are other affections which have claim to notice. The 
Bilious Inflammatory may terminate in a Typhoid
fever: but it most frequently runs on in a chronic form
As the Treatment of Typhus will be taken up hereafter 
I shall not anticipate the observations which I have 
to make on that head. But the chronic form claims
our notice. It is called Febricula and is known in the 
country by the name of inward fever. The pulse is
small corded and hard: there is much heat on the 
surface; a bilious complexion and tension of the forehead
combined with head ach or pain in the side. The patient
has oedematous Extremities and scanty high coloured urine




62
the type of the fever is Remittent or Intermittent. The cause
of the condition of things is too obvious to be mistaken it
arises from congestion in the large viscera particularly 
the spleen and liver. The appropriate remedy is a slight
salivation or what answers well as a substitute a course 
of Nitric Acid Of this about zi should be given every 
day for 8 or 10 days. Commonly however there is so 
much pain and fever that it is necessary to resort to 
small and repeated bleedings. [??sicating] applications 
are very important: they should be placed on the side 
if there be much pain but if the pain be absent 
and we wish to interrupt the morbid association on 
which the Fever depends I would greatly prefer them 
to the wrist and ankles. It is common to treat these
cases with Bark but the practice is highly prejudicial. 
It locks up the disease instead of liberating 
the system from it. After evacuations have
been promised; tonics may be employed. Of these
the Peruvian Bark is best: but if this fail we should 
resort to Fowlers solution.
Typhus Fever
The term Typhus is derived from the Greet [illegible], signifying
stupor or heaviness. By nosological writers it has been divided
into Typhus mitior and Gravior: but as one of these
is only an aggravated form of the other without any difference
specifically, I cannot perceive any reason for retaining 
the Distinction. It may be added that Typhus 
Fever, whether Idiopathic or the sequel of some other
disease, is of the same nature, presents the same symptoms 




63
and demands a treatment conducted on the same principles. The
only material difference between the two forms, mentioned by 
nosologists, is that the mitior generally comes on with more mildness 
in its symptoms and is more protracted in its continuance
several weeks sometimes elapsing before the occurrence of 
the crisis. Preceding an attack of this form of the disease
we often perceive [un?ousal] languor, listlessness, sighing etc.
without any other symptoms denoting its approach. There 
is no chill nor Fever, nor is there any pain or uneasiness
in any part of the body. The patient complains of debility
with some loss of appetite, and dejection of spirits. After
the case becomes more developed, a greater or less degree of 
derangement in the circulation, occurs. The Typhus gravior 
is marked by symptoms of greater malignancy at its most
and is more rapid in its progress. As in the milder shape
the patient is first seized with great prostration of strength 
in which the mind fully participates. But even at the 
early stages there is some tenderness and soreness of the 
muscles, with acute pain in the Back, Head and Extremities 
and an alternation of Chills and flushes. These symptoms 
are speedily followed by a well defined fever, by intense
heat on the surface, and considerable determination to the
head, as is indicated by the violent pulsation of the Carotids 
and temporal arteries: by the suffused countenance, the 
wild inflamed eye; and the tendency to delirium which 
constantly prevails. Examined at this period the tongue
is found dry hard & chapped, with a brownish encrustation.
The Gums are affected in nearly a similar manner: 
and the teeth are covered with the same dark fur:
In the commencement we generally find the pulse quick




64
corded and active, with much disturbance of the functions generally.
Respiration is generally laborious and frequently 
interrupted by deep sighing: the breath is singularly hot
and offensive. At this period the bowels are uniformly 
constipated: much heat pain and oppression are felt at
the pit of the stomach, combined now and then with vomiting
of Bilious matter, and unquenchable thirst. As the disease
advances the symptoms are aggravated. Great debility 
comes on: the pain is distressing and acute the fever
increases the pulse is small, tremulous, and so quick
that it can hardly be counted. The temperature of the
surface is various, the skin being sometimes hot and
dry, and at other times cold and damp. The nervous
tremors which from the beginning constitute a set
of the most prominent symptoms, are not so much 
aggravated as to amount to Subacutus Tendinum.
It is not uncommon for the Bowels to give way at this 
stage, when copious discharges of dark foeces, take 
place. Most generally there are dark hemorrhages
from the nose, Gums and mouth, associated with 
Petechiae and vibices, or with livid spots in different
parts of the body. The pulse now sinks, the extremities
grow cold, hiccough comes on and finally 
death. This is the ordinary progress of a malignant
case of extreme violence, terminating fatally
But when the circumstances are more favourable
authorizing us to calculate on recovery; an abatement
of febrile excitement takes place, the surface becomes
moist, the Tongue moist and clean, the pulse slower
and stronger, the temperature is reduced delirium goes off 




65
and glandular swellings with scabby eruptions, about the
mouth appear. As it regards the origin of Typhus Fever
not a little difference of opinion has prevailed. By a great
majority of writers it is maintained that a specific contagion 
is its only cause. That it is produced in this way cannot
be doubted. It has been shown by the Experiments of 
Haggarth, and is confirmed by the whole tenor of medical
experience e and observation. By the experiments alluded
to it is proved that Small pox itself is not more contagious
of 188 persons exposed to the Typhus Contagion, in a crowded 
and ill ventilated room, only 8 escaped the disease. It 
also appears that the sphere of its action is limited: the
disease never extended to a neighbouring apartment or
to any distance in the same room provided it was well
ventilated. It may nevertheless be conveyed by fomites
as wearing apparel, Bed clothes etc. It also adheres to the
walls and floors of houses, to ships and wooden furniture
The disease is more violent when produced by fomites
than when communicated by the individuals labouring
under it. What is a very curious circumstance, contagion 
may exist in the cloathing of an individual, so as 
to affect others with disease, whilst the individual 
himself escapes. It is probably within the recollection 
of some of you, that at the Blk [assizes] at Oxford a
number of prisoners were arranged in a row who had 
been brought from a Prison in which the Jail Fever
prevailed, but who had not been affected with it themselves
To such a degree was the contagion concentrated in their
clothes, that the Judge, Jury & many other persons were 
seized with the disease. Many other instances of the 




66
kind have been related: but in general the disease in invested
for its contagious nature to ill ventilated and crowded
rooms. As soon as the patient is removed to well ventilated
apartments, the disease loses the power of being propagated
by Contagion. In confirmation of this, a fact which was
lately observed in Philada may be noticed. Typhus fever
made its appearance in the criminal apartment of the Jail
the rooms of which were extremely Crowded and close.
It continued to spread among the prisoners until the 
sick amounted to 40 or 50. They were then removed into a
large apartment, which had previously been used as a 
place of religious worship. The disease whas then checked
because its power of generating contagion was at an end.
The precise period at which the contagion takes effect
cannot be determined with absolute certainty. Most generally 
it is 10 though sometimes 50 or 60 days. Extraordinary 
as this may appear, there can be no doubt of the fact
It is proved by the Experiments of [Haygarth], Bancroft
and other writers. my own opinion derived from experience
confirms this account. During the last 3 or 4 years many 
vessels arrived at this port with emigrants, among whom 
the Shi Fever prevailed to a great extent. In several
instances those who had not been affected remained in 
this city 4 or 5 weeks before they were attacked.
After conceding all this to the advocates of contagion,
it must be contended that the disease arises
from a variety of other causes. It proceeds from what
ever debilitates the system and depresses to any extent
the mind It is often occasioned by marsh miasmata




67
and sometimes by great fatigue, and a low abstemious 
diet. It has been a question whether the disease arising
from the last mentioned causes, is the same with that
produced by contagion. By Bancroft it is maintained
that Typhus Fever resulting from contagion is a peculiar
disease, which has existed from the earliest record
in medicine and can be produced in no other way 
than by the influence of that contagion which is 
the product of morbid vascular action in the disease.
Although the simulated forms possess many 
of the attributes of genuine Typhus, yet they can 
not propagate the disease by contagion
The Typhus Fever is not a common disease of this City 
and pervades not great extent in any part of the U.S.
it is found in Jails, Ships, Hospitals and other crowded
places but finds rarely within our happy country 
a source of generation or a medium of wide diffusion
Within my Knowledge it has never existed in this
city to any great extent. whatever may have
been their difference in theory, practitioners have 
concurred in the propriety of commencing the treatment
with an emetic, when called in the early or
forming stage. They were formerly prescribed under t
the impression that the contagious matter still remained
in the stomach and that ty evacuating it the further
progress of the disease was arrested. whether this be 
so or not there can be little doubt of the efficacy of 
the remedy. If they are beneficial as mere evacuants they 




68
are not less salutary in another way. The disease which 
we have described is to be considered as a chain, whose
first link is located in the Stomach. whence it is extended
to every other part of the system. By making a strong
impression on this organ we may interrupt the associated
morbid actions and thus assist very much in affecting 
a cure. For this purpose Emetics are the appropriate
remedies. But it is only in the forming stage that
they are at all admissible. Advanced at an advanced
period they highten the alarming symptoms and increase
the difficulty of cure. This effect is perhaps consequent
to the increased inflammation of the stomach.
The fever having fully formed itself we shall have
to resort to those means which diminish action and 
of these the first in importance is V.S. The quantity of 
blood to be drawn must depend upon circumstance
of the case it should generally be copious. The System
in some cases does not readily react after the influence
of the remote cause: we are of course not to bleed
until reaction is established by the warm bath, stimulating
frictions etc. The alimentary canal having
been evacuated, it was once the practice to treat the disease with 
antimonials medicines, so managed as to produce Nausea.
This was introduced by Cullen and followed by his numerous
disciples in every part of the world. It is now nearly 20 
years since the propriety of the practice was called in 
question and purging recommended in its stead. To Hamilton’s
work on purgatives, I refer you for illustrations of this latter
method of treating the disease. Not at all satisfied with the 




69
Antimonial Practice, after ample trials in the hospital of
Edinburg. he was induced to abandon it totally and to substitute
the purging plan. The result of his experience has been 
confirmed by the most respectable practitioners in every part
of the Country. He ascribes the efficacy of purgatives to their
acting throughout the whole extent of the alimentary canal, & 
to their carrying off the feculent matter which remains in large
quantities in the Bowels. To obtain their full effects he 
directs that they should be given every day and that the most
active as Calomel & Jalap seperate or combined should be
used. But whilst he is thus attached to copious purging 
he does not exclude other remedies. The advantages of his
plan have been well attested I can bear witness to its
efficacy. It is to be remembered that in 
cases of Typhus Fever, the bowels are always loaded and 
obstinately constipated. The patient has strong sensations of 
internal heat with gastric distress. These circumstances
seem to call for such evacuations and every practitioner knows
how much comfort and relief are afforded by them: No one
conversant with the operation of purges will fear their producing 
debility at this period. Nothing is now better established 
than the fact that when the alimentary canal is 
oppressed with accumulations of feculent matter, the evacuation 
of this matter relieves the irritation of the system and
invigorates its energies. That this is true has been too well
confirmed by the testimony of respectable practitioners to
admit of Cavil or Controversy. As one of the [sweating] 
remedies; much confidence has been reposed in the application 
of Cold to the surface. This is especially demanded by the 




70
burning heat of the skin, the quick active pulse; and by the general’
inquietude and restlessness of the patient. In this condition o f
the system it is well ascertained that cold applications constitute
the most effectual means of relaxing the vessels and producing
perspiration what ever may be the disease. The 
ancients were well acquainted with this fact. Celsus recommended
copious draughts of cold water in ardent Fever. Bu the
practice was rejected or lost sight of for many centuries. Nearly 
100 years ago it was revived; and so much [Me?on] had the [illegible]
of this change, for the remedy that he called it the “Febrissogum 
Magnum.” About 20 o4r 30 years ago it was employed by Dr –
of the Island of Jamaica. It did not however become general 
until the celebrated work of Currie made its appearance; since
which time it has received the sanction of distinguished practitioners,
in various parts of the globe. As yet it has not 
[been] generally adapted in the United States. Certainly not to 
the same extent as in G Britain and her colonial dependencies
in the East and West Indies. The practitioner of this
country are too much attached to the lancet, and other directly 
depleting remedies to make use of the Cold applications
By some of us, spunging the surface is employed to ally 
heat in the autumnal fevers; and we are also in the habit 
of employing ice in certain affections of the head but we 
carry the remedy to a very small extent comparatively 
In the European Hospitals, nothing is more common in 
the early stages of Typhus Fever, than to place the patient in a 
shower bath or to dash on him bucketsfull of Cold water
The effect most commonly is to induce perspiration and 
allay all existing symptoms. But a remedy which proves 




71
so active, should not be easily or indiscriminately employed
The circumstances demanding it, have been clearly indicated
by Currie. It is said by him, that cold applications should
be resorted to, when the heat of the body is steadily above
the natural point; when there is no sensation of Chilliness
and especially when there is not general or profuse perspiration.
Those cases should be excepted where there is 
any local congestion, especially from the lungs. The principle
on which Currie supposed the remedy to act, was merely 
by abstracting heat from the surface. But a different
view is presented by Dr Jackson, who though sometimes
lead away by enthusiasm, is Eminently distinguished by 
the force and originality of his mind. The cold applications
he supposed to operate by making a strong and general 
impression on the system, by which the existing morbid
actions are [all??ed] in a manner wholly independant 
of reduction of Temperature. It is all important in 
his opinion, to attend to the evidences to a susceptible
condition of the body which when wanting he endeavours
to restore by frictions and the warm bath. What
he means by a susceptible condition, is such a state 
that when cold is applied the system will react I 
have however been directed in the use of Cold applications,
by the precepts laid down by Currie. I have
not ventured to pursue a different course though I 
have never believed for a moment, that the remedy acts
merely by lessening the heat of the body. That it operates 





72
to a certain extent in this way cannot be denied; but it is 
infinitely more beneficial by the positive healthy action 
which it imparts to the system.
The disease not being arrested by the remedies already 
mentioned; it is proper next to resort to the means 
calculated to excite Diaphoresis. At one time it was 
the universal practice to manage the early stage of Fever
in this way. During the reign of the humoral pathology
a system of notions was entertained originating
in an eclipse of medical reason, and of which some
traces are perceptible at the present moment By 
these it was taught, that fever of this nature was 
excited and Kept up by particles of Contagion floating
in the circulation. Constructing their practice on the
Humoral hypothesis, they early resorted to sweating medicines,
and urged their use to great extent, with a view 
of Eliminating the offensive matter through the pores
of the skin. As medical science advanced
this doctrine was generally abandoned and is now recollected 
only, as one of the many examples afforded by our science,
of false theory being productive of mischievous
practice. In the present as well as most every case 
of disease, there is a point at which we may recur to 
Diaphoresis, beneficially. But there is nothing peculiar
in their operation, even admitting Contagion to exist
They act here on the same general principles, as in 
other [illegible]. when we administer them, due attention 
must be paid to the circumstances of the case, and the milder
or more stimulating should be resorted to, as they seem 






73
to be called for by the state of the system. The milder are
generally indicated. The Saline draught or Neutral mixture
is exceedingly applicable to the case. It is highly grateful 
to the Stomach, alleviates thirst, abates the heat and [relieves]
the Surface causing some degree of perspiration. Nearly 
the same effect is produced by the Spts Nitri Dulces, if
administered freely and at short intervals. The discredit 
into which this remedy has fallen is partly owing to the
small and inadequate doses in which it was generally 
prescribed. To obtain its salutary effects in the case
before us, we should give zi or more every hour or two
It has been administered in various states of combination
the best of which is made by the addition of Laudanum
if this be not prohibited by the symptoms of the case 
Even more effectual than the spts nitri, is the spts of
Mindereris. It is however less agreeable to the patient
and will sometimes be refused, when the former would 
be taken without hesitation. Either of these however 
aided by the vapour bath and warm beverages, are in 
most cases sufficient for the purpose. It would 
seem that the antimonials would be well suited
to this stage but so many Eminent writers condemn 
them that I feel sceptical on the subject. why 
they should not be so beneficial here as in other fevers 
it is impossible to say. But in the Practice of 
Physick we must be governed by the concurrent
testimony of Practitioners although we may not 




74
be able to understand the exact reason, why a remedy is 
not well suited to the case. Such are the principal
remedies with which we combat the 1st Stage of Typhus
fever. You will perceive that they are all of the 
evacuating Kind, or at all events that they are calculated
to reduce arterial action. Notwithstanding what
has been said to the contrary, it is demonstrated 
that this species of fever has in the commencement
more or less of the inflammatory diathesis. The heat on the 
surface, the hard, corded pulse, suffusion of countenance
and tendency to delirium, are all indications of this disposition.
Examined after death, the body shows many 
marks of Inflammation, and its usual effects especially 
on the Brain. Even blood drawn in the early stages of 
Typhus, is almost always sizy, and denotes a considerable
degree of Inflammation. But whatever may be the correctness 
of our pathological views, there can be no doubt
of the correctness of the practice.
My opportunities have enabled me to compare
this plan of treatment with that of stimulating from the 
commencement, and I am decidedly in favour of the 
former. Even in  Europe where prejudices in favour 
of the Stimulating plan were soi deeply rooted more enlightened 
views are now entertained. All their modern
authors recommend the evacuant plant; and as a part of 
it bloodletting to its fullest extent. among these I may 
mention Armstrong, Clutterbuck, Percival, [Robt] Jackson 




75
Welch etc. I have often employed the lancet and always with 
the most unequivocal advantage. It should be used with 
discrimination and is more applicable to Typhus occurring
in private practice, than to that which is met with in 
crowded Public Institutions. The treatment of this disease
has undergone an Essential alteration in a short
time: almost all of the late writers are in favour of 
VS. to a considerable extent. It was Sydenham perhaps
who first began the practice of bleeding in Typhus fever 
He was followed by Huxham, and other practitioners
of celebrity.
It is curious to trace the influence of Theory on the practice
of Physic. You all know the great change that was made in 
the practice of Sydenham. The Pathology of Typhus fever 
and the practice which flows from it, may be stated in 
a few words. Whatever may be the cause of the disease
the vital energies, are exceedingly crippled, and consequently 
all the functions of the body are imperfectly performed.
But this effect does not proceed from exhaustion 
In the early stages of all acute diseases attended by symptoms
of debility, there is oppression, and not exhaustion.
The energies of the system are to be relieved by evacuants.
In some cases however from the violence of the 
remote cause, the vital energy is so much crippled that 
the system cannot react in these cases VS. cannot be
borne. We must be governed by the symptoms. If there be
a feeble, tremulous pulse, cold damp skin, and low [illegible]
delirium, we must infer that the elasticity of the system is paralyzed




76
by the vehemence of the cause, and that it cannot react.
The stimulant and Cordial remedies are here to be used.
But if the pulse be hard and corded, with great heat, with 
great heat, a suffused countenance, strong pulsation of 
the Carotid and Temporal arteries, we must conclude that
there is an inflammatory diathesis, and that the case is to 
be treated by the directly depleting remedies. when these
symptoms occur, never fail to made use of the lancet 
and follow it up with evacuants.
The Treatment as I have delivered it to you, is what
I deliberately believe most applicable to the First stage 
of Typhus Fever. But if the disease be not arrested by these
remedies a great prostration will come on, when an
opposite practice will be required. Nothing is more difficult 
in the Practice of medicine, than to determine the 
precise point at which to recur to stimulants.
They are never to be used when there is much excitement
or topical congestion. They are to be prescribed with much
caution in the advanced stage of Congestion or Inflammatory
Typhus. If resorted to too early they occasion pain
in the head, delirious wanderings, parched tongue, hot
dry skin, and a quick hard and corded pulse. The best stimulant 
in Typhus fever is volatile alkali. It may be given
in various forms; but that which h as been employed
with the greatest success is the volatile Julep: made as
follows. Rx Carbon Ammonia zi, Gum arab zii Sacchar 
alb zi water vi. Dose a tablespoonful ever 2 or 3 hours 
or oftener. Strong wine whey should be prescribed at the 





77
same time. there seems to be a harmony between certain 
medicines, which should always be attended to; and in no case
is this more striking than between vol Alkali and wine
whey; To make the latter; take any quantity of milk, and 
add to it, whilst it is boiling ½, 1/3 or ¼ its quantity of Wine.
Then separate the curds, and sweeten the whey with Loaf Sugar
Camphor has gained a large share of confidence in this
disease. By many it is preferred to vol alkali. It is not 
my intention to institute a comparison between them 
my own conviction is that the alkali is decidedly the 
better: but in protracted cases it is better to use both.
After a few days the Carbon Ammoniae becomes disagreeable
to the patient or the susceptibility of the body to its 
action is diminished. The Camphor may then be used
with advantage, in the form of Julep or bolus but the
latter is apt to nauseate. The following is the preperation
which I use. Rx Camph zi Myrrh zfs Loaf sugar
zii water zvi. Camphor may be also given in milk
or seltzer water. Exactly at this juncture the [vesicatory]
applications are of the greatest utility. As in the
Inflammatory fever, the propriety of blistering in this
also has been denied. among those who are more 
opposed to them are Fordyce, Pringle etc. But on the 
other hand many others of no less respectability are in 
favour of their employment under such circumstances
They are recommended by Cullen and Lind whose experience
in Typhus was very great. If indeed there is 




78
any point in the Practice of Medicine so well settled as
not to admit of dispute. I think it is, that Blisters are
proper and advantageous, in the sinking states of all 
low diseases. They may be applied to the upper or lower
extremities, or to both if the symptoms be urgent.
It has been h eld by some authorities that as the object 
is merely to sustain the tone and excitement of the system
synapisms would answer better than blisters, because the
latter deplete: but the opinion is entitled to but little
attention. Blisters make a more permanent impression 
than Sinapisms and are therefore more efficacious
It is idle to suppose that they will occasion debility
by sheer depleting operation. In the low forms of disease
they most generally do not vesicate at all, but
merely act as rubefacients when they do vesicate the
effusion is very slight.
What shall I say of opium in Typhus Fever? No point 
of practice has bee mor controverted than this. Perhaps
it is well known to you all that Brown placed Opium at
the head of the class of Stimulants, and that he relied on 
it chiefly, in the treatment of Typhus Fever. But the
propriety of the practice has been questioned by many 
practitioners at the head of whom is the celebrated Fordyce
It is stated by him, that after a fair trial of the medicine, eh 
had no reason to believe that it exerted any salutary power
whatever, and that most generally he found it to aggravate
the symptoms it was intended to relieve. The [???ariety] of
opinion on this subject may be explained perhaps on the supposition,





79
that opium administered under different circumstances
and in different doses produces different effects. In large doses
it diminishes at once all the actions of the system, and 
operates as a direct sedative so far as diminishing the 
strength of the body and paralyzing or crippling its
energies can be called a sedative effect. But in small 
doses it proves stimulant and is calculate to Support
the actions of the system. In those countries where
the use of Ardent Spirits and wine is prohibited by religious
prejudices, opium is resorted to as a substitute.
The Turks employ it in abundance, either to exhilarate
their spirits, to dissipate their sorrows or to strengthen 
them and invigorate their fortitude and courage. In 
this respect it is similar to wine, and may be used 
as a remedy when that liquor is indicated. It follows 
from these views of the Properties and modus operandi
of opium, that it may be administered with 
advantage in this state of Typhus in small and repeated
doses: I gave 1 gr every 2 or 3 hrs in combination 
with Calomel. As a general rule, however I prefer
wine, It is more grateful to the patient, is always a 
stimulant, powerful and diffusible, and at the same
time, durable in its effects it also affords some 
nourishment. There is a choice in wines If it can
be procured Madeira should always be preferred. When 
this is not to be had Sherry or Lisbon should be substituted




80
Of late it has been fashionable to order Claret and the weak
French wines. There may be cases in which from Idiosyncrasy 
or other causes these may be preferable but as a 
general rule Madeira or Sherry is much better adapted
to the low forms of disease. It is constantly to be borne
in mind that Typhus Fever is characterized by an extreme
want of susceptibility to the actions of stimulant 
remedies, and that when we resort to wine, we should use 
it liberally usually one or two pints should be taken in 
24 hours. Cases sometimes occur in which the want 
of Susceptibility is so great, that even double or triple
this quantity is not too much. Even much larger 
does have sometimes been given: but they either expend
their excitability too rapidly or occasion an undue
degree of excitement although wine is generally superior
to opium, there is a certain condition which the 
latter is to be preferred. Delirium may arise from excitement
or debility of the vessels of the Brain; on the commencement
of Fever it generally depends on the first
of these causes: but in the latter stage it is always the 
consequence of [atony] or debility: It is to the latter case
that opium is suited. Connected with delirium the patient
is affected with a distressing degree of anxiety, restlessness,
and vigilance for the relief of which, opium 
is also well adapted. In this stage of Typhus there is frequent
Diarrheae; for this opium alone or in the form of [Cretaceous] 




81
Jalap is the chief remedy. To sustain the strength at the 
conjuncture, Peruvian bark has been freely employed. It 
seems however at present to have lost much of its former
reputation. The evidence on this point is very contradictory.
By some the remedy is highly extolled: though a 
large number are disposed to condemn its use altogether
in the Fever. May not the [contra?ety] of sentiment be
owing to the employment of the medicine under different
circumstances of the disease. It appears to be adapted, neither to the early or the advanced stage.
But the vigilant practitioner by carefully observing the
progress of Typhus Fever, will discover a constant tendency
to remit and intermit. This often occurs, no matter
what may have been the cause of the disease.
But when it arises from marsh effluvia, as it generally  
does in the United States, this tendency is uniformly observable.
It is exactly under such circumstances that 
the Bark is useful. The stomach is so irritable that
the medicine can rarely be administered in substance 
It must therefore be prepared as to enable the patient
to take it I have so recently given you the various
formula that is unnecessary to mention them again.
But in some instances such is the irritability of 
the Stomach, that Bark cannot be administered in
any form whatever. When this happens the best substitute




82
is the infusion of Serpentaria This is amongst
the most cordial of our Tonics, and particularly suited
to the Case before us. Of late Arsenic has been prescribed 
when there is a tendency to remit or intermit
As yet I have never employed it, believing that it ahs
no power to support the system, but that it operates
by producing debility. I have therefore always been apprehensive
of the consequences, when used in these cases,
To meet nearly the same indications and especially when
Nervous Tremors and subsultus Tendinum exist with 
low delirium, a [illegible] of medicines has been strongly 
recommended I mean the antispasmodics. The Chief of 
these are Musk, Castor and Asafoetida. The first
is principally confided in and most generally employed 
It may be administered in Bolus or Julep. The following
is the formula which I prefer. Rx Musk zii Loaf
Sugar zi Gum Arabic zii, water ziv or zv. The dose is
 a tablespoonful every hour or two according to the exigency
of the case. As respects the use of Castor, I have
but little to say. It never has been employed by me 
nor have I seen it used by other practitioners. But
Assafoetida, though inferior to Musk is an important
remedy in the disease. The mode of administering it
is in Pill, Tincture or Watery Solution. Of which the last
is the best. Rx Gum Asafoetida zii, Hot Water zvi which [illegible]




83
to be rubbed down. Dose a tablespoonful. As commonly 
stated by writers on Typhus Fever, the foetid articles
are possessed of some signal advantage. As might
be supposed in some cases, they seem to quiet nervous 
tremors, remove delirium, render respiration more
easy, and the patient altogether more comfortable. But
as a general rule, I am not sensible that they do 
more on these respects than opium, or are more
generally to be confided in. But if they are advantageous
in certain cases only, they ought not to be entirely
overlooked. Cases of the same disease are sometimes relieved
by one remedy when others fail. The symptoms in Typhus 
are occasionally relieved by Musk & Asafoetida, when opium
will not succeed. At one time no little importance was 
attached to Carbonic acid, in the form of yeast, in the latter
stages of Typhus Fever. To this practice, physicians were lead
by their notions of its power in preventing the tendency to 
putrefaction. But it has been ascertained that whatever 
may be the appearance of disease, putrefaction never takes 
place in the living body. The credit of determining this point
is due to our University. So far, indeed, is the old notion 
from being correct, that the Symptoms which were thought 
to prove the existence of this process are really indications of a 
contrary tendency. It has been remarked especially in 
the University of Edinburgh, that subjects brought into the 
dissecting rooms with vibices, petechiae, and [illegible] spots on the




84
surface, were less apt to run into putrefaction, than those whose
death had been occasioned by Inflammatory diseases. Nevertheless,
incorrect as is this Theory, the practice is decidedly useful
Carbonic Acis is one of the most cordial and agreeable stimulants 
more than many others, it relieves the stomach of nausea
and through the medium of that organ, imparts tone to 
the rest of the system. But it may be recommended in 
a more pleasant form than yeast. I would prescribe
it in seltzer water, the effervescing draught or malt
Liquors. Of the latter Porter is best and when perfectly 
ripe is one of our best tonics, in the Case of disease.
In some of the European hospitals Cider is preferred 
but though it may be more agreeable to the patient
it is much less Efficacious, Champagne combines all these
advantages, but it is of too high price for patients 
generally. If yeast should be administered you 
may give a teaspoonful every two or three hours.
With the same view of resisting putrefaction, the 
mineral acids have been employed. It is more
than half a Century since they were introduced in to 
practice in G Britain; but the credit of establishing
their utility, is due to Sir Wm Fordyce. He first employed
them in angina maligna, and was so 
well satisfied with them, that he extended their 
use to all the low stages of disease and especially 
Typhus Fever. His practice after evacuating the alimentary 





85
Canal, was to recur to the acids, and his reports respecting
them are altogether in their favour. To the attestations
of Fordyce, has been added a large body of evidence,
which might be cited. But on the continent
of Europe they are even more celebrated. During 
the late war in Germany, the Typhus fever prevaded 
to a great extent, in the military hospitals of that
Country. it was found that the disease was treated 
much more successfully by a physician named
Richt, than by any other Practitioner. So extraordinary
was his success that the King of Prussia gave 
him 50000 Crowns to discover his secret. It was found
that the acids were his remedies. Notwithstanding
the weight of testimony, I am not disposed to 
attach much weight to them. During my residence
in Europe I had ample opportunities of observation 
and though some refreshing and agreeable consequences 
resulted from their use, yet I never saw
an instance, in which they very sensibly benefited
the patient. Muriatic Acid is the one employed, & 
the dose is 10 or 15 drops given in an infusion of
Columba, or other bitter. Every 2 or 3 hrs. As might be expected
from the devotion of Practitioners to the employment
of Mercury in the febrile affections, this medicine has been 
used in the disease before us. I formerly mentioned that 




86
the Intestines became loaded with much offensive matter
in the Commencement of Typhus. This being removed by 
purging (and Calomel is generally used) the system [rises]
in activity. But in the advanced stages of the disease
Mercury is also used. At this time there are dark incrustations
on the Tongue, Gums, and fauces, and probably 
throughout the Alimentary Canal. Under such circumstances,
it has been strenuously advised to give
Mercury internally and to use it externally by [inunction]
The immediate advantage is the relief of the bowels from 
their dark encrustations. But this is not all. It is further
stated that the mercurial action is exchanged for 
the condition of the System previously existing. I have
no personal knowledge with regard to the remedy in 
this case: but it has always appeared to me to be hazardous
and not well adapted to the disease. If I were
ever to use it, it would be in the combination with
Cordial and Stimulant remedies. To withhold these and
trust to Mercury alone, would be to Knock away the props
of an Edifice, before the walls are complete. The treatment
of Typhus Fever by general or constitutional
remedies is such as I have stated.
There are certain local affections, which demand attention:
most of these have been considered when speaking
of opium, as Delirium etc. I then maintained that 
delirium may be very successfully managed by opium 




87
But the treatment of that determination to the head which 
frequently exists, is so important, as to require more precision.
All the phenomena of the disease, as well as 
the appearances of dissection, show that the Brain, if 
not the primary is at least the Chief seat of Typhus
Fever, or the part on which it spreads its force. In the
Commencement there is a suffused countenance and a 
violent pulsation of the Carotids & Temporal arteries.
In the advanced stage of the same thing is indicated by 
low delirium, and great prostration of Strength, Dissections
reveal to us all the marks of Inflammation and
its usual effects. The indication is exceedingly plain
it is to relieve the Brain by all the means which we
can command. Nothing is so successful as topical
depletion by means of leeching and Cupping. It is also 
useful to remove the Hair from the head buy this simple
expedient I have seen delirium entirely removed
When these remedies do not succeed, we must resort
to Cold applications and if these fail, apply a blister
extending over the whole scalp. I Know that objections
have been made to the vesicating applications, but 
they have no solid foundation: the propriety of the
practice is as firmly established, as not to admit
of dispute. As well might we deny, that mercury is
useful in syphilis, or Bark on Intermittent fever, as
to say that blistering is of no advantage in the low states 




88
of disease. These eccentricities of opinion, are common 
to the human mind, and we have no reason to hope
that our science will escape. I dwell more particularly 
on this subject, because I find that a modern author
much read by the students in this university, inculcates
a doctrine contrary to that which I have advised.
Taught by the influence which the spinal marrow diverts 
over the animal oeconomy, we should expect to derive
great advantage from blisters applied to the Spine and
especially the neck. By any interruption of the nervous
Influence from the spinal marrow, Respiration, Circulation,
and other functions are impaired or wholly destroyed.
There is in Typhus Fever much depravation of the 
functions of the Lungs, Heart, and Stomach. This arises
from an interruption of the nervous influence occasioned 
by the disease. By applying Blisters to the Spine much good
has been done. It has been proved lately in the West
Indies, that no treatment is so successful in cases of
Tetanus as blisters to the Spine. One writer remarks that
fever may be cured in this way. I have now detailed
what may be considered the medical treatment 
of Typhus. But this will avail but little unless the
management in other respects be properly regulated.
It is of the utmost importance to keep the apartment
well ventilated, so much is this the case, that when 




89
fresh air is admitted into the room, the disease almost always 
assumes a mitigated form. when the advantages of 
ventilation cannot be obtained, it will be proper to 
remove the patient to another room.  The motion occasioned
by the transference is not productive of any 
injury. We are informed by Dr Jackson, that the motion 
of a Carriage is one of the best remedies in Typhus.
It is necessary to pay particular attention to cleanliness
The bed line should be cleaned every day. All excrementatious
discharges should be speedily removed. The 
floor should be frequently sprinkled with vinegar and
ardent spirits. when the apartment is crowded fumigations 
should be employed. These are made by pouring
Sulphuric Acid on Common salt. Company should
be excluded. the presence of many persons in the room, not 
only vitiates the air, but it disturbs the mind of the patient
Notwithstanding the full discharge of our duty in these
respects, the disease will run on in some instances and 
develop a frightful train of symptoms. But we must
not abandon our patient: there is no disease in which 
recovery takes place, under such desperate circumstances
as in Typhus Fever. I have seen the patient get
well when there was not one favourable symptom
The doses of Medicine previously employed, are now to be 
augmented. The Vol Alkali should be administered in large 




90
doses and wine or ardent spirits freely drunk. It has
been fashionable of late to use Cayenne pepper liberally.
the dose is 8 or 10 grs repeated every 2 or 3 hrs it should be 
administered in pills. The spirits of Turpentine in doses
of a teaspoonful has been prescribed, with good effect.
Not much advantage is to be gained from Blisters at
this period. They rarely draw: and when they do Gangrene and 
mortification are the consequences. Much more may 
be derived from stimulating frictions. Of these the best
is Cayenne Pepper and brandy, in proportion of one
part of the former to 2 or 3 of the latter I have seen
it recommended to rub the patient with a solution of Phosphorus
in Olive Oil. Of the latter I know nothing but of the former
I have great confidence. You may also use a 
Tinct of Cantharides and Turpentine or what is preferred 
by some, a decoction of [flies] on the spts Turpentine
To prepare the latter, boil zi Cantharidis, in Spts Terebinth
zv. This is a powerful and efficacious remedy. It often
happens in the last stage of Typhus fever, that the 
patient becomes so low as to be unable to swallow:
but even here we should not despair. Most of the 
remedies already enumerated will act by the Rectum.
This is said to be the ultimum moriens however this may 
be, it is certain that medicines will act on the part 
when the stomach has become unsusceptible to their 





91
impression. By injecting opium, Musk, wine & vol alkali,
we may obtain their full effects. But they should be
used in three times the quantity, which is taken by the mouth
you should neglect no means of substituting a healthy 
for a diseased action, in order to preserve the life of the 
patient committed to your care. This is a high and solemn
duty. Never let the alarming symptoms drive you 
to despair. By perseverance you will sometimes find
yourself rewarded when you least expected it. Go 
on and call to your [illegible] assistance, which 
can be derived from the animal, vegetable and mineral
Kingdoms; and when these fail, as has been said,
with a holy Kind of enthusiasm, invoke the Kingdom
of Heaven itself, without whose aid, all our endeavours 
will be feeble, important and unavailing. “Love’s Labor
lost”
Causes of Epidemics.
Instead of going on with the other forms of Fever, we will 
now make some enquiries concerning the causes of Epidemics.
Desolate as our country has been and may again be by Epidemics,
there can be no subject more important than this.
All however, of which my time will admit must be a mere
Synopsis. By an epidemic is meant a disease of wide extent
and general prevalence. The ravages of these diseases have
excited much attention to their causes the ancients regarded 




92
them as the consequence of the displeasure, of some of their
deities. Many epidemics depend upon the [???ble] 
qualities of the air this was the opinion of Hippocrates
he believed, however that there was sometimes a mystical
influence exerted which he called [illegible]. They are
sometimes quite independant however of heat or Cold, moisture
or dryness; density or Rarity. The destroying angel moves
on with frightful regularity, without our being able to arrest
his progress, or divine the nature of the causes with 
which he operates. There seems to be no doubt but what 
some of the most deadly scourges, which have ever visited the
world were occasioned by, or in some way connected with the 
appearance of Comets, or other great and portentous natural
Phenomena as earthquakes, volcanic eruptions etc.
these, however can only be regarded as the first link 
in the chain of causation. The sensible qualities
of the atmosphere, which operate on causes of Epidemics,
are Heat and Cold. dryness and moisture, and Density 
and Rarity. Heat according to the Poets, who are among the
most accurate observers of nature, is a most powerful 
cause of disease. the morbific influence of a hot
atmosphere is well known it directly stimulates the system 
but its first effects are followed by relaxation and exhaustion
which render the system vulnerable to the causes of disease
Cold when succeeding heat produces a large proportion of our diseases.
Exposed for some time to a low temperature, the system 




93
becomes depressed, in which case it undoubtedly acts as a [illegible]
but when it is suddenly impressed by a cold bath, its actions
are invigorated. when the body is under the influence of the
causes of Pestilential diseases a change from hot to cold
induces the disease. Intense and protracted cold, produces
Winter Epidemics. Heat and Cold are relative terms: the
effect of either is proportionate to the degree of the other
which may have preceded it. Humidity of the atmosphere
operates as a cause of disease, only by the change of it induces, 
or the transition of dryness to moisture. Permanent
humidity is not unhealthy. In some Countries enveloped
in perpetual clouds (as Holland or Ireland) the people are
healthy and Robust. Moisture is genial to the oeconomy 
of plants, and probably to that of animals. Aridity of the
atmosphere, is more properly considered as a cause of 
disease. The atmosphere of Arabia in consequence of its
extreme dryness absorbs the moisture of the surface of 
Lungs, Fauces, producing symptoms of suffocation.
In temperate climates, dry weather is salutary on account
of the absence of Miasmata, to which humidity with
heat gives rest. Rarity of the atmosphere, occasions great
difficulty of breathing, and prostration of the strength. In 
ascending high mountains hemorrhage from the Nose
Eyes & Ears is said to have taken place.
Having completed our account of the sensible qualities
of the air, in the production of disease; we must now enter 




94
on the consideration of the morbid influence of a vitiated
atmosphere. The air which we breathe is impregnated with 
various foreign matter, for which it serves as a vehicle.
Miasmata are for the most part the product of vegetable
putrefaction, and require for their elaboration, the cooperation
of heat and moisture. Although marshes afford the
most common origin of miasmata, they are not their
only source. It has been recently discovered that they 
are readily generated in a clayey soil covered with Trees
It has been contended by Ferguson, with great strength 
of argument, that miasmata or malaria are not the product 
of vegetable putrefaction. He believes they are
emitted by a muddy soil when drying. Hence the ill effects 
of the overflowing of the mill, after the water has drained 
off hence, also the emission of noxious exhalation
from the margins of water courses after they have fallen
very low. He thinks that the exhalations thence
arising, are more injurious, as the muddy soil approaches
nearer to dryness. We find that the diseases arising 
from these exhalations, become more and more violent [until]
the Earth is quite dry, or again Covered with water. A rainy 
season if not too warm, I healthy; the falling rain 
precipitates the pestilential miasmata, which may have
borne on the atmosphere; washes away offensive substances
calculated to emit the causes of the disease: and 
by overflowing low grounds, prevents the action of the Sun 




95
by which miasmata are raised. A degree of heat equal to 
80 [degrees] Fahrenheit is necessary for their generation. Miasmata
act at a considerable distance Sometimes as far as 8 or 10 miles
when wafted by the winds. The Eastern shore of our water 
courses are most unhealthy, during the autumnal months
because the wind blows chiefly from the SW. Whatever
will arrest the course of these winds; will arrest the progress
of miasmata as Trees etc. The time, which elapses 
between the first impression of the vis moccas and the accession 
of the disease is various It generally appears from 9 to 15 
days after exposure. It is the opinion of the venerable
Jackson, that the disease observed a Supremacy period
rarely occurring before the 7th and frequently on the 14th day
Moisture promotes their operation. They also act more 
powerfully at night. The miasmata previously elevated into
the higher regions of the air are entangled and precipitated
by the dew. It is considered dangerous to be exposed to the 
exhalations of the Pontine Marshes near Rome after night 
and in this City we consider it more dangerous to visit 
the infected districts, when Yellow Fever prevails, at night, than 
at any other time. A predisposition to disease is endured
by the operation of the remote cause, which remains until and 
exciting cause occurs to produce the disease.
Endemical diseases generated by local causes, are more apt
to attack strangers, than persons who have always lived in 
the district, in which they originate. Indeed persons living 




96
under the influence of those Effluvia, to which the peculiar situation
may give rise, become so far familiarized to their influence
that diseases is not readily produced by them.
To old persons who have long lived in those districts, the
miasmata become one of the stimuli which support life;
and on moving to more healthy Districts they frequently 
become diseases. If a person who from long residence has
been familiarized to the action of these miasmata, leave the 
place of his nativity for a few years, his susceptibility 
to their operation is again awakened; and on his return
he is liable to be attacked by the Endemic. This has been 
proved by the Cases of students from the Carolina’s and
Georgia, who after spending 2 years in Philadelphia, are 
attacked on their return, with disease. In the process of 
putrefaction, malaria of different grades of malignity
are elaborated at different periods, which consequently 
produce different effects. Effluvia from animal matter
putrefying may disturb the system temporar4ily, producing
nausea, vomiting and even asphyxia but they never
become the main or perhaps even the accessory cause of
disease. This so directly opposed to common opinion 
that we will examine into the evidence in support of
the position. The corruption of human bodies particularly 
was supposed to give rise to disease by Bacon. Disease
if we may trust the accounts of the ancients has followed
Sanguinary battles, and by them was attributed to the putrefaction
of the bodies of the slain. But in modern warfare we have no 




97
instance of disease from the cause. The most extensive exhumation
have by order of Government taken place in two of the
Cities of France. In Paris at the burying place des [Janacens], are 
immense [illegible] of putrid matter in different stages of decomposition
was removed and those engaged in the work were not
affected by Fever. they were however in some cases affected
with asphyxia, from the non respirable gases, emitted by the
putrefying masses. In the worst period of the French revolution 
the Tombs of St Dennis, the repositories of Royalty, were broken
open, that the bones of the Ancient Sovereigns might be insulted; and
although some of those engaged in the outrage paid dearly for it,
there was no fever produced. The above observations hold true 
with regard to the putrefaction of other animals. Equally incapable
of producing disease does human excrement appear. When 
in a moist condition, I think it probable, that vegetable and 
mineral matter give off effluvia of a mild character.
The word Contagion and Infection, have frequently been confounded
the former, in its original signification, was only 
intended to include those affectations which are communicative 
by contact, as Itch, Syphilis, Variola, Vaccina etc. Infection
signifies those effluvia, which act through the medium of 
the atmosphere, as in Typhus, Measles etc. According to these
definitions Small Pox is infectious & Contagious. Among the 
Ancients there were few diseases of a Contagious nature they 
had no Small Pox. Measles, or Syphilis. The Contagion producing
them, originated perhaps, from crowding people together, or from some other 
cause, by which their elements were brought into contact. It is always
a very interesting inquiry, whether these diseases, thus originating have been 
propagated since, exclusively by Contagion, or whether they may be generated de [illegible]
under certain circumstances. 





98
Hectic Fever
As we have already observed Fevers, have been divided into
Idiopathic and Symptomatic. Of all the distinctions introduced
by nosologists, this is perhaps the most absurd and unprofitable
Every fever, whatever may be its nature, is necessarily secondary 
and sympathetic. To establish this point we need only [return]
to the origin of the different febrile affections. The position is admitted
without controversy, as it regards fevers arising from 
wounds and other injuries. nor is it less obviously true, concerning
those which are caused by inoculation, and the introduction o f
virus into the System. On the same footing, must be placed the 
similar affections produced by the action of poisons. the position
then is thus far indisputable. By tracing the Phenomena 
which present themselves, we shall find that it is no less
true, when applied to what is called Idiopathic fever. These
are caused by marsh miasmata or effluvia; or contagion. It 
is now a point sufficiently ascertained, that morbid matter 
can enter the system in no other way, than being tangled in 
the saliva and thus swallowed. Hence it follows that its primary 
operation is first on the stomach, and that the blood
vessels are affected, by means of Sympathetic connection, between’
that organ and the rest of the system. It must be 
confessed that there are some who believe the Lungs are the [illegible]
by which these effluvia pass into the system, or the parts on which 
they operate. But the latter opinion is disproved by the insensibility 
of those organs to impressions made upon them. Admitting
however that the Lungs were the parts operated on the validity of 




99
my Hypothesis would remain the same; As the lungs instead instead
of the stomach, would be the point of Commencement. My theory
of Fever is simply this. I suppose the disease originates in 
local irritation, which spreads itself more or less according to 
circumstances. Starting from a central point, it is extended
by means of sympathy. If the irritation be considerable, it diffuses
itself continually forming new centres of irritation until 
the whole oeconomy is in a greater or less degree involved. These are
remarks which I thought proper to make before entering on the 
consideration of Hectic Fever.
This disease is most commonly Connected with Pulmonary Consumption,
although other causes sometimes produces it. Whatever 
greatly irritates the system may produce it. It was formerly believed
and even is at present maintained by some, that the fever is occasioned
by the absorption of pus. But Mr [illegible] has proved that this cannot 
be the case, because it often happens when there is no abscess, and 
again the largest collections of Pus do not excite it. Besides 
Pulmonary Consumption. Hectic fever companies other diseases.
It is to be met with in what are called white swellings of the joints 
and also in Gout and Rheumatism. It attends Scirrhus & Scrofulous
affections, as well as Congestion and obstruction of the viscera 
without abscess. It is to be met with from the irritation of stone
in the bladder, and sometimes from Pregnancy from the irritation 
occasioned by gravid uterus.
This disease assumes the type and partakes of the general
nature of Intermittent fever. The two cases have indeed so many 
points of similarity that they may sometimes be confounded. But 
there are certain circumstances by which they may be distinguished
and it is of practical importance those should be recollected. 1st The 
Paroxysm of Hectic fever is rarely regular for any number of days in 
succession but after a short time comes on without any established 




100
order, at almost every hour of the day and night. 2nd The paroxysm
of Hectic is often not preceded by a chill, and frequently some
rigors are experienced without any hot stage. 3rd The Paroxysm
of Hectic is not always relieved by Perspiration, Chills and flushes,
continuing although the discharge by the Skin may be copious.
4th The Paroxysm of Hectic in the hot stage is attended with a circumscribed
redness of the cheek. 5h The tongue in Hectic is clean
florid, and sometimes preternaturally polished; but in Intermittents
it is uniformly furred & of a white or bilious hue 6. The appetite and
powers of digestion continue for the most part uninterrupted in 
Hectic; and the bowels are in their natural condition; but in Intermittents,
there is generally gastric uneasiness loss of appetite, and
constipation of bowels. 7. The urine is turbid during the paroxysm
and pellucid in the interval of Hectic whereas directly the revers
happen in Intermittent. 8. The mind is proverbially cheerful in 
Hectic, whilst in Intermittent it is anxious and distressed. It would
be easy to point out the circumstances in which the two diseases 
differ, but those which I have mentioned are the most prominent
and sufficient to form an accurate diagnosis.
As regards the management, Hectic Fever does not less
resemble Intermittent, both in general principles, and in particular
remedies. The treatment divides itself into 2 parts: that
which is necessary to prevent the Paroxysm, and that which is suited
to the intermission or Apyrexia. Of the means of prevention,
opium is confessedly the most efficacious. we do not however
follow it up with warm beverages, and other means of producing
perspiration on account of the great debility in Hectic. On the
same account we should withold those means in the subsequent
part of the paroxysm and should permit the hot and sweating
stages to pass off with little active treatment. But in the absence
of the Paroxysm we pursue a different course.




101
we here employ all those remedies which are recurred to in Intermittents
But among these there is a choice and I shall detail such only as
have strong claims to our attention. Hectic Fever is rather inflammattory
or otherwise when there is too much excitement, as is apt to be 
the case in the early stage the system should always be reduced
before Tonics are administered. most frequently VS is indicated, and 
the blood when drawn under such circumstances, always present
the appearance of inflammation. Nor will a single bleeding
answer: on the Contrary in most instances the operation should be 
most frequently repeated, though moderate quantities of blood 
should be drawn at a time. The Alimentary Canal not being oppressed
with accumulations of bile, nor in any respect implicated
in Hectic fever, evacuations from it are not particularly 
demanded. But I cannot help believing, from my own observations
that emetics may in some cases be given with advantage. They 
do not operate as evacuants, but on a principle which has already 
been explained. It may be advanced as a rule, to which 
there is probably not a solitary exception, that all diseases of a periodical
nature, or which observe the paroxysmal type are essentially 
benefitted by this class of Medicines; or in other words by repeated
and active vomiting. The System of the Patient being reduced by 
antiphlogistic measures, we may safely resort to Tonics. Of
these not the least celebrated is the Peruvian bark. It was the favourite
remedy of Cullen, who spoke of its efficacy without reservation
But though supported by his authority, and many other respectable
practitioners, I confess my confidence in it is not very 
high. Generally in my hands, it has proved offensive to the 
stomach; often ran off by the bowels, and scarcely ever suspended
the paroxysm. But I may have failed from the circumstances
of which I was not aware, and on my report alone; I do not  





102
wish that the remedy should fall into discredit entirely. Some
have found it beneficial to combine Bark with Myrrh. But my 
own experience teaches me that Myrrh will answer better,
when exhibited alone or differently combined. A celebrated prescription, 
employed much in Hectic fever, and Especially when it accompanies
Pulmonary Consumption, is the following. Rx Myrrh 
zii Sulph Ferri [?i] Carbonate Potash zi, Sugar zi, water zvi. Dose
a Tablespoonful every 2, 3, or 4 hrs. Many of the vegetable bitter, as
Camomile, Quassia Gentian, Columbo are better suited to the 
diseases; than the Peruvian Bark. Serpentaria and wild 
Cherry Tree Bark, do more good than any others of this class.
The latter possessing both Tonic and Narcotic properties, is peculiarly 
calculated to support the strength and colon irritation 
in Hectic. The urs ursi has been much used. It may be supposed
that arsenic, which is so valuable a remedy in Intermittents
has not been neglected in this disease, which now occupies our
attention. It has been freely prescribed and according to the 
attestations of practitioners with considerable advantage. My 
own experience does not enable one to speak in very high terms
of it. It has not been much employed by me, but in the few 
trials which I have made with it I have been disappointed.
Of late the Saccharum Saturni has been recommended. it is spoken
of in the highest terms by Dr Irvine of Charleston. Encouraged by 
my respect for his opinion, I have recently used it in several
cases of Hectic, but have not derived any advantage from it.
During my residence in Europe, the mineral acids were much 
employed. Of their ability there can be no doubt. The nitric is 
incontestably the most efficacious. It has been frequently used
by me & with good effect. Combined with the liberal use of opium 
it is certainly the most efficacious remedy, which can be administered
in Hectic Fever. my mode is to give as much nitric acid 





103
as can be conveniently taken during the day; and every night at
bedtime, to prescribe a dose of opium and another [anterior] to the paroxysm.
As Hectic Fever is purely a disease of irritation
it might be conjectured, that opium would serviceable and practice
fully confirms the Supposition.
There is another remedy of too much importance
to be overlooked. I formerly mentioned the powers of sulphur
over all diseases, of the Paroxysmal Type. It is the opinion more
particularly of Dr Physick, that it is perhaps our best remedy
in this disease. What I have seen does not allow me to go quite
so far, but I am prepared to pronounce favourably of it. It 
must be used so as not to induce purging. The last remedy 
which I shall mention is charcoal. Induced by the great efficacy
of this article on Intermittents fever, I have lately tried it
in a case of Hectic and was pleased with the result. Little
however will all these medicines accomplish, until the patient
is placed in a large and well ventilated apartment. Free ventilation
is a matter of much grater consequence than is generally 
supposed Exercise is very important, and riding on 
horse back should be preferred.
Such is the treatment of Hectic fever excited
by Causes which the surgeon cannot remove. But when the
source of irritation may be removed by an operation it 
should be resorted to. Such cases however come under the 
promise of surgery & to the professor of that branch, I 
resign [illegible] management of them.
Yellow Fever
It is not my intention to occupy your time with a very minute
history of this disease. To the writings of the late Dr Rush, I must
refer you, as well as to those of Drs [Hosack], Miller, Parscalis, Warren,
& Jackson, for details on this subject.





