R. Fol. Nicotian. incis. ʒii.Aq. bull. ℔ss.Sp. Vini rectif. ℥i digere per horam.
R. Fol. Nicotian. incis. ʒii.
Aq. bull. ℔ss.
Sp. Vini rectif. ℥i digere per horam.
I directed a spoonful of this to be given every two hours until it should vomit. This medicine had no better effect than the former ones, and he died some days afterwards.
November6th. Mr. H——, Æt. 47. In the last stage of a phthisis pulmonalis, suffered much from dyspnœa, and anasarca. Squill medicines gave no relief. Digitalis in pills, with gum ammon. purged him, but opium being added, that effect ceased, and he continued to be relieved by them as long as he lived.
November16th. Mrs. F——, Æt. 53. InAugustlast was suddenly seized with epileptic fits, which continued to recur at uncertain intervals. Her belly had long been larger than natural, but without any perceptible fluctuation. Her legs and thighs swelled very considerably the beginning of this month, and now there was evidently water in the abdomen. The medicines hitherto in vain directed against the epileptic attacks, were now suspended, and two grains of the Pulv. fol. Digital. directed to be taken every six hours. The effects were most favourable, and the dropsical symptoms were soon removed by copious urinary discharges.
The attacks of epilepsy ceased soon afterwards. InFebruary, 1781, there was some return of the swellings, which were soon removed, and she now enjoys very good health. Does not the narrative of this case throw light upon the nature of the epilepsy which sometimes attacks women, soon after the cessation of the menstrual flux?
January1st. Mrs. G——, of H——, Æt. 62. Ascites and very large hard legs. After trying various medicines, under the direction of a very able physician, I ordered her to take one grain of Pulv.Digital. every six hours, but it produced no effect. Other Medicines were then tried to as little purpose. About the end ofFebruary, I directed an infusion of the Fol. Digital. but with no better success. Other methods were thought of, but none proved efficacious, and she died a few weeks afterwards.
January3d. Mrs. B——, Æt. 53. Ascites, anasarca, and jaundice. After a purge of calomel and jallap, was ordered the Infusion of Digitalis: it acted kindly as a diuretic, and greatly reduced her swellings. Other medicines were then administered, with a view to her other complaints, but to no purpose, and she died about a month afterwards.
January14th. Mr. B——, of D——. Jaundice and ascites, the consequences of great intemperance. Extremely emaciated; his tongue and fauces covered with apthous crusts, and his appetite gone. He first took tincture of cantharides with infusum amarum, then vitriolic salts, and various other medicines without relief; Infusum Digitalis was given afterwards, but was equally unsuccessful.
February2d. I was desired by the late learned and ingenious Dr. Groome, to visit Miss S——, ayoung lady in the last state of emaciation from a dropsy. Every probable means to relieve her had been attempted by Dr. Groome, but to no purpose; and she had undergone the operation of the paracentesis repeatedly. The Doctor knew, he said, that I had cured many cases of dropsy, by the Digitalis, after other more usual methods had been attempted without success, and he wished this lady to try that medicine under my direction; after examining the patient, and enquiring into the history of the disease, I was satisfied that the dropsy was encysted, and that no medicine could avail. The Digitalis, however, was directed, and she took it, but without advantage. She had determined not to be tapped again, and neither persuasion, nor distress from the distension, could prevail upon her: I at length proposed to make an opening into the sac, by means of a caustic, which was done under the judicious management of Mr. Wainwright, surgeon, at Dudley. The water was evacuated without any accident, and the patient afterwards let it out herself from time to time as the pressure of it became troublesome, until she died at length perfectly exhausted.
Query.Is there not a probability that this method, assisted by bandage, might be used so as to effect a cure, in the earlier stages of ovarium dropsy?
February27th. Mrs. O——, of T——, Æt. 52, with a constitution worn out by various complicateddisorders, at length became dropsical. The Digitalis was given in small doses, in hopes of temporary benefit, and it did not fail to fulfil our expectations.
March16th. Mrs. P——, Æt. 47. Great debility, pale countenance, loss of appetite, legs swelled, urine in small quantity. A dram of Fol. siccat. Digital. in a half pint infusion was ordered, and an ounce of this infusion directed to be taken every morning. Myrrh and steel were given at intervals. Her urine soon increased, and the symptoms of dropsy disappeared.
March18th. Mr. W——, in the last stage of a pulmonary consumption became dropsical. The Digitalis was given, but without any good effect.
April6th. Mr. B——, Æt. 63. For some years back had complained of being asthmatical, and was not without suspicion of diseased viscera. The last winter he had been mostly confined to his house; became dropsical, lost his appetite, and his skin and eyes turned yellow. By the use of medicines of the deobstruent class he became less discoloured, and the hardness about his stomach seemed to yield; but the ascites and anasarcous symptoms increased so as to oppress his breathingexceedingly. Alkaline salts, and other diuretics failing of their effects, I ordered him to take an infus. of Digitalis. It operated so powerfully that it became necessary to support him with cordials and blisters, but it freed him from the dropsy, and his breath became quite easy. He then took soap, rhubarb, tartar of vitriol, and steel, and gradually attained a good state of health, which he still continues to enjoy.
April8th. Mr. B——, Æt. 60. A corpulent man, with a stone in his bladder, from which at times his sufferings are extreme. He had been affected with what was supposed to be an asthma, for several years by fits, but through the last winter his breath had been much worse than usual; universal anasarca came on, and soon afterwards an ascites. Now his urine was small in quantity and much saturated, the dysuria was more dreadful than ever; his breath would not allow him to lie in bed, nor would the dysuria permit him to sleep; in this distressful situation, after having used other medicines to little purpose, I directed an infusion of Digitalis to be given. When the quantity of urine became more plentiful, the pain from his stone grew easier; in a few days the dropsy and asthma disappeared, and he soon regained his usual strength and health. Every year since, there has been a tendency to a return of these complaints, but he has recourse to the infusion, and immediately removes them.
