Lectures &c..



William Bourne Sutton.



Lectures on
Surgery by 
Sir A. P. Cooper Bart.
Surgeon to 
Guy's Hospital &c..
Richard Sutton
December 1819.




1
Surgery. May be said to consist in a Knowledge of 
the appropriate remedies in external diseases, and in the 
performance of Operations.
Surgery is divided into principles and practice.
Principles are those rules laid down for the Practice and are
derived from three sources. Viz from observation of the living body
while under Disease, from examination of the dead, and from
experiments on living animals. From observation of disease you learn
the different stages of each disease, the remedies necessary for its
removal, and the changes which take place in the body while
they are applied; From the examination of the dead you learn the 
cause of disease. And from experiments on living animals you 
become acquainted with the process by which nature repairs 
injuries. It is not necessary for one to see every distinct injury in order
to be able to cure it, for when we know the method which is used by 
nature to cure injuries, we can always act on the same principle,
for instance encised wounds are all cured by the same method.
First the edges of the wound are brought together, and confined
in that position, in about twelve hours adhesive matter is 
thrown out, by which the sides of the wound adhere; this adhesive
matter soon becomes organised, that is arteries, and Veins,
are extending through it from the neighboring parts it is also supplied with
Nerves, and it is supposed with absorbents - When a wound bleeds freely, a
piece of Lint is pressed on it, this in a very short time becomes firmly glued
to its surface by a clot of adhesive matter, the suppurative process 
then takes place, and matter is poured out under the sink by which 
means it is removed; Granulations then shoot up from the bottom





2
of the wound, which is soon filled up by them, and lastly a Cicatrix is 
formed from granulations shooting in an horizontal direction from the
edges of the skin, and from these granulations only can skin be formed.
In the cure then of these injuries, only two principles are necessary,
the suppurative and adhesive processes. Adhesion is always to be
preferred when it is possible to unite wounds by it, but if suppuration
is necessary it is to be promoted by Poultices, and Fomentations. 
In compound fractures the treatment is similar to the above,
the wound should be healed by the adhesive process if possible, and if
this cannot be done suppuration must be had recourse to -
In the practice of Surgery a great deal consists in the mode of
applying remedies, neatness and readiness are very necessary - A Surgeon
ought at all times to collected and firm, as in case of accident the
Friends and bystanders of the Patient are all in alarm and confusion,
it then becomes a Surgeons duty to calm their minds, and direct
all that is necessary to be done; this inspires them with a confidence
in him that is not easily shaken. - 
In the performance of Operations. A Surgeon ought never to propose
an operation, which he himself would not undergo, where he in 
the same situation, the relief and the safety of patient ought to be
his only concern; the performance of operations merely for sake of
[operating] performing them cannot be too much reprobated. When he is
going to operate he ought to possess great Self-possession, and perfect
command over his mind, this is the only way by which he can regulate
his hand, this is in fact the most requisite quality of an operating Surgeon,
and if he does not possess this, if any untoward accident occurs the life of his
patient may be sacrificed, if for instance in amputating a limb, the 
torniquet breaks if the operator has not self possession his patient may
soon bleed to death, while he stands gazing or thunderstruck -





3
Never operate if the Patient is not in tolerable good health, if this is
not the case, it will only be giving a great deal of unnecessary pain to
the Patient, and bringing on yourself the credit of killing him -
Never introduce the finger oftener than necessary, by this the divided
parts may be either torn or brusied, and great delay occasioned in the
cure.- Anatomy is the foundation of all surgical knowledge,
it ought therefore by all means to be cultivated, without this it is impossible
to discover the true nature of disease, and not knowing its
Nature, how can anyone expect to cure it. A knowledge of some parts
are particularly necessary, as the Bones in order do understand fractures,
the Muscles in order to give an idea of the situation of arteries, the Joints
[in] to be able to reduce dislocations; the Arteries, and Nerves, and the 
other parts of Generation ought to be particularly studied, as well as
the different organs of sense, with the Brain, Viscera, and Nervous
System. Physiology is also necessary to be understood, it is this which 
has converted surgery from a mere art into a Science. Without a knowledge
of the Practice of Medicine it will be in vain to attempt, the 
cure of disease. Chemistry, and Midwifrey, are also necessary, the
former for every one, and the latter more particularly for those who
intend practicing that branch of the Profession. 
Lecture 2nd.. On Irritation.
By the term Irritation is to be understood some unnatural action excited
in the body by the application of some unusual Stimulus. __ Heat, Food, and
Air, are Stimuli, but these are natural to the Body, and excite necessary 
action; the Blood also is a Stimulus, of the same description. But if anything
is applied to which the Body is unaccustomed, unnatural actions
are produced, and these diseased actions are frequently taking place





4
at a considerable distance from the part to which such foreign
application or injury is extended. This is taking place from the 
influence of the Nervous System, and is termed Sympathy,
There are diseases of Sensation, and those of Action - As instances
of disease of Sensation, we may give the following. When the hip
joint is suffering under disease, the pain is not felt for a considerable
time in the joint itself, but is affecting the Knee, so that
an unexperienced Practioner might consider the latter joint, as the seat
of the disease. When a person is suffering a diseased prostrate
the pain is felt principally about the Anus, and extending down the inside
of the thigh. When a Stone is in the Bladder, the pain is felt
in the Penis, about an inch down urethra; the same is found to be
the case if a stone is in the Kidneys, or Ureters. When the Testicle is
suffering under disease, pain is felt in the Loins. These sensations are
extending along the Nerves, sometime from the extremity of the Nerve
which supplies it to its orign as in the diseased Testicle, at other 
times they are extending from the origin to the extremity of the Nerve,
these are all diseases of sensation. The following are diseases of altered
action arising from local irriation. A Stricture in the Urethra will sometimes
produce disease in the Testicle, the disordered action being set
up by local irritation. Even more remarkable instances may be adduced,
as Vomiting &c are produced in the Stomach from injuries of the
Head, the Stomach is sometimes disordered from the irritability of the
Skin. Professor Coleman when young had nausea and vomiting produced
if he exposed himself to the air immediately after his dinner.
Many other examples if it were necessary might be mentioned, but these
will be sufficient to show the fact. The irritation thus arising is either
Local, or Constitutional. Sometimes when a tooth is decayed, inflamation 
is set up, which goes on to Suppuration, and Matter is formed,





5
the Abscess discharging itself into the Mouth, but in bad conditions an
opening is sometimes formed through the Cheek; which will not heal under
any treatment, unless the irritating cause be removed, that is unless 
the Tooth be drawn. A Lady had a small sore situated on the upper
part of the cheek a little below the orbit, after a short time, a fungus
projected from the part which was frequently removed, both by Caustic
and excision, but it as frequently grew again, after a time it was found
that she had one of the Deutes Cuspidali decayed, immediately on the 
removal of this, the fungus was removed, and the sore healed kindly,
these are both cases of Local Irritation. Local Irritation is frequently
produced from the Slightest causes, and this producing so much Constitutional
Disease, that life is frequently destroyed. Very small Abscesses
are creating such a degree of constitutional disease as to bring on frequent
shiverings which is a symptom of the formation of matter. Life is
sometimes destroyed by a very slight blow on the Stomach, the cause of
this is supposed to be the sympathy existing between the Respiratory
organs and the Stomach, preventing the descent of the Diaphragm,
so that the Patient is incapable of making a deep inspiration. - 
Symptoms produced by serious accidents are producing constitutional Irritation.
Pains are felt in the Loins, Back, and Head; the tongue becomes foul, first
white if the irritation is slight, if in a greater degree it is Brown with a 
yellow streak down the middle, and if the irritation is still greater it becomes
Black resembling that produced by Typhus, the Stomach next become affected, 
by loss of appetite, and vomiting which last is a dangerous symptoms.
Secretion is stopped from the Liver, and other Glands communicating with 
the Intestines, the Intestines themselves ceasing to act, the Skin becomes dry 
and hot, prespiration being quite checked; the Urine becomes scanty and 
high coloured. We must not suppose that any one organ in particular is 
affected, and direct our remedies to that organ; but that the whole System





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is affected. Nature is obliged to shut up all the secretions in order to
direct her attempt to the restoration of any particular part, the action
of the Heart also becomes deranged, in the beginning it is much quickened,
then it becomes irregular and lastly intermitting, Respiration
is quickened, this is owing to increased action of the Heart, the Brain is 
synpathysing with the constitution, so as to produce pain in the head,
and frequently delirium, then Subsultus Tendinum comes on which is generally 
the prelude to Dissolution. Those symptoms which have their 
influence on the constitution, are depending on the following circumstances
1st. When any injury happens to an organ essential to life, as in rupture of 
the intestines, the constitutional irritation is so great that the Pulse
can scarsely be felt in a short time after the injury above the elbow joint,
and not at all in the Wrist. 2nd On the power of restoration which the
injuried part possesses; and the less living power any part posses,
the greater will be the constitutional irritation. As very slight injuries
in the tendons will frequently produce Tetanus. In the same manner
Death is frequently brought on from very slight punctures into the Thecæ.
3rd On the degree of Irritability of the Patients constitution; so that an
injury which is not productive of any inconveniences to one, will prove
fatal to another. One will die from the most simple operation that can be performed,
while another will go through the lingering cure of a compound fracture:
4th The age of the person. The symptom of irritability are most violent in
the middle of life, and those who are most health. Mr Cooper thinks that men
about the age of sixty will bear the operation for the Stone, better than at any 
other period, except in childhood, but in more advanced age, they do not
bear the operation so well, and old people will frequently die from a simple
fracture of the Thigh. - Treatment. Bleed freely especially if the pulse is
hard, or the Brain is affected. The different secretions of the Body as those of the 
Bowels, Kidneys, Skin &c. must all be restored as soon as possible. (Turn Over)




7 
After this give Opium with Saline Medicines, which is found very
usefull in diminishing the Irritability of the System. The Liquor Potassa
and other Alkalies may be given with advantages. 
Lecture 3rd On Inflammation.
The usual symptoms of inflammation are Redness, Tension, Pain, and 
Increased Heat. The Redness is arising from the serous Arteries, admiting
the red particles of the Blood, owing to their dilated state, this 
is distinctly seen in inflammation of the Eye, and in the Membranes
of the Body, as in the Peretoneum, and Plurs, the vessels of which do 
not admit of Red particles passing thro' them in their healthy state.
The Tumour, or Tension is also arising from the accumulation of Blood in 
smaller Vessels, and from the accumulation of Coagulable Lymph, which 
takes place in the cells of the Cellular Membrane, and in the surrounding 
parts, a quantity of Serum is effused encircling the Coagulated Lymph.
Pain is caused by the fullness of Vessels producing distention of the extreme branches
of the Nerves there is also extreme sensibility of the part. On this account. 
Operations ought not to be performed (if possible to avoid them} when
inflammation is present as the pain is most acute. The pain occasioned
by the removal of common tumours is very slight in comparison to what 
is felt in trifling operations when the part is much inflamed. Increase
of the Temperature of a part does not take place in the interior of the 
Body as was shewn by Mr.. Hunter who tried some experiments by injecting
a solution of Sublimate up the intestines of a dog so as to produce
violent inflammation, but no increase of heat took place. It is not
so however in external parts, the heat being frequently raised
under acute inflammation to about 95 degrees.
The Effects of Inflammation is either Local or Constitutional.





8
The Local Effects are four viz. 1st An Effusion of [Blood] solid substance
producing Adhesion, this was called by Mr Hunter Coagulable Lymph,
as he supposed it to be composed of the fibren of the Blood. But since 
his time it has been found to be Albumen only, and has been 
[found] called Adhesive Matter, this glues the Cells of the cellular
membrane together, serum being afterwards effused in the surrounding
parts. 2nd Effusion of Matter, this is poured out from the extremities
of secreting Arteries, into a part where adhesion had previously
taken place; It is in very small quantities at first, but by
its pressure on the surrounding parts it occasions an absorption
of those parts, and an increased effusion of Matter. 3rd Ulceration,
this is a increased action of the Absorbents, the solid parts of the 
body are taken up by them. In this way Matter when formed is making 
its way to the external parts, Ulceration always going on
most rapidly towards the surface. 4th.. Mortification or Gangrene.
Is the destruction of the life of a part; occasioned by the death of the
Arteries supplying that part, from violent action, or by the Arteries
being pluged up by a coagulation of the fluids, which last frequently 
extends a considerable distance up the Artery as is seen in Amputating
a mortified extremity, the Arteries being so filled with this coagulum
that no bleeding takes place. - The Constitutional Effects are
those arising from consitutional irritation. When Inflammation
is in the adhesive state it seldom produces much constitutional
irriation, except when it occurs in the Viscera, or other parts essential
to life. Rigors are the effects of this irritation in the suppurative
process, and are generally sure symptoms of the formation of Matter.
The Ulcerative process is productive of a Hectic constitution, with 
quick pulse, loss of appetite, and restlessness. In Mortification the 
constitution generally suffers severely, and in addition to the general





9
symptoms of constitutional irritation, there is frequently
Delerium and distressing Hickups. Inflammation is either
Healthy, or Unhealthy but it is not often to be considered in the 
character of Disease. It is generally a healthy process set up by 
Nature to repair Injuries. Not the smallest wound could possibly 
be healed without Inflammation. If arteries when divided did 
not inflame and pour out adhesive Matter, by which they are sealed,
or we should never be able to stop the Bleeding. Suppuration is necessary
for the healing of Ulcers. In them when no application is made [to them]
a scale forms over their surface, under which matter is secreted, and then
healthy Granulations are taking place at the bottom of the sore, by
which it becomes healed; The same is taking place under the dressings
which we usually apply to Ulcers. Matter is also making openings by 
which extraneous bodies are disslodged from the internal parts, and brought
to the surface. Ulceration is necessary to remove those parts which have lost
their vitality, and this is done by the absorption of the living parts, which 
are in contact with the dead, the latter being their seperated are thrown off
in Sloughs.- Mortification is also necessary for the removal of those 
parts which are no longer useful.
Inflammation is either Acute or Chronic, the latter is in general the
most unhealthy. This distinction ought to be remembered, as they require very
different treatment, as for instance Gonorrhæa at first is acute very
great pain being felt in voiding the Urine, in this state of the disease,
Purgatives, Bleeding by Leeches, Poultices, and evapourating Lotions, are 
necessary, but in its advanced state it becomes Chronic requiring
very different remedies, here Stimulants which would do much harm, in
the acute stay are required, such as the Balsam Copaiba Injections &c
In the Acute the Vessels are not only increased in their diameter but a greater
circulation is going on in them, hence they pour out a purulent discharge





10
this is continued in the Chronic from the distended state of the small 
Vessels. - Specific Inflammation. Inflammation is so
called where the same cause always produces a specific Disease. These 
diseases are arising either from the state of constitution as the malignant
diseases, or from the effect produced by several Poisons.- Gout is a specific
inflammation of the Ligaments preceded by acidity and disorder 
of the Stomach. The result of this Inflammation is an Effusion of Chalk
Stone, or Muriate of Soda, generally taking place in parts most distant
from the Heart, as in the fat and hands. Cancer is a specific 
disease, always arising (Mr. Cooper thinks) from some peculiarity of 
constitution, and altho it sometimes seems to be occasioned by a blow;
yet it could not be produced without a certain state of constituton.
Local applications are never of any service, removal of the part
is the only method of Cure, but this will not answer unless the constitution
is attended to at the same time. Fungus Hamatodes is a constitutional
disease, seldom confined to one part, the only chance of cure is in
removing the affected part, but this frequently fails, as the disease
may return in a distant part - This disease appears most frequently in 
young people. - Cancer in those advanced in life. Erysipelas is a peculiar
inflammation, usially accompanied by a specific fever. - Scrophula is 
is a specific constitutional Inflammation, differing from Chronic
Inflammation, the former is arising from a peculiarity of Constitution, 
the latter may be brought on by bad living and clothing, or other debiliting
courses. Specific Inflammation is induced by various poisons as
those of measles, Small Pox, Scarlet fever Syphilis &c. These Poisons
are not only producing their effects on the part which they are inserted, 
but upon the whole constitution. Causes. The Predisposing 
Cause is Irritability, the more irritable the constitution is, the more 
liable are such persons to suffer from inflammation brought on by any disease,




11
Those of the most delicate constitution suffer most under Inflammation, 
not only with regard to the constitution, but to inflammation on any 
particular part. These generally bear operations very badly, Mr Coopr
has known two persons die from injecting a Hydrocele, on account of 
their great irritability. People rendered irritable from fever as Scarlatina,
Rubeola, are frequently subject to mortification from slight causes, even
the application of a Blister in these diseases when the chest is much
oppressed, requires great care, as it is not unfrequently succeeded by 
gangrene and the Patient saved with the greatest difficulty.
Occasional Causes. In what ever parts of the Body into an unnatural
action, as by exposure to cold for any considerable time, and then 
heated too suddenly, this is producing irregular actions which are accompanied 
with Inflammation, and subsequent Mortification - Wounds,
the divided arteries of which cease to convey the Blood; the vessels of the 
surrounding parts are becoming enlarged in order to carry greater quantity
of Blood; Extraneous Bodies are also inducing unnatural actions.
Proximate Cause. By this is meant that state of the Body which immediately
precedes the Symptoms. Boerhave thought it to be thickness
of the Blood, and necessarily increased action to propel that blood forwards.
Cullen thought it to be spasms of the extreme arteries supporting an increased
action in the course of them. But on the contrary the stream of blood
is not only more rapid, but the vessels are in a distended state. A disposition 
of the Vessels of a part to dilate when any irritating cause is introduced 
is the first symptom. Increased action of the surrounding parts
taking place, this is seen when any small particle gets into the eye,
a copious flow of tears immediately takes place which is from the increased
action. -




12
Lecture 4th.. On the 
Treatment of Inflammation.
The Treatment of Inflammation is either Local or Constitutional. 
The latter is requrired where the Vital organ are affected either 
primarily or secondarily. The most powerful remedy that we have for 
diminishing constitutional irritability is Blood-letting, this acts not only 
by lessening the quantity of Blood and the frequency of the False, but 
also on the Brain and Nervous System in diminishing its power.
But this is the most evident when it is taken away rapidly, as it then
produces syncope; and a small quantity taken away quickly has a
greater effect on the Nervous power, produces syncope much sooner,
than a large quantity taken away slowly. We must judge whether it is 
necessary to repeat the Bleeding from various circumstances. Viz. the 
firmness of the Crassamentum, the state of the hard Pulse, the quantity of 
Serum, the Buffy or Cupped appearance of the Blood, the strength of the 
Constitution &c. - We must remember that the buffy, or Cupped appearance,
even under acute Inflammation is not taking place if the blood be drawn
away slowly and suffered to trickle down the arm, this does not depend so 
much upon the force as on the rapidity of the circulation. You may sometimes take away
Blood so as to affect the whole constitution, but more especially to releive some 
certain part, this is frequently done in injuries of the head, by opening the 
temporal Artery, and a small quantity of Blood lost in this way is more
servicable than a much larger quantity taken away from the Arm.-
There is a pulse sometimes in Inflammation, which at first you would
think indicated bleeding to be necessary, the Artery rises considerably
from its situation with a hard jerk, but if you press upon it you find this 
vibratory motion diminish, this pulse is rather increased, than improved by
bleeding. Some people of feeble constitutions will not bear to loose much Blood,




13-
a teacupful having as much effect, as a pint has on a stronger person.-
The second made treating Inflammation constitutionally is by acting on the 
different secretions, specially those of the Bowels, Kidney, Skin, &c.- Purgatives
act in three ways, first by increasing the secretion, by which the quantity of 
Blood is deminished, its watery parts being carried off. Secondly by Derivation,
that is by increasing the circulation of the Blood in the Intestines, by which it
is lessened in some other part that is inflamed. Thirdly, by the removal of the
irritating causes as the fœces, which have been too long retained. But it is not so much
the accumulating of the fœces in the intestines, that is productive of mischief as the
decreased secretion; as very large quantities of fœces are frequently accumulated
in the intestines without, any or at least very trifling inconvenience. -
The Nervous System very soon becomes affected from deficient secretion in
the intestines, especially in Children in whom it is producing Paralysis, Hydrocephalus,
or some other disease depending upon Nervous Influence; if stoped
only for a short time. The best Purgative for Children is Calomel either 
alone, or combined with Rhubarb, Scammony, or Jalap. In Adults the Calomel
may be combined with Cathartic Extract. These purgatives are not only increasing
the secretion from the Bowels, but also those parts connected with them, as the Liver.
Perspiration is very servicable in diminishing Inflammation, it is therefore
frequently desirable to increase this by Antimonials &c. Secretion of 
Urine may be increased by taking largley of diluent drinks by Squills &c-
Opium may be given in inflammation when there is great Nervous irritability
and is very usefull in Stone, and diseases of the Bladder. Nauseating
Medicines as Antimonials, are useful in inflammations as the diminish
Arterial action very considerably.- In this way also Digitalis acts.-
Chronic Inflammations are to be treated principally by acting on the
different secretions gently, by what are termed Alteratives. The most common of
of these is the Compound Calomel Pile, which is very servicable, and if the system 
is weakened, the Decoction of Sarsaparilla may be given at the same time.-


Where the Cold Bath increases the Pulse it acts as an irritant & only tends to increase
debility.
x In Inflammation of the Testicles Mr. C. generally punctures two or more veins
in the Scrotum (keep the patient in an erect posture) he soon procures a sufficient
quantity of Blood (the way he stops the bleeding is by placing the patient in a 
recumbent posture. _



14
this strengthens the constitution and diminishes the nervous Irritability -
The Oxmuriate of Mercury in small doses is extremely servicable in enlarged Glands 
generally, but especially the Mesenteric Glands in Children. Mr. Cooper generally
combines it with Bark, in the following way Tinctura Cinchona ℥ij, Oxymurias
Hydrargyri gr ij Misce; of this he gives one or two tea sponfulls three times a day.
Bark strengthens the system, while the Oxymuriate of Mercury increases the different
secretions. Many other preparations of Mercury are used as Alteratives. -
Local Inflammation. This may be treated in various ways. 1st By the 
application of Cold, which diminishes the Nervous power, and it is in this way
that it proves fatal when the whole Body is exposed for a considerable time, first 
inducing sleep, from which the sufferer never awakes. Cold diminishes the Action
of the Heart and Arteries, the Pulse becoming extremely small. It is used in Inflamt..
with a view to contract the extreme branches of the arteries, but too great a degree
of cold as Ice ought not to be used, unless the inflamed part is considerably below
the surface, as it is apt to irritate the skin and do harm. A slight degree of Cold
regularly continued for some time is likely to be of the most service, for this purpose
evapourating Lotions are generally used; Spirits of Wine, and Water is one of the
most simple; or the Lotis Plumbi either with, or without the addition of a small 
quantity of Spirits. This last is not only cooling the Acetate of Lead, as a direct 
influence on the Nervous power of the part. Mr. Foster applied this Lotion to an 
inflamed Eye, until the Eye became Paralysed from the effect of the Lead. Mr.
Cooper knew an instance in which the undiluted Liquor of Lead was applied by 
mistake to an inflamed Testicle, which produced Mortification of the Scotum.
The next method is by abstraction of Blood from the part by the application of 
Leeches, by opening small Veins in the part, or by scaryfying it, this by diminishing
the quantity of Blood, gives the vessels time to contract ‡ Derivation, or 
Counter irritation is also frequently had recourse to. This is setting up an increased
action in one part to allay that of another. Mr. Cooper had seen an instance
of this in the following way. He operated upon a Gentleman for Hydrocele,


* Mr. Hunter was of opinion that two diseased actions never wheat on in the System
at one time.
*[In consequence of] In inflammation of the Fingers &c. Mr Coopers recommends the 
Elbow to be raised as high as the Shoulder, and the Hand somewhat higher. - 


15- 
which was very much inflamed after he had injected it, the next
morning the inflammation had entirely subsided, but he had been 
attacked with a severe fit of the Gout. Antimonials, Setons, Blisters,
and Issues, all act from counter irritation. This has been denied to have 
any effect,* as the diseases measles, and Small pox have been said to attack
the same person at the same time; but it is impossible that the diseased
action of both could go on together.
The Consequences of Inflammation are Indurations, these may be
discussed by pressure, friction, rubbing in of the mercurial Ointment with
Camphor &c. In inflammation* Rest of the part affected is necessary 
and an horizontal position.- If the Testicles affected they ought to be 
suspended. -
Lecture 5th.. the Treatment of
Inflammation Continued.
Having allready mentioned to you that evaporating Lotions, were the most
effectual way of subduing Inflammation, and that this was done by
lessening the Nervous Energy and the diameter of the vessels, it will now 
be necessary to heat of the other remidies used in inflammation: -
Heat. It is allways necessary when heat is applied to inflamed parts, that
it should be combined with moisture - When Inflammation is situated
near the surface of the Body, the effects of heat is to unload the Exhalents,
acting in some measure like topical Bleeding. It is on this principle that fomentations,
and Poultices are employed, and in general it is of little consequence 
what ingredients we use, the more simple ones are the best, warm Water is as
good as any Fomentation we can use, but were any surface is abraded
it is usual to apply Poultices. Poultices are generally made of Linseed





