R. Fol. Digital. purp. recent. ℥iv. coque exAq. fontan. puræ ℔iss ad ℔i. et cola.R. Decoct. Digital. ℥iss.Aq. Nuc. Moschat. ʒii. M. fiat. haust. 2dis horis sumend.
R. Fol. Digital. purp. recent. ℥iv. coque ex
Aq. fontan. puræ ℔iss ad ℔i. et cola.
R. Decoct. Digital. ℥iss.
Aq. Nuc. Moschat. ʒii. M. fiat. haust. 2dis horis sumend.
The patient took five of these draughts, which made her very sick, and acted very powerfully upon the kidneys, for within the first twenty-four hours she made upwards of eight quarts of water. The sense of fulness and oppression across her stomach was greatly diminished, her breath was eased, her pulse became more full and more regular, and the swellings of her legs subsided.
26th. Our patient being thus snatched from impending destruction, Dr. Darwin proposed to give her a decoction of pareira brava and guiacum shavings,with pills of myrrh and white vitriol; and, if costive, a pill with calomel and aloes. To these propositions I gave a ready assent.
30th. This day Dr. Darwin saw her, and directed a continuation of the medicines last prescribed.
August1st. I found the patient perfectly free from every appearance of dropsy, her breath quite easy, her appetite much improved, but still very weak. Having some suspicion of a diseased liver, I directed pills of soap, rhubarb, tartar of vitriol, and calomel to be taken twice a day, with a neutral saline draught.
9th. We visited our patient together, and repeated the draughts directed on the 26th ofJune, with the addition of tincture of bark, and also ordered pills of aloes, guiacum, and sal martis to be taken if costive.
September10th. From this time the management of the case fell entirely under my direction, and perceiving symptoms of effusion going forwards, I desired that a solution of merc. subl. corr. might be given twice a day.
19th. The increase of the dropsical symptoms now made it necessary to repeat the Digitalis. The dried leaves were used in infusion, and the water was presently evacuated, as before.
It is now almost nine years since the Digitalis was first prescribed for this lady, and notwithstanding I have tried every preventive method I could devise, the dropsy still continues to recur at times; but is never allowed to increase so as to cause much distress, for she occasionally takes the infusion and relieves herself whenever she chooses. Since the first exhibition of that medicine, very small doses have been always found sufficient to promote the flow of urine.
I have been more particular in the narrative of this case, partly because Dr. Darwin has related it rather imperfectly in the notes to his son's posthumous publication, trusting, I imagine, to memory, and partly because it was a case which gave rise to a very general use of the medicine in that part of Shropshire.
December10th. Mr. L——, Æt. 35. Ascites and anasarca, the consequence of very intemperate living. After trying squill and other medicines to no purpose, I directed a decoction of the Fol. Digital. recent. six drams to a pint; an eighth part to be taken every fourth hour. This made him sick, and produced a copious flow of urine, but not enough to remove all the dropsical symptoms. After a fortnight a stronger decoction was ordered, and, upon a third trial, as the winter advanced, it became necessary to use four ounces to the pint decoction; and thus he got free from all his complaints.
InOctober1777, in consequence of having pursued his intemperate mode of living, his dropsy returned, accompanied by evident marks of diseased viscera. A decoction of two drams of Fol. Digital. siccat. to a pint, once more removed the dropsy. He took a wine glass full thrice a day.
InJanuary1778, I was desired to visit him again. I found he had gone on in his usual intemperate life, his countenance jaundiced, and the dropsy coming on apace. After giving some deobstruent medicines, I again directed the Digitalis, which again emptied the water; but he did not survive many weeks.
February—. Mrs. M——, Æt. 45. Ascites and anasarca, but not much otherwise diseased, and well enough to walk about the house, and see after her family affairs. I thought this a fair case for a trial of the Digitalis, and therefore directed a decoction of the fresh leaves, the stock of dried ones being exhausted. About a week afterwards, calling to see my patient, I was informed that she was dead; that the third day after my first visit she suddenly fell down, and expired. Upon enquiry I found she had not taken any of the medicine; for the snow had lain so deep upon the ground, that the apothecary had not been able to procure it. Hadthe medicine been given in a case seemingly so favourable as this, and had the patient died under its use, is it not probable that the death would have been attributed to it?
February11th. Mr. E——, of W——, Æt. 61. Hydrothorax, ascites and anasarca, consequences of hard drinking. He had been attended for some time by a physician in his neighbourhood, who had treated his case with the usual remedies, but without affording him any relief; nor could I expect to succeed better by any other medicine than the Digitalis. The dried leaves were not to be had; and the green ones at this season being very uncertain in their strength, I ordered four ounces of the roots in a pint decoction, and directed three spoonfuls to be given every fourth hour, until it either excited nausea, or a free discharge of urine; both these effects took place nearly at the same time: he made a large quantity of water, the swellings subsided very considerably, and his breath became easy. Eight days afterwards he began upon a course of bitters and deobstruents. The dropsical symptoms soon increased again, but he had suffered so much from the severity of the sickness before, that he was neither willing to take, nor I to give the same medicine again.