April24th. Mr. M——, of C——, Æt. 57. Asthma, anasarca, jaundice, and great hardness and straitness across the region of the stomach. After a free exhibition of neutral draughts, alkaline salt, &c. the dropsy and difficult breathing remaining the same, he took Infusum Digitalis, which removed those complaints. He never lost the hardness about his stomach, but enjoyed very tolerable health for three years afterwards, without any return of the dropsy.
April25th. Mrs. J——, Æt. 42. Phthisis pulmonalis and anasarcous legs and thighs. She took the Infusum Digitalis without effect. Myrrh and steel, with fixed alkaly, were then ordered, but to no purpose.
May1st. Master W——, of St——, Æt. 6. I found him with every symptom of hydrocephalus internus. As it was yet early in the disease, in consequence of ideas which will be mentioned hereafter, I directed six ounces of blood to be immediately taken from the arm; the temporal artery to be opened the succeeding day; the head to be shaven, and six pints of cold water to be poured upon it every fourth hour, and two scruples of strong mercurialointment to be rubbed into the legs every day. Five days afterwards, finding the febrile symptoms very much abated, and judging the remaining disease to be the effect of effusion, I directed a scruple of Fol. Digital. siccat. to be infused in three ounces of water, and a table spoonful of the infusion to be given every third or fourth hour, until its action should be someway sensible. The effect was, an increased secretion of urine; and the patient soon recovered.
May3d. Mrs. B——, Æt. 59. Ascites and anasarca, with strong symptoms of diseased viscera. Infusum Digitalis was at first prescribed, and presently removed the dropsy. She was then put upon saline draughts and calomel. After some time she became feverish: the fever proved intermittent, and was cured by the bark.
May3d. Mr. S——, Æt. 48. A strong man, who had lived intemperately. For some time past his breath had been very short, his legs swollen towards evening, and his urine small in quantity. Eight ounces of the Infus. Digitalis caused a considerable flow of urine; his complaints gradually vanished, and did not return.
May24th. Joseph B——, Æt. 50. Ascites, anasarca, and jaundice, from intemperate living. Infusion of Digitalis produced nausea, and lowered the frequency of the pulse; but had no other sensible effects. His disorder continued to increase, and killed him about two months afterwards.
June29th. Mr. B——, Æt. 60. A hard drinker; afflicted with asthma, jaundice, and dropsy. His appetite gone; his water foul and in small quantity. Neutral saline mixture, chrystals of tartar, vinum chalybeat. and other medicines had been prescribed to little advantage. Infusion of Fol. Digitalis acted powerfully as a diuretic, and removed the most urgent of his complaints, viz. the dropsical and asthmatical symptoms.
The following winter his breathing grew bad again, his appetite totally failed, and he died, but without any return of the ascites.
June29th. Mr. A——, Æt. 58. Kept a public house and drank very hard. He had symptoms of diseased viscera, jaundice, ascites, and anasarca. After taking various deobstruents and diuretics, to no purpose, he was ordered the Infusion of Digitalis:a few doses occasioned a plentiful flow of urine, relieved his breath, and reduced his swellings; but, on account of his great weakness, it was judged imprudent to urge the medicine to the entire evacuation of the water. He was so much relieved as to be able to come down stairs and to walk about, but his want of appetite and jaundice continuing, and his debility increasing, he died in about two months.
July18th. Mrs. B——, Æt. 46. A little woman, and very much deformed. Asthmatical for many years. For several months past had been worse than usual; appetite totally gone, legs swollen, sense of great fulness about her stomach, countenance fallen, lips livid, could not lie down.
The usual modes of practice failing, the Digitalis was tried, but with no better success, and in about a month she died; not without suspicion of her death having been accelerated a few days, by her taking half a grain of opium. This may be a caution to young practitioners to be careful how they venture upon even small doses of opium in such constitutions, however much they may be urged by the patient to prescribe something that may procure a little rest and ease.
August12th. Mr. L——, Æt. 65, the person whose Case is recorded atNo. XXIV, had a return of his insanity, after near two years perfect health. He was extremely reduced when I saw him, and the medicine which cured him before was now administered without effect, for his weakness was such that I did not dare to urge it.
September10th. Mr. V——, of S——, Æt. 47. A man of strong fibre, and the remains of a florid complexion. His disease an ascites and swelled legs, the consequence of a very free course of life; he had been once tapped, and taken much medicine before I saw him. The Digitalis was now directed: it lowered his pulse, but did not prove diuretic. He returned home, and soon after was tapped again, but survived the operation only a few hours.
September25th. Mr. O——, of M——, Æt. 63. Very painful and general swellings in all his limbs, which had confined him mostly to his bed since the preceding winter; the swellings were uniform, tense, and resisting, but the skin not discoloured. After trying guiacum and Dover's powder without advantage. I directed Infusion of Digitalis. It acted on the kidneys, but did net relieve him. It is noteasy to say what the disease was, and the patient living at a distance, I never learnt the future progress or termination of it.
September26th. Mr. D——, Æt. 42, a very sensible and judicious surgeon at B——, in Staffordshire, laboured under ascites and very large anasarcous legs, together with indubitable symptoms of diseased viscera. Having tried the usual diuretics to no purpose, I directed a scruple of Fol. Digital siccat. in a four ounce infusion, a table spoonful to be taken twice a day. The second bottle wholly removed his dropsy, which never returned.
September27th. Mrs. E——, Æt. 42. A fat sedentary woman; after a long illness, very indistinctly marked; had symptoms of enlarged liver and dropsy. In this case I was happy in the assistance of Dr. Ash. Digitalis was once exhibited in small doses, but to no better purpose than many other medicines. She suffered great pain in the abdomen for several weeks, and after her death, the liver, spleen, and kidneys were found of a pale colour, and very greatly enlarged, but the quantity of effused fluid in the cavity was not more than a pint.