16
Meal and Water; Bread and Water, or Bread and Milk; the latter of these is 
generally used, as on account of its greasy nature it keeps moist longer than 
the others, this effect may still be further be promoted by the application of oiled
Silk over the Poultice which prevents the evaporation of the moisture. Oiled silk
applied immediately to the part acts in some measure as a Poultice by confining
[the] the perspiration. This was formerly applied very much in Gout, and it is 
now used with much advantage in Hernia Humeralis. Soap Cerate is often used 
with the same intention. The next method of relieving Inflammation is by taking 
away Blood in various ways. In topical bleeding Leeches are most commonly 
had recourse to, but more advantage is to be derived from the after bleeding
than the quantity they suck themselves, which is very small. It is therefore
useful to promote this as much as possible, and placing the parts in depending 
position. In cases where it is inconvenient to apply Leeches as frequently
happens in inflamed Testicles, it is of advantange to puncture one or two of 
the Veins of the Scrotum, or if we do not see any Veins, we may scarify it 
in different parts, by which we may obtain a sufficient quantity of Blood,
if the patient is kept in an upright posture, and the bleeding may be stopped 
by directing him to lay down. In deep seated inflammation it is usual to draw
away blood by cupping, sometimes also from Arteries, as Temporal Artery
in Opthalmia, sometime from Veins coming from inflamed parts. When Wounds
will not inflame sufficiently to unite by adhesion, it is of great service to scarify
the edges. Or when we wish to allay the inflammation we apply Leeches to the 
edges. Inflammation is frequently subdued by Derivation that is by applying 
Stimuli to excite inflammation in some neighbouring part, which lessens the 
inflammation in the diseased part. So that it appears Nature has a difficulty
in supporting two local actions, at the same time near one another.
With this view we ought to rub in Stimulating Liniments, as tartrized
Antimony combined with the Linimentam Ammonia, with Oil, Water, 
of Lard, in any of these ways it is producing an eruption on the Sink,




17
and exciting external irritation. We ought always to attend to the position
of parts, for if they are allowed to remain in the depending position.
the Blood gravitates in the parts and thus renders the inflammation more
difficult to cure. In chronic inflammation it is always necessary to guard
against this. In accidents of the Hand we should always keep the fore arm
in an horizontial position by means of a sling, so that the Blood may slightly
gravitate towards the Elbow. When Inflammation is Chronic it is necessary 
to use Stimulants, as Liquor Calcis ℥iv. Calomel pp'ʒi Misce, this 
makes a very useful application in those sores arising from sloughing of the
Cellular Membrane. But we do not succeed in Chronic Inflammation without
combining medicines with Surgery, the former being equally necessary as 
the latter. The Oxymurias Hydrargyri it Aqua Calcis, in the proportions of a 
Grain of the former to an ounce of the latter, is a very servicable application to
excite action, when that is too weak Sulphates of Zinc, and Copper, and Limewater
with Spirits all have the same effect. Indurations left after inflammation
will generally give way to Ungt. Hydrarg. either alone or combined
with Camphor rubbed in on the part, Blisters and Bandages may be used when
we wish to produce absorption. Adhesive Inflammation is the one the least obvious
to the eye, the one upon which every process of restoration depends.- There are two
modes of Union, the first is by adhesion, and the second by granulation of the pox
Adhesive Process. By adhesive inflammation, is meant an effusion of solid
substance from the Blood, which was formerly called coagulable lymph, being
supposed to be fibrous parts of the Blood, but it is now ascertained to be coagulable
Serum or Albumen, this process is best seen under a Blister, the adhesive inflamtn.
taking place in twelve hours, if we raise the cuticle we see a substance like size
or jelly, which is adhesive matter, and is exactly the same with what is effused to
unite wounds, the appearance which this substance takes on is generally that
of Net work similar to the Cellular Membrane. The time required for its effusion
after inflammation is about six 12 hours; In Brutes it is taking place in three hours




18
After a wound has been made and Lint applied to stop the Bleeding,
we find it adhering very firmly, and rather than remove it roughly we
ought to apply Poultices. There are some parts of the Body more disposed
to go into the adhesive inflammation than others, such as serous surfaces,
and the Cellular Membrane. When it takes place in the intestines we
find it coated very much by this process. Generally when inflammation
takes place in the Abdomen, adhesion takes place between the peritoneal Coat of
the intestine, and the peritoneum which lines the Abdominal Cavity, the same
takes place in the Plura, Pericardinum, and Dura Mater, this principle
in Nature, has been called the Vis- medicatrix Natura. These surfaces in
their healthy state secrete a vapour, but readily under inflammation secrete
adhesive matter which soon becomes organized, arteries shooting into it 
which are derived from the Vasa Vasorum of the surrounding parts; Mr -
Hunter considered that they were formed with the new substance itself,
but this opinion is found by experiment to be erroneous; Veins are also 
passing to the part, and after a time Nerves, and Absorbents also. -
Adhesive inflammation is the first means Nature employs to heal
wounds. There is no such function in the body as what was ment by healing 
by the first intention, which was supposed to be merely a cementing of the 
parts together by blood. But so far from blood being servicable, it acts
only as an extraneous Body, and must be removed either externally by 
washing the Wound gently, or by absorption. After the Wound has
been perfectly cleaned from blood, and extraneous matter, it should be 
dressed by bringing the edge together by adhesive plaster; and not to stuff
it up with Lint &c as was formerly done. Another use of Adhesive
Inflammation, we observe in Hydrocele. When we wish to obliterate cavities
we throw in some Stimulating Injection to excite Inflammation.





19
Lecture 6th.. On Suppurative 
and 
Ulcerative Inflammation.
When Inflammation exceeds the bounds of the adhesive stage, the
Suppurative commences, and matter is thrown out, accompanied with 
either more or less constitutional irritation, according to whether it is formed 
in any part more or less essential to life, Rigors are generally attending the
formation of Matter, and if it is any important part they are more severe and
are succeeded with great heat and profuse prespiration; But rigors are generally 
thought to be essential symptoms of the formation of Matter. We can also 
judge of its formation from the appearence of the part, which becomes red and
painfull, accompanied with swelling, in a little time one part of Tumour becomes
elevated than the surrounding part, so as to give the appearence of two swellings.
Fluctuation is perceived in it when touched, and the skin generally begins to
peal off, attended with slight ulceration or vesication previous to its bursting
and the pain becomes more acute, giving the sensation as if a Lance had been introduced.
The redness and pain are perceived even when the Matter is deep seated. The parts 
most subject to suppurative process, are those surface secreting Mucus, this is 
a generally Law of Nature, as well as that of membrane secreting Serum, going 
most rapidly into the adhesive process. The Urethra, Vagina, Internal surface
of Trachea, mucous membrane of the Nose, Synovial Membranes &c. readily go
into suppuration. Surfaces secreting Serum when inflamed & go first into
the adhesive process, afterwards into the suppurative. In surfaces secreting
Mucus the contrary takes place. In wounds of the Thecæ of the fingers, suppuration
is taking place, from the arteries secreting matter, insted of Coagulable Lymph,
and when this matter is confined it occasions very great constitutional
Irritation. The opening into Mucous surface can only be healed by granulations.





20
If the adhesive inflammation was produced in these surfaces, life
would frequently be destroyed, when ever the Urethra became affected 
with inflammation, adhesion would take place and the consequence
would be fatal. The reason that Wounds into the Synovial membranes
of the Joints are so dangerous is that they go into the suppurative
process. If a wound is not healed by the adhesive process, matter
becomes formed, and the wound is healed by granulations. - 
Wounds are healed in two way. 1st. Adhesive process. -
2nd.. Suppurative process. If a wound cannot be healed by the first,
Matter becomes formed, this is a secretion from the extremities of the 
Arteries; It was supposed to take place from the solid parts becoming
dissolved, but instead of any diminution taking place in the surrounding
parts they frequently become enlarged. It may be proved that it 
is a direct secretion from the vessels of the part in the Urethra, and
still more plainly in Blisters. Matter soon after it is secreted is undergoing
a change, it particles becoming opaque, this takes place from
four to five minutes after it is secreted. It consists of two parts a fluid
which is Serum, and white particles resembling the particles of Blood
except in colour. It is supposed to be formed of the Blood, the particles
of which are changed in their Colour in consequence of the action of the 
arteries. The only portion of the Blood which is not effused in the fibrous
which has not yet been obtained from Matter. Matter is of two kinds
1st that which is secreted in Wounds. 2dly.. that which is the result of a 
specific inflammation, and is capable of reproducing that specific disease
as the Matter of Small Pox &c. -
The Use of Matter. The great use of it is to cover and protect Granulations
from the action of the air, and to keep them moist, under it granulations
will form favourably, but without it that process will not go on.
Secondly to assist the removal of extraneous bodies, protecting the




21
neighboring parts from being [ye] injured by them, and by its pressure
causing absorption to take place, generally towards the surface.
When a Bone dies and exfoliates, Matter is forming a hole through the 
Bone, through which the dead part passes; and it is worthy of remark,
that the bone becomes absorbed always on that side which is nearest
the surface, and not on that part covered by Muscles, this may frequently
be seen in the Tibia. When a discharge of Matter which has been kept
for a considerable time, becomes suppressed, it is productive of dangerous
consequences; this is taking place sometimes if an old Ulcer is healed, the
Lungs or Head frequently become affected. A Gentleman when young had
an Hemoptoe with which he had been troubled for sometime, when an Ulcer
formed upon his arm, immediately after which his former complain left
him, he however was anxious to get rid of the Ulcer, and as soon as that had healed
the Hemoptoe returned, but was again cured by the Ulcer, which broke out a 
fresh, and which he kept open, and was not again afflicted with the disease.
When a discharge of Matter is suppressed it is necessary to give Purgatives freely,
or to have recourse either to frequently Bleeding, or to the introduction of a 
Seton, or Issue. Ulcerative Process. By this is meant an absorption of 
the Natural parts forming the Body. The cause of this absorption is
pressure united with inflammation, it being very rarely that the latter
alone is sufficient to produce Ulceration. The inflammation may be 
very considerable, and the pressure very inconsiderable, or the pressure 
great attended with very little inflammation. Ulceration may take
place without Matter being formed, as in Aneurism, in which the 
Museles, Integuments, or even Bones frequently become absorbed.
Ulceration influences the Arteries, and Veins so as to occasion a thickening
of the parts and the Absorbents so as to take up these parts. Parts when 
Ulcerated have an appearance of roughness as if they had been [Gnawn].
Caries in Bones is merely ulceration [I] taking place in them, not their




22
becoming dead. The pain produced by Ulceration is oppressive but not 
acute, it is obtuse and is frequently called by patients knawing pain.
It is productive of Hectic fever more or less according to its extent and the 
part in which it is taking place. Slight fever is first set up, but it
is seldom accompanied with rigors, the appetite ceases and the constitution
becomes unhealthy. In Ulceration there is always a tendancy towards the
nearest external serface, this is seen when matter form between the 
Peritoneum and the Muscles of the Abdomen, it finds its way through the
substance of the latter, rather than thro' the former, although that is extremly
thin. The same takes place between the Plura and Sternum, the latter becomes
absorbed, and between the Cranium and Dura Mater, but in this case the constitutional
irritation is so high that the Patient seldom lives until the Matter
is discharged. Parts which readily takes on the adhesive inflammation do
not ulcerate so soon as other parts; Matter is therefore more readily making 
its way through Bones Muscles &c., than thro' these Membranes, this is the effect
of original structure and not depending upon any new power given them to resist
the Ulceration. Ulceration takes place much more rapidly than the restorative,
or adhesive process. Absorption will take place in a few hours to an extent,
as will require as many days or even weeks to restore it. Restored parts are much
more readily absorbed than original parts, on this account the Gums of Children
are readily absorbed through when once they have been divided. [through] This
was seen to a much greater extent in Lord Ansous voyage round the World; great
part of this Crew consisted of seamen who had been wounded, they were under
great depression of Spirits, and became attacked with the Scurvey, while in this
state their wounds broke out afresh, and the fractured bones became again
seperated, by the absorption of the restored parts. Parts most distant from 
the Heart, go into the ulcerative process sooner than those nearer it, except
tendons which are generally sloughing.




23
Lecture 7th.. On Abscesses.
Abscess is a formation of Matter which is usually surrounded by adhesive
substance. Inflammation being set up in a part, adhesive substance
becomes poured out, but if the inflammation continues still longer,
a change takes place in the action of the Vessels, and pus becomes secreted, 
this is only in small quantity at first, but by its pressure on the
surrounding parts occasions absorption to take place, the cavity thus
formed becomes filled with Matter, the Ulceration continuing until it
reaches the surface, this is the general way in which Matter is formed,
but sometimes the adhesive substance is so small in quantity that
it does not surround the pus, but allows it to gravitate through the Cellular
Membrane to a distant part, this takes place in Abcesses of the Back in unhealthy
constitutions. The danger which is attending Abcesses is arising
from their size, not so much from the large collection of Matter, but from
the process which is obliged to be set up by Nature, to fill up the cavity which 
contained it, when it is removed from the Body, this is always creating a
great deal of constitutional irritation. The largest Abcesses are formed in
the Liver, from which several pounds of Matter are sometimes discharged,
by means of a small puncture, next to that under the fascia Lata of the 
thigh. We must not be surprised at the degree of constitutional irritation
taking place from abcesses, when we reflect to what extent their internal
surface is exposed, and comparing it to as large an extent on the external part
of the body, which would be productive of still worse symptoms, in the next 
place the danger is more or less according to the situation of the Abcess, whether
or not it is situated in a Vital part. A small quantity of Matter collected in 
some situations, is attended with dangerous symptoms, as in the Lungs, the
Brain &c..; in the third place the formation of matter is attended with danger
when situated between the Periosteum and the Bone, as in Psoas, and Lumber -





24
Abcess; the former the Matter is formed between the Spine and Ligaments, -
and gravitates between the Psoas, and Illiacus internus musces, in the latter
it is situated between the Spine, and Ligaments externally. The danger
in these cases is arising from the adhesive process not taking place, the cavity
is obligest to be filled up Granulations. Treatment. This differs very 
considerably, depending upon whether they are healthy or unhealthy. - 
A healthy Abcess requires the application of heat and moisture combined
either in the form of Poultices or Fomentations, this proves to be a slight
Stimulus, and by increasing the circulation of the part favours the formation
Matter. When the constitutional irritation runs high the best remedy is the
Tinctura Opii given in the Liqur. Ammonia Acet. this allays the irritation
and brings on a gentle diaphoresis. It always enables the patient to bear 
the pain much better. When Inflammation is insufficient, or when too
great, matter is not formed so readily, in the latter case inflammation ought to be
partially subdued, by the application of Leeches &c. But when the inflammation
is Chronic, stimulating poultices ought to be used, composed of the stale
Beer grounds, Wine lees, or salt may be added to the water with wich they are
made, Linemt. of Ammonia or Spirits of Turpentine, are frequently used as
Stimulants, as are also Plasters of various kinds, as the Emplast Picis; Emplast
Ammoniaci; Emplast. Ammoniaci Hydrargyri, the last is one of the best applications 
in Chronic Inflammation, sometimes however it inflames the 
Glans of the Skin. When deep seated Glands are inflamed, Blisters may be used
with advantage. Wine, Bark, Ammonia &c. may be given to increase the tendancy
to suppuration; this they do through Stimulating the Body through
the medium of the Stomach, and strengthening the constitution. When Matter
is formed the sooner it is discharged the better, in the general way, as no
advantage is derived from allowing the Matter to remain, and if they are
allowed to break of themselves, the cavity becomes enlarged, and nature as 
more to do in the restorative process. They are best opened by the Lancett ~





25
The use of Caustic is attended with so much pain, that patients will seldom
consent to its use, and no advantage whatever is obtained from it. Setons
have been used in large Abscesses, and have been found servicable, in as much 
as they keep up a discharge from both ends of the Abcess. In Abcesses under the fascia
lata, you make a puncture in the most depending part, which is generally near the 
Trochanter, and having discharged the Matter apply a Roller tightly begining
at the Knee upwards, by this means inflammation is produced in a few days,
adhesive matter is thrown out, by which the sides of the Abcess become glued together,
the whole Granulating process being thus saved. In abcesses arising from enlarged
Glands in the Neck, it is very desirable that little or no scar should be left,
in order to affect this they ought to be punctured with a small Lancet as soon as 
fluctuation can be discovered, while the Skin is red and healthy, if you wait 
till this becomes discoloured, the part will Slough, and a large Scar will be produced,
the same will be the result if they are allowed to burst of themselves.
It is wrong to open Psoas, and Lumber Abcesses early, or abcesses of the Hip and
other Joints. If this is done, inflammation [inflammation] is set up which 
extends to the whole cavity of Joint, but if these be left until opened by Nature,
the whole cavity of joint becomes filled Adhesive [process] Matter. By leaving
this to Nature you avoid the censure [to] of having undertaken to cure a disease
which you was unable to do, and you avoid the danger of having opened them
too soon, those cases mostly do the best in which least is done; a senton
ought to be introduced near the part, and constitution supported. The constitutional
symptoms which are seceeding Abcesses are not produced by the Absorption
of matter, as was formerly supposed, this is proved by the quantities of
Matter which are frequently absorbed, without any inconveniance to the patient,
and by these symptoms being often produced when no matter at all is formed.
They may however be occasioned by pain. A much greater degree of constitutional
suffering is occasioned by a very small Ulcer in some Vital part,
as the Leg, although the Matter may be absorbed from the latter in a large quantity





26
These symptoms are produced by the efforts of Nature in restoring the
parts which have been destroyed, and filling up the cavity occasioned by
the Matter. This requires the Heart and Arteries to make great exertions, by 
which the Nervous system becomes affected, and the constitution suffers.
The cause of the internal part of Abcesses becoming inflamed when they are
opened, was said to be the introduction of Air, but that air is not capable of
exciting inflammation may be easily proved, or else why does it not take place
when air escapes into the Cellular Membrane, in cases of fractured Ribs, besides
the same takes place if the abcess is so opened as to exclude the air entirely.
The true cause then is the division of the Blood Vessels; and if the Stimulus thus
given is not sufficient to bring on an adhesion the inflammation goes on to 
suppuration, and Granulations take place, in order to restore the part, this 
process being attended with a greater degree of constitutional irritation,
if the cavity is large, or if it is situated in some vital part.
Lecture 8th On Granulation.
When an Abcess has been opened, the Inflammation which is set up
by the opening occasions a secretion from its internal surface, under
which Granulations are arising until the cavity becomes filled, the Vessels
which are passing into the new Granulations continuing to secrete matter
[until] as long as the process goes on. The substance of which these Granulations
are formed being the same as that which is thrown out under
the Adhesive Inflammation, the only difference being that the Vessels
passing into the one terminate in closed extremities, into the other they
end in open Mouths, which continue to secrete fresh substance. -
The manner in which a cavity is filled up is as follows; A layer of Adhesive
Matter is thrown out over all its surface, which becomes vascular, the vessels





27
secreting a second layer, which also becomes vascular, and produces a third
layer, and so on until they rise to the level of the surrounding parts, these
layers of organised adhesive Matter are what are called Granulations. -
They possess numerous arteries which are passing into them in a radiated
direction, accompanied with veins, when newly formed they have few absorbents,
but these become much more numerous after a time, they cannot be demonstrated
but that this is the case is infered from what we frequently see take place in them
Viz. that new granulations never become absorbed but readily slough; old ones
on the contrary become more readily absorbed than other parts. They are supplied
with Nerves, but the degree of the sensibility they possess depends upon the part from
which they are arising, those arising from Bone being quite insensible, those 
from other parts plentifully supplied with nerves possessing acute sensibility.
When two granulating surfaces are applied to each other, they first adhere,
from adhesive Matter with which each surface is covered, afterwards the 
vessels readily inosculate, and a firm union takes place. This is very adventagious,
and saves a great deal of time in the curing of some wounds. -
When a cavity has become filled by granulations the process of Cicatrization
commences, by this term is meant the formation of skin over newly
formed parts. Skin is not formed from the first process of Granulation
above described but by Granulations shooting from the edges of the 
old Skin towards the centure of the sore, first one little line of adhesive
matter is thrown out from the whole circumference of the sore, which
becoming organized inosculate with the granulations below, and in its
turn secreting fresh adhesive substance, this taking place until they 
reach the centre of the sore. In some superficial sores where the skin has
not been entirely destroyed, granulatious are arising from these small portions
of skin on the surface - this gives rise to the supposition that the skin 
was formed from the first order of Granulations. When cicatrices are
first formed they are more vascular than the surrounding parts,





28
looking quite red, but after a time [to] they become less vascular, and look paler.
This is owing to the distended state in which the vessels are when first
formed, and to their contraction afterwards, the contraction is taking 
place sometimes to a very great degree, so that after a sore, which has
healed smoothly, very great disfiguration is produced by drawing parts
out of their natural situation. In the filling up of cavities, or the formation
of new parts, most of those parts which originally existed, become 
reproduced, with the following exceptions; Muscles when divided become
united by a tendinous, and not muscular structure; Glands at least those 
which secrete fluids, the substance reproduced not possessing an excretory
Duct. Cartilages when divided, unite by bone in the Adult, sometimes 
by Cartilage in Youth. The extremities of Bones, situates within Capsular
Ligaments, do not unite by bone but by ligt. Treatment of Ulceration.
When a wound has happened the first application is generally 
a piece of Lint to allay the Bleeding, this adheres so firmly, that
it becomes necessary to apply moisture to remove it, with this view,
and to favour the secretion of Matter a poultice is generally applied, this
is done also where the cavity of an Abcess requires to be filled, it produces
a secretion of Matter by its stimulating effects, and thus promotes the 
formation of Granulation, when the granulations are level with the surrounding
parts, you endeavor to hasten Cicatrization, bringing the edges of 
the sore nearer to each other, by straps of adhesive plaster. When a
sore is quite healthy the granulations are arising a little above the level
of the skin, this favours the process of cicatrization, which will not take
place while the Granulations are below the edges of the Skin; when they 
rise too high, pressure is required, this may be [applied] done by applying a little 
simple Ointment and using a Roller, or the application of a little sheet
Lead may be had recourse to; besides this there are many other states which 
render cicatrization very difficult. The action of the vessels being too languid






29
these have a glassey transparient appearance, which is owing to the Vessels
not shooting into the Adhesive Matter, this requires a Stimulating Application
as the Nitrate of Silver, Sulphate of Zinc, or Copper. Wine and 
Stimulating Medicines may be given and if the sore is not on the lower extremity,
moderate excercise may be used. Inflamed state of the Granulations
they appeared covered with a brown crust, and require the use of Fomentations
and Poultices, Purgatives ought be given so as to subdue the disposition
to inflammation. The Sloughing State, this occurs when sores have been
neglected, and the Patient has walked about a great deal; use fomentations,
and poultices combined with some stimulating ingredients.
Spt of Turpentine may be applied warm, the best application is the
Nitric Acid Lotion, about 50 Drops to a Quart of Water, this not
only excites healthy granulations, but removes the offensive smell which
arises from the sore, and which is sometimes very distressing to the patient.
In Sloughs taking place in Children, the Blackwash is an excellent
application. Sloughs in the pudenda of Girls; under the neck of just Children,
behind the Ears &c.. are much benefited by it, Calomel ought to be given
at the same time, in doses of two Grains once or twice a day, this removes
the disposition to form Sloughs. When this is taking place in the 
Adult give Ammonia and Opium, and support the Constitution.
Irritable Sores; there is some times taking place a great degree of
Irritability without much inflammation, it is painful, and when
touched the pain is exquisite, the best application is the Ungt Hydrarg:
Midi ℥i Opii ʒi but if it will not bear the Mercury, the Opium may be rubbed
up with simple Ointment, giving at the same time Calomel gr ij Opii grivel
if this is the most effectual way of diminishing the irritability. A weak
Nitric Acid Wash is sometimes useful. Sarsaparilla diminishes the irritability
of the Body, especially when arising from the use of Mercury.
Infusion of Digitalis has been applied to these sores with advantage,





30
All the Narcotics have been tried. Sores kept up by the irritation of 
extraneous bodies, by the exfoliation of Bones &c. Nails are sometimes
producing very troublesome sores. 1st.. from the Nail growing
into the Skin at the edges, a fungus shoots up, which cannot be 
effectually removed without removing the cause, to do this the Nail
ought to be scraped thin, and the blade of a small pair of scissors introduced
under the Nail, the edge of which is to be turned up and Cut off, it ought to
be cut so as not to grow again to the same extent. 2nd When the Gland
becomes inflamed the Nail grows Black, in this case it is necessary to destroy
the gland, either by sulphate of Copper, or Arsenic, or else removing it
way of caring the disease. The Nail does not grow again after the gland
has been removed. There are sores arising from the cellular membrane
becoming dead, small tumors then form, suppuration takes place and
the dead portion sloughs away, these are returning frequently in different
parts, they arise from the intemperance, anxiety, or some weakening Cause. Give
alternative doses of Mercury, the compound Calomel Pile five grains twice
a day, and the Decot. Sarsapa..; apply poultices to the part. As the constitution
improves the sores heal, the disposition to the disease being removed. When sores
in females are accompanied with Amenorrhoa, they will go on favourably for 
a short time, but at the period at which the patient ought to have menstruated
a Bloody discharge is taking place from the surface, this returning at every
period, before you can come these it will be necessary to restore the accustomed
discharge, and when this has taken place, the sore will generally heal readily
The Blood discharged is natural, and not the true menstrual fluid.





