Aaron Cornish








Extracts from a course of
Lectures given by James
Jackson M.D. in Boston
1818-1819.
Nov. 17th
Lectr 1st The subject of medical science is 
As the human 
body is daily obnoxious to some one of the
various diseases which afflict mankind, the 
object of medicine is to preserve the health, and
to restore it when it is lost. The knowledge 
requisite to the attainment of this science, is 
an acquaintance with physiology and natural 
history. It relates to matter and mind, and
embraces their properties, relations and laws.
There are four great divisions of medicine
I. Physiology. II. Hygiene. III. Pathology. IV.
Therapeutics. From these are derived the rules 
and precepts of the practice of physicke
The whole science is not embraced in this
course. There is much that belongs to Anatomy, 



surgery, and midwifery, etc. animal chymistry, etc.
materia medical. There remains something to this
course in each division.
I. Physiology.
Physiology breaks of the science of life.
It embraces a consideration of the I. The composition
of our bodies II. Their structure. III. The properties
of our bodies and minds. IV. Their functions.
Thus far our race may be considered in what is
common to them. But considerable differences are 
to be perceived among individuals. Of these we
take notice under V. Varieties. They are all influenced
by and exercise an influence upon external
things. Hence we consider VI. The relation of the
human system to external things. It is by the 
[agency] of these that the functions of life are maintained.
From a deficience in them life may cease;
and if it do not, it must ultimately [terminate]
by a loss of the properties of [illegible]. There are
different modes of the termination of life considered


under VII. Death. A very large proportion of
what relates to this division (Physiology) is 
taught in other courses. Such parts will be 
considered in this course as are not so readily embraced
in those.
Lect. 2d I. The composition of our bodies
may be divided into eliments ultimate and proximate.
Their distinction I. ultimate. these are the
same as in common matter oxygen and certain 
combustibles matters as hydrogen & nitrogen in compound binary and
ternary, etc. These combined also in common matter
but not in the same proportions etc. Art cannot
imitate their combination in living bodies.
2. Proximate. All the substances in our bides
are composed of the ultimate elements. The simplest
combination of these constitute the proximate
elements. These elements are compounded by 
living power, and when decomposed cannot be
recompounded. Chymical compositions remain perfect,
while defended from foreign influence,
what composition s are the result of life, and this
requires foreign influence; and however aided, the 



vital compositions are necessarily transient. If
chymical composition be destroyed, the same elements
may be recombined and constitute again
the same substance. Not so with vital compositions.
they cannot be recombined after being once
destroyed, such as exists in proximate elements.
The principal proximate elements are to be found 
in the blood. They are albumen, febrin and red
globules. These elements of the blood go to constitute
the substance of the body, particularly the albumen
and red globules. these are distinguished
from each other by the colour of the red globules,
and the coagulation of the lymph, which takes
place at 150 [degrees] Far. Febrin is supposed to constitute
one of the principal solids. In other parts
the different proximate elements of the
blood are not well distinguished. The fluids derived
from the blood are exhaled, secreted and [illegible]
The solids are [illegible] by an analogous process.
Exhalations are merely aqueous secretions alkaline
[and] excretions acid. secretions generally have
the same quantity of water, as the albuminous contents
of the blood. Exhalations have more 



Secretions contain the albuminous contents of the blood
and in each a peculiar animal matter. [Excretions]
are more compound. All contain free [illegible] acid
II. Structure of our bodies. this is principally 
taught in the school of anatomy. As
it is of great importance shall mention it here.
The body as to its structure may be divided
into simple and compound. I Simple
is the structures of sensible parts in different
textures, as fibres, [lamina], etc. 2d Compound.
As the structures of organs in which simple
parts, similar and dissimilar, are combined 
mechanically. The organs are also to be noticed 
their form and connection
III. The properties of our bodies. They are
of two kinds physical and vital. I. Physical
being properties which are also found in dead
matter such as gravity, elasticity, electrical
properties etc. Likewise such as are mechanical,
arising from the configuration of organs
hence their adaptation one to another
II. Vital. which are divided into I. organic,
belonging to all organized beings;



2. Animals, or such as are peculiar to animals
These are not all found in every animal
1. Organic, properties are a mobility, & irritability.
Vital affinity, [??ification] [illegible]
2. Animal. These are in part corporeal, and
part intellectual. The latter to be noticed only 
as they are connected with the former. They
are f. sensibility, g. intellectual powers, [illegible]
property of transmitting volition & sympathy.
Lect 3d a. Mobility is the power of moving
It is exhibited in muscular fibre, in vessels
and their parts. Generally considered as derived
from other organs. The power of motion is considered
as contained in the parts in which it is
exhibited, and move under the influence of the
will. This influence being communicated to the
parts through the medium of the nerves. Hence
it is altogether an hypothesis that motion is derived
from the nerves. If this be correct, either [illegible]
takes place in the nerves, in which case they possess
mobility, or if no motion takes place in them
they have not that property, but only the power to 
give it to other parts. In either case the property is 


distinct from other properties. [illegible]. Irritability
The power of being affected by stimuli so as that
involuntary functions may be induced. The part
moves by the irritation of a nother substance.
It is various is different organs. Possessed by all
that have motions and by some that have not
As the muscles possess both irritability and mobility,
whereas the mucous membrane possesses irritability
only. Irritability and mobility differ as 
it regards strength. The one may increase and the
other decrease, as s the case with the alimentary
canal, the irritability of which is increased the
frequent exhibition of an emetic etc. 
c. Vital affinity. The power by which the ultimate
elements of matter are united and kept
in combination in living bodies. The elements
of animal bodies are not governed by the same laws
as dead matter. they are not combined by the lows
of chymical affinity as is evident from the decomposition
of the living body after death. Why does
this take place, is it not because the body
is deprived of that vital principle, life. This
vital affinity exists in fluids as solids. 


for we find they undergo decomposition as do
the solids. The analogy with chymical affinity
chymical affinity remains the same, and exerts
the influence on different bodies. Vital affinity
is different it is not inherent like that, but is
divided and [transient]. It is a property which 
the part possesses while it is alive. Duration of 
life in individual particles very limited
some suppose they may be worn out which 
is not the case as they are defended by the mucous
membrane e. Vivification. The power of
bestowing vital properties on common matter. 
Whatever be the vital properties, they are given by 
 the body enjoying to that which was previously 
distribute of life. This power exists under different 
modifications in different parts.  The matter assimilated
receives different properties in succession
nor does all this matter become endowed with 
every property. e. Synergy. The power whereby 
several organs, or parts of the same, conspire to affect
one object, acting either simultaneously or in succession.
In order to affect one organ a number 
must be affected at the same time a number of 


13
functions are performed at the same time for the same 
purpose. As is the case with the uterus when the 
organs opperate by a power within themselves 
while the mind does not take cognizance of these
Distinguished from sympathy 
f. Sensibility. The power in our corporeal organs
on which external material substances act in producing
perception. It exists in animals [illegible] in 
vegetables. This property is various, or modified
in different organs. The sense of touch is common
to the brain through the medium of the nerve
hence if the nervous communication is interrupted
or cut off the sensibility is destroyed. The mind 
does not exist in every part of the body as the mind
possesses the power of perception, and the fingers 
of sensibility. Intellectual powers. The mind
may be considered in a certain sense as [uncompounded]
or as a unit; yet it certainly performs various
functions and these by various powers. Those
most necessary for us to regard are perception 
and volition The first enables it to recognize
impressions made on the bodily organs; the other
to act on bodily organs 



There is a power in the body that assists our [??uption].
motion is under the control of the will.
the nerves transmit the desire of the mind to 
the muscles to be moved, which becomes submissive,
and obeys it dictates. But this power is
not possessed by all muscles, for instance the 
heart etc. are not under the influence of the will,
I Sympathy. there exists among all parts of the
living body, intimate relations; all correspond
to each other, and carry on a reciprocal intercourse
of sensations & affections. These links which [unite]
together all the organs, and cause one part to 
feel with another when one part feels pain the
others suffer also is called sympathy.
An influence exercised by one part on others, more
or less remote from it, without mechanical changes. 
It is impossible to explain how this power
exists, but that it does exist is an established point’
Mr Hunter distinguishes it into, continuous,
contiguous and remote.
contiguous in contiguous parts, remote as in the
liver and shoulder. It is also active & passive 


15
Lect. 4th IV. The functions of our bodies
The division of functions and their relations.
divided into vital natural and animal functions.
Two classes. First class. Those functions appertaining
to individuals. Second class those appertaining
to species. Third class. Two orders. Organic & 
animal. 1. Organic; common to all living organized
beings. In man these are those [illegible]. 1st Assimilation including
a mastication b deglutition c. digestion d. absorption
of chyle e. sanguification f. circulation g. respiration.
2nd Formation, including a. exhalation b. secretion,
c. nutrition. 3d Excretion, including peristaltic motion,
b. lymphatic absorption c perspiration d urinary
evacuations. 1st Assimilation is a function common 
to all animals, by which substances extraneous
to them, are introduced into their bodies, and
subject to a peculiar system of organs, their
qualities altered and new compounds formed, [illegible]
to their nourishment and growth. Animals alone
are provided with organs of digestion, all of them 
from man down to the polypus have an alimentary
cavity variously shaped & length. The existence of
of a [illegible] [illegible] may therefore be taken as the 


as the essential characteristic of the animal kind
a mastication In man when food is taken in
to the mouth it undergoes mechanical operation
or mastication by means of the lips, jaws and
teeth, with which these are furnished the muscles
by which they are moved, and those that form
the [illegible] of the mouth. It then passes
through the esophagus into the stomach by 
the process of b. deglutition. The stomach being
the common recepticle of the alimentary canal, it
is here that the food undergoes the process of 
c. digestion, principally by mixing with the gastric
juice, it forms [illegible]. In this state it
passes through the pylorus into the duodenum
here by mixing with bile and pancreatic juice
it is here seperated into two parts the one [???nutritious], 
the other chylous or nutritious.
The chyle is taken up by the absorbents
and goes to nourish the body, and the fecal
is carried a long the alimentary canal, [illegible] [illegible].
The aliment is disolved by the gastric
juice, and by the assistence of bile and
pancreatic juice. chyle is formed, which has always 


the same nature and properties, whatever may 
be the kind of food received into the stomach.
But there is a difference in food as it respects
the quantity of chyle it produces. Animal
food affords more nutritious particles than
vegitables. Animal producing 70 parts chyle,
to bile vegitable only 40 in a hundred
d. The chyle is now taken up by the lacteals & 
conveyed into the thoracic duct through the 
messentery, which is called the absorption of chyle
e. Through the chylopoetic vessels it is carried
and [illegible] into the left subclavian
vein, where it is changed into blood.
This is called sanguification. This process wherever
it is effected is anagous to digestion. [illegible] circulation.
The fluids are now sent to every part of 
the body, and so much as is necessary for the nourishment
of the body is distributed. The remainder
is brought back through the veins to the
lungs where it is exposed to the atmospheric air
by respiration, undergoes a change in its properties
& colour, becomes arterial blood, or fit for nutrition
and is again distributed over the system.


This change is affected by the oxygen of the air
uniting with the carbon of the blood, forming
carbonic acid, which is thrown out in expiration.
This leaves the [illegible] in a proper [illegible]
circulation g. Respiration. It is supposed
that animal heat is derived from respiration
as the blood, by experiment, has been [illegible] to be 
two degrees warmer in the arteries than urine
or after it has been exposed to the atmospheric air
from the oxygen it retains from the air
But this theory [illegible] of much speculation.
It is well known that animal bodies possess the
power of generating heat, once that they preserve 
the same temperature. While inorganic matter
always preserves the temperature of the surrounding
substances
Lect 5th 2d [Formation]. This may be considered
as the [illegible] of the organic functions
The [illegible] [achieved] in its qualities by a series of 
decompositions, [illegible] and rendered similar to the
substance of the being it is to nourish is applied to the
organs whose [illegible] it is to repair from the blood 



19
The instruments of this formation are the extreme vessels
or capillary systems. There are undoubtedly 
smaller vessels concerned in the function of nutrition
than we can discover, by which the functions 
of the body are carried on we find these vessels 
of nutrition in the stomach, and absorbents
The heart and arteries have been considered as 
mear mechanical tubes. But as one artery may 
become more distended than another, this doctrine
must be incorrect. The blood however is carried tho
these vessel to the cappillaries, where it is distribution
to every part of the body. The blood moves 
in different directions in these vessels, and does
not always bear the same proportion to the arteries.
The fullness of the heart and arteries has
some influence upon the capillaries. But they are
much more dependent upon the capillaries for their
fullness. The capillaries have a peculiar [illegible] 
by which they admit such parts of the blood
as [illegible] them and will become nourishing to the 
part it is to nourish The same matter is not
taken up by every part. each part selects such parts 


of the blood as is most congenial to its nature,
thus the febrin is absorbed to form [illegible] etc. hence
we see these filtrating vessels have a peculiar appertency, 
or irritability. As for example in the
two passages in the fauces. The epiglottis 
closes when any thing except air comes in
contact with it. The fibrin of the blood being the
same with the fibres, the fluids must undergo some
change. Consequently the secretion and excretion must
take place in these vessels. This change which 
is affected is analogous to digestion. 1 By exhalation
2. secretion these are alkaline 3. Nutrition 
which [illegible] in taking away those things which 
are redundant The absorbents take up the [illegible]
fluids. 3d Excretion a. by peristaltic 
motion b. Lymphatic absorption c. Perspiration
d. Urinary evacuations 1 Those which 
had one passage 2. Those which have more passages
than one 1. the alimentary canal, here the
matter is not discharged alone, but there is mix
with it bile, mucous etc. which occasions the [illegible]
of the feculent matter in [diorha] etc. 