October28th. Mr. B——, Æt. 33. Had drank an immense quantity of mild ale, and was now become dropsical. He was a lusty man, of a pale complexion: his belly large, and his legs and thighs swollen to an enormous size. I directed the Infusion of Digitalis, which in ten days completely emptied him. He was then put upon the use of steel and bitters, and directed to live temperately, which I believe he did, for I saw him two years afterwards in perfect health.
November14th. Mr. W——, of T——, Æt. 49. A lusty man, with an asthma and anasarca. He had taken several medicines by the direction of a very judicious apothecary, but not getting relief as he had been accustomed to do in former years, he came under my direction. For the space of a month I tried to relieve him by fixed alkaly, seneka, Dover's powder, gum ammoniac, squill, &c. but without effect. I then directed Infusion of Digitalis, which soon increased the flow of urine without exciting nausea, and in a few days removed all his complaints.
January23d. Mr. Q——, Æt. 74. A stone in his bladder for many years; dropsical for the last three months. Had taken at different times soap with squill and gum ammoniac; soap lees; chrystals of tartar, oil of juniper, seneka, jallap, &c. but the dropsical symptoms still increased, and the dysuria from the stone became very urgent. I now directed a dram of the Fol. Digit. siccat. in a half pint infusion, half an ounce to be given every six hours. This presently relieved the dysuria, and soon removed the dropsy, without any disturbance to his system.
January27th. Mr. D——, Æt. 86. The debility of age and dropsical legs had long oppressed him. A few weeks before his death his breathing became very short, he could not lie down in bed, and his urine was small in quantity. A wine glass of a weak Infusion of Digitalis, warmed with aromatics, was ordered to be taken twice a day. It afforded a temporary relief, but he did not long survive.
January28th. Mr. D——, Æt. 35. A publican and a hard drinker. Ascites, anasarca, diseasedviscera, and slight attacks of hæmoptoe. A dram of Fol. Digital. sicc. in a half pint infusion, of which one ounce was given night and morning, proved diuretic and removed his dropsy. He then took medicines calculated to relieve his other complaints. The dropsy did not return during my attendance upon him, which was three or four weeks. A quack then undertook to cure him with blue vitriol vomits, but as I am informed, he presently sunk under that rough treatment.
January29th. Mrs. O——, of D——, Æt. 53. A constant and distressing palpitation of her heart, with great debility. From a degree of anasarca in her legs I was led to suspect effusion in the Pericardium, and therefore directed Digitalis, but it produced no benefit. She then took various other medicines with the same want of success, and about ten months afterwards died suddenly.
January31st. Mr. T——, of A——, Æt. 81. Great difficulty of breathing, so that he had not lain in bed for the last six weeks, and some swelling in his legs. These complaints were subsequent to a very severe cold, and he had still a troublesome cough. He told me that at his age he did not look for a cure, but should be glad of relief, if it could be obtained without taking much medicine. I directed an Infusion of Digitalis, a dram to eight ounces,one spoonful to be taken every morning, and two at night. He only took this quantity; for in four days he could lie down, and soon afterwards quitted his chamber. In a month he had a return of his complaints, and was relieved as before.
January31st. Mrs. J——, of S——, Æt. 67. A lusty woman, of a florid complexion, large belly, and very thick legs. She had been kept alive for some years by the discharge from ulcers in her legs; but the sores now put on a very disagreeable livid appearance, her belly grew still larger, her breath short, her pulse feeble, and she could not take nourishment. Several medicines having been given in vain, the Digitalis was tried, but with no better effect; and in about a month she died.
February2d. Mr. B——, Æt. 73. An universal dropsy. He took various medicines, and Digitalis in small doses, but without any good effect.
February24th. Master M——, of W——, Æt. 10. An epilepsy of some years continuance, which had never been interrupted by any of the various methods tried for his relief. The Digitalis was given for a few days, but as he lived at a distance, so that I could not attend to its effects, he only took onehalf pint infusion, which made no alteration in his complaint.
March6th. Mr. H——, Æt. 62. A very hard drinker, and had twice had attacks of apoplexy. He had now an ascites, was anasarcous, and had every appearance of a diseased liver. Small doses of calomel, Dover's powder, infusum amarum, and sal sodæ palliated his symptoms for a while; these failing; blisters, squills, and cordials were given without effect. A weak Infusion of Digitalis, well aromatised, was then directed to be given in small doses. It rather seemed to check than to increase the secretion of urine, and soon produced sickness. Failing in its usual effect, the medicine was no longer continued; but every thing that was tried proved equally inefficacious, and he did not long survive.
May10th. Mrs. P——, Æt. 40. Spasmodic asthma of many years continuance, which had frequently been relieved by ammoniacum, squills, &c. but these now failing in their wonted effects, an Infus. of Fol. Digitalis was tried, but it seemed rather to increase than relieve her symptoms.
May22d. Mr. O——, of B——, Æt. 61. A very large man, and a free liver; after an attack ofhemiplegia early in the spring, from which he only partially recovered, became dropsical. The dropsy occupied both legs and thighs, and the arm of the affected side. I directed an Infusion of Digitalis in small doses, so as not to affect his stomach. The swellings gradually subsided, and in the course of the summer he recovered perfectly from the palsy.
July5th. Mr. C——, of W——, Æt. 28. Had drank very freely both of ale and spirits; and in consequence had an ascites, very large legs, and great fulness about the stomach. He was ordered to take the Infusion of Digitalis night and morning for a few days, and then to keep his bowels open with chrystals of tartar. The first half pint of infusion relieved him greatly; after an interval of a fortnight it was repeated, and he got well without any other medicine, only continuing the chrystals of tartar occasionally. I forgot to mention that this gentleman, before I saw him, had been for two months under the care of a very celebrated physician, by whose direction he had taken mercurials, bitters, squills, alkaline salts, and other things, but without much advantage.