31
Lecture 9th.. On Irritable Ulcers.
Ulcers are sometimes formning Sinuses of considerable extents,
which are occasionally proving very tedious in their cure, they are
kept open by the discharge which is secreted from their surface, and
which is destroying any advance which may take place towards healing.
If these are situated near the surface, the best method is to lay them open;
but if deeply seated a Bougie armed with Caustic may be used, or injections
as Tinctura Lytta, diluted with about eight [qu] times its quantity of Water;
and of these means stimulate the sides of a sore, so as to produce adhesion.
A Seton may be passed through them, which by its stimulating effects, promotes
[its] the granulating process, it may then be withdrawn, and [?]adhesion
takes place. Some of these sinuses will not heal without division, this 
takes place in muscular structure, the action of the Muscles separating the 
sides of the sore, this is the reason why Fistula in Ano is so difficult to heal,
and which cannot be done with certainty without dividing the parts.
Cutaneous Sores. When the cuticle becomes abraded, and the surface
beneath exposed, a new cuticle is then required, and to promote the formation
of this many Lotions, and Ointments have been used, as the Black, and Yellow
wash, the Ungt Hydrarg. Nit. Miti &c; the granulation of skin may be 
covered by cuticle in a few hours, by application of Sulphos Zinci gr i
Liquor Plumbi ℥i. But if the constitution is affected, attention must 
be paid to it, and it is occuring in Children, the best Medicine is 
Calomel. Varicose Ulcers. A state of enlargement of veins, is producing
extension desqumation of the Cuticle. When they do become distended their
valves does not act proper [affect]; and the column of Blood is with difficulty
supported, the Arteries are obliged to exert themselves more than naturally,
becomes altered in their action, and secretes a scurvy incrustation, instead of cuticles



* If the Black or Yellow Wash doth not succeed. Mr. Cooper
recommends a Lotion composed of equal parts of Milk &
Lime Water -
x In Inflammation of Veins [blea] bleed both Generally, & Locally, & 
adhere to the Antiphlogistic regimen.


32
*this may be relieved by applying the Black or Yellow wash, keeping the patient in the
recumbent posture, and using a Roller applied tight round the leg. Sometimes
while the patient is walking, or taking other exercise, he is suddenly alarmed
by the bleeding of a part by the bursting of a vein, this may be relieved by 
the recumbent posture, and a dossil of lint applied to the part with a
Roller applied round whole leg; in a few days the wound in the vein heals
under this treatment, but if it is neglected, inflammation of the Vein is
x liable to take place, which is frequently attended with the worst consequences.
Varicose Veins are sometimes producing large Ulcers, which are tedious in
their cure. If the sore is inflamed the recumbent posture will be necessary,
but if they are indolent a moderate degree of exercise will be necessary.
To cure these it was formerly a common Practice to tie the Vein, which
was frequently succeeded by inflammation and many of the cases terminated
unfavourably. In could never however succeed in curing the sore,
as it was wrong in principle. The different vessels are producing different
degrees of irritability, when Wounded. The Absorbents when divided are
producing more constitutional irritation than Veins, and wounds in Veins
are attended with worse consequences than in Arteries. This is owing not
only to their irritability but to the different modes in which each are united
Wounds into Veins are frequently followed by inflammation, and an Ulcer
takes place on the edge of the wound, this requires the application of a tight
bandage below the sore, which decreases the force of the circulation in the 
part, and gives an opportunity for the wound to heal. Inflammation
takes place more readily below a tight bandage than above it. When 
suppuration takes place in Veins, the sooner an opening is made into 
them the better, if the Matter is allowed to remain, the constitutional
irritation is very great. Ulcers are frequently supported by a dropsical
state of the part, these are occuring in the lower extremities; the[y] way
in which Nature relives Dropsy is by forming an Ulcer, through which 






33
a great quantity of fluid is discharged. These Ulcers are only to be
relieved by attending to the Constitution. Sores are prevented from
healing by the State of the edges, as when the Cuticle becomes thickened,
Caustic may be applied, or the edges may be scarified to produce inflammation,
and seperate the Cuticle. Arsenic may also be used, but great
caution is necessary as it readily becomes absorbed. The edges are sometimes
becoming inverted, the sore being quite concave, this requires the
application of Caustic round the edges daily also keeping the edges constantly wet with Black Wash. This is frequently the cause
in sores arising in weak constitutions, or after the use of Mercury.
The Decoction of Sarsaplla may be used with advantage, and a 
generous diet ought to be allowed. When the edges are everted, it is 
arising either from some irritating substance, as bone, or some extraneous
body in the Wound, or from the malignant nature of the sore,
as Cancer, Fungus Hematodes &c.. Treatment of Ulcers. When these
are first received into Hospitals they are more or less inflamed, and the usual
treatment is apply Poultices, or Fomentations, and give purgative
medicines, in a few days the inflammation subsides, and Granulations
begin to arise, to hasten this process it may be useful to apply a
little weak Ungt. Hydrarg. Nit. to Stimulate. When the cavity is quite
filled and the Granulations are arising a little above the surface;
straps of Adhesive Plaster may be applied, the advantages of this
application are three, 1st.. to bring the edges nearer to each other, 2nd
to gently Stimulate the sore, 3rd. to adapt the granulations of the 
Skin to those of the surface of the sore, by which, inosculation is more
readily taking place. But this injurious in irritable sores and 
those arising from a debilitated constitution.





34
Lecture 10th.. On Mortification.
Gangrene Sphacelus Mortification are synonymus terms altho'
differently applied, they [crossed out] signify the partial death of any part of
the Body. It is produced in two ways either by previous increased 
action, or by a diminution of the nervous power from cold. The first 
is by far the most frequent cause, the symptoms are pain, considerable
inflammation of an [crossed out] erysepelatous appearance attacking the aponeuroses
Musces, and extending to some distance. When this has continued
some time a vesicle appears of a brownish colour, which discharges
when broken a bloody serum; the constitution suffers very considerably,
Rigors, and Delirium, generally come on attended with vomiting,
but the most unequivocal symptom is a troublesome hickup, this is 
taking place before Mortification has actually commenced in parts
near the heart, but not until afterwards in the extremities. The pulse
is quicker than natural. When arising from exposure from cold the effect
is different. A person exposed to Cold finds some parts as the tips of 
the Ears, or the Nose benumbed, if warmth is applied immediately considerable
inflammation is produced, which after a short time is diminishing 
it returns however several times, and at length mortification is brought 
on from the increased action. In cold climates when any part has
been exposed to cold the circulation becomes completely arrested, but
may be restored without dangerous consequences by rubbing the part with 
Snow, but if warmth is applied mortification is produced; When the
life of a part becomes destroyed, a curious process is set up by nature
to seperate the dead part, around which is a white line situated on
the living parts, this is shortly becoming vesicated, and if punctured
a small quantity of Serum is discharged. The Surgeon anxiously looks





36 
for this white line, as he then knows that Mortification has ceased, 
and here it is that the suppuration process commences. After a short
time a groove becomes formed in this line, by the absorption of the living
parts, the dead do not become absorbed, at least in a very trifling
degree. After this Suppuration is taking place, and Granulations become 
formed which are extending into the dead parts, and which absorbs a
small portion of the dead parts in contact with them. When the Skin
has seperated, the Cellular Membrane becomes in part absorbed, but as 
this part possesses but little vascularity, it generally sloughs at a short 
distance [from] nearer the heart, than the skin. The Muscles are separated a little 
shorter than the skin, but not so short as the cellular Membrane, and a 
white line is first formed round them, the same as skin. A Tendon
possesses very little living power, they slough some times to considerable 
extent, thereby occasion suppuration to take place. Bones seperate
considerably shorter than the skin, sufficient muscles and skin being in
general left to cover them, and form a good Stump. The less living 
power any part possess the further the sloughs are extending, as in the 
tendons and cellular substance. Large Arteries are divided by this
process without any bleeding taking place, opposite to the part at 
which ulceration is likely to occur. the Artery become filled with adhesive 
Matter, and this is sometimes extending a great way up the Vessel, the 
same effect is taking place with respect to the Veins. Mr. Cooper 
when young had occasion to amputate a thigh for Mortification of the
leg, seperation was taking place below the knee; he was much surprised,
on finding that no hemorrhage took place from the femoral 
artery, when the torniquet was loosed, the Artery being closed with
adhesive matter. Predisposing Causes. The principles of these 
is weakness, but it may arise from other causes. It is liable to take 
place in the Nates after some fevers, if care is not taken to prevent





36
the patient from lying continually on his Bak. In Measles Blisters
are often followed by large sloughs, and great care is necessary also in
their application in Scarlatina, sometimes under the fever produced by
Mercury in Scrophulous habits extensive sloughs are taking place. -
Old age is a frequent cause of Mortification, some parts are more disposed
to mortify than others, as those parts which are situated at the 
greatest distance from the heart and those which possess the least 
vascularity. Occasional Cause. This is generally inflammation,
there being very few instances to the contrary. Inflammation produces
mortification by a destruction of the Solds from excessive action, the exceptions
to inflammation being the occasional cause, is in Hydrothorax, in 
which dark coloured spots are taking place in the lower extremities
without any previous inflammation. When parts are severely brused,
the life of that part becomes so effectually destroyed that inflammation
cannot take place, and they immediately go on to Mortification.
Mortification is first the result of the living power of Vessels being 
destroyed by increased action, and then of the coagulation of the 
Blood in the dead Vessels which takes place in about ten minutes
after their life is destroyed. Treatment. This principally consists
of two things, first to prevent it actually taking place when threatend,
and in the management of it when it has taken place. When parts are
disposed to mortify local but not constitutional bleeding may be
had recourse to, to remove the congestion of the vessels, this may be
done either by leeches or scarifications. Poultices and Fomentations
may be applied to subdue the inflammation. But Opium must principally 
be relied upon, this diminishes the frequency of the Pulse, and
strengthens the force of circulation. Stimuli ought not to be given
when the Pulse is quick, the tongue dry, and the secretions stopped.
Purgatives ought to be given, but great care is necessary, as they are -





37
very liable to bring on Diarrhea, which very much hastens Mortiftion
Steel may be used with advantage, as it strengthens the general
power without too much excitement. Inflammation of an Erysipelatous
kind in the country may require bleeding but in town it 
requires a contrary treatment, as Bark and nourishing diet. -
Leeches and Evapourating lotions may be applied to the part In caces 
of Sloughing you may apply slightly stimulating poultices as of 
Port Wine and Bread, or stale Beer grounds, fomentatious as hot as 
the patient can bear them, this is to be done with a view to excite
the surrounding parts into a state of inflammation. When the
process of Granulation has begun the Nitric Acid wash may be used
with advantage, this hastens the formation of Granulations, and removes
any unpleasant smell, which is sometimes very distressing to the patient.
In Children the Black wash will be found most serviceable. Opium may 
be given here with advantage. Bark is apt to disagree with the Stomach
Ammonia either alone or combined with Musk is extremely useful.
The constitation may be supported with Port Wine, or Spirits accord,
to what the patient has been accustomed. Amputation is generally 
[crossed out] unnecessary except where seperation is taking place at an inconvenient 
part; Nature will generally be sufficient, but the Bone may 
be sawn through to hasten the process. When the patients constitution
is weak and not able to support the process, it will sometimes better
to amputate. But it must not be done until Mortification has entirely 
ceased, and the Granulations must be perfectly healthy, or else the stump
will afterward Mortify - When mortification occuring from life of 
a part being suddenly destroyed, or where it is quiet local, the operation
may safely be performed, to prevent the extension of it, but where it
arises from constitutional causes the stump will mortify if the operation
is performed before it has entirely ceased. Old people are subject to [motification]





38
of the toes and feet more especially if they are tall, this is frequently
arising from the Ossification of the blood vessels, and on this account very
unmanageable; they are subject to it also from very slight causes, as a 
small cut, or abrasion, the disease is returning here if any operation is performed.
The whole limb ought to be rubbed with Linimt.. Ammonia which
increases the force of circulation or action, and it should be kept very warm
being wrapped in Flannels.
Carbuncle is an abcess forming in unhealthy constitutions, the cellular
membrane dies under the formation of Matter great pain is felt in the part
before the disease appears, general hardness, livid colour of the skin 
then takes place; a number of openings form in the [lives] part of the skin,
and the cellular membrane sloughs away through them. Granulations shoot
up from the Muscles, throwing off the cellular substance. When these are taking 
place on the[y] back they generally terminate favourbly, but the nearer
they are to the head the greater is the danger, and are never recovered from
when on the head. The treatment is the same as was mentioned in Sloughs,
but a crucial opening ought to be made through the skin in order to allow 
the free evacuations of the Sloughs.
Lecture 11th On Injuries of the Head.
As the Brain supports Sensation, as it influences the motions of 
the Body, and it supports the functions of the Mind. Injuries of this
organ must of course be attended with very numerous, extensive, and
often dangerous symptoms. When the Brain is injuried the first symptom
is generally vomiting, and when severe this is coming on almost immediately 
after the accident, this is occuring from sympathy between the
Brain and Stomach, the latter being supplied with nervous influence
immediately from the former, by the eight pair of nerves.





39
Blood is not unfrequently vomited up, but in general this is not
proceeding from a rupture of the Vessels of the Stomach, but of those
of the Nose. and as the patient lays in a recumbent posture the blood
trickeles down the Œsophagus. Bleeding from the Ears is a dangerous
symptom as it seldom occurs unless the Bones of the Skull are fractured.
The pupils of the eyes are sometimes contracted, but more frequently
dilated, and it now and then happens that one is contracted, and the 
opposite one dilated, this arises from the injury being received on one
side of the head affecting the eye on the opposite side. There is a general
loss of motion, and sensation; but the latter is not quite complete, but
in the most extensive injuries the patient betrays some degree of
feeling when operated on. The Fœces and sometimes the Urine are
discharged involuntarily, but more frequently a suppression of 
Urine takes place, and a Catheter is obliged to be had recourse to
Hemiplegia is sometimes produced. Occasionally the patient is only
stunned, and recovers immediately; but in more severe cases the mental 
powers [and] are not unfrequently weakened [fro] for the remainder of life.
The degree of diminution of the mental faculties is various, the patient
will sometimes continue to perform many things that they have been accustomed
to from the force of habit, although in other respects they are
quite irrationable; besides the above symptoms, the Bowels are costive;
the Heart acts laboriously, and the Pulse is slow; the Respiration is often
affected, the apoplectic stertor being frequently occasioned. The causes producing
these symptoms are two Concussion, and Compression.
Concussion is such a commotion of the Brain, as occasion either
an attraction of the action, or a Lesion of its substance. It is to be distinguished
from Compression by the patient appearing to sleep as in health, but
in compression the patient has the [aplopec] apoplectic stertor. The pulse 
is not affected while a sleep, but as soon as he begins to make any exertion





40
it becomes very much affected. But it is frequently very difficult to distinguish
between them, as when concussion produce Lesion, extravasion of Blood
is frequently taking place producing compression. It has been said
that on dissection of those who die of concussion no effect whatever
could be discovered on the Brain, but in those cases that Mr. C.
had an opportunity of examining the Brain he has generally found
more or less lesion and in one case he found a seperation of the Pia
Mater from the Brain had been produced. In concussion the danger is
arising from the subsequent inflammation which is set up, and in
caces where lesion is suspected extensive blood letting is necessary, but 
where that is not the case, moderate bleeding may be sufficient. In 
some cases where it has not been severe, the patient has been much releived
by vomiting, after this has taken place, the senses frequently
return; this has induced some Practitioners to give Emetics, and sometimes
this has been done with advantage, but where the injury has
been severe it is likely to be injurious, rather than serviceable.
The first object is to take a way a pretty large quantity of Blood, and
Mr. C. thinks this has quite as good an effect when taken from a
Vein in the Arm, as when the Temporal, artery, or Jugular Vein is opened.
Sometimes patients are labouring under such depression of Spirit,
that it is unsafe to take blood away immediately, but this may
be done with [crossed out] advantage, when the pulse is becoming quick, or stronger.
As the only view of removing Blood is to prevent the subsequent
inflammation, it would perhaps be safe in general to wait a short
time as little or no advantage is gained from bleeding immediately, and
it is sometimes [ad] attended with danger. In most cases therefore 
it will be advisable to wait until the nervous energy has regained
itself a little. The quantity of Blood required to be taken away is 
greater in concussion than in any other injury. Mr. C. once had a-


* In slight caces & when the Inflammation is subdued Mr. C.
advises the Bowels to be kept open with Calomel & the Sulphate
of Magnesia & the Scalp to be rubbed with Ungt Lytia or the
Linimt. Ammon: cum K Lytia; Electricity may be tried; but
when Irritation does not produce the effect, nor will it always
especially in people who are low & Nervous apply an evapourating
Lotion to the Scalp either of Other & Water or Spt. of
Wine & Water; & give the following Draught three or four 
times a day. Ry Ammonia Subcarbonates gr viij Aqua Mentha
Sativa ℥iss Tinctura Cardamomi Composita ʒi Misce - 


41
[case] patient from whom he took 208 Oz of Blood in the space of eight
days. If Bleeding is not strictly attended to and performed, as soon as
any inflammatory action shows itself in the system; Matter is thrown
out on the Brain which is producing compression, and the effusion is
not readily again removed. At the same time that the above depleting
plan is followed up, Purgatives ought to be freely given, Calomel in
the dose from three to five grains twice a day, combined with Sulph:
Magnesia et Sufusi Senna may be given; Acidulous drinks may be given
at the same time, with a view to irritate the intestines and by increasing
the circulation in them, to releive the Brain, by diminishing
the vascularity of that organ. In Children where bleeding cannot
be carried to so great an extent, Leeches may be applied to the Temples
The secretions of the Skin ought to be kept up, and for this purpose
Antimonials ought to be given, all sudorifics containing Opium
ought to be carefully avoided. Bottles filled with hot water should
be applied to the feet, this promotes perspiration, and in some
caces decreases the circulation [of it] in the Brain, by increasing it in 
the extremities. Blister must only be used very sparingly in the active
stage of the disease, and not so as to stimulate the system; in more 
remote stages they may be serviceable. In caces of Concussion no
operation is required, it adds considerably to the danger without 
being attended with any good effect. In the remote [cases] effects
as Idotism, or Insanity, little can be done, except when it depends
upon some extravasation. * In slighter cases as pains in the head,
the shower bath may be used with advantage, as well as shaving
the head and applying cold evaopating Lotions &c..




42
Lecture 12th.. On Compression.
Compression is arising from three causes, the extravasation of 
Blood, the pressure of Bone, or the formation of Matter. The
symptoms of extravasation, are in addition to those of Concussion,
the apoplectic Stertor, a slow irregular, or intermitting pulse, 
with one or both pupils dilated. If these symptoms are brought on
immediately, it may be infered that they are proceeding from a portion
of Bone, if they come on gradually, from extravasation, and if not
[from] for a length of time, from the formation of matter. In the treatment
of extravasation, there are three objects in view, 1st.. to prevent inflammation,
2nd.. to promote absorption of what in extravasated, 3rd.. to prevent
as much as possible greater effusion from taking place. These are all to
be accomplished in a great measure by bloodletting. The Blood is situated
either between the Dura Mater and Skull, where the quantity of Blood is
depending upon the size of the ruptured Vessels, and is sometimes amounting
to two or three Ounces, between the Pia Mater and Funica Arachnoides; or
between the former, and the substance of Brain, or lastly into the Brain
it self; the symptoms into all these situations of the Blood, are generally the 
same, except in some parts, it is affecting only one eye. It will be necessary
to take away Blood from the arm freely, and to give purgatives, automonials
will be found useful by acting up the Skin; if the symptoms continue it will
be necessary to trephine if the situation of the extravasated Blood can be found;
it is sometimes difficult to do this as for instance a person receives a violent
blow on the head by which he knocked down, and strikes his head on the
on the oposite side, it is not easy to determine whether the original blow,
or the one received in falling is productive of the extravasation, if this can 
be determined, it will be proper to trephine, and if you find extravasation




43
on the external surface of the Dura Mater, the symptoms will be immediately
releived, but it will be wrong to repeat the operation if you are unsuccessful
at first; it has been recomended to open the Dura Mater if Blood is supposed
to be beneath it: but this is very dangerous, wounds of this membrane
being seldom recovered from. When a portion of the bone is
removed there is an appearance which one might suppose was occasioned
by a fluid under the dura Mater, by that membrane rising and 
feeling quite flacced. Fractures of themselves produce no symptoms
of injury to the Brain, if these symptoms are arising, they are produced
by Concussion, or extravasation under the fracture. Fractures of the Base 
of the Skull are seldom recovered from, the injury received being so
great as to produce very violent symptoms of concussion or extravasation,
these cases generally occasion bleeding from the Ears, because the
the fracture is usually extending along the petrous portion of the Temporal
bone, however some cases have been known to recover, of the symptoms
are not severe there is no reason why the fracture ought not to be united 
in the Base as in any other part of the Skull. Fractures of the scale require
depletion, and if there arises no symptoms of compression, no operation
will be required, but if this should be the case it may be proper to trephine.
Fractures are sometimes occasioning depressions, but this is not always
productive of bad consequences, although at a superficial examination
the depression may appear considerable, it is to be recollected that the 
external plate of the skull is depressed considerably more than the internal.
Fractures are divided into Simple and Compound. Depression is sometimes
accompanied with symptoms of injury to the Brain, at other times not,
sometimes remote injuries are arising, as inflammation this is taking
place from ten to fourteen days after the accident depression may occasion
a total [‡] loss of the powers of the Mind for some weeks, but these will
immediately return, as soon as the portion of the Bone is raised. -


x In Compound fracture Mr C. advises the depressed bone to be raised
with the Elevator if possible, if that is not sufficient the Trephine 
must be had recourse too immediately after the Accident;
performing the operation when Inflammation of the Brain
has come on will be of no use. - 



44
A remarkable instance of this occured in a Sailor who lay quite
senseless under an accident of this kind for thirteen months, and who
recovered his senses about three or four days after the depressed
portion of bone had been removed. Depression occasionally gives
rise to Epileptic symptoms, by the irritation produced by a small
portion of Bone pricking the Dura Mater. If there is no wound in
case of depression, you simply prevent inflammation by depletion 
it is a bad practice to make an incission through the Scalp to find
a depression if there are no symptoms to indicate it. There is 
frequently a strong appearance of depression, this is arising from
the cellular membrane being so much condensed by the Blow, that
the extravasated blood cannot penetrate the cells of the part, but is 
powered into the surrounding parts, which swell up considerably so
that a hollow is left which may be mistaken for depression. When
depression is accompanied by a Wound, the depressed bone ought to
be immediately raised, otherwise inflammation is produced, and it
is dangerous to wait until that commence, no advantage being obtained
from raising the depressed bone. In simple fracture of the 
skull it will be only necessary to use depletion freely, if there are
no symptoms of compression come on it will be unnecessary to 
trephine; but if symptoms of compression come on it will be necessary
to trephine.X If the fracture is compound it will be necessary to trephine
whether there are any symptoms of compression or not. and if there is
depression the Bone must be raised. Cases however has been known
to recover, where no operation has been attempted, but the generally
prove fatal. 