21
The blood is a hetrogenious substance. The 
[illegible] matter is excreted. These excretions are carried
to those parts which have external openings.
This process is performed by the extreme vessels
as are the secretions. These exertive organs
are capable of performing each others office, as
we may observe in the urinary evacuation [illegible]
skin For instance in case of stranguary, the
excretion is carried on by the [emunctaries] of the
skin, and vice versa.
Lect. 6th This lecture was wholly devoted
to the books which are required and recommended
by the Massachusetts Medical Society 
for the student to read & study
which may be seen in the 2 no 7 vol of the 
New England medical journal
Lect 7th II. Animal functions. First class
second order. Animal functions occur on ly in 
animals, but all of them are not to be found in every 
species of animals General 1st Sensation. This is peculiar
to all animals, as a smell b sight c. hearing
d [Tasting] e [Feeling] including touch These constitute 


The external senses. 2d Exercise of intellectual power,
as of a. Perception, b. Consciousness c. Attention
d. Memory e. Reflection f. Imagination. g. Judgment.
h. Volition, etc. These are not all peculiar
to every species 3d Exercise of bodily organs under
the obvious control of the mind. a Locomotion b Voice
1st Sensation. The external functions are
called into action by the influence of external
objects acting upon the senses. Sensibility varies
in its acuteness, or differ in different organs,
one is more sensible to external objects than another
In different persons also we may observe a difference 
If we notice the eye or the ear we perceive the 
eye has certain organs peculiar to itself 
as the [illegible], by which it receives the rays of
light and so arranges them so as to occasion seeing.
The ear also so modifies the air as to produce
sound or hearing. There is one kind of sensation 
however, viz. that of feeling, which every part of
the body is capable of enjoying, in a certain degree
Some parts of the body possess a much [larger]
of this sense than others, the fingers possess this
function to the greatest perfections. Hence we always  


23
make use of them in the exercise of this function
Observe the contrast in the ends of the fingers and
the nose. It is not by one organ alone that we are able
to discriminate accurately, but by a certain 
peculiar organization. Thus it is by a peculiar
formation of the ear which is seen in anatomy 
that it receives the air and causes hearing
2d Of intellectual power etc. which have
been mentioned
3d The exercise of bodily organs under the
obvious control of the mind. Why are locomotion
and voice In locomotion the part or the 
muscles in constituting what part possess the power
[illegible] of moving in themselves. Although they are
under the immediate influence of the mind, which 
opperates upon them through the intervention of the
nerves. The voice is performed by the organs of the
mouth, so constituted as to [process] the air
Comparison of the animal and organic, organs & 
functions. The animal functions are double and
organic single. Consequently the organs that perform
these [illegible] functions are double and divided by a [illegible]
line on which depends the symetry and [illegible]
 


of the body. These two organs generally correspond
to each other, as we may observe in the
eyes, ears, the heart, [kidnies] etc. But we find
exceptions to this rule, as there are many which
do not perfectly agree in every respect. we
frequently observe a difference in the eyes of the
same person, the [strength] of one being greater
than the other, causes the weaker one to turn
aside and becomes [illegible]; while the strong eye
looks straight forwards at an object the other
is turned in toward the nose to avoid the rays
of light which face direct upon it. We may 
likewise observe a difference in the ears of the
same person, for which reason he is not 
to distinguish nice sounds in music. while
in whose ears harmonize and who is said to
have an ear for music, will discriminate the
best discord in any note. the other is not
able to distinguish one sound from another
The sides of the face also are not always perfectly
similar owing principally to the sides of the 
nose not always corresponding being sometimes more 



25
attracted to one side then the other. The limbs
also do not always correspond as to the size and
strength, an instance of which ws mentioned in 
which the small [cloths] did not suit both legs
This difference has been attributed to the
exercise of the right leg more than the left
(this being the one usually the largest) This
cannot be correct as they generally correspond
and harmonize in all [illegible] actions & movements
The brain is thought sometimes not to be perfectly 
ballanced. In consequence of which we often’
meet with those who have no decision of character, 
but are always wavering and undecided in
most all pursuit or object. This is attributed
to the unequal position of the brain, in consequence
of which the person is not able to bring both 
sides to balance at the same time
The animal functions exist in two states sleep 
and watching the organic functions do not sleep 
but are always ready to perform their functions
The excitability in the animal functions is 
soon exhausted, therefore requires sleep or rest in 


order to accumulate a sufficient quantity
to carry on its functions properly consequently 
the animal functions are not always ready for
action. Sleep is perfect and total or imperfect
and partial perfect when all the organs
are at rest imperfect and partial when but
part of them are asleep. We many times see
persons perform locomotion functions while
most of their organs are asleep, a person may rise
from his bed dress himself got to his daily business
and not be conscious of it upon waking. this
may be termed partial sleep. The animal
functions are subject to education and under 
the influence of habit. It is a great measure
from education that the ears of a person who has
made that his profession, is able to distinguish 
the least jar or discord in music, while a person
who has attended but little will not be able to 
distinguish. It is by the influence of habit also
the painter is able to [illegible] on a piece of painting
very readily, while a nother would not. By the
smell the apothecary will distinguish his medicine


27
which is from education and habit. so
also with the sense of touch. also from the loss
of one the others become more sensible. which arises
from the greater use we make of the remaining
senses. The organic functions differ in these respects.
They are single while the animal are double.
In the organic functions there is a dependence
on different organs to perform a certain function.
This we may observe in the reception of food and its
digestion. The aliment is received into the mouth
when it is masticated is then carried through 
the esophagus into the stomach where it is digested
The chyle is seperated taken up by the
absorbents carried to the thoracic duct, through
which it passes and is emptied into the blood
vessels by which it is distributed to the nourishment
of every part of the body. Therefore we see that
aliment must continually be supplyed or these
functions will cease. The animal functions are [illegible]
thus dependant on each other. The [illegible] are liable
to sympathy when one function, for instance the stomach
is affected the others all sympathize.


These functions are not under the control of the
mind as are the animal. Notwithstanding
the organic functions are not subject to sleep
themselves, they are mor or less influenced by the
sleep of the animal. They then go on more deliberately,
and are performed more perfectly.
Some of them are constant the actions occasional
The organic may be said not to be influenced
by habit; but this is not invariably the case
with all of them. For we find the fecal evacuations
may be regulated by habit in such a manner,
as that we shall have a discharge at the same 
hour of each day. By the animal functions
external relations are maintained and
operations of the mind performed By organic
functions foreign matter is converted into substance
suited to the nourishment of the body and
the internal economy of the system is maintained
The greater number of diseases arise in consequence
of some derangement of some of the organic
functions. On them depends the maintenance of life
and habit. The systems not independent of each other 



29
The mind takes cognizance of the organic
system and controls some operations necessary to it
From the cognizance it takes results appetite. The
appetites consist in wants or desires arising from certain
states of the organic viscera. though the same 
does not distinguish what constitutes these states
it has desires produced by them. These appetites
essential to prompt [illegible], [illegible] the source of
very many of our actions. The mind also has something
similar in this respect desire of knowledge
, of action and of affection, The mind controls
the evacuations except in extreme cases. The mind
and body influence each other by sympathy;
this to be noticed hereafter.
Lect. 9th Second class. Three orders Those
of male, those of female, and those common to the
two 1. Those of the male are a secretion of seminal
fluids to [illegible] of them II. Those of the female are a menstruation 
b conception c gestation d. parturition e. Lacatation
III. That common to both. [Copulation] The i. etc.
II genera of these functions may be considered as analagous
to organic functions not being under the influence 


of the mind. The 3d may be said to be
under the influence of the will, for they are performed
by the consent of the mind. These
functions also sympathize with the [minor] on
the mind with them for by [peculiar] thought
there is a much greater secretion of seminal
fluid, as will [?sijection] there is also a sympathy
between these organs and the whole system
which we observe at the age of puberty, when 
a universal change is effected in the system.
The voice is altered in the male and certain
evacuations are established in the female. If these 
evacuations are interrupted the system
sympathizes. In the male so great is the sympathy
between these organs and the system that 
the voice does not change if the testicles are
removed. Hence there are people that suffer
castration in order to preserve their voices
and become good singers. During conception there
is a very remarkable sympathy in the system. most 
observable in the mamma, after delivery there 
is a secretion of milk established which continues
untill the mother ceases to nurse the child


31
Relation of functions. Two kinds of relations. 
First, mechanical, depending on the convention
of organs, on their motions such as are obvious 
directly or indirectly, and are the transmission
of matter. The performance of one of these functions
effects the other, as one part operates on
another some pretend that the relations between
the stomach and the brain is owing to 
a nervous effusion arising from the stomach
to the brain but we believe this is not correct
Second. Vital, maintained by vital power 
and not depending on any known motion or 
transmission of motion. There is two kinds 
of vital relations a when the connection between
the parts related is obvious, and the influence
is always maintained a sound state of the
organs maintained by sensibility and the
power of transmitting volition
This relation is very obvious in between the 
brain and the retina when an image is painted 
on the retina, an impression is carried & made
upon the brain When any of our senses are called
into action, an impression is made upon the brain


How is this communication effected? This
must be carried on by the means of some
vital principle and not by the transmission
of any matter from the organ to the brain
The relation of distinct parts or their dependence 
upon each other is maintained by sensibility, 
or the power of transmitting volition
[6.] Where the relation is not obvious and the
influence has constant and uniform. The relation 
is maintained by sympathy.  The sympathy 
of the whole system with parts is most obvious
where the difficulty is the greatest; and this 
whether the difficulty arise from the magnitude
of the operation to be performed, or from inability
to perform it with ease. If one part
of the system is diseased the whole will sympathize
with that part; or a part will sympathyze 
with the whole This is not the case
with every part of the body at the same time,
There are several different systems that compose
the body, as the nervous, absorbent, circulating etc.
We are very apt to think the whole body diseased
when but one of these systems are affected


33
when parts are diseased the system sympathizes 
but does not when in health Persons differ
with regard to sympathy people of feeble habit
sympathize much mor readily than those of a
robust healthy constitution. The nervous system
of the feeble being more readily effected by any [illegible]
affection. This differs from debility
Of [Tone] or strength. Organs are not at all times equally 
prepared for performing their functions. As
sometimes they are more, at others less readily excited.
In most healthy states, the muscles maintain
a certain degree contraction, [chief] capillaries a certain
degree of fullness, and the organs a certain 
degree of turgescence. In these cases the [illegible]
is supposed to be in tone, and is compared to 
a musical chord when sufficiently tense to
produce a vibration their appropriate tone
The [illegible] states of the organs arise immediately
from different degrees and states of power
This may be measured by its effects. Two bodies
may be in health, & yet differ much in their
strength therefore it is said that all the powers
of the body increase and decrease together 


This cannot be determined by the state of the
pulse but goes to prove that this is not
the case as it may be increased in one part
and not in the whole. These effects to be 
regarded in three respects viz. as to rapidity 
perfection, and duration The deficiency of
strength or debility actually gives rise to many
embarrassments in the living body, but has been
charged with more evils than belong to it
When the muscles are in a proper state of contraction 
and ready to move whenever called by 
the will into action they may be said to be 
in a proper tone when the animal body has
a proper degree of fullness it is in tone when
fullness but softness, there is a want of tone
The varying state of the organs arises immediately 
from different degrees & states of power
We may judge of the strength of the person by 
the strength of the digestive powers. Thus one 
person will digest food which another cannot
his stomach is then in tone These powers 
may again be known by the length of time
different person can work upon the same food


35
Thus one may labour 10 another 12 another 16
the latter therefore may be said to have the
greatest strength, and to be in tone
But a system not able to perform these functions
to that length of time is feeble which is an evidence
of weakness and debility which has been
the cause of many diseases The functions may 
be in a sound state although weak & debilitated,
and not able to perform to the extent of
another in perfect tone Debility may be considered
as direct & indirect When it arises
from want of food it may be called direct 
when from excess or intemperance, indirect
Lect. 10th V. Varieties among the human
species. These may be ranked under
four heads. I. sex. II. age. III. race. VI. constitution
or temperament. I. sex. The differences 
in structure and functions these are great & generally
well known Properties alike in kind but different
in degree; as in mobility, irritability, sensibility
& sympathy Females in general possess more
sensibility than males There is likewise a great
or readiness to sympathetic feelings The labours 


of one part more readily effects the whole system,
as in the organs of gestation
II. Age. Of infancy and childhood, youth, manhood,
old age, duration of life III. There is a 
difference in the races of men although of the same 
species Hereditary differences. The offspring of two 
will resemble each other although not perfectly.
The offspring of the horse and the ass partakes of
the nature & resembles them both. So great is
the tendency of children to resemble their parents
that they can inherit many diseases from them 
as the gout scrophula etc. which are hereditary 
diseases [illegible] also preserve a differen 
such as to show unequivocal peculiarities as
to race. This is a subject of natural history.
The source not easily decided. There is 
a gradation of men. European, Asiatic and African
in which there are differences strongly marked
This difference may be [illegible] in shape of the
head, the african forming a middle place between 
the European and the monkey There being
about the same difference between the European & 


37
African, as the African & monkey in the facial
line or slant of the forehead The same difference 
exists also in the forearm, the African
being longer than the European, in the same
proportion that the monkey’s is than the African
in proportion to the body There are other
peculiarities also, as in the shape of the foot etc.
They differ also in mental endowments, the
African being much inferior in intellect to 
the European This by some has been attributed
to education It is not all owing to education
for as to their powers of mind, or capacity for 
receiving an education they fall far below the 
European as a people
IV. Constitution or Temperament. There is great
diversity among the productions of nature, in 
the vegetable as well as the animal  kingdoms
Even in the grass we are not find two [illegible]
alike so also among all the nations & races
of men upon the earth we do not find any 
two that in every respect resemble each other
The resemblance is more or less perfect Some 


resembling each other much more than 
others There is a general resemblance in 
in nations, or some peculiar works by which 
we determine a person to be of one nation
They are therefore thrown into groups 
as Spaniards, Germans etc. Their general
peculiarities [dispeached] by caricatures
The antients divided them into temperament
which they called sanguine, choleric, melancholia
& phlegmatic. distinguished by the
different fluids The [illegible] founded in theory
the distinction in observation when a 
physician called to a patient it is necessary 
that he should determine the temperament
& properties of the body in 
order to fix upon a proper quantity & quality 
of medicine The difference is most obvious
in the organs and functions, if these are perfect
the of the system will be in a proper
tone IF the powers exhibit disorder, we
find the organs also deranged The eternal
marks however do not all correspond 


39
1st The sanguine temperament is marked with 
[succulent] appearance in the countenance, the hair
red, chest full or larger than the abdomen
a certain rotundity of form as in females, pulse
full & frequent, large share of irritability and
sensibility not permanent but easily changed
medicine opperates upon them more readily, & 
sympoms appear a favourable when they are readily 
[illegible] again into the same state 2d Choleric
differs in having the hair darker, less
softness in the skin The abdomen as well as
chest large about the loins, somewhat irritable
but not so much as the sanguine bile
stronger and effects the whole body as in 
putrefaction, easily angry. 3d The melancholic
differs from both the former Their
complection is darker there is a sharpness
of fetures & dryness of skin, eye bros long
& bushy & sometimes [meet], the body smaller
possessed of but little irritability & sensibility
passions not easily excited, but when 
raised they are more permanent & lasting


They act without any intermediate agent, or
there is no intermediate agent between the objects
& the effect produced, the power being suspended, 
Other powers as lightning effect the
vital affinity & suspends bile Persons who 
die in this manner have their limbs flaccid,
the muscles do not contract, & the blood remains
fluid By this kind of death animals
which are hunted, die in the chase their flesh
also is more tender & sooner turns [illegible] to 
putrefaction, than the flesh of those which die
the common way, in consequence of the power of 
life being at once destroyed. How shall one know
their effects upon the body shall we examine 
their weight, colour, or chymical effect?
By neither of these can we distinguish them precisely,
their effects are only known by the best of 
experiment whether it be morbific or [illegible]
Substances applied operate either upon the
irritability or sensibility Stimulants act
on the irritability, their effects always local
but those of some more readily propagated by 
sympathy then others They act 


43
in succession indirectly or on the whole system
The immediate effects upon the system
are always local Sympathy either general or 
local The effects propagated by mechanical as
well as by [vital] relations The agents acting on 
the sensibility These are various External things
acting upon the organs change the functions of certain
organs These functions are changed by 
agents acting upon the vital parts, or irritability
VII. Death, or the termination of life, is not always
in the same mode In order to understand
death, it is necessary to know what is necessary
to the maintenance of life In order for this two 
conditions are necessary One that the body possess
certain principles of vitality This alone indeed
occasions us to consider eggs, seeds, & some dormant
animals as possessed of vital affinity. Certain
animal & insects may lay dormant for years & 
then be brought to life by moisture & other [illegible]
In these life may be said to be [illegible] The
other condition necessary to the maintenance of the
power of life is that there be certain vital functions
going on viz. Those of circulation, respiration etc. 