104
As perhaps you all know the Yellow Fever is an endemic of Tropical
Climates. To the West Indies however it seems particularly to belong.
It appears to have occurred occasionally in the United States, from 
the earliest period of their settlement; but it was not until the
year ’93, on account of the Extent of its ravages, and the panic tenor
which it unanimously created, that it came to attract the attention 
and medical Curiosity. Notwithstanding the number of writers on 
the subject, and the ardent and continued enquiries, which have been 
made, hardly one solitary point connected with it, is better understood,
or less a matter of dispute, than when the controversy commenced
Its origin, Nature, and treatment are still points concerning which 
“pendiale lite” The altercations which took place on subjects have
been entombed with those by whom they were conducted, and it
is very far from my design to [illegible] those disputes, which were
characterized little of that complacency, which should distinguish
discussions. Still however it is my duty, to afford information 
on this subject though I trust that in doing so, I shall be able
to temper my own admissions, by the respectful attachment, which 
I feel towards all the parties involved in the Controversy.
As it regards the mode of production, the dispute has been 
chiefly about the meaning of words. The disease has always originated
on the wharves, or about the shipping. Filth alone is not the cause
for we see that the disease never occurs in the vicinity of those
immense accumulations, from the streets, which are thrown out 
in heaps at the upper end of the City. I do not believe that the
disease was ever imported in a palpable or well formed Condition
My impression is that ships coming from Tropical climates, in 
a filthy state bring with them the materials, out of which they form
of pestilence is produced. Long ago it was suspected that the 
disease whether imported or generated in our own Country, could 
not take place, except under a high temperature, But it has
now been proved that unless the mean temperature of the summer 




105
months, is as high as 79 [degrees] Fahrenheit, the yellow fever cannot prevail in our
climate. In addition to filth and a warm summer, contiguity to the 
water, a confined ill ventilated situation, appears necessary to the
production of this diseases. The disease always commences on the Wharves
and runs up into the City. In 1820, it did not get higher up 
than 4th street. The miasms were carried by the winds in different
directions: this could be traced with great exactness in 1820.
From what has been said, it appears that filth, contiguity to 
the water, a temperature above 79 [degrees], and a Confined ill ventilated
situation (perhaps also some occult agency in the Constitution of
the Air) are necessary to the generation of the Cause of this pestilence
Thus it is frequently produced in the hole of a vessel, in which 
the cargo is sealed up; without affecting any of the crew during the
passage: but when the Cargo is taken out, the morbific miasmata
are let loose, and the disease produced.
Much controversy has existed as to the contagious nature of Yellow
Fever: but it is now well established, that this is not the common 
Character of the disease. The opinion of physicians to this [parport]
are as 500 to 20 of the opposite. It has been contended it
is not contagious. 1st Because it is of the nature of an Epidemic,
and therefore depends on a more general cause. It has 
been alledged, that the disorders preceding yellow Fever from 
one end of the union to the other, assume more or less of the
type of that disease. 2nd Because it never spreads beyond
the City infected by it. In support of this point irresistible 
evidence has been adduced. It appears that during the prevalence
of Yellow fever in the City: that although hundreds of people 
were received into the hospital, used for this purpose, and
were crowded together in small and comparatively illventilated
apartments, yet not one instance of the extension of the [disease]




106
occurred. The Physicians and Nurses, who were constantly among
the Sick, dying, and the dead; escaped without one solitary exception,
although dissection were carried to an almost unparalleled extent.
3rd It is uniformly suppressed by Cold weather: In which respect
it resembles the miasmatic fevers, but differs essentially from
contagion diseases all of which prevail, most extensively in Cold
weather & it is a disease of warm weather: Whilst Typhus fever and other contagious diseases prevail
most in Cold weather, which dissipates the contagious matter,
and allows a freer ventilation. It has been much 
questioned, whether Yellow Fever, attacks the same person
more than once. By the late Dr Rush, and many of the Physicians
of this City; it is believed it does. My opinion is, that 
it does not: and that one attack protects the system is completely 
against any future one, as Small Pox or Measles. To 
this point we have the testimony of many European & West 
India authors.
Yellow Fever is sometimes ushered in by the
Common signs of Pyrexia: Often the first manifestations of an
attack, is the appearance of incipient drunkenness or a vacant
idiotic Expression. There is sometimes, preternatural serenity,
at others great distress or remarkable malignity of Expression,
with a polished face of a leaden or bronze Colour. If pressed on
at this time, the Epigastrum is tender, with much burning
of the pit of the Stomach. The bowels at the commencement
are generally costive, with considerable torpor. After the
expiration of 12 hrs we have a more active pulse, a hot and dry
skin instead of the Cold and Clammy one; with accumulations of
blood in the Brain, or viscera of the Thorax and abdomen.
It is at this period, that the stomach gives away and we have
nausea and vomiting, of mucous mixed with [drinks] which the patient




107
may have taken, but never with bile. The manner in which 
the stomach evacuates itself is very peculiar: it is by a Kind of 
[Singultus], resembling the vomiting of a drunken man. To these
symptoms, are added much inquietude and restlessness. Not being
arrested the disease grows worse. The eyes become of a dirty 
yellowed hue, the Carotids pulsate strongly, and the condition
of the skin is oedomatous. Often some soreness of the throat
with a partial paralysis of the Extremities occur.
Towards the 3rd day, we have a apparent amendment
of the symptoms; but this is delusive. We soon have an in creased
thirst, which nothing can satisfy followed by the Blk
vomit. we have now a reduction of temperature, and of 
vascular action, but not always of muscular power, Next
an involuntary diarrhoea, Cold sweats, Hemorrhages of blk blood
from the eyes, ears, and ends of the fingers; low [delirium], with 
coma, laborious respiration, Sengultus and death.
This disease is very various in force persons sometimes fall
dead, as if by a blow. There have been cases, in which persons
have gone on; transacting their ordinary affairs these are called
walking cases. The only Complaint in some cases, was
of pain or [illegible] in the genitals of both sexes. In making
its attack, the disease always selects the weakest and most 
predisposed part. The Exciting Causes of Yellow fever, and 
sudden vicissitudes of the weather, exposure to Cold by thin
cloathing, excess in eating or drinking, inordinate exercise
copious Evacuations, grief or [illegible], watching and sleep.
The interval between the time of Exposure and attack is very 
various Sometimes a day on other occasions 2 weeks: the 




108
average is 3 days. The appearances on dissection develop
different stages of inflammation of the stomach.
The Black vomit is a vitiated secretion from the stomach
and not bile: it has been pressed out of the vessels, after
death. The marks of inflammation of the stomach were
never seen after the appearance of black vomit. The 
animalcula seen in the black vomit, have induced some
to recall the idea of the animalcular origin of disease. I am 
disposed to think however, that the same cause which 
occasions the fever, gives rise to the animalculae.
As relates to the nature and treatment of yellow Fever, much
diversity of opinion has existed. By one set of practitioners 
it was strenuously to be a fever of very feeble action, and
hence was [denomberated] Typhus Icterodis: whilst others of 
no less respectability entertained a directly opposite opinion 
with respect to its nature and treatment. What is the case
with the disease as it occurs in the West Indies I am not 
prepared to say: but as it appears in this City, and generally 
throughout the [illegible], it was a fever of a Typhoid or Congestive
Character. It is utterly impossible for me to give an attempt of al the 
forms, which it assumes at different times. In no two Seasons,
did it appear with the same symptoms, or demand a 
precisely similar mode of cure. Perhaps it is known to you 
all, that the late Professor Rush, throughout his whole life,
zealously and industriously maintained that yellow fever
is nothing more than an aggravated form of bilious Fever 
That this is not true was easily shown by the dissimilarity 
between the symptoms of the 2 Cases. The Hepatic system to 




109
use his own emphatic language is the seat and throne of all autumnal
diseases and these are truly bilious affections. As this
is universally admitted, I shall not occupy your time by addressing
facts, or forming a chain of reasoning to demonstrate it.
But as it regards the Epidemic now under consideration,
directly the reverse is true. There is not one symptom of 
Bilious accumulation, or derangement of the Hepatic System,
incident to Yellow Fever. ON the contrary all the indications
of this disease point directly to the Stomach, as primarily 
and mainly affected. What was at first only suspected, came 
afterwards to be demonstrated by Digestions carried to great
extent showed it beyond the possibility of doubt. These were
conducted principally by Dr Physick who was at that time
Physician to the Yellow Fever hospital, and from his reports
it appears that the morbid appearances were confined to 
the Stomach. Here Inflammation was detected in all its
various stages from the simple effusion, or blush, to 
[spacelus[ and absolute mortification. In some cases this
appearance was extensive: in others slight, consisting only 
of a few lines of inflammation, about the Pylorus. He also
showed that the Blk vomit was a vitiated secretion of the 
stomach. Of the method of cure on e consisted 
in the employment of the directly depleting remedies,
carried to a great extent, whilst a second, which 
was pursued chiefly by the French practitioners from the 
West Indies consisted in the use of remedies directed to the 
stomach, with the view of quieting it. Their object was first
to check the vomiting, and then to wash out the offending cause
To meet the former indication they resorted to the ordinary 





110
means, especially fomentations to the distorted viscus, and the warm
bath: having allayed the stomach, they deluge the Bowels with 
their [olisans] and diluent beverages. What was the comparative
success of the 2 methods, it is not easy to determine. The
latter has always been most popular here; but both were 
very inefficient, as may be learned from the prodigious mortality
which at that time prevailed. In the year 1798, 18000 persons 
remained in the City. Of this number it is computed that
6000 died of the fever. It is presumed that not more than
half of those exposed to the cause, became affected, and hence
upwards of a moiety of the sick must have persisted.
Encouraged by the Success of Mercury in the West Indies
the Physician of this City early imitated and fully tried the 
practice. The fevers of tropical Climates are undoubtedly 
managed in the way with more advantage, than by any 
other plan of Treatment. The fact is established by the concurrent
testimony of a large majority of the West India Practitioners.
Many of them and especially Chisholm trusted 
entirely to salivation. They exhibited Calomel in the largest
possible quantities, and applied the ointment externally 
by friction. The amount employed in some cases is almost 
incredible. Chisholm informs us, that he used 4 or 500 grs 
of Calomel in the course of 2 or 3 days; and a corresponding
quantity of ointment was rubbed in. The object was to induce 
salivation, and to allow that end, mercury was poured
into the system by every possible avenue. As described by the
writers of the West Indies, the disease was bilious, the Liver being 
the chief seat. On this account it is that mercury was 
successful. When the plan was first adopted in this City, it
was thought by many practitioners to be very successful: 





111
So much so that in the enthusiasm of the moment, they operated
that when Mercury could be made to act, a cure would
be certainly effected. On Cooler reflection however, they came
to distrust the remedy. It cannot be denied that salivation
is often successful. Two actions, so contrary cannot well
co -exist: but it is extremely difficult, to salivate a patient
in some Cases of this disease. The violent cases are too 
rapid in their progress, for so slow a remedy, and the moderate
get well without it. Again, many have died after 
a salivation has been induced. By dissection as I mentioned
before, the seat of the disease is chiefly revealed.
As might be expected Gastric distress is one of the most
prominent symptoms. An ordinary case of Yellow Fever
very much resembles the disease produced by Poisons. The
similarity indeed is so close, that one is often adduced as an 
illustration of the other. As soon as the pathology of Yellow
Fever came to e fully understood, the practice was considerably 
altered; and I believe become more successful. It was our 
object to subdue and Inflammation of the stomach, of a peculiarly 
malignant, Erysipelatous Character. The more
common course was to commence with the moderate use of 
the lancet, Cup to the epigastrium and Purging with Calomel.
The Stomach was composed with small doses of Spt Terebinth
whilst there was much heat on the surface, cold applications
were used; These were followed by mild diaphoretics In the
sinking state, we gave hot Toddy, vol alkali etc. In New
York, the French practice conjoined with the liberal use of diaphoretics,
was introduced by Dr Hosack. it failed in my hands.
After the success of our own, or any other practice in the disease,
we cannot so act. The mortality in every season has 




112
amounted to about one half of the sick. This could not be owing
to want of attention, for it was nearly as great in the hospital
as elsewhere. It appears that the proportion of deaths has been
equally as great in other places. In Gibralter in 1804 4/5th died;
In Cadiz 70 to 100; In New York more than half died. In 
1822 there were 411 cases & 240 died. In Baltimore nearly all 
died. The same indomitable character was displayed by 
the disease in New Orleans, Natches, & Charleston.
Convinced of the entire insufficiency of all former modes
of treating this disease, Dr Hewson and myself, who had charge
of the Yellow Fever hospital here in 1820, determined to 
try a new practice. Dissection has downs that the disease 
consisted in a peculiar inflammation of the mucous coat of 
the Stomach. We commenced with a mild emetic, which in 
this, as well as all other cases of Malignant Fever, is only proper
in the forming stage. This was followed by Magnesia, Super 
Tartrate Potassii, or Epsom salts: After this we gave Spts 
Turpentine in doses of zi every 2 or 3 hours. If further evacuation 
be required, we gave zi Castor Oil, with zi spts Turpentine
Under this treatment 12 out of 16 recovered. The state of the 
system is to be attended to, and such other remedies prescribed
as may be indicated. The vitality of the stomach is destroyed
in 10 or 12 hrs and with it that of the skin. I have poured
boiling spts Turpentine, on the skin without exciting pain. We
have also seen our remedies in the stomach, on examination 
perfectly unchanged. After a short time, you might as well
give medicine to a corpse, as to a patient in yellow fever.
Nearly about the same time, that the foregoing practice
was introduced here, the Spts Turpentine, was prescribed by Dr Faulkner 





113
in the Plague of Malta Orfilla recommended it in inflammation 
of the Stomach from poisoning. To which as I have before mentioned
Yellow Fevers bears a very strong resemblance.
The Saccharum Saturni has been introduced by Dr Irving of
Charleston, when tried here, it was found to possess power in 
contracting irritability of the stomach
According to the observation of Dr Physick, Yellow Fever may 
be divided into 3 grades, 1st the mild cases, which are relieved by 
the process of nature alone; 2nd The moderate which may be
cured by the timely use of proper remedies; and 3rd The violent
which are generally incurable.
The disease is one of great mortality, and rarely yields
to the powers of medicine. Let us not however on this account 
consider that our glorious art is disparaged. A mariner
amidst the rude bursting of a storm at sea, finds all his
efforts futile and unavailing, but if his ship be shattered 
on a rock, cast into Quick sands, or hurled to the 
bottom of the briny deep, one should not reproach his 
art. Thus it is with the Physician, when a tempest
howling Epidemic, lowers around him. The God of
Heaven has in each case, for the wisest purposes
determined that we shall not be able to afford relief.
The means of preventing Yellow Fever are to observe
proper cautions, with regard to the admission
of foul vessels into our ports, and attend carefully 
to the police of our cities. Quarantine regulation 
shd apply to vessels only, and by no means to individuals
as there is no sort of danger from contagions; 2nd
The Cargoes of foul ships, should be taken out at a 
distance from the Ciuty, and the vessel kept off for a 




114
sufficient time; 3rd I would advise that stone be used 
in the construction of wharves, instead of the filth of [cities]
and that the streets on the watery margin of cities shd
widened and opened; so as to admit of freer ventilation
4th when the disease breaks out in a city, the infected
spot shd be immediately evacuated; 5th As soon as the
existence of Fever is ascertained, let that part of the
Town be fenced off. Never visit an infected district
early in the morning or after nigh. Take food into 
the stomach, before exposure to the infection, and 
pay attention to diet and cloathing. 6th whether any 
advantage is derived from fumigation  with chlorine
or sprinkling with lime, is yet undetermined.
Pestis or Plague
As having in may respects a close analogy to Yellow
Fever, I now proceed to give some account of Pestis or Plague.
As I have never seen a case of the disease, all that can be
expected from me, will be to give a short digest of the most
prominent circumstances, connected with the subject.
By Cullen, it is placed among the exanthamata, and defined 
to be a Typhus Fever, highly contabious, and attended with 
extreme debility. Whatever may be the correctness of this
deffinition, the disease is certainly located very improperly 
It is undoubtedly a disease of febrile affection, and therefore
in every nosological arrangement, should be associated
with the Class of fevers. It is only a very few
years, since we have possessed any accurate information 
relative to Plague. The universal terror, which it excited very 
much retarded investigation concerning its nature.





115
During the invasion of Egypt, by the French, the medical men 
attended both armies, availing themselves of the amply opportunities
offered them, have much improved our intelligence
concerning it. Contrary to all preceding writers they have 
shown, that if at all Contagious, it is not so in a high
degree. A casual intercourse with the sick, did not produce
it. Neither the medical attendants nor nurses were often affected with 
the disease. Dissections were freely conducted, and with perfect
impunity. It would seem from the reports alluded to that it
never proved contagious, except in crowded or ill ventilated apartments;
and even under such circumstances, not more so than 
our ordinary autumnal fevers. Nor was it contagious, except in 
the height of the fever, or when the body was covered with Perspiration.
Discarding then the idea of the Contagious nature of Pestilence
the writers to whom I refer consider it to be depended on the ordinary
causes. As it respects the Plague of Egypt, it undoubtedly 
results from Exhalation, from the Nile. To establish the point
they bring conclusive and satisfactory evidence. It is always found
to follow the accession of that river, which as you all know 
periodically overflows its bank. The filthy surface, thus exposed,
after a while becomes dry, by the intense heat of the climate.
As soon as this is completely effected the Plague uniformly 
ceases. Like all fevers produced by miasmata, the disease
assumes different types. Sometimes it is Intermittent or Remittent,
but more frequently continued and of Typhus or inflammatory 
character. These varieties appear to depend much on 
local circumstances. By one of the latest English writers on the
subject (Dr McGregor surgeon in chief of the Army) it is stated that
among the troops, differently situated, the disease was considerably 
diversified. Among those who were confined to the Hospitals, it 
occurred with low Typhus Symptoms, while those in the camp near 
marshy places, were attacked with the fever in a Remittent or Intermittent 





116
form; and in high or more healthy situations, the disease appeared 
of a highly inflammatory nature. Admitting all of this to be true,
still it is not easy to refuse our Consent to the proposition that the 
Plague is on other occasions, highly contagious; I shall not here
repeat the stories, about its Contagious nature; which are found
dispersed through medical accords. Most of these are probably 
exagerated and deserve but little confidence. It is not right however
to overlook those facts which come to us well authenticated.
I shall say nothing of the accounts of the old writers, or of the more
recent accounts given by such persons, as have not had opportunities
of person observation. Nor shall I dwell on the introduction
of the Plague into Europe by [fo?icles]. But I must
say that although the Plague may be endemic in Egypt, and produced
like other diseases of that Kind, yet elsewhere, and at other times
it has proved contagious. More than one in European Countries
when the Plague has prevailed, persons have entirely escaped
by avoiding all sources of Contagion; Then it is stated on indisputable
authority, that during the ravages of the disease at Rome
all persons secluded in the monasteries remained healthy.
As yet it has not been accurately ascertained, at what time
after exposure to the cause of the Plague, the disease makes its
appearance. Probably this is not essentially different from that
which is observed by the febrile affections. In some instances
Nausea, Head ach, and Languor are felt for several days
previous to the attack. More commonly, however the disease
makes its appearance, without any well marked premonitory 
signs. As in other fevers the patient is seized with rigors,
succeeded by external heat, depression of spirits, prostration of [illegible]
[illegible] of the limb, anxiety, palpitation, Syncope, stupor, giddiness & 
delirium. The pulse, which is at first active and corded, soon become 
exceedingly weak and tremulous. These symptoms are in a short 
time followed by  foetor of the breath, vomiting of a dark matter 




117
resembling the black vomit of Yellow Fever, and in the more advanced
stage by Costiveness, Buboes, petechiae, Hemorrhages of dissolved
blood, Diarrhea, Cold sweats etc. The duration of the disease is
exceedingly various. Sometimes it extinguishes life in a few 
hours, and in other cases runs into the 10th, 15th, 20th or even to 25th
day. Dissections have shown pretty much the same
appearances, as presented in Yellow Fever. The stomach was
more or less inflamed, and in some instances where the fever
was protracted the Chylopoetic viscera were in a decreased
state. The liver very commonly manifested marks of diseased
action; differing, altogether in this respect from 
what happens in Yellow Fever. By comparing the history 
of the two, we shall be persuaded of their great resemblance
and perhaps of their ideality. They arise from the same
cause, and occur in the same season; They attack strangers
in preference to natives; Both are contagious under certain
circumstances, and tend to destroy the susceptibility of the 
system to a second attack; Both are arrested by Cold 
weather. Yet there are some wide differences, arising
it is probably from the difference of climate, customs,
mode of living, religion, and a variety of other circumstances.
It would appear that the Plague, among the natives
of Egypt, and other oriental countries, assumes the form o f
a highly malignant Typhus fever. this is what we should 
anticipate, from their poverty, filth, and squalid wretchedness
as well as from the small, ill ventilated, dirty habitations, in 
the ill fated section of the world. But when the disease attacks
the European troops, who were better fed, better clothed, and 
better lodged, it put on an inflammatory character. Carbuncles
buboes, etc. were formerly considered aa pathognomonic signs 





118
of the Plague, or circumstances which distinguished the disease
from every other. But they are not peculiar to the Plague.
I have seen Carbuncles and Petechia often occurring in Yellow
Fever, and they are not rare appearances in Typhus Gravior
especially when the case is long and protracted.
Treatment Determining from what has been said by the best
authority, it would appear that there was no material difference
in the treatment of Plague and Yellow Fever. The treatment of 
Plague is uniformly commenced with an Emetic, and thus differs
from Yellow Fever. It was resorted to in plague, under 
a supposition, that the cause of the disease was still resident
in the stomach, and by vomiting might be eliminated from 
the system, and the further progress of the disease thus arrested.
Whether the supposition was true or not, Emetics were found
very efficacious in the first stage. It is positively stated by 
the writers who were in the armies in Egypt, that in this
way, they very generally put an end to the complaint. In 
many cases of Pestilence, the stomach is greatly disordered 
buy bilious accumulations; when these are Known to exist
emetics are altogether proper.
The alimentary canal, being evacuated, one remedy was so 
much confide in as Vs. This was an ancient practice. It was 
resorted to, so long as the time of Botellers, who flourished two centuries
from the Present period, and its efficacy was finally [???nesed] 
by Sydenham. This remedy was also used by Russell
who had the most ample opportunities of seeing the disease
and determining the best mode of managing it. But he
confined the remedy within narrow limits, resorting to it only 
when there were evident signs of an inflammatory character,
and when local congestions and determinations existed. As it
regards VS, the Physicians both of English and French armies differ
in opinion. Some used it to great extent, whilst other rejected it at [illegible.




119
On examining the evidence for and against the remedy, I am disposed
to conclude that many cases may be successfully managed
by profused bleeding; others require only the moderate employment
of the remedy, and others again, do not at all admit of it.
To heat the Plague by sweating has long been an established practice.
it would seem to be indeed indicated by nature, as there is almost 
always a greater or less tendency to [diapho???] in the disease. But by 
the ancient practitioners, it was urged , perhaps to so great an extent 
from the peculiar notion, which they entertained, of the nature
of fever. They conceived that the disease originated from poisonous
matter floating in the system, and that it could be 
cured, only by the elimination of the offending matter, through
some one of the natural emenctories. Diaphoresis was therefore
effected by strong and heating remedies, and was urged to a very 
great extent; the consequence of which was such a slab of prostration,
and extreme debility, that most generally the cases proved
fatal and the remedies thus came into disrepute. But [illegible]
into sound discretion, it was generally found by the Physicians
of the French and English Armies, to be exceedingly successful.
It was the custom among the Europeans, especially among the English 
to employ for the purpose, the celebrated James Powder. Any of 
the antimonial preperations would probably have been quite as 
efficacious. But Diaphoresis was found to be more effectually 
promoted by external means, (especially the vapour bath) than by 
any other mode. Conformably to the fashionable practice
of the day, some practitioners much preferred cold applications
to Diaphoretics. These may be employed in different ways.
Water cooled down to the lowest degree, was sometimes dashed
by tubsfulls on the patient, but more generally it was applied
by sponges. Falconer, Buchan & others declare that no remedy from
which so great advantage was derived, had practiced by them.
By some physicians frictions to the surface with Ice was recommended,
when the surface was very hot. This was particularly the 




120
practice of a Russian, who was in Egypt during the prevalence of Plague.
Much relief was undoubtedly afforded, by these means. In confirmation
of the mode alluded to, many facts might be adduced.
It is stated by one writer, that it was by no means a rare occurrence
for patients while delirious to escape from the Hospital and leap into
the Nile; whenever they done this the symptoms were immediately 
relieved, and a cure often took place. Such instances were recorded
before the invasion of Egypt. One in particular was related by [illegible]
where the sick many, in the same vessel with himself, jumped over 
board and was cured. It was also stated that on an urgent occasion
Bounaparte compelled his troops to march, though a great
number of them were affected with fever. During the march
a heavy shower of rain occurred and continued for several hrs.
All the soldiers were wetted as if by the shower bath, and 
many were thereby relieved, while the whole were essentially 
benefited. There is an external application of an 
other sort, which has also been highly recommended in the treatment 
of the plague. It is now half a century since the most
extravagant accounts were given of friction with olive oil.
It was originally introduced by Mr Balwin, English consul in 
Egypt, who stated that by this means we could guard the body 
against contagion, or when the disease existed, affect a cure.
The account of Baldwin was confirmed by Dr Jackson his successor.
To the same point we have the attestations of medical men.
Very recently however it has been affirmed by travellers, who 
were a long time resident in that Country, that the account is
not entitled to the slightest confidence. They observe that Mr
Baldwin was a very benevolent man, and that the Turks, in 
order to obtain oil from him, invented the story of its efficacy
in the Plague, and thus were liberally supplied whenever they 
called on him. This does appear to be the foundation of the
report. Nevertheless it is not altogether improbable, that from the
Known efficacy of such frictions, in calming irritation and subduing
febrile excitement, the oil might have produced some good effect




121
in the management of the pestilence. In the advanced stage of the
disease not a little utility was experienced from the [vesicating] application
in no cases did they prove so advantageous, as in those in which some
local affection existed, especially of the head and stomach. At this 
Conjuncture, the vol alkali, Camphor & Opium were employed with 
advantage. But in the early stage of the pestilence, it was the common 
opinion of the best practitioners, that the [Brumonian] System [illegible]
to any extent, was always manifestly injurious, and often fatal in its
consequences.
[Taking] a supposed analogy between the Yellow Fever and 
the Plague, those Physicians of the British forces, who had previously been 
in the West Indies, and had witnessed the effects of mercury in that
climate, employed also in the latter disease. But they found that
from the rapidity of its progress, the disorder generally terminated
before a salivation could be induced. The same objection applies
to the use of Mercury in the Plague, which I have before stated to 
apply to Yellow Fever.
It appears from the statements of writers that the Plague is neither
a more violent, nor more fatal disease than the Yellow Fever.
By Comparing the bills of mortality, we shall find, that the number
of death is nearly equal in both Cases .It is stated by M.
Desginottes, who accompanied the army as physician general,
that about 1/3rd of those, who were attacked, perished. Nearly the
same degree of mortality was experienced in the Yellow Fever.
It is perhaps Known to most of you, that Dr Valli a
philosopher, famous for his investigations into the nature of
electricity and galvanism, lately visited this City. Before coming
here, he had been at Aleppo, and other places, where the 
Plague is apt to prevail in its greatest violence, for the purpose 
of ascertaining certain points relative to this fever. As communicated
by Dr Wistar, the result of his observations, and the Dr did 
me the favour to write down his remarks.
“The Plague is contagious, and persons who have had 




122
it once, rarely if ever have it a second time. Infection can be communicated
by rubbing the matter of a pestilential sore on the skin.
If pestilential and variolus matter mixed together, be rubbed on ‘
the skin of a person who has not been affected either with the 
Plague or Small Pox, a mild plague would be produced, which
would secure the patient from a future attack of either disease.
If the person had previously had small Pox, the disease thus
excited would not be mild. If pestilential matter mixed with 
Olive Oil be rubbed on the skin, a mild form of Plague is 
produced, which shields the body from future attacks. These 
results were obtained from upwards of 300 Experiments.”
As far as I know Dr Valli is entitled to full credit
His reputation as a philosopher is well known. Having 
satisfied himself relative to the Plague he came to this City
for the purpose of investigating the nature of Yellow
Fever. Not finding it here, he embarked for Savannah,
where he fell a victim to the disease, whilst enquiring into
its nature.
The Late Winter Epidemic
To Conclude the History of Epidemics, it remains to call your
attention to a disease,  allied to that Class, and Known by the
name of Pneumonia Typhoidis, or the winter epidemic.
In tracing the History of this diseases, we find
that so early as the year 1806, the attention of several practitioners, 
resident in New Hampshire, was arrested by some sporadic
cases of a fever, exceedingly malignant in its Character.
After lingering for a shirt time in that portion of this
country, it gradually diffused itself over New England and subsequently 
entered New York, and the Canadian provinces.
Pausing here, it after a while resumed its journey, and in a 
direct course passed through this state to Ohio and Kentucky.




123
About 5 or 6 yrs since, it prevailed in the N Western parts of Virginia
and finally extended itself over all the southern Portion of the US.
It first appeard in Philadelphia in 1813. Of its approach we
were not warned by any of those premonitory symptoms, which 
are commonly the precursors of pestilence. Nothing remarkable
was observed in the appearance of the weather or in the 
nature of the exciting diseases. It is true that on the shores
opposite of this City, at Campden, and in some parts of the
circumjacent Country, we heard for several preceding weeks
of the ravages committed, by an unknown pestilential fever.
Nevertheless we remained in perfect health, without any indications
of the dark cloud, which was preparing to burst
upon us. The Season being far advanced it did not continue
long among us: and however frightful in many particular 
cases, the aggregate of mortality was not considerable
On its return, during the succeeding winter, it assumed a 
more [illegible] form, and the victims of its ravages were 
infinitely more numerous. It is not to be expected that 
in the narrow limits to which I am restricted, I should descent
into minute details, so as to exhibit a complete view of an 
epidemic, which was modified by all those Causes, which 
influence other diseases. My intention on the Contrary, is to 
confine myself to the result of my own observation and 
reflections on the disease as it occurred in my practice & 
to what may be collected from the communications I have
received from practitioners in various parts of the Union,
on whose veracity I can implicitly rely.
All accounts agree in representing the disease as a
perfect Proteus, appearing in every variety of form and requiring 
not little diversity of treatment. But whatever form it assumes 




124
It was always accompanied with great and in some instances
sudden and unprecedented prostration of strength. It frequently 
commenced with extreme debility attended with alternate
chills and flushes of heat. The skin at first hot & 
cold in rapid succession, soon became dry and pale or of a 
mottled appearance. The face was sometimes livid, at other
times of a bronze hue. The [al?] of the nose were contracted
the forehead smooth and polished. the Eyes wild and glassy,
and the Physiognomy of the patient, altogether expressive of 
an extreme degree of anxiety and distress. The pulse which 
was at first slow, and apparently depressed, in a few hours
became quick, feeble and tremulous, like the vibrations of
a small chord, and ultimately sunk so low as not to be
perceptible. Now and then there was some affection of the 
head from the commencement, and frequent wandering of the
mind, which ran in wild delirium, and terminated in Stupor
or Lethargy. Occasionally the attack was much more sudden
and violent than described above. It is stated by the Massachusetts
Medical Society, that workmen at their labour were seized & 
[clo??n] down, as by a stroke of lightning. when the attack 
was slighter, it was attended by excessive pain in the joints,
and sometimes in the side, stomach, back, neck, head and breast 
and these were so acute, as to be compared to the sting of a 
bee or wasp; or the pounding of a hammer on the part.
These pains shifting from one part to another, were at last 
generally fixed in the head; they often proved the cause of 
various disorders of vision; as dimness of sight or total
blindness, and sometimes of Delirium, Coma or Paralysis.
But such cases were observed to be of rare occurrence. Most
commonly the pain, shifting from place to place for an hour or 





125
two fastened on the head. Even in the incipient stage extreme
languor of body comes on, in which the mind participated.
A dry skin feeble pulse, harsh tongue, and many other
symptoms, soon made their appearance. If the disease was 
not checked, all these increased with its advancement. To 
the pain in the head, other affections were superadded, as 
vertigo, throbbing of the temples, a painful stricture across
the forehead and eyes. Sometimes a morbid vigilance, wh:
nothing could subdue, at others a Somonolency so 
profound as to approach Apoplexy. Delirium was
experience, in all its various stages from mere incoherence
of ideas, to the most violent rhapsody. 
If the patient remained sensible he was harrassed by 
the fear of death: he would sigh continually, whilst his
imagination conjured up and presented before him the
most hideous group of phantoms and hallucinations.
It would be difficult to conceive a situation, in wh: 
the patient would be more restless, agitated and distressed,
or one more calculated to excite our sympathy and exertions
in behalf of the sufferer. On other occasions there was 
no local determination whatever. The Common Complaint
of the patient was listlessness and anxiety about the precordia,
with tension across the forehead. The pulse was 
feeble, irregular, and quick, amounting frequently to 140 
or 150 Strokes in a minute.
The disease was sometimes ushered in with the 
Symptoms of Pneumonic Congestion and inflammation 
These cases commenced with chill and fever, pain in the 
side and chest, and as might be expected, panting, difficult 






126
and laborious respiration. An uncommon determination to the 
lungs existed, and was indicated by the Excessive Cough
and bloody Expectoration; by the laborious breathing; by 
the flushed and tumid Countenance, and by the red, suffused,
and wandering Eye, which were found to be uniformly
connected with this form of Fever.
In very many of these Cases especially as it prevailed
in the southern states, and among the members of the Medical
Class, who came from that part of the country, there
was always some Gastric distress, and occasionally 
violent vomitings of Bilious matter. The pulse as far as
I have observed was in these instances, full and strong,
though soft, readily compressed and possessed none of 
that tension, which indicates active inflammation.
In every leading feature, the disease, as it thus appeared
resembled the ordinary Bilious Pleurisy of our Country; & 
if a practitioner unacquainted with its nature were 
called in, he would decide on treating it as an inflammatory
affection. But this state of things was not of
long continuance. In a day or two, and often in a few hours
all appearances of Inflammatory action were removed, & 
the Typhus Condition was distinctly marked & fully established. 
The muscular power which was not a little reduced
from the first, no rapidly decreased. All the previous
symptoms, were aggravated, and the mind of the patient before
distracted, now sunk into a heavy and stertorous slumber.
Most generally if the Tongue or Fauces were inspected, they were
found covered with encrustations of a dark, brown Colour, 
hard and dry to the touch; to these symptoms were added Cold
Extremities, haggard look, damp livid skin, sometimes specked 




127
with Petichiae or marked with vibices, hence arose the name of
Spotted Fever, which was commonly applied to the disease in some
parts of the Country.  These examples however, were comparatively
rare, not occurring in more than one Case out of a 
hundred. I have occasionally met with few Cases, where the 
throat was apparently the chief seat of the attack. These
however were seldom seen by me, although they constituted
the most common form of the disease to the South.
Nearly all of the cases, which I met with, on a visit to 
Virginia, were of this sort. There was nothing peculiar
in the mode of attack. The disease came on Exactly like
a common cold, with considerable debility. The Throat
was at first slightly affected, and the alarming symptoms
soon came on. At a moment not anticipated the patient
was attacked, by a total failure of strength, and by a difficult
and impeded respiration. The disease differed from 
all other anginose affections. No Enlargement of the Tonsils
was observable, but the lining membrane of the Fauces
was swoln and of a Mahogany Colour, not florid as in 
active inflammation. It is my Conviction, that this was 
the most malignant form, of the Epidemic. It seemed 
more rapid in its progress, and was attended by circumstances
not to be explained. What, Gent is this Extraordinary 
disease? To such a question, it is by no means easy to 
convey to you a satisfactory answer. That it is not 
fever (according to the definition of nosologists) in all 
cases at least, is manifest. The shape which it sometimes
assumes, is entirely destitute of any feature of the Febrile 
affections. It has been known to occur, without any preceding 




128
chill: without any augmentation of heat; without any acceleration’
of pulse, and [??fine] without any apparent functional 
derangement. Such cases were, however by no means
common. Dissections generally showed, that inflammation 
had existed in the lining membranes of the Cavities of the body
but of a weak erysipelatous character. The inflamed surfaces
appeared livid & partially [??did], as in the incipient
stages of Gangrene. In the brain Thorax & Abdomen there 
appeared almost invariably, extravasations of dark, thin 
[g??mous] blood, Exudations of an imperfect lymph, and 
effusions of a serous fluid.
Taking into view all the phenomena of the disease concerning
which we are treating, as well as the External symptoms,
as the appearance displayed on dissection, we
have no hesitation, in considering it, as a variety of
Typhus Action, differing however from all the species
of that order, which have been described. Nevertheless it
does appear that cases of a disease not wholly different 
have been noticed. By the early English authors; amongst
whom are Sydenham & Huxham, the history of disease is given
closely allied to our Winter Epidemics. But th eparallel is
certainly not compleat; though perhaps as much so as
between different cases of any disease occurring in different 
Climates, and among different people. That form 
in which the Pulmonary organs were concerned, was more
accurately described by Sauvages, and denominated by him
Pneumonia Typhoidi. Nor was it wholly unknown until 
of late, in our own Country. By Dr Bard of New York, a 
malignant Pleurisy, which took place on Long Island in 1749 is
described, and we are not without instances of the same disease





129
in other sections of the union.
The late doctrine of Congestion, or as the French 
term it, Engorgement, enable us to explain in a most satisfactory
manner, many of the Causes of Malignant Fever.
The Congestive differs from the Inflammatory condition, in 
this among other circumstances, that the veins are chiefly 
concerned in the former. there is always a great loss of balance
in the circulation. In a state of heavy congestion
the vessels feel as if they were distended with air, rather
than blood. When the arteries are affected we have the 
common symptoms of Inflammation, with acute pain
In inflammation the blood is sizy: In congestion dark & 
[guimous]. In Inflammation, we find on dissection, distention
of the Capillary vessels, Constituting the blush of 
Inflammation: In Congested Conditions, the large veins
are found distended, whilst the small ones are empty.
In all debilitated states, the tendency to congestion, is 
proportionate to the loss of vital energy. It is an [influ???]
derived from the Brain & nerves, which impels the moving
powers of the System: and any Cause, which in any way
prevents the distribution of this influence, diminishes the 
power of the heart and arteries. This may be occasioned by 
the remote cause of disease, by Concussion of the Brain to 
which the former is nearly allied, or by tying up the nerves
supplying those parts. Hence it follows, that we are to regard
Congestion, as the effect of some antecedent Cause
of this description.
Of the causes of the Epidemic little has been ascertained
In common with other diseases of this Class its origin is
involved in doubt and obscurity. As yet we know only, that it 




130
occurs in Cold weather, and is dissipated by the warmth of the Spring.
Hence it seems to be connected with a low temperature. This
opinion is supported by the fact that a fever may closely allied
to it, may be produced by an exposure to Cold. It is not
uncommon to find among the Paupers of the Alms House of this
City patients, who have been admitted in a state of torpor,
brought on in this way. From the Extreme Lethargy of the
senses, which prevails in the cases alluded to, it is difficult
to excite the body by any description of remedies.
But when reaction does take place a weak low fever is
the consequence; which resembles very much, some forms of
our winter Epidemic. Like that it is accompanied by low
delirium, with a small pulse, glassy Eyes, dilated or contracted
pupils and the same lank, haggard and distressing expression 
of Countenance.
On the other hand Cold alone cannot be the cause of
the Epidemic, because it does not invariably produce it,
and because the disease sometimes occurs during mild weather. 
In this dilemma, we are compelled to resort to the gratuitous
Supposition of a vitiated condition of the atmosphere.
That the disease is not propagated by contagion
is a general law, appears to be proved by the universality
of its prevalence, and by its obeying the general laws of 
Epidemics. This is manifested by its compelling all other
diseases to acknowledge its supremacy and to put on its
[livery.]. During the prevalence of the winter Epidemics in this 
City and other places, every variety of morbid affection,
whatever may have been its primordial nature received a 
complexional hue from its predominant influence and 
required the same sort of treatment. The lancet and other depleting
remedies were generally abandoned, and the stimulant 




131
and Cordial remedies resorted to, in all diseases. The approach of 
the Epidemic, wrought a complete revolution in the Practice
of Physic, throughout the United States, from which Physicians
have scarcely yet recovered. Even the ordinary cases of Winter diseases
are approached with the lancet by physicians, with 
much circumspection. Some cases have occurred in which there
was reason to suspect congestion as the origin of the disease but
there were very few. Bo some medical men, one doubt is entertained
on the subject. By those who support the hypothesis of
contagion, a fact is introduced, concerning the troops, which 
during the late war were stationed on the Canadian frontier.
It is stated that the militia more particularly in returning from 
the Camp, might be traced through their whole route by the
spreading of the disease. But it highly probable that the 
disease, thus disseminated, was not the Epidemic, but the
Typhus or Camp Fever, which is sometimes very contagious
As it regards the Exciting Causes of the disease, under consideration, 
there can be no doubt. They are the same as in 
all other Epidemics, and Consist of those causes, which 
diminish strength, as low living, fatigue, watching, anxiety
of the mind and whatever has any tendency to 
produce derangement in the functions of the body.
Treatment: Two modes of treatment have been proposed
and adopted by different practitioners. By one set it is maintained,
that the best methods of cure, is to commence immediately 
with the use of the direct stimulants, as Wind, Cordials 
and the vol Alkali: while by the other set, the sweating
plan is decidedly preferred. My opportunities of Comparing
these plans have been ample, and I have no doubt of the superiority
of the latter. The minds of the Physicians of this City are pretty 




132
well made up on the Subject, and all acknowledge the superior
success of the Diaphoretic plan early employed. Of the best
means of exciting Diaphoresis, you have already been informed.
I shall now therefore only remark, that in my practice,
nothing has answered so well as the Dover’s powder
given every 1, 2, or 3 hrs combined with wine whey, made so as
to be stimulating: and with hot fomentations applied to the
lower Extremities, Trunk & arm Pits. When sweating was early 
induced and continued steadily for 24 hrs, a recovery was almost
certain. I have found boiled Ears of Corn, placed in the beds
to succeed very well, in bringing on a sudorific effect.
As the disease advances and the depression increases, we are to 
employ that class of remedies which are called cordials or
Stimulants. The vol alkali, as was said of a hero of antiquity
is here ‘Ipse Agmen” I had almost said the unicum Remedium.
Not less than 5 or even 10 grs should in some cases be 
administered every half hour. As cooperating with this 
medicine hot Brandy or Madeira wine should be employed.
But if notwithstanding these powerful measures, sinking
of the pulse, and other indications of Extreme debility
occur, we should resort to the External use of a decoction of 
Cantharides, in Spts Turpentine, and to frictions with Cayenne
Pepper &Brandy so as to produce vesications.
The practice thus detailed is adapted to the more simple forms 
of the disease. In those instances in which there are local 
determinations, as in Bilious Pneumonia etc. the Anginosa Cases,
it is universally admitted that some differences of treatment are
required. Emetics under such Circumstances, are eminently beneficial.
The principle on which they act, is as well to evacuate 
the stomach of its contents, as to make a salutary impression 
on the system generally through the medium of that organ. 




133
To be serviceable, they require in some cases to be repeated several 
times, and the most active, as Tart Emetic should be preferred.
Whilst I was in Alexandria, during the prevalence of this fever
I proposed the use of James’s powder, which was afterwards 
generally adopted. It acts firstly as an Emetic, and then produces 
a Diaphoretic effect. when much bile exists, in 
Alimentary Canal, the Emetics should be followed up by the
Mercurial preperations. After the End for which these remedies
were administered, has been gained; and the disease
has been brought to a crisis, by the stimulating diaphoretics
and other means; if the local congestions & determinations
continue, Blisters are appropriate remedies.
They are especially indicated in the Pneumonic & anginose
affections and in delirium. In the first case apply them
completely over the chest, in the second around the neck:
and when the patient is delirious, extend them over the whole 
head. As relates to the use of the lancet much controversy 
has existed. Determining from my own Experience; what
I believe is the same with the same of a majority of our
practitioners; I should say that VS is never admissible. In the
commencement of the Pneumonic Cases, it would seem to be 
called for by the pulse, by the heat of the surface, by congestion 
of the Lungs, with acute pain in the chest, and by the
sizy appearance of the blood. Notwithstanding all these symptoms,
I have never in any one case seen VS employed,
without producing dangerous and commonally fatal symptoms.
The blood was hardly drawn before the pulse sunk & 
so great a palpitation occurred, that the patient often died.
I have been informed however by letters, from respectable 




134
practitioners, in different parts of the United States, that they 
had used blood letting and found it the only successful mode
of treatment
Concerning the use of the lancet and other remedies
in congestive conditions, much difficulty has existed.
Stimulation or depletion singly, are in many Cases, alike
contraindicated. The indications are to diminish the excessive
weight to be moved and to increase the moving power. In many 
of these cases, large proportion of the blood is congested in 
the large viscera, and who the circulatory mass of a quantity
equal to that locked up, in these deep seated organs. In 
these cases we have a small & weak pulse and the superficial
veins are empty. By suddenly abstracting blood, we diminish
only the circulating mass, without influencing the Engagement
in the viscera, and thus produces an alarming prostration,
if not a final cessation of the movements of vitality.
We should resort to the warm bath, use friction to the surface,
give stimulating cathartics and draw blood cautiously
from a small orifice if the pulse rise under it, we permit
the blood to flow, and repeat the operation afterwards as the
symptoms developed may require. If on the contrary the
pulse sink, we must bind up the arm, and endeavour to bring
about a reaction. In deep Congestion it would be unsafe to 
stimulate without using some evacuants the Congestion wd
be more firmly compacted by the impetus given to the blood.
Distinct in almost every particular relative to it, the
ordinary Prognosis cannot be applied to the disease of which 
we are treating. The patient is sometimes suddenly carried
off, though he had before displayed every symptom of [illegible]
convalescence. The pulse often totally fails us as a guide.




135
nevertheless there are some symptoms of great danger; among
which the least equivocal are such as may be deduced by an 
experienced practitioner, from a consideration of the countenance & 
habitudes of the patient. When the Case is dangerous, the countenance 
is marked by a peculiar expression of wretchedness; or is exceedingly 
placed with an absence of all Kind of intelligence, resembling
very much the Expression of Idiocy. There is also a smooth and
polished surface particularly of the forehead, which assumes a 
complexion like bronze These are fatal symptoms.
Such is a brief account of a disease which originated 16 or 18 
years ago in the Eastern section of the union; and has since travelled
over a greater portion of our Country, covering the spirits
of the people with appalment, and spreading Everywhere in its
progress terror and desolation. Nevertheless it is not necessarily 
fatal. By pursuing the practice which I have detailed, it
became quite manageable. Compared with the Yellow Fever it
is a mild disease. But to attain success in the treatment 
of it we must steadily and perseveringly use the appropriate 
remedies. Death in almost every case might be traced
to neglect a criminal remission in the Employment of 
the proper remedies. Happily this terrible disease did 
not remain long among us. No traces of it whatever can 
be found in this City, and there is reason to believe that 
it is Exterminated from every part of the Country. 





136
Haemorrhage
Having concluded what we have to say of Fevers, we shall 
now say something of Haemorrhages, which are properly affections 
of the Circulatory system.
These have been divided into Active and Passive but it 
is difficult to draw the line of distinction. Active haemorrhage
is generally preceded by a sense of fulness, with heat and itching
of the part attended by some inflammatory action. Dr
Cullen defines it “Pyrexia with effusion of blood in dependent
of external violence.” Cases occur connected with debility
and relaxation, to which the term passive, has been applied: 
but in these topical congestions generally exist.
We are most subject to haemorrhage about the age of
Puberty, because the growth of the body then ceases and that
quantity of blood, which was necessary during growth 
continues for a time to be elaborated, causing Plethora.
In early life Haemorrhagies take place from the arteries: but
from the veins chiefly in old persons. Haemorrhagies from 
the Liver, spleen, stomach, and haemorrhoidal vessels are generally 
venous; but those from the nostrils, Lungs & uterus
are arterial.
Epistaxis most frequently occurs in children: Haemoptysis at
the age of Puberty; and abdominal Haemorrhage in advanced life.
The cause of Haemorrhage is for the most part some local
irregularity of the circulation dependent on original peculiarity
of structure.
All of the causes which increase the activity of the circulation 
tend to [exce??] haemorrhage as violent exercise, undue 





137
passions etc. Heat has a considerable influence in the production 
of Haemorrhage it stimulates the arterial system & 
relaxes the integuments. It was once supposed to act by 
rarefying the blood; but the Experiments of Sauvage and
Halle, show that this fluid is not Expansible. Cold
suddenly applied by giving the blood a centripital
direction, occasions Haemorrhage from internal parts.
Ascending high mountains has frequently been followed 
by violent Haemorrhages from the nose, Ears and 
superficies: this takes place in consequence of the 
removal of atmospheric pressure, or rather the diminution
of it. We are more liable to Haemorrhage in 
‘the spring than any other season in consequence of 
the stimulus which the return of warm weather affords.
The ancients supposed Haemorrhagies to be of 4 kinds
1st Reais, or those arising from rupture, 2nd Diatroris or 
Erosion; 3rd Diapedisis or transudation & 4rth Anastomosis.
But the present doctrines of Physiology forbid the idea
of transudation in the living system, and it is probable
that Haemorrhage never results from Erosion.
Consequently Diatrosis and Diapedesis will be rejected.
Haemorrhage is for the most an Effusion from the 
exhalents, which by disease, are rendered more [pata?loies] 
than in health. This opinion is supported by 
Bichat & appears to be strongly corroborated by facts.
In a natural state these vessels exercise the office of 
secreting & throwing out mucous, Serum or more attenuated
fluids from the blood; when diseased, they lose 




138
this power and the blood passes through them unaltered, or 
in states more or less like their natural secretion. In 
dysentery and Haemoptysis, we frequently have mucous
streaked with blood, and when their secretory functions 
are completely destroyed, we have an Effusion of pure
blood. The first step in haemorrhage is very much 
like that in Inflammation. Some change in the vessels
invites an afflus of blood and then a topical congestion 
ensues this condition is relieved in haemorrhage by 
the discharge but in inflammation, relief is generally 
obtained by some other termination.
In Haemorrhage from eternal violence, if the
constitution be sound, and the contusion not too 
extensive the person gets well as soon as the 
flow is arrested. In real Haemorrhage, the vessels are in a 
wrong state of action previously, and unless the Bleeding be 
sufficient to relieve this condition, we have inflammation 
with its consequences.
An opinion was advanced by Stahl and supported by 
others, that it is improper to interfere with Haemorrhages 
because they are to be regarded as efforts of nature to throw 
off something which is hurtful to the constitution. This 
to a certain extent is true; it would be improper to suppress 
haemorrhage from the nose or Hemorrhoidal vessels 
while there was a disposition to apoplexy; or to endeavour 
to stop the blood in any of the critical discharges in Fever.
But nature sometimes gives the blood an improper direction 
as in Haemoptysis and effusion into the brain. She sometimes
also pours out too much blood.