45
Lecture 13th.. Inflammation of the Brain.
The third course of compression is the formation of Matter in the 
substance of the Brain, or its membranes. Inflammation is not 
taking place soon after accidents, seldom in less than six or eight
days, and frequently not for even two or three Weeks or more. Patients
having had injuries of the head, are not free from the danger of having
inflammation brought on by rather more exercise than usual, or 
by any excess in drinking for some considerable time. The symptoms
of inflammation are either constitutional, or local, of the former
rigors are most general, they however are always present, but for the 
most part two in twenty four hours, sometimes they are occuring more 
frequently, there is generally some fever present soon after the rigors
commence. Coma is generally produced, not very severe at the first,
the Patient becomes sleepy, and is with difficulty roused, but where that
is done the mind is still perfect, and after a time the Coma becomes
more considerable, the loss of Mental faculties is complete. There is 
nothing to be judged of the feel of the Pulse at the wrist, but the
Carotid arteries beat with extreme violence. When matter is formed
on the Brain hemiplegia is frequently the result this is affecting
the opposite side to which the matter is formed; Epilepsy is sometimes
also brought on, which affects both sides, but sometimes one more
than the other. The local symptoms are pain in the Head, inflamed
state of the Eyes, intollerence to Light, the Scalp becomes Odomatous,
and the Wound cease to secrete and becomes glassy, from the granulations
ceasing to convey Blood, the adhesive substance sereted
becomes transparent, this is arising from the want of inflammation
because of the increased circulation internally. Matter is found in
different situations. 1st.. Between the Dura Mater and Skull. (Over




46
2nd In the Sinuses. this is taking place either from Ulceration through
the Dura Mater, or from an original abscess in the sinus. 3rd Either between
the tunica Arachnoidea and the Pia Mater, or between the latter
and the Brain. The first of these is unfortunately not taking place
so often as the others, it is the only one in which operation can 
be serviceable. The Cause of inflammation after injuries of the Head
are various. Severe concussion, extravasation of Blood in small quantity
from being neglected, pressure of a portion of bone, inflammation of the 
Scalp, wounds of the Brain, these are all liable to bring on inflammation, 
and consequent formation of Matter. Wounds of the Brain
are not necessarily fatal even when large quantities of Brain have
been lost. Patients have been known to do well. They do not produce
immediate alteration of the functions of this organ, it is when they
are occasioning extravasation, and consequently symptoms of compression
they immediately destroy the mental powers. In cases of depression
where portions of Brain are expelled equivalent to the depression, there 
are no symptoms of compression arising. Hemiplegia is not unfrequently 
arising from wounds, and is attacking the opposite side to
which the wound was received. When a wound has been received in the
Brain, a fungus is generally projecting from the Dura Mater, this consists
of coagulated blood, adhesive matter which is thrown out by the Brain
and a small portion of the Brain itself, this sometimes continues to throw
off Sloughs until a considerable portion of the Brain is removed. The
mode of treatment, if the fungus is not arising above the skin is merely
to apply Lint dipped in a Lime water, or some other astringent with
straps of adhesive plaster, and over that a Roller so as to produce a
considerable degree of pressure; if the fungus arises above the skin it
must be removed first by ligature, for if pressure is applied previously
it [‡] will produce symptoms of Compression. This will generally succeed


{Mr. C. thinks Depletion, and Antiphlogistic regimen will be the
best way of treating this disease - he never saw a case of Carbuncle
upon the Head that got well- 



47
if the opening is not large, but where that is the case it will generally terminate
fatally. It used to be the practic to enlarge the opening in order to 
allow the Slough to come away freely, but this is attended with great
danger and no advantage. The treatment of inflammation consists in
[pl] depletion, either from the arm, or jugular vein, and in more severe
cases advantage is obtained by opening the temporal artery. Purgatives
freely administered external irritation by means of Blisters to the Head.
When rigors are occuring it is advisable to trephine. But unfortunately
little advantage is derived from this, unless the matter is situated between the
Dura Mater and the Skull, in this case the matter appears through the
teeth of the saw, as soon as they are through the internal table. There
is no hope of a recovery when it is situated in the substance of the Brain
or even under the Dura Mater, in the latter case it will be of little or
no service to puncture that membrane, but it may be done as a last 
resource. { After injuries of the head Erysipelatous inflammation is
attacking the scalp, more frequently when the injury is attended with 
contusion, there is then considerable danger, the inflammation is sometimes
very severe from slight injuries; they are productive of inflammation
of the Brain, from the free communication which there is between the 
internal and external parts. The treatment in these cases is to give
Bark in considerable quantity, after having given purgatives.
Operation of Trephining. The Instruments required for this operation
are few at present, they were formerly more numerous and complicated. -
A Scalpel with two edges, the one to devide the integuments, the other to 
separate the pericraneum from the bone; a crown of a trephine with a 
centre pin fixed by means of a screw, a handle by which this is worked 
and an Elevator. The places at which it is improper to trephine, are
1st. the Frontal Sinus, 2nd. in a line extending from the Nose longitudinally 
to the Occiput, 3rd. the anterior angle of the Parietal Bones:


~ Mr. Cooper prefers a Crucial Incision providing the Fracture
is not extensive. [?] After the bone is removed bring the edges of the wound
together & apply a Poultice over them - until Granulations arise.
If the extravasated blood is situated under the Trephined part
let it be separated by nature, but if it is situated under
the bone & Dura Matter further than the trephined part & is
producing Compression, you must remove it with a Director is
Puncturing the Dura Mater will be of no use. -
Exfoliation of a portion of the Cranium from Accidents with symptoms
of Inflammation of the Brain, the operation may be had recourse to -
Injuries of the Scalp frequently produces Inflammation of the Brain
owning to the communication which the Pericranium has with the 
Dura Mater by means of the Diplöe: the appearance after death in those
who die from injuries of the Scalp (fourth or fift day) we find the Dura
Mater inflamed. & a quantity of [blo] fluid between the Pia Mater
& Tunica Arachnoides - In Eruptive diseases of the Scalp Mr. C -
recommends the Yellow Wash, and the Bowels to be kept open with
Calomel &c. - Injuries of the Spinal Marrow are similar to those of the
Head; in Concussion of the Spinal Marrow upon the Loins apply
Cupping Glasses, & Bleed from the Arm if necessary, also keep the 
Bowels open, afterwards apply a perpetual Blister if necessary.
Extravasation of blood upon the Spinal Marrow takes place now &
then it produces gradual Paralysis of the Lower Extremities; we sometimes
have pressure upon the Spinal Marrow from fracture of the vertebra;
in these cases but little can be done - 


48
4th the posterior inferior angle of the same Bones. The incision is
to be made in that way in which the fracture can be best traced,
but more of the Scalp ought not to be separated than is absolutely
necessary, as exfoliation of the Bone is liable to take place, and delay
the cure. After sawing for some time the pin is to be removed as soon as
the saw will remain in the groove without [ut] it, having passed the deploe
great care is necessary, and it will be proper frequently to feel with
a probe whether you are through the Bone or not. It will be necessary 
to bear in mind that Children, and old people have no deploe. As soon
as one side is sawn through, the Bone ought to be raised with Elevator,
if you wait to saw the whole through you will very much endanger the
Dura Mater. Having [the] removed the Bone, apply a dossil of Lint to
keep up the discharge, and bringing the edges together heal by the adhesive 
process. 
Lecture 14th.. On Hydrocele.
Hydrocele is an accumulation of water in the tunica vaginalis testis, not 
betwen the tunica albuginea, and tunica vaginalis, but between the two 
coverings which the testicle receives from the tunica vaginalis. There is also
a collection of fluid sometimes taking place in the tunica vaginalis of the
Cord, this is called Hydrocele of the Cord.
Symptoms. These are swelling begining at the lower part of the Scrotum
and extending upwards, taking on the pyriform shape as it enlarges but
this it again looses when very large, an undulating motion may be perceived
through the whole extent of the swelling, at first it is soft and easily gives
way to the finger, but becomes more tense as it enlarges; it is unattend
with pain until it has much increased in size, when that is the case the
pain is felt in the Loins, arising principally from the weight of the tumour





49
the veins are sometimes a little varicose, the Scrotum is not discoloured,
the tunica vaginales is not adhering more than natural to the Scrotum
which may readily be moved upon the tumour. It is generally transparent, 
very seldom otherwise if proper examined, to do this the tumour
should be grasped at the posterior part so as to dilate the fore part of
the Sack, and make it as tense as possible, if while it is thus held, the 
room be darkened and a candle brought to the side of the swelling the
light may be perceived to shine through, this is however sometimes
not the case, from the thickening of the tunica vaginalis, or from the 
discoloration of the fluid contained in it, which is found upon examination
to be pure Serum. It sometimes happen that hydrocele is formed
on both sides, this however is a rare occurence.
Varieties. It is sometimes divided into two swellings, one extending
from above the Abdominal ring [downwards to the Scrotum] towards the 
abdomen, the other extending from the ring downwards to the Scrotum, this 
is very liable to be mistaken for hernia congenita, when thus formed it dialates
on Coughing, a part of the fluid being under the tendon of the external
oblique, is forced down by the contraction of that muscle. In this case the
only criterion of the moment is the transparency, but from its history more
may be learned, if it has gradually increased in size, and has never returned
into the Abdomen, we know immediately it is not Hernia. Hydrocele
not unfrequently communicated with the cavity of the abdomen; in this 
case it either may or may not be accompanied with Hernia Cogenita sometimes 
the aperture in the tunica Vaginalis is large enough to allow intestine
to discend, at other it is so small that water only can pass through it,
when the Patient is in recumbent posture, the water passes readily into
the Abdomen, this is generally thought to be Hernia and a Truss is applied,
but still the tumour returns when the patient is erect, the mode of practice
in this case is peculiar, a truss is to be applied, to bring on adhesion of the 





50
side of the aperture, so that all communication is cut off from the Abdomen, 
and then of the Hydrocele continues it may be tapped. In Ascites communicating
with the Scrotum it is sometimes preferable to puncture the Scrotum, and
allow the water in that way to escape, than to perform the operation in the 
usual way, and afterwards cure the Hydrocele. The pressure of the fluid upon
the tunica vaginalis is sometimes occasioning inflammation to take place,
which is succeeded by a thickening of the tunica, it has occasionly been ossified
from the same cause. It is this which occasionly destroys the transparency so 
peculiar to this disease. The Tunica Vaginalis is sometimes found adhering
to the testicle, which occasions the difference we sometimes find in the situation
of the latter. It is usually found at the under and back part, but in 
consequences of adhesion, it is occasionally found at the fore part of the 
tumour, or some times at the upper part, this requires a good deal of 
caution, as mistakes have been made in this respect, and the testicle
punctured by the trocar; it may generally ascertained by making
pressure on the part, when that part of the tumour is pressed where
the Testicle is situated, a sensation is felt as if the testicle
was squeezed. Within the tunica Vaginalis cysts are sometimes 
formed which baffle all attempts to cure the Hydrocele, after the 
fluid has been evacuated, these [G] Cysts go on enlarging soon reproduce 
the disease. Sometimes Hydrocele may happen in the Cord 
accompanied by a descent of the intestine, which is sometimes formed 
into a sac containing fluid in one of these instances Mr. C. tapped
the swelling and a fluid was discharged, differing from Serum in not
being coagulable by heat. Hydrocele is distinguished from diseased
testicle by the latter being much heavier, the form of the testicle being 
in some degree preserved, a little flattened at its sides, the Epidydimus
also [for] retaining its shape, and if the testicle is squeezed when 
enlarged, the same sensation is felt as when pressure is made on a healthy one 





51
In Hydatid enlargement of the testicle it is more difficult to discriminate, 
the fluctuation is only partial in this and does not extend from
side to side as in Hydrocele, there is also a feeling of elasticity by which 
the finger is in some degree raised when pressed; there is more pain generally
in enlarged testicle. Hernia Congenita is liable to be mistaken for
Hydrocele. Hamotocele is rather difficult to be distinguished from it also,
this has the same shape as hydrocele, but is more firm, is not transparent,
generally arises from a Blow, and is formed rather suddenly. In speaking
of this last disease, it may be well to remark the necessity of making 
an incision first into the tunica Vaginalis, to ascertain wether
the testicle is diseased or not previous to taking it away, as Mr.
Cooper has seen several caces where sound testicles have been removed,
when thought to be enlarged, it having been hamatocele merely.
The first incision made in this operation ought always to lay open 
the tunica vaginalis. Cause. This is said to be either increased 
circulation in the part, or diminished action of the Absorbents, but
Mr C. is of Opinion that no dropsical accumulation whatever is 
taking place from the latter, as the absorbents when injected in caces
of dropsy are always found increased in size, which is a proof of their
having undergone increased action. It is from a greater determination
of Blood to the part, not ammounting to inflammation, a relaxed
state of the Vessels, which are always larger and more numerous; if 
it was inflammed [action] no secretion would take place.
Cure of Hydrocele is left to nature, she will set about a mode of cure.
When it has become excessively large, Inflammation is set up in the 
whole Scrotum, which sphacelates in some one point only, this seperates 
at the edges, [only] and through the opening thus made the water
is discharged, the internal surface of the tunica vaginalis is exposed
granulations shoot up and a cure is thus performed. - 





52
When Hydrocele is burst by accident the water may be absorbed, and 
a tempory cure be the result, but the disease is apt to return. 
When a blow has ruptured a vessel, hamatocele may be produced, although
the water of the Hydrocele has become absorbed.
Lecture 15th.. Hydrocele Conted..
Treatment. This consist is either in palliating the disease, or 
radically curing it. The first consists in simply drawing off the 
Water, there are some persons so timid that they will not submit to
any other means being used, this may be done either with the Lancet
or Trocar, but the former is not so well adapted for the operation as 
the latter, the objections to it are principally two, first it is generally
attended with more bleeding from the divided Vessels, which in some
caces passes into the tunica Vaginalis, and forms hamatocele, the
second is because you cannot so completely empty the sac, a 
quantity of fluid remaining at the bottom of it. The Trocar is
to be passed into the Hydrocele, two thirds of its lenght downwards,
and inclined obliquely upwards, and backwards, if passed immediately
backwards it will be in danger of wounding the testicles
The Water being drawn off no other steps are further necessary 
than applying a peice of adhesive plaster over the wound. This 
operation [b] will be required to be performed every six Months
in the general way. But where it becomes necessary to draw it off more
frequently it will depend upon some Hydropic state of the constitution,
and recourse must be had to Medicines for relief, such remedies
must be taken as proves servicable in other forms of Dropsy.
But where it only forms about twice a year, it is a local disease
and cannot be affected by constitutional remidies. -





53
After the operation an evaporating Lotion may be applied; this will
seldom prove a radical cure, altho' instances have been known in
which it has succeeded. Simple as the operation is yet they are some
habits so very irritable, that it is followed by a good deal of constitutional
irritation, and Mr. C. has known two caces in which it
occasioned death, from the very violent inflammation which is set up.
Radical Cure. This attempted on three different principles, 
first by promoting Absorption, secondly by the process of adhesion
and thirdly by the process of granulations. It is very rare that 
the first of these succeeds, except when occuring in Children, when 
it may be had recourse to with advantage. Children soon after
birth are occasionally affected with Hydrocele, here a Stimulating
Lotion of the following kind may be used, ꝶ Aqua Ammonia Acetatis
℥iv Spt. Vini Rectift. ℥ss Ammonia Muriatis ʒij Misce. This being 
applied to the Scrotum sets up such a degree of irritation as will
occasion the absorption of the Hydrocele, and subsequent adhesion of
the Tunica Vaginalis. If it is not strong enough to occasion some 
degree of pain, and excoriation, some addition must be made to it, 
but if it is used too strong it may bring on constitutional irritation. 
The process of adhesion has been promoted by many different methods,
first by introducing extraneous bodies as Quicksilver, a few globules
of this thrown in, by its pressure on the most depending parts
produces ulceration, and such a degree of inflammation in the whole
tunica Vaginalis as shall produce Adhesion, Ulceration going on until
the Quicksilver is thrown from the opening made by it through the 
integuments. This method was however objectionable, as was also
the one which succeeded it that of introducing a peice of sponge
tent. Potts strongly recommends a Seton being passed, but this is not 
safe except in the case of Boys, about eight [9] years of age, in whom the


F. If the Scrotum is distended Mr C. thinks it causes the Cremaster.
Muscles to contract which will force the Injection into the 
Cellular Membrane._



54
Stimulating Lotion will not succeed, a single thread may be passed
though the Scrotum, with a curved needle, and allowed to remain
until inflammation is set up. Caustics where next employed but they are 
productive of great constitutional irritation, but the greatest objection 
to them was the difficulty of knowing when to leave off their application, 
and if employed too long they where productive of the worst effects.
Granulations are produced by excision, or incision, the operation for
excision was at one time very common, this was excessively painful,
and followed by a great deal of constitutional irritation, 
in this case the whole or greater part of the tunica Vaginalis was
removed. Incision was then used, this consisted the laying open
the tunica vaginalis from the top to the bottom of the tumour, 
and exposing the internal surface of the tunic, and sprinkling 
flower upon it to prevent Adhesion. This way occasionally be 
necessary when the testicle is suposed to be diseased and when it
is wished to be seen, to ascertain whether it is so or not. 
Injection The apparatus necessary for this is merely an elastic
Gum Bottle, which ought to hold about four Ounces, which will in
all caces be sufficient, [are] F as it is very improper to distend the 
tunica Vaginalis, but the Scrotum should be agitated a little while 
the Injection is in, the best fluid we can use is a Solution of
Zinci Sulphas in water, in the proper portion of a Drachm
to a pint, if wine is used, equal parts of that and water are generally 
recommended, but the strength of this must be very uncertain,
as the quality of wine is so various. Brandy has been prefered
by the some, in proportion of one part of that to five of water,
these however may be made stronger or weaker according to the
irritable, or indolent habit of Patient; when the Injection is 
about to be introduced, it will be very necessary to attend to the Canula





55
and prevent that from escaping from the tunica vaginalis, which is 
frequently occuring, the injection passing into the cellular membrane of the 
Scrotum, where it produces inflammation which is followed by sloughing,
and if the patients constitution is not good it may be productive of
death. The injection should be kept in about four or five minutes, according 
to the degree of pain it produces, in some it cannot be retained more
than two minutes, while in others it produces very little inconveniance in
the five minutes, but it never ought to be kept in longer. The subsequent
Inflammation does not depend upon the pain produced by the Injection.
The pain is first felt as if the testicle is squeezed, then in the Groin,
afterwards in the Loins, but in some instance it is felt very acute at 
the neck of the Bladder immediately after it is thrown in. Great care 
must be taken in the after treatment; if pain does not come on in
five or six hours after the operation, the patient should walk about 
to produce it, but if the pain comes on he should keep in the recumbent 
posture, if pain should not comes on by the second day, the scrotum should 
be rubbed, no bandage should be worn, he should walk about, and live 
well, even wine may be allowed until the Inflammation is excited. If 
this is too severe evaporating Lotions may be used. We may kow whether
a proper degree of inflammation has taken place by the redness of the 
Scrotum, its soft feel, its in elasticity, and odematous feel. In some
constitutions the inflammation will go on to the suppurative stage,
and this whether the injection has been used weak or strong. If the Abcess
points it may be punctured with a Lancet; no very dangerous consequences
are likely to ensue from this, but the patient is obliged to be confined
longer when Hydrocele is accompanied with enlargement of the testicle, this
should make no difference in the treatment, provided the disease is 
not malignant. Some enlargements have been known to be cured by 
the injecting the Hydrocele. In Gouty patients we must frequently expect





56
to be disappointed. When inflammation is excited in them from whatever
cause, it will in general be productive of a fit of the Gout,
which will very frequently follow this operation, all signs of inflamation
having completely left the Scrotum.
Lecture 16th.. On Gonorrhea
This is not considered truly syphilitic. It commences with a sensation of
titilation in the Urethra, communicating the feeling as if a drop of urine
remained in it, on examining the Glans penis it is found inflamed, in 
a few hours these slighter sensations become converted into pain with
Ardor Urina or external heat in voiding the urine, this is from the 
natural secretion of the part being stopped, after a little time it
passes with difficulty, and the stream becomes forked, this is followed 
by a considerable discharge of Mucus from the Urethra, which in a little 
time becomes yellow, and sometimes has a greenish tinge, now and then
it is mixed with Blood, and from this appearance we can judge of the [dre]
degree of inflammation which the Urethra has sustained. Sometimes
flakes of adhesive Matter and discharged which continues for a length
of time. The Inflammation extends over the Glans Penis, and 
begins to affect the prepuce, which swells and looses its sensibility
and Phymosis is sometimes produced, the next appearance of its effects
is on the Absorbent system, these vessels may be felt on the Dorsum
Penis, like cords with knots on them, this occurs more frequently in Gonorhea 
than in Chancre, sometimes two or three may be felt, at
other times only one, the Absorbent Glands in the Groins become
affected producing sympathetic Buboes, there are several of
them generally affected. It is in consequence of the inflammation
extending along the inner coats of Absorbent vessels





57
and communication with a Glands in the groin, they are therefore
improperly called sympathetic. These are the effects produced by
the external course of Gonorrhea, but besides these it usually affects
the internal part of the penis, not unfrequently producing abcesses
of the Lacana, this not only occurs anterior to the Scrotum, but
often takes place in the Perineum, producing fistula in perinea,
this occasioned by the mouth of the Lacuna being closed in consequence
of the inflammation, their secretion not being allowed to escape.
A Chordee is sometimes also produced, this is from inflammation
existing in the Corpus Spongiosum, which is not able to be distended
at the time of erection, with the Corpora Cavernosa, it becomes incarnated
Inflammation of Gonnorrhea when extending to the membranous part
of the Urethra is laying the foundation of Stricture, which occurs most frequently
just where the penis is joined to the Urethra. Another affection arising
from Inflammation extending internally, has its attack on the parts
surrounding the lower part of the Penis occasioning a spasmodic contraction 
of the Accelaratores Urina, and muscles of the perineum. When the inflammation 
extends so far in the Urethra as the Vera Mantanum, the 
testicle is generally becoming affected, "that is inflamed", prior to this the
Vasa deferentia becomes affected. Sometimes the Prostrate Gland is 
becoming inflamed. If Gonorrhea occurs in old persons, in five or six days
they complain in difficulty in making water, rendering it necessary
to introduce the Catheter, from enlargement of the prostrate. The
Bladder in these cases is affected, and there is frequent inclination to 
make water. The kidneys are rarely affected unless from Stricture. The 
time, which elapses from impure connection, before the symptoms
appear, is from four to seven days, sometimes however we meet with
persons who do not perceive any thing until three weeks, or more after
connection, but here we should be on our guard, not too precipately to -





58
to pronounce such cases gonorrhea, it is generally the result from some
other irritation. The seat of Gonorrhea is in the Lacuna of the Urethra, and
principally in the Lacuna Magna, though the whole are generally affected.
There is no appearance of ulceration in the urethra, if opened after death
a strong blush may be observed continued about two inches down the
Urethra, sometimes it is extending further down, but with regard to the 
Specific Inflammation of Gonorrhea, it is confined to within two inches
of the extremity of the Urethra. The mode in which Gonorrhea is produced,
is by the application of poison to the lips of the Urethra. It is not by absorption 
that the symptoms are produced, as the absorbent vessels take their 
course from within outwards. As to ulcers in the Urethra there are non existing.
Abcesses of the Lacuna often burst into the Urethra, and matter is
discharged from it, this has given rise to the idea that an Ulcer must exist
there. Gonorrhea is founded on a specific inflammation attacking the 
membranes of the Urethra, this inflammation may be suspended for a
few days from fevers &c.. and afterwards return. It is more difficult
to cure in those who are subject to Scrophula, but with regard to treatment
it is generally easy to cure. It is only the want of not making the use of 
proper remedies at a right time, that the disease gets into a gleety
state, Mercury has little or no influence over this disease, as in persons
[crossed out] who have Gonorrhea and Chancre at the same time. If Mercury
is taken the Chancre heals, but the class remains. Treatment of 
Gonorrhea, may be divided into four stages; the first stage is the 
inflammatory, and all that we then have in view is to subdue
this inflammation by Purgatives or other means, the Sulphate of
Magnesia two or three drams - three times a day combined with a 
scruple of the Nitrate of Potash, and half a dram of the powder of 
Gum Arabic, Diluents should be taken freely, Alkaline remedies may
also used; The Liquor Potassa thirty drops three times a day is very useful





59
when the Ardor Urina is great, especially if combined with three
grains of the Ext. Conii. Opii gr i. Camphor gr iij may also be given
every night with great advantage. The Carbonate of Soda, or Soda
Water is often servicable though it disagrees with some; if the 
inflammation still runs high, we should apply Leeches to each 
side of the Glans Penis, the sores they produce readily heal. They
should always be used if the inflammation extends far down the
Urethra, and Poultices, or Fomentations, should be applyed. When the
Ardor Urina is excessive we should give Opium. It is not proper to 
use Injections of any kind in this stage of the disease. After the 
inflammatory symptoms have abated, the second stage commences, it is 
then proper to give the Balsam Copibia gtt xxv three times a [dy] day,
either alone or combined with Gum Arabic, Almond Mixture, of Sulphic.
Acid, these have considerable power in diminishing the discharge,
but we must occasionally give a purgative; we may give the following
Mixture with advantages. ꝶ Balsam Copibia ℥ss Mucil Acacia ℥ij
Mist. Amygdala ℥iii & Liquor Potassa ʒij Misce Capiat Coch ij
ampliumter in dies. Apply on the extremity of the Penis the 
Liquor Plumbi Dilut. with a piece of Lint under the [penis] prepuce
If we do not use remedies to stop the discharge, it will go on for Month
and terminate in Gleet. The third stage is to be treated in the following 
way, having reduced the discharge we begin with the use of Injections
the following are very useful Acidi Sulph. gtt iv Aqua ℥iv Acct Zinci
gr vi Aqua ℥iv, the Sulphate of Zinc in the same proportion, it is much
better to vary the injection than to increase the strength. Calomel with the 
Liquor Calcis. is sometimes used, and the Oxymuriatis Hydrargyri gri
Aqua ℥viij, but even then it will be found too irritating. Mr. C. thinks
the Liquor. Plumbi Acct. produces Strictures, as he has seen many 
follow the use of it, any of these used in the inflammatory stage will