They may even cease for a time & still life be
restored, as in case of person apparently deceased etc.
But when these functions cease certainly 
life has departed as far as common observations 
go But in this case the body retains some of its
vital properties those especially of organic life
The irritability continues for a time much [illegible]
the vital affinity In order to support life it
is necessary that the capillary vessls should be
full & distended with red blood In order for
this that respiration should be kept up if
this cease the heart will send fourth black blood 
to the extremities the capillaries will cease to 
be distended & death will ensue Death
may be distinguished by expiration & absolute [death]
Expiration may arise from failure 1st of
the respiratory organs 2d In the [encephal??]
3d In the heart In what way does life depend
on the brain. not from the transfusion of any 
matter Death occurs in consequence of external
causes, which destroy the properties of [illegible]
This may be partial or general An effect may 
be produced by a foreign substance.


45
sufficient to destroy life in the part to which
it is applied, & by sympathy in the whole system
Absolute death does not take place untill decomposition
has commenced in the body When life is destroyed
by disease death acts gradually upon the body
destroying the organs in succession, untill it reaches
the heart, then the body dies In death from common 
diseases, the mucous collects in the air passages
There being not sufficient irritation or strength 
to throw it off, it obstructs the breath, consequently
there is not support to change the blood
The heart weakened in its [illegible] shows black blood
to the capillarys & the body dies
Lect. 12th Pathology. This branch of medical
science relates to the doctrine of diseases
what do we understand by disease? It is known only 
by contrast with health we must therefore [illegible]
health before we can understand diseases. What is 
health; it has its limits It is when we are free
from pain & suffering the composition & [structure]
of the body is perfect & the [illegible] [illegible] must be
felt at its usual time, & all the organs & functions


must be in tone Disease is a deviation from 
all these The [illegible] bodies disease is marked by 
symptoms In the dead body its [illegible] are
seen in change of organization in unusual [distention]
of the [fluids], in unusual deposition of them
in change of color in the parts & in the presence
of substances not usually found in the body
Differences between disease & disorder In disease
a change is effected in the structure of the parts
In disorder the organ may be perfect & the function
disordered in consequence of a disease of some other
part The heart for example may be sound, but 
in consequence of a disease of the [illegible] of the
[illegible], its functions will be disordered as
may be perceived by the pulse During life the
we [illegible] disease by symptoms Distinctive 
in respect to these Symptoms are I. such
as the physician may ascertain from his own
observation. II. such as he can learn only from the 
report of the patient. I. under his [illegible] we
have i> such as are manifested in the [patient] & are
ascertained by inspection & examination; & 2. such 



47
as are manifested in the evacuations, I. Those of
figure, colour, motion, position, temperature, dryness
& moisture of the surface which can be examined
pulse respiration voice cough, [illegible], [gassing]
hiccough; & those ascertained by touch pressure percussion
1st Figure, every thing that goes to make
up his expression as fullness & tension of the face or
emptiness also may be observed etc. 2d position likewise
is very important to be observed by the physician if
for instance you find your patient walking, you 
may make up your mind that he is negatively 
convalescent, but if you find him bent forward with
both hands upon his sides, you may conclude he has 
the cholic or some other violent pain The strength
of the patient may also be ascertained by the position
much however is owing to the passions, whether they 
have been excited or not. 3d Colour also of the body
may be observed as the petechia, & yellowness of the skin
& tunica conjunctiva, of the eyes in [illegible], sallow
countenance, [illegible] appearance under the eyes paleness
of the lips. 4th Motion owing to disease the [illegible]
to [motion] in the body is very usual [illegible]
The mind also becomes [illegible] & insensible.


5th Temperature must be [noticed] That of the 
lower extremities & trunk & the time of they 
remain in a high or low temperature. The
report of the patient & your own observations
do not always agree. The patient may complain
of cold, when by the thermometer his temperature
is much above the natural heat. 6th Dryness & 
moisture of the skin etc. a certain mellowness may 
be observed as may be seen by the temperament
to which he belongs The degree of the disease
may be determined by the degree of moisture or dryness
upon the surface of the body, the appearance 
of the eyes, nose & mouth; but principally from 
that of the tongue, we find the tongue usually [moist]
& that from its own secretion By a change in 
the appearance of this organ, or in the secretions
are indicated all the different changes which
appear in the various secretions in the circulation
Thus by the cooling upon the upper surface of the tongue
we discover the different stages of the disease & its
favourable or unfavourable crises. This cooling
is deposited & removed by degrees; first the edges
then the middle, afterward the root of the tongue


49
Next we have to consider the circulation, which is
of the greatest importance, much indeed may be learned
from the state of the pulse The rist is the usual place
to examine it although we sometimes examine it in other parts 
The radial artery sometimes divides & passes on the upper
side of the rist, in which case we find but a very small
pulse in the usual places The frequency of the pulse
depends much on the age sex & disease of the patient.
The natural standard for a man in health is 73
beats in a minute. In adults whenever the pulse
rises to 80, it indicates disease; somewhat serious at 100 
& if they continue at or about that in chronic diseases
it is very serious In some people it sinks in disease
& rises again as health returns The same instances
its natural standard is as low as 50 or 60 In females
it is naturally more frequent than in males, & in 
children still more so as in them the pulse may 
rise to 120 without any disease & even higher; but
if it that number it indicates some disease
The frequency of the pulse is influenced by the
kind of disease In acute it may rise to 120 with 
[illegible] serious at 140 Influenced by the [general]


or local situation of the disease For instance
if it be in the heart or brain & the pulse diminish
in frequency, it indicates danger But in disease
in general, when the pulse diminish, it is an indication
of decreased disease
Lect. 13th We come now to speak of the fullness
which is opposed to smallness. An unusual
fullness is not a [sure] proof of an unusual quantity
of blood. It may rather be atributed to a unequal
distribution. Then may be great fullness of the 
whole circulation in the arteries, veins & capillaries
& not discover greater quantity than usual, being 
unequal in its distribution. Neither is smallness
a sure indication of deficiency of blood
As the pulse may be small & still a plethoric
habit prevail The pulse will rise after bleeding 
in many diseases; but in colic complaint
there may be usual want of blood
Next is hardness which is opposed to softness
Hardness is a common indication of a buffy coat; 
& that of an inflammatory complaint. This buffy
coat appears in consequence of the coagulation of 


51
the blood, on the seperation of the crassementum from 
the serum In this case the seperation is longer in 
taking place & therefore gives him a more perfect
deposition of the fibrin, consequently renders the buff
more conspicuous. This is influenced by various other
causes, as the state of the coats, the quickness with which 
the blood is drawn, & the size & shape of the vessel into
which it is received. A hard pulse has the feel 
of a stick rising under the finger A small pulse has
the same feeling which is called a [wiry] [feeler] As
in pthisis pulmonalis, inflamation etc.
Softness is opposed to hardness, & is in consequence
of a peculiar softness of the coats of the blood vessel
It is characteristic of a particular inflamation 
of the lungs plura etc. Strength & weakness. If his
heart is excited & throws the blood with force
it may be said to be strong A weak pulse is
characterized by a feeble & languid motion of
the heart. A strong pulse is not a sure indication
of strong constitution, as we frequently find
feeble persons with strong pulse & vicae versa weak
pulse is not always found in the most feeble people
Although this is usually the case, yet it is not [in??iable]



Notwithstanding the pulse is usually regular,
it occasionally intermits which should be observed,
although it is not of the greatest importance
It may be observed that it is common
for the pulse of some aged people to intermit
while in health & to become regular in disease
It may arise from some organic affection of the
heart or arteries, when it does arise from disease 
it is of some importance If it arise from habit
or from old age it is a mark of disease
The pulse being sometimes full & then succeeded
by a very small one, [constitutes] an irregular 
pulse Upon this subject Bichat & [Sola??]
may be read, who pretended to be able to 
be able to foretell the [termination] or rise of a 
disease by the pulse The pulse varies according
as the organs of particular [viscery] one [effect??]
of the abdomen or thorax Different men have
made various discriminations, as Dr [Illegible] etc.
but they appear some what fanciful The
[illegible] differ in the different viscery above
& below the diaphragm it [rebounding] 


53
has also been distinguished by them by which
they would prognosticate the favourable or unfavourable
crisis of the diseases & at the commencement
disease will follow as the hemorage from the nose
[illegible] etc. The frequency of the pulse may 
always be distinguished with ease; 
This should always be attended to. Great advantages
are also to be derived from a frequent 
counting the pulse There is a difference between
a [quick] & frequent pulse In a quick pulse 
the sistole is performed instantaneous & a longer
diastole In a frequent pulse they follow each
other in quick succession As the heart & arteries 
of aged people sometimes become [illegible] & [occasion]
an essential difference in the appearance
of the pulse it is necessary they should be particularly 
examined [illegible] are sometimes liable
to be decreased by the radial artery seperating
just before it comes to the rist, & going above as well 
as before the rist Next we come to speak of
the symptoms arising from diseases effecting
the organs of respiration. Respiration is performed
by the [parietes] of the thorax, by the ribs & 



muscles; when these are injured respiration is
effected Likewise by apoplexy & sympathetically 
as in diseases of the mouth nose etc.
Lect. 14th The causes effecting respiration
should require particular attention Difficult
respiration arises from various causes It will be 
disturbed in inflamation of the plura & 
the viscera [illegible] the thorax This is also the
case with the abdomen & its parietes, likewise the
diaphragm In order to determine whether the 
disease is above or below the diaphragm attention 
should be had to particular appearances If 
below it may be ascertained by pressing the hand
upon the sternum, provided he depend upon the
dilatation of the thorax for respiration he will
be disturbed & uneasy And [with] other hand if the
disease be in the thorax & he depend upon the diaphragm
& abdomen for respiration pressure be made
upon the abdomen he will feel pain on inspiration
When both the chest and abdomen are diseased respiration
must depend upon the voluntary [illegible]
In this case the air passages become diseased, the
trachia narrowed He therefore fixes his hands upon 


55
his chair or whatever is near him, then exert his whole
chest & abdomen both voluntary & involuntary muscles
to get his breath When there is an accumulation
of mucous in the trachia there is a peculiar noise
in aspiration Likewise if the trachea be soft & flabby 
IF smooth & dry a noise like ratling is heard
There is sometimes also an inflamation in the 
mucous membrane of the air passages which occasions
great difficulty of breathing All these
symptoms may occur & still the difficulty be in the
thorax, as in hydrothorax In hydrothorax the water
necessarily presses the lungs & whatever compresses the 
lungs occasions great difficulty in respiration & a sense
of suffocation Respiration is often effected from 
sympathy. For instance when a remote
part is diseased, inspiration is [disturbed] arising
from sympathy, which [illegible] through the [illegible]
of the nerves Affections of the brain
also effect the breathing in proportion as the 
medulla oblongata is compressed
Voice. The strength of the voice depends much
upon the state of respiration the larynx nose etc.
Also when the system is effectual whether [relief] [illegible]


or sympathetically A strong or a weak voice
does not depend always upon the state of the lungs
A person may have a low & weak voice & strong
lungs & vice versa If the voise is changed & ‘
becomes weak in many diseases as has been observed
Cough. What make a cough? when any foreign
substance is lodged in the trachia, larynx or any
of the air passages cough is produced from irritation
of the membrane which removes the substance
from the part When a cough arises from 
irritation it does not always prove that there is
any foreign substance lodges in the air passages 
As it may arise from sympathy with some [illegible]
part In diseases of the contents of the abdomen
as of the stomach etc. it may arise from sympathy 
also in diseases of the uterus in females Therefore
when you meet with a cough first ascertain its 
cause & appearances When there is no matter
expectorated, but a dry cough, it is not of the
most dangerous nature; but if a tough mucous
is discharged it requires some attention
This kind of expectorated matter is generally transparent,
[illegible] & cough, not [illegible] in [illegible]


57
When we find a purulent opake mucous thrown 
out of a greenish yellow colour there is some deep
seated disease of a very serious nature When the 
patient is afflicted with a dry hack we may expect
some formidable disease is pending The largest
& loudest cough is not always the most serious 
we frequently meet with a large & broad chest in
such persons when coughing is excited, they make a 
noise as if the heavens & earth was about to meet
& still the cough be very harmless While on the
other hand, if the chest be small & contracted,
& very small cough may be very troublesome, & the 
most serious in its consequences Sneezing is generally
occasioned by a fullness of th head, & [alilelation]
on the schneiderian membrane, which is communicated
to the diaphragm through the medium of 
the nerves The operation of sneezing has a tendency 
to clear the head, & brighten the ideas. Gaping & 
Yawning. promotes circulation Hiccough when
arising in consequence of disease, is a very unfavourable 
symptom, therefore requires some attention
Touch Percussion & Compression It is advisable
to examine people while in health & observe 


the difference which is usually apparent in
different person In consequence of a peculiar [?acidity]
we feel things in one person & not in
another It is by the sense of feeling that we
ascertain the state of disease, & discover [many]
of the abdomen, as ascites by placing the [illegible]
upon one side & tapping with the other
By percussion we ascertain many important 
diseases of the thorax If we strike the thorax
when in health with the ends of the fingers, it will
give us a hollow sound, like that of an empty [cask]
or which contains not any thing except air The case
of hydrothorax, we have a dead sound, as of a 
cask filled with water If we strike over the [region]
of the heart, we have a sound as if the thorax
was filled with flesh
Lect. 15th 2d Evacuations. 1st Those common 
in health & disease. 2d Those peculiar to disease
The evacuations in disease are not all the same as in 
health, as we have some which we do not have in health
As the unhealthy secretions from scrophula & 
ulcerative sores From the kidnies in [illegible]
1st From the skin, lungs, mouth kidnies 


59
Intestines, testes, etc. The appearance & variations
of these evacuations must be particularly attended
too 1st Those of the skin. In health there is
always an insensible perspiration from the skin, & 
upon the continuance of this depends the health of 
of the patient This keeps the skin soft & supple
but it varies in people very much according to their
different temperaments When in health the
skin is moist & suple where disease the perspiration
varies in quantity & quality, & any chance
in this evacuation is an evidence of some alteration
in the disease We must observe whether the quantity 
be increased & whether its quality be the same as in 
health When it is increased or diminished [illegible]
it continues to vary observe the quality, whether it 
be [illegible] & whether there be an increased or diminished
heat. Its variations in sleep & [watching]
2d From the lungs, whether carbon be increased
or diminished, but this cannot be ascertained with
accuracy without some difficulty 3d Those from 
the mouth. Observe whether the saliva be increased changed 
in quality or quantity 4th From the kidnies more
is to be observed with regard to the urine than of 


either of the former except the skin & perhaps more 
important than even that We cannot fix upon 
the precise quality voided at a time, but is generally
from 4 to 5 [illegible] but varies in different [persons]
& diseases & in the same disease Urine in health
deposits a [illegible] mucous like sediment
In disease the quantity may be increased, likewise
changed in its quality whether of a local or
general nature When we find a large [illegible]
[illegible] red sediment of uric acid it is a 
favourable symptom in acute diseases, but unfavourable
in chronic complaints. When there is a larger 
quantity than usual of urine secreted & discharged
the saline substances are so much diluted that
it passes off colourless We frequently find
two acids the phosphoric & uric this the
latter being heavier sinks to the bottom while the
former is deposited on the sides of the vessel
The various changes & appearances of the [urine]
must daily be observed 5th The [illegible]
Great attention should be paid to the evacuations
ascertain what has been their usual
quantity & whether they are now different & whether 