March6th. Mrs. W——, Æt. 36. In the last stage of a pulmonary consumption, took the Infus. Digitalis, but without any advantage.
August20th. Mr. P——, Æt. 43. In the year 1781 he had a severe peripneumony, from which he recovered with difficulty. At the date of this, when he first consulted me, the symptoms of hydrothorax were pretty obvious. I directed a purge, and then the Infusum Digitalis, three drams to half a pint, one ounce to be taken every four hours. It made him sick, and occasioned a copious discharge of urine. His complaints immediately vanished, and he remains in perfect health.
September24th. Mrs. R——, of B——, Æt. 35, the mother of many children. After her last lying in, three months ago, had that kind of swelling in one of her legs which is mentioned atNo. VIII,XXVI, andXXXI. A considerable degree of swelling still remained; the limb was heavy to her feeling, and not devoid of pain. I directed a bolus of five grains of Pulv. Digitalis, and twenty-five of crude quicksilver rubbed down, with conserve of cynosbat. to be taken at bed-time, and afterwards an Infusion of red bark and Fol. Digitalis to be taken twice a day. There was half an ounce of bark and half a dram of the leaves in a pint infusion: the dose two ounces.
The leg soon began to mend, and two pints of the infusion finished the cure.
September25th. Mr. R——, Æt. 60. Complained to me of a sickness after eating, and for some weeks past he had thrown up all his food, soon after he had swallowed it. He had taken various medicines, but found benefit from none, and had tried various kinds of diet. He was now very thin and weak; but had a good appetite. As several very probable methods had been prescribed, and as the usual symptoms of organic disease were absent, I determined to give him a spoonful of the Infusion of Digitalis twice a day; made by digesting two drams of the dried leaves in half a pint of cinnamon water. From the time he began to take this medicine he suffered no return of his complaint, and soon recovered his flesh and his strength.
It should be observed, that I had frequently seen the Digitalis remove sickness, though prescribed for very different complaints.
September30th. Mrs. A——, Æt. 38. Hydrothorax and anasarca. Her chest was very considerably deformed. One half pint of the Digitalis Infusion entirely cured her.
September30th. Mr. R——, of W——, Æt. 47. Hydrothorax and anasarca. An Infusion of Digitalis was directed, and after the expected effects from that should take place, sixty drops of tincture of cantharides twice a day. As he was costive, pills of aloes and steel were ordered to be taken occasionally.
This plan succeeded perfectly. About a month afterwards he had some rheumatic affections, which were removed by guiacum.
October2d. Mrs. R——, Æt. 60. Diseased viscera; ascites and anasarca. Had taken various deobstruent and diuretic medicines to little purpose. The Digitalis brought on a nausea and languor, but had no effect on the kidneys.
October12th. Mr. R——, Æt. 41. A publican, and a hard drinker. His legs and belly greatly swollen; appetite gone, countenance yellow, breath very short, and cough troublesome. After a vomit I gave him calomel, saline draughts, steel and bitters, &c. He had taken the more usual diuretics before I saw him. As the dropsical symptoms increased, I changed his medicines for pills made ofsoap, containing two grains of Pulv. fol. Digital, in each dose, and, as he was costive, two grains of jallap. He took them twice a day, and in a week was free from every appearance of dropsy. The jaundice soon afterwards vanished, and tonics restored him to perfect health.
October12th. Mr. B——, Æt. 39. Kept a public house, drank very freely, and became dropsical; he complained also of rheumatic pains. I directed Infusion of Digitalis, half an ounce twice a day. In eight days the swellings in his legs and the fulness about his stomach disappeared. His rheumatic affections were cured by the usual methods.
October22d. Master B——, Æt. 3. Ascites and universal anasarca. Half a grain of Fol. Digital. siccat. given every six hours, produced no effect; probably the medicine was wasted in giving. An infusion of the dried leaf was then tried, a dram to four ounces, two tea spoonfuls for a dose; this soon increased the flow of urine to a very great degree, and he got perfectly well.
October30th. Mr. G——, of W——, Æt. 88. The gentleman mentioned inNo. XLVII. His complaints and manner of living the same as therementioned. I ordered an Infusion of the Digitalis, a dram and half to half a pint; one ounce to be taken twice a day; which cured him in a short time.
OnMarchthe 23d, 1784, he sent for me again. His complaints were the same, but he was much more feeble. On this account I directed a dram of the Fol. Digitalis to be infused for a night in four ounces of spirituous cinnamon water, a spoonful to be taken every night. This had not a sufficient effect; therefore, on the 22d ofApril, I ordered the infusion prescribed two years before, which soon removed his complaints.
He died soon afterwards, fairly worn out, in his ninetieth year.
November2d. Mr. S——, of B——h——, Æt. 61. Hydrothorax and swelled legs. Squills were given for a week in very full doses, and other modes of relief attempted; but his breathing became so bad, his countenance so livid, his pulse so feeble, and his extremities so cold, that I was apprehensive upon my second visit that he had not twenty-four hours to live. In this situation I gave him the Infusum Digitalis stronger than usual, viz. two drams to eight ounces. Finding himself relieved by this, he continued to take it, contrary to the directions given, after the diuretic effects had appeared.
The sickness which followed was truly alarming; it continued at intervals for many days, his pulse sunk down to forty in a minute, every object appeared green to his eyes, and between the exertions of reaching he lay in a state approaching to syncope. The strongest cordials, volatiles, and repeated blisters barely supported him. At length, however, he did begin to emerge out of the extreme danger into which his folly had plunged him; and by generous living and tonics, in about two months he came to enjoy a perfect state of health.
November19th. Master S——, Æt. 8. Ascites and anasarca. A dram of Fol. Digitalis in a six ounce infusion, given in doses of a spoonful, effected a perfect cure, without producing nausea.