[*] Pain is also felt in the Loins from the irritation passing along the 
Ureters to the Kidneys -


60
produce Strictures. Injections are commonly used about four or five
times a day, and the best instrument to inject with is the Elastic Gum
Bottle with a pipe, the injection should only extend about two inches
down the Urethra, they should be used the last [being] at night, as 
the discharge is very much increasing during the night. In the fourth
stage when the discharge is very obstinate we should frequently
pass a Bougie and use the injections; the Bougie has first the effect
of increasing the discharge, but it prevents the possibility of a 
Stricture taking place; it will often be necessary to continue the Balsam
throughout the whole course of the disease, but it sometimes produces
an inconvenience, which is an eruption on the Skin, under which 
circumstances it will be necessary to suspend its use, and give
purgative Medicines.
Lecture 17th.. On Strictures in the Urethra.
Strictures in the Urethra are of three kinds, the Permanent,
Spasmodic, and Inflammatory. Of the Permanent, the first
symptoms of this is a frequent disposition to discharg the Urine.
coming on first during the Night, this comes on long before there
is any diminution in the stream, the stream is observed to become
spiral, and when the interruption becomes considerable it is found
to be forked; the size of the stream is obviously diminished and
very narrow; an uneasy sensation is felt above the Pubes, and a
gleety discharge takes place from the Urethra, the stream now
becomes almost stopped, [*] but incontinuence of Urine now takes place
it dribbles away constantly, and the Bladder is quite unable to empty
itself, this however only occurs when the stricture is severe. In the 
begining the Urine is but little altered, but after a time flakes of




61
adhesive mater are discharged with it which gives it a whitish
appearance like whey, this takes place from the internal coat of 
the Bladder, which has become inflamed. It now and then happens
that a little blood is discharged with the urine, but this is rare, when 
they are very severe, they are productive of a kind of ague, the paroxisms
occuring one or twice in 24 hours, these do not yield to the usual remedies
for the intermittents, but are allayed by Opium. The result of neglected
Stricture are very severe. The Glans penis is subject to excoriations,
and sometimes ulcerations; the Urethra behind the Stricture becomes
considerably enlarged, but anterior [it] to it is diminished, the former
of these effects is in consequence of the force of the urine against the
stricture. The Lacuna become very much distended, frequently burst, 
and the urine is extravasated in the Perinaum and a fistula is the result,
sometimes they burst into the urethra, the Testicle is not unfrequently
affected, the irritation extending along the Vas differens to the Epididymus,
and from that to the Testicle, these becomes enlarged and have a
tuberculated feel, now and then the Prostrate gland has its follicles very
much enlarged, and filled with Mucus. The muscular coat of the bladder
becomes very much thickened, and its cavity much diminished; it will
sometimes be found nearly an inch in thickness, this is the natural
consequence of increased muscular contraction, it is the muscular coat
which becomes so thickened, the mucus membrance likewise becomes 
thickened, and inflamed, and frequently small cavities, or saculi
are formed, the Ureters become enormously enlarged; the Kidney are also
much changed, the infundibula become enlarged, the glandular texture
is entirely absorbed, and the investing membrane becomes much thickened;
Suppurative Inflammation is frequently set up, and is 
attended with great pain in the Loins. When Strictures are allowed
to go on until these effects are produced, the patient can never recover




62
his health, but will frequently fall a victim to the disease. 
The most common seat of Stricture is where the Bulb of the Penis
joins with the Urethra, this is about six or seven inches from the 
extremity of the Urethra, sometimes they are situated just behind
the glans, but more frequently about two inches and a half
from the extremity, but as they are merely inflammatory thickening
of the Membranes of the urethra, they may occur in any part of
it. It frequently happens that there is a second stricture immediately 
behind the first, of this Stricture there are three kinds, first the 
narrow, second the broad, or ribband stricture, third the filamentous.
The broad stricture seems to be [a deposit] produced, by a deposit between
the Mucus membrane of the urethra, and the Corpus spongiosum, this
is never benefited by the use of Caustic. Cause this is generally
the inflammation of Gonorrhoea, more especially if Injections are
used in the inflammatory stage; but they are sometimes depending
on other Causes. Mr. C. has seen a Stricture in a Boy only 13 years old. 
Treatment Strictures are generally to be removed by mechanical
means, which consists in introducing different kinds of Bougies.
First a soft white Bougie should be introduced, with a view to
ascertain the size, and extent of the Stricture, it should be about two
thirds the size of the urethra, it should be passed to the Stricture, and kept 
bearing upon it, two or three minutes, by this means it will become 
modelled to its shape, and we can easily find out the orifice of the Stricture
in the subsequent introduction. Bougies should always be curved, or
they will never pass into the Bladder. If any difficulty occurs in 
passing it through the stricture, it will be proper to curve the end of 
the Bougie, and when this has arrived at the stricture it should be 
turned on its axis, in order to find the opening, which is sometimes turned
aside. They should rather be insinuated through the Stricture, with




63 
slight pressure, then passed with force, this overcomes the muscular
power which surrounds the Stricture. They should be kept in above
two minutes or they will do harm by the irritation they produce, sometimes
the stricture is so considerable that the common bougie cannot be
introduced, in these caces the cat gut bougies may be used, if these do
not succeed Smith Metallic bougies may be proper, if however these are
used too small they will be liable to lacerate the Urethra, when the
strictures are so severe that neither of these will pass, recourse may be
had to the Caustic bougie previous to this being passed, a large common
one ought to be introduced as far as the stricture to dilate the urethra 
at first the caustic should only be allowed to touch the stricture, but
after it has been introduced a few times, it may be allowed to remain
about half a minute; the caustic bougie was frequently used too often,
the only circumstance which can justify its use, is when the Stricture
will not give way to other means. It is not useful in caces accompanied
with fistula in [perineao]. In this case retention of Urine cannot
occur, but in others it is frequently the use of Caustic. If [t] it is 
applied when the opening in the stricture is very small, the inflammation 
which is set up is sufficient to unite the sides of the
stricture, and retention of Urine is the consequence. It is frequently 
producing large sloughs, the Urine extravasating into the [Sco]
Scrotum, and Perineum, producing fistula in perinea, Copious
hemorrhage sometimes also follow the use of them.





64
Lecture 18th.. Stricture Contind..
Abcesses in that Lacuna, these are frequently ulcerating externally,
Matter accumulates within them, and a swelling is formed in the 
Corpus Spongiosum which may readily be felt, fluctuation may also
be distinctly perceived, if a Lancet be passed into them, the Matter
is discharged very freely externally, and in general [l] the wound readily
heals. The pressure of the Matter is not sufficient to establis the opening
from the Lacuna to the Urethra, but when the Matter has been discharged
the opening is restored, and a few drops of urine passes
through the external wound, when more urine is discharged a fistulous
opening is the result. Sometimes these abcesses burst into the urethra 
and a gleety discharge takes place, which occasionally continues
sometime. Sometimes they are situated to one side of the Corpus
Spongiosum, but more commonly in the perineum, laying the foundation 
of Fistula in Perinea, which not unfrequently destroys life.
The begin in the Lacuna, near the Prostrate Gland. The abcesses produce
ulceration and the urine becomes extravasated into the Perineum this 
is attended with considerable pain, and swelling, the matter should be 
discharged by a Lancet; after which the urine passes through this opening
when the Urethra suddenly gives way it is generally destructive
of Life, from the extensive sloughing which takes place. In these caces
the [Blood] Bladder is becoming very much diseased, and extremely thick.
Abcesses sometimes form between the Prostrate Gland, and Rectum, and
if these burst into the Rectum, the result is fistula in Ano, these
Abscesses more frequently destroy life. Treatment. When abcesses are
formed in the inflammatory stage of Gonorrhea, the sooner they are
open the better, the Matter is discharged for a day or two, and then 
ceases. When they form in the Scrotum, they should be opened as soon





65
as possible and very freely; and the same should be done when in the
Perineum, their being opened early prevents the extravasation of urine
from taking place into Scrotum, and Perineum; when fistula is
produced the best mode of treatment is to introduce a hollow Metallic
Bougie into the Bladder, and suffer it to remain in while the cure is
performed, the Sinus generally heals readily when this is done, they should 
be changed [hovever] every sever, or ten days, as the urine is rendering them
porous, and brittle, so that they will occasionally break. If the Instrument,
can be passed twice or thrice a day either by the Surgeon or Patient; it may
be done, and this will sometimes be better than constantly allowing the
Bougie to remain in the Urethra. The Elastic Catether has been recomended
it is more difficult to pass; if you cannot succeed in this way, and there
is Stricture remaining, it will be necessary to have recourse to the Caustic
Bougie. Fistula in perinea is sometimes the result of accident, by which
the Urethra is lacerated, and the Urine becomes extravasated into the Scrotum,
and Perineum, this productive of so great a degree of Constitutional irritation
as generally to prove fatal. In caces where the Instrument cannot be
passed on account of the Stricture, a Catheter is to be passed as far
as the Stricture and an incision to be made into the Urethra, before and
behind the stricture which is to be divided, the Catheter is to be passed
on by the assistance of a director. It is difficult to find the urethra
beyond the stricture, and the patient should be directed to force down his
urine, so as to distend the urethra, when it is more easily discovered.
the instrument being thus passed into the Bladder is to be left there
until the wound heals, we should bear in mind that the urethra at
this point is directly situated under the Symphisis Pubes. In cases
where the Urethra suddenly gives way we should be very careful to make 
an incision into the tumour in time, the urine passing into the Scrotum 
soon forms a considerable swelling, this is very painful, and extremely





66
red, after which Gangrene comes on, and that in the space of twenty 
four hours; if it is not laid open before this takes place it will
prove fatal; the incision should be made in the same way as the incisions
for the Stone. Spasmodic Stricture this only occurs in what is 
improperly called the membranous part of the urethra as it is the only
part of the passage which is muscular) and is owing to Spasm of the 
muscular fibres which surround this part, it is generally accompanied
with more or less permanent stricture; it is generally unattended with
pain, and produces a sudden stoppage of Urine. A bougie should be
gently passed, and allowed to remain against the stricture for some time, using
little fore, after a few Minutes the spasmodic contraction of the Muscles 
gives way and the Bougie passes readily into the Bladder. It must by no
means be attempted to be passed suddenly, in these caces the Tinctura Ferri
Muriatis, or the Liquor Potassa, as well as the use of the cold bath have
been found to remove the disease.
Inflammatory Stricture is more frequent than the former, and
is not unfrequently coming on in the inflammatory stage of Gonorrhea, this
is attended with excessive pain, and a feeling as if the Bladder could burst.
It is desirable to attempt to allay the Inflammation before a Bougie is
passed, but it is productive of so much pain that the Patient will not
wait until that be done; the urine will flow very soon after the Bougie is
withdrawn. Bleed freely from the Arm, give brisk purgatives, and 
apply Leeches to the neighbouring parts, the Penis may be dipped in
water as hot as it can be borne, which will frequently occasion a discharge
of the urine. The Pain is occasioned by the acceleratores Urina. Warm
Glysters may be given, they serve as fomentations to the part, the Liquor
Potassa may be given, Opium only exasperates the complaint, Blisters
applied to the Sacrum, or the Perineum, will frequently releive more than
any other remidy. If these are objected to a Mustard Poultice made with





67
Vinegar, and Water may be applied, this is to remain on until it produces
considerable irritation
Lecture 19th.. Diseased Prostate.
Enlarged Prostate is either occuring from simple Inflammation, or it
is a concomitant of old age, Chronic enlargement takes place as life advances,
and cannot be named as a disease. When it is arising from inflammation 
it is accompanied with great pain, with frequent and violent efforts
to evacuate the Bladder without effect, or at least only a few drops of urine
is passed. If a Catheter is passed and much force is used when it arrives at the
Prostate so as to overcome the obstruction, a gush of Matter takes place and
the patient is almost immediately releived; the formation of Matter having 
taken place in the Gland, the Catheter becomes thrust into into the abcess, and
the matter is thus discharged through the Catheter. The Chronic enlargement
is so far from being a disease, that it takes place almost always as people
become old, but if they then give way to Venery it is becoming excessively large, 
when this however is not the case the enlarged Prostate becomes of great service,
the Muscles about the neck of the Bladder become so weak as to be scarsely able to
retain the Urine, and are very much assisted in that office by this Gland in its
enlarged state. The first symptoms is slowness in making water, the person is some
considerable time before he can succeed in doing it, next a sensation of weight is





68
felt in the Perineum, if it is attended with inflammation the pain is more
acute, and similar to Stone taking place at the Glans penis. The fœces and
Urine sometimes pass involuntarily; when the swelling is larger the patient
when making water, bends the knees and Body forwards; the Bladder is becoming
irritable from this as well as other obstructions in the Urethra, and there is a
frequent desire to make water. Sometimes the urine is of the colour of whey
from the small particles of adhesive matter which are floating in [t] it, 
and which are secreted by the internal surface of the Bladder which becomes
inflamed. If the urine is retained it is becoming of a [Char] Chocolate Colour,
owing to the great efforts which the Bladder makes to discharge its contents,
forcing out a small quantity of Blood; when retention of Urine first
comes on it is generally in the morning, owing to the urine be retained
so long a time, as to press forward the vascular projection of the Prostate
obstructing the passage of urine into the Urethra. It is however taking 
place at any time if the Patient is negligent of himself in the day time.
The Prostate Gland is not naturally larger than a Chesnut, but is sometimes
becoming extremely enlarged; this is most frequently taking place
in the Lateral Lobes, and then it is not attended with any considerable
effect on the passage of the Urine; but when the third lobe is enlarged it 
gives [ro] rise to more unpleasant symptoms, the projects like a valve
over the mouth of the Bladder. When there is much difficulty in passing the
water, the Bladder frequently becomes filled with Sacculi, the Ureters
are also becoming enormously enlarged, there is frequently a large Sacculus
formed behind the Prostate towards the Rectum [the Rectum], and if the
Patient is subject to Calculi, one, or more of them are not unfrequently 
found lodged in this sac, which afterwards collapses, and forms a valvular
projection, over the mouth of the Bladder. The fungous disease is sometimes
taking place in the Prostate [is] and is generally attended with a 
frequent discharge of Blood. - 





69
Treatment. This is either Medical, or Surgical. 1st.. The Medical treatment
it is only when some slight inflammation takes place that Medicine
becomes necessary, the best remedies are the Carbonate of Soda ℥ss twice
a day, the Carbonate of Magnesia, or the Aqua Kali with Ta. Opii to allay
the irritability. If there is much pain apply Leeches, and having evacuated
the Bowels, give the Alkalines. When the Gland is much enlarged, and the
Bladder is becoming very irritable the Balsam Copibia may be used with
the best advantage, although from the general effects of this remedy we might 
suppose it would have contrary effects, yet when given in doses from five to
ten drops three times a day, combined with Mucilage it allays the irritability
of the Bladder more than any other remedy. It is not attended with much 
inflammation, but considerable debility, and slight Stimulants become 
necessary, depletion only increases the disease, when in this state the
Uva Ursi has recommended, but with little success.
Surgical Treatment. When called to attend a case of retention
of Urine, from enlarged Prostate, [wh] we should be provided with a
Catheter larger than in is necessary in other cases; it should at least
14 Inches in length, and a quarter of an inch in diameter. The Urethra
from the curved direction which it takes become lengthened from one 
to two inches more than Natural and its extremity is tilled up behind 
the symphysis Pubis. The patient should lay on his back, and the Catheter
being passed as far as the prostate, the handle of the instrument, should 
be inclined to the Abdomen and which it ought to touch being pushed
gently forward in that direction. by the projecting Gland, as soon as 
this is accomplised the handle of the instrument should be depressed as 
low as possible between the thighs, in order to raise the point immediately
behind the symphysis pubis; when the Catheter is introduced it will seldom
bear to remain in the Bladder, and must be introduced about twice a day;
After Silver Catheters have been used sometime a flexible Catheter may be




70
used, perhaps by the patient himself. but they can seldom be used in the first
instance; if the patient is not releived in a few times, the Pewter Catheter
may be introduced and left in the Bladder, being changed about once a
week. Sometimes, though very rarely an enlargement of this Gland is taking 
place in Children, being accompanied with the same symptoms as Stone,
for which it has been mistaken, Mr. Cooper has only seen one instance of it,
and that was in a Boy about thirteen years of age. The Oxymuriate of Mercury
in small doses has been proposed to be given in this disease.-
Lecture 20th.. Diseases following Gonorrhoea.
Irritability of the Bladder this is not an unfrequent consequence of
Gonorrhoea. It is a very painful disease, and is marked with more frequent
desire to make water, if the constitution is affected, there is 
a good deal of Mucus discharged, frequently tinged with Blood. It is 
sometimes mistaken for Stone, but may be distinguised from it by the 
pain in the latter coming on after the urine is evacuated, while in the 
former the pain is much lessened by the evacuation. It may be brought on by
retaining the urine too long; the internal surface of the Bladder when
examined looks like red Velvet. Treatment in the early stages
purge freely, apply a Blister to the Pubis, and Opium may either be
given by the Mouth, or injected into the Rectum, or introduced in the
form of a large Pill[s], in which case its effect is more lasting, especially
if it is combined with Extract Conii; An Elastic Catheter may be
introduced, and the Urine constantly allowed to drain off, Opium
may be injected into the Bladder with advantage; when the irritability 
has somewhat subsided, the Pilula Hydrargyri Submuriatis may 
be given with Decoct. Sarsaparilla Comp. If Mucous tinged with Blood
is discharged, ulceration has taken place, when this is the case we
can only palliate the disease, for which purpose we should inject


*Evapourating Lotions are better than Poultices, these getting warm excite
Erections: If the Bladder becomes irritable in Chordee, it may 
by alleviated with the Liqr. Potassa. -


71
Opium into the Bladder; it is however extremely difficut to cure if
not undertaken in the early stage. Paralysis of the Bladder,
is occuring most frequently in old people. The Symptoms are
inability to void the Urine, and if a Catheter is passed while in a
recumbent posture no urine will pass, but as soon as the patient rises
the urine discharges; Apply Blisters to the Sacrum, give Turpentine 
and Pulvis [Ly???] from 1/4 to 1/2 a grain of the latter, and five grains
of the former three or four times a day. Catarrh of the Bladder,
this is marked by a considerable discharge of bloody mucus, sometimes 
occuring after Gonorrhœa, sometimes from Stricture. When the Urine
after standing sometime be poured out of the vessel into which it was
received, a third part or nearly is found at the bottom of ropy Gelatine.
Give Balsam Copibia, and the Oxymuriate of Mercury, the former clears
the urine, and the latter lessens the irritability of the Bladder, and restores
the secretions, it destroy the disposition to disease, while the Balsam
destroys the present symptoms. Salivation however has sometimes
been necessary to cure this disease.
Chordee, this is a painful and imperfect erection of the Penis,
the inflammation from Gonorrha extending from the Urethra. to the
cells of the Corpus Spongiosum, and a quantity of adhesive matter is thrown
out [from] into them, by which they are rendered incapable of becoming distended 
with blood in the act of erection. the Corpora Cavernosa becoming
distended with blood the penis is of course considerably curved.
Treatment, purge freely, apply Leeches to the Glans penis, and Corpus 
Spongiosum, if necessary bleed from the Arm, a solution of the Extract
Conii may be applied to the Penis; When depletion has been freely used
give Opium griss Extract. Conii gr ij Camphor gr ij in the form of a Pill
at bed time, with a sufficient quantity of Calomel. The hardness left
in the Corpus Spongiosum is best releived by the Ung-Hydrarg. Mit. cum




72
Camphora. Blisters may be applied to the Perineum. It is sometimes
releived spontaneously by bleeding from the Urethra, which is sometimes
in large quantity, to diminish this make pressure on the part opposite
to where the Vessels have given way, the Compound powder of Ipecacuanha
may be used, and Turpentines are sometimes servicable.
Inflammation of the Testicle, this is a common consequence of 
Gonorrhœa, and is taking place when the inflammation is taking place
down the Urethra, to the bulb of the penis being propagated to the Testicle
to the Vas deferens. The first sensation is if a drop of wine remained
behind the bulb of the penis, pain is then felt in the direction of the cord
extending to the [Epydim] Epididymis which is affected before the Testicle,
and suffers most. When the testicle is becoming enlarged, the Tunica
Albuginia being tense and not giving way, a sensation is felt as if
the testicle was violently squeezed, Stricture is a common cause 
of this complaint, or any other cause irritating the Urethra is liable
to produce it; it is not a sympathetic inflammation as was formerly 
supposed, but is extending along the Vas Deferns, person labouring 
under Gonorrhoea, or Stricture, if obliged to take much exercise should 
always wear a suspending bandage. Treatment, if the inflammation
has been in the Epididymus, suspend the testicle immediately, apply
evapourating Lotions, purge freely, these means will generally prevent 
the progress of the disease, but if they do not scceed, at will be necessary
to draw blood from the part by Leeches, or by puncturing two or three
veins on the Scrotum, while the patient is in the erect posture, and before
the fire, to make them more tumid; the bleeding will stop in a few minutes
if the patient lays down, after which apply evapourating lotions, and 
continue to purge; Poultices are to be objected to on account of their
weight, Depletion if carried too far will prove injurious, when the
Inflammation has subsided give the Pulvis Ipecacuan. Comp. bis in dir.




73
If the Epididymus is remaining hard and indurated, the secretion from
the testicle will not be transmitted through it on that side. In these caces
a Blister may be applied to the Perinæum, which is afterwards to be
dressed with equal parts of the Ung; Hydrargyri, and Ungt.. Sabina; 
and Oiled [crossed out] Silk should be worn over the scrotum to prevent absorption;
the Epididymus sometimes goes into the suppurative inflammation, and
Abcess is produced, after this has burst luxuriant granulations shoot through
the tunica Albuginia, having filled up the cavity, project considerably, forming
a fungus, the treatment in these caces is to make an incision on
each side of the projection and cut through the neck of the fungus, 
and remove it, afterwards unite the integuments by two or more sutures
The operation of Castration is quite unnecessary in this disease. When 
Abcesses haven taken place, and large sinuses are formed, inject diluted
Tincture of Lytta, to promote adhesive inflammation. Sometimes
after inflamed testicle a process of absorption is set up to remove the
effusion of coagulated Lymph, which goes on until the whole of the testicle
is becoming absorbed; this is happening in young people of a bad habit of
body, and is occasioning Impotence, nothing being left of the testicle but
the tunica albuginia, and a few vessels, but not of the Seminal kind.
This may occur from inflammation of the testicle, from external violence,
Surgeons have sometimes recommended having recours to [tocom]
women, in order to prevent the absorption, but it has not been found to 
succeed. Irritability of the Testicle. Sometimes the testicle is becoming
irritable that it cannot bear the least touching, or moving of the 
thighs, or pressure from the cloths, the pain is sometimes extreme; it is not
from inflammation, but from unnatural sensation of the Nerves of the part,
Apply Blisters to the thighs, or in the groin in the direction of the Cord, Opium
has very little or any effect, small doses of the Oxymuriatis Hydrargyri
given at intervals with bark, this diminishes the irritability of the body




74
apply Extract. Conii, or Extract Belladonna, the Liquor Potassa [be] may
be given, but it is often very tedious of cure, and sometimes will baffle all
attempts to releive it.
Lecture 21st.. Diseases following Gonorrhœa Contd..
Sympathetic Bubo. When the inflammation in Gonorrhoea extends 
over the surface of the Glans penis, the absorbent vessels on the Dorsus
penis become enlarged, and feel knotty, the inflammation then extends
to the glands in the Groin, several of which becomes enlarged, they may
be distinguished from syphilitic, from several being affected frequently
on each side, and they are lower order of glands in the groin, being
below pouparts ligament. If these go on to suppuration it is from
neglect, or mismanagement, by the use of Mercury which ought by all
means to be avoided, when this has been given the absorbents on the Dorsam
penis not unfrequently suppurate, give purgatives, apply Leeches, and
evapourating lotions; they only suppurate when the constitution is very
irritable. Gleet, this is a discharge from the Urethra after the infection 
of Gonorrhoea has terminated, but it is extremely difficult to say when
this takes place; it is a Mucus discharge, but become purulent if the
patient gives way to intemperance. The seat of the discharge is from 
the Lacuna Magna, or those about it, sometimes occuring from those about
[it] the Stricture. The period which Gonorrhœa ceases to be infectious, is
impossible to determine, Mr.. C. has known one instance in which it proved
infectious fourteen months after it commenced, Mr. C thinks there
is danger of infection as long as there is any discharge, unless it is
kept up by Stricture; a discharge will sometimes be occasioned from 
the introduction of a Bougie, which has sometimes been communicated 
to the female, attended with ardor urina, going off in a day or two
with a purgative Gleets are very difficult to cure. The Injections which