61
the true feces are evacuated, as there may be
a mucous & billious discharge & nothing of the fecal
matter The [alvini] evacuations should be uniform
& regular in their occurrence A costive habit
or any retention of the feces is very injurious to 
the system & deranges its functions, if they are habitual
many persons will go several days
without a regular discharge & the evacuate an
unusual quantity which is very injurious
The quality also should be observed which
should be solid of a brown or yellow colour
Indigestible foods & [colouring] matter change its 
appearance, & sometime occasion too great a secretion
from the mucous membrane by the irritations 
it produces or its being in too great quantity.
Any substance which produces an irritation, necessarily 
increases the secretion for instance, if a foreign
substance be lodges in the eye, it occasions a very 
copious secretion from the membranes of the organ
followed by inflamation frequently Is likewise
with the mucous membranes of the nose & mouth
Their foreign & indigestible substances produce greater
secration of bile from the [illegible] parts less from [illegible]


but if it be mucous more profuse 6th From the
[illegible] This evacuation not important in the males
but the periodical evacuations from the female must
be had in [illegible] in all our attendance upon them
We must ascertain whether they have ben regular
in their occurrence & whether the usual quantity
has been voided which, in health is generally about
4 oz. If they vary compare them with those 
in health. The menstrual discharge does not
coagulate like common blood 2d Those [illegible]
to disease First those from the mucous [illegible]
The mucous membrane in a healthy state does not 
secrete a sufficient quantity to be discharged
when any irritating substance is applied to 
the mucous glands it occasions an
increased secretion& when this is increased
without any acrid matter being applied, it
indicates a debilitated state of the system
we must observe whether it be transparent or opake
if the mucous be transparent & adhesive it is
considered healthy, but if opake & purulent easily 
[???sible] in water etc. it is unhealthy Next
that from the blood vessels These when they 


occur in disease and sometimes salutary & form a
crisis to the disease 3d Those from ulcerated
surfaces, when these are profuse & healthy, they are 
favourable We must consider whether these discharges
are natural or artificial & whether they 
are morbid or healthy IF the former they require
particular attention In the case of blistered
surfaces if they dry immediately indicates debility
Lect. 16th II. Under this head we find those
symptoms which are learned from the patient
They are those which require sensation, apetite
intellectual power, moral effections motion & 
passions when awake & when asleep 1st sensation
We sometimes meet with difficulty in ascertaining
the true state of the disease from the patient
owing to his want of terms or languge to express
himself or the sensations which he feel by which
means the physician may be deceived with regard
to its nature. we can judge many by the outward
symptoms when the patient may be ignorant
himself of the state of his [illegible]
Thus when we see the patient express a [lack]


of anxiety etc. we infer an affection of the stomach
If you wish to ascertain the nature of 
disease without making a direct inquiry; [illegible]
such as will enable you to judge of the [real] disease
without coming direct upon the complaint
Pain is the most prominent symptom by which
we can judge of diseases Likewise the sensation 
of arising from sympathy of one part with 
another, as the loins with the intestine [illegible]
in disease of the viscera, & in fluor albus
which is chiefly felt in the loins by sympathy
of that part with the uterus Difference between 
pain & aching pain has a sensation of [illegible]
etc. The sensation of cold & heat must also
be attended too although it is not a sure
criterion by which to judge, because the [sensation]
conveyed to us & that expressed by the patient
do not always correspond we cannot always
ascertain the degree of pain by the expression
of the patient, for by judging in this way we
should be led into error. As we should conclude 
one person afflicted [unlike] [illegible] some pain
when in reality it was not so [illegible] as in [illegible]


that made little or no complaint at all
thence we see the importance of being acquainted 
with usual disposition of the patient & their
manner of expression & the great or little [illegible]
when in pain, in order to form correct conclusions.
The appetite also must be taken into 
consideration. The appetite fails in disease & 
its return indicates returning health. The 
appetite sometimes returns sooner than it can
be gratifyed, as the stomach remains too 
weak to digest the food that the appetite 
would crave we next mention the intellectual
powers They may be considered as they 
relate to the mind & body. They may be influenced
by physical as well as moral causes
and these many times of a very slight [illegible]
for instance effects arising from food received 
into the stomach of difficult digestion
It throws the mind into a state of dullness,
apathy & melancholy, as well as on all the animal
power An unusual constipation of the bowels 
likewise very perceptibly operates in the [illegible]
producing a greater degree of irritability & [illegible]



than usual We should observe the appearances 
during sleep as well as while awake
In this state the animal powers are direct
but not perfectly so, as the patient is [illegible]
very restless & uneasy during sleep, which [illegible]
it imperfect. We must ascertain whether this
disturbed sleep arises from causes existing in 
the mind or body It sometimes arises from 
food of different [illegible] being taken into the stomach just before
going to sleep. Then restless appearances
sometimes arise from organic affections of the
heart, which is necessary to be determined 
It is likewise important that we should be
acquainted with the period & order of the
symptoms occurring, as those tend to 
explain the appearance of them If we
should wish to know what gives rise to 
those symptoms we must in the [next]
place consider the Causes of Disease
These should be sought for allthough they
are not always to be ascertained. If you should
be asked the cause of a disease when its true cause
is not obvious, you may answer from a cold. This 


67
may satisfy the enquirer, although it may not
the physician himself. Remote causes
They are predisposing & exciting each cause has
properties in respect to the living body more or less
peculiar. The disease does not necessarily follow
from the remote cause The proximate cause
necessarily & immediately produces the disease as
is the disease itself The exciting cause
will produce different diseases in different 
individuals according to the disease to wich 
they have a predisposition.
Lect. 17th Remote causes have been 
divided into predisposing & exciting. The predisposing 
are either inherited from the parents 
or from a remote cause to which he has been
exposed. Exciting. A number of persons
may be exposed to the same exciting cause & 
it produce different diseases, from their predisposition
to different diseases The exciting 
causes may be various by removing the exciting
cause does not necessarily remove the disease
Predisposing diseases arise in different seasons
of the year, as the catarrh in winter etc. 



Proximate cause. The real state of the part
or system under disease. As diseases sometimes
consist in a succession of changes, so they 
sometimes have a succession of proximate
causes which are allied to each other
In order to ascertain the proximate cause we
must first learn the remote cause by enquiry
of the patient into his former & place of living
his exposedness to certain remote causes by
consideration of the changes induced as manifested
by the symptoms & by an examination of the
effects to be noticed in the bodies of those who 
have died under disease. The element necessary
to determine the proximate cause not always
sufficient Rules for the interpretation of 
symptoms so as to ascertain the seat & proximate
cause. We must ascertain the first symptoms
by various enquiries & in what part the 
first occurred. In what organ or subordinate
organ they appear, whether they are from primary 
or secondary causes or which from the sympathy
etc. They may be divided into


69
pathognomonic, diagnostic & prognostic
symptoms or signs. 1st Pathognomonic
symptoms are those which are found in a disease
& always occur in that particular disease
as spasmodic symtoms prove that [illegible]
is present. II. Diagnostic symptoms these 
are they by which we distinguish disease or
discriminate one disease from another
III. prognostic are symptoms by which
we are able to foretell the event of the disease
as if we observe a profuse sweat on the upper
parts & not on the lower we predict a long 
& dangerous disease. Termination of disease
they terminate in health, in [either] diseases, or
in death. There is a natural tendency in the
system to the recovery of health. A large
proportion of diseases end in health, which 
is evident from the fact that a person is
diseased many times & dies but once.
Therefore when there is tendency to health, we
should not intercept the salutary efforts of nature
by administering any medicine except 


that of a mild nature Therefore it is necessary 
to know when to administer medicine
& when not to. The loss of susceptibility to 
causes of irritation after a certain period.
The susceptibility to irritating causes
becomes impaired by constant use or habit
as by the constant use of opium, the [system]
becomes so habituated to its use that it is
very much out of tone without it Thus
the infusion of tea & decoction of coffee may 
at first be offensive but the stomach, by the
daily use of it soon becomes deranged if it
is not regularly received. Diseases differ
among themselves in various respects. The
most obvious & important of these differences
to be noted & that chiefly to express
the terms in common use.
1. In respect to their origin they are 1st
Hereditary. An hereditary disease is a predisposition
to some disease inherited from
parents; but not the disease itself
as the schrofula, which may appear in youth
The gout which manifest itself perhaps at 


71
40 or 50 & organic affections of the heart
which may not appear untill [50] These may 
be brought into action sooner or later as
they are excited by some proximate causes
2d Congenital. These are diseases born
with the child. 3d Family. are diseases 
which are introduced by the parents & 
occur in the whole family as in the case
of ptisis pulmonalis.
Lect. 18th Adventitious diseases
of which the causes appertain a to certain
ages. Diseases of this nature occur at different
ages. As dentition in infants, hydrocephalus
at the age of 12 or 13 chlorosis at puberty,
organic diseases of the heart etc. at 50. b.
to either sex diseases likewise differ in
the sexes we find one sex subject to one disease
the other to another as the female to [illegible]
[cutamenia], etc. c. particular seasons of the year 
influence the occurrence of particular diseases.
In the warm season those bilious the diaphragm
as colera morbus, iliac passion, 


[disenson], diarrhea & inflammations of various
parts. And in the cold season, diseases
that are peculiar to the parts above the
diaphragm; a ptisis pulmonalis 
asthma etc. a. modes of life & habits
These should be carefully observed by a
strict observance to regular diet, temperance,
& exercise. constitutional diseases may 
be kept back & others prevented from occurring
e. climates. These also promote
the occurrence of diseases In warm climates
those peculiar to the warm season 
those of cold climates to diseases of the cold
seasons. f. Effluvia from particular
sources. As the marsh miasmata & effluvia,
from the decomposition of animal & 
vegetable matter g. Diseases acting on [illegible]
communities; h. idiosyncracy or peculiarity 
of temperament; which is a peculiar liability
some have to particular diseases, as one person
may be particularly disposed to dispepsia, most
to some other disease. And by exposure to cold
or some other exciting cause the peculiar disease s


73
of his constitution is brought into action. Our
object should be to cure the disease as soon as possible
i. preceding diseases these bring on others or render
the system more liable to them than before.
5th Contagious. when a disease is propagated 
by coming in contact with a diseased person
it is said to be contagious. It may however 
be communicated by the insensible fluids eminating
from the body effected. Hence it is
not absolutely necessary that we should come
into contact in order to take the disease
Neither does it depend upon the quantity
but rather upon the quality of the matter, & 
the disposition of the person to receive the [causes]
It will also produce the same disposition to 
communicate it to another & be so a third etc.
It is not of a solid but of a fluid insensible nature
transmitted through the air. As in hooping
cough it is asseyed in an insensible form.
Every person is not equally liable to contagious
diseases & after having them once the susceptibility
is infinity destroyed.


How these diseases originate is unknown.
There being found on the annals of medicine
does not explain their origin for their first
production is all incognito. This matter is
a peculiar secretion from the diseased body
It is not increased by being mixed with the
atmosphere; but is rather diffused & dilute
in it in such a manner as not to act so readily
upon the system & of a small distance
is not capable of acting at all
Are infectious & contagious diseases synonymous
They are not, they ought to be used as [illegible]
Infection means to [illegible] or [illegible]
a disease. Thus when a person is long exposed
to marsh miasmata & is finally acted
upon by the fluid he takes the disease by 
infection. the disease may arise from [infec]
persons; but generally from the ground or from
noxious matter arising from the decomposition
of vegetables.  arising from the 
confinement of many healthy persons in this [illegible]
place are produced by infection


75
II. In respect to their occurrence they are 1st
stationary 2d Intercurrent Diseases of particular
constitutions of the year may be said to be
stationary Those which retire & occur at any season
of the year are properly intercurrent diseases
III. In respect to their prevalence they are
1. sporadic. These are those diseases which are
generally scattered about or prevail indifferently 
at particular places & times, attacking but 
a few individuals in a place 2. Pandemic
when diseases prevail generally or when they 
effect the whole community They may be divided
into a. endemic those that occur at 
particular spots & are liable to return in 
the same places. b. epidemic when they 
are not so much limited, but pervade whole
countries & sometimes continue for 2 or 3 years.
These are generally acute diseases
IV. In respect to their seat they are 1st general
or local. 2d Idiopathic or symptomatic
Idiopathic when the disease exist independent
of any other symptomatic when it arises
in consequence of some prevailing diseases



as fever from inflamation [illegible] 2d Fixed
wandering or retrograde. Fixed when the disease
remains stationary, or continues in one particular
part. wandering when the disease go
from one part to another, as in rheumatism
Retrograde when a disease has affected every 
particular part & left the same & then return
again by metastasis as the gout 4th
External & internal. External when the exterior
parts are affected as in abscesses & ulcers
Internal when some of the internal parts are
diseased. 5th Placed in parts of different 
structure, or texture even in the same organ
as a. in the mucous membrane, b. cellular membrane,
c. in the serous membrane, d. in the fibrous
textures etc. V. In respect to their nature, or
character they are 1st Light, mild & small; 
grave & great 2d Regular or irregular which
need no explanation 3d Benign, or malignant
Benign when the disease is not mild, but implies
a violent but safe disease. malignant
when the disease begins mild but unexpectedly 


77
terminates fatal. 4th Disguised or manifest.
Disguised when the [???nation] of the disease is
not understood. Manifest when the true seat
of the disease is obvious.
Let. 19th VI. In respect to their event they 
are 1st Dangerous or safe. Diseases that effect
any of the vital organs or any of the important
viscera may be said to be mor dangerous than
those effecting other parts. A disease however
may prove dangerous affecting every part of the body
although there are many which are [illegible] [illegible]
Propriety be [illegible] safe. 2d Depraved or 
injurious, or salutary. Many diseases may prove
injurious to the system, although they may be
[removed]. Others may be considered as salutary
by removing some mortified matter in the system
of these are [illegible]. 3d Curable incurable
or mortal. Those diseases that may 
be [controlled] by medicine may be considered as
curable. Those which cannot be managed by 
medicine are considered as incurable.
VII. In respect to their form & constitution they
are 1st simple or compound & complicateds



2d [Acute], peracute, & subacute when diseases
undergo regular processes they are acute. when 
they are [illegible] [illegible] longer when [illegible] peracute
subacute when a little longer than acute
3d Chronic. Those that have no immediate
termination or crisis, for example the gout
4th Continued, remittent & intermittent
Continued are those that remain the same
for any length of time. The remittent when
the violence of the symptoms remit or subside
in a degree; but not entirely, as the remittent
fever Intermittent, when the symptoms leave
the patient entirely for a time & then return
again in the same manner. example the intermittent
fever. 5th Periodical, when the 
disease is regular in its returns, or occurs at
regular intervals Of the arrangement
of diseases. Nosology. This is the
classing & arranging diseases in a systematic
manner. They have been arranged into
classes & occur, like plants & minerals
Yet these are not altogether correct, for
the same diseases manifest themselves by different 


79
symptoms in different individuals. If the same
diseases always produce the same effects or
symptoms all other circumstance being the same
this arrangement might be made; but this is
not the case as we find constitutions differ.
Although the lists of complaints are numerous
yet perhaps the elementary diseases are few. The
variety is produced by the difference in the seat
& degree, & by the combination of two or more
[alimentary] diseases The reason why diseases cannot
be arranged like plant & minerals has been stated
The difficulty is insuperable while we [illegible]
to arrange diseases in a single table. This
difficulty is obviated if we make use of two
instead of one The first table showed
symptoms methodically arranged & referring
to the diseases in which they appear
The second to contain those diseases.
The first table of symptom should be
arranged under five classes, viz. 1 symptoms 
of [comp??tion] [illegible] magnified in a [illegible] of composition
[illegible] 2 of structure; 3. of properties; 4 of [illegible]; 
5 of functions



In the arrangement of systematic nosology,
diseases have been arranged into orders, generas
species & varieties Orders relate to the different [illegible]
genera to the different textures in each organ. Species
to the particular kinds of effection. Varieties to the
differences in each affection in degree, & perhaps in 
other respects. The second table to contain the
actual diseases which effect the human body
considered as simple or elimentary in regard
to their proximate causes There may be some
question as to some effection whether they should
be admitted into this table. It is best to admit 
these, & to diminish the table hereafter, if the advance 
of science & [illegible] permit Also in this [illegible]
should be included those sympathetic diseases
which occur in the whole system or in any subordinate
system in consequence of some [local]
disease. Lastly should be included certain
diseases arising from the presence of certain’
remote causes lodge within the system
In denominating diseases, it is best to take
the [illegible] most commonly employed so far as
they are appropriate.