139
In the cure of Haemorrhage we first attempt to reduce the action
of the arteries by VS. refrigerants & sedatives and then remove
the disease by Revulsion and astringents. The Refrigerants
are External and internal of the former are Cold application
of the latter, neutral salts. Sedatives diminish the moving
power of the system, without occasioning any evacuation
as Digitalis and Tobacco; It is doubtful whether any articles
possess the power of Constringing the patulous mouth 
of the vessels but preperations of lead and alum mineral
acids and many articles from the vegetable Kingdom
have been given with this view.
Revulsion comprehends those means by which 
determinations are made from one part to others as by 
cupping and blisters, or stimulating pediluvium or Embrocations
of the same nature.
To prevent the recurrence of Haemorrhage, we
must endeavour to obviate the causes. In the active cases 
we must remove plethora by abstemious diet or when 
this is ineffectual we must occasionally call in more 
direct evacuations. In passive Haemorrhage, we endeavour
to invigorate the system; at the same time attention must 
be paid to local congestions. Exercise constitutes an important
part of the prophylaxis.
Haemoptysis
By this term is literally meant a spitting of blood but as 
commonly employed it denotes haemmorrhage from the Trachea
Lungs or Fauces. when blood proceeds from the Trachea on 
Fauces, it comes up by hawking without pain, cough or 
febrile excitement, or oppression. These local bleedings are
however sometimes of serious import and demands all of our 





140
case, being not unfrequently the precursors of Catarrhal Phthisis
When blood comes from the lungs it is florid and frothy; and its
appearance is attended with pain, oppression, cough and generally 
with febrile excitement and dyspnea. The Predisposition to haemorrhage
from the Lungs is laid by the original constitution 
of the parts marked by contracted Thorax, elevated shoulders 
and long neck, with delicate form and sanguine temperament.
The exciting causes of Haemoptysis, are all those circumstances, 
which accelerate the circulation, as long and loud singing
violent passions, considerable exercise and exertion, vicissitudes 
of weather and intemperance. It may also be occasioned
by the suppression of some other discharge.
It is a remarkable circumstance that Haemoptysis
is most apt to occur as might when the patient is in bed.
It would appear that all the causes calculated to accelerate 
the Circulation were removed at this time, and that therefore
the disease would be less apt to make its appearance then 
than at any other time. I believe it is in consequence of the
determination to the lungs which the horizontal posture
and the bent position of the lower extremities occasion.
Haemoptysis may occur from mere plethora periodically 
induced in the Lungs, which is relieved by this Evacuation.
I once knew a man in this City, who had this evacuation 
from the Lungs for many years, as regularly as menstruation.
It sometimes occurs from abscess in the Lungs wh:
succeeds ill cured Pneumonia, when it is always very dangerous.
Haemorrhage may proceed from 1st accidental rupture,
2nd violent Inflammation 3rd Metastasis, 4th [illegible] Plethora,
5th Tubercles associated with a scrophulous diathesis in 
what case, Consumption is very liable to follow.




141
Haemoptysis is generally preceded by a sense of weight, and oppression,
with slight pain and burning in the breast, dry hard cough, tickling
of the Fauces, full irregular pulse, and flushing of the face.
Sometimes the blood comes up in small quantities, with rattling of 
the throat from accumulation of Phlegm, and a saltiest taste. In 
other cases it comes up without effort, in a stream from the 
mouth. 
I shall commence the treatment by speaking of those cases
attended with activity of the circulation, in which the first indication 
is to remove febrile action. For this purpose VS is the
first remedy in point of importance. This has been objected to 
by Heberden and others, who argue that an advantage can result 
from bleeding in one place to stop it in another that if we
wish to reduce action, why not let the flow continue from 
the Lungs. But this is a sophism unworthy of the great man
who maintained it.
For if it were our object to reduce the activity 
of the circulation, it would be much safer to bleed from the arm,
than to suffer the blood to pour out and be coagulated in the
Lungs. But much is also affected by the known law of Revulsion.
The detraction of blood in those cases should be sufficiently 
large to produce a decided impression. The remedy is not however
to be confined to those cases in which, there are evidences
of increased action; but should be used in all cases where
the patients condition will bear it. Even in weak habits
local Congestions are to removed by bleeding. We bleed
largely in Apoplexy in such habits, and derive much advantage
from it. After the use of the lancet, it is my practice
to give a teaspoonful of common salt every 10 or 15 minutes
which has a powerful effect in constringing the vessels. The 
salt should be taken in substance, in order that by slow
solution, in the mouth, it may make a strong impression on 
the Tongue and Fauces. Cold applications to the Thorax and 




142
Arm Pits should be used, or the cold bath in extreme cases. The
latter remecdy was much used by Dr Bond of this City. Sacchoma
Saturni, the reputation of which has been injured by Sir George
Baker, and revived by the late Dr Barton; has been much used 
in Haemorrhagies of every description. It should never be used
however, until action has been reduced by copious Vs. It may 
be given in doses of 2 or 3 grs combined with opium and repeated
at short intervals. When given large doses the sugar of Lead 
purges, without displaying any astringent property, nor do
large doses induce Colica Pictonum. I once Knew a man to take
zi by mistake, which purged him freely, but no spasmodic affection
followed. When given in smaller doses for several
days, the cold pains sometimes come on. I have used opium 
with much advantage in some cases attended with much 
pulmonary irritation and cough. In very irritable cases
in which the pulse is much accelerated, and in which blood
letting would be inadmissible, Digitalis may be used with 
advantage. It should be used so as to keep down action to 
its natural standard. A Preparation of Zink called the Vitriolic
Solution, has been much praised as a remedy by [illegible]
Narcotics have been given, with the view of quieting irritation 
and reducing action. Not much is to be expected from 
Henbane or Hemlock, as advised in this disease: but from 
opium much more may be looked for. The properties of 
this article are peculiar. Although it is decidedly stimulating
on that account would seem to be improper in the case
before as, its power of assuaging pain and doing away irritation 
makes it admissable. The case to which I think it suits
is that in which there is considerable irritation & cough with 
spitting of blood. Digitalis is never to be trusted to the neglect
of VS: exhibited in ordinary doses, much time elapses before 




143
its effect on the pulse is manifested: if it be given in large doses
vomiting is apt to be induced, which at best is imprudent.
when there is slight habitual Hameoptoc with Cough and too 
much mobility for VS, it may be used with advantage.
Emetics were originally introduced into the treatment of 
this disease by Dr Bryan Robertson of Dublin, about 70 years ago;
but were abandoned by Dr Cullen on account of their [tem???]
In cases of active Haemorrhage they are certainly hazardous, but
when the haemorrhage is small & the inflammatory action not
considerable, they have done good. Recent Experience has
taught me, that the practice of giving emetics in Haemoptysis
is recommended by Willis of Great Britain, is under certain 
limitations safe and very efficacious. When the bleeding proceeds
from rupture and is very copious, they are improper.
When from Anastamoses they are highly beneficial. The Tart
Emetic in nauseating doses is suited only to Febrile Cases.
The whole of this class are of decided efficacy when given so as
to nauseate but the most decidedly useful in my opinion 
is Ipecacuanha. It may be given in doses of ½ or 1 gr combined,
with a small quantity of opium; repeated as circumstances
require. Of the Refrigerants the most useful 
is Nitre, which has a manifest effect in reducing vascular
action, and is therefore to be considered as an ancillary
to VS. it is most commonly given in combination with 
Tart Emetic.
Diuretics would seem calculated to do good in 
this as well as the other affections of the lungs, by determining 
the fluids from the lungs to the Kidneys. With this view
nitre may be used zi dissolved in a glass of water may 
be taken during the day. It is a remarkable fact, that the 




144
Stomach will not suffer so much from a dose of this
size, as a smaller one. Mineral acids have been given in
this disease with advantage the best is probably the sulphuric,
which may be given in doses from 15 to 20 drops
diluted with water.
Purging as one of the means of reducing inflammatory
action, is a powerful remedy in Haemorrhage. At least apt 
to nauseate the stomach, Epsom salts has generally been 
used. Haemoptysis is occasionally connected with 
a depraved condition of the Primae Viae, as shown by a loaded
tongue, costiveness etc. In these cases give 5 or 6 grs of blue Pill,
every night, with the view of correcting the condition 
of the Chylopoeitic viscera, which should be worked off by a 
gentle laxative in the morning.
Whenever the disposition to haemorrhage from the Lungs continues
topical depletion by Cups, together with blistering should
resorted to. Dry Cupping acts on a twofold principle Revulsion 
and vesication. Blisters are by some applied to the feet and 
ankles: but I would apply them to the breast or back the efficacy 
of such applications, being as the proximity to the part 
affected. When however we wish to interrupt morbid associations
Blisters should be applied to the upper and lower Extremities
alternately. With the view of preventing the return of 
haemorrhage, the patient should be placed with his shoulders 
elevated, and his lower extremities extended. 2 The Chamber 
should be kept cool, and well ventilated & the bed clothes
should be light. 3 Company should be excluded and the patient
should not be permitted to talk. 4th His diet should consist
of mild food, with the use of acidulated drinks, and his bowels
should be kept soluble.
There is a species of Haemorrhage attended with debility 




145
called passive, or more properly Haemorrhagic of feeble action.
Passive Haemorrhages for the most part occur in scrophulous
persons, and generally attend the incipient state of Pulmonary
Consumption. The quantity is generally small merely sufficient 
to streak the sputa. In other cases, however, where 
there is great laxity of the vessels, it flows off freely. The indication
in this case is to support the system and through
it to impart energy to the Lungs.
For this purpose a variety of preparations of Bark
Iron etc. have been used. Bark is generally given in infusion 
alone or in combination with Myrrh. Of the Chalybeate, 
the muriated tincture of Iron is the best. To arrest
passive haemorrhage spts Turpentine in doses of a 
teaspoonful repeated occasionally is used; but the Sulphuric
acid is the most valuable remedy to arrest the haemorrhage.
The Nitre, to correct the morbid condition on 
wh: it depends. They are often given in bitter infusion
The vegetable astringents as Kino & Catechu, Malt Liquors 
and exercise (after febrile symptoms are completely subdued 
as a [illegible] a sea voyage) properly regulated have
also been directed
Epistaxis
In conseqeunce of the tissue of vessels. spread out upon the 
[Sneidenan] membrane, bleeding from the nose frequently occurs
It is most frequent about Puberty, or in the decline of life
It is rarely to be met with in women,  who menstruate
regularly. The exciting causes are such as have been 
mentioned when speaking of Haemorrhagy generally, as exposure
to heat, violent exercise, blows, ligatures about the 
neck etc. The premonitory symptoms, are pain in the head, with 
heat and itching of the nostrils, vertigo, heaviness & tinnitus aurium




146
throbing of the Temporal and Carotid arteries, flushed countenance, 
with tumefaction about the nose. In some cases
the febrile symptoms are more compleat; as appears by Chills
& heats with constipation of the bowels. The only cases of 
Epistaxis requiring medical treatment, are such as are 
connected with certain deranged conditions of the vascular
system. In these cases we first endeavour to arrest
the flow of blood, and then do away that Plethora 
on which the disease depends.
To affect this first indication, it is only necessary in 
passive haemorrhagies, in which the pulse is generally more
quick and irritated, sometimes attended especially in girls by 
a pallid sallow countenance and flabby soft integuments,
that the patient should be placed in an erect posture, with 
the head directed backwards, and cold applications should be
made to the neck, nostrils, axilla and scrotum. Of these the
application to the scrotum is probably most effectual.
If these fail plug the nostrils with dry lint, or with lint
dipped in a solution of Alum, Lead or white vitirol or Sulph
Iron or blue vitriol, or muriated Tincture of Iron solution 
of Galls, Kino or Catechu or wet the lint and dip it in 
magnesia, flour, [arni??an] [illegible] or Charcoal (of which 
that prepared from Cork is probably best). In some
cases VS becomes necessary. The head should be immersed 
in Cold Water, which may be rendered colder by the addition 
of Sal Ammoniae, a Common Salt, the whole body has
been immersed in Emergencies The patient should be 
kept long in the water; or the reaction which follows
may produce an effect approach to that intended. In 
these cases I generally resort to compression which may 
be effected by a piece of sponge, introduced into the nostrils
or by pressing the sides of the nostrils, with the fingers until 
coagula form. As a prophylactic in passive haemorrhy
I have found nothing so good as Rubigo Ferri.







147
Epistaxis is sometimes vicarious of other discharges in this
case we should endeavour to reestablish the natural one
as in Haemorrhoids and menses. It also depends in some
cases on obstruction of the viscera this is to be removed
by salivation or other measures.
Though for the most part, an unimportant haemorrhage
it sometimes proves very unmanageable. It is more frequently 
fatal than Haemoptysis or Haemorrhage from the uterus. The
Unmanageable cases are generally met with in Cachectic habit.
It is remarkable that the System cannot bear so great a loss of 
blood as others Thus few can bear the loss of more than a few
ounces of blood from the nose or Haemorrhoidal vessels whilst
quarts from the uterus or lungs produce but little effect.
To effect the second indication we should adhere strictly to the 
antiphlogistic regimen, avoiding all of the exciting causes. Venesection 
and local bleeding, with the free use of nitre should 
be premised, when there is any determination to the head.
Purges are highly useful: but particularly demand our attention 
in cases connected with costiveness. Blisters may 
be applied to the neck or extremities; and if all these [mea?]
fail, we should endeavour to establish a perpetual blister
or drain elsewhere. Bleeding from the nose is critical on some
diseases, and should not be arrested as in violent fevers and 
apoplexy.
Uterine Haemorrhage
Menstruation is subject to derangement from several
causes, amongst which menorrhagia is not the least unpleasant. 
The discharge may be in excess; it may continue
too long at each period or it may recur too frequently. these
conditions are not always diseases. Menorrhagia properly 
defined, consists in an increase of menstrual discharge and
is a very rare disease. It rarely requires medical treatment. Rest’
a cool room, & sometimes a gentle laxative relieves it. if there be 
pain and irritation, an anodyne may be given. [illegible] it in our 




148
power to arrest the flow of the menses, it would be wrong. All 
the bad consequences of a suppressed secretion might be expected
to arise. Almost all of the profuse discharges from the uterus
observing a periodical tendency, which I have observed
were pure blood and not the menses. The Secretories in these cases
become diseased they lose their tone and permit the red blood to 
flow out of them. In a large majority of the Cases called menorrhagia, 
pure blood is discharged, constituting uterine Haemorrhage.
The circumstances, which direct the blood to the uterus
are constipation, Dancing, Excessive venery, frequent abortions
or organic diseases. The active forms of uterine haemorrhage
are accompanied with head ach, Dyspnea, pain in the loins
and back, with a full corded and tense pulse. In these cases
the leading indication is to reduce vascular action; for wh
purpose, the lancet is the first article to be used it shd
be pushed up far as the Circumstances of the case require.
To cooperate with this remedy laxatives are to be required. 
Under the head of Astringents, which are next to be used
the Saccharum Saturni stands first. Heberden called it’
a specific. It is generally given in doses of 2 or 3 grs with [illegible]
of opium every hour or two. This however is feeble practice
In order to produce the desired effect, 5 or 6 grs should be given 
every half hour until the effect is produced, nothing is to 
be feared from these doses, for I have given 20 grs without
detriment. Ipecacuanha is a highly valuable article in 
the treatment of these cases. It should be given so as to 
nauseate. 1 or 2 grs with ½ gr of opium, repeated every hour
or two, until the effect is produced. A state of repose
with a low diet should be enjoined. Vomiting is perhaps
hazardous in these cases generally, though I would use it 
under the same circumstances as in Haemoptysis. The mineral
acids & more particularly the sulphuric have been used. 




149
Alum has been presdribed in doses of 4 or 5 grs, with 8 or 10 grs of Kino
or Catechu, Alum combined with opium has been used; these
prescriptions are more applicable to passive haemorrage. When 
there is great irritation opium constitutes an excellent remedy.
Digitalis has been considered a substitute for VS, in active cases, 
but erroneously. After arterial action has been reduced we 
may have recourse to it, but not without caution. it 
appears to debilitate and [relave] the vessels. The local remedies
are cold applications by means of [illegible] out of cold
water or vinegar or Ice introduced into the vagina. The best
means of using Cold water is to pour a stream from on high
on the abdomen. Styptic liquors should be thrown into the Vagina
or as Dr Dewes prefers, into the Rectum the Dr says that when 
injections are thrown into the vagina, they do harm by breaking
the coagula, which form in the orifice of the uterus. When 
there is irritation and spasmodic action of the uterus, attended
with haemorrhage, Laudanum may be thrown into the
Rectum in quantity of 100 or 150 drops. In Europe it is very 
customary to give opium in all these cases but there is 
reason to believe that it has been used to generally and
indiscriminately. In the early stages of active haemorrhage it
would certainly be injurious but when connected with 
pain and spasm, with a gush of blood at every irregular
movement, opium is very useful.
Passive Haemorrhage from the uterus, is that in 
which there are evidences of debility. There are feeble pulses
quick and hurried respiration on slight exertions, damp
clammy skin, oedema of the lower extremities, pain in the 
lumbar region, and weakness of the back.
This form of uterine Haemorrhage is generally met with in
relaxed women, who have borne many children, had frequent miscarriages
or indulged much in venery. These cases are to be managed
by invigorating the system, by means of astringents and a well regulated 


There is only one kind of Haematemesis which is accompanied
by high inflammatory action, this is in 
Yellow Fever. This disease does not often prove
fatal. This disease is sometimes mistaken
for haemorrhage from the liver, but the mistake
is not dangerous, for the treatment is the same 
in both. Vomiting of blood is sometimes dependent
upon a Scrofulous diathesis. I knew a family of 
5 brothers and 1 sister, 2 of these died with this
disease, 3 others died of Phthis.
The Treatment is first to remove the congestion
by VS. but if there is great prostration, from 
the Haemorrhage you must use come other plan
of treatment as Cupping, Leeching. Sometimes it
is absolutely necessary to use drastic purgatives to 
relieve the congestion of the liver, and the best
of these is mercury which acts powerfully upon 
the Liver. In every case where there is costiveness
you must relieve it by some purgative
where you can use opium you should always 
use it not only in this Haemorrhage but in all 
others where there is not too much action. The 
Fox Glove is sometimes used, but I think it not 
of much benefit. In cases where there is much 
debility we must use all the astringent class
Blistering in this case is of great advantage



150
diet. The following prescription is well suited to this case Rx Bark
zii, infuse it for 2 days in a quart of Lime water. dose a wine
glassful.
About the time or after the cessation of the Catamenia, a 
periodical discharge of blood from the uterus takes place in many 
cases. In some cases there is a constant oozing of blood called a
Hemoptoe from the uterus. This for the most part depends on 
a cancerous deposition. If examination be made the uterus
will be found hard at its mouth and enlarged. In these cases 
the diet should consist of vegetables and milk. whenever there
is any activity of the pulse VS should be resorted to. If schirrus
be established we give Arsenic or Henbane, Hemlock.
sometimes resort to slight mercurial course but above all
relieve pain by opium.
Haematemesis
Haemetemesis or vomiting of blood, generally arises from concussion 
from swallowing very cold or acrid substances, or it may exist
as a vicarious discharge. It may arise from hard drinking or 
or the violent operation of an emetic. It is generally preceded by 
tension of the Epigastrium with nausea & vomiting and sometime 
a disposition to syncope. It sometimes occurs from 
sudden accumulations in the Vena Potarum without any 
premonition. this most frequently happens in dropsy.
I have seen one or two cases, in which these seemed to have
been a prodigious accumulation in the Liver or spleen, wh:
was suddenly discharged by vomiting. I knew one case in 
which the patient was treated for ascites, whose abdomen
was distended to an enormous size. he was taken with 
Haematemesis and discharged in the course of 10 days. 5 of 6 
gallons of guimous blood. The accumulation was in the spleen
from which the blood passed to the stomach through the 
vasa Brevia.
It is to be distinguished from Haemoptysis with 


150
diet. The following prescription is well suited to this case Rx Bark
zii, infuse it for 2 days in a quart of Lime water dose a wine
glassful.
About the time or after the cessation of the Catamenia, a 
periodical discharge of blood from the uterus takes place in many 
cases. In some cases there is a constant oozing of blood called a
haemopotoc from the uterus. this for the most part depends on 
a cancerous disposition. If examination be made the uterus
will be found hard at its mouth and enlarged. In these cases 
the diet should consist of vegetables and milk. Whenever there 
is any activity of the pulse VS should be resorted to. If schirrus
be established we give arsenic or Henbane, Hemlock
sometimes resort toa slight mercurial course but above all
relieve pain by opium. 
Haematemesis
Haemetemesis or vomiting of blood, generally arises from concussion 
from swallowing any Cold or acid substances, or it may exist
as a vicarious discharge. It may arise from hard drinking or
or the violent operation of an Emetic. It is generally preceded by 
tension of the Epigastrium, with nausea & vomiting and sometime
a disposition to syncope. It sometime occurs from 
sudden accumulations in the vena [P?tarum] without any 
premonition this most frequently happens in dropsy.
I have seen one or two cases, in which there seemed to have 
been a prodigious accumulation in the Liver or spleen wh
was suddenly discharged by vomiting. I knew one case in 
which the patient was treated for [a??itis], whose abdomen
was distended to an enormous size he was taken with 
Haematemesis, and discharged in the course of 10 days, 5 or 6 
gallons of guimous blood. The accumulation was in the spleen
from which the blood passed to the stomach through the 
Vasa Brevia.
It is to be distinguished from the Haemoptysis with 



I have seen as much benefit from Blisters as from
any other treatment I ever saw used. Light
diet should be used. [Gillies] should never be given
in this nor any other debilitated or inflammatory 
diseases, it is more indigestible than any other
animal food used, mutton chops, Beef Steaks etc.
are much more digestible than [Gillies].
[Haneahuca] is not always a symptomatic disease
but sometimes an idiopathic one. The disease at
first is attended by little fever, but it gradually 
increases. You will find more relief from the 
use of diluent drinks than any other.
If the disease is produced from calculus, we
must bleed, place the patient in the warm bath
and treat the case as we would other cases of 
calculi.
Irritating substances taken into the stomach as are
the Balsams, Spts Terebinth, Cantharidis sometimes 
produces this disease. Bleeding will cure this disease
We sometimes See haemorrhage in cases of 
putrid fevers Small Pox [illegible] we must treat


151
which, it has been confounded by the Colour of the blood, which 
is dark and guimous; and by the absence of the Pulmonary symptoms, 
connected with Haemoptysis. The blood thrown up by 
vomiting is sometimes from the Liver or Spleen in which 
case there is fulness and tension of the hypochondrium,
head ach, fever etc. vomiting of blood is sometimes symptomatic
of malignant fever. In the idiopathic disease
where the pulse is active VS should be resorted to this is 
to be followed by Cups and Leeches, with blisters to the Epigastirum, 
followed by Cold drinks. All the astringents except
the Turpentine are of doubtful efficacy of this however
a tea spoonful every hour or two constitutes an excellent remedy 
when the bleeding is from anastomosis, there is nothing like
Emetics of Ipecacuanha You are not to be deterred from 
the use of this remedy by Debility (Dr Cread some cases from 
the transactions of a Dublin association of Physicians, in which 
the practice is spoken of in high terns, even in sinking conditions 
of the system.) when haemotemesis is vicarious of 
suppressed Menses, or haemorrhoids, these discharges are to be
restored. The muriated Tincture of Iron in doses of 20 or 30 [illegible]
has had much reputation in these cases. The bowels should
be kept open by mild aperients. In the secondary cases, dependent
on obstruction of the viscera, Mercury should be given
The Spirits of Turpentine is a valuable remedy in passive cases
Haematuria
Haematuria or bloody urine is entirely symptomatic, resulting
from injury done to the Kidneys, or from irritation of stone
Haematuria may be occasioned by stimulating diuretics it is also
attendant on fever, and is sometimes an effect of organic disease.
It is attended by a dull heavy pain, or acute pain in the loins, reaching 
down the thighs and to the testicle: difficulty in urinating & gastric
distress, when the attack has been brought on by violence or there
are any evidences of Inflammation VS should be used also 



these cases upon general principles
Haemorrhoids can always be cured before
suppuration takes place when there is 
neat irritation nothing is so good as
emolient cataplasms. when they form
suddenly they are puffy and elastic
but when they form slowly they are
hard. In some women the haemorrhoidal discharge
is increased at the period of menstruation
The disease should be removed in all
cases the repeated recurrence of haemorrhage
[illegible] of Dyspepsia Dropsy and finally 
Death. The Sudden arrestation sometimes
brings on other diseases which will produce
sinous consequences but this can be prevented
by [illegible] the haemorrhoidal been 
when the disease first makes its appearance.
Abstemious diet cold bathing gentle
exercise at a carriage or walking [illegible]
on to hard bed are the Prophylactics.
IN the treatment I find that I have
[illegible] success by opening the vessels in all cases even 
if I have to use the [st???] ligature to stop the 
[Haemorrhoid] [illegible] [illegible] Calomel when 


152
The Liver is diseased. Saturnine and astringent 
applications are only palliative. they will 
arrest a slight haemorrhage for a time, but
it will return again. These remedies 
should not be employed when there is 
great irritability of the parts. In a [?allous]
state of the vessels Dr P has used 10 grs of
Corrosive Sublimate to 8 zi of water to give
tone to the parts. You may cure Leucorrhoea
with small serous discharge by these
astringent remedies. Balsam Copaiva should 
be given in doses of at least 60 drops, 3 times 
a day. One of his Patients took a tablespoon 
full night and morning and was entirely 
relieved by 2 doses. When the tumours become 
moderated by a great disposition of coagulable 
Lymph nothing but an operation will be 
of any advantage. No operation should be 
employed when the patient has Scrophula
Dr Potter.


153
when the swelling and pain are very urgent and these cannot
be obtained, puncturing the tumors, for the discharge of blood is
necessary. An ointment made of fresh lard zii Spermaceti ziii
Goulard’s extract of Lead zi Laudanum zii has been found
valuable. After the inflammatory symptoms have subsided
the unguent Gallae becomes the best remedy or Tar ointment.
Riding on horseback has been serviceable when the 
tumors become indolent: This disease has a powerful 
influence over the animal oeconomy. If any serious
complaint follows a suppression of the discharge we
should endeavour to restore the evacuation by [Aloetic] purges
and leeches. To relieve the pain, we may use solutions
of Lead with Laudanum or poultices impregnated with 
the article or warm water in vapour or bath by applying
soft extract of Cicuta by Embrocations of stramonium
or Elder ointment An enema of laudanum
or a suppository of opium. Dr James says that warmth 
affords temporary relief in Piles; but increases the disease
Lead applications are very beneficial.
Diseases of the Digestive System
Under the head I include more particularly the stomach and
Bowels. In consequence of the widely diffused sympathies of the
stomach, it is obvious that its diseases must exert a 
powerful influence over the animal oeconomy. It is indisputably
the most important organ of the body. Life has been 
known to exist without many other important organs, but never
without a stomach. As preparatory to entering on diseases of the
stomach, we shall first consider the nature of the complaint
arising from worms.
The worms, which infest the alimentary canal, may 
be divided into two genera: The Round and [Flat.] of the round
we have 3 Kinds The Lumbreii, Ascaridis, and Trichandis. The [illegible]




154
is the only flat worm, which occupies the human intestines. The
Lumbrici reside in the duodenum, Jujunum and Ilium, but 
are rarely found in the Stomach, or large intestines, unless retreating 
from the effects of disease. They are from 1 to 10 inches
long and sometimes collect in great members. The ascaridis
are sometimes to be found in the Rectum and sometimes in 
the stomach they are about ½ inch long and resemble
pieces of thread cut to pieces. The Trichinis or thread worm has a 
large head, two inches long armed with a proboscis which it can
thrust out at pleasure. Its tail is several times as long as the
body. It resides chiefly in the Ilium, and is of very rare occurrence.
The Tonia or Tape worm is of very great length from 
10 to 230 feet, formed of links or joints. Children are not
liable to worms from the 1st to the 5th year. Although
it has been argued that these vermin are perfectly innocent
in the system, there is scarcely a disease which their presence 
may not produce or imitate. The common concomintants
of worms are emaciation with slimy discharges from 
the bowels, pain in the belly, alternations of diarrhoea & costiveness
great thirst and voraciousness, foetid breath, paleness
of the face swelling of the lips, a livid circle around the Eyes
distension of the abdomen, disturbed vision, dry Cough etc.
There is a species of fever excited by the presence of 
worms called febris verminosa. It is a slow remittent with 
heaviness and drowsiness during during the exacerbation; and 
pain in the bowels and stomach with occasional purging
during the remission. It is contended by Butler that this fever
arises from acrid accumulations in the bowels and not
from worms. The alteration of voice, swelled lip and foetid
breath have been considered pathognomonic.
Anthelmintic medicines are of 4 kinds. 1st Thos wh:
are poisonous to them. 2nd Evacuants. 3rd Mechanical irritant
and 4th Correctives of that condition on which their generation depends




155
The Remedies for worms are first active purging of which Calomel
given in large doses at night and worked off with Castor
Oil in the morning is probably the best it shd be repeated 
tow or three times, with an interval of a day or two. The drastic
purges, as Gambronge, aloes & Scammony operate chiefly by their
purgative property in the repulsion of worms.
The Spigelia Marylandica or Caroline pink root may be given
in doses of 5 or 6 grs to a child 3 or 4 years old. The decoction
is prepared by throwing zi of bruised root into a pint of boiling 
water and simmering it down to half a pint. Dose a table
spoonful 4 or 5 times a day. The following formula has 
been much used Rx Rad Spigelia zvi Folae Sennae zii foliae
Sabinae zfs mannae zii wtare [illegible]. The chenopodium 
anthelmenticum of which the [copessid] Juice, ina tablespoonful 
may be given every morning or 8 to 10 drops of the Oil twice a day 
for 3 or 4 days when it should be omitted and a purgative prescribed 
again. The Milia Azaderack or pride of China, may be used in 
the form of a saturated decoction of which the dose is a tea cupful
The Foetic Helebore in doses of 6 or 8 grs to an adult, for several 
nights in succession has been productive of much advantage
The Gioffra Ivermis or Cabbage bark Tree of Jamiaca may be 
given in powder in the dose of 10 or 15 grs in Extract in the dose
of 2 or 3 grs. If the decoction be used it should be prepared
by putting zi of the Bark in a pint of water and boiling
it down dose for an adult a Teaspoonful. As a general
rule every article of this kind should be followed by a purgative,
after it has been used for 3 or 4 days.
Ascarides, generally occupies the Rectum. Their presence
is known by itching and tumefaction about the fundament, [a??sating] 
to an excessive degree of irritation in some cases. They sometimes
escape from the Rectum. The Remedies are Calomel combined
with drastic purgatives & Aloche preparation: Hierapicia 





156
appears to be more efficacious than aloes alone. It is 
given generally zy dissolving zi in a little of ardent spirits of wh:
a spoonful may be given to a child or 3 or 4 years repeated until 
when other remedies fail for the purpose zi or zii of Aloes in a 
pint of milk may be thrown up the rectum. A solution o f
common salt has also been used with advantage. A Cathartic
should be administered to assist with Expulsion of the worms.
The symptoms of Toenia are a gnawing sensation 
about the pit of the stomach, with much gastric distress,
tension and swelling of the nose, with craving appetite & 
great emaciation. This worm is supposed to feed on the chyle 
and hance the rapidity of the emaciation, which in some cases 
almost amounts to atrophy. 
Calomel has been prescribed in large dosses Gambronge 
in doses of 10 or 15 grs. The Polypodium Folia mas or [malifern],
has been in use ever since the time of Galen, and is now
in much repute Dose from 1 to 11 z followed by an active Cathartic.
The hairy speculae of the Dolicus Pruriens, have been 
given in doses of a Table spoon full in mucilage and was
supposed to operate by its mechanical property alone but
this is not the case, for it is found equally efficacious in 
fine powder. Ten [???ings] have been given in doses from 
1 to zii. Spirits of Turpentine has been given in doses of zfs to 
3 or 4 z early in the morning on an empty stomach it has
done much good. It has lately been said that Liquid Carbonate
of Ammonia with spts Turpentine, is the most effectual remedy
for this worm. When the worm protrudes its head it
has been advised to destroy it with a drop of Prussic acid.
to correct the condition, on wh: the generation of the worms depends
the various tonics, have been prescribed. The Carbonate of Iron
has been used by me with great advantage. The use of Common 
salt has a good effect in correcting the disposition alluded to . 





157
Inflammation
Previously to entering on the consideration of inflammation of 
the Stomach, we will make a few observations, concerning
inflammation generally. The causes of inflammation are
exceedingly various and numerous: whatever is adequate to 
disturb the regular order of the actions of a part being properly 
a cause of inflammation. Thus an infinity of chemical and 
mechanical causes excite inflammation. Redness, heat,
Swelling and pain have been considered the necessary symptoms
of inflammation. However generally redness may be an 
evidence of the existence of inflammation it is not always the
case. This we perceive, in the blush of innocence, or the suffusion 
of guilt. Heat may result from acceleration of the circulation 
without Inflammation. Swelling is accidental and occurs 
only in a loos cellular tissues the painful inflammations 
are free from it. Pain is an attendant of every morbid
condition being common to irritation, spasm, destitution 
and fatigue. Neither of the signs seperately considered
afford us conclusive evidence of the existence of the disease
but when all are combined we have no longer any doubt.
These then are the signs of external inflammation, but 
we are to judge of internal, by the pulse, the degree and
kind of fever, the appearance of the blood, disturbance of
function and the appearance of the tongue and by pain,
which is increased on pressure.
In the progress of Inflammation, there is much variety.
Diseased cation of every description is modified by two 
circumstances. 1st By the structure of the part in which 
it is seated and 2nd by the cause. The various tissues
of the body, thus modifying the inflammation, may be 
divided into six kinds. The Cellular, Dermoid, Mucous, 





158
Serous, Fibrous and Nervous. 1st The cellular comprehends the
general membrane, and the Parenchyma of Glands. Inflammation 
is here marked by pain throbbing, tumefaction a disposition
to circumscribe itself and to form abscesses it is the seat
phlegmon. 2nd The Dermoid, which comprehends the skin is in 
some places susceptible of inflammation similar to phlegma
as in small Pox but it is marked by some peculiarities, constituting
Erysipelas of which it is the proper seat. It manifests 
a disposition to diffuse itself rather than be circumscribed
it is also attended with pain, heat and redness. [I???]
of an abscess it forms vesicles all the inflammations of Dermoid
tissue are seated in the [Riti] mucosum. There is 
a remarkable similitude between the structure and functions
of this and the mucous tissue. Each is endowed with that
kind of sensibility which enables them to bear the impression 
of external bodies. 3rd The mucous tissue, which comprehends
the lining membrane of the various canals and outlets
of the body. In inflammation of these membranes; the tongue 
is in the beginning loaded with a yellowish fur, subsequently 
becoming brown; the pain is not considerable. These membranes,
when inflamed show it by changes in their secretions.
Different portions of the mucous tissue are differently affected
by inflammation. By the long membrane of the [Larg??]
coagulable lymph is thrown out by the Bronchiae a slimy 
fluid of phlegm: by the urethra, pus is elaborated, if mortification
do not anticipate it. Inflammation in the 
tissue generally alters the natural Secretion, and subsequently 
forms pus. 4th The Serous tissues are distinguished by compactness
of structure and pellucidity. The serous membranes are the
Pleura, Peritoneum, Pericardium, Synovial membranes etc. These 





159
terminate by extravasation of Coagulable lymph or by Effusion.
the former occasioning adhesion the latter dropsy. If the Pleura
be inflamed we have a vigorous active pulse, without much 
prostration of strength, but if the Peritoneum be affected in 
a similar manner we have a hard, [wiery] pulse with great
debility. 5th The Fibrous Tissue, comprehends the Dura Matter, 
Periosteum, Capsular ligaments, Tendinous [Expan???]
and muscles. It is here that we meet with Rheumatism
and arthritic Inflammations, attended with active pulse acute
pain, and high febrile excitement, It is slow in its progress 
and very liable to metastasis It never terminates in adhesion
abscess or Gangrene, but a chalky secretion sometimes 
takes place. 6th The Nervous Tissue comprehends the
arachnoid membrane, [Thica] of the spinal marrow, and
[neurelima] of the nerves. The inflammation of this tissue is 
accompanied with pain of the acute kind, and when the constitution
sympathizes, the fever runs high, with an active
hard and corded pulse. When the Phlogosus extends to the 
pulp of the nerves, we have dull heavy pain followed by suppuration.
It terminates by effusion of a serous fluid, if
properly confined to this tissue. The pulp of the brain & nerves
perhaps belongs to the cellular tissue.
Inflammation is not however, confined to one
tissue, but spreads itself to others, exhibiting a greater complication 
of phenomena. The inflammation is also much 
influenced by the cause.
The irritating cause, whatever it be, whether heat
cold, or any chemical or mechanical agent, produces that 
disorder in the function of the nerves called Nervous Irritation.
This impression being transmitted to the Brain, the 
Blood vessels become implicated for these being dependent
on the nerves for that power by which their functions are 




160
performed, must necessarily be affected by their derangement
This Nervous Irritation, which would appear to be the incipient
state of Inflammation, is a condition of the nerves
similar to Inflammation of the vessels. A congestion 
in the affected part now ensues wh: may be considered as 
the second link in the Chain of Causation. IT seems to 
have been known, even by Hippocrates, that irritation 
was always followed by an afflux of humors for he
says “But Stimulus ibi Effluxus” In what manner this
state of Congestion is converted into inflammation, we 
are perfectly ignorant. Two hypotheses have been 
maintained, concerning the proximate cause of inflammation.
One, which alleges that it consists in a diminished;
the other, in an increased action of the vessels. I 
acknowledge that on a view of the whole ground, I incline
to the former opinion, although I am aware o f
the weight of authority opposed to me. 
It is agreed by all, that congestion or [rem??] of blood in 
in the part precedes inflammation. The Causes act by producing
direct or indirect debility of the vessels, and thereby invite an
increased flow of blood to the part. All the stimulating
applications, which produce inflammation, when first
applied, increase the activity of the circulation, through the 
vessels of the part; as has been seen by Mr Philip, by means
of the microscope. So long as this effect continues, we 
have one Inflammation, but after a while, the excitability 
of the vessels is destroyed, and we have indirect debility.
The blood now moves slowly; the vessels become distended
and inflammation is established.
It is not sufficient for the production of inflammation 
that excitement only should take place; Inflammation does not
supervene without the [persistence] of debility.




161
It would seem absurd to suppose that congestion could take 
place if the circulation were accelerated. The Redness
heat, swelling, and Pain seem to be essentially dependant on an
obstruction to the motion of the blood through the vessels. The remedies
for inflammation act by removing this condition. By 
depletion we unload the vessels nearly paralyzed by distention;
and then by rest or the use of moderate stimulating applications,
the contractile power is restored. So long as stimuli
increase the activity of the circulation, none of the Phenomenae
of inflammation appear: but as soon as the excitability of the
vessels, become exhausted, and they fall into a state of debility
Congestion takes place, which is followed by inflammation.
From what has been said, we should consider inflammation
a highly complicated process. The first step is
nervous Irritation, which invites an afflux of fluids to the 
part: The 2nd Congestion, which consists in a distention of the
vessels by which they are excited to increased efforts to relieve
themselves of the preternatural accumulation, and the effort 
is Inflammation. If the effort thus excited be sufficient to 
restore the circulation the disease terminates in resolution
Nature triumphs and all is well but if nature cannot
relieve herself in this way, she resorts to Haemorrhage
or effusion of serum or coagulable Lymphs. If these endeavours
also fail, the vessels take on a Glandular action & 
pus is secreted by which they are believed. The ulcer consequent
to this action is readily healed by a new process established 
for that purpose. If however all the resources of nature
should prove inadequate to liberate her from the oppression 
under which she labours, Gangrene or death of 
the part ensues.
I have frequently stated that in all instances the 





162
Capillary vessels are the seat of the Inflammation. By the
Capillary vessels we mean that tissue which intervenes between
the large arteries and veins; and to which we consigned the
important offices of secretion, Exhalation, Evolution of temperature
etc. This system is divided into 2 parts, one which 
conveys the red blood, the other a white or greyish fluid.
Common inflammation is seated in the red vessels, but
it often occurs in Structures in which the pellucid vessels
exist without any of the phenomena attendant on [illegible]
inflammation; a third kind also exists in which neither
the symptoms of the red, nor those of the serous inflammation 
exist, but in which the two appear to be blended. From
this view of the subject we are not surprised to find that
the common symptoms of Inflammation are wanting
post mortem, when the disease has actually existed.
In many instances where the inflammation is of
the red kind, the appearances are changed in the moment
of death. Parts affected with Chronic Inflammation 
retain their blood after death; whilst those in which
the acute kind had existed frequently lose that which 
irritation alone had caused them to retain. The Two 
Chief Points to be considered in the treatment of Inflammation 
are the Causes and seat of the disease
Inflammations of the serous membrane require more
prompt depletion than that of the mucous. This when
Dysentery is restricted to the proper seat, the mucous
tissue of the bowels VS is rarely admissable unless at
the onset; But when it extends to the Peritoneal Coat as
is known by the acute, lancinating pain, Bloodletting is
indispensable. There are certain articles which operate specifically 
on the mucous membranes as Balsams & Terebinthinates.



162
Capillary vessels are the seat of the Inflammation. By the
Capillary vessels, we mean that tissue which intervenes between
the large arteries and veins; and to which are consigned the
important offices of secretion, exhalation, evolution of temperature
etc. This system is divided into 2 parts, one which 
conveys the red blood, the other a white or greyish fluid.
Common inflammation is seated in the red vessels, but 
it often occurs in structures of which the pellucid vessels
exist; without any of the phenomena attendant on [illegible]
inflammation; a third kind also exists, in which with
the symptoms of the red, nor those of the serous inflammation 
exist, but in which the two appear to be blended. From 
this view of the subject, we are not surprised to find that
the common symptoms of Inflammation are wanting
post mortem, when the disease had actually existed.
In many instances, where the inflammation is of 
the red kind, the appearances are changed in the moment
of death. Parts affected with Chronic Inflammation 
retain their blood after death; whilst those in which 
the acute kind has existed, frequently lose that which 
irritation alone, had caused them to retain. The Two 
Chief Points, to be considered in the treatment of Inflammation 
are the Causes and Seat of the disease
Inflammations of the Serous membrane requires more
prompt depletion, than that of the mucous. Thus when 
Dysentery is restricted to its proper seat, the mucous
tissue of the bowels, VS is rarely admissable, unless at
the onset; But when it extends to the Peritoneal Coat, as
is known by the acute, [lancenating] pain; Bloodletting is
indispensable. There are certain articles which operate specifically 
on the mucous membranes as Balsams & Terebinthinates.




163
Inflammation of the Dermoid [illegible] Nervous Tissues, may also in its 
feeble forms be cured by these counter agents or specifics. It is 
to be recollected however that the use of them is hazardous: for if
you do not select the proper stimulant, you will increase
the disease. This if you were to apply Cayenne Pepper to a
burn instead of spts Turpentine, you would do mischief. The
Inflammation of the mucous membranes is attended by 
fever of a weaker form than that which attends the serous
tissues. 2nly We should attend to the Cause which 
has excited the Inflammation; the cold induces a higher degree
of Inflammation, whenever it may occur, than any other
cause. 3rdly The stage of Inflammation should be 
attended to. I believe with Broussais that chronic inflammation 
has its seat in the serous vessels. It gives rise
to schirrous Tumors, Tubercles etc. 
In acute Inflammation, the remedies are VS, emetics, mineral
salts, & corporal repose, and opiates judiciously employed.
In the second stage, Diaphoretics, become proper, counter 
agents are beneficial, but require much judgment in their
use. In subacute Inflammation, the remedies are
essentially the same, but differ only in activity. When 
other remedies fail, alteratives become necessary. In chronic
cases, small and frequent Bleedings, purging and
alterations are proper.
Gastritis
Cullen divides Inflammation of the Stomach into 2 kinds
Phlegmonic, & Erythematic. The former being seated in the 
nervous or Peritoneal Coat, the latter in the villous. It is probable
that inflammation generally commences in the mucous 




164
Coat and extends itself subsequently to the Peritoneal, thus combining
the two kinds. When gastritis attacks the Peritoneal Coat, the
symptoms are much more active, than when it is confined to 
the mucous. Much also depends on the Cause of Inflammation 
when arising from cold, it is much more violent, than when
produced by any other cause. The mucous Coat is generally 
the primary seat of this inflammation because it is more
exposed.
Gastritis may be occasioned by the ordinary causes 
of the Phlegmasiae, as cold, stimulating, or acrid matter swallowed,
external violence or disease translated from other parts when 
arising from these causes, it is highly Inflammatory, but particularly 
when arising from Cold.
The symptoms are acute pain in scrobidulus cordis, soreness
to the touch, sense of internal heat, great irritability, copious 
vomiting, great thirst and anxiety, alarming prostration of 
power, with a small, hard & corded pulse, though not very 
quick. The disease is very rapid in its progress, and if not
[timely] arrested, an aggravation of all the symptoms soon appear.
The Patient has then so little strength, that he can’t be raised without 
fainting; his eyes are wild, his countenance is sunk, and his pulse
feeble; a hiccough now occurs, and a discharge of matter 
similar to blk vomit takes place, There is now great distention
of the abdomen, from flatus in the Intestines, which is either
a precursor of Gangrene, or an evidence of its existence.
Besides the regular symptoms, there are some anomalous, called
 delusive sympathies. The stomach has been highly inflamed
without the existence of any symptoms denoting its presence.
Inflammation may terminate in this regard, in resolution,
Suppuration, Ulceration or Gangrene and Schirrus. Acute inflammation 
if properly treated is most apt to terminate in Gangrene.
Scirrous and ulceration, are more frequent terminations of Chronic
Inflammation. 




165
The ordinary appearances on Dissection, are thickening of the
coats of the organ, redness of the inner membrane, with spots of
extravased blood. The redness appears more frequent in streaks
than in the blush like form. In malignant forms, or in cases
in which poisons have been swallowed, we find Gangrene
with erosions of the mucous Coat. Symptoms of Inflammation
have been found post mortem, when the disease certainly 
did not exist, which should be remembered, when we examine
the stomach of persons, supposed to have been poisoned. This
fact was first noticed by Dr Lillowly of London. It has been 
confirmed here in part. Dr Laurence found the vessels of the
stomach injected in a man, who had hanged himself. In 
another who had been drowned, it was not observed.
To distinguish the imitative from the real appearances
of Inflammation, is a smaller of considerable importance.
In Inflammation we have effusions of Lymph, with thickening,
ulceration or Gangrene of the mucous coat. The initiative
appearances of Inflammation in cases where the disease 
did not exist, are to be ascribed to the fact, that the stomach 
if not the Primum [Viveus], is certainly the ultimum [mor??]
and therefore retains its blood longer than other parts.
Treatment
The indications of Cure are obvious. We have to deal with 
an active Inflammation, seated in a very delicate organ, wh:
is rapidly advancing to its termination. It is our duty to meet
it with prompt and powerful remedies. Confessedly at the head
of these is Venesection. Regardless of the state of the pulse or the
degree of Fever, and prostration of strength, we must if there 
is acute pain bleed copiously (20 or 30 zi at the commencement,
and the operation must in many cases be repeated to the same
extent. I wish to impress on you the Importance of the early 




166
and free use of the lancet; You will find upon perusing most
authors, that small and repeated bleedings are advised; This is the
most pernicious advise that you can follow. You must remember
that the pulse and degree of fever are no guides for you 
It is one of the peculiarities of this inflammation that the
strength of the whole body, and especially that of the Heart, is
so much impaired, that there is hardly any action. By drawing
blood the energies of the system are developed, and you 
have an open case of Inflammation to manage. This is one
of those conditions of the system, in which the oppression 
results from stimulus. After free generall bleeding, Local
Bleeding should be resorted to.
After local bleeding Blisters come next, which 
are second in importance to bloodletting. Your own reason 
will teach you that as the disease is primarily seated in the 
stomach, they should be applied over that organ, and
ought to be sufficiently large to cover the whole Epigastric
region. When they are small, we derive from them 
comparatively little benefit, but if extensive, they are highly 
valuable. Fomentations of hot water or spirit in 
bladders may be used, and afford some relief.
The extreme irritability of the stomach precludes the 
use of internal remedies. The Bowels should be opened with 
Emolient Glysters, which as they act mechanically should
be large and mild. They should consist of a pint and a half
of water with sweet oil or molasses, and as the object is 
to foment, as well as Evacuate, they should be frequently 
repeated. As soon as the stomach, will receive any 
thing Castor Oil or Calomel should be given. I prefer the
Calomel, which may be given in cases of inflamed
Bowels, without any fear of aggravating the Complaint.
It seems rather calculated to reduce inflammation and will 




167
generally be retained if it linger or should be rejected, give
Epson salts. When larger doses fail Calomel will sometimes
succeed in doses of ¼ or 1/6 of a gr, every half hour. In the
Cholera Morbus of children, I know of nothing more valuable
than Calomel. I have often known it, to check the 
vomiting immediately buy turning the disease downwards.
We should endeavour to calm the stomach from the first
For this purpose Lime water & milk, Seltzer water etc. may 
be tried. In some cases, great advantage has been obtained
from anodyne Injections, which soothe pain, lessen
irritability & produce general composure. It has been 
common in this disease to administer copious draughts 
of Demulcent drinks but they are highly prejudicial.
They offend by their quantity and keep up a constant 
irritation and vomiting. The drinks should as sparing 
as possible; milk is the best article to allay thirst; 
The Warm Bark has been much used in this disease
but it should not be resorted to until after the use o f
the depleting remedies, when it becomes highly useful
by inducing perspiraton and allaying irritability.
When Gangrene is about to supervene, use opium & 
spirit of Turpentine the last is valuable even in the sinking
conditions of the system, aided by Rubefacients.
Having disposed of Gastritis from ordinary [cu???s] we
now come to treat of Poisons.
These are exceedingly various, there being scarcely an article
of the materia medica, which may not prove poisonous in 
large doses. They may be treated of under 2 heads the narcotic
and Corrosive.
All of the former affect the Brain and nerves primarily disturbance 
but when reaction takes place, we have considerable dist




168
of the blood vessels, under the operation of some articles
of this class, however, no reaction ensues, and the brain and
nerves bear the whole impression.
Of the Class of Narcotics, opium is the article from the use
mischief is most apt to arise. When called to a case in which 
large quantities of opium have been swallowed the first indication
is to evacuate the stomach. For this purpose a combination of 
Tart Emetic & Ipecacuanha, in large doses should
be given. From the external loss of tone, we are in some cases
unable to excite vomiting 20 or 30 grs o f Tart Emetic may 
be thrown up the Rectum, and large quantities of warm water 
should be drunk. If these measures should fail, we
must endeavour to Pump out the Poison from the stomach
means of the Instrument for that purpose, if it can
be obtained. The application of Cold to the head by means 
of cloths, wrung out of Cold water, or by means of Ice; or to 
the whole body by throwing in Bucketfuls of Cold water, 
will sometimes restore the susceptibility of the stomach
and occasion vomiting when poisons have been swallowed
after other things fail.
There are certain effects which remain after the operation
of these poisons, as a morbid tendency to sleep, stertorous
respiration etc. To prevent these it was formerly the practice
to keep the patient in motion more however may be expected
from sinapisms to the extremities, and stimulating injections.
It is probable that Castigation would have a good effect in desperate
cases. In these cases it was formerly common to give
vinegar or Lemon Juice under the idea that they were antidotes
to opium; but this has been shown to be erroneous. When vinegar
is given before the opium is evacuated, an [illegible] of morphium 
is formed, which is much more active than the opium 
itself. Acids do however correct the opiate action; and when the 





169
opium has been evacuated, may be given with great advantage
It has lately been said, that the Carbonate of Ammonia is the
best article in this Class. When Febrile symptoms appear in 
these cases, they do not bear depletion as under other circumstances.
The effects of other narcotics are to be treated in 
the same way. Digitalis & Tobacco, when given in large doses 
are so directly sedative, as to reduce the system below the power of 
reacting in which case stimulants become necessary to support
the remnant of life. Aether is here very useful; or Carbon ammoniae,
or Spirit of Turpentine But when any of the sedatives 
have been taken Brandy and water, half and half; constitutes
the best remedy. when the stomach is very irritable give Tinct [illegible]
When a person has drunk inordinately of strong liquor
there are generally evidences, of a considerable determination
to the Head, with most of the symptoms of Apoplexy, from 
which the case is to be distinguished by its history and the
odour of the patients breath. It is said that the occasional use
of opium, during a drinking frolic, resists the tendency to 
intoxication it is regarded as the Counter-agent of alcohol
and Digitalis. A German Physician has stated that Cabbage
is the Counter agent of Alcohol.
vomiting should first be excited in these cases by some
active article, and acid liquors then administered with cold applications 
to the Head. If the apopleptic symptoms are urgent
bleeding in some cases should be resorted to. The symptoms of 
inflammatory action, are often delusive, and should not
deceive us to use depletion too freely. The most inflammatory 
diseases when occurring in habitual drunkards, do not 
bear much depletion. The vital resiliency or elasticity [illegible]
of the Constitution is destroyed and the system will generally 
not react.