75
generally answer best are Hydrargri Oxymuriatis gr 1/2 Aqua ℥ij to begin
with, if used stronger, it will frequently produce a great deal of irritation
a little Ra.. of Opium may be added. Sulphatis Cupri gr 1/2 to gr i Aqua ℥iv
the most powerful medicine is the balsam of Copibia of this give about 
forty drops three times a day: Gum Olibanum with Rhubarb in equal
quantities may be used with advantage. The Alterative plan with Pil Hydrg.
Submur. and Decoct. Sarsaplla. has great influence, introduce Bougies
with balsam copibia smeared over it, or with the Ungt.. Hydrarg. Nit. Mit.
using Injections at the same time frequently changing them, passing bougies
secures the patient from stricture, which might otherwise be produced
by the injections. Gleet is a local disease, and constitutional remedies have
very little effect upon it. A particular species of Rheumatism, and also of
Opthalmia are sometimes brought on by no other cause than Gonorrhoea, 
The latter has been supposed to be occasioned by the direct application of 
the Matter to the Eye, but it undoubtedly occurs without any such application 
to remidy these diseases, you must cure the Gonorrhœa, when they will 
also disappear. A discharge is sometimes taking place from the Glandula
Odaurifera this is only from the glands going into suppuration, & inflammation, 
it may readily be cured by purgatives, and injecting Saturine lotions
If not unfrequently comes on in Children. Impotence. this is sometimes
complete, that is there are some cases of Males who never had erections,
and is of course incurable; sometimes it is arising from excessive irritability
of the muscles surrounding the Urethra, and of the Vesicules Seminales, 
use the general, and local Cold Bath, give a combination of Extract Hamuli
and Sulph. Ferri; some men are troubled with nocturnal emissions, which 
take place as soon as they get warm in bed, or the bladder becomes full, by 
which they are very much weakened, improve the constitution as in the last
case, apply a Yoke to the Penis, which occasions the patient to wake, as soon
as the erection is taking place. A man is not rendered Impotant by the





76
removal of one testicle only, but when both are removed, the patient
is capable at first of coition, but this entirely ceases after twelve Months
If Abcesses occur in both Testicles, or in the Epydidymi, they occasion
impotence, in the latter instance by closing the tubes through which the 
secretion should pass. In case of Hydrocele on both sides the vivid power is
somewhat lost for a time, but returns after the disease is releived. Bad
strictures near the commencement of the urethra are sometimes producing
impotence. Persons whose testicles have not decended may have the [viscid?]
power; although Mr. Hunter was of a contrary opinion. Imaginary Impotence
is the most frequent, and person who are affected so not unfrequently
commit suicide; it is to be cured by engaging the Mind of the Patient by 
appearing to be doing something from which he will fancy he receives
benefit.
Lecture 22nd.. On Chancre.
When the Venerial Poison is applied to a surface which has a thin cuticle
a specific inflammation is excited on the part; it first produces an itching
sensation, which in a little time is followed, by the appearance of a small
pimple, which soon breaks and discharges a serum, the surrounding skin
becomes thickened, the edges irregular, and there is soon considerable depth
of Ulceration, of the [Caustic] cuticle is not entire when the poison is applied, it 
begins to ulcerate immediately. Chancre is distinguished by the hardness
of the surrounding skin, and if it is taken between the fingers it gives 
the sensation of nipping half a pea, the inflammation is of a dark 
purple colour; after the Sore is healed, there is a hardness still remaining
and it is on the removal of this hardness that the Cure of Chancre depends.
The seat of Chancre is various, but the most common is between the Glans
Penis, and Prepuce, or on the Franum; it is frequently situated on the -




77
Prepuce, and from the tickening of this part it produces Phymosis, this
may also be produced in the healing process, by the contraction of the 
[Cicatr] Cicatrices. When situated on the frænum it is very difficult to heal
as this part has but very little vital power, and is not unfrequently destroyed,
it is necessary here generally to use Caustic freely, but not until the Venerial 
infection is destroyed; Chancres are often situated in the Urethra, and 
is therefore generally accompanied with Gonorrhœa, the lips of the Urethra
become hardened, and if they are opened the sore may be distinguised, it
is not unfrequently producing a contraction of the Urethra; Chancre is [not]
sometimes seated on the body of the Penis, or Scrotum, but these are rare
from the thickness of the Cuticle. Treatment [in] of Chancre in its
simple form. The use of Caustic in the first instance is improper for two reasons,
first that it is frequently followed with bad consequences, first the 
irritation it produces, and secondly because it destroys the judgment of the
efficiency of Mercury in the succeeding treatment of the disease, which cannot
be removed without Mercury; the sore may readily be healed by the caustic,
but the disease soon shows itself again in the Constitution. The best method is 
to give Pitula Hydrary. x gr every night and gr v - vel x every morning, this generally
succeeds in removing it in a month, or five weeks; a mercurial Lotion as the
black wash, should be applied to lessen the irritability of the sores, for this 
purpose Opium may also be necessary but all Unctious applications should 
be avoided. It is the Mercury alone, which has any effect upon the disease,
but the black wash lessens the irritability, and prevents the disposition to 
slough. Chancre is not and then putting on an indolent disposition, after the 
Mercury has been continued. The Venerial action is here generally removed from 
the system, and the sore may be made to heal, by daily touching it with the Nitrate
of Silver. Phymosis is frequently produced by the Chancre being seated on the 
prepuce, it causes a great deal of swelling and inflammation of the prepuce,
Mercury should not be employed, the patient should be purged freely.









78 
The penis should be suspended, and the black wash injected between the 
glans, and prepuce, and applied round the penis; Poultices, and Fomentations,
relax [crossed out] it too much, but Leeches are frequently useful in reducing the 
inflammation, we should immediately remove small adhesions by rubbing on
the Ung: Hydrarg. Camph: or they may be divided; when it is necessary to perform
the operation, a probe may be passed under the prepuce to the Dorsum
penis, the prepuce should then be divided, as far back as three fourths of the 
way to the Corona Glandis, if it is not divided to this extent, it will seldom
succeed. Chancre is sometimes situated behind the glans, and producing paraphymosis;
the glans becomes swollen, discoloured, and frequently proceeds to
slough from the strangulation; it then becomes necessary to return the prepuce
over the glans, for which purpose the glans should be taken in the palm of 
the hand and strongly pressed, for the purpose of returning the blood and thereby
diminishing its bulk, the prepuce should be brought forward by the two
first fingers of each hand, and the Glans pressed back by the thumbs.
No application should be used previous to the reduction, but afterwards evapourating
lotions may be applied, it is necessary sometimes to divide the band which 
produces the Strangulation, which is situated just behind the Corona Glandis; but
this is only necessary when the disease has existed for sometime. Chancre is sometimes
becoming very irritable, and is going on [the] to the sloughing process, this 
may arise from intemperance, from the abuse of Mercury, or from some improper 
treatment, it is attended with a great deal of Inflammation in the sore,
and when that is the case Mercury ought immediately to be laid aside.
The great secret in the cure of the Venerial disease, depends upon our knowing
when to give Mercury usefully, and when it will be injurious. When there is 
much inflammation, we must subdue it by purging freely; the pulse is extremely
quick being from 120 to 130 in a minute, and this can only be diminished
by the use of Opium given from grss to gri three times a day; the Decoctum
Saraparilla sometimes releives the irritable state of the Constitution, but




79
the Powder, or Extract is preferable; Ammonia gr v Moschi gr x three or
four times a day has been found extremely useful; when the constitutional
irritation has arisen from the use of Mercury, the Sarsaparilla, or Bark
are the best remedies. As a local application, a paste made of the following 
is very useful [Ba?] Opii Liquor Plumbi āā ʒij Conf. Rosa Galla ʒij Misce
the Nitric Acid Lotion may also be used, this produces a quick seperation
of the slough and gives the wound a healthy appearance. Poultices of Yest, or
of Carrots are also useful; the Black wash with Opium, is a good application
Chancres when in the irritable state frequently bleed freely, this is generally 
useful though it excites alarm, it may be stopped by the application of
the Sp Terebinth on Lint, sometimes however it is necessary to use the 
Needle and Ligature. It is no use here giving Mercury as that part of the sore 
which is affected by the Venerial poison sloughs; therefore it is as well to 
waite and see if secondrary symptoms appears. Sloughs on the Penis are
sometimes forming a communication with the Urethra, by which the urine
We can seldom succeed in restoring the urethra to its natural state, but
sometimes when the opening is very small and it is entering transversely, it
can be cured, by pairing off the edges with a part of the Corpus Spongiosum,
then by keeping the penis curved, the edges are brought together, when it 
has healed the penis soon becomes straight. Sometimes a contraction of 
the urethra is produced by the healing of the Chancre with the lips of 
the urethra; when they are situated in this part the penis should always
be suspended and a peice of bougie about two inches in length, and the 
common size of the urethra, should be constantly worn. It sometimes
occurs that from neglect of this circumstance the urethra bursts behind the 
contracted part, and lays the foundation of a most dreadful disease.




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Lecture 23rd Syphilis Conted..
Warts, these are frequently occuring in the parts of generation both in the female & 
male, but more frequently in the latter, they have considered Venerial, 
but they are really not so, as they do not require mercury to cure them, but
may be removed by local means; they arise from any irritating cause, as the
matter of Gonorrhoea applied to a part when the skin is abraded, or from want
cleanliness; they are enlargements of the papilla of the skin; they are either
soft, or hand, the former are easily removed by the ligature, or the Liquor 
Plumbi very little or not at all diluted, a drop of the Solutio Oxym. Hydrarg.
in Spt Vini applied sinks into the substance of the wart, and produces
such a degree of inflammation as to occasion it to slough, the Tincta
Ferri Muriatis, vel Oxymur. Hydrarg. in Aqua Calcis may be used for the 
same purpose, the harder kind are incapable of being acted upon by these
remedies, and require some thing more effectual, the Oxyd of Arsenic must
be had recourse to, this answers in both species, Oxyd of Arsenic ʒi Ungt.
Simplex ℥i spread very thin upon Lint and applied once or twice a day
will be sufficient; it acts by exciting inflammation, which occasions a 
sloughing to take place, it produces a good deal of pain, if the Solution
is used it will be in danger of becoming absorbed. When the surface is 
large is sould only be applied to one part of it at once Hydrargyri Nit.
Oxydi. Acct. Cupripti and sabina rubbed into fine powder and mixed, may 
be sprinkled on the surface, which will frequently destroy them. In the 
Female they are frequently arising to an enormous size; the fluid produced
by Warts, is capable of communicating the disease. 
Bubo. when the venerial poison becomes absorbed in Chancre, in 
passing through the first absorbent gland, it frequently produces inflammation,
this depending upon the irritability of the gland, as it does not
by any means generally take pace, it is quite uncertain on which side




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it shall appear, and may take place on both. When a Gland is inflamed
and left to itself it goes on to form Abcess, like common Inflammation,
but the pain like all other venerial pains is coming on most violent towards 
Evening. There is never more than one Gland enlarged on each side, and always 
those nearest the penis; when they are several on one side we may be pretty 
certain that they are sympathetic. It is the upper order of Glands which
become enlarged, and when taking place two inches below pouparts ligamt.
we may rest assured that they are not sympathetic. When called to a
person with a Bubo give an active purgative, this not only subdues the 
inflammation, but promotes the action of the absorbents; after this give Pilula
Hydrargyri gr x every night, and morning, combined with a small quantity
of Opium, which lessens the irritation of the Gland, and subdues the common
inflammation; at one time friction with the Mercurial Ointment was
prefered, on amount of its passing through the Gland, but this is not true as
a Gland when inflamed becomes useless for a time, and the fluid passes 
by the Vasa Circuita to the next Gland, and if it did really pass through 
the Gland no good could be derived from its local application. After 
Mercury has been given for a few days it frequently happens that the 
Bubo is becoming more inflamed and painful, means must be used to remove
the inflammation, as Leeches and Evapourating Lotions &c, and if the infammation 
is very severe the mercury must be suspended until that is subdued.
When matter is formed it is shown by a blush on the Gland, we should prevent 
this if possible, but if we cannot we must suspend the use of Mercury
and open the abcess as soon as fluctuation can be perceived by means of 
a Lancet, if it is very large an opening at each end; this not only saves
the patient from a tedious Ulceration and pain, but when the Ulcerative
process has gone on until the edges have become thin, and having little [liev]
living power, great Sloughs are thrown off. When the matter is discharged
and the inflammation ceases, then begin again with [e] the use of Mercury




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When Buboes becomes indolent a Blister is the best thing that can be applied, 
while the Mercury is continue this will seldom fail to promote absorption 
of them, this may also be done if any enlargement remains after a long
course of Mercury. After matter has sometimes formed the Ulcerative process and 
pain suddenly ceases; Mercury being now renewed will produce an absorption
of the [part] matter, and if it is not employed the Bubo remains until the secondary
symptoms come on. Buboes sometimes become excessively large, in this case we
should not consider the disease truly Syphylitic, but try to improve the
constitution by the Pil. Hydrarg. Submur. and Decoct. Sarsaparilla; but
mercury should not be given, and it will be proper to wait to see if secondary 
symptoms come on before we have recourse to it again. These sometimes
suppurate in a small part only, after which the whole of the Tumour
disappears. When a chain of enlarged Glands take place, they are to be considered
as Sympathetic, and denote a constitution extremely unhealthy, they 
frequently come on after the use of Mercury; we should endeavour to improve
the constitution, and not treat them as Syphilitic. In unhealthy constitutions,
when the Gland is granulating, the granulations frequently arise 
above the surface, this requires local means as the Liquor Calcis cum
Oxymar. Hydrarg., or a little part made with Oxym. Hydrarg. gr ii and any
convenient article, and made dry, this is to be pointed and passed into
the granulations, producing sloughs; they are  producing Phagudenic, that
is having the edges extremely thin and ragged, of a livid colour and deeply
ulcerated, this arises from a bad constitution, or from the use of Mercury while
Inflammation is present; apply once a day to the surface of the sore a solution
of the Nitrat of silver; over which Lint dipped in the Black Wash.
Support the constitution and avoid giving Mercury. This is the best treatment 
for this kind of sore when occuring in any other part of the Body. Sloughing
Buboes are frequently occuring in unhealthy constitutions, or when they are
much exposed to the inclemencies of the weather, they sometimes spread extremely 




83
rapid, and occasionally lay bare the femoral Artery, and Vein, sometimes the
patient dies from ulceration of these vessels when he quickly bleeds to death 
but more frequently they destroy life by the great degree of constitutional 
irritation which they occasion; we should first give a purgative, and then 
support and improve the constitution, and by no means ought Mercury to
be employed. - 
Lecture 24th.. Secondary Symptoms of Syphilis.
When the Venerial poison has passed through the Glands in the Groin
it passes through various others in its passage to the Thoraic Duct, but these 
latter are never affected by it, when it gets into the blood and becomes circulated
through it, it affects three different parts of the body. Viz the 
Throat, the Skin, and the Bones. Of the Throat, the part most frequently
affected in the Tonsil Gland first inflamed, and then ulcerated, the sore
looks like a primary Chancre, having elevated and raggy edges, the surface
indented and of a yellow sloughy appearance. This Gland is seldom much enlarged
but when that takes place it betrays a stramous constitution, and in these cases
Mercury will generally be found prejudicial, there is but little pain in sallowing
Acids occasion slight smarting, there is however a dry husky sensation 
which is increased towards evening. The second seat is in the Pharynx. this 
is more dangerous, very large slough frequently taking place in bad constitution
which destroy the surrounding parts, so as to bring on a fatal termination. 
There is great difficulty of swallowing, and fluids are regurgitated 
through the Nose; the Words are improperly sounded having the nasal accent,
both of which are occasioned by the Velum Pendulum Palate loosing the
power of acting as a Valve; thirdly the Palate is sometimes affected, this 
may be either the soft or bony [part] palate. An Ulcer forming in the Velum
Pendulum Palate an orifice communicating with the Nose is quickly formed,




84
through which fluids are returned, and the accent is the same as in the other
case last mentioned. When it has ulcerated through the soft, the boney palate becomes
affected the bone exfoliates and an apperture is thus formed between the Mouth,
and Nose, through which the food passes when the patient attempts to Swallow.
Fourthly in the Larynx this is most dangerous, frequently proving [dangerous]
fatal; when ulceration has taken place in the Larynx, the voice degenerates
into a slow whisper, this is attended with Cough and considerable expectoration
frequently bringing up Sloughs. It is frequently attended by Venerial Eruptions,
by which it may be detected, but when this is not the case it is 
liable to be mistaken for Phthisis. A very small quantity of Mercury
used here, quickly releives the most threatening symptoms, and if perisisted
in eradicates the disease, but if it is neglected it soon proves fatal
Portions of Bone which exfoliate are coughed up, after having produced 
great irritation, but this is sometimes so great that the patient sinks
before the exfoliation take places. Sometimes a fatal Hemorrhage
comes on, from which the patient soon sinks. Our chief dependance is to 
be placed upon Mercury, in the cure of all these affections; when the Ulcers
are irritable me may use local applications to sooth, or when sloughing we
may use Acids to seperate the sloughs, for the first fumigations of warm
water, or the poppy fomentation, for the last Acid fumigations are preferable
to Gargles, as the action of the Muscles in gargling produces a great
deal of irritation. Nitric Acid Diluted, or the Mel Aruginis may be
applied by means of a dossil of Lint, on the end of a probe; these are very
serviceable in seperating the sloughs when the ulcers have lost their irritability,
and disposition to slough, we may again have recourse to Mercury
which of course is not to be given while that character is present.
When the Bone is exposed we can act Chemically on that by the Diluted
Nitric or Muriatic Acid which very much assists nature in the exfoliation
When situated in the Larynx we must get the constitution affected as soon




85
as possible with Mercury. Use Mercurial fumigations so as to keep up a copious
secretion from the Vessels of the part, by which the inflammation is lessened.
Give Mercury either internally or use friction. It requires a mouth, or five
weeks course of Mercury to completely eradicate the Venerial poison in
cases of sore throat of this is not done the disease will be apt to return.
Eruptons These assume a great variety of appearances as to size,
the part in which they first appear, and the Character which they take
on after they have appeared some time; they are generally elevated of a
Copour colour and encrusted, sometimes the crust rising very high,
When ulceration takes place the edges are elevated and ragged, the surface sloughy
and Bleeding a little, covered over with a crust, and if in a bad constitution
these Ulcers are becoming very irritable and sloughy attended with a great
deal of pain and extending rapidly. In general the eruption begins about
the head face and breast; the extremities being affected least, the occasion
in general but little inconvenience but this however is increasing towards
evening; give mercury, at the same time give the Oxym. Hydrarg.; this irritates
the Stomach, which by its sympathy with the Skin, is frequently removing the 
eruptions sooner than any other remedy, and assists the Mercury in affecting 
the constitution sooner. Mercurial action must be kept up here for some 
considerable time. Local applications are of little service, the best 
is the natural incrustation, but when ulcerations has taken place we
may use with advantage the Ungt.. Hydrarg. Nit. Mit cum Opia; when they 
are irritable; Mercury being abandoned while the irritation remains
Sores remaining in bad constitutions after the eruption his disappeared
are best treated like those after bubo, by washing them
one a day with a saturated solution of the Nitrate of Silver, and
keeping the surface constantly moist with the black wash; giving
the Pilula Hydrarg. Submur: and the Decoctum Sarsapalla.. to 
improve the constitution. The Bones are not unfrequently affected




86
the Vomer is attacked in consequence of the Inflammation which takes
place in the Mucous Membrane of the Nose, this being thinly spread 
over the bone, it is soon ulcerated through, the Bone being exposed
soon exfoliates, here we must attend to this as well as giving Mercury.
The Ulcer is at first covered with a dry hard scab which being 
removed with difficulty by blowing the Nose, it exposes the bone, 
and a most offensive smell issues from it. After remaining in this 
state some weeks small portions of the bone come away, until the 
greates part of the Vomer is seperated; sometimes ulcer occur in the 
Septum Narium occasioning an aperture through it, this although
not attended with any venerial affection is extremely difficult to cure,
it now and then occurs before Puberty, and is not attended with any 
offensive smell, we must in these caces improve the constitution by
giving the Pilula Hydrarg sub; and Decoct. Sarsapa.. Apply a solution
of the Nitrate of Silver. The Ossa Nasi is becoming affected after the
Vomer and exfoliates, when this is the case from [M.] Venerial poison
give Mercury and as local applications inject diluted acids, or use Acid
fumigations to assist in promoting exfoliation; if there is much internal 
inflammation apply leeches, and evapourating Lotions to the Nose 
and Cheek, do not use Mercury while the inflammation is present; 
nor should it be continued longer than is necessary to destroy the venerial
poison. If a person applys with a sore in the nose, and Mercury is
used for four or five weeks the patient seems at first cured, but after
a few days an uneasiness is taking place, and peices of bones are again
seperating, upon which it is not unsual to make the patient go through
another cours of Mercury which quite destroys a constitution. But
there is no necessity for this. Exfoliation does not go on while the patient
is under Mercury, but commences after he desists from it, at least of
portion which was exposed, and this must of necessity come away;





87
we should only endeavour to improve the Constitution; the Cylindrical
bones are frequently the seat of this disease; this is at first known by
slight pains, coming on at first in the evening aftwards increasing after
this the [patient] part becomes tender and swelled; the Periosteum becomes inflamed
seperates from the bones and a deposition of boney matter takes between it
and the bone, forming a Node; the pain is obtuse taking place about 
five O'clock and remaing until about two or three O'clock, increased
by external heat; when a Node has contined for some time, a glary fluid
is poured out frequently between the Periosteum and Bone, after this
suppuration takes place, the skin becomes red, fluctuation may be perceived,
and Ulceration goes on until a hollow is formed in the bone, or
the Matter burrows beneath the Periosteum for a considerable distance;
when they ulcerate through the integuments, the bone becomes exposed and 
generally exfoliates. Treatment if there is much inflammation and pain
apply Leeches, after which if the pain continues apply Blisters, which are
to be kept open with the Ungt.. [Sq?a], this will generally promot absorption
of them, if a glary fluid is only thrown out, and suppuration not 
commenced; Mercury is to be given at the same time; but if they are 
attended with redness of the skin, which indicates suppuration to have
taken place, the will not be absorbed, and we must then by a small puncture
discharge the Matter, first having discontinued to mercury. When 
it attacks the flat bones the disease is suspended for a time by the use of 
Mercury, but the suppuration continuing to go on accompanied with
exfoliation. We must improve the Constitution with the Pilula Hydr:
submur: and Decoct Sarsap:, applying the Nitric Acid Wash;
if we persist in the use of Mercury we shall destroy the constitution.
Pains in the bones are sometimes originating from taking cold while
under Mercury, especially when this has been injudiciously given. But 
when the nocturnal pains are taking place from Syphylis, they require a four, or
five weeks course of Mercury.-





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Lecture 25th.. General remarks on the Venerial Disease.
The primary symptoms of this disease are Chancre, and Bubo, 
these occur previous to the Poison passing into the Blood; the second 
are Inflammation, and Ulceration of the Mucous Membrane, Eruptions
on the Skin, affections of the Bones and Periosteum. There are many
parts of the body which are incapable of being acted upon by this 
Poison, as the greatest part[s] of the component parts of the body; those
parts most essential to Life are never affected. Some persons are never influenced
by this poison at all, some have frequently Gonorrhœa, and escape
Chancre, while others frequently have Chancre, and never have Gonorrhœa.
Matter produced by the secondary is quite incapable of communicating the
Disease, the Poison having undergone some changes by passing through the
Absorbent Glands, and system, as well the circulation. The Matter from 
Buboes will not produce the Disease, but that of Chancre does. The Matter of
Gonorrhœa will not produce Syphilis, this is frequently seen when Leeches have 
been applied in Gonorrhœa, the Matter coming in contact with the wound, never
produces sore of any consequence, Mercury therefore is never to be used in the 
cure of this disease. Venerial Poison is found to be incapable of having its influence
destroyed by Mercury under particular circumstances, as in pregnant women 
here if it is given to the greatest extent the disease will always be found to return
after parturition. Children born of women who labour under syphilis, frequently 
have symptoms of the disease upon them, as Eruptions, of the hands, and feet,
these are not to be cured by Mercury being given to the Child but to the Mother.
Women secreting Milk will not have the Salivary secretion increased by 
the use of Mercury, but although salivation cannot be produced yet both
the Mother and Child get cured of the Disease. The parts which are subject
to the Venerial Disease, are also liable to become affected by other diseases,
hence it has been thought that other poisons have been communicated by sexual