81
Lect. 20th I. Febris, or feavres, are diseases
without any primary local affection, generally 
effecting the whole system, precluded by [illegible]
& other symptoms of debility.
II. Phlegmasia. synocha fever with inflamation 
or topical pain; the function of one internal part
being at the same [illegible] [injures] the blood upon [venesection] 
exhibiting a buffy coat. III. Hemorrhagias.
pyrexia, with a profusion of [illegible] without
any external violence, the blood drawn from the veins
having the same appearance as in Phlegmonae
IV. [Proflu???] pyrexia with increased [secretion]
not naturally bloody. V. Adynamic
A diminution of the involuntary motion, either’
vital or natural. VI. Dolores. VII. Spasmi
Irregular motion of the muscles, or of the muscular
fibres. VIII. Dysorexia. Discordance opposite the
symptoms not primary, best symptomatic. They
sometimes however appear as primary IX. Vesania.
Disorders of the judgment, want of health in the mind
refferable to physical excuses generally; but not in all
cases; they are sometimes [illegible]. X. Morbi organici,
organic diseases arise from disease in the 


structure of the parts not properly elimentary
as in affections of the stomach of [illegible] disease
it may be effected. It is convenient to consider them
by themselves. XI. Morbi ex. adventibus in corpore
inclusis, diseases from foreign substances
in the body. They produce a variety of derangements.
XII. Morbi Sympathetici sympathetic diseases
produced by a variety of derangements, placed
by themselves to show how they present themselves
These are all the primary diseases that occur
in the body. Secondary are of more importance than
primary. A full nosology divides these diseases 
into orders, & to arrange all their symptoms under
their respective heads & again the actual diseases
opposite to their symptoms It requires time to 
make these arrangements perfect; yet they may be
done by each person.
Therapeutics.
The fourth branch of medical science [illegible]
the treatment of diseases. There are two general
modes; active & [illegible] or expectant. These 
considered generally we may wander over the [illegible]
system to ascertain whether those symptoms occur which 


83
effect a cure If accidents occur they employ 
some remedy, but not upon the primary disease
As in case of fractured bone, so in [illegible]
The active [illegible] had is different from this, here you 
employ means to check the disease. Some physicians
always use the active, others the mild or
expectant It is important that a physician should
know when to use active [means] & when at all
By interfering with nature we many times injure
rather than cure the disease Diseases are
mostly compound. we must analyze the disease
to ascertain whether one or more organ in effected.
thus we shall be able either by direct our treatment
to the most important part, or to the the
most dangerous effection or to combine means
so as to effect several purposes at once
Of intentions & indications we first learn 
the indication, then the intention From 
the symptoms we determine the indication
& our intention from the effect which follows
the employment of such medicines as the 
symptoms indicate The when any foreign or [illegible]
substance is becomes the same as the symptoms


causes & indicate the use of a vomit we therefore
administer a dose of ipecac & with the intention
of throwing of the offending matter. The distinction
between rational & empirical practice
Indications furnished by the symptoms by 
remote causes & by proximate causes The [symptoms]
may furnish indications to particular diseases. [illegible]
they are the least satisfactory. We must [illegible]
them with caution. Thus in tic doloreau we
cannot rely on the symptoms unless experience has
proved them to be safe we must then have
[illegible] to the remote cause. If the remote cause 
be [removed] the disease is not always removed 
but will continue as in intermitant fever
This however is not always the case we must
therefore remove them before the disease will [subside]
The indications from remote causes [never]
safely [illegible] than the symptoms but they are
often inadequate Indications from proximate
causes the most important & satisfactory, & must
be removed. Although they sometimes follow in a
succession of processes these may sometimes be interrupted
& their occurrence checked; but not always with 


85
impurity. The indications may be clear, but our
powers limited. Means to be employed for the
removal of diseases. The agents for the removal
of diseases act agreeably to principles considered in
treating of the relations of the human system to external
things. Every remedy opperates on the irritability or sensibility
or vital affinity Remedies are sometimes
employed to lessen the disposition to disease, some agents
increase the vital powers indirectly. The operation of
some remedies is not understood. we must therefore sometimes
act imperically for want of sure indications. We 
must therefore employ such remedies as tend to remove
the pain & disease. On the mode of operation of 
some of the principle remedies employed in diseases.
1st Bloodletting general & local. General bleeding
should be from a large vessel when the whole system
is effected, & from a large orifice when we wish to 
produce immediate effects on the system or produce syncopes
Local bleeding is by means of cupping & 
leaches etc. some contend that the immediate effects
are to reduce plethora, others that some morbific
matter is drawn off When the circulation is [illegible]
high, the abstraction of blood lessens the irritation


& excitement, so far as it regards the distention of
the heart this is sufficient; but the blood vessels do 
not dilate & empty themselves. Taking away blood
occasions a greater contraction. By what powers do
the arteries contract? They have the power of elasticity,
& another which is brought into action after the
power of elasticity has cause to operate. this is 
their vital power. Elasticity would not [reduce]
the blood vessel much below their common dimentions
They exert their vital as thin [illegible]
If the blood vessels be reduced below their elasticity
their vital power operates. The action of the heart is 
effected most, & the arteries least by bloodletting
when the power of the arteries is called into exertion
it demands the power of the whole system
The symptoms, arising from blood being draw is
great, or in to great quantity, are sympathetic, or 
faintness etc. Bleeding also effect the capillary
system. Therefore the secretion is also diminished
for want of proper distention These effects however
are soon removed in persons in health, as blood is now
formed in greater abundance than before. The disposition
to plethora is increased by bloodletting, therefore 


87
persons in the habit of being bled frequently become plethoric
In disease. The vessels are not equally full
at all times This variation in the fullness of the 
vessels does not arise from too great or too small a
quantity of blood in them; but from an unequal
distribution of it. 1st There is a plethora ad [vines]
2d a plethora ad vasa. In the first the strength
of the heart is increased & act with increased force,
In the second the heart is languid & feble,
while the vessels are full the pulse slow & feble
consequently the blood is collected in the heart.
Therefore from a diminution of blood, the heart 
will act with [illegible] vigour. The plethora ad vaca
is a fullness of the vessels They may be comparatively 
too full Therefore be the abstraction of blood their
fullness is diminished & ease & relief is given to the 
vessels There is sometimes an inequality in the distribution
of the blood, but we cannot tell when that
happens The external veins are not a sure guide
In the large vessels & capillaries there frequently 
are inequality, as in faintness we find the pulse full
& strong, in consequence of the blood; leaving the capillaries 
& causing a too great fullness of the arteries 


In spontaneous hemorrhage from the lungs from 
a too great fullness of [illegible] relief is obtained by 
bleeding The capillaries are sometimes full [while]
the large vessels are smaller than usual Their
different states of plethora produce disease In [illegible]
[illegible] from a diminution of blood Hence it is
improper to take a large quantity from old people 
IN disease from plethora ad vasa bloodletting is
required & with more confidence than the former
Universal plethora may also occur How does blood
letting relieve when a plethora does not exist. If the heart
is diseased it is required, still more proper when 
the lungs are effected as relief is obtained as 
the blood is drawn. The vessels of diseased
parts contract more than in parts which are
in local. If a spontaneous inflamation arise
depletion will act upon that part; not so when 
it arises from the introduction of a foreign body
Lect. 21st Of the medicines called 
1st stimulants. whenever power is deficient, employ
stimulants these tend to awaken & bring into action
the power of the system which lay dormant The exercise
of the power tends to increase them But if you 


89
increase the action beyond the power it tends to [debilitate]
when the patient cannot take food stimulate with
caution 2d Tonics or permanent simuli
They do not act on one part only, but on all, they 
are used when the organs do not perform their
functions with perfection. By some they are supposed
to act on physical principles They act
in so small quantities, they cannot be supposed
to act on the fibers The powers of the system
appear to be increased by these tonics. Tonics
do not always remove debility, by increasing the
powers. They are useful only to carry the patient
over the bridge & no farther & thus bring your patient 
to a proper state to receive nourishment from food
& exercise. 3d Astringents. These tend
to diminish secretion, & check hemorrhage from
the open mouths of extreme vessels. These again 
are supposed to act on the living fibers. They 
act on distinct parts immediately as the sulphate
of copper in hemorrhages from the [uterus]. 4th Alteratives.
when certain medicines alter the states
of the parts they are called alteratives. The mercurials
are the most remarkable medicines of this class.


Their most obvious effects are seen in syphilis. In 
[illegible] they alter the state of the part & are therefore
called specific stimuli, because they act on a
particular part by sympathy They have an active
affinity or power, we see a priori they are not 
in all cases capable of effecting a cure, but from experiment
we learn that mercurial will control the 
morbid action. When the disease has a circle of 
processes to perform they are not capable of being [illegible]
by alteratives, as in variolus etc. Antimony 
also act as an alterative, this is from the vegetable
kingdom. 5th Sedatives, some pretend these are 
not sedatives, but I believe these are. They first
exert the powers & then exhaustion follows. [Opium]
is the most remarkable of this class of medicines. It
effects the organic actions. It will remove pain
No previous fullness, quickness or any excitement
is perceived in the pulse. 6th Refrigerants
7th Emetics. They operate by producing a compression 
of the stomach between the diaphragm 
& the abdominal muscles. They produce a sporadic
contraction of the pylorus & muscular
fibers. By sympathy they operate on the whole system.


91
Their operation is promoted by administering large doses
of warm liquids. Ipecac & antimony are articles
which will always produce their effects if
given in proper quantities. These medicines relieve
the stomach by evacuating the oppressive matter.
They also give it tone which enables it to perform
its functions with ease. As every part of the body
sympathizes with the stomach any effection of operation
produced on the stomach is felt by 
the whole system. These medicines act also
as alteratives.
Lect. 22d Cathartics. These increase the
peristaltic emotion of the intestines, also the secretion 
of the mucous & bile. Different articles produces 
this effect in different degrees Hence some of
them are called laxatives others purgatives & 
drastic purgatives. Some mearly produce a increase
of the peristaltic motion, without affecting
the biliary secretion. When there is an unusual [load]
upon the stomach, or an oppression of effusive matter
cathartics tend to relieve it by causing an alteration
in the determination of fluids. Thus they relieve the
head in some cases by causing a determination to these parts


The saline purgatives do not occasion so great
a determination of the blood, as many others. Some 
have a tendency to stimulate & increase action
therefore when this is already an increased action 
these should not be used. 9th Sudorifics.
These are medicines which increase the sensible [perspiration].
Diaphoretics increase the insensible perspiration.
In order that these remedies should have
their due effect the air should be kept from the
patient or uniform & the patient in a horizontal
position. some articles increase the heat & not the
sweat. warm water tends to promote perspiration 
also herb teas; but the more surely to produce
its proper effect employ nauseating doses.
applications to the skin also have a good effect 
as warm liquid etc. It even happens that cold
produces perspiration sweating is a [illegible]
evacuation, by its causing a determination of
blood to the skin. It is useful in the course 
in the course of diseases; but not the course of [illegible]
10tgh Diuretics. are articles used in case of
difficulty of the urinary or some other parts, occasioning
an obstruction in the passage of the urine.