Perhaps this patient might have been saved, if I had been well acquainted with the management andreal doses of the medicine, which was certainly in this instance made very much too strong; and notwithstanding the caution to stop the further exhibition when certain effects should take place, it seems the quantity previously swallowed was sufficient to distress him exceedingly.
March11th. Mrs. H——, Æt. 32. A few days after a tedious labour, had her legs and thighs swelled to a very great degree; pale and semi-transparent,[5]with pain in both groins. After a purge of calomel and rhubarb, ung. merc. was ordered to be rubbed upon the groins, and the following decoction was directed:
R. Fol. Digital. purp. recent. ℥ii.Aq. puræ. ℔i. coque ad ℔iss et colatur. adde.Aq. cinn. sp. ℥iv. M. capiat. cyath. vinos. parv. bis quotidie.
R. Fol. Digital. purp. recent. ℥ii.
Aq. puræ. ℔i. coque ad ℔iss et colatur. adde.
Aq. cinn. sp. ℥iv. M. capiat. cyath. vinos. parv. bis quotidie.
The decoction presently increased the secretion of urine, and abated the distension of the legs: in a fortnight the swelling was gone; but some days after leaving her bed, her legs swelled again about the ancles, which was removed by another bottle of the decoction on the 21st ofApril.
March29th. Mr. G——, Æt. 47. Very much deformed; asthma of several years continuance, but now dropsical to a great degree. Took several medicines without relief, and then tried the Digitalis, but with no better success.
April10th. G—G——, Æt. 70. Asthma and anasarca. Took a decoction of the fresh leaves of the Digitalis, which produced violent sickness, but no immediate evacuation of water. After the sickness had ceased altogether, the urine began to flow copiously, and he was cured.
July10th. Mr. M—— of T——, Æt. 54. A very hard drinker; had been affected sinceNovemberlast with ascites and anasarca, for which he had taken several medicines without benefit. A decoction of the recent leaves of the Digitalis was then directed, an ounce and half to a pint, one eighth of which I ordered to be given every fourth hour. A few doses brought on great nausea, indistinct vision, and a great flow of urine, so as presently to empty him of all the dropsical water. Indeed the evacuation was so rapid and so complete, that it became necessary to apply a bandage round the belly, and to support him with cordials.
In something more than a year and a half, his dropsy returned, but the Digitalis did not then succeed to our wishes. InAugust, 1779, he was tapped, and lived afterwards only about five weeks.
For more particulars, see the extract of a letter from Mr. Lyon.
September12th. Miss C—— of T——, Æt 48. An ovarium dropsy, and anasarcous legs and thighs. For three months in the beginning of this year she had been under the care of Dr. Darwin, who at different times had given her blue vitriol, elaterium, and calomel; decoction of pareira brava, and guiacum wood, with tincture of cantharides; oxymel of squills, decoction of parsley roots, &c. Finding no relief, she discontinued the use of medicines, until the urgency of her symptoms induced her to ask my advice about the end ofAugust. She was greatly emaciated, and had almost a total loss of appetite. I first tried small doses of Merc. sublim. corr. in solution, with decoction of burdock roots, and blisters to the thighs. No advantage attending the use of this plan, I directed a decoction of Fol. Digit. a dram and half to a pint; one ounce to be taken twice a day. It presently reduced the anasarcous swellings, but made no alteration in the distension of the abdomen.
October9th. Mrs. B——, Æt. 40. An ovarium dropsy. Took a decoction of Digitalis without effect. Her life was preserved for some years by repeated tapping.
February8th. Mr. R—— of K——. Had formerly suffered much from gout, and lived very intemperately. Jaundiced countenance; ascites; legs and thighs greatly swollen; appetite none; extremely weak; confined to his bed. Had taken many medicines from his apothecary without advantage. I ordered him decoction of Digitalis, and a cordial; but he survived only a few days.
March13th. Mr. M——, Æt. 54. A thorax greatly deformed; asthma through the winter, succeeded by dropsy in belly and legs. Pulse very small; face leaden coloured; cough almost continual. Decoction of seneka was directed, and small doses of Dover's powder at night.
17th. Gum-ammoniac and squill, with elixir paregor. at night.—26th, Squill and decoction of seneka.—30th, His complaints still increasing, decoctionof Digitalis was then directed, which relieved him in a few days; but his complaints returned again, and he died in the month ofJune.
August18th. Mr. B——, Æt. 33. Pulmonary consumption and dropsy. The Digitalis, and that failing, other diuretics were used, in hopes of gaining some relief from the distress occasioned by the dropsical symptoms; but none of them were effectual. He was then attended by another physician, and died in about two months.
September21st. Mrs. M—— W—— G——, Æt. 50. An ovarium dropsy. She took half a pint of Infus. Digitalis, which made her sick, but did not increase the quantity of urine. She was afterwards relieved by tapping.