89
intercourse besides the Venerial Disease. this however Mr. Cooper denies, he allows that
there are Syphiloid diseases existing, but not that are originating from a 
specific poison. Mr. Hunter was of opinion that this was a local disease, but
Mr. Cooper thinks it a constitutional one, as those patients who are about to be 
affected with secondary symptoms are also attended with evening Exacerbations.
Effects of Mercury. Mercury is supposed to cure the disease by the Fever
which it excites, destroying the action which is set up by the Poison; it requires
that the Mercurial action should be kept up for some time in order to have its 
full effects, even after the primary symptoms have entirely disappeared; it
should be given not so as to produce any considerable effect, but a continued 
one. It is from want of protraction [that] of the Mercurial action that
the disease returns. Those cases which give way most readily to Mercury are
the most liable to be succeeded by secondary symptoms. Mercury used 
for a month will generally ensure the cure of the primary symptoms, the 
secondary require a cours of six weeks. The best form in private practice 
is the Blue Pill combined with Opium, ten grains given every night, and 
five every morning; this will soon affect the Constitution, and must be regularly
persisted in, Opium prevents the influence of the Mercury on the Bowels and 
ensures its action on the constitution; Friction may be used when it can 
be done conveniently, it is not so liable to affect the Bowels as when given
internally. Other preparations are not all to be relied upon in the cure of 
this disease. When there is any considerable degree of inflammation, Mercury 
ought never to be used. When it occasions irritability or inflammation, when
it passes oft by the Bowels, or occasions profuse prespiration, or fever it should
immediately be suspended until the effects are removed. It is according
to the indolence or irritability of the Constitution that the Mercury acts
more or less rapidly on the system. When its action is extremely slow, if
we are using friction, the feet may be put in warm water at bed time,
or if using the Pill we may employ the warm bath, to relax the constitution 





90
and bring on a degree of irritability which will hasten the action [the action]
of the Mercury; or this may be done very effectually by applying Blisters to 
the Groins and dressing them with the Ungt. Hydrargyri; when its action 
is too great, and severe salivation is brought on so as to produce sloughing
of the Sips, and Gums, the patient should be exposed to cold, but should
be done cautiously so that the patient shall not suffer from its effects. Gargles
of a solution of the Nitrate of Silver may also be used with advantage;
Mercury is not unfrequently producing are [Eyr] Erythema on the Skin now
called this disease first attacks the Sebacious Glands of the skin extending
from gland to gland. A Crustacious cuticle is secreted, which is rubbed off
in [brany] branny scales. The Eyes are red and inflamed, the hearing dull, and 
the patient gradually sinks, this brought on by exposure to cold while under
Mercury, it is very difficult of cure, but is to be releived by strengthening the constitution
by diet. Country Air &c..; local applications are not not of much service 
the best are the Liquor Calcis et Lactis p. a. vel Litio Nigri. It has been said 
that Mercury passing by the pores will act chemically on Gold and other 
Metals, which are exposed to any of the secretions, this is however not the case.
Lecture 26th.. On Scrophula.
Scrophula may be defined to be inflammation, accompanied with 
original debility, in which respect it differs from common inflammation,
the latter may be brought on in originally strong constitutions by intemperance
the former is hereditary. That it is inflammation may readily be seen
by the different processes which are taking place; but not [not] in an healthy
manner as in common inflammation, first the adhesive process, but the adhesive
matter which is thrown own is incapable of becoming organized from
want of sufficient action, it is then capable of being taken up by the absorbents,
it is also impossible to inject this matter, the second process then commences,
Suppuration, this is also imperfectly performed, for instead of a healthy




91
pus, a quantity of serum is thrown out, with small portion of coagulable
lymph floating in it; thirdly Ulceration this is very slowly performed.
When they have burst and the Matter is discharged, they are very
difficult to heal, the Adhesive Matter which was first thrown out 
being disorganized and possessing no living power comes away in sloughs
and in consequence of the weak action of the Vascular system the process 
of Granulation is very slowly and imperfectly performed, as is also that 
of cicatrization, the edges being ragged and unhealthy, a large scar is 
generally left. The Persons most subject to this disease are those of a
fair complexion, and a thin soft skin. The action of the external jugulars
is generally seen more distinctly in them than in others. The 
arteries shining through the skin in the Cheeks with the delicate whiteness
of the [skin] Neck, giving to a careless observer the appearance
of the best of health, these are generally accompanied with [the l] a
tumid lip, and enlarged extremities of the fingers. These marks are 
not to be neglected, as they are found to be connected with internal 
structure, which structure gives rise to scrophulous actions. These
diseases generally show themselves in childhood, the first symptom
is enlargement of the Abdomen, from swelling of the Mesenteric Glands,
after which the Absorbent Glands in the Neck become enlarged. It will 
frequently happen that these Glands enlarge during Dentition, without 
any Scrophulous affection, they are then more rapid in their progress,
the different processes are healthy, and they heal leaving a very small
scar. Enlarged Joints are taking place most frequently from the age of 
five years to Puberty, frequently brought on by great exercise. Large Acesses
occur in the spine about the same age, these sometimes project in the Loins
at others downwards and forwards bursting in the thigh forming Psoas
Abcess. At Puberty Phthisis is most frequently taking place, this disease
is depending upon the same debility of constitution, and occurs in those





92
who have evident external marks of a scrophulous habit. Fungus Homatodies
is not frequently occuring in scrophulous persons in after Life; Mr. C. has thought
that they were more subject to Cancer but is not quite decided in that point 
Scrophula occurs in those of an indolent, irritable habit more frequently
in the former, in those it is a very long time before the Constitution is 
destroyed, but in the latter it is more rapid, two or more joints are frequently
affected at the same time, or as soon as one is cured the disease is making
its appearance in another, until the patient sinks under it. Scrophula
is very much excited by the climate and season; it is a rare disease in warm
climates; but Children brought from warm countrys to this very frequently 
die of Scrophula while young, and if they escape this they die of Phthisis
after Puberty; this is more frequently the case with those from the east Indies
than any other part. This is not unfrequently in the Brute creation,
Monkies very frequently, and now and then Birds die of Scropulous tubercles 
in the Lungs. Quadrupids also die of scophulous diseases when brought
into changable climates. Cold combined with moisture are the principal
causes exciting scrophulous action, therefore these diseases are not numerous
in Spring and Autumn, particularly the former. Cause The 
immediate cause if that which increases original debility; or deficiency
of pure Air, want of Food, or Exercise. Fevers are also giving rise to 
scrophulous diseases, even the Inoculation of the Small Pox from the 
severity of the fever is frequently producing it. Scarlatina, or the use of 
Mercury, the latter by the Mercurial action which is set up is very much
weakening the constitution. Proximate Cause Children born of scropulous parents
not only have the external marks of Scrophula, but the internal structure 
of the body is more delicately [frormed]; they have the heart, and arteries,
formed weak, and of course a deficiency in the circulation, this may be
seen by persons who die under scrophula, having a considerable quantity
of Blood found in the arteries, which does not take place in others, but by





93
the contraction of the arteries, is forced into the Veins. The Digestive
organs also weak, the coats of the Stomach are weak and thin 
the Nervous system is also less excitable than usual, by which not
only the Circulation, but most of the Animal functions are weakened.
So that Scrophula is not arising from one part being deficient, but 
from the whole system being weak and delicately formed. The Cure of 
this disease then does not depend upon remedying the symptoms, but giving 
a better frame to the system, in producing better Blood, and invigorating
the [system] constitution. To do this we must have recourse to Food, Air,
Exercise, Medicine, and Cloathing. To produce better Blood. Animal food
becomes necessary, as it is not only more easy of digestion, but contains
a much greater quantity of nourishment. In persons whoes digestive
organs are weak, vetagable food is passing through the alimentary canal
very little if all changed. They should take food at least four times a
day, which should be principally animal food. Thus having rendered
the Blood more nutricious, the next object will be to invigorate the circulation,
this is to be done by air and exercise. Pure Air is necessary to
decarbonate the Blood, hence the air of large towns is always to be avoided,
when this is properly taking place and the blood has parted with the whole of
its Carbon, it stimulates and invigorates the Nervous systems more powerfully.
The sea air is very servicable in the summer Months, but being
damp and cold at other seasons proves injurious; and those who stay at the sea
side in the winter droop more than in any other situation; those who 
have lived in large towns, find more benefit from the sea air than 
those who have lived in the country; Exercise is also very necessary to
the circulation of the Blood. Children ought to play more, and the rigid
customs of boarding schools ought for a time at least to be laid aside.
The attempt to learn Children too much, or too many things at one time,
seldom fails of destroying their health. -





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Lecture 27th.. Scrophula Continued.
In addition to Air, and Exercise, as well as food, we must also have
recourse to Medicine for the cure of this disease; they should be such as
assist the Digestive functions, different forms of Mercury may be
given the Pilula Hydrargyri submuriatis, with Decoct. Sarsaparlla. C
are sometimes useful; the Medicine which answers best for Children
is Hydrarg. Oxymur: gr i Tinct Cinchona ℥ij Misce one or two tea spoonful
to be taken twice or three times a day. It is supposed that the Oxymurious
becomes deoxidated by the Bark. but whether or not that is the case the 
composition is found to be very servicable; it readers the secretion of
the Bowels more healthy, stimulates the Stomach, and has a tonic effect
on the system. The Hydrarg. cum Creta gr ij Ferri Carbonas gr v
Misce this may be given twice a day. Calomel and Soda are useful when
there is much irritation in the system, or when we wish to increase
the action of the Absorbents. Muriatic Acid is also a good medicine.
Muriates of Lime, Burytos, and the Liquor Potassa have been much 
recommended, but Mr. Cooper thinks they are of very little service; the 
cloathing of the Patient should be attended to, it should be such as to 
preserve an equal warmth, Flannel should be worse next the skin, the 
feet should not be suffered to be cold, this drives the blood from the extremities
to the superior parts of the body, and the Lungs especially are more loaded,
so as to produce inflammation and lay the foundation of scrophulous 
tubercles, and ending in Phthisis. Tepid bathing is useful about eleven
o'clock in the fore noon, after which the patient should take a gentle walk- 
Salt may be added when sea water cannot be obtained; cold water produces 
too grant a shock on the constitution, and is generally Injurious.
Diseased Glands; the Glands in general in the Neck become enlarged




95
and instances have occured in which they have destroyed Life; this may be
done in three ways, viz. by pressure on the vessels so as to bring on Apoplexy,
by suppurating into the Larynx, by ulcerating into the vessels. Cause
exposure of the part to the visitudes of the weather; when the Ears have been
exposed to severe cold the Glands immediately below them enlarge.
Treatment, when Scrophulous action is set up in them, they go first into 
the adhesive process, here it will be proper to give Calomel and Rhubard
either in a strong dose now and then, or a small one every night and morning,
apply evapourating lotions, as Lotia Plumbi ℥vss Spt Vini ℥ss, this 
plan will generally produce absorption of the Adhesive Matter. If they 
are in an indolent state with insensibility and having no blush, apply
Emplast. Ammon: cum Hydrarg, this requires to be kept on a considerable 
time, it may also be useful to apply friction, or pressure. When Suppuration 
occurs it is to be treated as in other parts of the body, increase
the vigour of the circulation, by which the process will be much hastened,
and allow a generous diet, and stimulating poultices may be used made 
of stale Beer Grounds. When matter has formed, and fluctuation can 
be perceived by a red tint, they should be opened with a small 
lancet; if they are allowed to burst; or are not opened until the skin
becomes a brownish red, which shows that it is extremely thin
and possesses very little living power, large sloughs are coming away, 
and the process of granulation being imperfectly performed in the part,
a very large scar is left; which may be avoided by opening them sooner
a probe being introduced daily to evacuated the matter, the orafice being 
frequently stopped by portions of coagulated Lymph, which are floating
in the serum. The sores may be washed with a weak solution of the Nitric
Acid, about six drops, to four ounces of water; the Ungt.. Hydrarg. Nit.
Miti, or the Ungt.. Hydrarg. Nit. Oxyd. may also be used. Sprinkling the 
Carlonate of Iron very much improves the Granulations.





96
Glands sometimes become enlarged situated at the root of the Lungs,
and not unfrequently an earthy matter is deposited (which is coughed
up sometimes). The Mesenteric Glands generally becomes affected
first in Children, most frequently from six Months, to two years old, 
the occasion considerable swelling of Abdomen. Cause imperfect 
digestion, the food going into putrifaction, and by this means irritating
first the Glandula Agragata, and Solitariæ, and from them extending to
the Mesenteric Glands; sometimes these children will eat ravenously, and
sometimes scarsely anything. The first is from the very little nourishment 
derived from the undigested food, the child endeavouring to make up the
deficiency by taking in a larger quantity. A white matter is not unfrequently 
discharged from the Bowels resembling Chyle. They sometimes go
on to suppuration, bursting into the intestines, or externally forming an
artificial Anus. When the latter is the case it will be of no use to try to 
heal this, until the system is improved, when it may be occasionaly be cured.
A large quantity of earthy matter is sometimes deposited. Treatment
it is a very manageable disease, and will generally be found to give
way to the Tincta. of Bark combined with the Oxymuriate of Mercury
given in the proportions as before mentioned; it promotes absorption;
improves the secretion of the Bowels, and strengthens the system;
at the same time apply Emplast. Hydrarg. cum Ammon: over the 
Abdomen very little else but animal food should be taken, as Milk,
Broths, and Meat; the milk sometimes turns acid on the Stomach,
and the Broths will sometimes derange the Bowels: solid Animal food
taken frequently, and in small quantities will be found the best.
By this treatment they may generally be recovered, if they have no
Cough, or disease in the Lungs; Mr.. C. has seen several instances in which 
they have afterwards had dropsy, but from which they have recovered,
after the water has been drawn off, and proper attention to diet,
air, and excercise has been continued. - 




97
Lecture 28th.. Diseases of the Joints.
Scrophulous Diseases of Joints are vulgarly called whtie
swellings, probably from the skin not being discoloured, they go
through the adhesive, suppurative, and ulcerative, processes. When 
it first commences there is stiffness of the joint, a little swelling
is next observed, and slight pain in motion, sometimes the pain is
excessive. The Constitution generally suffers very little in the adhesive
process; when they have remained in this stage a month, or five weeks,
the suppurative process commences, which generally begins in a single
spot, as the joint is already filled up with adhesive matter, after
this has continued for sometime, it breaks generally three or four inches
from the part where suppuration first commenced; a fistulous
sinus leading to the joint; the suppurative process is indolent, and seldom
attended with much pain, but the constitutional irritation is 
sometimes considerable. The Synovial Membrane is the seat of the
disease; the Ligaments, Cartilages, and Bones become affected secondarily.
Treatment. When a Child is seen with these enlargements, 
the Parents should be aprized of the necessity of attending to the rest
of the part, Purgatives should be give as the Sulphate of Magnesia,
with Calomel; the disease in the first instance should be treated
as Inflammation, a Lotion with the Liquor Ammon: Acet. should
be applied, to the part being exposed to the air, to assist in evapouration.
In general these diseases may be cured in their infancy, but if 
they are neglected in this stage, the cure is extremely difficult; if
evapourating lotions do not succeed in reducing the inflamation, leeches
should be applied, and if the [inflammation] enlargement continues
after the inflammation is removed, Stimuli may be applied as Blisters


The operation of amputation now is as one to twenty to what it - 
was formerly. 


98
dressed with the Ceratum Sabina. Ungt.. Cera ℥i Antim. Tart. ʒij
Misce, this is a useful application in this stage of the disease, as it 
excites external irritation. Vinegar Poultices may be used for the same
purpose. Setons in general are prejudicial as they extend the inflammation
back to the joint. After the inflammatory stage pressure may be made
with straps with Emplast. Hydrarg cum Ammoniac. with a bandage.
When the swelling is diminished, and stiffness is only remaining, friction
is employed with great advantage; Mr. C has seen many cases
of this kind cured by Mr. Grosvenor's plan of treatment. When we are
about to anchylose a joint; it should always be done in a bent
position, as it will generally be more useful to the patient. The operation
of amputation is now seldom performed for this disease
and the only thing which can justify it is that the constitution
has suffered so materially, that if it is not removed it will be production 
of more serious injury, but Anchylosis of either the knee or 
elbow can generally be accomplised before the constitution is much affected.
[Is] In diseases of the Hip [of] their is generally the same symptoms
produced as in other diseased Joints, but there are some peculiar symptoms;
the pain is first felt in the knee, but upon examination there is found
to be no enlargement of this part, the pain is felt at the upper part
of the Patella, or a little to one side, or sometimes in the course of the 
Sciatic Nerve. When a person complains of these symptoms, we should look 
for diseased Hip, rather than knee, and upon examination the motions of 
the thigh will be found to be difficult, and pain is produced when it 
is rotated, fixed or extended, the foot is turned a little outwards, but if 
pushed much outwards it gives great pain; the limb is from half an inch
to an inch shorter than the other, and the spine is a little curved.
The shortness arises from the absorption of the head of the bone, and
of the acetablum, if the patient is laid upon his face the clift of





99
the nates will be found be unequal, and there is also a there is also a depression in
the groin, but the strongest characteristic mark of a diseased hip, is
the flatness of the Nates on that side, pressure behind the Trochanter a
little above its level gives considerable pain, these are the most common
local symptoms, in addition to which there is sometimes very acute pain
and when this occurs, the disease is generally of more easy cure. The disease
remains in the adhesive stage for sometime; Absorption is constantly going
on, there is generally no effusion, but what appears like a solid Mass.
Matter however is now and then formed, and it frequently extends a considerable
way from the joint, the greater its extent from this part the more easy will be 
the cure; the matter is sometimes taking different directions in some of which 
it is proving destruction to Life; sometimes it finds its way into the rectum,
in others it is bursting into the Vagina, and it occasionally passes to the 
vicinity of the Femoral Artery, and produces ulceration of that vessel or 
some of its branches. When a Hip Joint has been examined which is the 
subject of this disease, the synovial membrane is found to be inflamed, and 
sometimes ulcerated, the Ligaments are thickened, the Cartilages, and a
portion of the Bone absorbed, sometimes a hole is formed thro the Acetatlum
into the Pelvis, through which the head of the bone not unfrequently passes.
When a person applies with this disease; rest should be strongly recommended,
and that in the first instance in the recumbent posture, without
this no relief can be given. Calomel purges must be administered, the dose
should be varied according to the age of the patient, and given every second 
or third night, the feet should frequently be put in warm water, or
if the patient is young the whole body should be immersed. If the
Inflammation is not releived by this treatment Leeches should be applied, 
and afterwards large Blisters, the Cuticle removed and dressed
with the Ungt.. Sabina, vel Lytta. You should always endeavor to remove
the disease in its infancy; Mr Cooper thinks that if a Medicinal man is





100
committed within a month of its first appearance, that the disease may 
be generally cured; but if neglected until after this time we can seldom
succeed in removing it; the disease however steals on so insidiously, that 
it is with difficulty that it can be discovered before this time. If Blisters
do not succeed, Issues, or Seatons may be had recourse to, the disease is
the first instance is Inflammatory, and requires an active treatment,
but when it assumes the Chronic form it requires a protracted one.
When Matter is formed we should avoid opening the abcess early, this 
circumstance is necessary to be remembered in all diseases of joints, the 
reason is that if the Abcess is allowed to take its own course for a time, it will
extend further form the Joint, which will becomed filled up with Adhesive
Matter. But if it is opened early high constitutional irritation will be
the result. When the disease is in the ulcerative stage, advantage is frequently
derived from external irritation, by Issues, or Setons, which will generally 
succeed in diminishing the discharge. As soon as the Acute form of the 
disease is over, the [s] patient should be allowed to walk with Crutches, or have
the Limb supported in a sling carried over the neck as in fracture; the
foot should not be allowed to be first on the ground.
Lecture 29th On Lumbar Abscess.
The joints of the Spine are liable to the sames affections as other joints, and
as there is no synovial membrane, the interverbal substance becomes the seat of 
the Inflammation; Absorption of the bodies of the Vertebra is then taking
place, the consequence of which is curvature of the spine, the spinous processes
are felt very distinctly, projecting further than usual, either one or more
according to the number of vertebra affected. Paralysis is coming on,
being produced by pressure, it differs from common Palsy as the muscle
are in a rigid state, so that the limb cannot be moved, which is not the 
case in common Palsy. The Muscles become affected, and they are liable to 





101
spasmodic contractions, which is principally caused by the irritation. The 
sensibility is destroyed the actions of the muscles are irregular so that the 
legs are crossing each other in walking, or the foot is set in a different 
place to where the patient intended. The disease remains some weeks or even
Months in the Adhesive stage, it then goes on to suppuration, and large
quantities of Matter are formed, this is bursting in different parts, if 
it is formed externally to the transverse processes it burst in the Loins
if internally it makes it way to the Groin, or Thigh; sometimes it 
makes its way to the Thorax, communicating with the Lungs, a large quantity 
of Matter is spit up. Sometimes one or two, or even as many as
five Vertebra are affected, and according to the number affected will 
be the deformity produced. Sometimes after the patient has had
Paralysis a very long time, he will recover slowly, generally when 
extensive ulceration has taken place; they are sinking under the 
suppurative process. Treatment, rest in the recumbent posture is 
absolutely necessary, but he ought not to lay much upon his back,
but should turn occasionally from one side to the other, or if when 
on his back the shoulders ought to be raised; Nutricious Diet ought 
to be given, and this must consist chiefly of Animal food, Ale, Porter
or even Wine when it does not create a feverish heat may be taken.
A Calomel and Rhubarb Purgative may be given twice a week to keep
the Bowels open. Machines for keeping the Back straigh ought not to 
be used, as they are effectually removing all chance of cure, which by the
uniting or anchylosis of the Vertebra, to admit of this the body must be
kept curved, which will very much hasten the process. External irritation
may be used, but should not produce any very extensive effect.
Issues on this account a seldom proper. Rubbing the Spine with the 
Ungt.. Antim. Tart., or the Linimt.. Antim. Tart. is sometimes useful, 
and it may now then be proper to apply a Blister. -





102
Psoas Abcess and Lumbar Abcess are different variations
of the same disease. In the former the matter makes it way down
the Illiaces Muscle, and having reached the tendinous expansion over
that muscle, the Psoas Muscles next becomes excavated giving passage
to the Matter which bursts in the Thigh. If the disease begins external
to the transverse process the Matter passes backwards, and bursts in the 
loins; pain is felt in the Loins for some months before a tumour
can be discovered, the thigh [can be o] is brought forwards, and 
incapable of being straightened. If these Abcesses are left to themselves
they open by small orifices, and clots of adhesive matter are preventing
the quick discharge of the Matter; previous to the matter being discharged
the Patient does not suffer much from constitutional Irritation,
but very soon afterwards hectic symptoms appear. Patients frequently 
fall victims to this disease, but if the bone is not ulcerated to any
great extent, they sometimes recover. Exfoliation of the bone
occasionally takes place, peices of bone coming through the opening.
The plan recommended by Mr Abernethy is to be adopted, opening the
Abcess and discharging a small quantity of Matter obliquely, the opening 
is then to be healed, and after a short time a repetition of this 
operation will be necessary healing it as before, this is done with a view
to prevent constitutional irritation. A small Trocar is the best instrument 
we can employ. Rest is necessary and the [sam] same mode of
constitutional treatment as before mentioned. Lumbar Abcess is to
be treated the same as Psoas. Scrophulous Pimples on the Face.
These require the general health to be improved Low Diet will sometimes
remove them for a time, but it only increases the propensity to 
the disease and the only mode to prevent this is to have recourse to
noroushing diet. and a due quantity of exercise should be used: they 
should be opened with a Needle as soon as they are formed.