93
In health they increase this evacuation, but in 
sickness they often fail. Liquids of any kind tend
to increase the urinary discharge. In summer the
discharge by the skin is increased & the urine diminished
in winter an increase of urine & perspiration is 
obstructed. some contend that there are no [illegible]
but there are those articles which have a direct
effect upon the kidnies themselves. If you produce
any irritation upon any one part of them you increase
the urine. Digitalis & [illegible] super tartrit
of potash are of this class, the former used 
in dropsy indirectly as a diuretic.
11th Emmenagogue. No article acts
specifically as an emmenagogue except the argot
or [illegible] [illegible]. This however is not recommended.
We are not certain of any other article; having
a direct effect upon the uterus The castor has a
partial action. 12th Anthelmintics. There are
supposed to be articles in the materia medica which 
act on the intestines. others that kill worms
Thus any articles which have a tendency to injure
or kill them occasion this expulsion. By abstinence
from food the same thing happens as in other diseases.


most apparent is [lumbricis] [illegible]. The effect
is produced by employing the lower part of the canal
preparations of gin & arsenic etc of the [illegible]
The volatile oil of terpentine in [illegible]
13th Lithontriptics. Are articles employed
to check the further formation of calculi in 
bladder, kidneys ureters etc. Mr Brand’s theory
that if the uric acid predominate the alkalies
magnesia & if the uric acid is discharged it
is beneficial; but if the phosphoric acid [illegible]
the muriatic acid is most beneficial. They do 
not act chymically but indirectly on the part 
magnesia, antimony, acids & purgatives
14th Expectorants. No articles act directly as expectorants
they effect the inflamation of the mucous
membrane & cause expectoration. 15th [????pastics] 
& 15th Rubifacients. produce [sensation]
upon the skin. When they produce a discharge upon the skin with or without inflamation
they are epispastics. Rubefactions when they produce
a determination of blood to the part & relieve
other contiguous parts. Epispastics sometimes 
a permanent inflamation which may relieve [illegible]


95
internal part. As tonic stimulus where there are [illegible]
of the parts. Vesication upon the head when 
there is torpor of the brain. & on the region of the
liver in hepetitis. 17th Errhines & 18th Sialagogues.
The former are articles which increase
the discharge of mucous from the membranes of the
nose Sialogogues are those which serve to increase
the salivary discharge. Mercury has the most
powerful effect of this kind by its effects on the
salivary glands. 19th Demulcents employed
when the urinary parts are affected. mucilages,
gums & flaxseed. Acids & alkalies may 
specifically upon each other but not upon the
organs. We should use means to prevent an acid
[disposition], rather than correct it after it has formed.
Lect. 23d The description & treatment
of particular diseases. As the preceding
parts relate more especially to theory, so this [illegible]
the practice of physick. Yet as practice has been 
referred to in those, so must theory be in this.
Diseases to be considered in the order which will
render them most intelligible; & as all cannot be
considered the most important will be related


Particular diseases to be grouped in so 
a [illegible] as will render the consideration of 
the most convenient or advantageous. Their description 
is divided into history & phylosophy.
The history of a disease explains its causes.
In describing a machine we cannot have a full
idea of it unless we have the parts exhibited. So 
also in describing a disease.
Fever. We cannot give a just
idea of fever. It is a disease in which all or a 
part of the functions are deranged. It extends
to the mind as well as body. The whole aspect 
is altered. the air & motions. languor [illegible]
& other symptoms of debility. when there is no
local affection on which the disease depends
it is idiopathic. symptomatic when it arises
from a disease of some other part.
In order to arrange these symptoms there
must be some theory. we shall first take the
most simple view of this disease. Then a more
complicated one. This is a disease to which all
are liable. more especially those who are feble, those
who are irregular in their living & diet


97
Those who over labour & intemperance in eating
& drinking, soldiers in armies, those confined
in crowded places, anxiety of mind & wasting also
produce fever. There is a peculiar idiocyncrancy
in some to fever. what is fever. when it arises
from to great heat there is an accelerated pulse.
it is idiopathic & symptomatic. The most [essential]
symptom in an idiopathic affection, is its
effecting the whole system at the same time; but
not every part to the same degree
as one organ may be more effected than another.
The mind as well as the body is deranged.
This phenomenon of fever occurs in certain order.
There is a succession of symptoms & when they 
are perfect in their occurrence they are called a paroxism.
This paroxism of fever may be divided
into 4 stages. These stages have their periods like
the disease. Fever is divided or may consist of one
or more paroxisms, one paroxism consisting of four 
perfect stages constitutes an ephemera. An ephemora
or single & perfect paroxism consist of four 
stages, the [access], cold stage, hot stage & crisis.
Symptoms of the access. 1st of the animal system


there is lassitude languor etc. the fever as well as
the disposition to exercise the animal powers is effected.
It is necessary that the mind as well as the [illegible]
should be excited. he cannot exercise the animal
powers so well being [illegible]. pain, this 
may occur in any part of the body, more particularly 
the head, sometimes in the limbs, it is an aching
rather than pain restlessness & a constant desire
to change his places, paralysis, coma, slugishness some
times with or without coma, delirium lassitude,
inability to motion which occur in kind & degree
& restlessness. Next symptoms in the organic
systems. This system is probably first effected.
1st the appetite is changed the appetite for
food is lost or depressed while that for drink is 
increased, digestion is many times stoped at the
time the access takes place The peristaltic [motions]
are so diminished that constipation takes place.
The secretions & excretions are diminished. IN consequence
of the diminution of the secretion of fluid the [solids]
are diminished, the tongue becomes coated, the skin
dry & a diminution in the action of all
the extreme vessels. sallowness of the skin from 


99
a constriction of the extreme vessels, these symptoms [illegible]
from a stoppage of the perspiration, nausia, & 
vomiting also occur. The vital functions also are affected
during this stage. The pulse do not rise above
90. From a peculiar sensation about the heart respiration
becomes slow, with anxiety as well as oppression
of the breast. These are the most remarkable symptoms.
There is also great depression of strength, as a man
a few hours ago may be well at work, now is so depressed 
as to be unable to sit up. In this case his strength is
not lost, but depressed as an elastic spring 
which bends when pressure is made upon it by a weight 
will recover its former place, when the pressure is removed.
There is not limits to this depression [illegible]
& even death is sometimes brought in by it.
This stage exists sometimes a day or two before the
other stages appear sometimes even for weeks & months
but not generally more than 2 or 3 days
Lect. 24th Cold Stage. The symptoms of this
stage are not such as are confined to this disease but
occur in other diseases as in parturition lactation etc.
In the cold stage shivers, rigors, & shuddering are 


appearance of gooseflesh, the shaking & coldness
not uniform; the tongue & the fauces become more
dry the tongue adhering to the root of the mouth.
These are added to the access, sometimes both occur
at the same time. At the termination of the cold
stage the symptoms are relieved by vomiting or throwing
off the offending matter from the stomach.
This stage has a precise beginning; but [terminates]
gradually into the hot stage. At the termination
of this stage in the hot stage the patient feels cold
when to the touch of the physician quite warm 
& visa versa, he may give off heat to the 
living body & cold to dead bodies; his colour changes
into yellow, red etc. his eyes also become red.
The skin continues dry generally but not always
The pulse becomes more frequent if not a greater
fullness, respiration becomes obstructed, the pain 
 more violent & distressing as well as more [illegible]
over the whole head. these pains are uncertain. [There]
is frequently a delyrium, sleep is disturbed, he
has an aversion to food & a repugnance to swallowing.
The thirst becomes extreme swallowing liquid
is [grateful] there is an unpleasant taste in the 



101
mouth the discharge of urine is small & clear
AT this period some of the symptoms of the access
continue as of restlessness & depression. He
is incapable of any clear & distinct ideas, sometimes
delirium occurs, symptoms relieved by bathing
There is an incapacity to measure time, a few
minutes many times appear very long & sometimes
a long time appears short. These symptoms continue to
increase for a time, then terminate
The cold stage is sometimes wanting but the hot
stage very seldom. The hot stage terminates in crisis
hemorhage or inflamation These do not always 
terminate the paroxisms but sometimes the inflammation 
brings on a termination of the disease. A 
hemorhage that will terminate a fever is generally 
violent. The inflamation & hemorhage may 
be favourable when it goes on to form a crisis
This determines the [contest]. The crisi may be
favourable or unfavourable occurring to the
when favourable the symptom are of three kinds
1st those of subsistence 2 of 3 The exercise of
healthy action. 1st those symptoms that mark the
subsidence of the disease. He [illegible] his functions


with more [ease] & is more capable of exerting himself
he retains the [illegible] of things as well as the [duration] of [illegible]
The bystanders perceive the change before the [patient]
himself. 1st the appearance of external symptoms
The contraction of the extreme [vessel] is removed
the vessels are open, by a large draught of cold [illegible]
the symptoms often subside. The dryness of the
mouth & fauces ceases; the coat is removed from 
the tongue; in short all the morbid symptoms
go off & the healthy ones show themselves. Not
only negative symptoms subside but positive ones
come on. 3d If the healthy powers were restored 
at once would he appear in every respect as before?
No. the organs & functions will be different in consequence
of the contents of the stomach being new or [illegible]
Also in consequence of the contents of the alimentary
canal being [illegible], the secretion of fluid will be
different or in an unusual quantity, & a [diarrhea]
is brought on in consequence of the efforts exerted
to throw off these foreign bodies. The evacuations
from the skin or by urine sometimes [prove] critical.
The first form does not consist in a [heavily] [illegible]
in all the functions, by a discharge of their contents



103
Their evacuations are sometimes large & excessive. The
symptoms occur in succession, sometimes an interval
of several days or more distant periods.
Lect 25th Crisis unfavourable. There
is an increase in the morbid appearances & an indication
of the failure of the powers, a pressure on the parts.
The countenance becomes unnatural, fetures indistinct
& a general inexpression of the countenance. Of course
the general characteristics of the person are lost, there 
are some of the usual contractions of the muscles, but 
a general flaccidity, the eyes are changed; the tongue
furred, red or dry; face change from a [illegible]
to a leaden colour, now pinched in, the manner
of laying implies want of power, he slips down 
to the foot of the bed, there is also coma, inability
to motion picks at the bed cloths mouth dark
tongue dry loaded with a thick coat or very [illegible]
skin hot & dry sometimes cold sweats [trunk]
warm, [illegible] cold, hands cold, arms warm,
evacuations large, but not well concocted & mixed
nausea & vomiting also ensue, all the discharges are
involuntary, in these cases thirst is excessive,
the pulse frequent small & diminished sometimes slow


but not in direct order as one organ may fail before
another, when the brain is not effective respiration
is quick. under these circumstances if the [patient]
be moved he sinks or fails & faints in an erect
position Thus the patient sinks by convulsions
first at the extremities then at the center
Next duration of the states. They are not
always uniform. 1st The access & cold stages are
generally about 2 or 3 hours. The hot usually 
from 2 to 4 & the crisis about 4 hours. The
symptoms of the hot stage subside gradually & 
the crisis may be 6 hours, an ephemera is [usually]
18, sometimes even 26, this prolongation is [illegible]
to the hot fit. These are the principles of fever.
The symptoms of the access generally run into the
other stages. According to Sydenham, it is
the exertion of the system to throw off some
morbid matter. The symptoms of the access [illegible]
through the other stages to the crisis, & as
the symptoms of the access go off [illegible] is [illegible]
if the other stages do not increase The symptoms
of this stage come in gradually, though 
they are not always observed, sometimes they do 


105
not occur untill the moment the cold stage commences.
We cannot fix upon any one or mor symptoms
as distinctively characteristic of fever, as there are none 
that are necessarily so. The best symptom is that
the whole body is sick without any one part particularly
The description here given may be considered
as refering to a model, rather than to any actual
case. This is inevitable in endeavouring to give distinct 
& just ideas of all the parts. In almost every 
case some symptoms are wanting, & not symptom
which may not be. The disease shows itself in the
whole system but unequally.
Of compound fever.
This is a fever of more than an paroxism or parts 
of paroxisms. They are continued intermittent & 
remittent fever. In general fever appears to [illegible]
disease periods. They are divided into intermittent
& continued. Of intermittents. They have paroxisms occurring
daily or every other day etc. at the interval between
the paroxisms, the patient is free from the symptoms
of the disease, while in the other they continue
though the disease & the symptoms occur regularly
every day or every other day which are distinct


The interval is from the commencement of one paroxism
to that of another. The intermission for
the termination of one to the commence of another
They are of different types or forms quotidian
tertian & quartan. The quotidian over in 24 
hours, tertian in 48, & the quartan over in
72 hours. The tertian is the most common
All that is essential in intermittents is it [illegible]
The paroxisms of an intermittent resemble an
ephemera generally; but they are more distinct & [illegible]
The cold stage is more formal & [severe] there in [illegible]
fever, more severe & longer. This is not to be [relied]
on entirely, some epidemic continued fevers are characterized 
in part by severity etc. of the cold stage
sometimes the other stages most severe There [illegible]
in crisis; but it is less perfect than in [illegible]
in the first paroxisms, than in ephemera. According
to Dr Fordyce if this was not the case the [disease]
would not [recur] again The second paroxism
occurs on the third day or 48 hours, sometimes they
vary from 48 to 50, but this is not considered
as an irregularity There are symptoms remaining after
the [imperfect] paroxisms. The [illegible] is not [illegible]




107
well although he may be called so, he has a pain in 
his head [shack] nausea at the stomach he will almost
recover before the next recurrence of the disease
The paroxisms are less distinct during the first week
than after that time. It is at this period that it 
[illegible] the name of the remittent after this they become
more distinct then [illegible] the [close] of the [illegible]
again; but [his] [illegible] as well as [illegible] [distinct]
The duration of the disease according to Fordyce 
is 4 months The disease of ten forms a crisis & 
terminates in [health] after a severe paroxism.
Lect. 20th Tertian sometimes ends in 
death, by frequently producing other diseases, but 
very seldom if it is a simple tertian From 
the violence of the paroxism is exhaust the
patient & [illegible] [insues] Quotidians are less frequent
than the tertian, & it is the opinion of many that
the tertian is the true form of intermittents & the
quotidians are double tertians Quotidian paroxisms
are longer & the remissions very short. therefore apparently 
more so than the continued. When every [distinct] 
paroxism resemble each other it is a double
tertian Quartans occur on the third day & [illegible]



not made up of distinct paroxisms. It is the opinion 
of many however that it is formed of regular paroxisms
but that the second comes on before the first goes off
or that the second begins before the first has formed
its crisis consequently leaving no intermission At
least from 7 in the evening till 2 to 4 in the morning 
there is a subsidence of the paroxism, although 
the depression of strength is not removed. Periods
of remission. In the evening the symptoms more [illegible]
than morning or noon more severe on the second day 
& so on alternately increasing every other day to about’
the 7th sometimes to the 14th After this period it is 
stationary for a week then the disease decreases till
at length a crisis is formed, but not so distinct 
as in intermittents on one day there is some [illegible]
of crisis & the following not any for a number of days
while one symptom decreases another increases 
If he submits to the disease with quietness, the fever
goes on with more mildness & vice versa
Lect. 27th There is a great variety of fevers
they have a specific difference. The varieties
depend on many circumstance. A man after being
unwell for two or three days is then taken with fever 


111
cold shiverings & rigors, which are succeeded by heat
with incoherence & delirium the first night appears
very long in the morning he has a quiet nap for a
few minutes like a remission, his appetite now
begins to fail, he has a degree of pressure in the [chest]
& pain in the head & back & legs, sometimes excessive
great discharge of urine There is a yellow
sallow red or dirty colour of the skin, the
tongue has a full coat of a yellowish colour & 
very dry skin hot & dry pulse from 85 to 100 
but 92 is the usual standard If you now exhibit
[an] [emetic] & relieve the alimentary canal, it will arrest
the disease & perhaps stop it altogether. If
you are not called till a late period enquire into 
the history of the disease if 2 days after the disease
has [illegible] you will not give the emetic, exascerbations
more severe, the second in the evening more so than the first
delirium arises, heat & pain more severe, next morning
more relief from the exacerbations, on the third day 
more severe relieved by vomiting, fourth still increase
followed by nausea, two discharges, fifth
nausea, still continues, every thing disgusts him, even 
cold water is offensive strength diminishes


tongue becomes more dry, pulse quicker than [illegible]
the 5 & 5 7 diarrhea, very little fecal matter 
the tongue brown but covered with [sordes] Thus it 
continues for a week, on the 14th day you find the tongue
begin to grow clean at the edge, has some appetite
diarrhea, less severe urine increases in quantity,
thus it goes on to the [1?], pulse diminish to 95, [illegible]
the 17 when the tongue grows bright, has some desire 
for food & cordials as wine etc. his voice begins to 
return, less in an unnatural position, he now [illegible]
his countenance more natural, yet after the 
17 if any little circumstance occurs, an exascerbation 
is felt, but if nothing of this kind happens he grows
better in to the 21. This course of symptoms in
active fever. A nother example, a patient may 
be dull & melancholy for a week but not sick,
every thing goes wrong, but still he attends his [business]
HE has some chills, after some days head ach
appetite impaired, dull & heavy, you find him alone
when you come to see him, his general appearance
is altered, has a dull, sallow or dirty countenance, his eyes
dull, stupidity prevails he is unwilling to give an
answer when you speak to him, his tongue, skin & mouth 