The reader will perhaps remark, that from the middle ofJanuaryto the first ofMay, not a single case occurs, and that the amount of cases is likewise less than in the preceding or ensuing years; to prevent erroneous conjectures or conclusions, it may be expedient to mention, that the ill state of my own health obliged me to retire from business for some time in the spring of the year, and that I did not perfectly recover until the following summer.
January15th. Mrs. G——, Æt. 57. A very fat woman; has been dropsical sinceNovemberlast; with symptoms of diseased viscera. Various remedies having been taken without effect, an Infusion of Digitalis was directed twice a day, with a view to palliate the more urgent symptoms. She took it four days without relief, and as her recovery seemed impossible it was urged no farther.
May1st. Mrs. D——, Æt. 72. A thin woman, with very large anasarcous legs and thighs; no appetite and general debility. After a month's trial of cordials and diuretics of different kinds, the surgeon who had scarified her legs apprehended they would mortify; she had very great pain in them, they were very red and black by places, and extremely tense. It was evident that unless the tension could be removed, gangrene must soon ensue. I therefore gave her Infusum Digitalis, which increased the secretion of urine by the following evening, so that the great tension began to abate, and together with it the pain and inflammation. She was so feeble that I dared not to urge the medicine further, but she occasionally took it at intervals until the time of her death, which happened a few weeks afterwards.
May18th. I was desired to prescribe for Mary Bowen, a poor girl at Hagley. Her disease appeared to me to be an ovarium dropsy. In other respects she was in perfect health. I directed the Digitalis to be given, and gradually pushed so as to affect her very considerably. It was done; but the patient still carries her big belly, and is otherwise very well.
May25th. Mr. G——, Æt. 28. In the last stage of a pulmonary consumption of the scrophulous kind, took an Infusion of Digitalis, but without any advantage.
May31st. Mr. H——, Æt 27. In the last stage of a phthisis pulmonalis became dropsical. He took half a pint of the Infusum Digitalis in six days, but without any sensible effect.
June3d. Master B——, of D——, Æt. 6. With an universal anasarca, had an extremely troublesome cough. An opiate was given to quiet the cough at night, and 2 tea spoonfuls of Infus. Digit. were ordered every six hours. The dropsy was presently removed; but the cough continued, hisflesh wasted, his strength failed, and some weeks afterwards he died tabid.
June19th. Mrs. L——, Æt. 28. A dropsy in the last stage of a phthisis. Infusum Digitalis was tried to no purpose.
June20th. Mrs. H——, Æt. 46. A very fat, short woman; had suffered severely through the last winter and spring from what had been called asthma; but for some time past an universal anasarca prevailed, and she had not lain down for several weeks. After trying vitriolic acid, tincture of cantharides, squills, &c. without advantage, she took half a pint of Infus. Digitalis in three days. In a week afterwards the dropsical symptoms disappeared, her breath became easy, her appetite returned, and she recovered perfect health. The infusion neither occasioned sickness nor purging.
June24th. Mrs. B——, Æt. 40. A puerperal fever, and swelled legs and thighs. The fever not yielding to the usual practice, I directed an Infusion of Fol. Digitalis. It proved diuretic; the swellings subsided, but the fever continued, and a few days afterwards a diarrhœa coming on, she died.
July22d. Mr. F——, Æt. 48. A strong man, of a florid complexion, in consequence of intemperance became dropsical, with symptoms of diseased viscera, great dyspnœa, a very troublesome cough, and total loss of appetite. He took mild mercurials, pills of soap, rhubarb, and tartar of vitriol, with soluble tartar and dulcified spirits of nitre in barley water. After a reasonable trial of this plan, he took squill every six hours, and a solution of assafetida and gum ammoniac, to ease his breathing: finding no relief, I gave him chrystals of tartar with ginger; but his remaining health and strength daily declined, and he was not at all benefited by the medicines. I was averse to the use of Digitalis in this case, judging from what I had seen in similar instances of tense fibre, that it would not act as a diuretic. I therefore once more directed squill, with decoction of seneka and sal sodæ; but it was inefficacious. His strength being much broken down, I then ordered gum ammoniac, with small doses of opium, and infusum amarum, continuing the squill at intervals. At length I was urged to give the Digitalis, and considering the case as desperate, I agreed to do it. The event was as I expected; no increase in the urine took place; and the medicine being still continued, his pulse became slow, and he apparently sunk under its sedative effects. He was neither purged nor vomited; and had the Digitalis either been omittedaltogether, or suspended upon its first effects upon the pulse being observed, he might perhaps have existed a week longer.
July26th. Mr. W——, of W——, Æt. 47. Phthisis pulmonalis, jaundice, ascites, and swelled legs. As it was probable that the only relief I could give in a case so circumstanced, would be by carrying off the effused fluids. I tried squill and fixed alkaly; and these failing, I ordered the Infusum Digitalis. This had the desired effect, and, I believe, prolonged his life a few weeks.
August15th. Mrs. C——, Æt. 60. Ascites, anasarca, diseased viscera, paucity of urine, and total loss of appetite. These complaints had heretofore existed repeatedly, and had been removed by deobstruent and diuretic medicines; but in this attack the symptoms were suffered to exist a longer time and in a greater degree, before assistance was sought for. The remedies that used to relieve her were now exhibited to no purpose. Mild mercurials, soap, rhubarb, and squill were tried; but she grew rapidly worse. Saline draughts with acetum scilliticum seemed for a few days to check the progress of her complaint, but they soon lost their effect, and diarrhœa ensued upon every attempt to increase the frequency of the dose. Draughts with Infus. Digital. were then directed to be taken twicea day. The effect was a powerful action on the kidneys, and a reduction of the swellings, but without sickness. A degree of appetite returned, but still the tendency to diarrhœa existed, and kept her weak. Tonic medicines were then tried, but without advantage, and in a month it was necessary to have recourse to the Digitalis again. It was directed in a half pint mixture; an ounce to be taken thrice in twenty-four hours. On the 2d day, finding her symptoms very much relieved, she took in the absence of her nurse, nearly a double dose of the medicine. The consequence was great sickness, languor continuing for several days, and almost a total stop to the secretion of urine, from the time the sickness commenced.