170
Connected with the fever of Drunkards, we may, with 
propriety make a few remarks on Mania apotu. This affection 
generally makes its appearance after the accustomed stimulus is withdrawn.
An attack is generally ushered in with soreness of the eyes 
suffusion of the Face, vi9olent pulsation of the Carotids, with hot
and parched skin. The pulse is strong and full but readily compressible
& the tongue parched with head ache. In the advanced
stage the strength is much reduced; but sometimes we have
paroxysms of prodigious strength, followed by great relaxation 
and Convulsions. The mind which in the commencement was
 much disturbed, in the latter stages, becomes the [illegible] of every alarming
hallucination, which the deranged imagination can conjure
up they are very apt to think that the house is falling or that
some person is going to murder them. On superficial
examination we should be disposed to deplete, but precisely 
an opposite course becomes necessary. Hot Toddy should 
be given freely, and the patient should be confined in a dark
room, free from noise or other disturbance, in order that 
sleep may come on which is a sine qua non. In the 
commencement give Neutral Mixtures with laudanum
of the latter very large doses in conjunction with Brandy 
Toddy are sometimes required. In some cases the susceptibility 
of the system becomes exhausted. To restore it
an Emetic should be given, if the strength permit. After
which the opiate and Brandy treatment should be urged so 
as to produce sleep. After sleep has once been procured
the patient convalesces rapidly. The practice of treating
extremely debilitated cases of this disease with emetics is very 
hazardous. I lost 2 patients by it. So liable is it to do injury
in the cases of habitual drunkards, that their use has generally 
been abandoned in this City, under such circumstances. When it
arises in Constitution, which have not lost their integrity from 





171
habitual drunkenness, Emetics may be beneficial. In prostrated
cases, the Camphor and opium, vol alkali, musk, julep or
Assafoetida should be resorted to. To remove morbid vigilance
The tincture of Hop in doses of zfs is the best remedy.
Of Mineral or Corosive Poisons
The nature of the mineral substances, which operate as poison
on the human body, will be told you by the Professor of another
department; It is my duty to speak of the manner of preventing
or curing their morbid effects. In the first place Emetics
and the other means of exciting vomiting are required in these
cases. After evacuation there are certain antidotes to be used.
The symptoms produced by Mercurial Poisons are great thirst
fulness, burning, constriction of the Throat & great anxiety with 
vomiting of Black matter. To these symptoms which are those
from poisoning by all metallic substances, a metallic taste lancinating
pain in the stomach & Bowels. The most common mineral
poison is Corrosive Sublimate. There is at no stage much 
general Excitement. The pulse is small and quick, the skin cold 
and clammy, succeeded by great debility with vomiting and purging 
of dark matter, cold sweats, haggard Countenance, diminutive
pulse, Cramps, Convulsions, and death. The antidote for mercury
is albumem the practical inference from which is to 
administer the white of Eggs or milk. The same course is to be
pursued with regard to preperations of Tin. If these fail
the case is then to be managed on general principles.
The only symptoms peculiar to Copper are a copperish taste
and in some cases a most copious discharge of water, amounting
to Pyrosis. The antidote for copper is sugar or molasses 
or any thing containing a large portion of the saccharin 
principle. The antidote for the nitrate of silver is common salt
Lead is distinguished by a sweetish astringent metallic taste 




172
Its antidote is sulphate of magnesia, or soda. The sulphates 
of magnesia and soda are also the corrections of the preparation 
of Baryty
The antimonial Preparations are followed by violent 
vomiting & cramps. In some cases, however sensibly is 
so much distroyed, that vomiting does not take place.
An infusion of Bark, Common Tea, or any astringent is
the proper antidote for the antimonial preparations.
The mineral acids cause an intense heat in the stomach. Calcined
magnesia, or the Carbonated Alkalies should be given.
The Alkalies give use to a peculiar, [urinous], caustic taste.
common vinegar is the antidote. We have as yet no
antidote for Bismuth, Zinc, Nitre, Muriate of Ammonia,
Phosphoric or Arsenic. Nitre occasions violent heat
& Cramp with great suffering. It induces violent inflammation 
of the stomach which is to be treated by copious 
VS. Cups, Blisters etc. The same treatment is required when 
Phosphorus has been swallowed. 
When Arsenic has been swallowed, the stomach shd 
be evacuated by the means mentioned for the ejection of opium
mucilage should then be pourd in oil has been recommended, 
but it has been shown to increase the activity of the
Arsenic and shd of course be avoided,  when we have not been 
able to evacuate the person successfully, a fever resembling
Yellow Fever is sometimes occasioned. For the care of which 
Bleeding. Blistering & Soothing medicines should be resorted
to. In the sinking state of the system, the spts of Turpentine
is the best remedy. Bertrand recommended Charcoal as an
antidote for Arsenic, but it is possessed of no efficacy.
Mr Hume an ingenious apothecary of London has recommended 
the following Rx Carb Magnesia zi, Aquae fontan zxv, vin
opii zifs, Spts Laud ziii, Sacch alb zfs. Dose 2 tablespoonful every
10 or 18 minutes.





173
We are not in any case of poisoning to depend on antidotes to 
the neglect of the various means of Evacuating the stomach.
We first pump out the stomach, then puke, and afterward
give antidotes. In the sinking conditions of the system 
from the use of Arsenick, give Turpentine by the mouth 
and rectum. Apply Sinapisms to the extremities and rubefacients 
to the surface. with many symptoms of immediate
dissolution, patients generally live for several days 
after taking arsenic. I once knew a woman to take zii 
and she did not die until the 3rd day.
Enteritis
The disease in its symptoms, treatments, and many of its 
causes, is so closely allied to Gastritis, that I need say but
little concerning it. Its most common causes are Cold
and Constipation it is frequently consequent to the spasm
of Colic. The symptoms are acute pain about the 
umbilicus, increased on pressure, much thirst, anxiety & 
restlessness, with a small, weak and quick pulse.
If the pain gradually subsides, the bowels become ulcers and 
natural stools are voided; if the pulse become fuller & the 
skin soft, we may Calculate on a favourable termination.
The most important of all remedies is VS. The Bowels 
are constipated in consequence of their inability to propel their
contents; All parts in a state of Inflammation being possessed
of less power than when in health. By VS we relieve
the inflammation & thus enable the vessels to unload themselves
spontaneously or by slight assistance. I have frequently 
known a patient to desire to go to stool before the 
arm could be tied up; after a copious bleeding.
The treatment of this disease as it regarded the use of purgatives,
differs from that of Gastritis in this: that in Enteritis 




174
you open the Bowels immediately without the necessity 
of waiting for the irritability of the stomach to [subside] 
as in the former case. For this purpose Calomel is to be preferd
It should be given in doses of 2 or 3 grs every hour or two until 
it operate if it be sluggish in its operation Epson salts
should be given. the residue of the treatment is so nearly 
identical with that for Gastritis, that it need not be detailed.
Peritonitis
Inflammation of the Peritoneum, is more insidious in its
Commencement, than either Gastritis or Enteritis. Like the
inflammations of the Alimentary Canal, it commences with 
chills, accompanied by pains in different parts of the body 
to which Fever supervenes. The length of the Cold stage is 
very various commonly for a day or two. When reaction takes 
place we have head ache, hot skin, pain in different parts
of the abdomen, dryness of the Tongue & Fauces. The pulse is small
quick and corded with much gastric distress, and the Bowels are 
uniformly constipated; the pain is much augmented by pressure
and tenderness is complained of, over the whole region of the abdomen
In the Course of 24 hrs the weight of the bed clothes cannot be
bourne. As the disease advances the Tongue becomes
more or less encrusted, and the Countenance is distressed. The 
pulse rises to 120 or 139, the abdomen continues to enlarge. In 
some cases the pain ceases suddenly, without any amelioration
of the other symptoms, which is always a bad sign.
In advanced stages the pulse is generally increased in frequency
but is diminished in force; and a Black matter is ejected
by a kind of singultus, Cold clammy sweats appear and at length
difficult respiration and death. Cases sometimes occur in which 
the disease runs on to its termination, without being attended by any 
of its symptoms.
The Causes are such as excite the Phlegmonic generally 
one of the most common is sleeping in damp beds or lying on  




175
damp ground. It is also induced by the Infiltration of Certain 
fluids into the Cavity of the Peritoneum, and by blows or violent [illegible]
of the abdominal Muscles. This disease in some cases spreads rapidly 
and would seem to have been dependant on an Epidemic
influence. Broussais, Hey & others say that the disease is contagious
but I cannot believe it.
It may be induced Secondarily, by the extension of some
other disease to the Peritoneum. It may be confounded with 
Gastritis & Enteritis. In Peritonitis, there is no immediate ease
from evacuations of the bowels, whilst in Enteritis, the relief
from opening the bowels is a remarkable Symptom. The patient
is disposed to lie on his back, by which the weight of the bowels 
is taken off from the inflamed membrane. The pain in Peritonitis
is more constant than in Colic & more lancinating than 
in Enteritis. If the patient attempt to erect his body or make 
a deep inspiration in Peritonitis the pain is very severe. Between
this disease and Gastritis, after the latter has extended to the Peritoneum; 
there is no difference.
It sometimes terminates in Gangrene, but never in 
ulceration it may also terminate by extravasation of Coagulable
lymph. There is no disease in which the
practice is more unsettled whilst some advice the opiate
practice, others are equally in favour of the depleting plan
of treatment. There is certainly some peculiarity in this inflammation,
arising out of the structure of the tissue in wh:
it is situated. Guided by my own experience, I draw in 
the first instance as much blood as the strength will permit
the pulse being but little guide; The bleeding generally [???nts]
to 20 or 30 zf. As in Gastritis, we have an inflammation 
[illegible] in its progress which must soon terminate fatally if
not arrested. The bleeding should be repeated the same day if
the disease do not yield to the first. Leeches should be applied
to the abdomen, in number sufficiently great to draw 12 or 18 [illegible] of
blood, which is of great importance VS will not do without it.




176
Blisters are very useful, when well timed, but if resorted too early 
they increase the fever. Then we should always be preceded by 
liberal depletion and fermentations to the abdomen by means 
of [mush] Poultice. Cold applications have been [usually] recommended,
but I am very distrustful of them warmth is
much better.
Peritonitis has been considered as a disease, in which 
an attention to the bowels, did not constitute a primary 
indications. I think that Purging, as one of the assistants 
to VS. is highly useful, and has been too much neglected.
Depletion such as we have mentioned proving insufficient,
we next resort to Diaphoresis, which act with centrifugal
force. To induce sweating, Dovers powder, aided by the 
vapour bath, is a very good remedy. Sweating in these cases
by determining to the surface, draws blood out of the inflamed
membrane and relieves the capillaries. I once attended 
a case of Peritonitis in company with Drs Wistar and
Physick, in which all the common remedies had been used 
without effect, when the most decided advantage resulted
from sweating induced by the vapour bath. In the 
incipient state of Gangrene, Calomel & opium are generally 
prescribed, but I have found the spts Turpentine more useful
In oppressed or locked up cases, we do not deplete too freely 
at first; but we should use the warm bath. Mild Diaphoretics,
and moderate VS. when the system reacts we have
an open disease, requiring the free use of the lancet
Chronic Peritonitis
Examinations post mortem, prove that terminations of 
Inflammation are very various, in this membrane.
The most common of these, when the disease proves fatal
is Gangrene; but the inflammation, sometimes subsides, 






177
into a half cured case, constituting the disease now under consideration.
There are however cases of this disease, which are primary 
arising from causes similar to those which produce the 
acute Inflammation.
The disease is generally ushered in by soreness of 
the abdomen, acceleration of the pulse, furred tongue & pale face.
After which we have anorexia constipation of the bowels
languor and anxiety, which in some cases continue for a 
considerable length of time, and then an acute disease is
developed. The disease generally pursues a very silent course
rendering it an exceedingly difficult matter to discover its [??istence].
In the advanced periods we have a slower fever 
of the Hectic Kind, the face is flushed and the abdomen painfully 
distended. This distention proceeds either from the thickening
of the Peritoneal Coat or from dropsical effusion. Diarrhoea 
is often associated with the advanced stages. All the causes of
Acute Peritonitis, acting on a debilitated from, or a slow
phlegmatic habit, produce the chronic form. Hence it
occurs most frequently in the lower classes of society Particularly amongst those who work with their  bodies bent
as in Shoe Making Taylors, Weavers etc.
The appearances on dissection are thickening of the membrane
or the changes of stricture, as granulations, tubercles, ulceration
etc: agglutination of the intestines; dropsical effusions,
and effusions of a whitish curdled matter resembling milk.
The protracted chronic Peritonitis, which had originally been
an acute disease, is to be regarded as a relapse and is to be 
treated as such, making proper allowances for debility.
An original case of Chronic Peritonitis has been regarded as incurable: 
but in the Commencement the inflammatory 
diathesis, which lays the foundation of the subsequent mischief
might be cured. Whilst the disease is properly of a chronic
nature, it should be treated by occasional VS, local bleeding 


178
by leeches, Purging; and the antiphlogistic regimen generally. If 
these be not sufficient resort to the combination of Calomel
Ipecacuanha & opium, used so as to act rather as an alterative
than salivant
Colic.
This disease has been defined a painful distention of the lower 
abdomen, with a sense of twisting about the umbilicus accompanied
by vomiting, constipation and spasmodic contraction
of the abdominal measles. For the purpose of practical convenience 
this disease may be divided into 3 kinds: the Flatulent 
Biliary & Colica Putonum
Flatulent Colic is induced by indigestible food as Cabbage [illegible] 
by cold, and by Constipation. When it proceeds from indigestible
food, the stomach is affected with sickness and vomiting.
The pulse is at first not much affected, but if the disease continue
violent, it becomes feeble and diminution, with clammy 
sweat, when Inflammation comes on which it is apt to do
if the stricture continue the pulse is still small though 
hard and corded with tenderness of the abdomen and increase
of temperature. The pain is paroxysmal attended by flatulence
7 corresponding intumescence. When there is a free
discharge of foeces and wind, with diminution of pain and 
warmth of the surface appears we may calculate on recovery.
On the contrary when the constipation continues obstinate,
with feeble pulse, clammy surface [illegible] expression
of countenance and turbid abdomen. Gangrene may 
be expected. Stercoracious vomiting is generally fatal.
On Digestion we find distention from flatus. Inflammation 
of Gangrene of the large intestines with irregular contractions 
of the bowels. they are sometimes [met] with alternately contracted and 




179
dilated. The pathology of the disease seems to be generally 
agreed on: A stricture from spasm takes place in some part 
of the intestinal canal, which continuing in production of Inflammation.
This constriction generally exists in the stomach or 
colon.
If the spasm continue 6 or 9 hrs, Inflammation is apt 
to supervene. What is the immediate cause of pain is a 
matter of some doubt. It has been though to depend on spasmodic
constriction, but this is not always productive of pain
as we see in convulsions. It has been supposed to depend on 
preternatural distention from flatus, consequent to the 
stricture. I think both causes conspire to produce the effect
In cases resulting from indigestible food, the indications of cure 
are twofold. 1st To assist the evacuation of the stomach by 
Chamomile Tea or an Emetic: & 2nd To relieve the spasm for
fulfilling the second indication, Toddy, Ginger Tea, Aether
Pepper mint and laudanum may be given. An excellent
mode of giving aether in these cases is to dissolve zi of sugar
zii of water, and add zfs of Aether. The spt of Turpentine has
been used to relieve the spasm, in doses of at Teaspoonful every 
15 or 20 minutes. The unpleasant taste of this medicine may 
be removed by shaking it up with alcohol and then seperating
them. One of the best prescriptions, for this purpose 
is oleum Terebinth zi ol Menth zi mix them and give the
patient 40 or 50 drops in sugar and water. Water as hot as
the patient can bear sipped by the teaspoonful will often relieve 
spasm. when you wish to give an Injection in 
Flatulent Colic, either to open the bowels or Expel wind. Take 
pint of water for an Emulsion or dissolve assafoetida in 
hot water and inject it. when colic proceeds from cold
we resort immediately to the use of remedies for reducing spasm 
without evacuating the stomach. We should also apply warmth 
to the surface by means of hot bricks to the feet and fomentations to the abdomen.




190
After the disease is suspended the bowels should be kept open to prevent
a relapse. The Iliac Passion may depend on Intussusception
or inverted Peristaltic motion. The leading indication is to [illegible]
on the Bowels by purging or Injection. If we cannot succeed in this
we shall put the patient under the opiate Impression, by injecting
2 or 300 drops of Laudanum into the Rectum, which may 
be repeated every 5 or 6 hours until the vomiting may be [allayed].
Bilious Colic
The disease is Endemic in some climate it is for the [illegible] part
a form of Bilious fever. on the first accession of warm weather
we have in this city, Bilious Colic, & Cholera morbus, then
Bilious Fever, and lastly Dysentery.
Bilious colic frequently comes on, with a chill, and is attended 
with considerable accumulation of Bile, with activity of the 
arteries & [excrutiating] pain about the umbilicus, with vomiting.
The head is often much affected, and depraved vision is common.
I once knew of a case in which the patient was blind during
the remission of pain, but had his sight restored when the spasm 
returned. After the pain left him, he remained blind and his 
sight was restored by irritating the bowels by drastic purgatives
On Dissection, the liver is found in various degrees of congestion,
with Inflammation of the stomach and small intestines.
As a febrile affection attended by spasm VS. constitutes
the first remedy 20 or 30 z of blood should be taken away 
in violent fever. We should then open the bowels, which are
for the most part obstinately constipated. Articles introduced 
for this purpose are frequently rejected. Opium by the mouth 
to allay this irritation is a [precarious] remedy. it is better to 
inject it. To assist in accomplishing this purpose the warm 
water should be used. If these measures fail, Bleed again 
and give aperient Injections Senna Tea [illegible]with zii
Jalap Tart Emetic 20 or 30 grs Distending the bowels with one or two 
quarts of warm water. The Tobacco [Injection], or what is safer the 





181
Fumes or suppository may also be used. If the regular apparatus
is not at hand, we may blow up the fumes by means of a common 
clay pipe, with the stem introduced into the anus, and 
a piece of linen placed over the bowl Cold water thrown up the
Rectum, will sometimes have a good effect. The mildest enemata
sometimes succeed when the most powerful will not; the bowels
are here in a very irritable state and stimulating articles excite 
and confirm the spasm. Our failure with Injections is often owing
to our imperfect means of throwing them up. In introducing 
a short pipe the Rectum is frequently irritated & contracts 
spasmodically, so that the Injections runs out immediately. The 
proper Instrument is a Catheter like that of the Oesophagus, 9 
or 10 inches long, and as large as the finger. By this means I 
have thrown up from 4 to 6 quarts of warm water. An opiate
Injection sometimes removes the spasm, when every thing else
fails. Throw up 4 or 400 drops of Laudanum into the Rectum or
suppository of opium 6 or 9 grs may be placed in the Rectum. A 
candle introduced and suffered to remain 5 or 10 minutes will sometimes
succeed. After having allayed the vomiting purgatives 
should be administered. It is a remarkable fact that the [mildest]
laxative, will sometimes operate, when Drastic purgatives fail
there would seem to be a certain harmony between the tone of 
the system, and the power of some medicine, which should 
always be attended to. my favorite prescription is 2 or 3 grs of 
opium, with 12 or 16 of Calomel, repeated every 4 or 5 hours in urgent
cases. The spasm is removed by the opium where the Calomel is 
enabled to purge.
Blisters large enough to cover the greater part of the abdomen
are of much importance. Professor Hosack has addressed
Emetics in Bilious Colic, with the view of exciting the bilious secretion
which he believes, to be deficient in many cases and also for the purpose
of inducing general relaxation. It is a favorite practice 
with Dr Physick, which he says he learned from Mr Hunter, to
give Tart Emetics in nauseating doses, so as to relieve the system 




182
and thus remove spasm. After the stomach has been quieted, one
of the most prompt purgatives is zi Castor Oil, with zi Spts Turpentine
The Croton Oil in doses of one drop is well suited to cases in wh:
arterial action has been reduced. When every thing else fails in 
Bilious Colic, Salivate. I never knew a case to terminate fatally,
in which Salivation was effected. the manner in which salivation
operates, in relieving constipation is by increasing the Biliary sensation.
So soon as the mouth becomes affected purging generally 
takes place.
Colica Pictonum
The disease is brought on by the use of lead in various ways. The
practice of sweetening acid wines with lead, in the province of [P??t?]
in France gave rise to this Cilic and hence the name. It has also
been called Devonshire Colic, because it is induced by the use of Cider
sweetened in the same way in Devonshire in England. It has 
been brought on by sleeping in newly painted rooms, but it is generally 
met with among the workers in lead as miners, glaziers & especially 
in Printers and Painters. A disease of exactly the same [matter]
is produced by Cold, unnatural accumulations of acrid bile, flatulent 
vegetables etc. It comes on with pain at the pit of the 
Stomach, extending downwards, great sickness and anxiety, thirst
obstinate constipation & tremors, with a small quick and corded
pulse, differing from the full strong and voluminous one,
met with in Bilious Colic. In the second stage we have more
violent pain with soreness of the abdomen, the abdominal
muscles are thrown into hard and irregular knots; and there
is a vomiting of Blk bile with Paralysis. The disease hardly 
ever yields, in less than 5 or 6 days and is prone to relapse. It is
apt to settle down into Palsy of the superior extremities, or it
terminates in Chorea or Epilepsy. The indications of cure
are the same as in colic Bilious. 1st To induce action. 2nd 
to evacuate the bowels. To accomplish the first indication VS.
is the remedy. Regardless of the state of the pulse we should promptly 
abstract blood, graduating the quantity to the urgency of the symptoms.





183
To meet the 2n Indication Calomel & Opium should be given.
After the attack has been reduced, the Bowels should be preserved
in a soluble Condition by means of Castor Oil, or some other
laxative. At this stage of the disease, a large Blister should
be applied to the abdomen. To mitigate pain and carry off the 
remnant of disease Alum has been given in doses of 10 or 15 grs
every 5 hours by Percival. I prefer opium combined with laxatives
to meet the indication. Dr Mosely prefers the vitriolic
Solution to Alum in these Cases he gave a tablespoonful every 
4 or 5 hours. The volatile Tincture of Guiacum has also been 
used. The Nitrate of silver has been sued by Dr Roberts of London
in doses of from 3 to 5 grs 3 times a day, increased to 5 grs every 
6 hours in which quantity it acts as a purgative. Judging 
from my own experience, however I should say that the
most efficacious practice is to salivate with mercury. By 
this remedy we not only cure the diseases but also prevent 
or remove the Palsy consequent to it. It has lately been 
said that Lad and Mercury are Counter agents & hence that
one should be given to correct the action of the other. From 
the few trials I have made I am disposed to confide in the 
Statement.
Cholera Morbus.
This disease is one of warm weather chiefly though generally to 
be regarded as a form of autumnal Disease. It results in 
some cases from Anger, Cold, or Indigestible food. The cases
occurring from these causes are rare, however, and perhaps always
require a state of Predisposition. It is sometimes epidemic
Eight or Ten years ago, or broke out in a more violent form in 
India, than had been known there before, and since that period
it is said to carry of a million of Inhabitants annually. They 
have attributed it to putrid Rice etc. but it is dependant on an 
Epidemic Influence.
The symptoms are an excessive vomiting and Purging
of Bilious matter, with Pain and griping. 




184
It usually comes on with soreness, distention and flatulence.
A great diminution of [grength] supervenes with much Gastric
distress. Cramps etc. It is distinguished from Colic by the absence
of Constipation; from Dysentery by the nature of the
discharges. This is properly a Gastric disease. The primary 
operation of the [illegible] is on the stomach, which becomes
highly irritated, and the disease is extended to the liver, increasing
the secretion of bile. In proof of the this first discharges
are the contents of the stomach alone, unmixed with Bile, but 
they after a while become Bilious.X By the Continuance of 
the disease, the Energies of the stomach, on which the various
parts of the body so closely depend give way, and the liver, losing
its tone, becomes engorged. 
Although the Disease has its origin in irritation o f
the stomach, it becomes necessary to evacuate the large accumulations
of bile, which [illegible] before we attempt to calm the
irritation. To do this I prefer an Emetic to diluent. The former
relieves the system from oppression and excites it to 
actively. I gave [?i] Ipecacuanha, with plenty of warm water. 
When there is spasm, with much pain, VS. must be resorted
to, if the patients strength justify it the pulse is no guide.
To relieve the irritability of the stomach an old opium pill or
laudanum by injection is the best remedy. From its great
utility in arresting something in Bilious Fever, I suspect 
the sugar of lead would be a good remedy here. The lime
water and milk should also be used. Minute doses of 
Calomel or spt Turpentine, may also be resorted to. To give
tone to the stomach and bowels and prevent a relapse, direct
the vegetable bitters, as Columbo, Quassia etc. with Elixir
vitriol: Flannel to the skin, and a careful avoidance of 
Cold or other exciting causes of the disease.
X I believe the primary cause is congestion of the Liver
as soon as bilious discharges take plce the patient is relieved 
EGJ






185
Cholera Infantum
This disease is almost peculiar to the climate of the US. Children
are most subject to it between the age of 12 & 18 months or the
summer after they are weaned. It occurs early in July and continues
to prevail until frost. In South Carolina it commences
as early as May.
In some cases it come on as simple Diarrhea but frequently 
the stomach is affected with nausea and vomiting.
It is sometimes attended with considerable spasm, in which case
it does not differ from the Cholera of adults in other cases it
appears in the form of dysentery. The fever which supervenes
is generally of the Remittent character, the pulse, is small, quick
& irritated. The Thirst excessive. There is always a very inequal
distribution of temperature, the head and region of the abdomen being
hot whilst the extremities are cold.
The discharges from the bowels are exceedingly various, presenting
widely different indications. The natural foeces are usually 
returned, whilst slimy, then discharges occasionally mixed with
blood come away. the colour is greenish or yellow or resembles 
the Latura Carnium. There is no disease in which emaciation 
more rapidly takes place. when the disease assumes
the character of Cholera morbus, it runs to course very 
speedily; but when it takes on the form of Dysentery it
generally continues from 3 to 15 days. When the pulse 
become fuller and slower the temperature Equalizes, irritability
calmed, and the discharges changed to a natural
colour, or become dark and tenacious, evincing a restoration 
of the Bilious Secretion, we may judge favourably. on the
contrary if these symptoms be absent if there be great
sensibility is remarkable insensibility and if the discharges
give the napkin, a pink colour we must expect our unfavaourable
termination. 





186
On dissection in recent cases, we find no morbid appearances
of Consequence, in the Brain, except congestion; in older
cases, we find effusions laying the foundation of Hydrocephalus.
Dark livid spots are found on the small intestines,
with effusions of Coagulable lymph, and thickening of the
coats of the Bowels. The large Intestines are never involved
unless the Disease had assumed the Dysenteric form. The 
liver is always greatly enlarged, without any apparent derangement
of structure. The Boles contain a tin tenacious mucus occasionally involving lymps of foecal matter.
The remote or predisponent cause of the disease would appear 
to be the impure air of large Cities. The exciting causes are
Cold, Dentition, Indigestible food, too early weaning etc.
The primary operation of the cause is on the stomach
from which the impression is transmitted to the Liver.
This organ becomes stimulated to considerable activity but
its increased action is followed after a while by depression.
The state of exhaustion or torpor gives use to engorgement
or congestion. In some cases the remote cause operates so powerfully,
that the functions of the liver and of the stomach are
suspended, and we have neither Bilious secretions nor digestion.
In mild cases we commence the Treatment with purging.
In more intractable forms, other medicines must precede this
according to the symptoms. But you can never cure the disease
until you restore the secretion of the liver. In violent cases 
we should commence the treatment by endeavouring to allay 
the irritability of the stomach by lime water, Alkaline Mixtures;
strong Coffee, a teaspoonful every 10 or 15 minutes, fomentations
with a [clove] bag, or general warm bath, or by Anodyne
Injections. We next resort to Calomel & opium, 
in preference to castor Oil. Calomel by its weight frequently 
remains on the stomach when nothing else will. The proportion
must depend on the age of the patient and other circumstances’;




187
From 1 to ½ gr Calomel with 1/8 or 1/16 gr opium, every hour when the 
Irritability of the stomach is very great, the quantity of Calomel
should be diminished to 1/4 , 1/8 or 1/16 gr and the opium increased. The 
effects produced by very minute doses of Calomel, in irritable
conditions of the Primae Viae, are astonishing to persons who 
are unacquainted with its use in such cases. Adapted as 
the remedies mentioned may be to the ordinary forms of 
the disease, they are insufficient in more urgent cases.
If the irritability of the stomach, will not admit of 
the exhibition of other medicines, a gentle Emetic of Ipecac
should be administered provided there be no Symptoms 
of Inflammation of the Stomach, nor too much protraction 
of power. It tends to produce ulceration of the surface,
and to direct disease thither, and to relieve the stomach 
of its offensive contents. When there is much prostration
of power, they are inadmissible. In that case
the warm bath with irritating frictions, Sinapisms and
opium should be resorted to. As in every other febrile 
affection, if we find any hardness of the pulse, VS is required. 
we often bleed 3 or 4 times in this disease when there 
is any fixed pain in the abdomen, Local bleeding becomes 
necessary. After the Stomach has been prepared for it
a mercurial purge should be given; which [??dges] the Liver
and evacuates the bowels. If the discharges are bilious, dark
and tenacious, we must keep up the Evacuation, until they 
are altered. If on the contrary the stools are watery, give
small doses of Calomel and opium. Opium 2 gre Cal 2 or 3 grs
Ipecac 2 grs To be divided into 8 or 10 powders, of which one
may be given every hour.  After you have continued the
prescription for 1 or 3 days give a dose of oil and [recur] to the
Calomel and opium. Whenever symptoms of Congested Liver
or reaccumulation in the bowels takes place we must recur 
again to purgatives.
It has long been my opinion, that we purge too 
much in the profluvia. The accumulation of acrid matter in these
cases is the effect of previous irritation in the stomach and limbs 





188
occasioning increased effusion upon the mucous follicles. [illegible]
to combinations of Calomel, Ipecac & opium to correct this condition 
and interpose a mild Purgative occasionally, to remove any acrid
matter which may accumulate. The warm Bath is an
important remedy, when there is much inequality of temperature.
The effects of this remedy are very evanescent; In cases
of great debility we may add salt, Brandy, Mustard etc. to 
the bath, and use friction on taking the patient out of it.
Blisters applied to the Stomach, Abdomen and Extremities
are of much value when the skin is very dry they frequently
promote perspiration. In cases of Cholera, in which 
the stomach and Bowels are highly irritable the oleaginous mixture
may be used or, what is better, Injections of [melted Butter]
Combinations of Sacchar Saturni, opium & ipecac have an 
excellent effect in these cases; or Creta Preparatae zii, Laud
10 drops, Sacch Alb zi water ziii. Dose a dessert spoonful:
or Rhubarb 15 grs, Calcined Mag 30 grs Laudanum 10 drops water
ziii. Dose a dessert spoonful. After a while this disease is 
much disposed to run into Diarrhoea. The stomach becomes 
exceedingly irritable and loses the power of digestion. The 
preparations, with anodyne Injections, are here the appropriate
remedies. Sal Tart zii Cret Preparat. zii. Tinct opii gutt 15 Sacch
alb zi, water zi. Dose a teaspoonful every 2 or 3 hrs or the
Spiced Rhubarb, which is well suited to these cases, or Combinations
of Chalk, with Tinct of Kino; Thus Creta Preparat:
zii Tinct Kino zi, with a small quantity of Laudanum, to 
2 or 3 [illegible] of water. Dr Physick is much in the habit of giving 
a saturated decoction of Dogwood, in doses of a dessert spoonful 
every 2 or 3 hrs. One of the best remedies, is a saturated decoction
of the root of the Dew Berry, in doses of a Tablespoonful
Sacch; Saturni has been advised: 1 gr with 1/8 gr opium, every 2 or 3 
hrs. Anodyne Enemata are of great importance, when there is 




189
Tormina or Tenesmus. In the Collequative State, give Alum
1, 2 or 3 grs with opium or spirit of Turpentines. Even in this
state, of the Liver be tumid and congested & the discharge indicate
a want of bile, or a vitiated state of that secretion
Calomel is the best remedy. when there is much relaxation, 
a flannel roller should be worn.
The Diet should consist of breast milk. sweetened Cow’s
milk, Gum Arabic Tea, Balm or Marsh Mallows Tea, or 
Burnt bread & water. In the advanced stages the Farinaceous
articles should be used as sago, Arrow root, Tapioca ol. a few
handfuls of flour tied up in a piece of line, and boiled for 3 or 4 
hours, from a hard and compact mass when cold, this may be
broken up, and used for the purpose of thickening milk. After the
active symptoms have passed by a small piece of ham or
salt herring, or ripe fruit may be allowed. A change
of Air is very important. In order to prevent a recurrence
of this disease, the child should never be weaned within the
year, the Cold bath should be frequently used. Flannel should be
worn next to the skin, with worsted stockings; Excess or irregularity 
of diet must be avoided; and the Gums attended to during
Dentition.
Dysentery
This disease is a fever turned in on the bowels, as evinced by 
Het, thirst, and other symptoms. It comes on with Chilliness
succeeded by flushes of Heat with increased activity of pulse. there
is a disposition to go to stool frequently with much griping and
Tenesmus. The discharges though more frequent, are much smaller
than natural; they consist principally of mucus mixed
with blood & sometimes an admixture of natural foeces in 
the form of [Seybale]. when the disease consists of white mucus
only, the disease is called Dysenteric Alba. There is sometimes
a discharge of blood, nearly pure. The Cheesy appearances sometimes
observed are the product of morbid secretion. Throw 





196
to membraneous substances, are sometimes discharged they consist
of coagulable lymph. The discharge of Seybalae frequently affords
temporary relief. The puilse is rarely full or active, however tense
or corded it may be. In proportion to the openness and Inflammatory nature 
of the disease will generally be the favourableness 
of our Prognosis. The unfavourable symptoms are sudden
sinking of the pulse, prostration of strength, discharges resembling
greasy eater or of dark fluid blood, cold sweats, singultus, 
Petechiae, vibices, distressed Countenance etc.
Dissection has shown that this disease generally spreads
itself, in the large intestines; though it is sometimes confined 
to the Stomach & small Bowels. when the disease is confined
to the small Intestines there is more Gastric distress and lancinating
pain, unattended by Tormina or Tenesmus.
The disease is an Inflammation of the mucus membrane of 
the bowels; whilst confined to that issue, we have mucous 
discharges without much pain; when it extends to the muscular
coat we have Tormina & Tenesmus; and when to the 
Peritoneal Coat we have lancinating pain.
The Cause was once supposed to be a specific Contagion,
 but this is by no means generally the case. It has been
recently supposed, that the disease was Contagious, only 
when it assumed the Typhoid form. in this case it is [bilious]
in the extreme vessels take on an action, by which contagion
is eliminated. But if this were so Typhus ought to be
produced and not Dysentery. The more common causes
maybe found in those circumstances which occasion the
Autumnal Fevers; as Miasmata, varieties of weather, suppressed 
perspiration etc. Dysentery is generally a disease
of the Country and especially of elevated situations; it frequently 
prevails on the hills, whilst Bilious Fever exists in the neighbouring 
valleys. The Cool air of High Situations is supposed to 
invite disease to the Bowels. The Fever is sometimes Intermittent,
at other times Remittent or continued.
In Dysentery we are called to Treat an Inflammatory disease 
of the bowels a ggravated by spasm. We should therefore 




191
commence the cure by VS which of all the means of awakening
the sensibility of the system, is probably the most direct.
Connected with the Inflammatory action, there is also a degree
of spasm, for the removal of which, VS. is equally necessary.
With the removal of spasm, a hot and dry skin is frequently 
converted into one comfortably moist. The bleedings however 
have generally been too small zxx should be taken at the 
commencement of an attack, in robust habits. Used at the
onset; a prompt bleeding generally cuts the disease short.
Dysentery when completely formed is incurable; we may abate 
its force the thereby prevent its destroying the patient, but it will 
run its course.
The Cases in which Emetics are required are such as are 
accompanied by a loaded stomach producing nausea & distress.
They have however been used in cases of every description 
and probably with advantage. To resort to Purgatives however,
with the view of cleansing the Bowels, of their effusive
contents, is however the more common practice. Castor oil
has been used for this purpose; but to do good several 
ounces must be given in 24 hours. The mercurial Purges
are in my opinion much better adapted to the case. I prescribe
Calomel alone or in Conjunction with Rhubarb, giving Epsom
salts, subsequently if it should linger. This being done, [illegible]
more Purging with mercury is necessary, unless the Hepatic
system be much deranged, Castor Oil or Epsom salts
should now be used, until the appearance of the stools is
altered. Believing that the acrid discharges depend very much 
on Irritation for their formation. I have been in the habit 
fo giving opium, much earlier than it is generally recommended.
At this juncture Diaphoretics are much presented.
For the purpose of allaying irritation; determining to 
the Skin and gently opening the bowels. I prescribe the following 
formula Rx opium grs 4 Cal grs 16. Ipecac grs 10. To be made 




192
into 8 or 10 pills, one of which should be taken every 2 or 3 hrs.
The good effect of minute doses of Calomel, in the Bowel affections
has not been sufficiently attended to. Dovers Powder
is frequently prescribed in this stage. Two articles have a higher 
reputation in the treatment of Dysentery than Ipecacuanha.
It seems to be particularly adapted to those cases in which there 
is much Haemorrhage, pain or Tenesmus. Much has been said
of the utility of the Antimonial preparations, but they are greatly 
inferior to Ipecac. The application of warmth to the surface
is very serviceable in reducing spasm and lessening pain.
Of late it has been recommended to use a flannel roller
around the body, instead of the warm Bath [illegible] I 
have no doubt of its efficacy. A large Blister to the abdomen
after action has been reduced is highly beneficial
Some prefer them to the Extremities, believing that they are
rendered painful by the frequent motions in going to 
stool, when applied to the abdomen. My own practice
is to apply a blister 10 or 12 inches square to the abdomen
if very decided relieve be not obtained by one or two bleedings 
& by Evacuating the bowels. Mercury has been much 
used in Dysentery. Calomel in doses of 6 or 8 grs with 
opium, as a purge has been used by Dr Cleghorn I the Early 
stages of the disease. Whether it be proper to give opium in 
the Early stages I cannot positively determine. Judging however
from my own views of the Pathology of the disease, I
should think it sound practice. Cleghorn also pushed the use
of mercury to salivation with decided advantage. Although 
this is a valuable remedy, it is not required in common 
cases it is particularly indicated when there is any Hepatic
derangement In the sinking stages of the disease stimulants become necessary as wine whey, opium 
Carb ammon. spt Turpentine etc. The spt Turpentine is the 
best; it has been much used by the Physicians of this city
and certainly has peculiar power in inflammation of secreting 





193
surfaces Dose a tablespoonful. It is also given with Carb
ammoniae & opium. For the relief of Tormina and Tenesmus
which occur in all the stages of the disease. a variety of remedies
have been used. 1st Oleaginous Mixture Ol Ricini zi Gum 
Arabic zii Loaf Sugar zi Laudanum 40 or 50 drops, water ziii.
Dose a Tablespoonful. or Ol Ricini zi Loaf Sugar zi white
of one Egg, Laudanum 40 or 5 drops mix them together and 
pour over them zii or ziii Lime water. We have got
much into the habit of prescribing lead in Dysentery.
My practice during the last season was to bleed at the 
commencement of this disease; then purge with Cal & oil or 
Cal & Rhei after this I gave Sugar of lead grs 2 with ½ gr
opium every 2 or 3 hours. After the use of this for a day 
or two, interpose a purgative and again use the sugar
of Lead. The Cretaceous Julep, or a solution of Common 
salt (zi in zii vinegar) given in doses of a tablespoonful 
every two or three hrs. or calcined Magnesia Enemata of
Melted Butter are also valuable inject half a pint first
It should be recollected that the animal are much more 
bland than the vegetable oils. The diet should be as bland 
as possible. Demulcent drinks, as Barley Water, Rice Water,
very thin arrow root Tea, Sago, Tapioca, mucilage of Gum
Arabic, flax seed Tea & Slipery Elm ta should constitute the
diet in Dysentery.
In crowded places as Hospitals, Ships etc. this disease sometimes
puts on a Typhoid form. It has been supposed that
this form has been produced by the effluvia from the excrements
but there is no evidence of it. It has been contended
by a late author that the Disease is only Contagious,
when it assumes the Typhoid form but if this wee so we shd
have Typhus fever & not Dysentery. I Believe that the low form
of the disease, depends on an Epidemic Influence but that it is never contagious 





194
In this form of Dysentery, we have from the beginning, more debility
with less acuteness of pain, a smaller and more feeble pulse
cold clammy sweats, dark encrusted Tongue, with greasy fluid discharges.
In the final stages we have Petechiae, vibices & passive Haemorrhages.
The Practice is similar to that [illegible] in the 
low form of other diseases, Emetics should be the first remedies
employed; then after slight evacuations from the bowels.
Cordials & stimulating Diaphoretics, with Blisters
become necessary. The diaphoretics suited to the case are
Carbon Ammoniae, Dovers Powder & some whey. These may 
be assisted by the vapour bath. You should vesicate 
freely from the commencement apply a large blister to 
the abdomen, and also to the ancles and wrists. Mercury 
is the remedy most to be relied on: the safest practice is to 
resort to salivation, at once, supporting the system under 
the use of it, with stimulating Diaphoretics.
The diet in the commencement should be the same in 
the ordinary forms of the disease subsequently however
wine and spices may be added. 
Dysentery sometimes assumes and Intermittent Character
in which case Bark has been advised, during the apyrexia in 
addition to the remedies used for the bowel affections. But I do 
not consider this sound practice; nothing is more Irritating
than Bark to Inflamed Bowels. Charcoal has also been used
under these circumstances. I address my remedies exclusively 
to the Bowel affection in the first instance; and after the 
bowel complaint has been removed I prescribe for the Intermittent.
The Chronic forms of Dysentery are attended by 
Considerable tenderness of the Bowels, with small, frequent 
highly offensive, and griping stools. The skin is dry and
hard. The complexion sallow, and the features sunk; the
Tongue is loaded; little appetite exists; and the food taken in is 
not digested. In this Chronic form of the disease VS. small
and repeated, gentle Purging; & Dovers Powder at night with the 





195
flannel roller, and all those remedies, which promise relaxation
of the surface are proper. When we have reason to 
suspect obstruction of the viscera Calomel or the Blue
Pill, or Nitro Muriatic Acid should be used. The Nitro 
Muriatic Acid should be used, when there is too much 
debility for the use of Mercury. It has been much used
in this City. The Bark is prepared by adding zi of a mixture
of equal parts of Nitre & Muriatic Acid to a gallon o f
warm water, increasing or diminishing the acid according 
to the delicacy of the skin. When either of the acid is taken 
internally zi shd be diluted with zfiii of water and taken in 
the course of 24 hrs. This is prescribed in almost all the chronic
Bowel Complaints, but I have not found much advantage
from it.
Diarrhoea
Diarrhoae has been defined to be a morbid increase of the Peristaltic
motion of the Bowels. It has been divided into Idiopathic
and symptomatic. The Causes of Idiopathic Diarrhoea act either
on the stomach primarily; or through the medium of the system.
Of the first kind are improper food, as to quantity and quality; 
if the second, suppressed perspiration, violent passions, [illegible]
Symptomatic Diarrhoea is the effect of irritation derived
from some pre existing disease, which is most generally 
situated in one of the viscera or from consumption.
Diarrhoea may also be divided into acute and Chronic
The acute is very analogous to mild cases of Dysentery; and
under the line of distinction cannot be drawn between the 
mild case of one, and a violent case of the other. Nosologists
argue that Diarrhoea differs from Dysentery in being unattended
by febrile symptoms, or Inflammation, as well as 
being accompanied by a more natural appearance of the 
stools; but this is erroneous. In recent attacks, if [illegible]
from offensive matter taken into the stomach, that organ
is destroyed with nausea & vomiting, the skin is Cold and 




196
clammy, and the pulse feeble. It sometimes approaches as 
a febrile affection with anorexic furred tongue, quick and 
irritated pulse. The stools are various Sometimes thin & watery
at others thick and tenacious, mixed with slime and frequently 
ash coloured, pale, or of a Bilious hue. The discharges sometimes
consist of the ingesta, which pass through the Bowels unaltered,
constituting what is called Lientery.
Dissection, displays nearly the same appearances in this
disease as in Dysentery Inflammation, Ulceration, Erosion
& [sphacelus]. In Chronic cases, various derangements are presented;
thickening of the mucous coat, granulated, Tuberculated
and fungous appearances. The follicles sometimes become
indurated, schirrous, and even cancerous. The liver, pancreas & 
spleen exhibit the traces of morbid action.
In the Treatment of the disease, the Indications are twofold
1st To remove the offending cause of the disease, and 2nd To
correct the action of the Bowels. With a view to fulfilment 
of the 1st indication an Emetic should be given. To 
fulfil the 2nd we resort to VS & purging in active cases, or 
if the symptoms do not call for VS. to moderate purging 
with Castor oil, calcined Magnesiae etc. opium and Diaphoretics
should next be used. After the primary remedies
have been used, good effects will result from the following 
formulae; Rx Ipecac grs 10, Cal grs 10, opium grs 4, to be divided
into 10 powders one of these should be taken every 2 hours 
during the days, with Dovers powder at night. The warm
Bath should not be neglected it should be succeeded by 
frictions with the flesh Brush after getting to bed.
In  Chronic cases attended with tension & hardness of 
the pulse VS should be used. The Blood letting should be 
repealed every 2 or 3 days, whilst the pulse and strength justify
it, if relief be not obtained. I have bled from 10 to 12 times, taking
away from 4 to 6 z of blood each time and alternately succeeded in 




197
effecting a cure. It shold be recollected that chronic Inflammation,
though not immediately dangerous is much 
more difficult to remove than the acute. After action has’been sufficiently reduced, Emetics repeated every 2 or 3 days
have a good effect in correcting the deranged actions going 
on in the stomach & Bowels. when the preceding diaphoretic 
formula fail, one of the best prescriptions is Alum grs 5 & 
opium gr 1/s, 3 or 4 times a day. and the Blue Pill given
as an alterative. If the skin be dry & hot and the Bowels
griped, Ipecac should be added. This prescription is one wh:
I press on you with confidence experience has convinced
me of its efficacy. The vitriolic solution though highly 
valuable, ahs been neglected on account of the Nausea which 
it is apt to induce. Blisters should be applied alternately
to the ancles and wrists they act by [??ussion]. when the
Symptoms denote visceral derangement, Mercury is 
the most valuable remedy. It is given in Combination 
with Ipecac & opium, rather as an alterative than salivant
The Gleety discharge from the Bowels consisting of Mucous
or puriform matter are to be treated by the Balsamic & Terebinthinal 
remedies. Of these the common Rosin is the best
It should be given in doses of 10 or 12 grains, combined
with an equal quantity of loaf sugar, 3 or 4 times a day. The 
same Treatment is proper in ulcerated Bowels. Diarrhoea 
dependant on debility or relaxation of the Intestinal canal
is often the first stage of the acute form above described.
It is often a primary disease arising from the debility of 
old age or other causes. The Indication is chiefly to restore 
their tone. For this purpose use the following Rx Infus
Gallae ziv, Creta Preparat: zii. Laudanum zi. Dose a Table
spoonful, every two or three hrs. or Rx Gallae zfs Sugar zii Brandy
1 gill. Burn off the alcohol, and thereby convert it into a very 
astringent syrup, or Rx Tinct Kino ziv. Creta Preparat ziv. Laudanum zi
water ziv. Dose a tablespoonful every hour or so.




198
Logwood is an excellent remedy the Infusion should be used
for children, and the decoction for adults in doses of a spoonful
A Tea of Cloves zi to the pint of water is very useful. Many 
indigenous articles have been used; and among others the
Geranium Maculatum boiled in milk but I prefer the 
decoction of the Dew Berry to all others. A decoction of the 
flowers of the Pomegranate is a good remedy. Great advantage
is sometimes derived from the Saccharum Saturni
It possesses the two fold property of allaying irritability and astringing 
the Bowels, It should be given in doses of 1, 2 or 3 grs
with opium every hour or two. Contrary to the common
practice I have prescribed vinegar with advantage. The 
Nitro Muriatic acid internally, and in the form of Bath has
been used with advantage. Mercury has succeeded when every 
thing else has vailed
Medicines will avail but little however, without a due
attention to diet, cloathing, and the avoidance of the causes.
The Diet should consist chiefly of Farinaceous articles, Tapioca 
& Sage, are prepared by adding zfs or zi to a pint of boiling water
by which they are dissolved. You may then add Nutmeg
wine as the symptoms require. these are mucilaginous
concretis. Arrow Root should be made into a mush or jelly 
It should first be mixed with Cold water. The boiled flour 
and milk as recommended in Dysentery is well suited.
When there is great relaxation of the Bowels, a small quantity 
of salt Ham or Herring should be allowed. Soups shd
never be given. The drink should be brandy Port wine etc.
The Bread should be hard biscuits or Crackers. The Flannel
roller should be used & exercise on horse back or a sea
voyage to some temporal climate.