113
are dry no [illegible] nor [nausea], although there is [something]
disagreeable urine diminished Thus he is brought 
to his bed in the 2d week with stupor, in the third
week the strength is gone there is a [smothering] delirium,
skin dry the tongue is dry & sticks to his 
mouth If you put your finger he puts out his tongue
from association. the coat now peals off & leaves the
tongue [nice] & dry in the 4th week he begins to [illegible]
very [slow] begins to have an appetite [perforce] before he
has really [illegible] or his stomach will digest it you 
may now give him cordials with what he is at first pleased
but soon grows tired of this kind, which must be changed
for a nother Thus he continues for 5 or [illegible] weeks in a torpid
dull state & has to recover very slow his appetite is very
voratious Thus his desire for food increases before
the strength of mind or body You may be called by 
a child able to play about till 5 or [6] oclock he then wants
to [be] grown his pulses are rapid in the morning he is
better thus he [illegible] on for a number of days, till the 2 
week when the exascerbations grow more scarce 3 week 
still more so mouth dry tongue clean thus [illegible] change
the disease in this manner You at another time find 
[illegible] man out at his business well, surging with [illegible] at his work


the pain is transferred from his extremities to the head, his
strength is protracted, he becomes faint, throws himself
down upon the bed pulse frequent relieved in 
the course of 24 hours This is a petechial fever 
the first may be called a bilious fever the 2 a
nervous or [dyphy] & the 3d fever of the [illegible]
Lect. 28th Autumnal Fevers. These 
seldom continue more than two weeks, when proper remedies
are employed, somtimes not more than one that
is you may leave the patient by this time although not 
perfectly well, some not short of 3 weeks they differ in 
different [illegible] It has been supposed that there are
certain critical days, on which the crisis is generally 
formed which are the 3, 5, 7, 9, & 11 which observe the
tertian type & the 13, 17, & 20 which observe the
quartan This has not been observed by myself
although it may have been by others Terminations
when the commencement is very violent if frequently terminate
favourably by crisis; but if the disease comes on gradual
it continues longer, in this case he neglect to use proper
care & to employ suitable remedies The continued fever
generally terminates at once by crisis as intermittents
sometimes also terminates by hemorrhages or by infection


115
If these do not terminate the disease, they increase it
Symptoms of a low & exhausted state of the system
in fever This state of the system is frequently 
reduced by giving cordial & stimulants before the
nature of the disease [illegible] them out There is
an indistinct appearance of the countenance the voice 
is lost the patient is unable to turn over in bed
or of any motion he has lost his mind he appears at
all times asleep when awake. the tongue is dry.
appetite for food entirely lost he takes a bottle
sometimes two, of wine, a day, which induces this 
state sometimes the patient is unable to take food
from gulping up the wine his discharges are
very disagreeable [illegible] the [illegible] The abdomen is [weak]
in to the [illegible] the skin rough, hard & rigid
Thus he becomes ematiated to a great degree countenance
is sunk, or a hollowness [more] sharp, lips thin the
cheeks thin skin hard & dry a relaxed & dirty appearance
of the cheeks this colour is varied by a red spot
These symptoms continue, the patient sinks & death
follows. By proper nursing & care after a long sickness
he sometimes recovers Of the appearances
after death. The opportunities [illegible] a certain [illegible] [illegible]


in respect to simple fever whether ephemera, intermittent
or continued, are very infrequent Examinations have
been made without any refference to the symptoms which
were obvious in life The simple continued fever does 
not depend on ay organic change Formerly the
structure was not so well understood as now, [illegible] of
the brain In order to ascertain the disease every 
part must be very minutely examined some have
contended that the disease was seated in the spinal
marrow, but that is unknown The examination
should be made by men well [illegible] in the disease
as well as anatomy both morbid as well as healthy 
Causes of Fever. Many phenomena noticed in the
history of fever have not bee noticed. A distinction 
has been made which is theoretical. But this not 
only tends to give [material] [illegible], it facilitates the communication 
of facts even if incorrect As much as
is commonly thought essential to the disease has been
described. The remainder may be more distinctly stated
after discussing causes It is important to regard
the distinction of proximate causes, because it has not
been satisfactorily ascertained. Remote Causes IN respect
to some of them there is not abundant evidence that 


117
their existence cannot be doubted. Yet they often occur
without producing fever, & even produce other diseases
They are the occasional or exciting causes They are
causes which generally tend to interrupt the regular performance
of the functions The disease gets its character
from the predisposing cause The disease is brought
on at one time by one cause at another by another There
is no doubt but there is a cause producing the disease
1st seasons with us fevers arise most frequently in
summer than in winter. generally in August & continue
to increase through Septr Octr when they gradually 
decline in Nov. & Decemr when they disappear.
When fevers are the least frequent they are the more distinct
The nature of the fever varies in the different
months, consequently our treatment should vary according 
to the nature of the disease The occurrence of 
fever with us is very rare in winter, although it may 
happen. But in Great Britain more frequent in winter
than summer. 2d Of The Qualities of the weather
of heat & moisture, heat alone will opperate as an
occasional cause of fever, at 85 or 90 [degrees] moisture does
not operate directly as a cause unless the cloths are
moistened & then exposed to [???oration], but in this
way opperates [illegible]



Heat & moisture together by producing the composition of
vegitable matter will produce or operate as a cause
of fever when they are in a proper state for the effect
Dry seasons most favourable. The decomposition of vegetable
matter produces the marsh miasmata which 
is a nother cause of fever The intermittent is therefore
usually produced by this cause It does not act at a [fixed]
distance Its action is diminished as the [distance] [illegible]
It will not generally produce the disease at a greater distance
than ½ mile Its [illegible] favoured by the wind
Against the wind it will not act more than a few yards
low grounds or plains are more liable than more [illegible]
situations The disease is more liable to be produced
in the evening than at any other time more liable
at the foot of hills than at their tops
Lect. 29th Marsh Miasmata is another
cause of fever. The nature of this is unknown
does this arise from animal or vegitable matter
some contend that it arises from insects with vegitable
In this country the decomposition of hemp
& flax have given rise to intermittent fevers [Fresh]
& not salt marshes give rise to fevers Then it is evident
that vegitable matter does give out something which 


119
produces fever It is also [illegible] to arise from living [men]
when a large number of these are [crowded] together in 
small apartments From the sick & from contagion.
Matter undergoing decomposition. If fever arises
from living persons, it would in the slow slave ships, where
so large a number of them are crowded together
in the hold of the ships The case of two englismen
being crowded in the hole of Calcutta, when 19 out of 20
died in one night does not prove this to be a cause as
it no doubt arose from the insensible fluid emitted
from their bodies In the French revolution, when men
were crowded together in the holds of small ships in 
filth & died. They were not effected with fever
Des [illegible] observed that in the hospitals of Plymouth
when men were from long voiges & crowded together in 
small lace did not induce fever unless they went on 
shore Then if filth & crowded places produce fever
they would be the most liable. Sick producing fever
From what can be learned from such places it does
not produce fever. Contagion This does not produce
fever so readily as the small pox, but in a less degree
not by a short exposure but by infection or a larger
power of a number of fevers it takes a long time


more will be affected with fever than when they are [exposed]
but a short time Animal matter after death. supposed
to induce fever. Many diseases arise from this source
but no satisfactory evidence has been found that fever
has been induced from animal matter animal matter
is daily under-going decomposition about slaughter houses
& [illegible] but we do not find that fever is produced neither
does it arise from burying grounds as may have [illegible]
As in Paris & Germany they were not exposed to the air
In [illegible] is a manufactory for [adipose] by [illegible]
of [horses] Hence we see that only one [true] cause of
fever has as yet been found. that of marsh miasmata
& this only by large exposure Intermittents do not occur
in this country, unless exposed to marshy grounds [illegible]
other [countrys] or [southern] states it then acts as a remote
cause even after a long time after the [illegible] of the matter
or exposure Thus the remote cause may act a long 
time before the fever is brough in to action by the exciting
cause It most frequently occurs in the warm season
& southern climates.
Lect. 30th Proximate Cause of fever. The opinions
of men on this point are numerous. Whatever opinion is 
formed of the system they will form of fever. There is one 



121
opinion that has been maintained by a large portion of
physiologists viz. that fever is in part or in whole
a salutary effort to remove some evil. There is a reason
for this opinion, which is that a great number of persons
terminate in health or salutary. what part are
salutary? There is a difficulty in drawing a line between
the morbific & salutary processes. If this could be done
we should probably ascertain the proximate cause
Cullen & Fordyce have thought that all that preceded
fever was rigors, but the cold stage is sometimes
wanting. The various opinions respecting the 
proximate cause may be reduced to four. 1st in 
composition. That some morbific matter entered into
the system. This is the opinion of Sydenham. Some
suppose that there is some foreign substance received into
the blood, but not into its composition. Therefore these
substances do not produce fever by change of composition
2d Change in its structure. This has not been supported 
by any pathologists. Hence we see it not in composition 
or structure. 3rd In the properties. 4th In the
function. By Cullen & Hoffman. It is the opinion of
Cullen that the remote causes are sedatives that all the vital
change is produced in the brain, that these instances produce 



a change in the structure of the brain. That there is 
a vis medicatrix nature in the system His opinion 
is that the diminished energy of the brain causes a contraction 
or spasm of the extreme vessels. This causes 
an increased action from the center to the circumference
which fairly overcomes the contraction of the extreme
vessels. There is no satisfactory evidence of diminished energy
of the brain, & it does not appear that there is any
always before the cold stage which ought always
to be The pains in fever are generally [illegible] in 
[illegible] of [illegible]. [Prof] Curran & Physic place the
cause in the spasms of the extreme vessels & the extremities
of the nerves. And at the end of the disease the
contraction is relieved. According to this theory if any 
of these appearances are wanting at any time they will
be through the remainder of the fever. There are some
who contend that the heart is not unusually excited with
fever still go through its natural [illegible] therefore this
theory must fall. [?hellenback]& others believe that fever
depends on an inflamation of the brain, [illegible] [illegible] local
affection. But we do not find this to be the case in 
fever, for the whole system is effected & not locally
hence this system must fall, as no derangement of the
brain has been found on disection



123
after death. Various pathologists have believed that 
all fevers do not always arise from any one particular
organ, but sometimes from one, then from another. As was
the theory of Armstrong & others. Brown’s theory, that 
debility was the proximate cause of all fevers, if this were
the case the fever must continue ad infinitum. As
the debility always increases to the end of the disease
Phylips also supports this theory, with one exception,
In fevers foreign substances do not leave their [illegible] effect
in the system. All the stages are not peculiar
to fever, as the cold stage is sometimes wanting, also the
hot In the crisis the evacuations by [illegible] influence & on the effect of
a forming crisis, & not a cause of the crisis.
Lect. 31st Varieties in fever. There is
not any precise form which is regular. It is only when
the [deviation] is considerable that it is called an [illegible]
[illegible] or variety. Besides the different types there are
many varieties of fevers. When fevers approximate
very near to each other they are called regular, when 
a considerable deviation is observed, it is a variety
The principle varieties of simple fever founded on
the unequal effection of the system. The lines are
not [distinct]. First the animal system is
particularly effected. Symptoms 


First the brain is particularly effected, as in [illegible]
consequently volition is impaired, in consequence of
which tremors take place & contraction of muscles &
spasms. great prostration of strength, pulse [great]
& small; skin dry tongue dry with a thick coat
teeth furred over. These symptoms occur in the
fever; but they differ in their rapidity & power.
This is called typhus mild or grave typhus 
more severe when the patient is most prostrated 
& the tongue much furred. This called typhus
[illegible] Second. the chylopoetic [illegible]
particularly effected. Symptoms. The coat
upon the tongue is thicker & always constant. It is a 
coat very thick, but less than in other fevers
Great oppression at the chest nausea vomiting
of mucous mixed with bile, which at first is yellow
after along time become green, fullness of the abdomen
for considerable time followed by diarrhea
of brown & sometimes of a green colour If a little
be put into a [illegible] of water you discover the colour
yellowness of the skin. These are the gastric
symptoms. Sometimes when you succeed in removing
these symptoms, you remove the disease, but not 
always 



125
Third. Circulating system particularly effected. There
is difficulty in forming an opinion on the point.
Symptoms. pulse small & rapid; but other parts
of the system are not effected in an equal proportion,
He can for a short time attend to his business. The
secretory system is also effected as the skin becomes
dry tongue [illegible], It is not a bilious inflamatory
or typhus, but is called slow nervous fever.
Fourth. the powers of vital affinity particularly 
effected, as is manifest by the tendency of the fluids
to putrefaction. Symptoms. The contents of the alimentary 
canal undergo decomposition. After death the solids
& fluids undergo this change [illegible] then persons dead of
other diseases Ardent heat, & acrimony The [illegible]
is greater than in typhus. the pulse is soft and rapid
often full, but not hard The proper secretions do not
take place, the fluids are [illegible] not undergoing their
proper changes red blood flows out the vitality of
the blood is lost, it is [illegible] under the skin
From the want of power this disease has been called adynamic,
in putrid form There are other varieties,
but they are perhaps [illegible] distinctly marked which are
infections & other camp, jail, or local fevers 


& oppression of the parts; the mind is also
deranged. There is a variety in the degree with
what it is effected Inflamation is sometimes
violent then slow in its progress pain 
serves as a mark of inflamation There is 
a sense of weight & uneasiness according to the
degree fo congestion, & if this is violent in the
brain the patient becomes comatus & even
apoplectic There is also sometimes congestion
in the lungs which interupting the functions
of the brain occasions death This determination
or congestion is irregular; if the state of the 
skin is interupted in its functions it causes
a determination to some particular internal
part (Armstrong’s work upon irregularities
may be consulted) once more, one part of
the system may escape while all the other parts
are effected In this case the medicine may 
not have its effect upon the disease, but spends
all its power upon the unaffected part
Hysteria is mentioned by Fordyce as another
cause of irregularity. A little affection of the 
stomach brings on convulsions, effection of mind,
stupor etc. When hysteria occurs [illegible] [illegible]