October28th. R—— W——, Æt. 33. Ascites and universal anasarca; countenance quite pale and bloated; appetite none, and the little food he forces down is generally rejected.
R. Fol. Digit. purp. siccat. ʒiii.Aq. bull. ℔i. digere per horas duas, et colat. adde aq. junip. comp. ℥iii.
R. Fol. Digit. purp. siccat. ʒiii.
Aq. bull. ℔i. digere per horas duas, et colat. adde aq. junip. comp. ℥iii.
He was directed to take one ounce of this infusionevery two hours until it should make him sick. This was on Wednesday. The fifth dose made him vomit. On Thursday afternoon he vomited again very freely, without having taken any more of the medicine. On Friday and Saturday he made more water than he had done for a week before, and the swellings of his face and body were considerably abated. He was directed to omit all medicine so long as the urine continued to flow freely, and also to keep an account of the quantity he made in twenty-four hours.
These were his reports:
On Wednesday he began to purge, and the purging still continues, but his appetite is better than he has known it for a long time. No swelling remains but about his ancles, extending at night half way up his legs.
Omit all medicines at present.
On Tuesday the 17th, some swelling still remainedabout his ancles, but he was in every other respect perfectly well.
He took a few more doses of the infusion, and no other medicine.
December8th. W—— B——, Æt. 60. A hard drinker. Diseased viscera; ascites and anasarca. An infusion of Digitalis was directed, but it had no other effect than to make him sick.
In the beginning of this year we had many dropsies in children, who had suffered from the Scarlatina Anginosa; they all yielded very readily to the Digitalis, but in some the medicine purged, and then it did not prove diuretic, nor did it remove the dropsy until opium was joined with it, so as to prevent it purging.—I did not keep notes of these cases, but I do not recollect a single instance in which the Digitalis failed to effect a cure.
January1st. Mr. H——. Hydrops Pectoris; legs and thighs prodigiously anasarcous; a very distressing sense of fulness and tightness across his stomach; urine in small quantity; pulse intermitting; breath very short.
He had taken various medicines, and been blistered, but without relief. His complaints continuing to increase, I directed an infusion of Digitalis, which made him very sick; acted powerfully as a diuretic, and removed all his symptoms.
About three months afterwards he was out upon a journey, and, after taking cold, was suddenly seized with difficulty of breathing, and violent palpitation of his heart: he sent for me, and I ordered the infusion as before, which very soon removed his complaints. He is now active and well; but, whenever he takes cold, finds some return of difficult breathing, which he soon removes by a dose or two of the infusion.
January5th. Mrs. M——, Æt. 69. Hydrothorax, (called asthma) ascites and anasarca. I directed an infusion of Fol. Digital. siccat. three drams to a pint; a small wine glass to be taken every third or fourth hour. It made her violently sick, acted powerfully as a diuretic, set her breath perfectly at liberty, and carried off the swelling of her legs; when she was nearly emptied, she became so languid, that I thought it necessary to order cordials, and a large blister to her back. Mr. Ward, who attended as her apothecary, tells me she had some return of her asthma inJuneandOctoberfollowing, which was each time removed by the same medicine.
January11th. Mr. H——, Æt. 59. Ascites and general anasarca. A large corpulent man, and a hard drinker: he had repeatedly suffered under complaints of this kind, but had been always relieved by the judicious assistance of Dr. Ash. In the present instance, however, not finding relief as usual from the prescriptions of my worthy friend, he sent for me; after examining into his situation, and informing myself what had been done to relieve him, I was satisfied that the Digitalis was the only medicine from which I had any thing to hope. It was therefore directed; but another patient requiring my assistance at a distance from town, I desired he would not begin the medicine before I returned, which would be early on the third day; for I was well aware of the difficulties before me, and that he would inevitably sink under too rapid an evacuation of the water. On my return I was informed, that the preceding evening, as he sat on his chair, his head sunk upon his breast, and he died.
This case, as well ascase VI.is mentioned with a view to demonstrate to younger practitioners, how sudden and unexpected the deaths of dropsical patients sometimes happen, and how cautious we should be in assigning causes for effects.
August31st. Mr. C——, Æt. 57. Diseased viscera, jaundice, ascites and anasarca. After tryingcalomel, saline draughts, jallap purges, chrystals of tartar, pills of gum ammoniac, squills, and soap, sal succini, eleterium, &c. infusion of Digitalis was directed, which removed all his urgent symptoms, and he recovered a pretty good state of health.