The case now became totally unmanageable in my hands, and, after a fortnight, I was dismissed, and another physician called in; but she did not long survive.
This was not the first, nor the last instance, in which I have seen too large a dose of the medicine, defeat the very purpose for which it was directed.
August22d. Mrs. S——, Æt. 36. Extreme faintiness; anasarcous legs and thighs; great difficulty of breathing, troublesome cough, frequent chilly fits succeeded by hot ones; night sweats, and a tendency to diarrhœa. Apprehensive that themore urgent symptoms were caused by water in the lungs, I directed an Infusion of Digitalis, with an ounce of diacodium to the half pint to prevent it purging, a wine glass full to be taken every night at bed-time, and a mixture with confect. cardiac. and pulv. ipecac. to be given in small doses after every loose stool.
On the fourth day she was better in all respects; had made a large quantity of water and did not purge. In a few days more she lost all her complaints, except the cough, which gradually left her, without any further assistance.
I was agreeably deceived in the event of this case, for I expected after the water was removed, to have had a phthisis to contend with.
August25th. T—— W——, Esq; Æt, 50. A free liver, diseased viscera, belly very tense, and much swollen; fluctuation perceptible, but the swelling circumscribed; pulse 132. This gentleman was under the care of my very worthy friend Dr. Ash, who, having tried various modes of cure to no purpose, asked me if I thought the Digitalis would answer in this case. I replied that it would not, for I had never seen it effectual where the swelling appeared very tense and circumscribed. It was tried however, but did not lessen the swelling. I mention this case, to introduce the above remark, and alsoto point out the great effect the Digitalis has upon the action of the heart; for the pulse came down to 96. He was afterwards tapped, and continued, for some time under our joint attendance, but the pulse never became quicker, nor did the swelling return.
September7th. Mr. L——, Æt. 43. After several severe attacks of ill formed gout, attended for some time past with jaundice and other symptoms of diseased viscera, the consequences of intemperate living, was sent to Buxton; from whence he returned in three weeks with ascites and anasarca. Under this complicated load of disease, I prescribed repeatedly without advantage, and at length gave him the Digitalis, which carried off the more obvious symptoms of dropsy; but the jaundice, loss of appetite, diseased viscera, &c. rendered his recovery impossible.
February12th. Mrs. C——, Æt. 54. A strong short woman of a florid complexion; complained of great fullness across the region of the stomach; short breath, a troublesome cough, loss of appetite, paucity of urine; and had a brownish yellow tinge on her skin and in her eyes. She dated these complaints from a fall she had through a trap door about the beginning of winter. From the beginning of January to this time, she had been repeatedly letblood, had taken calomel purges with jallap; pills of soap, rhubarb and calomel; saline julep with acet. scillit. nitrous decoction, garlic, mercury rubbed down, infus. amarum purg. &c. After the failure of medicines so powerful, and seemingly so well adapted, and during the use of which all the symptoms continued to increase, it was evident that a favourable event could not be expected. However, I tried the infusum Digitalis, but it did nothing. I then gave her pills of quicksilver, soap and squill, with decoction of dandelion, and after some time, chrystals of tartar with ginger. Nothing succeeded to our wishes, and the increase of orthopnœa compelled me occasionally to relieve her by drastic purges, but these diminished her strength, more in proportion than they relieved her symptoms. Tincture of cantharides, sal diureticus and various other means were occasionally tried, but with very little effect, and she died towards the end of March.
March31st. Miss W——, Æt. 60. Had been subject to peripneumonic affections in the winter. She had now total loss of appetite, very great debility, difficult breathing; much cough, a considerable degree of expectoration, and a paucity of urine. She had been blooded, taken soap, assaf. and squill, afterwards assaf. and ammon. with acet. scillit.: but all her complaints increasing, a blister was applied to her back, and the Digitalis infusion directed to be taken every night. The effect was an increasedsecretion of urine, a considerable relief to her breath, and some return of appetite; but soon afterwards she became hectic, spat purulent matter, and died in a few weeks.
April12th. Mrs. H——, of L——, Æt. 61. InDecemberlast this Lady, then upon a visit in London, was attacked with severe symptoms of peripneumony. She was treated as an asthmatic patient, but finding no relief, she made an effort to return to her home to die. In her way through this place, the latter end of December, I was desired to see her. By repeated bleedings, blisters, and other usual methods, she was so far relieved, that she wished to remain under my care. After a while she began to spit matter and became hectic. With great difficulty she was kept alive during the discharge of the abscess, and about the end of March she had swelled legs, and unequivocal symptoms of dropsy in the chest. Other diuretics failing, on the 12th of April I was induced to give her the Digitalis in small doses. The relief was great and effectual. After an interval of fifteen days, some swellings still remaining in the legs, I repeated the medicine, and with such good effect, that she lost all her complaints, got a keen appetite, recovered her strength, and about the end of May undertook a journey of fifty miles to her own home, where she still remains in perfect health.
April17th. Mr. F——, Æt. 59. A very fat man, and a free liver; had long been subject to what was called asthma, particularly in the winter. For some weeks past his legs swelled, he had great sense of fullness across his stomach; a severe cough; total loss of appetite, thirst great, urine sparing, his breath so difficult that he had not lain down in bed for several nights. Calomel, gum ammoniac, tincture of cantharides, &c. having been given in vain, I ordered two grains of pulv. fol. Digitalis made into pills, with aromatic species and syrup, to be given every night. On the third day his urine was less turbid; on the fourth considerably increased in quantity, and in ten days more he was free from all complaints, and has since had no relapse.