127
the physician, it being difficult to manage
This occurs more frequently in females than males.
you would suspect spasms, convulsions etc. as
symptoms; but globus hystericus is the most
characteristic of hysteria If these
opinions are not correct they enable us to form 
some distinct ideas of [Fear]
Irregularities in intermitents. If they 
do not vary more than two hours, they are
not irregular, but if they occur at shorter
periods or vary more than two hours, or appear in 
[illegible] hours they are irregular They are occasionally
prolonged when to more than 50 hours they 
are irregular
Lect. 33d Epidemics These occur
perhaps once in 2 or 3 years & these appear
to be a regular succession in the occurrence
Causes Rather than acknowledge ignorance 
men wil assign a variety of causes for epidemics
1 They look to the sensible stat of the death
It is said that hot or some particular seasons
have a tendency to produce epidemics, but the
inference is refuted the [illegible] ever by their [continuing]


through seasons of different characters. 2 The
cause has been imparted to the food which we
take if it has been bad or unhealthy Mr. 
Webster supported the idea that they occur
with the appearance of the comits This opinion 
has not been without its advocates
It is also said that exhalations from 
the earth produce epidemic fevers grant 
this to be the case we [achieve] not benefit from
it, as the cause is not known till we [see]
the effect The causes are finally unknown 
Some contend that they have a particular 
character. Sydenham that they expell
& convert other diseases into the same
till they who have the predisposition on being
exposed to the exciting cause, will have
the disease; but if they are not exposed to 
the exciting cause, they will not have the
disease. although possessed of the predisposition
That every disease has a specific character
in epidemics, cannot be established
although there may be some symptoms that
resemble each other, there is a difference in 
the character of the disease & this is not 


131
a difference in degrees but there is a specific difference
in the character of the disease & many varieties
in epidemics If there is a specific character
in epidemics a uniform mode of treatment
might be pursued [illegible] as this is not the case,
this routine of practice is not to be adopted
If a case should happen out of the common
course this mode of treatment would fail
& we be left without a remedy
Fevers common in summer & autumn
in our climate In summer or about
July diseases of the gastric organs appear 
symptoms heat, prostration of strength
They continue 2 sometimes three weeks
& as the season advances they assume the
form of a regular fever & continue three
or four weeks they are of a typhoid kind
Epidemics of a more violent nature are called 
malignant or yellow fever, Their type
is intermittent The epidemic that prevailed
in this vicinity was continued The hot stage
violent but not uniform The patient was chilled
through & struck down immediately



There is a violent inflamation of the brain 
or intestines, the skin becomes yellow from
which it derives its name, but is not characteristic
of the disease The black [illegible]
or the discharge of matter resembling coffee
grounds, is considered characteristic, but is [not]
in all cases Has been examined by Dr.
Bancroft & others Spotted epidemics
The first attack is violent, but becomes less so
afterwards The access & cold stage occur suddenly
at once & extremely violent & life is destroyed
The hot stage more mild This disease has been 
very mortal, but at present not so much so as
formerly Symptoms, There is [illegible] [illegible]
local affection, a congestion of the brain, diseased 
stomach, [illegible] & lungs petechiae appear
but are not characteristic of the disease as in yellow
fever sometimes erysipellatous inflamation
appears
Lect. 34th Prognosis It is observed
if the whole disease be mild the prognosis
will be favourable The symptoms may however
be severe & the prognosis favourable. Violence
is not always to be considered unfavourable nor mildness



favourable unless the whole system is in this
state Unfavourable when there is great pain 
and depression. the mind impaired, the countenance
sallow & a peculiar [inexpression], if
the pulse is feeble & frequent in the crisis & hot
stage. it requires attention, more particularly 
the frequency if one part of the body is hot
& another cold it is unfavourable, also if profuse
& frequent evacuations with sinking, but if relief
is obtained by these evacuations, favourable
when the skin is dry & the appearance of the body
changed it is very unfavourable when 
the evacuations differ from those in health, or 
when they are composed of but one kind of matter
as of blood, bile & without any mucous, they are
unfavourable, except on the mucous membrane when 
they should be pure mucous, also when there is an 
apetite for animal food; unless the disease is 
mild, absence of thirst for drink if long continued,
as the organs on their deranged animal functions
if not effected to a great degree when the 
pulse are small feble & frequent when the
ideas are incoherent disproportion in the stages of 


when the cold stage is prolonged & the hot does not
follow, when complicated with some local
affection as hemorhage & inflamation danger
in proportion to the importance of the organs affected,
worse about the head & in the abdomen
Likewise in proportion to the violence rapidity
& kind of affection. Every thing that manifests
great action in any of the vital organs
Diagnosis & Treatment of Fever
Many contend that by administering [illegible]
to arrest the disease you thereby interupt the
salutary [??mination] The practice of giving 
medicine every hour or half hour is improper
but a proper quantity at an early period is
proper Respecting Treatment look first
to the proximal cause The remote cause may 
be removed & not the disease. In order to remove
the disease the exciting cause must be removed
Lect. 35th Treatment of a [illegible]
continued fever. Often a fever has commenced
at an early period it may be arrested. It is
therefore not a specific disease It is not always
[illegible] at an early period that we can arrest the disease [although]



135
it may be checked The period in which a fever may 
be [illegible] is three or four days. Any means of a violent
nature may succeed in arresting fever, but 
it is not safe or sure Evacuations have generally 
been employed for this purpose 1st Bloodletting
This the most general In simple fever it is not
generally useful But this fever should be distinguished
that in which inflamation is combined, in this
case it may be had [recourse] too 2d Sweating
This as an evacuation is useful, as the internal
organs are relieved by [illegible] the extreme vessels
It is however not to be relied on with certainty.
as it does not always remove fever In some cases 
relief is obtained, in others it is not It favoured
the antients theory, by supposing that it threw off
the [con??cted] & [illegible] matter sweating is
used a sa secondary remedy when the hot stage does
not follow the cold The best method of promoting
sweating is by continuous moisture with heat
by placing the patient in a horizontally in bed
with no more clothing than what is natural
when there is dryness of skin & heat by [illegible] the
temperature by administering medicines which cause a 


little short of producing nausea Internal medicines
should be slightly aromatic, rather than 
viscous liquids opium may also be combined
with evacuating medicines 3d Vomiting
By this evacuation you promote secretion As
an evacuation it is not so powerful nor so easily
managed as bloodletting It is not a natural
evacuation in health like purging, but this
does not [militate] against its use as it may be
natural in disease and in infants It is better
that offensive matter be thrown from the stomach, [illegible]
that it should be carried through the whole system 
Some contend that the stomach is the seat of the disease 
therefor vomiting is necessary; but this is not orthodox
as the principal efficacy probably arises from the 
violence of irritation The stomach being in [illegible]
susceptible of strong impressions & acts upon the
whole body by sympathy & produces a change through
the whole body Hence it is that such powerful 
affects are produced from this organ Subjects
differ with regard to the case of producing vomiting
owing to a peculiar idiosyncracy produced [illegible]
when there is a [great] [illegible] or disorder in the stomach 


137
It is sometimes necessary to evacuate the intestines 
first, the skin also is to be attended to Persons
differ with regard to effects produced by emetics
& other medicines This you should enquire into
before you deal out your medicine Articles used
some more sure to opperate than others 1st 
Tartrite of antimony & 2d Ipecac the effects
not limited to the stomach Antimony is the
most powerful of the emetics & effects the whole
system, therefore the most sure in its operation & 
gives the greatest distress some however will bear 
a large dose than others Ipecac affects the stomach 
only Hence when the disease is violent
& the patient strong antimony may be used
But when the disease is mild & patient feble
ipecac will be prefered but in general they 
should be combined. Physicians differ, with 
regard to the effect, whether it ought to be mild or
powerful. But my opinion is that a powerful 
emetic is the most salutary. The patient should 
be informed of the necessity of using this powerful
remedy One emetic is not always sufficient
It is therefore necessary to [illegible] it on the second or third 


day, sometimes on the same There is caution necessary
in delicate habits in administering powerful [illegible]
It is not always necessary to give large doses as [illegible]
antimony gr ii or iii sometimes only I gr
Ipecac from gr 40 to 60.
Lect. 35th Purging more powerful as
an evacuation than vomiting employed
for the discharging of fecal matter from 
the bowels As a general rule the contents
of the bowels should always be evacuated
This is not always so easily effected as is imagined,
as the [nose] is frequently deceived with 
regard to the matter discharged, leaving the
natural fears retained in the [illegible] It is 
necessary to see or to be informed by an experienced [illegible]. the
quality or appearance of the matter discharged. This is 
a necessary evacuation through the whole course of the disease
you may sometimes arrest the fever by purging, but it [illegible]
[inferior] to vomiting for this purpose, yet it is a powerful auxiliary
Give the cathartic before the emetic & then you [have]
their due effect Employ the sub. [merc] calomel, aloes etc.
but these are not sufficient alone. they may be followed by 
[illegible] salts These are not however given with impunity


139
thus, bloodletting in sweating, vomiting & purging with 
only some evacuations [illegible] [can] use
Another mode of arresting fever, is by external
applications This by cold water, or other liquids.
These may be used at a later period of the disease
they may [illegible] check but not arrest the disease
We should therefore attempt to bring on a crisis
for after the second week we cannot stop the fever
After the early period the evacuations should be mild
The remedies should now be used that promote crisis
called alteratives by changing the action of the extreme
vessels Then [illegible] of quicksilver antimony 
& ipecac When these produce a violent action, a 
little opium may be combined If antimony be given
to the amount of gr i it produces nausea. 2 grs vomiting
should therefore begin with 1/3 gr & increase it by degrees,
buy which means you can administer it oftener
& in greater quantity without producing vomiting
If it produce purging, opium may be given after
taking it a five days it produces a [illegible], which is not
[illegible], in these cases the disease is overcome You 
may then diminish the quantity & frequency also
After an intermission of 2 hours begin again gradually 


2d Ipecac may be given to those that cannot bear
antimony 3d Quicksilver if it produce a soreness
of the mouth, it indicates its good effects
It is not so easily managed as the other articles
it is also very uncertain in its effects When administered,
1 or 2 grs of calomel may be given in 24
hours Excepting these, there are no medicines that
produce any medicinal effect, although others are 
sued The cynchonas & other tonics in general are
of no effect in shortning the disease
2d Of Intermittents simple It is obvious that
something should be done during the intermission
It has been discovered that the cynchona will [arrest]
the disease some caution is however necessary in using 
this remedy The stomach and bowels should first be evacuated; 
then give the cynchona It produces the best effect
when used after a perfect paroxism, but grows less as you 
continue its use till it is finally lost Quantity not less than 
zi [illegible], commence as soon as the paroxism has ceased,
and continued till the hour for the next paroxism to come
on The dose should be large at first & less at each
succeeding dose should be continued some time after the 
[fever] has ceased Guard against the exciting causes of [illegible] [illegible]


141
Lect. 37th The cynchona is preferable to any other
medicine in the fever, but this sometimes fails
from a difference in the quality of the bark The
red bark is generally considered the best The yellow
was at a time thought preferable to the red The
bark often fails from its being of an inferior quality
The situation etc. of the patient must be attended to
There are substitutes, which are frequently used for the
bark; as 1st the vegetable berries & astringents 2d 
the opium, but the practice of using it is not recommended
3d Charcoal has been used in the same manner
as the bark and succeeded 4th Minerals of 
iron & copper, preparations of arsenic also have been used
which in their effects, are considered next to the bark
Its being generally used after the bark, we are not 
authorized in ascribing the whole of the effect to the
arsenics consequently cannot say that its powers are equal
or superior to the bark It is not dangerous if proper 
care be taken in giving it The preparation is the powder
mineral solution, or arsenate of potash The effect
is heat obtained by first giving it twice a day afterwards
three times very small doses should be given at a time
Begin in adults with 4 drops & increase to 8 or till
nausea is produced Then suspend until the nausea is gone


After he finds the number of drops that will produce
nausea, let the number be diminished 1 grs It also
sometimes affects the eyes It should be given in 
1 or 2 oz water, which should be pure without any 
saline substance In this way the paroxisms will
disappear, but the medicine should be continued 3 
or 4 days after the paroxism has ceased The [bark]
does not act altogether as a tonic as there are other [illegible]
in tonic power which do not produce like [effects]
The arsenic does not act as a tonic, and [illegible] the disease
External Remedies Plunging into cold water has [arrested]
the fever These act upon the imagination
Tinct of opium camphor and bark applied to the
skin, have been used with success when the stomach
will not admit the internal use of these medicines. The
external application may be used by rubbing in tinct 
of opium or bark once in 2 hours from ½ to 1 oz at
a time In the employment of the arsenic not so
great regard is to be had to the crisis as in the uses of
the bark The stomach should be a proper state
when the paroxisms are imperfect the cause of the imperfection 
should be removed, which is generally in the stomach
& bowels. In this way they will become more perfect


143
Diet and Regimen. in both intermittents and continued
Always take those substances into the stomach which
are easiest of digestion Vegitable rather than animal
when nothing can be digested give those substances that
will pass easiest through the canal without irritation
They should be vetigable as they are not so irritating
as animal, if undigested They should be given 
in a liquid form, as in this form they pass the canal [illegible]
if undigested Therefore we give vegitables in a
liquid form fruits also which are grateful to the patient
Those substances that effect the whole system as stimulants
act on the vascular system and skin, should not 
be used, except in a [convalesent] state
The Rules as to diet vary as the disease advances
Attention should be had to his appetite, when that returns
the probability is that his stomach will digest whatever
the appetite craves Food should not be given when there are
foreign substances in the stomach neither because the patient
has been sick 3 weeks Cordials in the early stage of the
of the disease should not be given; but after it has passed
its acme, they may be given in small quantities From 
the time the patients begins to be convalesent, the mildest
cordial may be used in small quantities as of cyder a 


a spoonful or 2 at a time till he becomes wear of this
then some other cordial, a little foreign wine
In Intermittents, food should be taken 4 hours before
the paroxism takes place, and at the usual time, each
stomach will then best digest the food. If the intermissions
are perfect take such food as will afford
the most nourishment. The cordial will enable the
stomach to bear the bark better and give him [illegible]
etc.
Lect. 35th Regimen when the patient becomes
so unwell as to be under the necessity of lying down
he should lay aside his bodily clothing his bed
clothing should be adapted to his feelings, provided
he has judgment to direct, which is not always the
case If he become uneasy you conclude it arise
from to great a quantity of cloths, therefore you must
remove them as your judgment shall dictate
The air should be kept pure, and the room well ventilated,
especially if small much company should 
not be admitted as it has a tendency to render the air impure
The temperature of the room should be kept
lower than the point that would render it comfortable to
a fever in health in order to make it comfortable to a
[illegible] in bed In the cold season when temperature may be 


145
1t 50 or 60 [degrees] of Farheites Even in a convalesent
state, he should be kept from company as much as possible
and also from all conversation of importance or which would
excite interest
Treatment when active measures are forbidden
wither by the late period of the disease, or by any peculiarities
of the case In these cases the patient should 
be supported by food of the mildest kind and easiest ingestion
Liquids are of this class therefore should be
administered cordials of such a kind as are congenial
to the patient when no active measures are necessary,
You should give medicine of a mild and soft nature 
[illegible] for the satisfaction of the patient which have some
sensible quality as febrifuges with camphor and [illegible]
Third heat for the treatment must be
modified in the varieties of fever. When there is a determination 
to any particular part [illegible] should
be employed by which it may be removed & relief obtained
1st Where the animal system is particularly affected
When there is a violent congestion in every important organ
general evacuations 1st by bleeding put from a large vessel
until the patient is relieved or sinks from [illegible] 18 to 24 oz
The force of treatment should be regulated according to 
the [fever] of the disease