September11th. I was desired to visit Mr. L——, Æt. 63; a middle sized man; rather thin; not habitually intemperate; found him in bed, where he had been for three days. He was in a state of furious insanity, and had been gradually losing his reason for ten days before, but was not outrageous the first week; his apothecary had given him ten grains of emetic tartar, a dram of ipecacoanha, and an ounce of tincture of jallap, in the space of a few hours, which scarcely made him sick, and only occasioned a stool or two; upon enquiring into the usual state of his health, I was told that he had been troubled with some difficulty of breathing for thirty years past, but for the nine last years this complaint had increased, so that he was often obliged to sit up the greater part of the night; and, for the last year, the sense of suffocation was so great, when he lay down, that he often sat up for a week together. His father died of an asthma before he was fifty. A few years ago, at an election, where he drank more than usual, his head was affected as now, but in a slighter degree, and his asthmatic symptoms vanished; and now, notwithstanding he has been severaldays in bed, he feels not the least difficulty in breathing.
Apprehending that the insanity might be owing to the same cause which had heretofore occasioned the asthma, and that this cause was water; I ordered a decoction of the Fol. siccat Digital, three drams to half a pint; three spoonfuls to be taken every third hour: the fourth dose made him sick; the medicine was then stopped; the sickness continued at intervals, more or less, for four days, during which time he made a great quantity of water, and gradually became more rational. On the fifth day his appetite began to return, and the sickness ceased, but the flow of urine still continued.
A week afterwards I saw him again, and examined him particularly; his head was then perfectly rational, appetite very good, breath quite easy, permitting him to lie down in bed without inconvenience, makes plenty of water, coughs a little, and expectorates freely. He took no other medicine, except a little rhubarb when costive.
September15th. Mr. J. R——, Æt. 50. Subject to an asthmatical complaint for more than twenty years, but was this year much worse than usual, and symptoms of dropsy appeared. InJulyhe took G. ammon. squill and seneka, with infus. amarum and fossil alkaly. InAugust, infusum amar.with vin. chalyb. and at bed-time pil. styr. and squill. His complaints increasing, the squill was pushed as far as could be borne, but without any good effect.September15th, an infusion of Digitalis was directed, but he died the next morning.
September18th. Mrs. R——, Æt. 30. After a severe child-bearing, found both her legs and thighs swelled to the utmost stretch of the skin. They looked pale, and almost transparent. The case being similar to that related atNo. VIII.I determined upon a similar method of treatment; but as this patient had an inflammatory sore throat also, I wished to get that removed first, and in three or four days it was done. I then directed an infusion of Digitalis, which soon increased the urinary secretion, and reduced the swellings, without any disturbance of her stomach.
A few days after quitting her bed and coming down stairs, some degree of swelling in her legs returned, which was removed by calomel, an opening electuary, and the application of rollers.
October7th. Mr. F——, a little man, with a spine and thorax greatly deformed; for more than a year past had complained of difficult respiration, and a sense of fulness about his stomach; these complaints increasing, his abdomen gradually enlarged,and a fluctuation in it became perceptible. He had no anasarca, no appearance of diseased viscera, and no great paucity of urine. Purges and diuretics of different kinds affording him no relief, my assistance was desired. After trying squill medicines without effect, he was ordered to take Pulv. fol. Digital. in small doses. These producing no sensible effect, the doses were gradually increased until nausea was excited; but there was no alteration in the quantity of urine, and consequently no relief to his complaints. I then advised tapping, but he would not hear of it; however, the distress occasioned by the increasing fulness of his belly at length compelled him to submit to the operation on the 20th ofNovember. It was necessary to draw off the water again upon the following days:
During the intervals, no method I could think of was omitted to prevent the return of the disease, but nothing seemed to avail. In the operation ofFebruary23d, his strength was so much reduced, that the water was not entirely removed; and on the 9th of March, before his belly was half emptied, notwithstanding the most judicious application of bandage, his debility was so great, that it was judged prudent to stop. After being placed in bed, the faintness and sickness continued; severe rigorsensued, and violent vomiting; these vomitings continued through the night, and in the intervals he lay in a state nearly approaching to syncope. The next day I found him with nearly the same symptoms, but remarked that the quantity of fluid he had thrown up was very much more than what he had taken, and that his abdomen was considerably fallen; in the course of two or three days more, he discharged the whole of the effused fluid; his strength and appetite gradually returned, and he was in all respects much better than he had been before the last operation.
Some time afterwards, his belly began to fill again, and he again applied to me; upon an accurate examination, I judged the quantity of fluid might then be about four or five quarts. Nature had pointed out the true method of cure in this case; I therefore ordered him to bed, and directed ipecacoanha vomits to be given night and morning: in two or three days the whole of the water was removed by vomiting, for he never purged, nor was the quantity of his urine increased; his appetite and strength gradually returned; he never had any further relapse, and is now an active healthy man. I must leave the reader to make his own reflections on this singular case.