May7th. Miss K——, Æt. 8. After a long continued ague, became hectic and dropsical. Her belly was very large, and she had a total loss of appetite. Half a grain of fol. Digital, pulv. with 2 gr. of merc. alcalis. were ordered night and morning, and an infusion of bark and rhubarb with steel wine to be given in the day time. Her belly began to subside in a few days, and she was soon restored to health. Two other children in the family, affected nearly in the same way, had died, from the parents being persuaded that an ague in the springwas healthful and should not be stopped.—I know not how far the recovery in this case may be attributed to the Digitalis, but the child was so near dying that I dared not trust to any less efficacious diuretic.
June13th. Mr. C——, Æt. 45. A fat man, had formerly drank hard, but not latterly: last March began to complain of difficult breathing, swelled legs, full belly, but without fluctuation, great thirst, no appetite; urine thick and foul; complection brownish yellow. Mercurial medicines, diuretics of different kinds, and bitters, had been trying for the last three months, but with little advantage. I directed two grains of the fol. Digital. in powder to be taken every night, and infus. amar. with tinct. sacr. twice a day. In three days the quantity of his urine increased, in ten or twelve days all his symptoms disappeared, and he has had no relapse.
June17th. Mr. N——, of W——, Æt. 54. A large man, of a pale complexion; had been subject to severe fits of asthma for some years, but now worse than usual. The intermitting pulse, the great disturbance from change of posture, and the swelled legs induced me to conclude that the exacerbation of his old complaint was occasioned by serous effusion. I directed pills with a grain and half of thepulv. Digital. to be taken every night, and as he was costive, jallap made a part of the composition. He was also directed to take mustardseed every morning and a solution of assafetida twice in the day. The effect of this plan was perfectly to our wishes, and in a short time he recovered his usual health. About half a year afterwards he died apoplectic.
MaryB——. A young unmarried woman. Her disease appeared to me a dropsy of the right ovarium. She took an infusion of Digitalis, but, as I expected with no good effect. She is still, I am informed nearly in the same state.
July12th. Mrs. A——, of C——, Æt. 56. After a series of indispositions for several years, became dropsical; and had long been confined to her chamber, unable to lie down or to walk. She was so feeble, her legs so much swelled, her breath so short, and the symptoms of diseased viscera so strong, that I dared not to entertain hopes of a cure; but wishing to relieve her more urgent symptoms, directed quicksilver rubbed down and fol. Digital. pulv. to be made into pills: the dose, containing two grains of the latter, to be given night and morning. She was also ordered to take a draught with a dram of æther twice a day, and to have scapulary issues. Her breath was so much relieved,that she was able soon afterwards to come down stairs; but her constitution was too much broken to admit of a recovery.
July16th. Mr. B——, of W——, Æt. 31. After a tertian ague of 12 months continuation, suffered great indisposition for 10 months more. He chiefly complained of great straitness and pain in the hypochondriac region, very short breath, swelled legs, want of appetite. He had been under the care of some very sensible practitioners, but his complaints increased, and he determined to come to Birmingham. I found him supported upright in his chair, by pillows, every attempt to lean back or stoop forward giving him the sensation of instantaneous suffocation. He said he had not been in bed for many weeks. His countenance was sunk and pale; his lips livid; his belly, thighs and legs very greatly swollen; hands and feet cold, the nails almost black, pulse 160 tremulous beats in a minute, but the pulsation in the carolid arteries was such as to be visible to the eye, and to shake his head so that he could not hold it still. His thirst was very great, his urine small in quantity, and he was disposed to purge. I immediately ordered a spoonful of the infusum Digitalis every six hours, with a small quantity of laudanum, to prevent its running off by stool, and decoction of leontodon taraxacum to allay his thirst. The next day he began to make water freely, and couldallow of being put into bed, but was raised high with pillows. Omit the infusion. That night he parted with six quarts of water, and the next night could lie down and slept comfortably.July21st. he took a mild mercurial bolus. On the 25th. the diuretic effects of the Digitalis having nearly ceased, he was ordered to take three grains of the pulv. Digital. night and morning, for five days, and a draught with half an ounce of vin. chalyb. twice a day.August15th. He took a purge of calomel and jallap, and some swelling still remaining in his legs, the Digitalis infusion was repeated. The water having been thus entirely evacuated, he was ordered saline draughts with acetum scilliticum and pills of salt of steel and extract of gentian. About a month after this, he returned home perfectly well.
July28th. Mr. A—— of W——, Æt. 29, became dropsical towards the close of a pulmonary consumption. He was ordered 12 grains of pulv. fol. cicutæ and 1 of Digitalis twice a day. No remarkable effect took place.
July31. Mr. M——, Æt 37. Hydrothorax. A single grain of fol. Digital. pulv. taken every night for three weeks cured him. The medicine never made him sick, but increased his urine, which became clear; whereas before it had been high coloured and turbid.
August6th. Mr. C—— of B——, Æt. 42. Asthma and anasarca, the consequence of free living. He had been for some time under the care of an eminent physician of this place, but his complaints proving unusually obstinate, he consulted me. I directed an infusion of Digitalis to be taken every night, and a mixture with squill and tincture of cantharides twice every day. In about a week he became better, and continued daily mending. He has since enjoyed perfect health, having quitted a line of business which exposed him to drink too much.
August6th. Mr. M—— of C——, Æt. 44. Ascites and anasarca, preceded by symptoms of the epileptic kind. He was ordered to take two grains of pulv. Digitalis every morning, and three every night; likewise a saline draught with syrup of squills, every day at noon. His complaints soon yielded to this treatment, but in the month of November following he relapsed, and again asked my advice. The Digitalis alone was now prescribed, which proved as efficacious as in the first trial. He then took bitters twice a day, and vitriolic acid night and morning, and now enjoys good health.