103
Lippitudo is to be cured by the Ungt.. Hydrarg. Nit. Mit. rubbed
on the eye lids, or the Ungt.. Hydrarg. Nit. Oxyd. and the disposition to
the disease is to be removed by improving the health. The Testicle is 
sometimes affected with Scrophulous enlargement, in Boys about the 
time of Puberty; this requires the Bark and Oxymur. Hydrarg. they 
are sometimes very large but the above remedy will generally be found
sufficient. Rickets are occuring in Children of debilitated constitution,
and are generally the first appearance of any scrophulous disease, they sometimes
come on in six months after Birth; the make of these Children is 
peculiar, they have large hands prominent fore heads, flatness of the 
upper part of the head, the skull growing from a determination of
Blood to the part, the Teeth are ill formed, sometimes decaying very 
early, the Chin is protruded, Spine curved in the shape of an Italics,
the Ribs are altered in their form falling at the sides, and occasioning 
the Sternum to project, in the Pelvis the Ossa Innominata are narrower
as are also the tuberosities of the Ischium, the Thigh Bones have joints
formed in them, in consequence of a falty deposit of Boney matter, the
Cartilages yielding to pressure give a slight degree of motion; the 
Tibia, and Fibula fall inwards; Joints are formed in the Humerous, and 
sometimes even in the Radius and Ulna. The Bones readily break with 
the least accident. It is in consequence of a want of [vigrour] vigorous
circulation, the Arteries which secrete bone, being incapable of throwing
out a sufficient quantity of Boney Matter. Cause want of healthy air,
as in close towns, want of due [noroush] nourishment, and exercise
It is to be releived by avoiding these, and giving frequently small
quantities of animal food, the Blood being improved by Air and exercise,
in warm dry situations. Girls may be allowed to ride on horse 
back changing the side on which they sit frequently, or the Spine
will be incurvated in consequence. Bark and the Oxym. Hydrarg. -





104
may be given or the Hydrarg. cum Creta with steel. Cold bathing with salt 
water twice a day, the body afterwards being well rubbed with a coarse 
cloth to increase the circulation, if sea water cannot be obtained one
ounce of Salt may be added to a pint of water, will be a useful substitute.
Machines which are used to keep the Spine straight are weakening
the Ligaments, and rendering it impossible for the patient to do without
them. When they can be contrived to do this by passing under the Arms.
and resting on the Ossa Innominata, so as to keep the Spine stright 
without weakening the Ligaments, they may be beneficial, in this case
also they will [be] not be exposed, and of course more preferable on 
that account. _
Lecture 30th.. On Wounds.
Wounds are divided into four kinds, first the incised, which is a
division of the soft parts with some sharpe instrument; 2nd the lacerated
in which the parts are torn asunder; 3rd.. the contused, here the parts
are not only seperated but disorganized; 4th the punctured, those 
seperated by the penetration of some pointed instrument, the parts
being seperated as if by a wedge. Incised Wounds when a wound 
is occasioned by a cutting instrument, there is generally a considerable 
flow of blood, owing to the complete division of the Arteries, when much 
blood is lost, fainting is usually produced, this seems to be provision of 
Nature to stop the hemorrhage, by allowing time for the blood to coagulate
and fill up the mouths of the Vessels, this ought not however to be [encorouged]
encouraged, as there is frequently a difficulty in recovering 
those who are of a weak constitution. To stop the bleeding we should
always apply pressure, it will be mostly sufficient, always avoiding 
the too frequent use of ligatures, as these are setting up an interruption to 
the healing process. Having done this all the coagulated blood is to be





105
cleansed away from the surface of the Wound, and the edges are to be brought
together, when this is done nature sets up a process of adhesive inflammation, 
and an effusion of adhesive matter takes place, blood vessels 
then shout out from the sides of the wound through the adhesive
matter, these are principally derived from the vasa vasorum of the
divided vessels, this may be done in about ten days. The substance by
which parts are united, is generally the same as the divided parts, but
there are some exceptions to this, as Bone united by ligament within 
Capsular Ligaments, Cartilages in the adult unite by Bone &c.. Union
by adhesion will take place between soft and hard parts. If parts
are nearly seperated from the body, [crossed out] they will unite, and in some instances
where they have been completely seperated. One part may 
also be engrafted into another, at least in the Brute creation.
When union by adhesion can be excited, all danger from the wound ceases,
except when some internal viscus is wounded, and when the inflammation
extending is productive of serious consequences; various circumstances
prevent union by adhesion. 1st. too many sutures may have
this effect. Adhesive plaister when sufficient ought always to be 
used, but in wound of the face extending into the mouth, the Eye
lids &c plaister will not keep the parts in their proper situation. 
In the Scrotum if sutures are not used the sides of the wound turn
in, which sets up a great obstacle to the healing of the wound. 
2nd. too many ligatures on arteries, when numerous ligatures are applied 
and very small vessels are secured, as ulceration naturally takes place,
great obstruction is set up to the healing of the wound. Silk ligatures
seldom remain quite on arteries, but are generally seperated by
suppuration, and ulceration, those of Cat gut, however in some 
few instances, in which they have been tried, have remained without
producing ulceration. 3rd. impatience on the part of the Surgeon, after





106
an amputation, or extensive wound, the dressings ought not to be removed as
some days. On the fourth day one Strap ought to be removed, and after the 
matter is cleaned away to be renewed, the following day two straps, and
so on until the whole dressing is removed, which ought not to be before
eight days at soonest. 4thly Poisons, in these cases it becomes necessary
to remove the parts which have been affected by the Poison, before
union can be expected to take place. 5thly.. When numerous Absorbent
Glands have been divided as in transverse wounds in the Groin, or 
Axilla, in which case a great quantity of Lymph is thrown out,
which prevents the union. [to] 6thly.. Wounds into secreting surfaces, of the
Mucous kind, here adhesion will not take place from their going readily
into the suppurative inflammation, they are therefore healed by 
Granulations. -
Lecture 31st.. On Lacerated Wounds &c.
The parts are torn asunder, the bleeding is generally extremely 
slight, the cause of this disease is two fold, first because the Arteries
are torn off short, while the cellular membrane hangs about the
vessels, retarding the flowing of the Blood, and allowing time
for the coagulation to take place. 2ndly.. the mouths of the vessels
are found open so as to admit a probe, but contraction from
over distention has taken place higher up the vessels. These wounds
are more frequently succeeded by Tetanus than the former, hence we ought
to avoid any thing which will debilitate as much as we can.
Depletion ought not to be used to any great extent, and the patient
should live much as usual, and in an unirritable state, by
the almost constant use of Opium. Extraneous Matter is very 
likely be introduced, and great care ought to be taken to remove 
this. More inflammation is attending these, than the former wounds.-




107
therefore after the strapping has been applied, it will be proper also 
to apply a bandage, which is to be kept wet with the Lotio Plumbi,
and if the inflammation increases Leeches ought to be applied, and
if it the proceeds the Plaisters are to be removed, Poultices, and 
Fomentations to applied, to promote a secretion of Matter.
Contused Wounds. These differ from any of the former, in [the?]
being accompanied with disorganisation of the parts, which disorganised
parts must be frown off, hence there is no use in trying to
promote adhesion, which attempt will only add to the inflammation,
Very slight contused wounds on the Tibia, when only a very small
portion of skin is destroyed will require at least a month or six weeks
to heal it. We must encorouge secretion, and suppuration of the parts
by Poultices, or the Nitric Acid Wash, the latter will generally be the 
best. Suppuration takes place in a moderate sized wound in a 
fortnight or three weeks, after this Granulations shoot up, an then it
is that we must approximate the edges, the process of restoration will 
be about three weeks longer; we must give purgatives occasionally, Opium
should be used freely, Bark is of little except when the constitution is
very much debilitated. Punctured Wounds these are the most 
dangerous, it seems the parts are rather seperated, than properly divided,
and the inflammation arising from this kind of injury is very 
extensive; the Nervous system frequently becomes affected, and Tetanus
is not unfrequently the result. Punctured Wounds are exerting their influence
first on the Absorbents. 2ndly.. When Fascia are punctured. 3rdly
Influencing the Nervous System - first of the Absorbents, a puncture 
made into skin exposes the Cells of the cellular membrane, into which the
Absorbents open, which become affected, the inflammation extending 
along their course to the Glands which enlarge and suppurate; the 
inflammation does not stop here always, but is affecting nearly the





108
whole side, various parts which Abcesses form; the inflammation
depends more upon the constitution, than the form of the wound.
When this last is suspected, the best treatment will be to introduce the
point of a Lancet, and make an incised wound; cauterizing the edges
of the wound with a solution of the Nitrate of Silver, we must give 
Calomel and Sulph. Mag. with opiates occasionally. If inflammation
arises apply poultices made with Lotio Plumbi, and if this is not sufficient
apply Leeches in great number; Stimulants must not be given 
in the inflammatory stage. One Gentleman who took a large quantity
of Urine died in a few hours, and in another case which was also attended
with a fatal result, the [Gell] Gentleman rubbed in Mercurial Ointment.
Bark may be given after the inflammatory stage has subsided.
2ndly.. When Fascia are punctured, as the fascia lata of the thigh, inflammation
is set up, and suppuration takes place in the inner side 
of the fascia, this burrows there and produces great constitutional 
irritation unless freely opened. 3rdly.. Influence on the Nervous system,
punctures into nerves produces long continued irritation; when this takes place
numbness is the result, and Chilblains are produced in parts thus deprived of
Nervous energy in cold weather, which are sometimes very extensive. Universal
Spasms differing from Tetanus are not unfrequently the result of punctures.
In some cases from very slight punctures, the person is complaining in
about a week of a stiff neck and supposes he has taken cold; the Muscles
of the Neck become stiff the Jaw cannot be moved, next the muscles of the 
Abdomen, then of the thighs, and lastly those of respiration become affected,
so that the person breaths with the greatest difficulty, as the other parts become
affected the jaw becomes relaxed. There is a fever which is present the
whole of the time, the pulse is steadily quick about 120 strokes
in a minute, and while this is the case, although the Muscles 
may be relaxed, yet [?no] relief can be obtained. Tetanus is either Chronic
or Acute, the latter of which in this Country is never cured, the former is




109
frequently cured or the patient recovers from the disease being completely 
worn out; Calomel in considerable doses, and the cold bath are most 
likely to be useful. Bleeding exasperated the disease. Trismus seldom
proves fatal, and is best treated by Blisters applied to the back
of the Head. Purges, Calomel, Opium &c..
Lecture 32nd.. On Aneurism.
Is - a tumour containing blood, having a pulsatory motion, and communicating 
with the interior of an Artery. The symptoms may be divided
into three stages, the first stage of and external aneurism, is a pulsatory
tumour, it may be much lessened by pressure, and a cessation of the
pulsatory motion is the consequence, but if the pressure is removed, the
tumour suddenly increases again, and motion returns, the skin is of
a natural colour, and rather weak. 2nd- Stage after the above symptoms
have remained some time, the tumour becomes filled with coagulated
lymph, and is hard, and incapable of being emptied. Pain is now 
produced by pressure on the Nerves, and if it is situated in the lower
extremity the limb becomes adamatous, from pressure on the veins obstructing
the circulation; the skin is of the natural colour. 3rd- Stage by the 
pressure of the contents of the tumour on the skin becomes of a dark colour,
Inflammation is set up; after a few days vesication takes place, and 
the inflammation continuing, Mortification of the Integuments [illegible],
from the Bottom of which fresh sloughs are seperated until the interior
of the sack is laid open, when a copious flow of blood takes place
not so as to destroy the patient at first, fresh sloughs seperate,
and discharges of blood taking place every few days, until at last
they become so considerable as to destroy life. But in this state they 
may be preserved for some weeks, by forming an artificial covering





110
to the tumour, by means of lint and a roller, so as to allay the violence
of the hemorrhage. Aneurisms are divided into External, and Internal
When those placed internally have proceeded to ulceration, the patient dies
suddenly from the first bleeding of the tumour taking place in the 
Cavities of the Body. The Heart is sometimes subject to Aneurism
which happily is a very rare disease. It is not a mere enlargement of 
its cavities, which is not unfrequent but of the giving way of some
part of the Parietes, by which a Sac is formed containing blood, 
and communicates with the interior of the Heart. Aneurisms frequently
occur in the ascending Aorta, this produces a Cough and difficulty in breathing;
a fulness is found near the Nipple of the right breast, if this occurs
on the left side we may suspect the heart to be the seat of the disease, and
not the aorta. The tumour pressing on the [right] Sternum, and the 
Cartilages of the Ribs, occasions absorption to take place in them, after which 
the Pectoral Muscles form the covering of the Sac, and in their turn
they also become absorbed, and so on until it ulcerates through the 
integuments and breaks externally. This disease also occurs frequently
at the arch of the aorta, in this case the tumour does not begin to project
until it has arived one third upwards on the common Carotid Artery 
so that, that Artery is frequently mistaken to be the subject of the disease,
or the subclavean Artery may be suspected of having produced it. 
In this situation their progress is the same, but they sometimes destroy
life by pressure on the Trachea, or bursting into it, which occasionally 
takes place, the patient dying immediately from suffocation. When
seated [on] in the descending sorta, they press on the Osophagus, and produce
either a stricture there or symptoms very similar to it, these
destroy life by bursting into the Chest, or Œsophagus. When in the
abdominal Aorta, if just below the Diaphragm the project into
the Scrobiculis Cordis, where pulsation may be felt, this is producing




111
vomiting if much food is taken into the Stomach at once. It is however
but rare that they are placed in this situation. They occur 
more frequently lower down the Aorta, the tumour being felt in
the abdomen, these are producing death by bursting in the Abdomen
or into the intestines. When passing from the posterior part of the 
Aorta the Vertebra become absorbed, the tumour passing backwards
into the Loins, there producing a swelling which does not pulsate, and which 
has sometimes been mistaken for Lumbar Abscess, but may be distinguished
by the want of fluctuation; when thus situated they have sometimes
been punctured, and that without proving fatal, a dossil of Lint and
slight pressure being sufficient to stop the hemorrhage, until the 
adhesive process has taken place, and the wound healed. The internal
Iliac artery is sometimes the subject of this disease, the tumour is 
felt under the Gluteus Maximus, projecting through the Ischiatic
match, and may be mistaken for aneurism of the Gluteal or Ischiatic
in one of these caces Mr.. C was going to operate by taking up the
Gluteal artery, but was very fortunately detered from it by observing
that a quantity of Blood was occasionally voided with the Urine
When Aneurism appear externally they are most frequently situated
in that part of the artery which is opposite joints, the probable cause
cause of this is the frequent flexion of the artery, by which their coats
are weakened. It has been said by some writers, that those people who 
are much in the habit of riding, are more liable to aneurism, but
this opinion is hardly founded on path. The Popliteal artery is the 
most subject to this disease; but it occurs also in the Groin; in the 
upper extremity they are most frequently in the Axilla, but occasionally
happen at the Elbow; the Carotids are not unfrequently affected; 
they occur more frequently in the large, than in the small arteries;
but they are sometimes produced in the Temporal, Occipital, and


[??] Aneurism of the Carotid artery may be distinguished from Bronchocele,
by requesting the patient to swallowing if the Tumour rises
it is not Aneurism, if it remains stationary it is; "a pulsation is
felt in Brochocele."



112
even in the posterior Aural Arteries, generally occuring [th] in
these however from bleeding or punctures; some persons have 
several of these at one time. Mr. C. has seen several at one 
time in the same subject; when opened they are found to consist
of a bag communicating with the artery, and filled by successive laws
of adhesive matter; The sac is not unsually the coats of the artery, it 
is made up of any part of the body, with which they come in contact,
whether Bone, Muscle, or Integuments, the parts which compose
the sac is continually throwing out adhesive matter.
Aneurisms are produced in four ways. 1st.. Absorption of the Coats of 
the Artery, in this case the Artery first becomes white and semitransparent
and becomes gradually thinner; the way in which nature guards against
this danger is by throwing out on the inner side of the artery adhesive 
matter, covering the weakened part, and which afterwards forms the 
sac. 2nd.. By a general dilation of the coats of the artery, this is 
sometimes occuring on one side, sometimes on the whole circumference
of the Artery, and forms what was usually called a true Aneurism.
3rd.. By Laceration, the blood escapes into the cellular membrane which 
forms the sac in the first place, this as the same progress in its course
as the others. 4 By a blow with a pointed instrument, where the
Artery is situated on Bone; Aneurisms situated in the Arteries of 
the Head, are most frequently brought on in this way, except those
in the temporal artery, which sometimes follow bleeding in that
Vessel. - 




113
Lecture 33rd.. Aneurism Continued.
In general Aneurisms are readily distinguished from other diseases
Tumors however situated either over or under an Artery, are 
sometimes liable to be mistaken for Aneurism, as the pulsation
of the Vessels frequently imparts a pulsatory motion to the 
tumour. If the tumour is situated over an artery, it may be raised by 
the fingers so as to be removed from the artery, when the motion instantly
cases, if situated under an artery [a] pulsation is only felt in the
middle and not in the sides of the tumour; but the most unequivocal
mark of distinction is by pressing upon the artery which runs to the 
tumour, if when this is done the tumour becomes smaller, and suddenly
increases when the pressure is removed, we may rest assured it is aneurism;
but if the tumour remains stationary, and cannot by gentle
pressure upon it, be in any degree lessened, we may justly suppose it is 
not aneurism, unless it has been so long standing as shall have given
time for the sac to become filled with Adhesive matter.
Prognosis. This generally unfavourable but some instances both
of external and internal aneurism have been known to spontaneously
subside. In one case a man was admitted into Gags Hospital who had 
aneurism of the external [illiac] Iliac Artery, which after some time
burst and a quantity of blood was effused under the Iliac fascia
which occasioned such a degree of pressure on the Artery above the 
tumour that is become entirely obliterated as high as the internal iliac
and the aneurism thus spontaneously cured; this man died some time
after of aneurism of the aorta. But unfortunately these caces are 
but rare, and in general if an operation is not or cannot be performed, 
a fatal termination is to be expected. This disease occurs
most frequently in the middle period of Life, very seldom in those





114
under twenty five years of age, although one case happened to Mr. 
H. Cline in a child only thirteen; the most advanced age at which 
Mr Cooper has seen was 80. It occurs much more frequently in Men
than Women, which may readily be accounted for [f] by the much
less severe exercise being taken by the latter. Cause This is generally
exercise disproportioned to the Strength; it is happening in those who
have brought on an irritable habit from intemperance. When the Arteries
are in a weak state, the circulation becomes much quickened, by any
violent exertion. a degree of inflammation is the consequence, which
proceeds to ulceration and afterwards to aneurism. Medical 
Treatment. Very little can be done constitutionally to releive this 
disease, the patient should be kept quiet, and every thing should
be avoided which can lead him to make the least exertion; his mind
ought to be tranqualized as much as possible; Digitalis has been
recommended with a view to lessen the frequency of the Pulse, and 
Arterial action, with the same view small quantities of Blood has been 
taken away occasionally. Little food should be taken and that not 
of a stimulating nature, but sufficient ought to be taken to nourish
the system, and prevent the ill effects of weakening too much which 
would only aggravate instead of diminishing the disease. But with all 
these means the life of the patient can only be protracted a few Months,
and it is doubtful whether constitutional treatment is of any service
or not. The length of time therefore before they destroy life is uncertain,
but depends very much upon the situation of then; if situated
under a substance which readily ulcerates through, the time is much less,
but if placed under a strong fascia, as that of the thigh it may be several
years before it bursts. Operation This may be done according to
the old or new plan, the old method [mas] was after applying a 
Tourniquet either to take up the artery above or below the sac, and





115
afterwards remove the Coagulum, or lay open the sac and take 
up the Arteries which pass into it, in this case it will be 
necessary to pass a probe into the vessel to see in what direction
the ligature should be applied. In aneurisms of the Temporal,
Radial, Ulnar, or Anterior Tibial artery, it will be necessary on account
of the very free anastomoses which these Arteries have with the neighbouring
ones to secure the Vessel above and below the sac; But there
are very considerable objections to this method, the surface which 
exposed is very great, especially in Popliteal Aneurism, in these
cases the constitution becomes affected before the wound can be
healed; and also the length of time that they require is very considerable.
It is to Mr. Hunter that we are indebted for the great improvement
in performing this operation, which concists in cutting off
the stream of Blood which is passing into the sac, the limb
below being supplied by the anastamosing Vessels, the aneurismal
Bag being left to nature, its contents in time becoming absorbed
Mr. Hunter performed the operation by mearly tying the Artery
and allowing the Ligature to ulcerate through. Mr Abernethy
advised that two Ligatures should be applied and the artery divided
between them, and Mr. C thinks the operation we now have is
the safest, although several different methods have since been 
tried. Mr. Lawrence has recommended that the ligature should be cut
off close to the Knot, and the wound healed immediately, this however
is sometimes followed by suppuration, and occasionally when the artery
is ulcerated through it retracts with such violence us to occasion
hemorrhage. When the femoral artery has been tied it is usual to find
the corresponding Vein obliterated for some inches above and below
the ligature, the irritation from which occasions Inflammation
in the Vein, and Adhesive Matter becomes thrown out. -



Mode of tying the Femoral Artery with two Ligatures, make an
Incission about four inches in length through the Skin, beginning
one third down the thigh, to the inner edge of the Sartorious
Muscle, next seperate the inner edge of this Muscle from the 
surrounding cellular substance, which will bring the femoral sheath
into [a] view, then make an opening into the sheath, & pass a blunt
needle under the artery, armed with two ligature. "Dutch twine"
apply the ligatures, about an inch asunder, the artery must then
be divided, & edges of the wound brought in contact, to unite
by the adhesive process - Great care must be taken not to include the 
Nerve in the Ligatures, & also not to seperate the Artery from the surrounding
parts, more than is necessary.
4 The Vein lays upon the inner side of the Artery; Mr Cooper
has performed this operation eight times, seven of the cases out
of the eight recovered.


116
Lecture 34th.. Aneurism Contd..
After the operation as described in the last lecture, the sides of the 
wound are to be brought together by straps of Adhesive Plaister, no
roller ought to be applied as this only obstructs the circulation of 
the Blood in the unastomosing vessels. The Limb especially in cold
weather should be wrapped loosely in flannel to keep up up the heat,
and prevent Mortification; which occasionally takes place, if this 
is neglected. After 12th, or 15th days the Ligatures will come away 
in most instances, but they should not be meddled with until the 21st.. 
day when if they do not then seperate, they may be gently pulled when 
the wound is dressed. The Patient should be kept quite still and not
allowed to get up until the 21st.. day at soonest, even if the ligatures
have come away as early as the 12th.. day; the patient should lay as 
much as possible on the outside of the Limb. The operation performed
in the above way answers very well in most cases of Aneurism, even 
that of the anterior, or posterior Tibial artery when [a] situated
high up the Leg, but when the aneurism is situated near the Ancle it
becomes necessary to open the sac, and take the vessel up both above
and below. Operation for securing the External Iliac
Artery. The first incision is to be a semicircular one, extending from 
the external abdominal ring, to about an inch of the superior and 
anterior spinous process of the Ilium, and to its inner side, the next
step is to cut through the tendon of the external oblique muscle:
then lay aside the knife, and turn up the internal oblique, and 
transversalis Muscles (which will be exposed) as high as the internal
abdominal ring, through this opening you see the artery, which 
is first to be seperated from the vein by the handle of the Scalpel.





117
an Aneurismal Needle, with a double Ligature in it, to be introduced
under the artery; when the ligatures are both secured, the one as high 
and the other as low as may be necessary, divide the artery as in the 
former case. It is necessary to be very cautious of wounding the 
Peritoneum in this operation. The Internal Iliac Artery has twice 
been taken up, and once with success, through an opening made above
pouparts ligament, in a similar way to the above. In Aneurisms
of the Temporal, Occipital, or Aural Arteries, after pressure has
been made on the vessel running to the Sac, this must be opened and
the vessels secured, the disease is not diminished by merely taking up 
the artery which runs to it, as the vessel in this part anastomose very
freely. Carotid Artery. The operation for securing this is as 
follows, the first incision is to be made to the inner side of the Sterno
Clido Mastoidens Muscle, turning this aside you see the Omo Hyodeus
crossing under the former Muscle, and immediately under these two,
where they cross each other, lies the Carotid Artery, pulling these aside
you see first the internal Jugular Vein above and to the outer side of 
the Artery, in Inspiration this vein is almost receding from view,
but in Expiration it is swelling up immediately before the Artery,
and if great care is not taken it will very liable to be wounded,
and some caution is also required so as not to include the Pars Vaga
in the Ligature, which would bring on a great degree of constitutional
derangement. if not Death; the Nerve lays behind and to the outer side
of the Artery, having passed an aneurismal needle with two ligatures
divide the Artery as before mentioned, and bring the sides of the 
wound together by straps of adhesive Plaister. Subclavian Artery
Tying up of this artery above the Clavical, has never been performed
with success in this country, but one case related by a Gentleman at 
New York (America) is said to have succeeded; taking it up below the Clavical


Mr. Cooper once tied the Abdominal Aorta, partly he says with
success; the Patient lived 48 hours after the operation; beautiful
adhesions had taken place in the vessels "it has been done in 
the dog without any bad consequences."-



118
is a much more simple operation and does well; Aneurisms are seldom
occuring in the upper extremities, except from punctures in bleeding.
The Brachial Artery. Sometimes requires to be taken up,
this is a very simple operation an incision is to be made a little
below the middle of the arm, to the inner side of the Biceps Muscle,
this lays bare the artery, which in this situation is very superficial,
care must be taken that the Radical, or Median Nerve, which passes
to the inner side of the Artery, is neither wounded, nor taken up in the
ligature, if the latter was to be the case, the patient would loose the use
of his Hand, even if he escaped from the constitutional irritation,
which would undoubtedly follow; the Artery is found lying between
the Nerves, and to the inner side of the Biceps; the Artery is then to 
be tied and divided as before. In Aneurisms arising from wounds
of the Ulnar, or Radial arteries, it is necessary to cut into the tumour
and secure the Arteries both above, and below and not to trust, to
pressure, which will seldom if ever succeed. In some of these operations
for aneurism, the Surgeon has been so negligent as to 
tie up the Nerves, instead of the Arteries, but with a little care
they may always be distinguished, the Artery is much more elastic
than the Nerve, and admits of being drawn much more readily 
out of its situation.






















Index. Page. 
Irritation -                
Inflammation -                 
Specific Inflammation -           
Treatment of Do -         
Adhesive process -          
Suppurative Do -           
Use of Matter -         
Ulcerative Process -           
Abcess -        
Granulation -           
Cicatrization -         
Irritable Ulcers -          
Gonorrhea -
Stricture in the Urethra -
Permanent Stricture -
Abcesses in the Lacuna }
of the Urethra - } -
Spasmodic Stricture -
Inflammatory Do -
Diseased Prostrate -
Index. Page. 
Cutaneous Sores -
Varicose Ulcers -
Mortification -
Injuries of the Head -
Compression -
Fractures of the Skull -
Inflammation of the Brain -
Wounds of the Brain -
Operation of Trephining -
Hydrocele -
Treatment of Hydrocele -
Injection of Do -




















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