January11th. Captain V——, Æt. 42. Had suffered much from residing in hot climates, and drinking very freely, particularly rum in large quantity. He had tried many physicians before I saw him, but nothing relieved him. I found him greatly emaciated, his countenance of a brownish yellow; no appetite, extremely low, distressing fulness across his stomach; legs and thighs greatly swollen; pulse quick, and very feeble; urine in small quantity. As he had evidently only a few days to live, I ordered him nothing but a solution of sal diureticus in cinnamon water, slightly acidulated with syrup of lemons. This medicine effecting no change, and his symptoms becoming daily more distressing, I directed an infusion of Digitalis. A few doses occasioned a copious flow of urine, without sickness or any other disturbance. The medicine was discontinued; and the next day the urine continuing to be secreted very plentifully, he lost his most distressing complaints, was in great spirits, and ate a pretty good dinner. In the evening, as he was conversing chearfully with some friends, he stooped forwards, fell from his chair, and died instantly. Had he been in bed, I think there is reason to believe this fatal syncope, if such it was, would not have happened.
February6th. Mr. H——, Æt. 63. A corpulent man; had suffered much from gout, which for the last year or two had formed very imperfectly. He had now symptoms of water in his chest, his belly and his legs. An infusion of Digitalis removed these complaints, and after being confined for the greater part of the winter, he was well enough to get abroad again. In the course of a month the dropsical symptoms returned, and were again removed by the same medicine. Bitters and tonics were now occasionally prescribed, but his debility gradually increased, and he died some time afterwards; but the dropsy never returned.
February17th. Mr. D——, Æt. 50. Ascites and anasarca, with symptoms of phthisis. He had been a very hard drinker. The infusum Digitalis removed his dropsical symptoms, and he was sufficiently recovered to take a journey; but as the spring advanced, the consumptive symptoms increased, and he died soon afterwards, perfectly emaciated.
March5th. I was desired to visit Mrs. H——, a very delicate woman, who after a severe lying-in, had her legs and thighs swollen to a very great degree;pale and semi-transparent. I found her extremely faint, her pulse very small and slow; vomiting violently, and frequently purging. She was attended by a gentleman who had seen me give the Digitalis in a similar case of swelled legs after a lying-in (seeCase XXVI.) about six months before. He had not considered that this patient was delicate, the other robust; nor had he attended to stop the exhibition of the medicine when its effects began to take place. The great distress of her situation was evidently owing to the imprudent and unlimited use of the Digitalis. I was very apprehensive for her safety; ordered her cordials and volatiles; a free supply of wine, chamomile tea with brandy for common drink, and blisters. The next day the situation of things was much the same, but with all this disturbance no increased secretion of urine. The same methods were continued; an opiate ordered at night, and liniment. volatile upon flannel applied to the groins, as she now complained of great pain in those parts. The third day the nausea was less urgent, the vomitings less frequent, the pulse not so slow. Camphorated spirit, with caustic volatile alkaly, was applied to the stomach, emulsion given for common drink, and the same medicines repeated. From this time, the intervals became gradually longer between the fits of vomiting, the flow of urine increased, the swellings subsided, the appetite returned, and she recovered perfectly.
March16th. Mr. D——, Æt. 70. A paralytic stroke had for some weeks past impaired the use of his left side, and he complained much of his breath, and of a straitness across his stomach; at length, an anasarca and ascites appearing, I had no doubt as to the cause of the former symptoms; but, upon account of his advanced age, and the paralytic affection, I hesitated to give the Digitalis, and therefore tried the other usual modes of practice, until at length his breath would not permit him to lie down in bed, and his other symptoms increased so rapidly as to threaten a speedy dissolution. In this dilemma I ventured to prescribe an infusion of the Fol. siccat. Digital. which presently excited a copious flow of urine, and made him very sick; a strong infusion of chamomile flowers, with brandy, relieved the sickness, but the diuretic effects of the Digitalis continuing, his dropsy was removed, and his breathing became easy. The palsy remained nearly in the same state. He lived untilAugust1782, and without any return of the dropsy.
March18th. Miss S——, Æt. 5. Hydrocephalus internus. As the case did not yield to calomel, when matters were nearly advanced to extremities, it occurred to me to try the Infusum Digitalis; a few doses of which were given, but had no sensible effect.
March19th. A young lady, soon after the birth of an illegitimate child, became insane. After being near a month under my care, swellings of her legs, which at first had been attributed to weakness, extended to her thighs and belly; her urine became foul, and small in quantity, and the insanity remained nearly the same. As it had been very difficult to procure evacuations by any means, I ordered half an ounce of Fol. Digital. siccat. in a pint infusion, and directed two spoonfuls to be given every two hours: this had the desired effect; the dropsy and the insanity disappeared together, and she had afterwards no other medicine but some aperient pills to take occasionally.
April12th. Mr. R——, Æt. 32. For the last three or four years had had more or less of what was considered as asthma;—it appeared to me Hydrothorax. I directed an infusion of Digitalis, which presently removed his complaints. InJunefollowing he had a relapse, and took two grains of the Pulv. fol. Digit. three times a day, which cured him after taking forty grains, and he has never had a return.
May15th. Mrs. H——, Æt. 40. A spasmodic asthma, attended with symptoms of effusion. An infusion of Digitalis relieved her very considerably, and she lived four years afterwards without any relapse.