199
Constipation
The disease consists in a preternatural retention of Excrementitious
matter. It is however a relative term; for whilst a large
majority require a daily operation, there are some who do
not suffer for many y ears obstruction. Haller mentions 
the case of a man who had 28 years without an evacuation.
There have been numerous instances in which habitual
constipation existed without injury, but it is generally otherwise.
The habit of body is marked by Headache, Nausea,
vertigo & foetid breath the patient smells like a privy.
Febrile symptoms sometimes attend Piles & varicose vein
are produced by the interrupted circulation & congestion.
It gives rise toa great variety of diseases. The whole class
of Neurosis may result from it. The mind is rendered listless
and the temper sour, gloomy and despondent.
The numerous causes of Constipation, may be arranged
under 2 general Heads: 1st A want of irritability in the Intestines; 
& 2nd A vitiation of the Biliary Secretion.
Calomel should be given in large doses at an interval
of a day or two for 2 or 3 sulphuris & calcined magnesia,
taken at bed time or by equal parts of Castile Soap & Rhei.
Pills made of Rhubarb zii. Syrup zi, oil of Caraway gr #10.
To be made into 40 pills, of which 2 should be taken at a 
dose. These are called in London Peristaltic persuadus 2 
of them purge better than 20 grs of Rhubarb alone. A better
prescription is Rhubarb zi, Aloes zfs, Ipecac [?i] ol Caraway
[illegible] drops. To be made into 30 pills. It is a well established
fact that emetic substances, when added to Purgatives increase
their activity. A pill made of the extract of white walnut
is a very certain laxative. The habitual use of [aloes] is 
apt to induce or aggravate Piles. 




200
The Bile of the [illegible], has been occasionally prescribed. It should be
evaporated on a sand bath, to the consistence of an electuary
and 5 or 6 grains made into a pill may be given at a dose.
Charcoal which of late has acquired much reputation in these
cases, should be prescribed when the Tongue is furred. The mouth
clammy and the Breath foetid. Dose a Tablespoonful. This
which has the power of destroying foetor, which has never
been Explained.
When the habit of Constipation has been strongly [confer???ed] 
give 5 grs of Blue Pill, every other night, and purge
it off with a laxative in the morning. The small intestines 
as the Duodenum & Jejunum frequently become loaded from 
Torpor, which has occasioned me much embarrassment
This condition is attended by a sense of weight at the pit of
the stomach, with Hypochondriacal symptoms. It is to be
distinguished from the oppression felt in Dyspepsia [illegible] 
this circumstance That in Dyspepsia it is felt immediately 
after eating, whereas in the constipation of the 
Duodenum, it comes on after 2 or 3 hours. For the purpose 
of removing the accumulation I have found noting so 
effectual as the following. Rx Fol Sennae zi Rad Gentian zi*
Infused in water lbi. Dose a wine glassful whenever
oppressed. This condition sometimes exists in the Rectum
It frequently happens in women who refer the pain to 
the uterus. The accumulation must be removed by a 
scoup, and aloetic medicines administered, as in the following
Rx Aloes zi, Rhubarb zfs, Calomel grs 15, Comp Extract Colocynth
grs 15. Sapo Castili Qs. Ft mass. To be divided into
40 pills, and give 1, 2, or 3 every other night or every nigh.
Structures of the Rectum or Tumor, are sometimes regarded as 
simple cases of constipation. To distinguish the Rectum 
should be examined The shape given to the foeces will assist
in determining. IN constipation, such Diet and habits
shd be enjoined as well as cooperate with the medicines Mush 



[Dusp??] does not occur often before puberty
This disease [illegible] appear before puberty from 
disease of the Liver or Excessive Onanism.
Then in a disease of all Seasons but generally 
[illegible] when the perspiration becomes stopt.
Men are more subject to the disease than
women. 
Dyspepsia is frequently a symptomatic
from other diseases frequently from Inflammation
of the Lungs, which I suppose [illegible]
in the mucous coat of the stomach
[illegible] of the uterus frequently produces 
[dyspepsia] [illegible] [illegible] constitution have
[illegible] and in fact most
are the [illegible] produces the 


201
and Molasses form an excellent diet. This is also the diet by 
which we can cure Prolapsus ani in children. The 
child should be put on this diet and directed to pass his
stools in an erect posture. The Diarrhoea Mucosa wh:
is very much like a Gleet, is best managed by the Balsamic
and Terebinthinate remedies, particularly Rosin.
Dyspepsia
The primary symptoms of Dyspepsia, are a sense of oppression 
after eating, nausea and sometimes vomiting, sour
eructations, furred Tongue, foetid breath, uneasy sensation
about the Epigastrium,, vitiated appetite, constipation etc.
As the disease advances we have Pyrosis, Gastrodynia 
Cardialgia, Palpitation & irregular Bowels. The pulse is small 
and corded, and the depression of spirits, in some cases amounts
to Hypochondriasis. There are also certain anomalous 
affections as acute pain in the chest and head. Depravation 
of vision, vertigo and palpitation of the heart.
The scalp in some cases become exceedingly tender, amounting 
almost to Tic Doloreux. Hysteria, Tetanus etc. are
also symptomatic of Dyspepsia. The evacuations from the 
bowels vary much on their appearance. Sometimes they 
have a clayey appearance; at others a Bilious hue.
Not being arrested the case after a while assumes a new 
aspect the vascular system becomes involved, and we have the 
symptoms of febrile excitement.
The Causes of Dyspepsia may be divided into three
which act immediately on the stomach, and those which affect
that organ Through the medium of the system. Of the first Kind 
are excess in Eating or Drinking or improper food, and undue
limitation of diet, with the view of restraining obesity or to
cure other diseases; the Excessive use of Tobacco, Tea Coffee, and 
Spirits, or any exclusively vegetable diet; and too frequent tampering 



disease


202
with medicines. Emetics too frequently repeated are [illegible]
calculated to destroy the tone of the stomach so also, is the
long continued use of Nitre. Of the Second kind
are Indolent and Sedentary habits, intense study, close
application to business within doors, Grief, Disappointed
Ambition, Excessive venery, exposure to Cold, Suppressed
perspiration & Cold feet.
Dyspepsia is not always Idiopathic It is sometimes
Symptomatic of the diseases of the Liver, Spleen, Pancreas
Brain or Uterus. The Irritation of decayed Teeth, has brought
it on; a patient of mine, who laboured under Symptoms 
of Dyspepsia, was released by the extraction of decayed Teeth
On Dissection the stomach is generally found flabby 
relaxed with some alteration in structure and enlargement 
of the mucous follicles. In other cases we find evidence
of chronic Inflammation.
Nosologists have uniformly considered this disease 
consisting in debility of the mucous coast of the stomach or 
deficient secretion. They are partly right but have regarded 
an Effect as a cause. In its commencement the disease
is purely Nervous Irritation, but the Continuing, Inflammation
with its ordinary consequences follows. In the first
instance, there is functional disorder the digestion is very 
imperfect with flatulence, sour eructations etc. The muscular
power is also impaired by the same cause, and the
food is in consequence not driven into the bowels whence
the load which oppresses it In the Second Stage of the 
disease, Inflammation frequently supervenes, and we have
tenderness of the Epigastrium hard corded pulse, warm
skin, and burning of the Palms of the hands.
The first indication in the Treatment of the disease is
to cleanse the stomach by means of an Emetic of Ipecacuanha


Emetics should not be given unless there be some
offending Ingesta in the Stomach, the Sulp Cupri
is the best emetic in these cases. Ipecac may 
be used but Emetic Tartar should never be [used]
I never myself have used an Emetic


203
This should be repeated if necessary. We next resort to
gentle laxatives, which evacuate without irritating as
Rhubarb with Calcined magnesia, Castile Soap or Tinct of
Rhubarb. Before resorting to Tonics, we should carefully 
ascertain that Inflammation does not exist. I have
no doubt but what mistakes in relation to this point 
are frequent. Dyspepsia is too generally regarded
as mere debility of the Stomach. If however the symptoms 
of Inflammation do not exist we must resort
to Tonics for the purpose of restoring Tone, of these the
vegetable Bitters as Gentian, Columba, Quassia & Bark,
should be used as in Infusion with Orange Peel.
The Carbonate of Iron may be given in doses of 10 or 15 grs 
3 or 4 times a day with Ginger. A Calybeate wine made
of Rubigo Ferri zifs, Gentian & orange peel a a zfs to a
bottle of Portwine. of this a wine glassful should be given 
frequently during the day. The Sulphate of Iron may 
be given in doses of 2 or 3 grs made into a pill. The 
Muriated Tincture of Iron may be given in doses of 20 
drops in doses of a wine Glassful, 3 or 4 times a day has  
used with advantage in the cases of intemperate persons.
In the progress of the disease particular affections arise,
which if neglected react on the disease. Whilst however, 
we palliate these symptoms, we should keep the permanent
cure constantly before us. The first of these which we 
shall notice is Cardialgia, which is a very painful 
affection arising from acidity. To correct this, Lime Water 
and milk, Magnesia or any of the Alkalies may be used.
The Sal Tartari as in the following formula, Rx
Sal Tart zi, Gum Arabic zii, Spts Lavendule zi, Sacch Alb
zi, Laudanum drops 39, Aquae ziv. Dose a Tablespoonful
A Domestic remedy of considerable importance, which 




204
was successful in the Case of Dr Physick is prepared as follows
Rx Hickory ashes 1 quart, Soot one tea cupful, Boiling water
1 Gallon. To be decanted after the sediment falls. dose half
a wine Glassful 3 or 4 times a day, taken after each meal
when the stomach is full. A super carbonate of Potash
has lately been introduced, here, which was successful in the
case of Dr Wilson, the celebrated clergyman in this City. It
contains as much Carbonic Acid as the Alkali can possibly 
take up. Dose a teaspoonful in a glass of Cider. I have
known much good from chewing almonds in these cases.
When the stomach is much debilitated use Carb Ammoniae
or Rx Aquae Ammonia, Magnesia Calcinate a a zi Aquae 
Cinnamoni zii Aqua Fontana zvi. Remarkable as it may 
seem, I have known acidity of the stomach corrected by the
vegetable acids. The Stomach is thrown occasionally
into violent spasms, called Gastrodynia. It is treated by 
opium, Aether, Musk etc. A glass of milk will sometimes
relieve when opium fails. Distending the stomach with Tepid
water, which operates by releasing it has afforded relief. Hot
water taken into the Stomach stimulates powerfully both the 
body and the mind, and has afforded reliev. It is said that
the celebrated Edmd Burke drank hot water to excite the energies
of his mind, whenever he wished to speak eloquently. 
To prevent recurrence of the spasms, great advantage may be 
derived from Hiera Picca, Warners cordial, and the oxyd of Bismuth,
or as it is now called the Sub Nitrate. This last is 
now much in vogue; it is given in doses of 5 or 6 grs combined
with Gum Arabic, when the preceeding remedies fail, a Blister
should be applied to the Stomach.
Flatulence connected with Gastrodynia is to be relieved by 
Carminations. To do away the tendency to it 10 or 15 drops of 
the Elixir Vitriol with a Wineglassful of the Infusion of [B?t]
may be given. When it comes on immediately after eating
it may be relieved by an old [duco] pill of Ipecacuanha. [illegible]




205
Pyrosis, or Wagter Brash, another of the symptoms of Dyspepsia
is endemical in some countries, according to the opinion of
Linaeus. it is produced by the too free use of salted meats. It
arises from excess in eating or drinking or from the habit
of distending the stomach with large draughts of
Cold water. The treatment consists of Emetics in the beginning
followed by the use of Antacids: oil of Amber 10 
or 15 drops, Sacch Saturni. Subnitrat of Bismuth etc.
The Palpitation, the remedies are antacids and antispasmodics,
as opium, Aether, Hoffmans anodyne.
The Sick headache, which is also symptomatic of Dyspepsia
is treated by Emetics, large doses of Calcined Magnesia; harthorn
10 or 15 drops; aqua ammonia 10 or 15 drops, or Laudanum
25 or 30 drops. The vegetable acids sometime relieve it.
When vascular action attend draw blood and apply sinapisms 
to the extremities Tenderness of the Scalp, is to be treated
by Emetics. Genuine Tic Doloreux, not unfrequently 
has its origin in irritation of the Stomach. I have known
this affection in 8 or 10 cases to result from the irritation of 
decayed Teeth. Extraction relieves it. The affections which 
have been mentioned are not to be regarded as the necessary 
concomitants of Dyspepsia it often runs it course without 
them.
If all other means fail in the treatment of dyspepsia
try the alterative course of Mercury advised by Mr Abernethy.
Five grains of Blue Pill should be given at night
and purged off in the morning with Rhubarb and Magnesia
this course should be continued until the system is impressed 
by mercurial action. Mr Wilson Philip has recently 
used Galvanism with advantage from the following
view of the Pathology of Dyspepsia. He believes the disease
to consist in diminished Nervous influence: having seen 
that digestion was suspended by tying or cutting the nerves
which supply the stomach. Believing also that the nervous
and Galvaned fluids are essentially the same he has recommended 





206
Galvanism to supply the nervous deficiency which exists.
What has been said hitherto relates to the simple form o f
Dyspepsia. It is always prone to change the primary form
of irritation for that of Inflammation: the latter is known
by a strong sensation of heat and pain, hard, corded and
quick pulse, a diminutive fever of the Hectic kind, hard
dry cough, tenderness of the Hypochondrinia & Epigastrium.
It may be readily mistaken for Pulmonary Consumption
and indeed may induce that disease, Symptoms of Pulmonary
disease frequently result from irritation in the stomach & 
bowels arising from other causes. I knew them to occur
in a boy from the presence of a large number of [???brecoidis] 
in the Bowels. By the play of morbid affinities
other structures become involved, as the Liver, spleen, Pancreas
and especially the Duodenum etc. The Symptomatic diseases
thus arising are often more known than the primary
affection. In these cases small and repeated bleedings
are necessary as in all other inflammatory diseases of a 
Chronic form. It should be remembered that the pulse is but 
 a poor guide in all gastric affections. Local Bleeding and
Blistering should next be resorted to. small doses of Ipecac
we now of great value. it appears to act as an alterative
imperceptibly changing the Condition of the stomach to its
natural action. The Bowels are to be attended to. The
neutral salt although by no means suited to simple
Cases of Dyspepsia unattended by Inflammation are here the
proper remedies. Having by these means reduced the 
activity of the symptoms, Mercury must next be resorted to 
so as to obtain its alterative effect or if there be much 
visceral obstruction, salivation should be brought on.
During the Inflammatory stage, the Diet should be as 
low as possible. when Dyspepsia has arisen from Intemperance
accompanied by vomiting and spasm, opium volatile
alkali, musk etc. are to be used: and to effect a permanent [illegible]


Strict regimen of diet is more necessary in
the cure of dyspepsia than all the medicines
of the Shops. The first rule to be observed is
to permit your patient to dine from only 
the dish, and a small quantity of this at
a time but frequently repeated so as to keep 
the Stomach constantly employed. Large
potations of all kinds should be forbidden
Persons liable to this disease should dress
warmly in winter. Exercise on foot or 
horseback should be recommended. The 
best exercise is walking, it gives tone to 
the Stomach. Dyspeptics should retire 
early to bed and arise early
I think it advisable to lay aside Tea and Coffee
altogether and place the patient on a milk diet
In some cases the milk becomes sour on some
stomachs at the commencement of the diet in such 
cases it is better to add lime water with the milk.
All acid drinks are injurious. Spiritous drinks
should also be forbidden. If they do drink any 
stimulating drinks they had better take a glass
of madeira wine, Ice water should not be allowed
in warm weather.
The Bread should be well fermented and 
baked very hard and kept a day or two before
used. The unfermented bread such as Ship [B???]
crackers, which are made p with nothing
but water and baked very hared is the best
bread which can be used. All Bread should 
be a day or two old before used. All Bread
which is made up with oil or butter is very 
injurious to dyspeptic patients. Ginger Bread
made up with a warm aromatic is proper
food for a patient in this disease. However 
milk and mush are improper. Rice simply 
boiled with a little nutmeg is very easily 
digested, it should not be [illegible]
Potatoes roasted may be eaten by the dyspeptic
[illegible] there is very few vegetables which 
can be used. 



207
the patient must undergo a compleat reformation in his habits.
Dyspepsia is very rarely consequent to other diseases of the 
viscera, being much more frequently the primary disease
by which the former are occasioned.
Little if any benefit will be derived from medicine
if the most scrupulous attention be not paid to Diet etc.
The Stomach is at once the seat of the disease and the receptacle
of food, I need hardly tell you, that the Diet should
be suited to its condition. Such food as is light and occasions 
the least exercise of the digestive functions should be 
used. Milk is of all other articles decidedly the best.
It should be new. It is sometimes ejected from the stomach 
in a coagulable state, but this is no objection to its use 
for coagulation is the first process in the digestion of the 
article. Chocolate is also proper. It should be first boiled
in water, then sit by until it becomes cold, when the impurities
should be skimmed off; it should then be boiled again 
and poured over sugar and cream as Coffee. Neither Tea
nor Coffee should be allowed weak black Tea may be admissible.
The proper articles for dinner are Beef Mutton
white Poultry, Game or Oysters. But neither Pork, Veal,
Lamb, Geese nor Ducks are admissable. The essence o f
Beef is well suited to Dyspeptics. It is made thus: Take
lbi of lean beef, cut it into very small pieces, and boil’
it in a quart of water with a few Cloves. Fish are generally 
inadmissable but you must consult the Idosyncracy  
of the patient.* As little vegetable matter as 
possible should be allowed. Rice well boiled; or Potatoes
mashed may be used. No Dessert is to be allowed. Soups 
are inadmissable. IN cases of great debility of the stomach 
a little ham or salt fish should be allowed; when on the 
contrary the stomach is Inflamed vegetable Diet, especially 
mucilaginous drinks should be allowed. The Bread should 
be Stale and without Butter. Every kind of Toast should 


Roasted beef done rare, may be considered
the best animal food which can be used, this
should be used without any condiment except
a little salt. If the patient have been accustomed
to salted provision you must allow him
Bacon. Beef Steak broiled on Coals is the very 
best manner of cooking. So soon as the part
next to the coals become brown we burn it
over and by this means we retain all the
juices. Mutton can be used, no young animal 
can be used. wild fowls are much more
digestible than tame. All strong gravies or
spices, all pastries and in [illegible] all oils and
fatty substances should be restricted.
The lean parts of fat meats are the most easily 
digested, if the patient prefer salted meats, let
him have Beef, venison, little Bacon Smoaked.
No dried fruits I believe will agree with the 
dyspeptic stomach. No pickles can be used
Ginger, Pepper and Onions are the best of all other
pickles. Oysters when raw all more digestible
than any other diet
Take zii SubCarb Potas zfs Rhei rubbed well
together and then mixed with zviii water dose
a tablespoonful 2 or 3 times a day is a very good
prescription as a mild laxative in this disease
Aloes sometimes is the best purgative in this
disease. Andersons pill contain no active principle 
but aloes.


208
be rejected on account of its liability to grow sour.
In the management of the patients diet the following rules 
should be attended to.
1st He should eat very frequently and but little at a time.
to this however there is one exception which is to be found 
in that condition of the stomach which as resulted from 
satiety. Here the stomach should be permitted to rest
2nd Let the Patients food be as simple as possible.
3 Do not let him drink during meals.
4 Do not let him take exercise for an hour or two after
eating.
5 Let the Dishes be small and surprise the patient with them.
Water is the best drink, but it should be used sparingly. Old
Porter sometimes agrees with the patient. If wine be at all admissable.
Madeira or Old Lisbond is to be preferred. there are
certain remedies which should be addressed to the general system as
1st The warm Bath 2 or 3 times a week. 2nd Cold Bath 3rd Frictions
with finely pulverized salt.4th Exercise particularly 
on horseback. 5th Flannel to the skin in all seasons. When 
there is great sensibility to cold, direct a waist coat & drawers of buckskin,
when the feet are frequently Cold, Buckskin socks, should be 
worn over the stockings; Cayenne Pepper shd be sprinkled over the inside 
of the Socka or shoe makers wax, applied to the soles of the feet.
All our efforts avail nothing unless the habits of the patient are totally ‘
changed. If he be intemperate, he must become sober; If he use
Tobacco, he must abstain from it, If he live luxuriously, he 
must become abstemious; If he be indolent he must be excited
to enterprize; If he be studious, he must quit the midnight
lamp. And if he be in affliction, he must be encouraged
to hope, and to look forward to the gilded prospect which 
may yet await him. 




209
Respiratory System
This comprehends the diseases of the lungs and their appendages.
The symptomatic connection between the skin and Lungs has
always been observed. Exposed to the Cold, the skin becomes constricted
and perspiration is for a time suspended. this is substituted by 
the increase of urine and of the Pulmonary halitus. when the application 
of cold is longer or more intense the Capillaries become torpid.
Cold produces a congestive or Inflammatory disease according
to the recuperative powers of the system. when the blood is drawn in 
upon the lungs from the constriction of the surface, and these 
organs are vigorous and healthy we have an open inflammatory 
disease if this be not the case a congestive form arises. The 
operation of Cold in the production of any other disease is similar 
when the skin is acted on in the manner described, that
part becomes affected which is in the highest state of predisposition.
As the most simple of the pulmonary affections, we 
shall first speak of Catarrh. This may be brought on by an 
circumstance, which suppresses perspiration. It comes on with 
pain in the Head, lassitude, diflusion from the Nose and Eyes.
Hoarseness dry irritating cough, with more or less fever. In a few 
days the first symptoms abate, and if the disease be not violent the cold
[illegible]. If the Patient have frequent colds, Phthis Pulmonalis is to be 
dreaded. The Pathology of the disease is obvious. It commences for 
the most part in Inflammation of the mucous membrane of the
Nose and fauces, which extends itself down the Larynx & Trachea.
The remedies are divided into those which are proper in the forming
and those which are required in the confirmed state of the disease.
In the first or Incipient stage, I know of nothing so efficacious
as a dose of Laudanum. If any peculiarity of constitution prohibits
the use of opium, the mild Diaphoretics, with sweating beverages
and the Pedeluvium should be resorted to. One of the best beverages 
is molasses whey, which is particularly useful in relieving hoarseness.
If pleurisy be apprehended it may generally be prevented
by putting your patient under a good sweat by means of Pleurisy
Root, Eupatorium or something similar.
Being [compl???ly] formed the disease generally requires
Vs. for its reduction which must re regulated by the Pulse and 




210
other circumstances of the case. Purging is early resorted to and the
Saline medicines are generally preferred but if the Inflammatory 
symptoms are violent, Calomel will be necessary. For the purpose
of relaxing the skin and keeping the bowels open, the following formulae
has been used Rx Sulph Sodae zi Nitre [?ii], Tart Emetic gr i
water ziv, dose a tablespoonful every 2 or 3 hrs. Much confidence
has been reposed in Blisters applied in the early inflammatory 
state, they are highly injurious, but in reduced cases they are 
valuable. Of the various Cough mixtures there is hardly one into
which opium does not enter freely. It is therefore obvious that 
they should not be used before the disease is broken. The following
is a very good formulae Rx Extract Glycyrrhage ziii, warm
water ziv. add to the solution zii Spts of Nitri, zi antimonial wine
and 40 or 50 drops of Laudanum or Sal Tart zi, vin antim zi
Laudanum 40 or 50 drops, Spt Lavend zi water ziv or v. A syrup 
of the Common horehound is very useful. Loaf Sugar moistened
with a little vinegar and heated to the consistence of syrup is very useful
for hoarseness. The diet should consist chiefly of demulcent
drinks as Barley water, Flax seed Tea etc. Gum Arabic, Candy 
and Cream Tart zii aa to a quart of boiling water make a very 
excellent drink.
I wish to impress on you the Importance of the 
Antiphlogistic regimen in Catarrh because popular prejudice is
against me. It is a common saying that we must feet a cold
and starve a fever, but the propriety of abstinence in Catarrh
is as great as in fever. Jellies or stewed fruit may be allowed. The
vegetable soup which is used in all Inflammatory Cases may be
used in this disease. It is made of 2 Potatoes, 2 Turnips, 1 onion, 
a pint and a half of water with a slice of bread; the whole should
be boiled down to a pint. It is very important to guard against
fresh exposure to cold. The patient should lie in bed.
Catarrhus Epidemicus. This is a disease of wide extent appearing
at times over a whole continent, or indeed, over the whole
world. It has been called Influenza by the Italians, in consequence of its wide 
dissemination. It is very analogous to the Common Catarrh, but arises from
the insensible, instead of the sensible qualities of the atmosphere; It requires 
the same treatment as the Common Catarrh; when it puts on a Typhous
form the treatment is similar to that recommended for the cure of our
Winter Epidemic.





211
Cynanche Trachealis
The best name for the disease is Trachitis, which is calculated to 
give uniformity to our medical nomenclature.
It has been considered a modern disease, the first description of it having
been ascribed to professor Home of Edinburg. It has been for the 
most part confined to early life, as that period between the 1st and fifth
year. Robust and Plethoric children are most liable to it. It sometimes
occurs after Puberty, though rarely; The freedom from the affection
after Puberty is owing to the change which takes place with 
Larynx about that period. There is no reason to believe that it 
ever arises from Contagion. It seems to depend on the influence
of a cold and moist atmosphere, and hence is more prevalent in Spring
and in situations bordering on the Sea Coast. It has been divided by 
authors into Spasmodic and inflammatory. It would seem that in
some cases the muscular fibres of the Larynx are first affected with 
spasm, but that inflammation comes on subsequently. If this distinction 
were well established, no change would be made in the
treatment for nothing is more efficacious in the reduction of spasm
than depletion. The Croup comes on with 
a day. Stridulous cough, difficult breathing, quick irritated pulse & 
great restlessness. on some occasions it advances gradually with Catarrhal
symptoms. My mode of managing this disease is the following.
Called in the Commencement endeavour to puke the 
child freely with Ipecacuanha and Tart Emetic, which is one of the 
most active of our Emetics its operation is accelerated by the addition 
of Calomel. In common cases Tart Antim in solution is to be used.
when this fails to excite vomiting combine it with Ipecac & Calomel
Thus Tart Subm gr I, Ipecac grs 4 or 5, & Calomel 4 or 5 grs. At the same
time I direct the child to be put into the warm bath for 10 to 15 minutes.
If the Emetic do not operated, or if the disease effect be not produced by ‘
its operation, I then bleed copiously and repeat the Emetic and warm
Bath. next use local bleeding by means of leeches or cupping. Then
apply sinapisms or Blisters. when the attack is fiercely spasmodic
apply flannels wet with spts Turpentine.
If the attack do not now yield I blend deliquum animi wh:
is almost always successful. This I learned from Dr Dick of Alexa
In all acute diseases the VS in the commencement should be copious 
so as to produce a decided effect. Small bleedings abate, but large
evacuations of blood arrest the disease. when the disease has suddenly 




212
been reduced by copious bleeding there is much less functional [d????ment]
and convalescence is [illegible] greatly more speedy. The disease being
broken I thin administer a large dose of Calomel. If the Cough continue
I administer seneka or what is most bitter. Dr Coxes [illegible] syrup.
Of the disease continue for 10 or 12 hours it is apt to extend itself
‘down the Bronchia and into the Lungs where it occasions congestion
or engorgement. This may be of 2 kinds. 1st from a copious
secretion of mucous and 2nd from an engorgement of the vessels [illegible]
blood When the engorgement arises from large accumulations of
mucus, the pulse is languid, the strength depressed, respiration very
difficult, attended with a peculiar wheezing. when it is sanguineous,
the pulse is stronger and more laborious without cough.
In the mucous Engorgement the child should be placed in the warm
Bath and vomited with stimulating Emetics of these the juice of the
Onion is a very good article. Dr [illegible] always prescribed Sulph Zinc
in these cases. If the oppression continue, we must draw blood [???tionely] 
or if VS be inadmissable cupping from the back should
be prescribed. The Blister with hot water, pledgets of lint dipped in 
canth & oil or Turpentine, or nitric acid. After this expectorants 
become necessary of these Dr Coxes [illegible] syrup is the best.
Calomel is a remedy of great importance, but the plan of
treatment which I have recommended is I think preferable to the
mercurial practice. From what I have said you will perceive
that the disease is firstly a spasmodic or Inflammatory affection 
of the Larynx, and subsequently, one of the forms of [Prussa????ia]
notha.
Cynanche Laryngea
The first account of this disease is given by Dr Baillie in 1809.
It commences like a common sore throat; followed by pain in the 
Larynx much augmented by pressure, difficult respiration great
hoarseness amounting almost to aphonia, pain on deglutition with 
Febrile symptoms. This Case sometimes terminates by suffocating
the patient; in which there is much protrusion of the Eyes and
distortion of the countenance. This disease like most of the Phlegmasiae, 
is generally occasioned by cold. It may be distinguished
from croup by the absence of the cough, and by the time of 
life at which it occurs. this disease being generally met with 
in advanced life. It is distinguished from Cynanche Tonsillaris
by the difficulty of swallowing which exists in the latter affection
In the treatment of the disease, the most prompt and vigorous 




213
remedies are to be used I bleed ad deliquum apply [illegible] to the
Throat, purge with Calomel and apply a large Blister. If these measures
fail Laryngotomy should be resorted to.
Cynanche Tonsillaris comes on with pain and soreness of the 
throat, with difficult deglutition. It originates from exposure to 
cold, and is more liable to attack persons who have previously 
been affected with it. The Treatment is divided into that which 
is proper in the former state, and that which is required when it
is formed. In the Commencement a stimulating Gargle (as that
of red pepper) or stimulating applications frequently arrest the 
disease at once. The Cayenne pepper is decidedly more efficacious
than any thing else. When the disease is formed depletion 
becomes necessary. Of the depilating remedies, Emetics are the first
in importance. they should be followed by saline purges. If 
these do not reduce the disease VS becomes necessary. it is however
a curious fact that VS. is not so serviceable in this as in 
other inflammatory affections. Next local bleeding by Cups o r
leeches and Scarification of the Tonsils. fomentations with corn
mush or well mashed Potatoes. Blisters the blistering plaster
should be so spread that none of the [flies] should act on the 
part immediately anterior to the Traches. Inhalations of the 
vapour of warm water. Gargles are always pernicious in the
Inflammatory stage. when the Tonsils suppurate the matter shd 
be evacuated with the lancet. After this mild detergent gargles
as milk and water or Honey and water should be used. The 
Tonsils sometimes continue enlarged and indurated. In some cases
this enlargement will disappear spontaneously, but at others it will
not. In the latter case astringent gargles as Tinct of Galls shd 
be used or if these fail Extirpation.
Cynanche Parotidea is generally dependant on an Epidemic
influence. It generally goes off in about 4 days.
Pneumonic Inflammation
The morbid condition of the Pulmonary system has been divided by 
nosologists into several diseases: as Pleurisy, Pneumonia, Pneumonia 
Notha etc. according to its seat. I shall divide Pneumonic Inflammation 
into Pneumonia vera & notha. The former shall comprehend 
Peripneumony and Pleurisy. the latter catarrhus Suffocatious or Bronchitis
and the sanguineous congestion or engorgement. When the Pleura 




214
is inflamed the pulse is said to be harder and the pain more acute than
when the disease is seated in the Parenchyma of the Lungs.
True Pneumonic Inflammation generally comes on with pain about
the short Ribs, a full, hard pulse, hard dry cough, difficult respiration
and deficient expectoration. The duration of the disease is various;
but it is most apt to give way on the 3rd 5th or 7th day. It terminates
in suppuration, Gangrene, or Resolution according to nosologists. But
the more frequent termination are effusion and extravasation. The
causes are vicissitudes of the weather exposure to cold when the body 
is heated or violence. It is most apt to affect persons of plethoric habits.
The unfavourable circumstances are a long continuance of the febrile
symptoms and delirium with acute pain and deficient expectoration.
The favourable symptoms are the revers of these; as abatement oftener 
free respiration and expectoration of thick, yellow, puriform matter
The disease is probably of all others best understood and most curable.
The first Remedy is Copious Blood letting. The orifice from which the
blood is drawn should be large in order that it may flow in a 
full stream. it is now well established that the effect of VS in 
inflammatory complaints is proportionate to the suddenness of the 
evacuation. In an adult of robust constitution, labouring under 
violent Pleurisy, about 3 oz of blood should be drawn at the first 
bleeding. Called at the commencement of a violent attack. I bleed until 
the pain remits and the respiration becomes easier, as the quantity of
blood drawn what it may. By taking away a large quantity of 
blood, we subvert the disease while by small bleedings the inflammation 
is abated only you do good pro tempore.
In the advanced stages of the disease such [illegible] measures 
are not required. The Capillaries are now to be addressed, but the lancet
is not to be entirely withheld. Pulmonary inflammation requires more
bleeding than any others. When the circulation is sufficiently reduced
local measures are required. Of these Blisters are first in importance.
They should not be applied until action is sufficiently subdued.’
A Blister will often arrest the attack if applied in the forming state.
Local Bleeding should precede the Blistering. Purging should not 
be resorted to in pulmonary diseases as one of the depletory measures 
after the Bowels are opened they should be merely kept soluble.
when however a Bilious disease has preceded the attack of Pleurisy
or pneumony, purging with mercurials become more necessary. In 
the Inflammatory states combinations of Nitre with Ipecac or
[illegible] Tart Emetic and Calomel are to be prescribed. As soon 
as the loos cough appears the disease may be considered 




Whooping Cough has been considered by some not to be
contagious but this certainly is an error, it must be however
confessed that some persons appear to have the power
of resisting the contagion, but on the contrary there 
are other persons who take it by [respiring] the contagious
air no matter how diluted it may be. There is one
fact which seems to be peculiar, it is this, that there
is a fever in this than any other which seizes upon 
 the Lungs, but if the child be exposed to cold it has more
fever and the disease remains longer.
Children are generally affected with this disease
as it affects persons but once in their lives, the older
the person is who has this disease, the more violent
it is. The addition of catarrh with Pertussis always
makes the disease more violent, and requires a more
vigorous treatment, the fever is more considerable and
sometimes we find the Blood sizy.
Dr Cullen says the hooping is the characteristic
symptom of this disease, but I think he is wrong.
Do we not see hooping in Catarrh when the fit of
coughing very great? Doe we not also see this cough
in Phthisis. When the stomach becomes affected so as 
to throw up the contents, I have always found the 
disease to be less injurious.
The Countenance of the disease is various, and it
is thought that it will run through its course whether 
medicine is given or not. It lasts from one months
to three. The question now is to know when the contagion
ceases to exist it is thought by some that when 
hooping ceases the contagion does not exist. this is not 
the fact for I have frequently seen persons who would
communicate the disease who never had the hooping 
This disease if well taken care of will hardly goes
on fatal unless it be complicated with Cholera Infantum
then the child is very likely to die. When the paroxysms 
are very violent and long we have haemorrhage from
the nose, ears and I have seen it from the Eyes, this 
we must relieve by VS. & other remedies which will
lessen the plethora. Some persons have natural pulse 
others have full and strong. these must be bled
I have never had a bad case that I bled not [illegible]


215
broken, and we should resort to Demulcents and Expectorants.
Of these the Brown mixture is best. In the advanced stage
when an urgent cough is the only symptom, which distresses the
patient, a combination of opium, Ipecac & Calomel should 
be presented.
Whooping Cough. This disease is called by nosologists
Pertussis. It has also been called Tussis Convulsiva or Chin Cough.
about the 17th Century. It comes on with Catarrhal symptoms
which continue in some cases throughout the disease. It is 
sometimes attended by the whooping at an early period. The [paroxysm]
consists of many convulsive expirations in rapid succession and
a generally terminate by vomiting or a copious discharge of mucous
from the Bronchiae. The whole time of its continuance is generally 
about three months. It is a very dangerous disease in young children,
or in consumptive habits. It sometimes occasions suffocation
by spasm of the Glottis or by large accumulations of viscid matter
in the Lungs. I am inclined to believe that it is dependant on an
epidemic Influence, though it does sometimes arise from contagion.
There has been much difference of sentiment with regard to the 
Pathology. Dr Watts believes that the disease is always inflammatory 
and that it is sealed in the mucous membrane of the larynx
Trachae, Bronchiae etc.
The Irritation of the remote cause, occasions an inflammation of 
the mucous membrane in some or all of these parts by which 
mucous is thrown out which obstructs the passage, exciting 
cough for its expulsion. The Practice in this disease should be first
to overcome the violence and second to remove the habit of [illegible]
action which has been induced. With the first view if the patient
be strong & robust or febrile symptoms attend, VS becomes necessary.
Evacuations from the Alimentary Canal, are also required 
of these emetics are best suited to the cases of Children. To keep 
up the impression the Hebe Syrup of Dr Coxe should be given.
To relieve the constipation which is so generally met with, laxative
medicines should be given. it is the practice of this City, to commence
the treatment with a mercurial purge: the late Dr [Rush] gave 2 or 3
doses of Calomel, and then administered the watery solution of asafoetida
Cupping & Blistering are sometimes required. In mild cases nothing more
is required than an occasional emetic with nauseants.


Children should be exposed to a cool fresh air when they 
are kept in a warm room they become more [excitable]
and the disease is more violent. they should have light
nourishing diet. Gent you must always bleed when 
the disease is violent by so doing you remove all predisposition 
to catarrh or any other disease to which 
he may be predisposed. I bled one boy who had the 
disease from Nov to March [illegible] [illegible] and from calculation
took more blood than the boy weighed.
We find in some instances at the latter stage of this disease 
the symptoms takes on the appearance of Phtis, night
sweats the nails become blue etc. these cases generally 
prove fatal. There are very few who die from 
Pertussis alone. they more frequently die from Pneumonia
With respect to the Treatment it is a good
rule to draw a little blood whenever there is any 
inflammatory action. The most common remedy
in the first stage is an Emetic, but I have seen
some cases in which emetics have aggravated the
disease, but in many cases they are very useful.
Wherever there is a degree of Inflammatory action
you should never give an anodyne but when 
there is an irritability of the nervous system
anodynes are useful Purging appears to be of 
no advantage, the bowels should only be kept soluble.
I have seen purging from the debility prove
fatal. Whenever there is no symptoms of Inflammation
you may use the Stimulating diaphoretic
and Expectorants such as Squills, Assafoetida etc.
In the last stage of Pertussis when it takes on ‘
the Symptoms of Phthisis you will find Blisters & 
[illegible] to be of [illegible] advantage. The oleum Puligii
is very beneficial in the last stages of this disease. I 
once gave it to a child who had Whooping Cough
all winter 3 drops of this remedy and gradually increased
the dose and in 20 days it was it was rushing bout the [illegible]
The ol [Illegible] Musk & Aether is very beneficial, [illegible]
[Lis?en] [Islandic??] is also used. [illegible] the [almost] [illegible]
by removing to any other place will cure the disease
I have never seen [cinchona] to be of any advantage
Tinct of Cantharidis has curedthe disease in the latter
stages The Sub Carbonic of Potash (the old Specific)
zi in zii or zii Dose a teaspoonful is beneficial
A change of diet from a vegetable to animal diet I 
have seen cure the second stage. The prussic acid has
lately become in Germany a very popular remedy.
If a child be vaccinated at the commenced of Pertussis it
certainly diminished the disease.



216
After the disease is subdued the following prescription is very much used
Rx Carb Soda grs 3, Vin Ipecac gutt 5, Laudanum gut 1 water zi. To
repeat every 3 hrs toa child one year old. or Carb Potassa zi Cochineal
grs 10, water ziv, sugar zii. Dose a Teaspoonful every 3 hours to a
child one year old. In all cases, where a mild Expectoration is required
the Alkalies are useful. their modus operandi is unknown.
At this stage of the disease opium has been recommended and I have
not found much advantage from its use. it is probable that stramonium 
if smoked by adults, would have some influence; in 
preventing a recurrence of the Paroxysm. Musk has been used with 
great advantage in Europe. Dr Dewes says that it is of more
value than any thing else in the treatment of this disease. Rx
Artificial Musk zii, Alcohol zviii, dose 8 or 10 drops 3 or 4 times a 
day. Of the antispasmodic I prefer Assafoetida.
For the purpose of meeting the second indication (that of interrupting
the chain of morbid association) Tonics must be used. Dr Cullen
speaks highly of bark in these cases, but I rarely prescribe it for children
The Arsenical Solution Saccharum Saturni [Nitr] Argeni [Spt]
[Tinii] etc. have been used by different practitioners; but I have
not done much good with them. Cantharides constitute a 
valuable remedy. Rx Tinct Cinchonae zvi, Paregoric zfs Tinct 
Cantharides zi, gradually used so as to induce stranguary. I 
use the simple Tincture giving tree or four drops to a child of
one year, until the stranguary comes on, when the Whooping
will be found to cease.
Pneumonia Biliosa. This is a disease of Winter, and is most apt
to present in Miasmatic Countries; or in those persons, who have
been subjected to the remote causes of antimonial disease. There are
violent head ache, much Gastric disorder, vomiting of Bile, with
a dark and Yellow Tongue. The powers of the system appears to
be less considerable, than in the other forms of Pneumonic Inflammation;
often sinking under one or two bleedings. When we find
this to be the case, the lancet must be laid aside, and the patient
should be freely purged. Then Diaphoretics of the 
most active kind are required. Cupping and blistering 
may be resorted to, to relieve local inflammation or
Congestion.



RMJ


217
Peripneumonia Notha. Much difference of opinion has
prevailed with regard to the nature and treatment of this disease.
This difference is probably owing to the different forms, under wh:
the disease has appeared in the hands of different practitioners.
There are probably 2 forms of the disease, Catarrhus Suffocatione
and that form in which the Lungs are in an apoplectic condition.
The first comes on with the symptoms of Common Catarrh.
When confirmed there is a distressing wheezing, weak languid pulse
without any acute pain, but with heaviness from fulness and 
stricture. In examinations post mortem the Trachea is [found]
full of a fluid, of a serous mucous, or pureform nature, wh:
instead throughout the ramifications of the Bronchiae. when 
the mucus accumulation is absent, the lining membrane of 
the Bronchiae, is found injected with blood. The disease frequently 
terminates fatally, if the attack be violent. The first remedy
is VS. if the system be not too much prostrated to bear it.
it should be used with great caution. Not a little is to be 
expected from vomiting; for this purpose which vitriol or 
Ipecac alone or combined with Tart Emetic. After this a large
Blister shd be applied over the chest. opium may be liberally 
prescribed in all the stages of the disease. it is most
commonly given in combination with active expectorants.
Rx Lac Ammon zviii, oxymel of Squills zii, Peregorick zfs Dose
a Tablespoonful. or Nitric acid zi water zviii, poured on zii
Gum Ammon, then add Elixir Paregoric zfs. The Balsam Tolu and
Copaiva have been much used. The Carb Ammon in the form 
of Volat Jalap has been frequently prescribed dose a Tablespoonful 
in a wineglassful of seneka Tea. Inhalation of the steam 
of hot water alone, or with the addition of zi Balsam [illegible] or
Spts Turpentine, to the pint of water. The fumes of Tar or Resin
are highly useful, in old or debilitated persons. In that chronic
species of Bronchitis affecting old people, in cold weather, [illegible]
has been called Tapis Senilis. we have a large accumulation
of viscid matter, which cannot be thrown off by the feeble
powers of old people. Death sometimes suddenly takes place
suddenly in these cases from suffocation. The remedies are
the same in kind, as those advised for Bronchitis, but they 
shd not be pushed too far.


Frequent Catarrhs, Pneumonia, and exposure
to cold predisposes to Asthma in old
persons especially when these diseases
have not been treated by copious VS.
congestion of the Lungs produce asthma
Persons predisposed to Phthisis frequently 
have this disease. Symptoms of asthma
and produced by substances introduced into 
the Lungs such as carbonii oxyde carburetted
Hydrogen Dust and such like
Substances, Calculi in the Lungs
The proximate cause is a sudden accumulation 
of blood into the vessels of the 
Lungs which passes on the Bronchia and 
will not permit a free passage of air into
the air cells. I suppose the repetition of the 
disease to be owing to the dilatation of the [illegible] 
from repeated distention.
Asthma must frequently 
occur about the age of puberty. Males are more 
liable to it than females. Sanguine temperaments 


218
Chronic Bronchitis may supervene in all cured acute case
or it may be primary. It occurs most frequently in debauched 
habits. In the management of Bronchitis VS. if admissable shd
be practiced Cups to the Back and Blisters to the Breast, with
small doses of Calomel, squills & opium. In the last stages the
Terebinthinate remedies are chiefly used. The Congested or apoplectic
condition of the lungs comes on suddenly with infused
respiration, dull heavy pain, bloated face, tightness [illegible]
the forehead, with wildness in the expression of the eyes. The
treatment consists of prompt and copious VS (I have known
60 z taken at once). we should next administer a stimulating
emetic & then apply a large Blister. The subsequent treatment
consists of opiates and expectorants.
Asthma
This term originally embraced every case of difficult breathing; but 
it is now limited to the particular disease of which we are about 
to treat. The causes of Asthma are such as act immediately on 
the Lungs or moderately through the general system.
Of the first or local causes, may be enumerated the various
[seral] poisons, acrid particles floating in the air etc.
Those which act secondarily are wrong impressions on the alimentary 
canal, as worms indigestible food, [enanition] or repletion. It ay 
arise also from the indulgence of violent passions, or from [illegible]
Some of these cases may be considered as exciting a predisposition
having been induced by the original structure of the parts.
It commences with cough tightness, and great difficulty of
Breathing, which is augmented by motion or a recumbent posture.
The face is sometimes almost livid. The attack goes off by 
perspiration or free expectoration. It generally comes on at night.
The suddeness of the paroxysms their periodical recurrence and the 
peculiar violence of the dyspnea distinguish it from other diseases.
The more common termination is a conversion into some
other disease, as Consumption, Dropsy, Aneurism etc. As [illegible] regard]
its Pathology little is understood. Cullen considered it a spasmodic
construction of the muscular fibres of the Bronchiae.
The ordinary division of the disease is into spasmodic & 
humoral. The one is supposed to occur in the early the other in 
the advanced stages of life. The Treatment divides itself that wh:
is proper during the paroxysm & that which is [required] in the internal 



are more liable to it especially persons with 
short necks
Symptoms are difficult respiration a
wheezing noise disposition to cough an inability to 
talk without stopping in the middle of sentences or
by monosyllables The heat of the Skin is natural 
and sometimes below the natural temperature
The pulse sometimes intermits, but there is no
danger in this symptom The pulse is at times
preternaturally weak After the subsidence of the 
paroxysm an unusual flatulence occurs & other
symptoms of Dyspepsia. Asthma when with 
complicated with other diseases is not fatal. Catarrh
is more frequently an accompanying disease with 
asthma than any other.
The treatment divides itself into
two parts, 1st into that of prophylactics and cure
The prophylactics are all those remedies which keep 
off a congestive state which I consider the
predisposing cause and the only remedies which
will prevent the disease, diet should be very
light and easily digested. All malt liquors
are injurious, liquors of all kind, opium warm
spiced drinks and all things which debilitate the
stomach are improper flannel worn next to 
the skin and exercise should always be recommended.
change of climate frequently prevents
the disease. asthmatic persons never have any 
symptoms of the disease in miasmatic atmospheres 
The shower bath during the intermission 
is very beneficial it gives tone to the system 
Riding on horseback is more injurious to asthmatic
patients than any other kind, walking
swinging sailing, riding in a carriage is much 
more beneficial sleeping on a hard bed is of 
very great advantage I never would have 
a fire in my bedchamber nor sleep in a feather 
bed if I had this disease 2nd The [tretment] for 
the cure of this disease VS except in a few cases
of long standing is always advantageous Purging 
so as to keep up diarrhoea for 3 or 4 days so 
as to deplete sufficiently is of great advantage
when there is Plethora The reason [illegible]
purging is not recommended in [illegible]


219
In violent Paroxysms VS is required when debility prohibit the
use of this remedy, cupping should be used. Of the use of emetics
little difference of opinion prevails they are proper whether 
the disease is spasmodic or humoral. The Ipecacuanha is the 
best article for this purpose. The Squill has been greatly [ex???]
by some authors. it is suited to the cases of old persons, whose
lungs are torpid. A combination of these two articles is probably 
best. Nauseating doses after the paroxysm has subsided
become valuable remedies. As might be supposed from 
the known effect of Purging in Pulmonary diseases, this
remedy is not much used. The bowels should be merely 
opened with Calomel. opium has been used in the subdued
form of the disease, with advantage. Blisters to the Breast 
are serviceable, but have not done as much good as might
have been expected. Some authors advise the application 
of Blisters to the Extremities. An Issue should be made by 
means of a plaster of Tart Emetic. Relief has sometimes 
been felt from drinking cold water or what is much 
better strong hot Coffee. 
Angina Pectoria
This is comparatively a new disease having been first noticed by 
Heberden, about half a century ago. It is of such rare occurrence that
its existence if at all has been doubted by many eminent Physicians.
It sometimes comes on without any premonition, the person being 
seized with pain, about the Sternum, which extends to the arm whilst
the patient is walking it generally goes off if the person stops. It 
sometimes makes its appearance whilst the body is in a state of repose
The most common exciting cause is ascending a flight of stairs.
though it is readily occasioned by violent passions or Emotions. In 
violent cases the patient is affected with palpitations of the heart,
difficulty of breathing, with great uneasiness and anxiety. It 
attacks chiefly persons in the middle stage of life and more frequently 
men than women. In recent cases the disease is
generally curable. the fatal terminations are as sudden as an 
Electric shock. By Darwin and others it is considered a spasmodic
disease. I consider it Gout of the stomach, extending its
influence to the heart or lungs or both.


of the [illegible] I conceive it be owing to its inability
to [illegible] sufficiently. From repeated
observation I have never known VS to be
injurious except in those cases of a [illegible]
I have mentioned when VS is not
necessary we depend upon Stimulating
medicines which act upon the Lungs.
I have known a temporary relief by emetics of
Ipecac, but I think we can do very well without
them. [Seatons] & Issues have been employed with 
advantage in the early stage. The Lobelia [In??on]
has been used. Some persons have used 
the fumes of Resins Frankincense etc. but 
without much advantage. Antispasmodics
taken into the stomach have been of some
service, those which act most promptly 
as assafoetid should be used. when you use
these remedies the pulse should be weak 
and the system in a debilitated state.
The Arum Americanum or the skunk
cabbage is said to be of more advantage 
in this disease than any other. It should 
be given in Tincture or Extract. It has 
all the diffusibility of Asafoetida but it is 
more pungent and lasting. Dr Rush used
to employ Carb Terri and Ginger which 
appears to stop the disease for some time 
but so soon as the tonics cease [that] [illegible]
the disease returns. The stimulating
Diaphoretics have been used but they [illegible]
worse in this than any other disease. In 
fact Gent I [know] no cure for this disease 
Muriatic and nitric & muriatic acids have
been recommended as a tonic in this disease
but I have not seen so much benefit from 
them as I have from the preperations of Iron
[N] Potter


220
The Treatment is divided into that which is proper during 
the paroxysm, and that which is required during the interval. During
the Paroxysm the patient should be placed where he may be at 
rest and where he may be as tranquil as possible. The lancet shd
then be used as freely as the strength of the patient will admit
until the patient is relieved. Then purge with the mercurials. A 
dose of Laudanum or Aether will sometimes arrest the disease if
given in the commencement. this practice is proper also after 
VS has been used. During the interval some Counterstimulation 
shd be established for which purpose the Emetic Tartar may 
be used. The general remedies are Tonics the preparations
of Copper, Zinc, and Silver have been used. The Diet
should be light and easy of digestion, with exercise on horseback 
or in a carriage. It is remarkable that the patient [illegible]
on horseback will, when he cannot walk at all without bringing 
on the disease.
Phthisis Pulmonalis
The word Phthisis signifies a destruction or wasting: when applied 
to the Lungs, it signified a Consumption. All writers have considered
ulceration, as essential to the disease: but it has certainly has
run its course and terminated fatally without any lesion of the 
organ. The first species of Consumption of which I shall treat
is the Tubercular. Tubercles are small masses of indurated white
or greyish matter, in the Lungs, which have a smooth and cartilaginous
appearance when cut into. They are I think the
product of serous Inflammation, and seem peculiar to the [s??mous] 
or scrophulous diathesis. they are certainly not enlarged
lymphatic glands as supposed by some. They sometimes
remain indolent for many years, producing but little inconvenience.
Excited however by the common causes of Pneumonic Inflammation,
they enlarge and take on red inflammation; suppuration
follows and a vomica is formed. After the bursting of the 
abscess ulceration goes on rapidly, with copious expectoration of
purulent matter. The ulcer occasionally heals and a temporary suspension
of the disease is observed; but on being again exposed 
other tubercles ulcerate and the disease progresses. The patient 
continues thus sometimes better at others worse until his strength
being much exhausted, Hectic Fever comes on.




