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medical-notes-003294-006r
Sal. Ammon. creed. - do. Vol. -Dicerel. -Polychrest -Puchelle... -Limon -Socla. x. -Do Phos. Santal, Recl: Sancher, Sateerini x saho cast. ----Venet, sagoin gran, Sernen Annies ----Cardamillion ----Cairi ----Coriander ----Fenic x ----Cummin ----Fenugric Shangia 5/6/8 Shae H. Piera.. Sherm. Gaeli, Suc, Glyri x ----Do dep. Sht. Salis. Marinacio ----C.C. Vol. --Lavend. C. --sil. x. ------- x, --Sal. Ammon. Vol. --Volal. Aromat. --Vin X --Vitriol. x. --x. Bilial. Syr. Bals. Sinp. -- Do C
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medical-notes-003294-007r
No.16. Nov 27th, 1811. P. Smith.
The Tonsils from their situation are frequently Inflamed and enlarged, and sometimes require an operation – They cause difficulty in swallowing and ratling in breathing – They may sometimes be removed by astringents – If they remain large for a long time it becomes necessary to remove them. It is best done by a Ligature applied with Graves Instrument. It is dangerous to cut them with a knife on account the Hemorrhage. A Physician was called to a girl 9 years old who had a difficulty of breathing the Phy said it was dropsy in the thorax. I was called, examined the throat and found the Tonsils enlarged and removed them, which cured the dropsy. I knew a very young Child die by neglecting them. Polypi are more difficult to remove, but may be removed by ligature, by Cutting, by Forceps, or by twisting them, day after day. After they are removed we should use some astringent to prevent their return — as blue vitriol, Allum and bark. Care should be taken that inflamation does not follow.
medical-notes-003294-007v
No.17. Nov. 28th 1811. P. Smith.
With regard to amputations, no general Rules can be given. The Surgeon must be governed by existing circumstances, by his experience, by his knowledge of existing methods of the most eminent Surgeons. The Causes which most frequently require Amputation are Compound Fractures, Diseases of the joints, and Mortifications. Recent fractures should not be amputated if any prospect of a cure, but if fractures extend into the joints, and large blood vessels are ruptured, we had better operate. Also if there is violent Inflamation likely to take place, and this is much more likely to follow in some Persons than in others. When an operation is determined on, some Surgeons chose to wait untill the inflamation is over, thinking the operation more safe, but as we know no limits in a mortifying limb, I would not risk the inflamation, or wait for matter to form, but I would not operate in a verry high State of inflamation, but as soon as the inflamation begins to subside I would amputate, unless Mortification had
medical-notes-003294-008r
taken place, in that case you must wait untill there is an evident separation between the sound and mortified portion. Where there is no hope of Saving the limb, I would, if possible operate before inflamation commenced. In case of Neucrosis, or Ulceration of the bone where the disease proceeds slowly I would not operate, unless the ulcer was such as to endanger the whole system, for it is not from the absorption of matter, but from a peculiar iritation that Hectic is produced. In White swelling we must be governed by the circumstances. Sometimes these run their course in 2 or 3 months, at other times they run as many years, in either case untill the Cortilages, Ligaments and bones are destroyed. The best method of Amputating is to make two semmicircular incisions※ in the Skin, then retract it a little and continue the Same incision down to the bone, then saw the bone off, bring the lips together and retain them with adhesive plaster and bandage. If the thigh is cut let the angles be on each side, if the leg, let the angles be above and below
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