May26th. R—— B——, Æt. 12. Scrophulous, consumptive, and at length anasarcous. Took Infus. Digital. without advantage. Died theJulyfollowing.
June4th. Mrs. S——, of W——, Æt 49. Ascites and anasarca. Had taken many medicines; first from her apothecary, afterwards by the direction of a very judicious and very celebrated physician, but nothing retarded the increase of the dropsy. I first saw her along with the physician mentioned above, on the 14th ofMay; we directed an electuary of chrystals of tartar, and Seltzer water for common drink; this plan failing, as others had done before, we ordered the Infus. Digital. which in a few days nearly removed the dropsy. I then left her to the care of her physician; but her constitution was too much impaired to admit of restoration to health, and I understand she died a few weeks afterwards.
June13th. Mr. P——, Æt. 35. A very hard drinker, was attacked with a severe hæmoptoe, which was followed by ascites and anasarca. He had every appearance of diseased viscera, and his urine was small in quantity. The powder and the infusion of Digitalis were given at different times, but without the desired effect. Other medicines were tried, but in vain. Tapping prolonged his existence a few weeks, and he died early in the following autumn.
June27th. Mr. W——, Æt. 37. An apparently asthmatic affection, gradually increasing for three or four years, which not yielding to the usual remedies, he took the infusion of Digitalis. Two or three doses made him very sick; but he thought his breathing relieved. After one week he took it again, and was so much better as to want no other medicine.
In the course of the following winter he became hectic, and died consumptive about a year afterwards.
July6th. Mr. E——, Æt. 57. Hydrothorax and anasarca; his breath so short that he could notlie down. After a trial of squill, fixed alkaly, and dulcified spirit of nitre, I directed Pulv. Digital. gr. 2, thrice a day. In four days he was able to come down stairs; in three days more no appearance of disease remained; and under the use of aromatics and small doses of opium, he soon recovered his strength.
July7th. Miss H—— of T——, Æt. 39. In the last stage of a phthisis pulmonalis became dropsical. She took the Digitalis without being relieved.
July9th. Mrs. F——, Æt. 70. A chearful, strong, healthy woman; but for a few years back had experienced a degree of difficult breathing when in exercise. In the course of the last year her legs swelled, and she felt great fulness about her stomach. These symptoms continued increasing very fast, notwithstanding several attempts made by a very judicious apothecary to relieve her. The more regular practitioner failing, she had recourse to a quack, who I believe plied her very powerfully with Daphne laureola, or some drastic purge of that kind. I found her greatly reduced in strength, her belly and lower extremities swollen to an amazing size, her urine small in quantity, and her appetite greatly impaired. For the first fortnight of my attendance blisters were applied, solution of fixed alkaly, decoction of seneka with vitriolic æther,chrystals of tartar, squill and cordial medicines were successively exhibited, but with no advantage. I then directed Pulv. Fol. Digital. two grains every four hours. After taking eighteen grains, the urine began to increase. The medicine was then stopped. The discharge of urine continued to increase, and in five or six days the whole of the dropsical water passed off, without any disturbance to the stomach or bowels. As the distension of the belly had been very great, a swathe was applied, and drawn gradually tighter as the water was evacuated. As no pains were spared to prevent the return of the dropsy, and as the best means I could devise proved unequal to my wishes, both in this and in some other cases, I shall take the liberty to point out the methods I tried at different times in as concise a manner as possible, for the knowledge of what will not do, may sometimes assist us to discover what will.
1780.July18th. Infusum amarum, steel, Seltzer water.September22d. Neutral saline draughts, with tinct. canthar.26th. Pills of soap, garlic and millepedes.30th. The same pills, with infusum amarum.October11th. Pills of aloes, assafetida, and sal martis, in the day-time, and mercury rubbed down, at night.December21st. The accumulation of water now required a repetition of the Digitalis. It was directed in infusion, a dram and half to eight ounces, and an ounce and half given every fourth hour,until its effects began to appear. The water was soon carried off.30th. Sal diuretic. twice a day. To eat preserved garlic frequently.1781.February1st. Pills of calomel, squill and gum ammoniac.3d. Infusion of Digitalis repeated, and after the water was carried off, Dover's powder was tried as a sudorific.March18th. Infus. Digital. repeated.26th. Pills of sal martis and aromatic species, with infusum amarum.May5th. Being feverish; James's powder and saline draughts.10th. Laudanum every night, and an opening tincture to obviate costiveness.24th. Infus. Digitalis, one ounce only every fourth hour, which soon procured a perfect evacuation of the water.August11th. Infus. Digitalis.October19th. An emetic, and fol. Cicut. pulv. ten grains every six hours.November8th. A mercurial bolus at bed-time.16th. Infus. Digitalis.December23d. An emetic—Pills of seneka and gum ammoniac—Vitriolic acid in every thing she drinks.25th. Squill united to small doses of opium.1782.January2d. A troublesome cough—Syrup of garlic and oxymel of squills. A blister to the back.4th. Tincture of cantharides and paregoric elixir.28th. Infus. Digitalis, half an ounce every morning, and one ounce every night, was now sufficient to empty her.March26th. Infus. Digitalis; and when emptied, vitriol of copper twice a day.April1st. A cordial mixture for occasional use.Two months afterwards a purging came on, which every now and then returned, inducing great weakness—her appetite failed, and she died inJuly.