Before the Digitalis was prescribed, he had taken jallap purges, soluble tartar, salt of steel, vitriol of copper,&c.
August10th. Mrs. W——, Æt. 55. An anasarcous leg, and sciatica; full habit. After bleeding and a purge, a blister was applied in the manner recommended by Cotunnius; and two grains of fol. Digital. with fifteen of fol. cicutæ were directed to be taken night and morning. The medicine acted only as a diuretic; the pain and swelling of the limb gradually abated; and I have not heard of any return.
I must here bear witness to the efficacy of Cotunnius's method of blistering in the sciatica, having used it in a great number of cases, and generally with success.
August16th. Mrs. A—— of S——, Æt. 78. About the middle of Summer began to complain of short breath, great debility, and loss of appetite. At this time there were evident marks of effusion in the thorax, and some swelling in the legs. The advanced age, the weakness, and other circumstances of this patient, precluded every idea of her recovery; but something was to be attempted. Squills and other remedies had been tried; I therefore directed pills with two or three grains of the pulv. Digitalis to be taken every night for six nights, and a saline draught with forty drops of acetum scillit. twice in the day. She took but few of the draughts, seldommore than half one at a time, for they purged her, and she disliked them. The pills she took regularly, and with the happiest effect, for she could lie down, her breath was very much relieved, and a degree of appetite returned.Sept.4th, some return of her symptoms demanded the further use of diuretics. I was afraid to push the Digitalis in so hazardous a subject, and therefore directed tinct. amara with tinct. canthar. and pills of squill, seneka, salt of tartar and gum ammoniac. These medicines did not at all check the progress of the disease, and on the 26th it became necessary to give the Digitalis again. The pills were therefore repeated as before, and infus. amarum with fixed alkaly ordered to be taken twice a day. The event was as favorable as before; and from this time she had no considerable return of dropsy, but languished under various nameless symptoms, until the middle or end of November.
Aug.16th. Mrs. P—— of S——, Æt. 50. For a particular account of this patient,see Mr. Yonge's second Case.
Sept.20th. B—— B——, Esq. A true spasmodic asthma of many years continuance. After every method of relief had failed; both under my management, and also under the direction of several of the ablest physicians of this kingdom; I was induced togive him an infusion of the Digitalis. It was continued until nausea came on, but procured no relief.
October5th. Mr. R——, Æt. 43.(The patient mentioned atNo. 102.)He had pursued his former mode of life, and had now a return of his complaints, with evident marks of diseased viscera. His belly not very large, but uncommonly tense. From this circumstance I did not expect the Digitalis to succeed, and therefore tried for some time to relieve him by the saline julep, with acet. scillitic. jallap, mercury, syrup of squill, with aq. cinnam. decoction of Dandelion, &c.; but these being administered without advantage, I was driven to the Digitalis. As he was very weak and much emaciated, I only gave two grains night and morning for five days. As no increase of urine took place, I used alkaline salt with tinct. cantharides:—This proving equally unsuccessful, on the 18th, I directed two ounces of the infusum Digitalis night and morning. This was continued until nausea took place, but the kidney secretion was not increased. Squill with opium, deobstruents of different kinds, sublimate solution, fixed alkaly, tobacco infusion, were now successively tried, but with the same want of success. The fullness of his belly made it necessary to tap him, and by repeating this operation he continued alive to the end of the year.
October19th. Mrs. R——, of B——, Æt. 47. Supposed Asthma, of eighteen months duration. She had kept her room for four months, and could not lie down without great disturbance; was very thin, and had totally lost all inclination for food. She was directed to take two gr. of pulv. fol. Digital. night and morning for five days, and infusum amarum, at the hours of eleven and five. In the course of a week she was much relieved, and could remain in bed all night. After a few days interval she took the Digitalis for five days more, and was soon after that well enough to come down stairs and conduct her family affairs.
InApril1785, she had a slight return, but not such as to confine her to her chamber. She experienced the same relief from the same medicine, but continuing it for seven days without interruption, it excited nausea.
October28th. Mr. A——, subject to nephritis calculosa: After an attack of that kind, had still a troublesome sense of weight about his loins, now and then rising to pain, and a degree of dysuria, together with a want of appetite. These symptoms not readily yielding to the usual methods of treatment, I directed an infusion of Digitalis. The fourth dosecaused a copious flow of urine; the sixth made him sick, and he was more or less sick at times for three days; but felt no more of his complaints.
I don't believe it is at all necessary to bring on sickness in these cases, but an unexpected absence from town prevented me from seeing him time enough to stop the exhibition of the medicine.
October31st. Mrs. C——, of W——, Æt. 67. Asthma, and very thick hard legs of long continuance. The last month or two her breath worse than usual, her belly swollen, her thighs anasarcous, and her urine in small quantity. After trying garlic, squill, and purgatives without advantage, I directed the Digital. Infus. After taking about five ounces, her urine from thick and turbid, changed to clear and amber coloured, its quantity considerably increased, and her breathing easy. Contrary to my orders, but impelled by the relief she had found, she finished the remaining three ounces of the infusion, which made her very sick, and the free flow of urine immediately ceased. No medicine was administered for a fortnight, during which time her complaints increased. I then directed an infusion of tobacco, which affected her head, but did not increase her urine. She had recourse again to the Digitalis infusion, which once more removed the fulness of the belly, reduced the swellings of her thighs, and relieved her breath, but had no effect upon her legs.
Nov.2d. Miss B—— of C——, Æt. 22. A very evident fluctuation in the abdomen, which was considerably distended, whilst the rest of her frame was greatly emaciated. The presence of cough, hectic fever, and other circumstances, made it probable that this apparent ascites was caused by a purulent, and not a watery effusion. However it was possible I might be mistaken; the Digitalis was therefore given, but without any advantage.
The further progress of the disease confirmed my first opinion, and she died consumptive.