221
Of the exciting causes already alluded to, we may mention catarrh 
illcured Pneumonia, repelled eruptions, certain occupations in wh:
the patient is kept much bent, or by which he is exposed to an 
atmosphere, loaded with small particles, calculated to irritate the
lungs when inhaled. Pulmonary Consumption, generally comes on
with a cough, which is slight and soon becomes habitual without
being much attended to by the Patient. The respiration is hurried
on slight exertion, and the patient soon becomes languid & 
indolent. This state of things often continues for a year or two,
no complaint being made except that the patient being affected
with cold more readily than usual, he often has a cough
which is supposed to arise from cold alone, and on that account
excites no alarm in the patient or his friends. on taking
cold the cough becomes more considerable, especially at night
and continues longer than usual. This now excites attention 
particuly if it be in the summer season. The cough is at
first unattended by any expectoration, but after awhile the 
quantity of matter becomes more considerable, and has a 
mucous like appearance. By degrees it becomes more copious,
viscid and opaque. assuming a yellowish, purulent 
appearance. when the dough continues through the
night, and the matter expectorated exhibits these changes, the
breathing becomes more oppressive, the emaciation and debility
increases and the Hectic fever is fully formed. Tubercular
consumption is generally attended by a peculiar confirmation 
of the body as [long], weak, narrow chest, high 
shoulders, prominent cheek bones, delicate complexion, light
hair, fair skin, tumid lips, blue eyes, great sensibility and
veracity of the mind etc.
The indication on the first stage is to arrest
the inflammation of the Tubercle. For this purpose VS is the 
first remedy. The use of this remedy has been abused by the
celebrated Dover, but it was revived by Dr Rush. In resorting
to bloodletting, great judgment is necessary. we should constantly 




222
bear in mind, the necessity of subducing the Inflammation,
but great attention should be paid to the extreme
debility of the patient. After VS has been carried as far as providence
will permit, we may use topical bleeding by Cups.
This is preferable in many cases to the lancet. it relieves the
patient as effectually and does not exhaust the strength so 
much. where the loss of blood is totally inadmissable, dry
cupping has been used with advantage. There are some 
cases of Consumption in which bleeding in no form can 
be employed. The importance of Counter irritation in this 
disease has long been known. it is accomplished by a 
blister, seaton or Issue. To obtain the full effect from blisters,
they may be kept open stimulating applications.
The Tartar Emetic plaster has become fashionable 
latterly, but a perpetual blister is better.
Emetics have done much good in the early stages of the
disease. They equalize the Circulation, promote absorption 
and determine to the surface. Ipecac is the article generally 
employed. If however the full effect of vomiting is desired
you should not suddenly desist. an emetic shd be given daily 
for 2 or 3 weeks. Purges should be used merely for the 
purpose of keeping the bowels. we should carefully guard
against free purging, as it is productive of mischief in 
every variety of Pulmonary Consumption for the purpose
of keeping the bowels open the antimonial preparations 
have been used.
Although mercury has been presented in every form
of Consumption, it is certainly detrimental in hereditary
Tubercular Phthysis. The Digitalis, of which so much has
been said, is supposed to be suited only to the incipient
stages. It is peculiarly adapted to the cases of diluent, irritable
patients who have slight haemoptysis, with cough, pain in 
the side, accelerated pulse, and considerable debility. In such 




223
cases VS is inadmissable and digitalis constitutes a good substitute.
when the disease is not arrested and abscesses, have
formed with Hectic fever the case is generally fatal. The
Treatment is now palliative, and is directed chiefly to the 
hectic fever, on account of which has already been delivered.
The cough is exceedingly distressing and calls loudly 
for relief. Most of the Pectoral mixtures mentioned
under the head of Pneumonia may be used. The Nitric
Acid and the milk of Gum Ammonia are exceedingly valuable.
Of the Balsamic Articles the Balsam of Tolu is 
to be preferred. Opium is one of the most valuable articles
and accordingly forms the active ingredient in many pectoral
mixtures.
Catarrhal Consumption
This species differs from the former in several particulars.
It occurs for the most part without any constitutional
predisposition: and instead of being seated in the substance
of the lungs, is located in the membranous lining of the 
Trachea and Bronchia. It always commences as a simple
Catarrh, and indeed may be considered as that complaint
protracted and confirmed by ill management. There is much 
expectoration of Phlegm and mucus which generally becomes
purulent. Ulceration frequently does not exist when 
matter is thrown up: this is secreted by the mucous membrane
of the bronchiae. It is never attended with haemoptysis.
Inflammatory symptoms should be subdued by the 
depletory remedies so frequently mentioned. Emetics are 
valuable. The best practice is to put the patient under a 
course of Mercury and continue it for several weeks.
Salivation is generally productive of much good, and never
of harm in the form of Consumption.




224
Apostematous Consumption
This form of Consumption is the consequence of Pneumonic inflammation,
and has received its name from the abscesses wh: exist
It is attended with deep seated fixed pain in some part of the 
chest constant Dyspnoea and oppression, violent cough and
copious expectoration of mucous & phlegm.
In the early stage the object is to prevent the formation
of an abscess. The antiphlogistic remedies are to be actively 
employed for the purpose. In these cases salivation with 
mercury is to be induced, which may be regarded as the 
most important remedy. when abscess has formed, it 
should be opened if pointed externally. If it does not rupture
spontaneously, emetics have been used for producing that
effect. In some cases after the abscesses have burst the
Lungs remain inflamed with Dyspnoea and other distressing
symptoms. In these cases, expectoration may 
be promoted by inhaling the vapour of warm water and 
vinegar or the vapour of Aether. I have described much advantage
in some of these cases from the sue of Nitric Acid 
and Ammonia. To prevent the occurrence of the latter
stages of this disease it has been long customary to remove
the patient to a dry, temperate and equable climate.
It was the practice of the late Dr Bond of this City to 
remove his patients to Miasmatic districts, in order that they 
might take Intermittent fever. It is now taught in Europe
that Intermittent and Fever are incompatible and consequently 
that Phthisis is removed by the Ague & Fever. Exercise on 
horseback properly regulated is productive of much advantages
if the pulse be full with much Inflammatory 
diathesis it does harm. The diet shd be light and easy of
digestion. Milk is the best article.




225
Diseases of the Cutaneous System
Cutaneous diseases have been divided into Acute and Chronic
it is of the former that we shall treat. Cullen says these are 
contagious and occurs but once in the same person
Though certainly true in regard to some of the forms of
these diseases it is totally inapplicable to others. Erysipelas is
never contagious: Scarlatina rarely so. Erysipelas so far from 
attacking the same person but once. Sometimes recurs periodically;
and again in those predisposed to it, its attacks are
excited by exposure to cold or other slight causes.
No diseases present more satisfactory evidences of Gastric
origin commencing with Gastric distress relief is afforded 
by the eruption whilst a most deadly sickness results
from a [st??ing] in the eruption. Extensive eruptions 
often result from the operation of offending
matter on the stomach.
All the Exanthemata have their origin in irritation 
of the mucous membranes of the Primae Viae. The disease 
passes to the surface by metastasis, and is not an extension 
of it along the same or similar structures. Dissections 
show that when the eruption does not take place, the morbid
appearances are confined to the mucous tissue of the 
upper part of the Alimentary Canal.
Erysipelas
That form to which I shall confine my observations is Erysipelas 
of the face. The treatment applicable to this form is 
proper in every other. It is ushered in with coldness, shivering
and other symptoms of Pyresia. Erysipelas is an inflammation 
of the skin; attended by some swelling. It may be constitutional 
or local, Idiopathic or symptomatic & a disease of high action
or one connected with a low Typhoid condition of system.
The Inflammatory form of which we are treating may 
occur on any part of the body. Erysipelatous Inflammation 
rarely extends below the skin, when however it does extend
to the cellular substance the case is compounded with Phlegmon
Erythemia is a delicate blush of Inflammation in the Skin, it is 




226
the diminutive of Erysipelas. (Euthysmus is a condition of the
general irritability from abuse of Mercury or other causes)
When the hot stage comes on, the operations of the mind are
somewhat confused, amounting in some cases even to delirium
or coma. The skin during the progress of these symptoms is hot
and dry, the pulse is frequent hard and full. These symptoms
having continued for 2 or 3 days, some part of the face becomes
red and sensibly harder than other parts. The colour of the part 
affected is a dusky red, which readily disappears on pressure,
but returns speedily when the pressure is removed. The redness
is not regularly circumscribed at first, it extends gradually 
over the face, thence to the hairy scalp, and then proceeds 
down towards the clavicle. as the swelling and inflammation 
spread, they become less at the part, at which 
they first appeared, and gradually increase until the whole
face becomes tumid. The Eyes are often closed from the swelling
of the Eyelids. sooner or later Blister or vesication
appear on the surface, containing a yellow or colourless
fluid. In those parts where there is no vesecation, the 
cuticle disquamates. The disease generally lasts 9 or 10 days
when fatal it terminates generally on the 7th, 9 or 11th day 
It is by no means contagious, but often seems dependent
on a Gouty diathesis, whatever may be the 
immediate cause of the disease, it is radicated in the stomach.
In the Treatment of Erysipelas of the
face, very prompt attention must be paid to the evacuation 
of the Alimentary Canal. In the Commencement an
emetic proves very valuable. If the emetic do not arrest
it will not fail to alleviate the disease. Desault found
Antimonial Emetics to be very beneficial even Tart Emetic
to nauseate was of advantage. This should be followed 
by free evacuations from the bowels by means of Calomel 
worked off by means of Calcined Magnesia. Then free perspiration,
by means of the milder Diaphoretics, constitute
all that is necessary in the early stage. This is the plan
pursued by the celebrated Richter To be at all successful 




227
it must be adopted before the disease is completely formed.
When the disease is fully established, if the pulse be full frequent
and hard with coma or Delirium, VS should be urged to considerable
extent, after which we should vomit and purge freely.
As different as the course may be from that laid down in [illegible]
it is the only one which has done good in the Country.
If After the Alimentary Canal has been freely evacuated, and the
pulse reduced by bleeding, coma or Delirium remains, we must
have recourse to Cupping. leeching and blistering. Even in the
comatose condition, I have seen decided advantage from Emetic
a spontaneous flow of blood from the nostrils is in these
cases highly beneficial. I once knew this imitated with advantage,
by applying leeches to the nostrils. When the system 
begins to skin, it must be supported by proper remedies, both
internal and external. The external are sinapisms Blisters etc.
The Internal which I have found best are vol alkali, opium
Camphor, wine & Bark. In the progress of the disease the cutaneous
affection is so troublesome as to require particular 
attention. The best remedy which I have found to allay the
irritation of the surface is a watery solution of opium 
frequently applied. when the irritation of the skin is moderate,
much relief is afforded by dusting rye flour or starch
The powder sometimes becomes incrusted by mixing with the 
discharges from the part and occasions irritation. Fomentations
with decoction of Poppies & Elder are useful. A physician
of this City speaks highly of a lotion of Corrosive sublimate RX
[illegible] zi of water. In that form of Erysipelas commonly called
shingles, I have used Citrine ointment with advantage.
When the Erysipelatous inflammation threatens to run into
Gangrene, a blister is the proper remedy. When the usual
means of discussing the swelling in Erysipelas compounded 
with Phlegmon fail, Mr Hutchinson has advised laying
open the integuments down to the muscles.
There is a specie of Erysipelas attacking Infants soon 
after birth; it appears first on the lower part of the abdomen &
extends over the Genitals to the [Nates]. Its seat is the cellular
membrane. I have seen it attack adults or children somewhat 




228
advanced very much in the form of Phlegmasia Dolens the
part considerably swolen and tense without discolouration. In 
this case there is a deposition of Coagulable lymph producing
consolidation and obliteration of the cells. The remedies used
for it are of doubtful effect. I have relieved it by the internal
use of Carb Ammonia. Mercurial ointment may be 
tried. The best treatment consists of warm fomentations 
with vinegar.
Erysipelas though generally Inflammatory sometimes
appears in a Typhoid form. These cases are most within
the aged, feeble and infirm or in hospitals. VS is here inadmissable
we evacuate by emetics and purges moderately 
and then resort to mild Diaphoretics, with warm bath. Next
we recur to Cordials and stimulants, as Vol Alkali & opium
or Peruvian Bark with acids wine or aromatics. when the
sinking condition is manifested, the indication is to uphold
the system by stimulants [watever] may have been the 
original form. Local erysipelas sometimes arises from sting
of the wasp or bee. Cold lotion, Saturnine solutions, spts wine
spt Hartshorn Spt Turpentine may be used when Gangrene
is threatened Blister. Erythema is to be treated by the same
remedies, though of less activity. An application latterly much 
in fashion in Erysipelas, is the mercurial ointment, from 
which very good effects have resulted when applied to the 
face it is apt to salivate. I have also used [citron] ointment.
An ointment made of Calomel zi to Lard zi is the best
remedy for the Infantile eruptions resemble Erysipelas
Scarlatina
This disease derives its name from the Colour of the skin. It is a 
disease of modern origin, which was scarcely known to the Ancients.
It broke out in Spain in 1610. it was supposed to have
been derived from Africa. Eight years after it prevailed Epidemically 
in Naples. In 1689 Morton the contemporary of Sydenham
mentions it has prevailing in London; in 1735 it appeared in 
New England and thence extended itself over the United States.
Scarlet Fever is a complaint of Winter & Spring, more than 
summer & Autumn and attacks the youthful rather than those
advanced in life. The disease has been divided by nosologists into 





229
3 forms, Scarlatina [Simplex], Anginose and Maligna, but these
are to be regarded only as different grades of the same disease.
Scarlatina [simplex] is a constitutional disease without any 
affection of the Throat: Scarlatina anginosa is a higher grade of
the same disease, in which the Throat is inflamed and swelled
& scarlatina maligna is a grade still more violent: The Throat
is affected and the symptoms are of a malignant character.
Like most other Fevers Scarlatina comes on with chilliness
head ach, lassitude, Nausea & vomiting. The degree of these introductory 
symptoms, indicating the strength and character of the
impending disease, which is always proportionate to the violence
of these symptoms. The attack for the most part is sudden. The 
patient feels sick and faint, the head is giddy and rather confused
the stomach foul. The patient is sometimes suddenly prostrated
as if overwhelmed by an oppression [load]. The face becomes
palid or livid: the eyes glairing and [mouth] with an [???eated]
oppression. on the third day from the Commencement the
febrile symptoms become considerable. the skin becomes acutely 
sensible, and begins to show an efflorescence or florid eruption.
at the same time there is a degree of redness and swelling of the
face. The reaction of the system being completely [develop???]
the pulse is preternaturally quick hard & full. The eruption 
generally appears in patches in the neck and face. it is not regular
as to its appearance or duration. The appearance of the 
Tongue is peculiar no papillae project through the white matter
on its surface. The eruption usually continues about 2 day s
and goes off with disquamation of the cuticle; but there is not
much abatement of the Pyrexia, either when the Eruption appears
or when the disquamation takes place. As the disease proceeds
the neck & lower jaw become stiff, the Tonsils swell and are
marked with specks by degree ulceration supervenes and 
sloughs form in the fauces, which separate about the 10th day
leaving ulcers which heal kindly. 
The fever now abates and the general improvement
is evident. In the more malignant forms the
sloughs are foul with a foetid discharge from the ulcers and 
painful induration of the glands about the neck. The disease
has been considered contagious, but I believe it to be dependent 




230
on an epidemic influence. It may be taken for measles by 
the inexperienced. whether scarlatina attacks the same person
more than once is not fully ascertained. it seems probably 
that one attack affords some security against future ones
In the latter disease however, there is more of opthalmia and 
Catarrh and the eruption is smaller and better defined. It is also 
attended by a hoarse Cough and frequent sneezing. The peculiarities
of the Tongue is the best distinguishing mark in Scarlatina
there are red points on the surface projecting through a 
whitish crust. The anorexia, nausea, and vomiting sufficiently 
point out the Gastric origin of scarlatina. The opinion wh:
locates it in the throat cannot be sustained.
In its simple form Scarlatina requires very little
medical aid. An Emetic of Ipecac with moderate purging VS.
if there be fever or pain in the head, mild Diaphoretics, Diluent 
drinks and a strictly regular diet, constitute the remedies wh:
are required. In the Anginose state much more is to be done.
Much reliance is to be placed on the thorough and continued
evacuation of the alimentary canal: when the symptoms 
are violent the lancet shd be used immediately. We shd 
begin with active vomiting with Tartar Emetic. Emetics are
here of the highest importance. Given in the forming state 
it is said that they sometimes remove the disease before the 
constitution has been sufficiently impressed to afford it
protection against future attacks. Emetics should be followed 
by a purge of Calomel & Jalap. these should be repeated according
to circumstances. If the pulse be full and hard VS 
should be resorted to. In performing the operation, the relief
experienced by the patient, the appearance of the blood and the
effects produced are to be our guide. The Cold bath if used at
all, is suited to the early stages, when there is considerable
arterial action, with great heat of the surface. The cold bath
as a remedy is certainly very hazardous. Currie and Gregory
were in favour of it. It is said that the latter lost one of his
own children by it. I prefer ablutions. when the eruption 
has receded and there is much languor I have known the 
warm bath to the beneficial.



The measles have been called by man names, from what it 
is derived from we know not, it has been Rubeola, variola etc.
This disease arises from a certain condition of the atmosphere,
It has been divided into 3 kind 1 the Rubeola [medaris], 
2nd The French Measles, 3rd Rubicella. In the first
used the eruption is larger and there is more fever, this kind
is called in Scotland, [Nasles]. This disease appears in 
all countries not uniformly hot, every five years.
The Symptoms of measles are very various, but we 
always have either pneumonia inflammation, cough or
Sore throat, the most common feeling of the patient
is a Sore throat and hoarseness, the Lungs [B?????]


231
For the relief of local Congestions remaining after the use of general
remedies, topical bleeding and blistering are required. A fomentation 
of mashed potatoes to the Throat has proved beneficial. Emetics
should be used to cleanse the foul ulcers of the Throat. Detergent
Gargles should next be employed. Of these a very good one is composed
of the decoction of the Bark and Tincture of Myrrh, a very 
common Gargle, is Barley Water acidulated with Sulphuric Acid, & 
subsequently conjoined with honey. The remedy on which we 
can most rely in the treatment of this disease is purging with 
Calomel. In the malignant state we use emetics & mercurial
Purges. the latter were introduced by Dr Douglass of Boston.
When symptoms of sinking occur, we must sustain the 
system with cordials and stimulants. we should apply Blisters
to the stomach and extremities, and give opium internally or 
Camphor, Carb ammoniae, Bark & wine. Spt Turpentine, the muriatic
acid was introduced by Sir W Fordyce who gave 10 drops to a dose,
in an infusion of Bark. It has been lately said by the German
Physicians that the attack of scarlatina, may be prevented by the use
of the Belladona. Taken moderately for 7 or 8 days. it is said to induce
and anginose form of disease, which by occupying these parts wh:
constitute the seat of scarlatina exclude the latter from the system.
They use a solution of the extract in Cinnamon water 3 grs to zi.
The best mode of treating the dropsical effusions of the lower
extremities, consequent to this disease, is to purge moderately and then 
give Digitalis. Gargle in scarlatina An [g???a]. Rx Cayenne
Pepper 2 Tablespoonsful, Common salt 1 ½ Teaspoonsful, warm
water zviii, vinegar zviii. Digest one hour and strain. This
prescription is much used in the W. Indies. 1 or 2 Tablespoonsful
taken internally occasionally. In the malignant form.
Measles
The Measles was brought into Europe at the same time, with small
Pox, and for a long time was regarded as a modification
of that disease. As late as the time of Diembrooke and Morton, the 
notion of its identity with small Pox was entertained. Sydenham 
was the first who gave a distinct account of it. In [18?1] the disease 
overran a great part of the US. It is said that during its
prevalence those who had previously had it labour under a Rubeolous
cough and that even the [brutes] feel its influence demonstrating  



and Traches are all affected. This disease is very [danger???]
if not properly treated, how many persons do we see
die during the Summer afterwards with Phthisis and
other diseases, but if the disease we properly healed
we see none of the ill consequences. [illegible] should
never inoculate until the patient has entirely recovered
from measles. Pregnant women go through this disease
frequently without any injury. But in small Pox they 
always die. Measles begin in the month of January 
and they travel from East to West. It is very remarkable
but certainly true that all mortal Epidemics travel 
in this direction in Europe as well as this country, 
a warm spell of weather always stops the disease, heat
appears to volatalize the contagion, the contagion of this
as well as small Pox always [ascends], but never [dis??]
a person in the lower story will give Small Pox
to all in the upper stories who have never had the
disease. The European writers think that the disease
is more mortal in cities than the country it is not
the case in the US.
The disease commence with a general lassitude
followed with alternate chills and [flushe] in adults
accompanied with violent headach but coma in 
children, the eyes become very [??sible] the Secretion
is increased, the [secretion] from the nose assume
very acrid, violent pain about the praecordia come
on and nausea and vomiting, in others we see 
a Sweat comes on which affords but little relief
great thirst the tongue is white, about the 4 or 5th 
day the skin has the appearance of being bitten
all over by fleas, the eruption first appears on 
the face then to the neck and gradually descends 
the eruption is more abundant upon those
parts wh: are kept warm except the face where 
they are always most abundant, when the disease
appears in its mildest form the symptoms mitigate
after the eruption comes on, It appears to me that
there is some sympathy between the contagion
of this disease and the Liver.
There is one circumstance with 
respect both to Small Pox & measles that is you cant communicate
the disease before the eruption takes place, but
these diseases can reproduce before the eruption by inhaling 
the breath of the patient without the 8 or 9th day [illegible]
[?alls] off [scales] from the eruption. [Desau] has given
one of the best remedies on measles of any other writer
The measles is frequently followed by a second 
fever which frequently kills the patient. this should be
[??ated] by tonics. It is brought on by improper [illegible]
by not bleeding and purging enough


232
its atmospheric origin. The evidence of its contagious character
is very slender. Whenever a disease can be traced to an
atmospheric origin, we are not to regard it as at any time
contagious. nature would not use such dissimilar
means of answering the same end. It is not proper
however that we should permit those under our care
to be exposed to the disease. we may be mistaken and 
it is best to err on the right side. It has been doubted 
whether the disease can be had the 2nd time. The
Rubeola Sine Catarrhs or French Measles give [illegible] protection
against an attack of the genuine disease
This disease not only commences in a specific contagion
generated by the morbid action of the system, but it
prevails also as an epidemic, and is propagated by the
medium of a vitiated atmosphere. It is one of those 
diseases to which we are liable but once. It is chiefly 
a disease of the winter and spring and attacks the young 
rather than the old. Extremes of heat or cold augment the
violence of the disease. It is generally believed that measles
make their appearance every 7 years. in corroboration 
of this opinion it may be remarked, that the disease has
prevailed Epidemically in Philadelphia, every 6 years for 
the space of 40 years (according to Professor Caldwell)
This disease is ushered in with languor, chilliness,
anorexia, Heat, anxiety, sickness & vomiting, the fever is
always most severe, just before the eruption breaks out
which usually takes place on the 4th day. the Eruption 
continues until the 6 or 8th
The fever is attended with more or less hoarseness
a frequent hard, dry cough, difficult respiration, soreness
and pain of the chest, swelling of the Eyes, a troublesome
coryza and considerable drowsiness. The eruption which 
makes its appearance on the 4th, first about the face, retains
its original redness for 2 or 3 days then turns somewhat brownish,
and in a day or two mor, disappears. followed by a 


The Eruptions of Measles are very [gnomalous], we 
sometimes have the disease without any inflammation.
Called the purple or Putrid measles, this is
nothing more than a Typhoid action which must
be treated by tonics, at other times the Epidemic
is Inflammatory then we must use the antiphlogistic
regimen. The disease sometimes seizes upon the 
trachea, producing all the symptoms of Croup here 
we treat it exactly as we would croup.
Every person affected by this disease is
liable to affectations of the Lungs, the general Treatment
therefore will be in the first stage, to bleed
at first, and place the patient in a room well
ventilated, it is better to keep them too cold than 
too warm, the patient should be directed to sit up 
if the patient be not to sick give him cold drinks
and purge him with Calomel and bleed.
In the eruptive state the eruption cannot
come out by the violent action of the heart, wh
is known by oppression about the heart & lungs 
[illegible] is the only remedy wh: will bring out a plentiful
crop. In the typhoid state you must Blister
and give Vol Alkali and such stimulants wh: will
bring out an abundant crop. this stage must be
known by the weak pulse & general debility
Great distress of the stomach sometimes
prevents the appearance of the eruption wh: will
be restored by giving an emetic. The affection of
the eyes is sometimes very troublesome which will 
be very much relieved by washing with cold water
You will find the common people giving Saffron etc.
and mint [toddy] in the first stage nothing is more
injurious, in the second stage you can give any 
warm [drink] porter and opiates, but in this stage you 
can give almost any thing as the disease is gone if
properly treated in the first.
[Potter]
Jany 22, 1829



233
[branny] desquamation. There is not so much abatement
in the febrile symptoms, or the breaking out of the eruption:
The fever usually continues until the desquamation 
is compleat and sometimes later. The 
cough is more protracted than the Fever. An imperfect
efflorescence is unfavourable. the common notion is
that there is not sufficient energy to bring out the 
eruption; I believe however that it manifests 
the existence of a fixed and established disease of the 
mucous membrane of the Primae Viae. This is in all 
cases the primary seat of the disease, and is relieved
by the eruption. This disease is more apt to be succeeded 
by other affections, than any other. Opthalmia
and Phthis are not unfrequently consequent
to it.
In the slightest forms of the disease, no medical 
treatment is required. when the attack is more
violent, the temperature of the room should be regulated
with great care. It should be as such as to favour
cutaneous action, but not to increase fever. it shd 
range from 62 to 69 [degrees] Fah. In the beginning we evacuate
the Alimentary Canal freely [the] emetics & purges.
we then endeavour to promote the eruption by diluent 
drinks. If the Fever be high, cough troublesome, pulse
frequent, full & hard, VS will be necessary. Convulsions
sometimes appear in children during the Eruptive
fever. To remove these VS, warm bath and 
Laudanum are the best remedies. An enemy, especially 
if the bowels are constipated are required.
In the course of the disease, the bowels should 
be kept free and open and rather by the mild than 
drastic articles. We allay the cough by the mucilaginous
mixtures, as barley water, Flax seed tea, Gum
arabic etc. To procure rest at night an anodyne of
opium & Ipecac or of Laudanum & Antimonial wine 





234
should be used. Should Pulmonic symptoms come on 
the treatment is the same as in other cases of Pneumonia.
Cold to the surface is objectionable on account 
of Pulmonary symptoms.
The Typhoid form was first noticed by Watson
it occurred in Edinburg in 1816. The symptoms of the
eruptive stage, are singularly violent the eruption
is very apt to recede. Symptoms of malignity in 
all diseases depend on the crippled condition of the 
stomach by its energy the powers of life, are
to a certain extent maintained, & consequently 
experience the most alarming prostration, when 
that energy is diminished. In the Typhus 
form we rely chiefly on vomiting & purging after
which we endeavour to excite cutaneous action by 
warm bath & stimulating drinks. If the eruption be 
deficient in colour or quantity, Rubefacients, especially 
sinapisms & Blisters to the epigastric region, with 
cordials & stimulants internally. For allaying thirst
use the following Rx Gum Arabic zi Cream Tart zi
Sugar Candy zi, Water 1 quart – Dose a table spoonful
every 2 or 3 hours, or as the case may require.
The Sequela of Measles are opthalmia, Paraphonia
Aphonia Diarrhoea etc. If any part be weak, disease
is very apt to be excited in it by Measles.
IN Hoarseness or loss of voice we give emetics and
bleed if there be inflammation. we then give Carb
Ammonia which has proved very beneficial. Inhaling
Hoffmans Anodyne & Laudanum has done 
good. If it be owing to permanent thickening of
the lining membrane of the lungs, Blister and use
mercury as an alterative.
Sydenham found that the Diarrhoea following
measles could not be cured by astringents. We must
resort to moderate & repeated VS. warm bath, Blister
to the abdomen and Dover’s powder at night.


Small Pox
Since vaccination has become so fashionable this disease
is not hardly mentioned by writers as it is thought
that vaccination will prevent this disease, but I will 
cut the matter short by stating at the commencement 
that vaccination will not prevent the Small Pox.
This is the only general disease since the days of Adam
which require a general quarantine, for it is certainly 
the fact you may carry the contagion all over
the world in your coat sleeve or Handkerchief, & give
it to the last man you may see.
This disease may originate from causes wh: are 
unknown but where there was no contagion to produce
the disease, wh: I saw exemplified in Caroline 
County where the disease broke out in a family 
which saw no person who had the disease.
Inoculation certainly mitigates the disease 
this acts sooner by acting on the Nerves of the arm, 
it is produced earlier by inoculation than by inhaling
the contagious air into the Lungs.
This disease is thought to have been brought into
Europe by the Crusaders but it is not the fact, we find
historical account of its being in Britain long before I 
believe this disease can arise in any country where
the materials are which may contaminate the atmosphere.
We have accounts of the British [laying] the Small
Pox as they though the disease would be milder by 
[??ying]. the practice was to put a little of the matter
on a piece of Cotton or Silk and placing it on the
arm. The Revr D Mather introduced inoculation into
Boston, before it was adopted in England, 1721 in Boston
1722 in Britain. Inoculation was known as early as
the 3 or 4 Centuries in China.
There are various mode of inoculation the
Turks introduced the matter into the nose, this was abandoned
because it produced violent symptoms. it then was the
practice to make an incision in the arm and after the 
bleeding had stopped then they put a thread soaked in the
matter into the wound and adhesive plaster placed over it
This practice is now to elevate the skin with the point 
of a lancet or needle dipped into the matter.
You cannot inoculate persons who have inflammatory
fever, or the Itch, [Tonae] Capitis Catarrh, Croup or
when there is any fever or inflammation. You cannot
inoculate pregnant women, persons with Syphilis
persons with this invariably die. any kind of eruptions, ulcers, Sore legs, asthma, should always deter us
from inoculation, but on the other hand it cures
many [cronic] diseases, chronic Rheumatism, Lumbago,
Difficult menstruation & many other of
such diseases



235
Variola or Small Pox
This disease which was deprived of many of its terrors by the
cooling regimen adopted by Sydenham, and subsequently by 
the introduction of inoculation: we had hoped was robbed
of every remaining power by the discovery of vaccination.
but as it too frequently happens in [sublunary] affairs 
the foundation of our best hopes has been shaken
and we have been compelled to witness the insufficiency
of our prophylactic powers of the Cow Pox in the
prevention of this disease.
Small Pox was unknown to Greece and Rome.
Rhaze, an Arabian author, who flourished about
the 9th Century, gave us the first distinct account o f
it. Some traces of its existence in the east are however
to be found on record, as early as the year 572. It seems
to have been brought into Europe by the Crusaders, & 
thence spread through all Christendom. The vernacular
term has its origin from the Saxons. small being added
to distinguish it from the venereal disease which 
was known by the name of great Pox.
That small Pox arises from a specific contagion
no one doubts: though much difference of opinion 
has existed with regard to the distance at which 
it can act. It was formerly believed that
it might be wafted by the winds for several miles.
The experiments of Haygarth go to prove that the sphere
of its action is not more than 6 or 8 feet. It is yet
undecided whether the disease can be communicated by [fomite].
By Haygarth the greatest of modern contagionists it is declared
that it cannot; and the fact that the clothes of medical men
& nurses, exposed to the contagion, do not communicate the
disease is strong argument in favour of that opinion.
The latest period of this contagion is 10 or 14 days. It is 


The different mode of preparations for Inoculation
 [illegible] Nettleton gave Rhubarb, and sometimes emetics, others
bled first and Purges afterwards they placed them on 
vegetable diet he made 2 incisions and put matter
in each, this plan produces great inflammation,
afterwards the matter was introduced by thread,
Since the use of preparing mercury the abstemious
diet has in a great measure been dispenced with
If the patient be reduced very low from abstemious
diet he cannot receive the disease, I saw a case
where Inoculation was performed 10 times without
producing any symptoms, he had to take more
nutritious diet and wine before he could be affected 
with the contagion. The only preparation which is
necessary I think is a few doses of Calomel, it is
not necessary that the mouth should be affected.
This disease may be had locally and this will
account for the reports that persons have this disease
twice. The fever began in 3 cases on the 5th day
some on the [6] but the common time is on the 9th or 10th
day, after the matter is introduced into the arm.
I know one case in wh the patient had no fever until 
the 21st day. The scab does not fall off in the [con??ent] form 
before the 25 or 30 day
The first change in the pustule is a brown spot in 
the middle they are first papular, then vesicular and 
finally pustular. You may distinguish the disease
from the effluvia of the Lungs, and the pustules are
more elevated than measles. the disease with wh
it most resembles. Inoculation is frequently 
followed by considerable fever and great swelling
in the Glands of the Axilla. Local Inflammation 
may Sometimes require some treatment, by Leeching
VS etc. IN vaccination if you let out all the
fluid by puncturing you will destroy the effects 
of this vaccination, but it is visa versa in inoculation
you cant destroy small pox after Fever and Suppuration
commences. After inoculation has been performed
about the 8th day your patient will complain of
headach and chilliness with other Symptoms of
fever, no treatment is necessary except cool air
[This] after the disease subsides but 
this is entirely useless. It was given to purge off
the Humour of the blood according to the Humoral
pathology.
The contagion of Small Pox is carried
about in the hair of animals and flies from one 
family to another. I have seen several cases communicated
by the bite of flies.


236
very certain in its effects and all ages are liable to it; even the
foetus in utero. Jenner states 2 or 3 cases in which the foetus
was attacked in uteri, although the mother was not affected
having been protected from a previous attack of the disease.
In these cases it is alledged that the contagion must act
through the system of the mother, but if this were the case
we should expect to find the mother affected by the vitiation
of the blood. I believe that the disease is communicated
by the contact of the infected atmosphere.
Some individuals seem to have no susceptibility to 
Small Pox, having frequently been exposed to the contagion
without contracting the disease. It has been estimated that
1 in 50 enjoy this immunity. it fequently happens however 
that a person who is not affected by exposure at one time
will contract the disease at another.
Whilst contagion must
be admitted as the common cause of this disease, there is good
reason to believe that it is sometimes dependent on an
epidemic Influence. This is to be inferred from sudden appearance,
its general prevalence and its immediate disappearance.
The dominion which it exercises over all coexisting diseases
During the prevalence of Small Pox here, last winter we 
had an endless variety of non descript exanthemata almost
every febrile affection was attended by some eruption. It 
must at least be conceded that there is a constitution of the 
atmosphere, which may be termed variolous that furnishes
the Pabulum of the disease.
When the disease prevails epidemically, the records
of Medicine in every age, inform us, that it is more violent
and that it is disposed to attack those who have previously had it.
as well as those who have been vaccinated. (see Thompson
on Small Pox)
There are two principle varieties the [confluxent]
and distinct. In the distinct the fever is moderate
and of the true inflammatory character, marked by the
ordinary symptoms of Pyresia. If confined to bed and 
covered the perspiration is more copious, than in any other
Febrile affection, and emits a strong and peculiar odour.
About the 3rd day after the fever appears, the eruption 
begins to break out, about the neck and face. (I would here
remark that all the exanthemata show the eruption first in 



If a woman have the Small Pox any time after the
5th month of pregnancy abortion is always produced
and the mother dies of uterine Haemorrhage, the foetus
is always covered with the pustules as thick as the
mother and Dr Jenner saw a case in which the skin 
of the child was completely affected with the eruptions
when the mother had not the disease at the time
Authors have made the disease to consist
of many kinds but this is all a [farce] [illegible], there
is only one kind, it is only different degrees of the
same kind. This disease kills in different states
Sometimes by Pneumonic Symptoms at other, a Sore
throat but the most frequent termination is in the
confluent stage by absorbing the pus and producing
a fever Sui Generis, something alike Hectic, when
the patient is in a Typhus state we must give
your patient to get into this state. In the Inflammation 
wh: is the first you should give purgatives and use
VS freely, give your patient a plenty of the Supr Tart
potass to drink. The second stage of Small Pox is
a state of indirect debility. in this stage you gain 
more by opium than any other remedy, Bark
wine whey, generous diet, and other tonics. In one
case I saw a patient drink a qt of Rum in 12 hours
The season for inoculation is generally supposed 
to be the month of April the worst season is cold
weather. the season in wh. marsh miasmata is
not a good one, when inoculated in this season 
the disease invariably is intermittent. The
proper time for inoculation is the mid Summer
I know this from experience, the reason is
that we can keep the system in a more equal
and uniform state. I inoculated 185 souldiers
in the month of July and there was not a single
one who had more than a dozen pustules. It is a 
matter of great importance to know that a secondary
eruption sometimes takes place about 
24 days after the disease disappears wh: sometimes
proves fatal. I know one case of secondary 
eruption to be brought on by the patient sleeping
with his wife and the pustules were 10 times more
numerous than the first. when [spatchelas] takes 
place Blisters and opium are the proper remedies
In every stage you must keep the patient from 
exercise, & if the patient has been properly 
prepared you can let your patient have 
milk and such diet.



237
about the head and face in consequence of the thinness of the
skin. whenever therefore you are at a loss about a febrile
affection, watch for the eruption about these parts.) The
eruption is generally completed about the 5th day.
From the commencement of the eruption the Fever begins
to decline, and ceases entirely with the completion of the 
eruptive stage. The pimples are round and distinct,
towards the close of the 5th day there is a small vesicle
on the top filled with colorless fluid. The pustular
character is now developed and an inflamed ring now
surrounds each pustule; by the 8th day they are filled 
with purulent matter and by the 11th they burst and discharge
the matter, which forms a crust when the scales 
are thrown off the skin remains of a brown colour.
When the pustules are numerous a secondary fever appears 
about the 10th day, which gave off as soon as
these mature and discharge their contents.
There are 4 Stages the Febrile, Eruptive, Maturation
and Declination or Scabbing. between each of these then 
is an interval of about 4 days. The Benign distinct
form which we have described is subject to many 
varieties.
Confluent Small Pox
In this form the course of the disease is similar
but the symptoms are much more violent. The eruptive
fever is of a Typhoid character: The eruption after
shows itself earlier than in the distinct form; and is
frequently preceded by an Erysipelatous Efflorescence. As
the pustules fill they become ragged on the edges, and run
into each other; the fluid, though it changes in colour & 
consistence never becomes purulent. The Throat is sore
with difficult deglutition and copious salivation or diarrhoea.
The secondary fever is also higher and is accompanied
with Petechiae, vibices and dark colour of the skin
There are many varieties of the Confluent Small Pos, as the
Erysipelatous, Morbillous, Milliary, Sanguineous, [Gangrene] [illegible]
Rock: when the Inflammation penetrates to the cutis vera, we have
pits from ulceration of the skin.




238.
The more perfectly marked, the distinct form is, the less is the
danger, and the more confluent, the greater. Great Severity of
the Secondary fever is very dangerous. the 11th & 13 days are to 
be considered the most dangerous.
Dissection shows that in the early stages of the disease, the
Mucous membrane of the Primae Viae and the Pulmonary apparatus
is in a high state of Inflammation. In the later
stages the stomach , Grain & abdominal viscera are affected by 
a weak Inflammation or congestion as in Typhus. It was
formerly maintained, that the pustules only appeared on those
parts exposed to the air. but it has been found lately that
this is not true. Of the Gastric origin of the disease
we have the strongest evidence. On no other supposition 
can we explain the difference between the casual and [???ulated] 
Small Pox, than by the difference between the 
Lymphatics and connections of the stomach.
Treatment of the Small Pox
This is an incurable disease. Like most affections depending
on a specific contagion, it will run a definite course in 
spite of all our exertions. Nature institutes an action for 
liberating the system, by which a similar matter is 
produced to that which gave rise to the attack. It is then 
that the semena morbi are produced. and sine it is
the will of Providence that contagious diseases shall exist, it
is not permitted us to cure the attack and thereby disturb that 
process by which the cause is eliminated. Although we cannot
cure we can palliate the disease. We should commence
the Treatment in distinct cases, with an emetic.
The Stomach being relieved we next evacuate the alimentary 
canal, thoroughly with the saline Purgatives
and afterwards keep them soluble by small doses. In the 
interval of purging, mild Diaphoretics should be given.
When the Fever is high, with dry heated skin and local determinations
to the Lungs, Brain or other important parts VS
will be demanded. Under such circumstances, effusion 
of Cold Water, have been advised; but it is certainly hazardous.
sponging the surface will answer much better.
In children, convulsions are apt to come on during the 





239
eruptive fever, which are said not to be dangerous. nothing
is necessary but cool, fresh air, or the warm bath. Should
they recur frequently VS. Laudanum, Sinapisms to the feet
etc. should be used. The eruption sometimes does not 
come out well or recedes after it has appeared. In either 
case the Treatment is the same: An Emetic, with diaphoretic
stimulants, as camphor & wine whey, conjoined
with Pedeluvium or sinapisms. when there is great
nervous irritation, it may be removed by opiates,
Hoffmans anodyne, & Camphor.
Our leading object is to keep 
down Arterial Action. we should be particularly ;careful 
to place the patient in a cool, well ventilated apartment
or a mattress, with little or no cover. Anterior to the
time of Sydenham precisely the opposite course was
pursued: The patient was confined to a heated room and
the most [al??pharmic] articles administered.
Confluent Small Pox may be highly Inflammatory
or directly the reverse; In the former the remedies already 
mentioned may be used, graduating them to the violence
of the case. In the Typhoid form the treatment is 
materially different. we have here a disease of weak 
action, which is to be managed on general principles.
We commence with an emetic followed by gentle
purging. Early in the case we are compelled to resort to 
the means of sustaining the system, which have been 
so frequently mentioned, that I need not repeat them.
To promote the maturation of the Pustules, Bark and
opium with vol alkali have been used. The warm 
Bath, sinapisms, blisters & especially Wine are useful
for the same purpose. At the full maturation of the 
eruptions, we have often a secondary fever, from irritatioin
of the surface. it requires no peculiarity 
of treatment. It is very important to prevent the 
deformity from marks in females. Covering the face
with fine camberick, spread with simple Cerate, so 
as to prevent the contact of the air, has prevented the
appearance of the eruption. Camphor is said to have 




240
the same effect, when applied to the surface. Should
these means fail, we abate the Inflammation of the
Pustules by cooling saturnine lotions and puncture them 
directly they fill to let out the matter. It is said that
a bag of Camphor placed over the eyes will prevent
that troublesome and dangerous opthalmia, which 
is apt to follow small Pox.
Innoculation
By Innoculation, small pos, as we have already 
intimated, was rendered much milder. it was estimated
in the European Hospitals, that only 1 in 500 Died.
It is not known precisely where the custom originated.
it is claimed by the Chines. If tradition may 
be trusted, it seems to have prevailed much earlier among
the Brahmins in Hindostan. It is however to Lady 
Mary [Woolly] Montague, that the honour is due of having
introduced it into Europe. Early in the reign of Queen Ann
she had her son innoculated at Constantinople, where 
she then was with her husband, who was ambassador
at that place from Gt Britain. It encountered on its 
introduction the most violent opposition. Enlightened
on the Subject the then reigning family of England, submitted
to it. Being a voluntary act, we can induce the 
disease, when time and other circumstances make it
most suitable. The mild weather of spring and autumn
are most favourable. A child of weakly constitution
or under the age of 6 months should not be inoculated; 
but it should be remembered that the disease is milder
in children than adults. It was formerly thought necessary 
to prepare the system, by diminishing the diet and 
instituting a mercurial or antimonial course 10 or 15 days
before inoculation. we now only [illegible] the patient after
Innoculation & administer a purgative occasionally.
It was once though important that the matter from 
a mild case should be chosen. but this makes no 
sort of difference.
We introduce the matter under the cuticle.
It does not matter how much, for the disease will be
the same, whether induced by a small quantity or a large. 


Vaccination has been considered ever since the day 
of Dr Jenner to be a prophylactic to Small Pox but observation
has convinced me that vaccination does not
prevent the disease. Vaccination does frequently act
locally and then the constitution may be as easily affected
by the contagion of Small Pox as if the patient
had never been vaccinated. If you insert the matter
of vaccination and that of Small Pox into two different
incisions, the inflammation of each had its own
appearance until the 7th day but after that it 
partaked the nature of both, I inoculated the scalp 
of a healthy girl with the matter of both and the 
consequence was that the girl had complete small
pox, she had never had Small Pox. It is a curious
fact that after vaccination when the child has small 
pos that the fever of Small Pox goes off precisely at
72 hrs, unless the eruption takes place.
Sometimes when you vaccinate with vaccine
matter you have all the Symptoms of Small Pox
except the scab wh: partakes the nature of both
diseases. I have seen persons have the varioloid
disease several times. it is owing to the 
virus affecting different constitutions differently 
I have also seen persons have the variolated
disease after the variolus, it appears to me 
that the varioloid disease increases the predisposition 
to the disease, now Gen the Small Pos
[illegible] has this effect when it once produces its
[effects] on the nerves. the patient is former [illegible]
vaccinator in the [illegible] vaccinate took [illegible]
and after he pronounces them exempt from the 
disease I will bet any sum that I can give 


241
Nothing affords a stronger argument in favour of the
local origin of the disease than this fact. for if the matter 
were taken into the system & circulated through the blood its
violence wd be proportionate to the quantity absorbed.
About the 4 or 5th day the part begins to inflame; it increases
until the 6th or 7th when Constitutional Symptoms 
appear. The Treatment of the Case is the same with that o f
the distinct small Pox. It was formerly believed that 
if there was fever, with soreness of the axilla, the constitution
would be protected against future attacks.
the pitting of the skin is regarded as the most certain.
Variola Vaccina 
It is said that vaccination, was long known in the East.
whether this be so or not it is to Dr Edward Jenner, that
the honour of establishing it is exclusively due. he first
directed his attention to the subject in 1768 whilst a
student. His communications to the Royal Society on
this subject, were treated with the most marked disrespect.
At length in 1798 he promulgated in the most
modest style, an account if his illustrious discovery.
He conclusively demonstrated that it is a preventative
of small Pox, that it is a much milder disease, that 
it can be communicated only by innoculation; and that
it is not productive of subsequent disease. The British 
Parliament voted him 30000 [pounds]. In the United States it was
soon adopted. It is to Professor Coxe & DR Waterhouse that
we are chiefly indebted for its introduction. It was once 
supposed that the vaccine and variolous diseases were the 
same. the latter modified by frequently passing through
the human system for a number of years. That this is not so
is shown by the fact the matter of Small Pox does not affect 
animals, & that it is incapable of intermixture, with the 
vaccine: Thus if you insert the 2 kinds of virus into the same 
part at the same time, you will have both the vaccine and
Small Pox Pustules. If however you delay the variolation
until the 9th day after vaccination, the susceptibility of 
the system to the former is destroyed. when the System has
undergone a successful vaccination, the vaccine or small 
Pox virus, will only induce a local disease.


to one [?ard] and likely to one half of the number
the varioloid disease in some manner. Another
great objection Gen is that you get only 50 cts and
if you do [??stice] to the patient you must pay 
5 visits to them, now gent you either lower your 
self or your profession of your wish to make
a trade of it you can do it. when vaccination 
has been complete Small Pox will have no effect
on the constitution after the 8th day, you will a little
local inflammation before the 8 day, but no fever.
The strongest objection to vaccination is that its
effects wear off afer a time. this objects was also
against Inoculation, both objections are incorrect
The celebrated [Parre] who lived 150 was Inoculated
early in life, at 115 years he was exposed to Small
Pox, but did not take the disease, it was not owing
to want of action in his system, for 125 years old
he got a [illegible] with child. It had a patient named
John Scott who had the vaccination 63 years before 
and had never had any disease afterwards.
Some persons say they can tell when vaccination 
has been complete by looking at the Scab but 
it is not the fact I have known those [illegible]
fail frequently. when in scab is perfectly [illegible]
You should let the scab fall off to produce its 
full effects on the system but if you let not
much of the matter the vaccination will not
come to maturity. It was a maxim of Dr
Jenner that the matter was ready to vaccinate
in 8 times 24 hrs but I say it is much better to 
let the Scab fall off and inoculate with it.


242
Vaccination should not be performed earlier than 3 eks
after birth. The extreme frailty of the constitution of the 
new born babe renders it hazardous. it is also believed
that the immunity which it afforded does not last. Now
of the ordinary diseases of the month, interfere with it.
when Cuestia Lactia, or other cutaneous diseases exist, it
is inadmissable. Jenner preferred the pellucid fluid, taken
from the pustule before the matter becomes opaque, and 
before the areola is formed around the base. But as this 
fluid is in very different condition in different stages
of the pustule and as taking it out of the pustule may 
disturb the regular action of the disease, I think it better
to use the scab exclusively. Those which are hard and
compact, of a dark mahogany colour, with a uniform
and well defined margin are best. we should scrape
off the outer surface, then cut off a piece, powder it
& moisten it with water. It should be worked under the 
cuticle with the point of a lancet. The incision then 
heals, and about the end of the 3rd day, a small red elevation 
appears which feels as if it encloses a hard substance.
This gradually enlarges, and about the 6th day a small vesicle 
is formed, having a flat surface. indented in the
middle with a round margin. on the 7th 8th or 9th day 
an efflorescence is thrown around the base of the pustule
The vesicle is now at its [highth] and continues in this
state for several days and then fades. The scab hardens
and falls off about the 3rd week. About the 7th day the
common symptoms of fever, with soreness under the 
axilla appear: The scar is small circular, raised & pitted.
If febrile symptoms run high gentle laxatives followed 
by spts nitri may be administered. To allay excess of 
Inflammation, cold water or vinegar & water or solutions
of Lead may be used.
The vaccine pustule will sometimes go through its 
successive stages and elaborate genuine virus, without
affecting the constitution, so that although the matter 
thus formed may induce the genuine vaccine disease
in others, which shall protect them from small Pox
it will not afford to the system in which it has been 
produced, any such immunity. In these cases the 




243
affection is entirely local. The vaccinists of Gr Britain
think that security is most certainly obtained by multiplying 
cotemporaneous vesicles. Mr Moore who is at the 
head of the great national vaccine Institution of Gr Britain
makes 2 incisions on each arm. I can see no advantage
however from this practice, as the disease is the same 
in both cases. AS we have no criterion of a constitutional 
affection on which we can rely, it seems best 
to repeat the vaccination, until it does not act. Notwithstanding
the allegations against it, there can
be no doubt, but what vaccination protects the system
against the old form of small Pox.
Varioloid Disease
This disease seems to have prevailed for the first time, to any 
extent in Edinborough in the winter of 1818. It has previously
shown itself in some of the Provincial Towns of
Scotland, without exciting particular attention. Cotemporaneously 
or nearly so, it raged in England and on 
the Continent. During the next year it appeared in 
Lancaster in this state, and subsequently in the City of 
Baltimore. It attacked 3 descriptions of persons. 1st
Those who had had small Pox. 2nd Those who had been 
vaccinated and 3rd Those who had neither been vaccinated 
nor variolated
The eruption was generally vesicular, but in a few
cases was pustular. The vesicles sometimes had a central 
depression & sometimes they had not The eruption was
very irregular & seemed to occupy the surface of the skin.
it came out in successive crops. The fluid contained
in the vesicles appeared to be lymph, rather than pus,
and dried away into a [ho??] scab, covering a Tuberculous
elevation of the skin. These were sometimes
followed by pits. The eruption had none of the odour
of small Pox & was rarely attended by secondary fever.
It is sometimes very extensive resembling genuine
small Pox at others it was more like varicella. The 
latter was a form which it generally assumed in 




244.
children. In persons who have had neither small 
Pox, nor vaccine disease, the eruption is very various
and is generally preceded by considerable Fever, which 
usually lasts about 3 days. In 205 cases of this kind, which 
occurred to Professor Thompson 50 died. In those who had
previously had small Pox, the eruptive fever was sometimes
violent and the eruption resembled varicella.
of these 3 out of 71 died. In 2 of these fatal cases, the varioloid
came on about 3 weeks after recovery from small Pox.
That form of the disease occurring after vaccination 
resembled that which succeeds small Pox though it 
was milder. Of 300 of these only 1 died. There was only 
one instance of a second attack of varioloid. Vaccination
was found in Great Britain, to be the best 
preventative & it rarely occurred after the vaccine 
disease.
As it appeared in this city, the symptoms & 
character of the disease generally corresponded with 
the accounts given by the British writers. with regard 
to the comparative powers of vaccination & variolation
in preventing the disease, our experience was
very different. Not less than 4 or 5000 cases have 
occurred in Constitutions wh: had previously had
the genuine vaccine disease whilst only 40 or 50 occurred
in persons who had been variolated, and not one, in 
a system which had had natural small Pox. But
of the power of vaccination to temper the violence
of the attack & preserve the system, we have the most flattering evidence. Of 148 cases which occurred
to Dr Mitchell 47 had been vaccinated. Of these none
died 8 had been variolated; of whom 4 died & 90 
had neither been vaccinated nor variolated: of whom 
52 died.
The opinions have existed with regard to the nature
of this disease one that it is a modification of Small Pox
occasioned by its passing through a system previously subjected
to variolation or vaccination. The other that it is a malignant 




245
varicella. In Gt Britain the former opinion is
entertained. Indeed Professor Thompson, believes that varicella
itself is a modification of small Pox. This latter
opinion however is certainly untrue, since varicella 
never results from variolation, nor odes small Pox
ever occur from the introduction of Varicellous matter.
I believe that the recent epidemic was not genuine small
Pox. To this conclusion I am lead chiefly by the fact that
variolation and vaccination were insufficient to prevent it,
whilst all experience has shown their entire sufficiency
as preventive of old fashioned Small Pox. There is nothing
inconsistent in believing that disease take every thing else,
is liable to change and that the disease in question may 
be modified by a variety of circumstances. When first 
known the venereal disease was communicated like small
Pox & measles, by the atmosphere of the room and now as
you know, it is only communicated by contact of part.
On the Continent of Europe, it was believed by many
authors, to be malignant varicella.
From a review of The Evidence in the case I believe that 
there can be no possible reason for withdrawing our
confidence in vaccination, and returning to variolation.
For even if the latter should prove a better preventative 
the power of the former in preserving the System against
the violence of the disease, is most decidedly superior.
Again vaccination is a mild and comparatively a trivial
affection, whilst Small Pox by innoculation is not only
a serious disease, but is liable to extend itself by contagion.
In Gt Britain before the introduction of vaccination 
it is estimated that 50,000 died annually with small Pox,
The King of Denmark ahs driven Small Pox from his 
dominions by prohibiting innoculation, and fostering
vaccination. It appears that time has no influence on 
doing away the immunity which vaccination affords.



Dropsy may be produced either from debility or
from Inflammatory action, but when Inflammation 
is excessive we do not have the disease
Dropsy may arise from any cause which may 
produce fever, Catarrh, or any inflammation.
The effusion of dropsy is very various in its consistence
and appearance, from a serous fluid to a gelatinous
consistence, and in one case which I saw
with Dr Brown the whole peritoneum was covered
with small scales of [a??ific] matter, wh: was
thought by one of the attending physicians
to be fishes scales, deposited by animalcula.
The water in every kind of dropsy is exactly 
the same. I have tried them with acids which 
has no action on it. not will heat at the
temperature of 146 [degrees] produce coagulation
The long continued effects of marsh miasmata
will sometimes produce this disease without 
producing any visceral disease. Ardent spirits
will also produce the disease from its long continued
action upon the coats of the stomach. All
long continued haemorrhage will produce the disease
obstructed menstruation also produces a predisposition
to dropsy. In dropsies there is always 
congestion in some part. It is said that dropsy is 
produced by a congestion of the Hepatic System. [illegible] is 
the fact but how is it done? It produces an increased 
action of the vascular system, which creates
a peculiar action in the arteries which secrete
the dropsical fluid and deposits it in any place
where there is an accumulation of the veins there
in disposition to dropsy. Large draughts of
water has been thought to produce or increase the
disease, I think it has no effect upon the disease
[pl???]. The dropsies which take place from [illegible]
effusion is much easily treated than all others if 
it did not proceed from dyspepsia. I have never
seen a case of dropsy caused by Dyspepsia 
symptom, cured by any means.
I shall now divide the Treatment of Dropsy
in to External and Internal. The external 


246.
Diseases of the Absorbent System
Dropsy is a preternatural accumulation of serum or
watery fluid, in the cellular membrane or cavities of the 
body receiving different appellations according to the particular
situation, in which is my be deposited.
As however the principles and treatment of one case are
applicable to all I shall only treat of the 4 principle forms.
These are Anasarca, Ascites, Hydrothorax and Hydrocephalus
Internus.
Dropsy must either depend on 
an excessive effusion or imperfect absorption. According
to my own experience, it is in a large majority of cases
dependant on the former cause. Destruction of balance
between exhalation and absorption must always be the 
cause of serous accumulations, but we must seek for
the proximate cause in a state preceding effusion. Theis
is an altered, and as we have observed, for the most part
an increased action of the blood vessels, which produces
the effusion as its affect. It is in this way that nature 
generally relieves herself, and if the effused fluid should
be carried off, by perspiration or by Urine, all is well.
When however it is poured out into the different cavities
and the absorbents do not take it up, Dropsy results.
It is exactly on the Same principle that Haemorrhage
takes place in diseases of Excitement.
Entertaining the notions, which I do, of the Pathology
of this disease, it may be asked why I have placed it in 
the Absorbent systems? In every attempt at Classification
we have to encounter innumerable difficulties: I have
located the disease, in this place, because our remedies are
addressed chiefly to the sympathetic vessels.
In ascertaining the nature of each particular case of 
dropsy, it is a matter of great importance to ascertain 
the nature, and degree of action, with which it may be
associated. On this chiefly depends our failure at success.
Most European writers, have maintained until lately, that
Dropsy is always a disease of debility. We on the contrary 
have gone too far in asserting that it is always a disease
of excitement. Dropsy is unquestionably associated with 



remedies are of not much advantage, rubbing the skin
with the hand probably is the best it gives tone to the
part, Blisters are of very little advantage, rubbing
the part with Sweet Oil has been recommended 
but I have found no benefit from it. [The] vol
Linaments have also been much used, it probably
may be of advantage for the 1st or 2nd applications
but they are apt to produce vesication
wh: should be avoided. Scarifying the most
dependent part of the dropsy has been recommended
to cure the disease. it sometimes cures 
the disease but it more frequently terminates 
in deep abscesses which cannot be cured.
Blistering in this disease when it is produced
by inflammation of the Liver or Spleen has been 
highly recommended, but I have never seen any 
benefit from the use of Blisters either in dropsy
or in any disease of the Liver or Spleen.
Paracentesis is the best remedy is always the 
best practice which we can use. It should
be broken down and repeated as after all the
water returns, when we perform the operation
we should use a flannel bandage, and use the 
lancet. the operation may be performed in 
any part of the abdomen the only danger is
in the Epigastric Artery. If the accumulation diminishes 
after each operation you may always 
draw a favourable prognosis but if the accumulation
increases the disease will be difficult
to cure.
The best if all in dropsies of debility 
is the Guiacum. I have cured a great many cases
of this kind of dropsy when there is no visceral
obstruction, You must use the Ammoniated
tincture of Guiac gum in milk, water 
decomposes the Tincture or acts upon it in 
a manner which chemists cannot account 
for the dose is from 30 to 60 drops.
Whenever you find the blood sizy you may 
always expect VS to be of great advantage.
By lessening the action of the heart we not only 
remove congestion but we prepare the system
for mercury. wh: has been the greatest
improvement in the cure of dropsies. The
mercury should never be used when the
disease depends alone upon debility 


247.
very opposite states of the system, requiring for its cure
very opposite modes of practice. Every Physician has seen 
it occurring as a disease of excitement accompanied
by great fulness & activity of pulse. By Stahl, it was
believed that dropsy was a febrile disease. Botallius 
subsequently entertained the same opinion. It was
common in the time of the latter to bled in every disease
and it is this practice, which we find ridiculed in Gil Blas.
Dropsy is also, in coms cases a disease of debility. No
point is better established than that effusion may take 
place in the most opposite conditions of the system.
Appearances of debility are sometimes present to considerable
intent, when the pulse is irritated and febrile: under such 
circumstances, vascular action must be reduced.
Blackall says the qualities of urine afford a good test
for the different conditions of the system with which the 
different forms of Dropsy are associated. Thus in a dropsy
of high excitement he avers that the urine is coagulated 
like serum by heat or nitric acid. Dropsy with visceral
obstructions is accompanied by scanty high coloured urine
loaded with a red Sediment, and depositing nothing on 
the application of heat. In Dropsy of feeble action the 
urine is scanty and pale, not coagulating, and depositing 
no sediment. These rules however are subject to many 
exceptions and should be received with caution.
Dropsy is generally the consequence of some previous
disease by which the animal oeconomy has been much 
deranged as Intermittent Fever. It is produced by obstructions
and certain depraved conditions of the abdominal
and Thoracic viscera. obstruction to the circulation 
through the Vena Potarum is a frequent causes of dropsy 
any thing which obstructs the circulation in any part
may become a cause of effusion. It frequently 
arises from repelled perspiration, which causes an effusion
from the internal exhalents. A very common
cause of Hydrothorax and Ascites is preceding chronic
Inflammation of the Pleura and Peritoneum. Now and
then dropsy comes on from mere debility and relaxation 
without any previous morbid change in the
system there being only what is called the Hydropic 


but when there is any local inflammation it
is better than all other remedies of the Mat Med.
Purgatives. [as] the most drastic kind have been used 
with great benefit when there is any Inflammatory 
action but where they can be of any advantage. I 
should expect to find more advantage from VS and
mercury. Emetics have also been used. The Squills
are the best of this Class, Sulph Cupri is also used, the
Cuprum Ammonacum is a very good diuretic. this
medicine has been nearly laid aside, but I sometimes
use it. The dose of this is ½ gr to 1 gr three
times a day. Diuretics should be [divided] into [???tion]
and those which stimulate the Kidneys 
Squills, Digitalis, and NItre are all of the first class 
The Nitre is one of the most valuable articles of this
class, it should be given in much larger doses 
than is usually given. I give it sometimes
Anasarca, at first appears locally, sometimes in 
the arms a case of this kind I saw the other day, but
more frequently in the larger extremities, the swelling
appears at night but disappears by morning
This swelling is attended with a little fever. The oedma
generally increases if the patient suffers the lower extremities
to hang down. The effusion increases slowly upwards
until it becomes general.


248
diathesis. It is here that the absorbents are principally 
in fault. On examination Post Mortem in dropsy
we find in the different cavities, a fluid of various consistence
and appearance. The Liver, Spleen, or Pancreas is
enlarged, tuberculated, or engorged with blood: the Peritoneum
is inflamed, the mesenteric glands are enlarged 
and hardened: & the blood vessels are affected with Polypi
& specifications.
with regard to the Prognosis, we may say that in proportion 
to the duration of the complaint and its complication
with visceral obstructions, will be the difficulty of
care. It is much more intractable in children, than 
grown persons.
Anasarca
The symptoms of Anasarca, are firstly swelling of the
feet and ancles, towards evening, which disperses in the
morning; the tumefaction is soft and inelastic, and the skin
assumes a pallid appearance: It also pits on pressure. The
swelling gradually ascends, occupying the Thighs, Trunk, Face
& Eyelids. As the disease advances the internal parts
become affected; difficult respiration in consequence of
effusion into the cellular membrane of the Lungs comes on;
and a watery fluid is poured out into the abdomen constituting
universal Dropsy.
In every stage of the disease, the Bowels are constipated
the urine scanty & high coloured; the skin hot and dry;
the pulse small & corded with great thirst. After this 
in the progress of the case, torpor and heaviness with a slow
and indistinct fever come on. The distinction in some cases
is as great as to force the water through the skin, and in 
others vesicles are formed which sometimes burst and
terminate in gangrene: The disease proceeds in this way 
if not arrested until the patient is completely exhausted and 
sinks. Like all the other forms of Dropsy, Anasarca 
may be attended by an excited or debilitated condition of 
the system. whatever may be the nature of the case
there are two indications of treatment, which always present
themselves. 1st To evacuate the fluid, which has been accumulated,
& 2nd To change the condition of the system on which 


& in doses of zi in a gallon of water to be taken
in 24 hours, Dr Martin gave zi of Nitre, through
mistake in a dropsical case, and it cured the 
patient, entirely in a very short time. I believe
it to be the best remedy in dropsy except the
mercury. Mercury and Digitalis are sometimes 
combined, it always reminds me of an apple and [terd]
floating down a stream, when the [terd] says [damm?]
how we apples swim.
IN cases produced from debility you will give
Tonics, exercise should also be recommended. If your
patient has been in the habit of drinking much 
spiritous liquors, you may give Gin with great
advantage. As a diuretic I believe the plant 
commonly called the [Pis a bed] the best that can be 
had.


249.
the accumulation depends. I shall first treat of 
Dropsy of high action. It is fortunate, that the remedies
for this form, whilst they reduce excitement, also promote
absorption. The Blood vessels and absorbents are to a certain 
extent antagonizing powers: if therefore we would promote
the action of the latter, we should abate the energy of the
former. 
Venesection in these cases regulated by a sound
description is a very important remedy if the febrile
symptoms continue the bleeding should be repeated. it is
common in the City to bleed 2 or 3 times a week, in the
commencement of the cases, to the amount of 10 or 12 [zfs]
each time. Cases have occurred in which a copious
Haemorrhage has cured the disease. As auxiliary to 
VS. emetics should be used if the stomach be loaded or
oppressed. They have also been prescribed with the view 
of promoting absorption. I have used them with advantage,
when there was much torpor and insensibility
to the operation of remedies. More confidence is
reposed in Purgatives. These are useful by their acknowledged
power of promoting the action of the Lymphatics, as well as 
of reducing febrile action. They are also required to remove
the obstinate constipation incident to dropsy. Sydenham
purged in Dropsy every day unless debility prohibited it.
The Saline Purgatives are best. Cream Tart zi, with
Jalap grs 10, every 4 or 5 hours, will keep up the discharge 
almost unremittingly. This is the best purge that I have
used in Dropsy & I can say with Truth, that by the 
steady and persevering use of Cream Tart & Jalap, I have
had as much success in the treatment of this disease
asl almost any other.
If however the case will not yield to Purgatives, we
must then resort to Diuretics. Of the diurectics applicable
to inflammatory Dropsy, the best is Cream Tartar. Dissolved
in a large quantity of water, it acts merely as a diuretic; 
whereas the same quantity given in the form of an 
electuary, will operate as a Hydrogogue. I consider it 
most beneficial when it operates on the Bowels & Kidneys
both. Dr Physick prefers the soluble Tartar in these cases. 




250.
I have known a combination of equal parts of soluble Tartar 
Cream Tart & Carbon Potassae to act as a Diuretic, when 
neither of the articles seperately had that effect.
The Cases of Dropsy in which the Alkalies are useful 
are such as are connected with great depravation of the 
powers of digestion such cases are frequently met with 
in drunkards. It is not uncommon in such cases for
an acid to be dissolved in the stomach producing many 
disturbing affections, which may be neutralized by the 
Potash. Th Potash is the Alkali generally used. The powers
of these medicines are much improved by combining them
with some of the Bitter Tonics, as Gentian Columbae etc. Thus exhibited
they remove the Gastric disorder and invigorate the
system their diuretic effect is also increased. This practice
originated with Sir John Pringle. I have used the Sal Tart
& Lemon Juice, or the Alkaline mixture and Lemonade.
The Nitrate of Potash is eminently adapted to Dropsy of
high action. The objection to its use is that when prescribed 
in adequate doses, it is apt to nauseate & oppress the stomach.
They may be obviated to a certain extent by giving it 
[illegible] free dilution. A very good form of administration is
to dissolve zi Nitric, in a quart of Cider, and give a wine
Glassful occasionally. when there is much phlogistic diathesis 
Tartar Emetic should be combined with Nitre.
The Spts of Nitre is well adapted to the cases of Children. dose
for an adult zii 3 times a day. In smaller doses, it has no
Diuretic Operation, but is apt to act as a Diaphoretic.
The Spt of Nitre may excite Febrile symptoms, if it do not
pass off by the Skin or Kidneys. The following diaphoretic
formula, frequently acts as a diuretic, when the skin is [illegible]
Rx Spt Nitre zi, vin Antim 30 drops, Laudanum, 30 drops water zfs
of the milder Diuretics, the Common Parsley, combined with 
water melon seeds has frequently done good. I prefer the 
roots of the Parsley made into a Tea, to any other part of 
the plant.
When Inflammatory Dropsy has not been properly 
treated, a torpid inactive state sometime supervenes. For 
the purpose of purging in these cases, the most drastic
articles are required as Calomel combined with Gamboage,





251.
Colocynth etc. The Resin of Jalap is sometimes used which acts
as a diuretic, as well as a Purgative. I have found the
following combination very useful: Rx Gambonge grs 4, 
Elatin ½ gr. Spt of Nitre zi, water ziv. A tablespoonful should
be taken every hour or two, until copious watery discharges
are induced. The Extract of Elaterium in doses of 1/10 to 1/8 of age, 
every 3 hours, until it operates: or Croton Oil 1 drop every 
2 hrs until it purge.
Digitalis acts best in a system feeble & exhausted. As long 
as there is much constitutional vigor or fulness of pulse
it will be detrimental. Darwin thought it best suited to 
cases, brough on by intemperance & debauchery. This medicine
does no good unless the system be gradually placed
under its influence. if you give a large dose at once,
it does not act beneficially. Tobacco has been introduced
as a remedy in these cases by Dr Fowler, but I have not
used it. It is employed in the form of Tincture of which 
the dose is 10 or 15 drops. The following is Ferrar’s prescription 
in dropsy: oxymel of Squills, oxymel of Colchicum, Tinct
of Tobacco and spt of Nitre z z zi. Dose a Teaspoonful 
4 times a day, Purging in the morning with Cream Tart.
The most important of all Diuretics, is the Squills. It is however
considerably stimulant and should be properly regulated.
It has been a question whether its diuretic effects 




252
and Syrup and the vinous Tincture. Of either of these preperations
the dose is zi three times a day. the Colchicum is supposed to be
the base of the Eau. Medicinale. There are 2 Tinctures of Colchicum,
that of the Roots is stimulant, that of the seed is sedative
The plant is said, not to arrive at perfection in America and
consequently when cultivated here, it is inert.
Of the Aliaciae, the common Garlick is the most active as
a diuretic. It is best adapted to those cases, which have arisen
from drunkenness, and are accompanied by debility of the
Stomach. Equal parts of Garlic, Mustard Seed, and Horse
Radish, often operate actively as a Diuretic. The Guaiacum
and Sarsaparilla are best adapted to those cases, connected
with stumous or scorbutic diathesis.
Preparation of Iron, by invigorating a debilitated stomach 
has cured Dropsy.
I consider Sweating as a remedy for dropsy, much more
important, than it is generally regarded. Sweating and Diuresis 
being inverse, it has been supposed that the former wd 
not be beneficial in Dropsy. It has been said that the
practice cannot be defended on any principle that the only 
effect of sweating must be to diminish the watery parts of
the blood, but that it can produce no change on the effusive
fluid. I answer that purging and diuresis do no more.
Dropsy is generally dependent on increased effusion
and if you diminish that, the absorbents go on to remove
what is already poured out. Diaphoretics may also act 
by diverting the action from the internal to the external
exhalents. Sweating as a remedy for dropsy, is suited to such 
cases, as having arisen from Intermittents are kept up by 
visceral obstructions and are associated with great debility & 
emaciation. In these cases there are generally extreme [atony]
a small, tense and corded pulse, cold extremities, pallid
countenance, dry skin with other circumstances denoting
a feeble and depressed circulation on the surface of the
body. Diaphoretics from their centrifugal operation
relieve the viscera from oppression, determine the blood
to the extreme vessels and tend to restore the equilibrium
of the Circulation. It would appear that in certain cases
of Dropsy, the accumulation of water is owing to an inverted
action of the Exhalents. For the purpose of correcting
this, Diaphoretics are indicated. Sweating is frequently promoted
by the warm Bath or the vapour Bath. The combination
of opium, Ipecac and Calomel is however chiefly 





253.
relied on. Or the diaphoretic combination of Laudanum, Antim 
vinum, & Spt Nitri. Opium has been used for this purpose 
but I prefer Dovers Powder. The Eupatorium Perfoliatum, has 
been employed in this disease. I should suppose that it wd
be best suited to cases occurring in Miasmatic Districts in 
which a combination of the Tonic and diuretic property 
would be advantageous. Mercury is much better suited to 
ascites than Anasarca. when however the latter originates
in and is kept up by visceral obstruction, no practitioner
would hesitate to use mercury. when the disease arises
from imperfect absorption, rather than effusion, the remedy 
will also be required.
When the Extremities are painfully distended with water
much relief is afforded by evacuating it: The punctures for
this purpose should be small and superficial, or they may 
mortify. The needle used in acupunctuation is well suited
to this purpose. We are sometimes called to treat Gangrene
in Cellular dropsy, which has been occasioned by the extreme
distention, by external force, or by a torpid condition of the 
Capillary vessel. A frightful sphacelus sometimes ensues 
Blisters, which are so successful in arresting Gangrene
generally cannot be used here for they sometimes occasion 
Mortification. What I have found most successful in these
cases is to compress the limb moderately above and below the
affected part with a flannel roller. This invigorates the power 
and action of the part, and thus enables it to resist the encorachment
of mortification. Blisters though generally prejudicial,
have sometimes done good.
Ascites By the term is meant a collection of water
within the abdomen. Most commonly the fluid is contained
within the sack of the Peritoneum, though occasionally it is 
met with in the intervenous space between the membrane
and the abdominal muscles. Ascites is often preceeded 
by loss of appetite, sluggishness and inactivity, dryness of the 
skin, some oppression of the chest, cough, diminution of the 
urinary discharge and constipation. Not long after the appearance
of these symptoms, a protuberance shows itself in the
upper part of the Hypogastric region, which gradually extends
until the whole of the abdomen is uniformly swelled an d
tense. Respiration also becomes difficult from pressure
on the Diaphragm and the countenance becomes pale and 
bloated. You may then make the fluctuation evident by 
placing your hand on the abdomen, on one side, and striking 


a diarrhoea is a frequent and troublesome symptom in the
first stage of ascites. P.


254.
the opposite side, with the other hand. These symptoms serve
to distinguish it from Tympanitis & Pregnancy.
The cause of Ascites are essentially the same with that of 
anasarca: but it results more frequently from obstruction
and other morbid conditions of the Liver. It seems probable
from the great complaint of flatulence in the commencement 
of Ascites, that the blood vessels do sometimes secrete a Gas
which is condenced into water by some process, not understood.
Ascites requires very much the Same Treatment, with 
that form of dropsy already mentioned. As it arises more
frequently from a morbid condition of the Liver, mercury 
is more generally required. Combinations of Calomel, Digitalis,
& Squills are generally preferred.
Much of the efficacy of the mercurial treatment depends 
on the gradual manner in which the system is brought under
its influence. If salivation be suddenly brought on, no satisfactory 
impression is made on the case; but on the contrary 
it is frequently rendered worse. If the patient be very susceptible
to the action of Mercury, friction should be used. when 
extreme exhaustion precludes the use of Mercury altogether, the 
nitro muriatic acid bath & the internal use of that medicine
may be substituted. It is a general rule that when mercury 
is obviously indicated, and the System cannot bear it, to give
Nitric Acid. Mercury is alike unsuited to dropsy of high action 
and that of great debility. It is best adapted to constitutions 
of some tone, after the case has been reduced by evacuants.
when the abdomen becomes so much distended, as to occasion 
pain, to disturb the respiration, and to render the patient uncomfortable 
in every respect. Paracentesis should be performed,
without delay. Dr Fothergill insists much on the 
propriety of early Tapping. The operation when performed in 
time affords considerable relief a [illegible] the susceptibility
to the operations of Medicine: but is certain that after the 
patient has been extremely debilitated, it is not only useless
but even hazardous. Before Tapping, the effect of 
a large Blister should be tried. This has sometimes occasioned
the discharge of a large quantity of water. After Tapping
the patient should be purged briskly for 2 or 3 days.
As a modification we will now mention Encysted
Dropsy. By this term we mean to designate a collection 
of water in small sacks attached to the viscera of the abdomen
and supposed to originate from Hydatids. The accumulation 
of fluid between the muscles & Peritoneum, has been included



I have cured a case of dropsy of the Ovareum with 
Conium Maculation given in doses of one grain, three 
times a day
Hydrothorax, The Symptoms are the same as those
which are mentioned on the opposite side
when Hydrothorax is not connected with a general 
[Hydro???] diathesis it is much more easily cured
The operation should only be performed when the 
water is in the cavity of the Pleura, but if it be in the
Pericardium or in the air cells or the Substance of the
Lungs the operation is entirely useless. Mr Barr
recommends pure oxygen in Hydrothorax, its
inflammatory stages I think the oxygen will 
increase the inflammation, but the case in wh 
MR Barr used was in an old man of 70 or 80 years
In every case of Hydrothorax which I have
examined I have always found evident marks
of Inflammation.



255.
under the head: but as its nature is different, I shall not
continue the error. To discriminate between ascites and encysted
dropsy, the following circumstances should be attended to 
Ascites is preceded by a peculiar diathesis, or hydropic disposition
of the system. the swelling of the abdomen is gradual and equal:
and there is more or less tumefaction of the Extremities & other 
parts, particularly the face. In encysted dropsy there are none 
of these symptoms, and we have some peculiar indications.
The dropsy is local and the water generally accumulates on 
one side; there is little thirst or febrile affection; the urine
is neither sensibly altered, nor diminished; and if the disease
occur in Women, the menses continue uninterrupted which 
is rarely the Case in Ascites.
The same general Treatment should be pursued in this
Case; as in those dropsies already mentioned. the mercurial
practice is decidedly useful. As the disease is local
Topical remedies are more efficient than in general dropsy.
Of these a Blister is best.  when the water collects so 
as to point, Tapping should be performed.
Hydrothorax. This is by far the most formidable of all
the cases of Dropsy. In Hydrothorax the collection of water
takes place in the cavity of the Pleura. It is often in both sacs
but more frequently in one, and sometimes tho’ rarely in the 
Pericardium. In some cases the water is collected in the cellular
tissue of the Lungs themselves, called by some water Anasarca
Pulmonalis.
Hydrothorax come on with oppression and tightness about 
the Icrobiculus Cordis, difficulty of breathing and inability to lie
in the recumbent posture, without elevating the head and shoulders.
The patient often starts in his sleep and complains of
anxiety about the precordia dyspnoea, and palpitation of the
Heart, which are relieved by an elevated posture. The urine
is high coloured and scanty, and there is generally oedema of
the lower extremities.
In the progress of the disease, the pulse becomes quick irregular
and active (this however is not always the case) there is paling
of the countenance, a purple hue of the lips and cheeks; a 
cough which in the first stage is dry, but is subsequently
altered with an expectoration of mucous or phlegm. Occasionally
the face swells and pit are produced on pressure, especially 
in the morning, these symptoms are attended by debility
and emaciation. The symptoms generally progress slowly





256.
and a considerable time elapses, before the disease is established.
At length the difficulty of Respiration becomes excessive and the 
patient can seldom remain in the recumbent posture for any 
length of time. There is a convulsive action of the muscles of 
the upper Extremities, and violent palpitation of the Heart
The patient sits with his mouth open showing the utmost
anxiety for fresh air: & the face and extremities are cold.
The disease may be confounded with Empyema, Angina
Pectoris, Asthma, organic affections of the Heart and Aorta
and certain complaints of the Stomach. In addition to the 
above criteria, it is stated by Covisart, that by striking the
sternum when the patient is erect, you can always hear
the fluctuation of water. Bichat tells us that pressure
on the Abdomen uniformly aggravates all the Symptoms.
and especially the sense of Suffocation. This criterion is
most to be trusted Fluctuation can only be heard when 
air exists in the cavity. this is rare. Percussion affords us
a pretty good Criterion. When there is water in the chest
the sound is heavy and inelastic; but this also is the case
in Empyema, Hepatization, or other consolidation. Succession
or shaking the chest will frequently occasion a
noise, like shaking a vessel containing water.
Causes all the causes of the other Hydropic affections 
may give rise to this: but it is more frequently consequent
to habits of drunkenness, or to ill cured Pneumonic 
Inflammation. It may arise from asthma, Misplaced 
Gout or Dyspepsia. It may also exist as an Idiopathic
affection, but it is generally Secondary.
Like the other this form of Dropsy may exist as a disease of 
Excitement or Debility, constituting Tonic or Atonic
Dropsy: but from what I have seen I should say that
it is almost always Inflammatory in the first stage 
at least. The Effusion in this disease is generally 
confined to one side. If it be considerable the side enlarges
and the lower extremity of the corresponding side is
oedematous. Effusion in both cavities would soon 
destroy life.
Why the dropsy of the Pericardium can be distinguished from 
the other forms of the disease, I am not able to say. The symptoms
which are said to distinguish it are a sense of weight
about the region of the Heart with pain great [dyspnoea]




257.
increased by the slightest exertion, bloated face and frequent
syncope. It is in these cases that death takes place so
suddenly and unexpectedly.
Hydrothorax in vitiated habits generally proves fatal: but
in better subjects, it is generally as curable as Ascites. Recollecting
however how suddenly it sometimes terminates, we should
be very garded in our Prognosis.
In Cases of Hydrothorax connected with a Tonic condition 
of the system. We should commence the Treatment with 
VS. which should be regulated by the pulse and other circumstances
as pain in the side and oppressed respiration. In 
all pulmonary diseases requiring depletion more blood
should be drawn than in any other diseases of similar 
nature. As auxiliary remedies, Cups should be applied to 
the Back of the Neck, the sides and between the shoulders.
Cupping is of great importance in the early stages. The best
internal remedy at this time is Nitre combined with Tartar
Emetic. After this Blisters to the breast are very useful.
These when kept open by stimulating sentiment are preferable
to setons or Issues.
After reduction of arterial action Diuretics should be 
resorted to. Of these the Combination of Calomel & Squills is to 
be preferred. when the mouth becomes affected it is an auspicious 
sign. we should merely keep the Gums tender for
2 or 3 weeks. When the case is not serious the squill may 
be used alone or Garlic with honey. The Digitalis in 
my hands has done less good in this than any other form
of dropsy. The only cases in which it acts at all kindly 
are those of exhaustion and debility. The following is the
formula which Dr [Feniar] found most useful. Rx
extract of Elaterium gr I, Spt Aetheris Nitrosi zii, Tinct Scillae
oyxmel Colchici a a zfs. Syrup of Back Horn zi (unimportant)
dose zi with a little water, every 4 or 5 hours.
Although the general tenor of my Experience, with regard
to Digitalis is, as stated above, I must observe that I have
lately seen great advantage from the use of saturated Tincture 
in doses of 5 drops, every 4 or 5 hours.
Emetics are indicated for the purpose of relieving the Lungs
of oppressive accumulation of Phlegm.
In Hydrothorax as well as the other diseases of the chest
Purging is inadmissable as a general rule: but I have 




258.
derived some advantage from Purging in the early stages especially 
in women. The Drastic articles should be used as
croton oil Elaterium etc.
As a [???er] resort I would advise Tapping the Thorax
You should be well assured of the Existence of Effusion 
before you operate. This operation was performed in the
time of Hippocrates and has lately been revived in France.
From Experiments in the Alms House, we have good reason
to believe that it is very beneficial.
The Second Indication in the Treatment of Dropsy is to 
correct that disposition on which the increased effusion 
depends. The local remedies for this purpose are frictions bandages
Cold Bath etc. The general Treatment may be divided 1st 
into the use of those Tonic medicines which are required to 
strengthen the system; & 2nd The avoidance of all the causes 
of the disease.
The diet in Dropsy must depend on circumstances. In 
dropsy of high action it should be very low. even abstinence
has been productive of much benefit. Dr Johnson
was cured by fasting.
In Atonic dropsy, we must pursue and opposite course.
Nutritious diet is here necessary, Eggs, Oysters, & Jellies, contain
much nourishment in small bulk and are therefore 
well suited to the case. In atonic cases however we are carefully 
to watch the effect of diet. the slightest repletion 
of the vessels will sometimes give rise to effusion.
More difficulty has existed with regard to drink. It 
has been doubted whether any drink should be allowed but 
I believe that a prohibition of it conduces to inactivity
of the Kidneys, and consequent increase of effusion whilst
The moderate use of it promotes the Secretion of urine.
Cider & water make a pleasant drink, or Juniper berry Tea.
An infusion of the buds of the Silver Pine or [Scabia???] Tea
have also some diuretic effects. Should the patient be very 
low, Gin or whisky & water may be allowed, especially to 
Drunkards. The secretory office of the Kidneys being fully 
established, the drink should be limited. To prevent a recurrence 
of the effusion avoid all of the exciting causes, and
corroborate the system with Bark & the vegetable Bitters, in 
combination with Chalybeates.
Should accumulations take place during the use of Tonics
Diuretics are to be combined with them especially the Carb 






259.
Potassa which is well suited to these cases. Frictions and Tight
bandages around the distended part may be resorted to with advantage.
Exercise is highly beneficial. The patient should
commence with such kind of exercise as are suited to this
chamber. Subsequently to Walking, Riding Sailing etc.
Hydrocephalus
This disease is divided into acute and chronic. The latter is 
frequently congenital. The head id distended to an enormous
size; and the organization of the brain, apparently altered
but the patient retains his senses. I once saw a case in 
company with Dr Hosack of New York of a man of 20 years 
of age in whom the head was expanded to an enormous
size, and was so transparent that when a candle was placed 
on one side, the light shone through it.
This conversion of the Brain into a membranous sac can
only be explained by the view of its structure, taken by Gall 
& Spursheim. In this form of the disease no medicine
is of any service. It has been proposed to evacuate the’
water by an operation and there is much reason to believe
that it would be beneficial.
The Ancients though well acquainted with the chronic ha d
not observed the Acute form of this disease. By Petit the
eminent French surgeon, it was first noticed and not
a great while after by Whytt of Edinburg. By the Early
nosologists Hydrocephalus was distinguished into Internus
and Externus. In the latter the water is situated between the 
Scalp & Cranium in the former, in various situation s
within the Cranium. This distinction is however not
abandoned. Cases of watery intumescence of the integuments
of the Head, do occur but are generally to be regarded as 
instances of Anasarca.
The acute Hydrocephalus is chiefly incident to children 
and according to Morgagni more frequently attacks Girls
than Boys. It does however attack Girls in later life and
is peculiarly apt to affect Girls about puberty, when menstruation 
is irregular. Two reasons have been assigned
for its frequent occurrence in children. 1st Disproportion of 
the Head to the body; and 2nd Their liability to falls on the head.
There is a greater vascularity in children, and consequently 




260.
a more ready determination of blood to the Brain. This is
evinced by readiness with which Delirium supervenes
in them from slight febrile excitement. Whatever share
these causes may have I am inclined to believe that the
disease most frequently has its origin in derangement
of the Primae Viae
The disease frequently succeeds Catarrhal and Autumnal 
Fevers. so close is the sympathy between the mucous membrane 
of the Prima Viae and the Brain, that Irritation and
Inflammation of the former are frequently attended by 
effusions into the latter. Hydrocephalus, like all other
diseases makes its attacks in different modes. It sometimes 
on very insidiously. The child complains of languor and
Anorexia; the Tongue is furred; skin harsh; the Alvine
discharges greatly vitiated; there is pain in the Head or
Soreness of the scalp, tumid abdomen and disturbed sleep
Being fully developed, its progress is marked by 3 stages;
In the 1st stage which is that of Increased sensibility, there 
is great aversion to light and sound, pain in the Head;
active pulse, constipated Bowels, disturbed sleep and dry 
cough arising from irritation of the stomach.
In the 2nd stage or that of diminished sensibility, there is 
stupor or heaviness, knitting of the Brow, dilatation or Contraction 
of the pupil, slow pulse, slimy or watery stools,
exhibiting an oil appearance; and partial delirium 
magnified by a wild look and distracted cry.
In the 3rd or Paralytic state there is squinting with a
widely dilated or contracted pupil: the child rolls his head
and tosses his hands perpetually. there is a low and muttering
or raving delirium; the pulse is diminished and
thready, though exceedingly rapid, the breathing is laborious
with sighing and pauses; deglutition is difficult the muscles 
are affected with local spasms or general convulsions
and the discharges of urine & foeces are involuntary.
In this state of wretchedness the child frequently remains
for several days presenting a most shocking appearance 
Examinations post mortem discover effusions in to the ventricles
and convolutions of the Brain, or between its membranes.
The fluid differs in consistence & quantity. The latter is generally 
from 5 to 10 zs. The vessels of the Brain are in every part
filled with dark blood, with an interspersion of minute 




261.
red vessels. The substance of the Brain is softened, blanched
fimbricated, or schirrous and ossified. The Chylopoetic viscera
are variously deranged. Difficult as it is in the common 
[??ment] to distinguish this disease it is easy when the
complaint is confirmed. it is most apt to be confounded 
with the Fibres verminiosa. But in the latter the
voice is altered, and the Exacerbations are attended with drowsiness
whilst a morbid vigilance attends its remissions.
In Hydrocephalus there is generally an inclination to vomit
aversion to light, a dilated or contracted pupil, squinting
and heavy respiration. The patient can only remain in 
the recumbent posture sickness and fainting being induced
by the effect.
Much difference of opinion has existed with regard 
to the Pathology of the disease. Cullen places it among the
Species of Apoplexy whilst other authors consider it as 
a case of dropsy. My own experience is that it is an
altered and generally an increased action of the vessels of 
the Brain, giving rise to effusion or derangement of structure.
It has been regarded as a less degree of that action 
which exists in Phrenitis but there is some difference of 
between it and Phrenicula. The action in this affection 
is a modification of Inflammatory action identical or 
nearly so with that which gives rise to dropsical effusions
elsewhere. It is evidently not high Inflammatory
action, because we should in that case have a deposition 
of coagulable Lymph, or an extravasation of 
the blood, and not an effusion of Serum.
Treatment As a leading indication we call into use
the remedies which are calculated to subdue action; as
VS. active purging with Calomel and its ordinary [adj???]
It might be supposed that VS is the most important
remedy, and it certainly should not be neglected in 
the commencement; but it is to continued and active
Purging that we are to look for advantage. It is 
certain that in Hydrocephalus, bleeding is not so
beneficial as might a priori be expected. But by 
active and unremitted Purging, from the commencement 
we shall have most success. It is called for by the determination
to the Head as well as by the disordered condition 




262.
of the Alimentary Canal, & Liver.
Emetics may now and then be beneficially employed,
when the symptoms appear to result from an 
oppressed or irritated condition of the stomach. they produce
very good effects. Emetics also operate by changing 
the condition of the [s???ing] vessels (as in Hemorrhage)
and thus preventing further effusion. These remedies
may be aided by the Application of Cups, Leeches, Cold & 
Blisters. The Blisters should embrace the whole of the head,
from the ears upwards and should remain on 24, 36 or 48 hrs
until the suppurative process commences on the scalp.
The Head should (if delay be admissible) be shaved sometime
before applying a blister in order to avoid stranguary.
By pursuing this course the disease will often be
arrested.
It is by no means rare for the symptoms to subside
in 10 or 15 days so as to engender hopes of recovery.
but this is a most treacherous and delusive calm, destined
to be succeeded in a few days by the most
frightful tempest. The abatement of the system in this
case, is owing to the effusion by which the vessels relieve
themselves: but the effused fluid being retained within 
the Brain, acts as an extraneous matter [???citing] the 
disease. It is now to be regarded as desperate or nearly 
so. Effusions into other cavities may be taken up, but
experience teaches us that this rarely happens in the Brain.
In this state of the Disease, the most liberal employment
of Mercury constitutes our only dependence. It sd
be given internally in as large quantities as the stomach
& bowels will bear & externally bin inunction. In the 
case of my own child, I put on flannel drawers, [smeared]
with strong ointment introduced the hands and arms
into Gloves lined with the same; and applied a band
over the abdomen thickly impregnated. On the 14th day 
after the commencement of this treatment the Gums became
slightly affected. the ointment was then washed
off and she recovered.
Hydrocephalus sometimes occurs in Scrophulous habits
connected with general debility & topical relaxation of the 




263.
vessels. Depletion of the lancet is not often admissable
here. We must use Cupping and leeching, but above all
Purging. Afterward Mercury combined with squills or 
Digitalis. The Disease is most manageable when it originates
in derangement of the chylopoetic viscera.
When there is great indisposition to be raised up, it is
an unfavourable symptom. The most unfavourable
Symptom is a deflusion of the nose. It has been supposed
that an operation might be beneficial in the active
as well as the chronic form If tried it should be at that
period when the symptoms subside, in Consequence of effusion.
If the effused fluid in these cases could be removed
before it had excited the Brain to an increased action, it is 
probable that recovery would take place. 
Scrofula
This disease most commonly appears between the 1st, & 5th years 
of life, rarely after puberty. It makes its appearance in the
form of very small hard and elastic tumours of the lymphatics
especially about the neck which at first are not painful.
These after a time become discoloured and ultimately suppurate
the matter soon puts on a viscid serous appearance
and an ulcer now forms which remains for 
years. It is now universally admitted that scrofula may 
be transmitted by parents to their offspring. it sometimes
passes over the intermediate generation and appears in the 3d.
The Strumous Diathesis thus entailed is marked by 
many peculiarities. The child is distinguished for personal 
[??ality], and veracity of mind; it has a delicate complexion 
flaxen hair, rosy cheeks, delicate skin, large veins, and 
light blue eyes. the most sinking characteristic, however
afforded by the features is the tumidity of the lips, which 
have the appearance of having been divided by a deep
fissure. These marks are not invariable. Carmichael
found the disease to appear in children of various complexions
The Causes which are supposed to produce Scrofula are
moderate climates, especially when they are variable and
moist, as in Gt Britain; exposure to moisture, as by sleeping 
in damp sheets, a low meagre diet, confinement to an 





264.
ill ventilated apartment, want of comfortable clothing, and 
inattention to cleanliness. all of which are illustrated in ‘
European manufactories.
The Seasons have much influence on Scrofula. it is
apt to be developed in Spring. Scrofuloris activa is also
developed by Syphilis & small Pox. There is no reason to 
believe that Scrofula is even propagated by contagion.
I believe that the disease consists in a disorderes condition 
of the shole apparatus subservient to digestion, assimilation,
and nutrition. The disease begins in the stomach 
and extends into the Bowels, it is there conveyed into the 
lacteals and Mesenteric Glands. We have now small tumours
under the skin and without pain, which afterwards become
livid, inflamed, and then suppurate.
In the Treatment of scrofula, there are 2 sages, which require 
some difference in the remedies: The first stage which 
is called occult is that in which there is neither Tumor
Ulceration nor other local affection. The course in 
this case is chiefly preventative. The patient should be
removed beyond the sphere of those causes, which are
known to exercise a powerful agency in the production 
of the complaint. Much may be done by a change of 
diet, with exercise and a removal to some other climate.
IN the early stage the Alimentary Canal is not a little affected:
as is indicated by a Nausea, loss of appetite, furred
tongue, indigestion  & constipation. I purge freely and
give Tonics. when there is much Gastric disorder Emetics
are sometimes eminently beneficial. The Stools are dark
and offensive. Purgatives should be given every 3 or 4 days 
for months. use Calomel & Rhubarb at first, and afterwards
Rhubarb alone. The Blue Pill may sometimes
be used with much advantage. The best Tonic is Peruvian
Bark alone or combined with Chalybeates.
The Cold Bath has been used with much advantage. when 
it produces Languor, chilliness or other unpleasant sensations,
the warm Bath impregnated with salt should
be used: this last used daily has done much good.
It prepares the system for the cold bath, sea Bathing 
has been very beneficial; although a maritime residence
may give rise to the disease.




265.
In the second stage when the disease is fully developed 
accompanied with Tumours or Foul ulcers, Purging is still
the remedy Cathartics have been too sparingly used in the
whole of the Cachectic diseases. Deterred by the false appearances 
of exhaustion, Practitioners have given these medicines
but an imperfect trial. Nothing is more useful in occasioning
the detumescence of the Tumours in scrofula than
Purging. As a cooperating remedy venesection is often 
called for, by the pain, swelling & Inflammation of the Tumours
as well as by the state of the pulse. If these measures fil 
Mercury very gradually introduced sometimes does good.
Sulphur has been added to increase its alterative effect.
It is a remarkable fact that though large doses of mercury
invariably do harm, small ones may be given with great
advantage. I generally give 1/6 to ½ grain of Calomel 3 times
a day for 3 or 4 weeks. great care is required to prevent too
great an impression. when there is much pain or irritation 
I combine opium & Cicuta pretty freely with Calomel.
When the Tumors are painful and inflamed Topical
Bleeding, by leeches should be presented, and afterwards 
the ordinary discutient applications beginning with 
such as are cooling and sedative.
When the Tumors are insolent, it becomes necessary to use 
stimulating applications as lotions of Salt water frictions with 
mercurial ointment simple or Camphorated etc. Blisters
successively applied are advantageous of late the Tart Emetic
ointment has been much extolled. It is made by adding
zi of Tartar Emetic to zi Lard. When the Tumor shows a 
disposition to suppurate this should be encouraged. For this
purpose [Hoti?g] hot [spirit] or hot brine may be used. I believe
that the matter should be evacuated. Much has lately been 
said of Iodine, in Indolent cases. 48 grs or Iodine are dissolved 
in zi Alcohol or 48 grs Hydrate of Potash in zi water
and 10 drops of either solution are given 3 times a day.
It powerfully excites the bloodvessels. It is externally 
in the form of an unguent made of zfs of the Hydriodata
of Potash to zi Lard. Friction with a piece of the size of a 
nutmeg is used morning and evening in scrofula and
Bronchocele.
When Scrofula is connected with a very vitiated 




266.
condition of the system with much debility we must 
endeavour to restore healthy action. Of the remedies for
this purpose, Cicula which was originally introduced by 
Baron Stoerk, has the least equivocal reputation. We should 
commence with small doses and gradually increase them until 
nausea Giddiness or nervous tremors come on. The Stramonium
has been employed under the same circumstances.
Small doses of Corrosive sublimate combined with these
Narcotics frequently of much advantage. The Guiacum
Sarsaparilla, Mezereon & Sassafras either singly or united
in decoction in the form of a Lisbon Diet Drink should be 
copiously used. Nitric Acid freely given is a remedy of
great importance. It should be given in the quantity of 
zi or zii in 24 hrs. I have known the nitric acid used internally 
& the Citrin ointment externally to cure Scrofula
when every thing else failed. One of the most efficient
remedies is, Sea Bathing which should always be presented.
The [Pip??ssiva] has been used with much advantage
In the first stage of Scrofula the diet shd be such as
is suited to Dyspepsia milk with the light meats.
Exercise is very beneficial, especially on horseback. Over
exertion & fatigue must be avoided, as they have [illegible] it.
The patient should dress warmly and if possible remove to a 
warmer climate until the time of puberty is passed.
In all ulcers of a Phagedenic character preperations 
of Iron have been used. The ulcer may be sprinkled over
with the Rubigo Ferri or washed with the muriatic Tinct
whilst the Peruvian Bark alone or combined with Chalybeates
is given internally. The white or Blue vitriol, as
well as a solution of Glauber salts, have been lused topically.
We sometimes meet with sores, shooting up a luxurient
fungus requiring escharotics. Nitric acid may be used
and the sores dressed afterwards with Citrin ointment.
Poultices of Hemlock or Dulcamara or decoctions of their
leaves or Stramonium Ointment have a good effect.
After the cure of the local affections the next consideration 
is to Impart tone to the System. of the various
Tonics for the purpose, Bark & Steel combined with 
Myrrh & Aromatics have the best effect. Sea Bathing
is highly useful.





267.
No disease is more pervading than Scrofula. next to the
Lymphatics it most frequently attacks the Testicle & Mamma.
Much of the want of success in the Treatment of Scrofula 
may be ascribed to the empirical manner in which it 
has been treated. The same remedies have been prescribed
without any kind of discrimination I n the different stages
of the disease. It must be confessed however that it will 
sometimes prove intractable, under the most skillful
management. Nature sometimes cures the disease
about the age of puberty and remedies used at this period
have acquired a reputation which they did not deserve.
Hence the supposed efficacy of the Royal Touch etc. this
superstition originated with Edward the Confessor. The
common notion of the danger of curing Scrofulous 
sores is very erroneous. On the contrary we may by 
healing them remove a serious irritation.
Marasmus or Tabes Mesenterica
This disease is confined chiefly to children, in whom it
appears soon after weaning. It usually commences with 
great depravation of the processes subservient to nutrition 
attended by obstinate pain of a dull kind through the 
abdomen which gradually swells until it becomes hard 
and distended. Emaciation takes place rapidly. It has 
long been the practice to treat the Disease by Tonic, but
I have had much more success in the Purgative plan.
My view of the Disease most generally arises from a 
Torpid condition of the Alimentary Canal, consequent to 
a strumous diathesis. In consequence of this Torpor
the Intestines are filled with a Black foetid sordis which 
obstructs the passage of nutriment and prevents the absorption 
of Chyle, producing that languor which ensues 
from inanition.
Two stages are distinctly marked in children, the 
Incipient and Confirmed.
In the first stage the bowels are not altogether inactive
and mild purges at proper intervals are to be employed.
In the second stage there is but little sensibility in the 




268.
in the Alimentary Canal and the accumulations of foeculent
matter are sometimes prodigious. The most active purges are
here to be employed. Calomel in large doses frequently repeated
has done more good than any other thing in my hands.
Extraordinary as it may seem long continued Purging
instead of increasing the debility of the child will be found
to augment its strength. After this Course of Purgatives
Tonics may be resorted to as Bark or steel & Rhubarb 
Cold bath & Exercise in the open Air.
If these do not answer recur to Mercury as an 
alterative.
Diseases of the Muscular System
Gout
This is a painful affection originating in the stomach, though
it displays its effects principally in the muscles. Like other
diseases it has been distinguished by different grades of
violence and hence has been divided into Tonic and Atonic;
or regular and irregular Gout. when it attacks the feet
it is called Podagia. Much controversy has existed with 
regard to the Pathology of the disease. I have long entertained 
the opinion that it was primarily situated in the stomach & 
intimately connected with the Calculous affections. Equally are
both connected with excess sedentary avocations vexation of
mind, certain articles of diet and hereditary predisposition 
It has also been shown by analysis that the Calculous Concretions
in the Bladder are similar to those in the joint 
called chalk stones.
Treatment In the Treatment of Gout, there can be very 
little expectation of performing a radical cure after the
disease is fixed and established. The two indications are to 
conduct the patient through the paroxysm with as little
Suffering as possible and to break the force of the disease
and lessen the tendency to return. Gout is most apt to 
attack men of Corpulent frame and robust habits. It
sometimes however occurs in the old and infirm and frequently 
in delicate woman and children.




269.
During a paroxysm of Gout the European practitioners 
envelope the limb with flannel and encourage the 
patient to endure the suffering. I adopt the most active
measures. purging actively is my chief remedy. I at first
give a dose of Calomel and Rhubarb every day, until free
discharges are induced: and then use a combination of
Rhubarb & magnesia. To the reasons already mentioned in 
Support of that Pathology of Gout which I have delivered.
I may add that it always comes on with Symptoms
denoting a diseased condition of the stomach and bowels.
The precursory Symptoms are flatulence, sour eructations
Indigestion, depraved appetite, nausea, strong sensations of
internal heat, and obstinate constipation or laxity of the 
Bowels. When Gout is associated with Intermittent
Fiver, or occurs in a patient residing in a miasmatic
district Emetics should be used. If the pulse should
be febrile with local determinations, more particularly 
to the Head & Lungs VS is required. VS is however rarely 
necessary. The complaint is seated I the Alimentary
Canal and the bloodvessels take a morbid action
which is symptomatic of the accumulation in the Alimentary 
Canal. By removing these morbid accumulations, 
we prevent the irritation of the Blood 
vessels and if this previously exist it generally removes
it. If however the action of the Bloodvessels be not
reduced by Cupping VS becomes necessary. As auxiliary 
remedies Diaphoretics are to be used. A Paroxysm 
of Gout when it goes off spontaneously is generally 
terminated by Diaphoresis, Diarrhoea, or Diuresis.
Diaphoretics are proper in that form which succeeds
to the acute stage, or in those cases of atony 
arising out of a frame naturally feeble or debilitated
and brought on by vicious indulgence. The cordial
and stimulating Diaphoretics are to be preferred in these
cases. Combinations of the Acetate or Carbonate of Ammonia
with opium, wine whey etc. I have found to be well 
suited. As a part of the general treatment Diuretics
should be employed. I have formed the Sweet Spt of Nitre




270.
to answer very well. A remedy exceedingly extolled in this
disease is the Eau Medicinale. Although we are as yet ignorant
of the exact composition of this article its effects on’
the system are manifest. As a purge it operates actively & 
something vomits violently, producing at the same time
copious perspiration. diuresis also sometimes takes place
The pain and swelling of the Joints subside So rapidly 
under its operation, that the patient is sometimes relieved 
in 24 hrs. I have used it successfully in retrocedent
Gout: I cannot say from my own experience whether 
its use is prejudicial to the constitution or not.
As Topical applications warm fomentation shave been 
sued. Local Bleeding by means of leeches does much good.
Enveloping the limb in flannel or what is better in 
Cotton, is productive of much advantage. Some practitioners
advise cold applications, but these are in may 
opinion improper. If it is ever serviceable, it is so 
probably when there is great pain and Inflammation 
with a vigorous constitution .
Retrocedent Gout.
Gout though apparently well fixed in one of the extremities
sometimes changes its posture and seizes on a more vital part
to the eminent danger of the patient. The part may be the 
Brain. Alimentary Canal, Lungs, Heart, Kidneys and other
parts. It most commonly attacks the stomach which
is affected with sickness, vomiting & violent Spasms, which 
if not speedily relieved often prove fatal. It is customary 
under these circumstances to resort to the most
powerful of the diffusible stimulants and antispasmodics 
as Opium, vol alkali, Aehter, musk, wine or ardent spirits 
in the form of Hot Toddy. In the commencement most
confidence should be placed in opium and aether; subsequently 
if the attack be protracted, the volatile alkali & 
musk Julep should be used. The stomach in most of
these cases loses its susceptibility to the action of medicines
and hence the dose must be considerably increased. Opium 
may be given in 3 or 4 times the ordinary quantity. As cooperating 
with these remedies Hot fomentations to the 




271.
epigastrium should not be overlooked. They tend to relieve
pain and tranquilize the stomach. This treatment often fails
unless accompanied by a liberal use of the Lancet. This is one
of those cases in which opposite and apparently contradictory 
measures must be resorted to. To Bleed however whilst
we stimulate powerfully is the only means of affording relief 
in some cases. Much judgment and Care are required to 
regulate the Bleeding. The pulse will hardly serve as a guide
being very frequent weak and depressed it he more violent
forms. In making up your opinion, as to the propriety of
this remedy, you should take into view the strength of the
patient, the vehemence of the pain, the warmth of the surface
and other proofs of the power of the System to react. notwithstanding
the objection to it by European practitioners VS is 
freely practiced by myself, and other physicians of this City
in Gout of the Stomach.
When translated to the Stomach, Gout Sometimes provides
a train of Symptoms in imitation of Pneumonic
Inflammation or asthma. In either of these cases the
practice is the same or if it has been produced by vicissitudes
of the weather or other cause.
When the complaint 
seizes on the Brain you should bleed generally and locally:
apply a blister to the Back of the neck & purge copiously 
such other remedies should be used as the particulars of 
the case require. If the disease assail the Heart it occasions
syncope or a total extinction of life by suppressing the circulation.
Unless the attack is very slight, you cannot
do any thing for your patient because death takes place 
so suddenly. when time is allowed to interpose our
remedies VS and the antispasmodics constitute the proper
means. In the Treatment of retrocedent Gout there is 
one precept of universal application. it is steadily to invite
back diseases to the extremities. For this purpose Pedeluvium 
made stimulating by the addition of salt, mustard, or
Cayenne Pepper or sinapisms or blisters to the ankles
are the most effectual means.
Misplaced Gout. considering the extremities as the regular
seat of Gout, nosologists call it misplaced when 




272.
it originates in any other part of the body. The disease is
characteristic by many such irregularities, sometimes
appearing in Head, lungs, Alimentary Canal etc. It is to be
treated on the same principles as retrocedent Gout.
Atonic Gout
This is the weaker and less distinct form of the disease wh.
occurs most frequently in women. By atonic Gout we
mean that the state of the disease in which though in 
arthritic diathesis prevails there is not vigour enough
to induce the local disease. In this case we have a
group of very distressing symptoms chiefly in the stomach 
as loss of appetite, indigestion, nausea, vomiting, acrid’
and sour eructations, cardialgia, Gastrodynia etc. These symptoms
are frequently attended by pain and cramps in different
parts of the body, which are relieved by discharging
wind from the Stomach. The Bowels are constipated or morbidly 
relaxed. The state of the Stomach and Bowels described 
is productive of Hypochondriasis with great depression of
Spirit The mind is constantly disturbed by a Thousand 
hallucinations. The patient has also palpitations fainting 
Asthma, Headach, vertigo, and sometimes Apoplexy.
In the management of this disease we endeavour to restore
tone to the Stomach and to invigorate the whole system.
To meet the first indication the practice is nearly the
Same as in Dyspepsia. As a leading object we are carefully 
to guard against constipation by the use of magnesia,
Rhubarb or Sulphur of the Tonics. the preparation of
Steel alone or with Peruvian bark are generally preferred.
Bitters long continued are improper. Little will
any remedies avail unless the diet be strictly regulated
and the habits of indulgence exchanged for those of 
activity and temperance. The best diet is milk with 
a slight addition of light and digestible animal food.
Water is the best drink. It is now generally admitted
that all malt Liquors are injurious, and I think the same holds
with regard to wine. In the cases of drunkards a little ardent
spirits may be added. To relieve various painful affections 
as head ach, spasm of the Stomach etc. I have much advantage 




273.
from the volatile Tincture of Guiacum or Carb of Ammonia
Warner’s Cordial is also in much repute. The soals of the
feet should be kept moderately stimulated by dusting the 
Stockings with Cayenne Pepper or a plaster of Shoe maker’s
wax, which is much used here.
Rheumatism
This is a disease nearly allied to gout in many of its leading
forms Rheumatism generally occurs in consequence 
of some evident cause as cold whilst Gout comes on without
any such cause. Rheumatism has no antecedent complaint
Gout is preceded by all the Symptoms which denote gastric
distress. Rheumatism is generally seated in the large
joints. Gout in the smaller. The limb in Rheumatism
although swollen does not exhibit that bright appearance
which is seen in Gout.
Buy nosologists, Rheumatism is divided into Acute & 
Chronic; which are more properly different stages of the
same disease than different species. Acute Rheumatism
is an Inflammatory disease with high fever chronic 
the reverse. Among the causes of Rheumatism may be 
mentioned all those which excite the other Phlegmasia
more especially the vicissitudes of Heat and Cold. Hence it
is most prevalent in Spring and fall. Acute Rheumatism
though occasionally met with in all ages most generally 
attacks the middle age. By most writers the acute Rheumatism 
is considered as a genuine Phlegmasiae, but it 
would appear that as in Gout the action to a certain 
extent peculiar, having few or none of the properties
of Phlegmasiae in its progress or termination.
In the Treatment of Inflammatory Rheumatism
VS is called for by all the Symptoms and should be repeated
as long as the indication continues. there is no 
substitute for the Lancet. after Blood letting, the Bowels 
should be freely opened by mercurial & saline purgatives.
When the disease arises in miasmatic districts, vomiting 
may be freely required. Sweating is so important in the
treatment of Rheumatism that it would seem to have been 
consecrated to this purpose. it must however never be resorted 




274.
to until sufficient depletion has been promised. After sufficient 
depletion we may commence with the [nitrous] & 
antimonial Diaphoretics and afterwards resort to the
more stimulating. Of these perhaps the best is Dovers
powder. when Perspiration is excited it should be steadily 
kept up for 24 hrs if it only continue 8 or 10 hours though
there be some mitigation of the Symptoms they often return
with increased violence. when Sweating fails Diuretics
may be resorted to.
For the relief of the topical affection Local bleeding
by Leeches or Cups should be resorted to After the successive
application of Blisters so as to keep up a discharge 
from the part should l be resorted to. Balfour of Edinburg
has recently advised the application of a flannel roller 
drawn sufficiently to compress the part. There are 2 other 
forms in which Rheumatism is occasionally met with.
Sciatica & Lumbago. The first is situated in the Hop the
second in the Loins. The remedies are VS Purging Cupping
and Blistering.
Chronic Rheumatism
By this time we mean that condition of the System in wh:
there is pain without much fever in Inflammation. It 
may be original or consequent to a badly managed acute
attack. But in whatever manner it appears it is always
connected with an atonic state of the System and demands 
a precisely similar mode of treatment.
Chronic Rheumatism is sometimes very lingering & protracted.
The Phlogistic Diathesis of the arteries is kept up whilst the
general strength is so much relieved as to forbid the further
loss of blood. Even when the remaining vigor of the System
would seem to make VS admissable, its only affect is
to increase the excitability of the vessels. Chronic Rheumatism
frequently yields to those remedies which make a strong impression 
on the Surface Not less to awaken sensibility than to 
relax the Surface the warm bath is frequently beneficial. To 
cooperate with the most active Diaphoretics as Dovers powder
are employed. But profuse Sweating in the protracted
stage is an equivocal and precarious practice. In this
stage more is to be expected from those articles which 




275.
without exciting much sweat have a relation to the skin, as the
Terebinthinal preparations Camphor, Sarsaparilla, Sassafras,
Guaicum etc. The best of these are vol alkali & Gum Guiacum.
In some of these cases Peruvian Bark is undoubtedly serviceable:
alone or in combination with volatile alkali.
Arsenic has also done good: to produce an effect it must
be continued for some time. Exactly on the same footing wd:
I place Sulphur, which I consider a valuable remedy.
I have used it much and the more I have seen of its effects. the
better I am satisfied with its powers. The 3 last articles are 
particularly suited to that form of the disease which occurs in 
Miasmatic districts and which observe the paroxysmal type.
Among the remedies for the last stages of Chronic
Rheumatism there are none better than Savin. The System
must be completely under the impression of the article before
it produces any good effect. It should be given in doses 
of 10 or 15 grs 3 or 4 times a day and increased until some
positive effect is produced. it must be continued for several 
weeks. Mercury has frequently succeeded when other 
articles have failed it should be given in combination with 
Ipecac & opium or with Cicuta.
Local Treatment: If the Joints be must swollen and painful 
Cupping is of great advantage. Next a Blister to the afflicted
part subsequently keeping up the discharge. The Tartar
emetic plaster has been used as a substitute for a Blister:
A Caustic Issue in each side of the Inflamed Joint sometimes
answers better than either. When the Joint is affected
with rigidity great advantage is derived from frictions with 
the flesh brush or stimulating Linaments. The application 
of a flannel roller is an important remedy.
The liability to a relapse is very great. To obviate
this the patient must avoid all the exciting causes especially 
the vicissitudes of the weather
If he live in a situation exposed to a marsh atmosphere 
it should be exchanged for a dry one. In cases 
where there is great exhaustion of the strength, coldness of 
the surface, dryness or clamminess of the extremities rigidity
of the joints with pain aggravated by the Slightest change 




276.
of weather, the Savin displays uncommon powers. The pain 
which had been small, weak and accelerated becomes under
the use of Savin full active & comparatively slow.
I commence with a dose of 12 grs of the powdered leaves
3 times a day and gradually increased it until its effects
are observed. Do not withdraw it suddenly; for however
little good it may seem to do at first its effects 
rarely fail to be manifested.
When Mercury is used in this disease Calomel 
should be combined with Antimonials or Ipecacuanha
Blister or Issues should be kept up at the affected part.
Tonics are only admissable in miasmata districts or
where the disease is of the Intermittent Type.
Diseases of the Sensitive System
This includes the Brain, Spinal Marrow and Nerves
1st Apoplexy.
This disease attracted the notice of Physicians at an early 
period. By Hippocrates it is distinctly noticed.
NO age is exempt from it though it is chiefly to be 
met with in advanced life. It very rarely occurs before 
puberty; but is met with most frequently between
the 50th and 70th years of live. The attack comes on very 
narrowly. In most cases the patient falls suddenly 
with a flushed or livid countenance, stertorous breathing 
frothing at the mouth, deprivation of sense and motion 
a full slow pulse and much inequality of temperature.
There are other cases in which the Stomach suffers with 
nausea and vomiting, pain and tension of the forehead;
Syncope paleness of the face, coldness of the Surface & 
diminutive pulse. These cases are generally of Gastric
origin. Life is sometimes extinguished by a fit of
Apoplexy, without a struggle, but a fatal paroxysm
rarely terminates sooner than 2 hours.
The causes of Apoplexy are remote and exciting.
Of the former as already intimated we may [illegible] in old
age whetever prematurely impairs or [?ncr??tes] te Constitution




277.
may produce the same effect as debauchery, indolence etc.
Extremes of weather predispose to it. There is a certain conformation
of the body which would appear to dispose to
apoplexy more strongly than the causes above mentioned.
this is marked by a large head, florid complexion, short
thick neck, broad shoulders, short stature & general fulness
of the system.
The exciting causes are excess in eating or drinking
irritating Ingesta, worms of constipation of the Bowels,
exposure to the direct rays of the Sun, hanging over the 
fire, remaining too long in the warm bath, the shock
of a Cold Bath, violent exertion of the body or mind,
violent emotions of joy or anger or any impulse
mental or corporeal which may be capable of exciting
the arterial system.
Examinations post mortem discover the whole
vascular system of the Brain to be loaded with blood,
with extravasation in various parts. Morgagni met 
with extravasation most frequently in the corpora striata
and Thalami; but rarely in the cerebellum while
Cheyne found such a condition to exist most frequently 
in the cerebellum. we sometimes meet with 
effusions of [Serum] only and in other cases mere 
engorgement of the vessels. every variety of organic
lesion is occasionly met with: as encysted or [st?at?matous]
tumours, schirri, ossifications, fungi etc. The Lungs, Liver,
and Stomach are also found in various conditions of 
morbid derangement Apoplexy has sometimes terminated 
fatally without exhibiting any morbid appearance
after death.
It would appear that compression of the Brain is 
the proximate cause. This has been denied by [Lerie] & 
others it has been declared that the Brain is incompressible.
The effect of compression of the Brain from depressed bone, on 
effused blood together with experiments performed by the
celebrated Portal, Sir A Cooper & others, leave no doubt in ‘
my mind but that the proximate cause of apoplexy is
generally compression. A considerable depression of the 




278.
substance of gthe Brain is required to produce symptoms of
apoplexy. [Leries] believes that effusion or extravasation
is the consequence and not the cause of apoplexy.
He maintains that the proximate cause is an irritated
condition of the Brain or membrane: and that the phenomena
differ according to the seat of this irritation.
When it is seated in the meninges, we have no paralysis.
when in the substance of the brain we have. That
apoplexy does sometimes depend on the causes I cannot
doubt, though I am quite certain that this is not its
common character. Abercrombie of Gt Britain believes
that apoplexy does not depend on pressure or undue 
determination to the Brain but on an abstraction to 
the return from the head by the veins. He argues that
as the heart impells the blood through all the parts of
the System; it cannot communicate any impulse to 
a part which will not be felt by the whole, and 
that consequently no increased determination to a part
can take place without an enlargement of the vessels
by which it is supplied or an obstruction of the
trunk distributed to the other parts of the system. Hence
he infers that when an increased accumulation takes
place in any part it is because the veins do not carry off 
the blood as fast as it is brought by the arteries. I do not
believe in this doctrine however although it is very 
ingeniously made out. Although the Heart is the chief
agent in the circulation of the Blood, it is manifest that
the arteries bear a part in that function more than simply 
to transmit what the Heart impels. If however an increased 
accumulation takes place in the way which he mentions 
it is obvious that compression of the Brain would be the
consequence. For if the cranium (as in the Case) be completely
filled by the Brain ordinarily and increased quantity 
of matter cannot be introduced without compressing
that which it already contains.
Nosologists have divided Apoplexy into Serous and
Sanguineous but I shall not adopt this division.
It is doubtful whether Serous Effusions ever produce
it; and if they do the distinction is of no practical utility.




279.
It is more universally admitted that Apoplexy may originate
in the Stomach as well as the Brain. I shall therefore
consider it under the heads of Gastric & Cerebral.
Epilepsy is more apt to be confounded with Apoplexy
than any other disease. In Epilepsy although the patient
falls there is great spasmodic movement of the muscles & 
the attack soon passes off whilst in apoplexy all power
if motion is suspended and the patient does not recover 
for some days if at all. Coma, Lethargy, [Cataphora]
etc. are all inferior grades of Apoplexy. To distinguish
between the 2 forms of Apoplexy is however much more difficult.
A Gastric attack is usually preceded by Dyspeptic 
Symptoms sometimes it may be traced immediately to the
effect of a full meal, drink or narcotic substances, which 
have been taken in. with regard to Prognosis, it is obvious
that if the case proceed from an affection of the Stomach 
it will be less dangerous than if it has its origin in 
the Brain. In the cerebral form the danger will depend 
on the condition of the Brain. It is a common opinion that
recovery cannot take place after a rupture of a vessel & 
consequent extravasation but this is wrong. Sir A Cooper
believes that in this case the clot of blood is not absorbed
but that the brain acquires the power of accommodating itself
to the pressure. The French Pathologists have ascertained 
however by digestion that a sac forms around this clot by 
the effusion of coagulating lymph; this sac secretes of a fluid
which by thinning the clotted blood facilitates its absorption 
and that finally both sac and blood are absorbed. These
Sacs are noticed by Morgagni in his work on causes of 
Scorbus Morborum.
Apoplexy is generally most formidable and fatal
complaint. when the respiration is slow, heavy & laborious
or the pulse slow weak and remitting not rising after blood
letting, the prognosis is bad. The approach of fever in 
the latter stages is unfavourable. shivering as indicating
the formation of matter in the Brain is unfavourable.
Cold surface with profuse perspiration is fatal. Disorder
of the muscular system is unfavourable when [????ting] 
to convulsions it is fatal. Redness of the face, quick
circulation, bleeding at the nose, a spontaneous salivation 




280.
warm moist skin, free bowels etc. are favourable.
Treatment
From the urgency of the cases our first attention is directed
to the relief of the Paroxysm without any regard to ‘
the cause producing it. we place the patient in that posture
which least disposes to determination to the head and remove
all ligatures from the body as cravats, Garters, shoes etc.
Plenty of fresh air must then be obtained by [thr???] opening
the doors and windows and excluding all persons whose
presence is not necessary. we now draw blood in quantity 
proportionate to the circumstances of the case. [Exapt?y]
Fothergills & Heberden all authority is in favour of the 
measure. As a general rule from 30 to 40 zi must be 
drawn. this however will be regulated by the age, constitution
and habits of the patient & by the state of the pulse.
Dr Physick once took 96 zi of Blood. It is a matter of considerable
importance to draw off the blood suddenly.
hence you should make a large orifice and sometimes 
open an orifice in a vein of each arm. It sometimes
happens that the energies of the system are so depressed
by the compression that the circulation is very feeble
these cases should be managed like congestion of
the Brain. The efficacy of bleeding in Apoplexy
will depend on the mature of the case. If it arises from 
congestion you cure it at once. If caused by extravasation,
the advantage is less striking as might be expected,
but here we bleed to arrest further extravasation and 
to obviate Inflammation. Topical bleeding as subordinate
to the general, is very important.
We next attend to evacuating the Alimentary Canal
by Emetics or Purges. when caused by offensive ingesta
or connected with a loss of Cerebral or Nervous Influence
the attack will be much relieved by emetics. By 
Sydenham, Fothergill, Pitcairn & Kirkland they are recommended
and Cullen was opposed to them. Limited to 
the above cases, I have no doubt of their utility.
Active purging is a remedy however which possesses
unusual confidence. Calomel worked off with Sennae 
repeated daily; continued evacuations of the most powerful 




281.
kind constitute a very important part of the Treatment.
when symptoms of debility come on the Ancients
gave Stimulants freely. the Modern French practitioners
give Ardent Spirits & Carb Ammoniae. when of gastric
origin the Case will benefited by this treatment but to 
cerebral cases, it is entirely inappropriate. When Febrile
symptoms come on we continue the Antiphlogistic treatment
particularly antimonials in small doses, cured by cold 
applications to the head with Blisters to the neck, and 
afterwards to the head and wrists. If all of these fail I wd:
advise salivation from its decided effect in Hydrocephalus.
Patients disposed to Apoplexy must avoid all of the 
exciting causes; be careful in the selection of a proper
diet and the avoidance of Cold. Exercise is a good prophylactic 
when judiciously employed. To prevent an
attack we resort to VS, moderate purging and rest.
Paralysis
Between apoplexy and Palsy there is a very slow resemblance
being [convertible] diseases. Palsy may be primary
or consequent to apoplexy. the ancients considered 
apoplexy and Palsy identical, differing only in degree
they believed apoplexy to be an universal and Palsy
a partial disease and this with a few exceptions is the 
present opinion.
Palsy is divided into 3 kinds. 1st Hemiplegia in which 
one side of the body is paralyzed. 2nd Paraplegia, paralysis 
of one half of the body taken transversely, & 3rd Partialis, one
affection of a part only. Palsy is sometimes preceded
by a train of Symptoms resembling those which [fore???]
apoplexy we sometimes meet with intermitting cases.
There is a loss of motion and sometimes of sensibility
at the moment of attack the part is generally numb and
cold with convulsive twiching. The vital and natural
functions are but little disturbed. Mr Earle found paralytic
limbs to be colder than other parts but Mr John Hunter
believed the contrary. whenever a paralyzed part is found 
to be warmer than the other I have no doubt but it is
owing to the covering by which it is enveloped. It is generally
supposed that the affected part is deprived of sensibility 




282
but I have known it to be acutely painful.
The other senses as those of Smell, Taste etc. are said to be
very acute by Dr Cooke.
The Intellectual faculties are very much impaired
or entirely destroyed. The memory fails first. The temper is
much affected. mild persons sometimes become morbid & 
the reverse. As it regards general Palsy, the
causes are the same with those produced by Apoplexy.
local palsy may proceed from injury to the spinal marrow 
or Nerve. The principal predisposing cause is age.
The exciting causes are the same as in Apoplexy.
In all cases of cerebral origin the Palsy takes place in 
the side opposite to that which is affected. this was observed
by Hippocrates
Palsy is to be regarded as a Gastric as well as Cerebral
affection; that it occasionally originates in the Stomach, [illegible]
established. Paraplegia is generally owing to mechanical
injury or disease of the Spinal Marrow but it sometimes has
its origin in the Brain. Partial Palsy may have it origin
in the nerve of the part, the Spinal Marrow or the Brain.
Hemiplegia never depends on the Spinal Marrow or Nerve,
but always on the Brain or the Stomach. The distinction
between Gastric and Cerebral cases of Apoplexy, is the same 
as in Palsy.
In relation to the Prognosis in Palsy, we may observe 
that in the more violent attacks, recovery is extremely rar.
The difficulty of cure is proportionate to the length of times
during which the patient has been affected, and to the age
during which the patient has been affected, and to the age
of the person. Hemiplegia as generally originating in the
Brain is the most formidable. Boerhaave says that an affection 
of the upper is more dangerous than the lower extremities.
Local Palsies except when attacking importan organs
are least to be regarded, and are generally curable. this 
does not apply however to the nerves of sense. one of the
most favourable symptoms in the return of sensation.
The termination of Palsy is various. when combined with 
apoplexy it often proves fatal very suddenly. The recovery 
when it does take place is always very Slow. It sometimes
happens that in the active form of the disease. So much 
amendment will result from VS & purging judiciously
employed as to induce me to expect a speedy recovery 





283.
but we shall be often disappointed. The most melancholy
forms of the disease are what we called Bedridden Cases.
The Treatment of that form of the disease which is consequent
to apoplexy is the same as apoplexy itself. if the
remedies mentioned under that head no one mode is more
decidedly useful than Purging long continued actions and 
persevering. when the case is consequent to injury of the
Spinal Marrow it comes under the management of 
the Surgeon. Palsy often proceeds from Inflammation
or irritation of the Spinal Cord. Cases of this description 
are to be managed by the remedies already 
enumerated assisted by Cupping and Blisters to the part.
Rest is of all other measures the most important.
Partial Paralysis sometimes arise from the pressure
of Tumours on the nerves. these should be removed.
it may arise from the Inflammation of the [neuralima] & consequent
effusion. cups & leeches are here to be used. afterwards [???tions]
with mercurial ointment to promote the absorption of
the effused fluid.
In the advanced stages of Palsy when vascular
action has subsided, the remedies both external and internal
should be stimulant. The internal remedies are
Cantharides, Turpentine, Mustard seed etc. opium and other
narcotics have been advised but they are always inappropriate. 
The Nuca Vomica has been highly recommended 
of late. It induces at [Tetanic] condition and restores as 
is alleged the power of the paralyzed muscles. It is given
in substance in the dose of 4 grs or 2 grs of [illegible]. alcoholic
extract several times a day. The dose has been increased
to 30 ro 40 grs. The external applications are Blisters to the
Head and affected parts, Sinapisms, [M??a], the actual
cautery, electricity etc. The [mo??] is an old remedy received
by Baron Larrey & others. it appears to be only a painful
mode of making an issue. I have never known Electricity
to do any good. the same opinion is given by Galvani and
Dr Franklin. Strong mental emotions have been resorted
to, with a view of rousing the excitability of the nerves.
I once know a man who had been confined for a considerable
time to his bed to be cured by an alarm of fire.
This is too dangerous to resort to. it would in many cases
carry the patient off with apoplexy. As a far more important 




284.
remedy, I may mention the Warm and Cold Baths. The
warm springs in Virginia are frequently used with 
this view. Cullen speaks favourably of the Cold Bath
provided it be followed by reaction. when the latter
does not take place readily, friction will be serviceable.
I have known exercise gradually increased to cure Partial
Paralysis Thus If a man have the muscles of his arm
so paralyzed that he can scarcely raise it, I have directed
him to lift a small weight and increase 
it every day until the tone of the part is restored.
IN the Treatment of Palsy it is a very common 
error to resort to stimulants too early. it should be recollected
that the disease is one of oppression I the first stages
and not of exhaustion. one of the best purgatives
which I have used is the Elaterium. The use of frictions
should be limited to the advanced stages. in the stage of
excitement they are always detrimental. The preventative
regimen is the same as in Apoplexy.
Epilepsy
This is a disease which has attracted attention from the
earliest times. It was elaborately discussed by Hippocrates
and noticed by Celsus. Yet in every relation of it is still
involved in much obscurity. It is incident to every age
but more liable to young than old. according to Heberden 
& others, it is said to attack men more frequently than
women and this accords with my experience.
The remote causes of Epilepsy are not always intelligible
It is sometimes connected with malformation of the head.
In the uncertainty of our knowledge the predisposition
has usually been ascribed to a certain constitution of the
Brain and nervous system, rendering it inordinately susceptible
of impressions. It is the temperament of [illegible]
and of passion. Hence some of the most celebrated characters
which the world has produced were affected by it. of 
these are Julius Caesar, Mahomet, the arch Duke Charles of 
Austria, Napoleon etc. It is sometimes met with however 
in the dull and stupid.  But as a general rule extreme
delicacy and irritability of body with a sensation deep within
the mind may be considered as forming the predisposition. 





285.
Epilepsy is often Hereditary. Like other diseases of this
character, it is sometimes latent in the first and breaks
out in the 2nd or 3rd generation.
Of the exciting causes, there is less doubt. Some act
directly or indirectly on the Brain. Thus the pressure of 
Tumours, depressed bone etc. may excite it. Certain states
of mind which operate by increasing or diminishing the
energy of the Brain as fear, grief, and the depressing
passions on the one hand; and joy, anger, & the other
stimulant passions on the other, often act as exciting
causes. Powerful impressions on any of the Senses
may excite it. The recession of eruptions, the suppression 
of accumulated discharges etc. give rise to Epilepsy by Metastases.
Most of the causes mentioned act on the Brain
but there are others which affect various organs.
It arises frequently from irritation of the alimentary
canal. This form occurs most frequently in 
children. Of the causes acting on this surface, are painful 
dentitition, worms or sordes, constipation, excess in 
eating or drinking, improper ingesta, poisons [illegible] or 
narcotics etc. Impressions on other organs especially 
the uterus, whether in an impregnated or unimpregnated
state may produce it. Those resulting from 
the irritation of the pregnant uterus are called 
The uterine epilepsy occurring the unimpregnated state is
generally dependant on Amenorrhoea or some other morbid
condition of menstruation.
It may also result from an affection of the Spinal
Marrow: or from pressure or injury of a nerve. One case
is recorded which was produced by the pressure of a
Calculus on the Sciatic nerve and another in which 
it was consequent to the pressure of a cartilaginous substance
on the nerve of the fingers. these substances
being removed the disease was cured.
Plethora is one of the most common accessory causes.
The liability to an attack is greatest during sleep. partly 
perhaps from the increased sensibility and party on
account of the increased determination to the brain. It 
sometimes cannot be traced to any causes and hence in 
the darker ages was ascribed to planetary influence.
The mode of attack is very various. It sometimes comes 




286.
on without any premonition, the person being suddenly 
seized with a loss of feeling and of consciousness. An attack
is general preceded by ringing of the ears, dimness of 
vision, peculiar odours (particularly of Musk) fulness
of the vessels of the neck and temporary alienation of
mind. connected with these symptoms we have sickness 
and vomiting, laborious respiration, copious discharges
of pellucid urine, flatulence, coldness of the extremities
and the Aura Epileptica.
The paroxysm in mild cases commences with frothing
of the mouth, some agitation of the head & extremities,
attended by a vacant fixed expression. these symptoms
go off speedily & the patient recovers. Sometimes it
assumes the form of catalepsy, in which the patient
stands with rigid muscles, vacant countenance and 
loss of sense. In the more vital forms, there are
stupor, insensibility to all impressions and loss of muscular
power. whether any degree of consciousness
remains is doubtful. In other cases the whole muscular
system is thrown into vital contortions resembling
Tetanus. The face is pale & livid; the eyes are
open and rolling wildly or fixed; the mouth foams,
the teeth chatter and the Tongue is protruded. At the
same time, the Heart palpitates, the pulse is irregular the 
breathing is laborious, the stomach is sick and the bowels
give way.
The Paroxysm may continue from a few seconds to 
several hours. the average during is 15 or 20 minutes.
The patient is now either aroused or falls a sleep. In 
some cases another paroxysm soon follows & the attack
is thus protracted for several days.
The terminations
are vary various. Death rarely takes place during the
paroxysm, though it sometimes degenerates into Apoplexy.
By the protraction of the complaint all the powers 
both mental & corporeal soon suffer. Idiocy, or what
is more common mania is not an infrequent consequence.
The disease has however continued during 
life without any such effects.
The appearances on dissection are very similar. 





287
to those in apoplexy and Palsy. with regard to the
diagnosis, little need be said. It is most apt to be
confounded with Hysteria. This last however is 
known by the Glabus Hystericus, by the sudden transition 
from laughing to weeping, and by its duration.
In forming our prognostic in Epilepsy, we have regard
to the age, habits, & constitution of the patient, as well
as to the cause producing it. When dependant on
congenital malformation it is generally incurable.
When occurring after puberty it is more unfavourable
than in early life. In children it is more favourable,
when symptomatic of initiation elsewhere, than 
when dependent on primary irritation of the Brain.
It sometimes ceases at the age of Puberty & is occasionally 
cured by fever and other diseases.
With regard to the Pathology of Epilepsy much 
obscurity has always existed. Little more seems to have
been ascertained than that this and its kindred affections
depend on a disordered condition of the Brain 
and nerves. It has long been my opinion, that the
whole of the [neuroses]; though commencing in Cerebral
or Nervous irritation soon affect the Blood vessels, giving
rise to congestion or inflammation. The proximate 
cause appears to ba an afflux of blood to the Brain.
That this is the case we may conclude first from the
causes, all of which are calculated to produce such an
effect. As a large Head, blows, mental emotions, violent
bodily exertions etc. 2nd from the symptoms; as vertigo,
Tinnitus Aurium, dimness of vision etc., which precede 
the paroxysm. 3rd From its analogy to diseases confessed
to depend on the condition of the Brain. thus
it is convertible into apoplexy or Palsy. 4th From the
phenomena on dissection. these are congestion, extravasation,
effusion, etc.
S it presents several forms, convenience requires
some arrangement: I shall therefore treat of it under
the heads of Idiopathic & Symptomatic. The treatment
divides itself into that which is necessary during the 
Paroxysm, and that which is proper during the interval.





288.
During the Paroxysm, the patient should be placed
in bed with his head elevated; his Cravat and all
ligatures about his body should be removed, his should
be held to prevent his body from injury during the struggle;
and his tongue should be dissuaded by the interposition
of some soft substance between his teeth.
Erroneously supposing that the case was analogous to 
Syncope, it has been a practice with some to use frictions
to the surface and apply stimulatories to the nostrils.
these are improper. Synapisms to the feet may be 
used with advantages. Emetics when judiciously employed
are of great utility. They are best suited to the Gastric
cases, and are in admissible in heavy congestions. Directly 
the reverse holds with regard to VS. this should be limited
to those cases marked by Cerebral fulness or excitement.
In establishing the mode of treatment suited to the
interval we should first endeavour to ascertain the
seat of the disease and the condition of the vascular system
with which it may be associated. Commonly there is
general plethora, with determination to the Head. VS is
here indispensable and should be repeated as often as circumstances
require. This is most frequently demanded in
cerebral and uterine cases. We next recur to evacuations
from the Prima Viae by Emetics or Purges. Emetics
are only applicable to such cases, as are of Gastric origin.
Much confidence is reposed in Purgatives.
Hamilton revived the practice of purging in this disease,
but he limited their use to cases arising from 
Intestinal irritation. I have used them with the greatest 
advantage in every form of the disease whether I wished
to remove irritating matter or to reduce arterial actin.
when we determine on their use we must not 
be satisfied with merely opening the Bowels, but
we must repeat them daily for weeks.
‘It is unnecessary to inform you that the strictest attention
must be paid to diet and regimen; without
which all of our prescriptions are entirely Purgatory.
After the system has been thus prepared for it, we may 
resort to Tonics, as in other diseases of a paroxysmal
type. It is however a very important matter to 




289.
subdue arterial action sufficiently before we enter on 
the use of these medicines.
A great variety of these articles derived from [illegible]
the vegetable and mineral Kingdom, have been used
for this purpose. as Peruvian Bark etc., of the vegetable
kingdom: & Lunar Caustic, Sacc Sat, Zinc sulph and
oxyd, Cuprum Ammoniacum etc. of the mineral kingdom
a popular prescription which as been very beneficial
here is the following: Take a Teaspoonful of Ginger
& the same quantity of Sage leaves: Take them every 
morning for 3 mornings in succession, then omit it
for 3 days, and again use it in the same way.






Hydrophobia
At the commencement of a description of
this disease, I say that there is no such disease.
I shall therefore treat of Canine Madness. This
is produced by the bit of the Canine Spica, the
Dog, Fox & wolf. It is a poison sui genera
arising from something peculiar in the constitution
of this species of animals. This poison
has given rise to a disease wh: is more uncontrollable 
than any other disease, but it has
been cured, and I am in hopes that I shall show
you that it can be cured. The best essay upon this
disease was written by Dr Mayse of Phila and the
only one which comes any ways near the rationale of
the disease. The Antiquity of this disease has been
denied by a great number of physicians but Gent
the denial of its antiquity shows a great want or
research in antient History as well as antient diseases
The most antient account which I have seen is found
in the 9th Book of Homers Iliad, in the 8 and 13th Book
of the Iliad described [Hedor] as mad from the bit of dogs.
This disease prevailed in 1809 among foxes in Maryd
and part of Delaware. We have also facts of this
disease among the wolves up the Mississippi river. 
There is one fact with respect to this
poison is that it has no excessive time when it
produces the disease. It is known that the poison
did not produce its effects in 12 & 20 years and
in other cases the day after the bite was inflicted
There cannot be a more vulgar opinion that 
the feline tribe can communicate the disease the
bit of this tribe can’t produce the disease.
It is said by some that man can [illegible] this disease
without being bit. It is true that Hydrophobia can 
be produced but this is not the disease I have seen 
the dread of water in Hysteria a great deal worse
than I ever saw it in Canine madness. this [illegible]
of water may be produced by inflammation of the
stomach and oesophagus. why? Because the pain in 
drinking is greater than the pleasure of the fluid.
Certain articles of the strong hot astringent vegetables
produce inflammation in the Oesophagus, followed 
by the dread of water. this is called Hydrophobia.
The symptoms of Canine madness differ, some are
very inflammatory others spasmodic convulsions 
[illegible] maybe thought that the symptoms were always
spasmodic affections which [required] stimulants 


Notes from Dr Physick’s Lectures
Dr Physick told us that there was a disease of the
spine sometimes occurring in young persons
from compression of the muscles by tight lacing.
The muscles which preserve the erect position
of the spine being thus deprived of their power
deformity follows. He advises that something
like a bandage should be removed, & 
the person made to act with these muscles
by carrying a weight on the head or standing 
with the back against the wall until their 
power is restored.
Dr P once knew of a man in which the power
of the muscles was permanently destroyed 
by great exertion in running.
The Deltoid muscle is sometimes bruised
by a fall on the shoulder and deprived
of the power of raising the arm. This has been 
frequently confounded with dislocation. 
A partial division of the tendon of the Biceps
in the common operation of Phlebotomy sometimes
gives rise to Subsultus of that tendon. This is often
communicated to the other muscles, and produces
a condition resembling Tetanus. This may be readily 
relieved by preserving the arm steadily in a [semiflex]
position by means of a splint carved out of
wood to fit the anterior of the arm; by this means
the edges of the wound are brought into contact.
When a nerve is wounded in the operation of
bleeding, pain is always felt at the time with a 
stinging sensation in the course of the fascia given
off by the Biceps to cover the ore arm, inflammation 
is frequently excited in the cellular substance lying 
under it and suppuration sometimes follows. I
have always succeeded in preventing suppuration 


but I have seen this disease very inflammatory 
wh: required copious VS. There are many cases
on record of Tetanus which are called Hydrophobia
but I will show you that they had not the symptoms 
of Canine madness. Mr Arne has described
a case of Hydrophobia in ST Domingo is one of the
very best description of Tetanus I ever saw. Van
Swieten describes a case of a man who drank a 
large quantity of spirits, who says this was Hydrophobia,
I suppose that the man was made sick
by the quantity of Liquor and the Idea of drinking 
associated with the sickness caused aversion to water
he recovered in a few hours a fine case of 
Hydrophobia to be recorded! I saw a case of [Croph]
in a man of 30 years who after asking for water
became convulsed at the sight of it & he flew into
 a violent passion after he became more calm, he 
informed me that his throat was so sore that the
thought of swallowing produced the effects wh: he
could not controul. This disease is very rare in 
countries uniformly hot or cold, but in climates wh:
have cold winters and warm summers Volney says
this disease in Syria and Egypt. Dr Moseley says that
a great many dogs had the disease and that dogs 
on board of vessels in the port which had no
communication with any other dogs had the
disease showing the disease to be owing to 
atmospheric influence. It has been uniformly 
the case in the US that after a cold winter
the disease becomes epidemic.
At the commencement of the disease
you will see the dog very languid his eyes
red and its excretion increased, he shuns the
company of other dogs and secretes himself 
until a reaction of the circulation takes
place when he invariable leaves his 
home and seeks other dogs that he may 
bit. Dr Mayse considered that the 
disease is produced by putrid animal
matter taken into the stomach. this argument
is very easily refuted for if putrid matter
were the cause why does not all dogs 
which feed upon putrid matter have
the disease? This disease is always epidemic.
It appears only once or twice 


2
by elevating the arm above the head by means of a 
pillow and applyhing a blister over the inflamed part
If pus has formed make an opening into the abscess
and evacuate it. The operation of cutting down
to the bone through inflamed parts is cruel and
dangerous.
Ulcers on the anterior part of the leg
immediately over the tendon of the Tibulais
Anticus will not heal unless that muscle
is kept from acting.
In abscesses situated under the facia Femoris
the fatter should be let out by a depending 
opening; and the leg compressed above and 
below the opening by means of a flannel roller,
whilst the opening is kept free by interposed
lint. The limb should always be kept extended
because the adhesion of the fascia 
closely to the muscles sometimes occasions stiffness
of the limb for 10 or 12 months.
Inflammation of the Synovial Membrane
of the knee joint may be induced by exposure 
to cold or by a contusion. I have known
it to occur in a Lady from slightly bruising 
her knee in pushing in a drawer. There are pain and
stiffness with increased heat of the part. The first
thing to be down in the treatment is to enjoin rest 
in the recumbent posture. you are not to 
permit your patient to sit up for that is just
half as bad a standing. Bleeding from the arm
is then to be practiced to as great an extent as the 
patients strength will bear. it should be repeated
daily until the pain is relieved . Local Bleeding
though much trusted to by some is not beneficial.
Nor is blistering proper in this case.
Why, I know not but experience has taught me 
that such is the fact. The practice of using frictions
to the part is very prejudicial. I do not
prescribe purging because it occasions [M??ntion]
bowels should be soluble.


in 20 or 30 years. There is no doubt that this
is produced by some contagious influence
of the atmosphere following a cold winter.
This like all other diseases must have a 
first cause and this is certainly a general
cause. Dr Wilkins informed me of a dog
in his neighbourhood which fed on a putrid
dog which was killed for canine madness.
it had no other effect upon the dog but
to fatten him. It has also been thought
that the disease is produced by a want 
of water in the hot seasons but this is 
not the fact for I have seen the Epidemic
prevail in one of the counties of [Md] in 
which there are 9 navigable streams in 
the county. In some of the Islands of the
W Indies the water is so scarce that it 
sometimes sells for a half [illegible] a Gallon there 
has never been seen a single case of Canine
madness. Another Hypothesis is that there 
is a worm in the tongue of dogs which Pliny 
says if taken out when the dog is a pup will 
prevent the dogs forever after from disease
Since the days of Pliny many physicians
have thought this worm produces the
disease if suffered to remain. Dr Hamilton
expressly says that if the ligament is cut out 
the dog has the disease notwithstanding.
Dr James says that dogs thus treated are just
as liable to the disease. Dr Mays thinks
that the disease is produced from a want
of perspiration. this is not the fact for doges
do perspire.
In the commencement of Canine madness
in dogs it is very difficult to tell the Symptoms 
they are like any other febrile disease but ti
is quite different in the latter stages, the first
symptom is often fallacious, a want of appetite
The aversion to water is as fallacious as the above
Dr Hampton mentions 2 instances where the dog
lapped water just before death. a watery excretion
and redness of the eye is a more certain one.


3
I once had a case which proved the correctness
of one of Mr Hunters opinions. that though we
may cure a diseased action, we cannot cure
a predisposition. A young man rode in the
fore part of a stage on a cold day with his
knees exposed to the wind. Soon after this Inflammation
supervened in one knee. On the use of
the proper remedies, I effected a cure in a short
time afterwards Inflammation came on in the 
other knee. Now although I had bled him freely 
for the cure of the first attack it had not removed
the predisposition to the second. The patient should 
be confined for 4 to 5 weeks.
In that disease of the Knee Joint called
while Swelling I have succeeded by a particular
mode of treatment in doing away the necessity
for that terrible alternative Amputation and cannot 
help recommending it to your notice with confidence
You must always inform your patient that
the cure only be effected by perseverance and
you must particularly enjoin that no person 
shall be permitted to interfere with the treatment. 
A confinement for 3 or 4 months to as many 
years is sometimes required. A splint carved out
of wood to fit the limb should be applied on the
back part of it from the Tuber ischii to the foot.
it should be kept elevated. After enjoining
rest and applying the splint I give a purge
once, twice, or three a week, according to the
patients health. I then make an Issue on the
flat upper surface of the Tibia, by means of 
caustic. the Splint prevents motion of the joint
and thus obviates Hectic fever, with all that train 
of Symptoms, requiring amputation.
I have seen 3 or 4 lateral dislocations of the Knee Joint
in which the leg was thrown outwards. the reduction


Pulmarius says the most certain sign from 
which we can tell this disease is from the
actions of other dogs. they have this instinct according
to the author but I do not believe that this
symptom is worth recording. Mr Petit says that
if the dog which gave the bite he killed and a piece 
of meat be rubbed over the teeth of the dead dog and
give it to another if he refuse it the dog was
mad
The effects of the poison is first to 
create pain in the better part, this is not always the
case, when the disease does not appear in a 
short time after the bit. There is a general lassitude
at the commencement of the disease as in all
fevers. The pains after the disease has commenced increase 
very rapidly and generally produces stranguary
the poison of this disease has as much 
effect upon the urinary organs as Cantharides.
There is pain in the throat and precordia a [conste?]
jaculation about the bed, a constant complaint
of being cold in the remission. At the first of the
disease if he sleeps it is only for a short time
& he generally wakes in a slight convulsion, the
eyes are feverous & penetrating, the countenance
changes frequently, a copious flow of Saliva, and 
the throat becomes very painful which throws him 
into convulsion when he attempts to drink fluid.
The lungs are also sometimes affected. After these
symptoms have appeared the pain in the bitten 
part ceases and sometimes the part becomes
paralyzed. after a time the secretion of the glands 
of the mouth is very much increased. The muscles
of the Glottis become inflamed and frequently there
is a Sonorous Cough wh: has been compared
to the barking of a fox. now the Symptoms are 
such as to produce convulsion & by any thing 
which associate the idea of pain as the sight of
water etc. During the intermission the mind appears
perfectly calm and sane. Writers had [illegible]
more about the pulse than any other symptoms 
One case which I saw the pulse was 130 and very 
strong and in another the pulse was as full and 
strong as any pulse I ever saw. Dr Colegate saw
a case in which he bled him 9 times and [took] several
doses of Calomel which produced [illegible] cure


4
is readily affected, but it is not so easy to keep the bones
in place. to do this I apply a long splint with bandages
and keep the patient confined for 2 or 3 months 
not only until the ruptured ligaments united but
until they have acquires sufficient firmness to 
bear the use of the Limb.
In Dissecting tumors from the Parotid gland
I have found great advantage to result from gentle
pressure for a week or two before operating. by 
this means the absorbents are excited to action, and 
loosen the attachments of the tumor. The total removal
of the gland is an operation never to be performed.
In the treatment of Ranula, I
have found nothing so beneficial as a Seaton, passed
through the tumor and permitted to remain until
the artificial openings are established.
Two plans of Treatment are so successful in
Goitre as a removal from the place at which it
was contracted. I have never known this to fail 
if the disease had not existed longer the 3 or 4 months
I have sometimes succeeded in curing it with
Burnt Sponge 10 grs 3 times a day.
In those fistulous sores of the mammae consequent 
to deep seated abscesses in the cellular substances
connecting the gland to the Pectoral muscle, I have
found the best effects to result from passing
a Seton through the deepest of the [Sinuses].
MR Hey advises cutting them open to the bottom
this would be a very painful operation and is
I think unnecessary.
In puncturing the Bladder from the rectum
recollect that the Peritoneum is reflected from the
posterior surface about ¾ Inch above the
Prostate gland.


Just before the fatal termination we have false vision
Subsultus and the convulsions increase, the [voise] is very
hoarse, the muscles of the face become spasmodically
contracted, the muscles of the lower jaw are relaxed
and there is a trembling motion of the jaw.
Sometimes they die very calm at others they die in 
convulsion.
This person seems to require an exciting [illegible]
it appears to act upon the nerves and produce great irritability
of the nervous system which may be acted upon 
by any thing which will increase the irritation. I believe
there are two fevers on the Irritation and the 2nd a
fever of reaction.
It has been believed that the poison of Canine 
madness is absorbed but I think this is not correct
because specific contagion when it acts by absorption,
produces the disease in a given time
It is a very remarkable fact that this disease can’t
be produced unless we have some blood from t
the part where the poison is placed. The French
physicians were of the opinion that this disease
could not be produced without the bite of a 
mad dog, they persuaded a man to inoculate
himself with the Saliva from a man laboring
under the disease. the inoculation produced 
the disease which killed him. The Secretions 
from an animal labouring under this disease 
when taken into the stomach produces no disease
the milk of cows can be taken with impunity.
It has been thought that the disease could be
produced in the foetus in utero but this is not the
fact as I have seen a case of a bitch which
brought forth a littler of pups at the very time
she was labouring under the disease. the pups
had not the disease.
III We will now attempt to show that the poison
produces a secondary action in the heart and
arteries and that it is not a disease of the nervous
system alone. In post mortem examinations we
always find a hardening of the brain or some marks
of Inflammatory action. this is shown by many distinguished
Professors. I shall offer a few remarks on 
the general action of this poison. The mineral
and vegetable poisons act very different but the
vegetable and animal poisons have sometimes
more similitude in their action. But of all the 




animal poisons the poison of Canine madness is more
fatal than all others. The length of time which 
exists from the commencement and termination is
from 4 to 6 or 7 days.
The Symptoms of this disease are very numerous but very
constant. I believe that fever is a constant one, which 
is known first from the general lassitude before
reaction takes place, 2nd from the local pain and
infammation in the part bitten, 3 from the pain 
in the pharynx which produces the pain in swallowing.
4 the inflammatory action on the urinary 
organs. The pain about the Scrobicalus Cordis wh:
is met with in this disease is frequently seen
in fevers. The intolerance of light is also another
symptom of this as well as other fevers. there is
always a hoarseness is from the increased secretion 
of the Trachea. The acuteness of the intellectual faculties
the high excitement and delirium shows this disease 
to be febrile.
The Treatment divides itself into Those which
prevents the disease and Those which cure the
disease after it has made its appearance.
The only Prophylactic is calomel and if this be
given in sufficient quantities to produce the 
mercurial effects it will be very likely to 
produce its beneficial effects. If the dog
bite through clothes The poison is apt to be
prevented from entering the wound. The only radical 
prophylactic is extirpating the bitten part. the
part should be removed in a short time after
being bitten. The actual cautery was the practice
formerly but this does not answer the purpose
so well as extirpation. If you cannot extirpate
you should always the caustic alkalies. this will
penetrate every part which the boot has [illegible]
and it will produce extensive suppuration
which is more effectual than any thing else except
the knife. In applying the Alkali you should use
a small sharp pointed [illegible] syringe introduced ½ inch
into the wound. the common syringe will not do




The patient bitten by a mad dog should be kept quiet
and if he be an athletic person bleed him, then give
some saline cathartic, after give mercury, & continue
it until the patient is completely salivated
keep it up for 3 or 4 weeks.