1780.
July18th. Infusum amarum, steel, Seltzer water.
September22d. Neutral saline draughts, with tinct. canthar.
26th. Pills of soap, garlic and millepedes.
30th. The same pills, with infusum amarum.
October11th. Pills of aloes, assafetida, and sal martis, in the day-time, and mercury rubbed down, at night.
December21st. The accumulation of water now required a repetition of the Digitalis. It was directed in infusion, a dram and half to eight ounces, and an ounce and half given every fourth hour,until its effects began to appear. The water was soon carried off.
30th. Sal diuretic. twice a day. To eat preserved garlic frequently.
1781.
February1st. Pills of calomel, squill and gum ammoniac.
3d. Infusion of Digitalis repeated, and after the water was carried off, Dover's powder was tried as a sudorific.
March18th. Infus. Digital. repeated.
26th. Pills of sal martis and aromatic species, with infusum amarum.
May5th. Being feverish; James's powder and saline draughts.
10th. Laudanum every night, and an opening tincture to obviate costiveness.
24th. Infus. Digitalis, one ounce only every fourth hour, which soon procured a perfect evacuation of the water.
August11th. Infus. Digitalis.
October19th. An emetic, and fol. Cicut. pulv. ten grains every six hours.
November8th. A mercurial bolus at bed-time.
16th. Infus. Digitalis.
December23d. An emetic—Pills of seneka and gum ammoniac—Vitriolic acid in every thing she drinks.
25th. Squill united to small doses of opium.
1782.
January2d. A troublesome cough—Syrup of garlic and oxymel of squills. A blister to the back.
4th. Tincture of cantharides and paregoric elixir.
28th. Infus. Digitalis, half an ounce every morning, and one ounce every night, was now sufficient to empty her.
March26th. Infus. Digitalis; and when emptied, vitriol of copper twice a day.
April1st. A cordial mixture for occasional use.
Two months afterwards a purging came on, which every now and then returned, inducing great weakness—her appetite failed, and she died inJuly.
None of the accumulations of water were at all equal to that which existed when I first saw her, for finding so easy a mode of relief, she became impatient under a small degree of pressure, and often insisted upon taking her medicine sooner than I thought it necessary. After the 26th ofMarchthe degree of effusion was inconsiderable, and at the time of her death very trifling, being probably carried off by the diarrhœa.
July12th. Mr. H——, of A——, Æt. 60. In the last stage of a life hurried to a termination by free living, dropsical symptoms became the most distressing. He wished to take the Digitalis. It was given, but afforded no relief.
July13th. Mr. S——, Æt. 49. Asthma, or rather hydrothorax, anasarca, and symptoms of a diseased liver. He was directed to take two grains of Pulv. fol. Digital. every two hours, until it produced some effect. It soon removed the dropsical and asthmatic affections, and steel, with Seltzer water, restored him to health.
August6th. Mr. L——, Æt. 35. Ascites and anasarca. Pulv. Digital. grains three, repeated every fourth hour, until he had taken two scruples, removed every appearance of dropsy in a few days. He was then directed to take solution of merc. sublimat. and soon recovered his health and strength.
August16th. Mr. G——, of W——, Æt. 86. Asthma of many years duration, and lately an incipient anasarca, with a paucity of urine. He had never lived intemperately, was of a chearful disposition, and very sensible: for some years back hadlost all relish for animal food, and his only support had been an ounce or two of bread and cheese, or a small slice of seed-cake, with three or four pints of mild ale, in the twenty-four hours. After trying chrystals of tartar, fixed alkaly, squills, &c. I directed three grains of Pulv. fol. Digital. made into pills, with G. ammoniac, to be given every six hours; this presently occasioned copious discharges of urine, removed his swellings, and restored him to his usual standard of health.
August17th. T—— B——, Esq. of K——, Æt. 46. Jaundice, dropsy, and great hardness in the region of the liver. Infusion of Digitalis carried off all the effusion, and afterwards a course of deobstruent and tonic medicines removed his other complaints.
August23d. Mr. C——, Æt. 58. (The person mentioned atCase XXIII.) He had continued free from dropsy until within the last six weeks; his appetite was now totally gone, his strength extremely reduced, and the yellow of his jaundice changed to a blackish hue. The Digitalis was now tried in vain, and he died shortly afterwards.
August24th. Mrs. W——, Æt. 39. Anasarcous legs and symptoms of hydrothorax, consequentto a tertian ague. Three grains of Pulv. Digitalis, given every fourth hour, occasioned a very copious flow of urine, and she got well without any other medicine.
August28th. Mr. J—— H——, Æt. 27. In consequence of very free living, had an ascites and swelled legs. I ordered him to take two grains of Fol. Digital. pulv. every two hours, until it produced some effect; a few doses caused a plentiful secretion of urine, but no sickness, or purging: in six days the swellings disappeared, and he has since remained in good health.
September27th. Mr. S——, Æt. 45. Had been long in an ill state of health, from what had been supposed an irregular gout, was greatly emaciated, had a sallow complexion, no appetite, costive bowels, quick and feeble pulse. The cause of his complaints was involved in obscurity; but I suspected the poison of lead, and was strengthened in this suspicion, upon finding his wife had likewise ill health, and, at times, severe attacks of colic; but the answers to my enquiries seemed to prove my suspicions fruitless, and, amongst other things, I was told the pump was of wood. He had lately suffered extremely from difficult breathing, which I thought owing to anasarcous lungs; there was also a slight degree of pale swelling in his legs. Pulv.fol. Digital. made into pills, with gum ammoniac and aromatic species, soon relieved his breathing. Attempts were then made to assist him in other respects, but with little good effect, and some months afterwards he died, with every appearance of a worn out constitution.
About two years after this gentleman's death, I was talking to a pump-maker, who, in the course of conversation, mentioned the corrosion of leaden pumps, by some of the water in this town, and instanced that at the house of Mr. S——, which he had replaced with a wooden one about three years before. The lead, he said, was eaten away, so as to be very thin in some places, and full of holes in others;—this accidental information explained the mystery.
The deleterious effects of lead seem to be considerably modified by the constitution of the patient; for in some families only one or two individuals shall suffer from it, whilst the rest receive it with impunity. In the spring of the year 1776, I was desired to visit Mrs. H——, of S—— Park, who had repeatedly been attacked with painful colics, and had suffered much from insuperable costiveness; I suspected lead to be the cause of her complaints, but was unable to trace by what means it was taken. She was relieved by the usual methods; but, a few months afterwards, I was desired to see her again: her sufferings were the same as before, and notwithstanding every precaution to guard against costiveness, she was never in perfect health, and seldomescaped severe attacks twice or thrice in a year; she had also frequent pains in her joints. I could not find any traces of similar complaints either in Mr. H——, the children, or the servants. Mrs. H—— was a water drinker, and seldom tasted any fermented liquor. The pump was of wood, as I had been informed upon my first visit. Her health continued nearly in the same state for two or three years more, but she always found herself better if she left her own house for any length of time. At length it occurred to me, that though the pump was a wooden one, the piston might work in lead. I therefore ordered the pump rods to be drawn up, and upon examination with a magnifying glass, found the leather of the piston covered with an infinite number of very minute shining particles of lead. Perhaps in this instance the metal was so minutely divided by abrasion, as to be mechanically suspended in the water. The lady was directed to drink the water of a spring, and never to swallow that from the pump. The event confirmed my suspicions, for she gradually recovered a good state of health, lost the obstinate costiveness, and has never to this day had any attack of the colic.
September28th. Mrs. J——, Æt. 70. Ascites and very thick anasarcous legs and thighs, total loss of strength and appetite. Infusion of Digitalis was given, but, as had been prognosticated, with no good effect.
September30th. Mr. A——, Æt. 57. A strong man; hydrothorax and swelled legs; in other respects not unhealthful. He was directed to take two grains of the Pulv. fol. Digit. made into a pill with gum ammoniac. Forty grains thus taken at intervals, effected a cure by increasing the quantity of urine, and he has had no relapse.
November2d. Mr. P—— of T——, Æt. 42. A very strong man, drank a great quantity of strong ale, and was much exposed to alterations of heat and cold. About the end of summer found himself short winded, and lost his appetite. The dyspnœa gradually increased, he got a most distressing sense of tightness across his stomach, his urine was little, and high coloured, and his legs began to swell; his pulse slender and feeble. From the 20th ofSeptemberI frequently saw him, and observed a gradual and regular increase of all his complaints, notwithstanding the use of the most powerful medicines I could prescribe. He took chrystals of tartar, seneka, gum ammoniac, saline draughts, emetics, tinct. of cantharides, spirits of nitre dulcified, squills in all forms, volatile alkaly, calomel, Dover's powder, &c. Blisters and drastic purgatives were tried, interposing salt of steel and gentian. I had all along felt a reluctance to prescribe the Digitalis in this case, from a persuasion that it would not succeed.At length I was compelled to it, and directed one grain to be given every two hours until it should excite nausea. This it did; but, as I expected, it did no more. The reason of this belief will be mentioned hereafter. Five days after this last trial I gave him assafetida in large quantity, flattered by a hope that his extreme sufferings from the state of his respiration, might perhaps arise in part from spasm, but my hopes were in vain. I now thought of using an infusion of tobacco, and prescribed the following: