Chapter II: Part 2

_January_ 11th. Mr. H----, AEt. 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 as case 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.

CASE XXIII.

_August_ 31st. Mr. C----, AEt. 57. Diseased viscera, jaundice, ascites and anasarca. After trying calomel, 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.

CASE XXIV.

_September_ 11th. I was desired to visit Mr. L----, AEt. 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 several days 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.

CASE XXV.

_September_ 15th. Mr. J. R----, AEt. 50. Subject to an asthmatical complaint for more than twenty years, but was this year much worse than usual, and symptoms of dropsy appeared. In _July_ he took G. ammon. squill and seneka, with infus. amarum and fossil alkaly. In _August_, 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. _September_ 15th, an infusion of Digitalis was directed, but he died the next morning.

CASE XXVI.

_September_ 18th. Mrs. R----, AEt. 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 at No. 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.

CASE XXVII.

_October_ 7th. 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 of _November_. It was necessary to draw off the water again upon the following days:

_December_ the 8th.
-- -- 27th.
1780. _February_ the 4th.
-- -- 23d.
_March_ the 9th.

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 of _February_ 23d, 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 rigors ensued, 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.

1780.

CASE XXVIII.

_January_ 11th. Captain V----, AEt. 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.

CASE XXIX.

_February_ 6th. Mr. H----, AEt. 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.

CASE XXX.

_February_ 17th. Mr. D----, AEt. 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.

CASE XXXI.

_March_ 5th. 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 (see Case 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.

CASE XXXII.

_March_ 16th. Mr. D----, AEt. 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 until _August_ 1782, and without any return of the dropsy.

CASE XXXIII.

_March_ 18th. Miss S----, AEt. 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.

CASE XXXIV.

_March_ 19th. 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.

CASE XXXV.

_April_ 12th. Mr. R----, AEt. 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. In _June_ following 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.

CASE XXXVI.

_May_ 15th. Mrs. H----, AEt. 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.

CASE XXXVII.

_May_ 26th. R---- B----, AEt. 12. Scrophulous, consumptive, and at length anasarcous. Took Infus. Digital. without advantage. Died the _July_ following.

CASE XXXVIII.

_June_ 4th. Mrs. S----, of W----, AEt 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 of _May_; 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.

CASE XXXIX.

_June_ 13th. Mr. P----, AEt. 35. A very hard drinker, was attacked with a severe haemoptoe, 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.

CASE XL.

_June_ 27th. Mr. W----, AEt. 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.

CASE XLI.

_July_ 6th. Mr. E----, AEt. 57. Hydrothorax and anasarca; his breath so short that he could not lie 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.

CASE XLII.

_July_ 7th. Miss H---- of T----, AEt. 39. In the last stage of a phthisis pulmonalis became dropsical. She took the Digitalis without being relieved.

CASE XLIII.

_July_ 9th. Mrs. F----, AEt. 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 aether, 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.

_July_ 18th. Infusum amarum, steel, Seltzer water.

_September_ 22d. Neutral saline draughts, with tinct.
canthar.

26th. Pills of soap, garlic and millepedes.

30th. The same pills, with infusum amarum.

_October_ 11th. Pills of aloes, assafetida, and sal martis,
in the day-time, and mercury rubbed down, at night.

_December_ 21st. 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.

_February_ 1st. 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.

_March_ 18th. Infus. Digital. repeated.

26th. Pills of sal martis and aromatic species, with infusum
amarum.

_May_ 5th. 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.

_August_ 11th. Infus. Digitalis.

_October_ 19th. An emetic, and fol. Cicut. pulv. ten grains
every six hours.

_November_ 8th. A mercurial bolus at bed-time.

16th. Infus. Digitalis.

_December_ 23d. An emetic--Pills of seneka and gum
ammoniac--Vitriolic acid in every thing she drinks.

25th. Squill united to small doses of opium.

1782.

_January_ 2d. 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.

_March_ 26th. Infus. Digitalis; and when emptied, vitriol of
copper twice a day.

_April_ 1st. 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 in _July_.

INTERVALS.

From _July_ 9th, 1780, to _December_ 21st, 171 days.
From _December_ 21st to _February_ 3d, 1781, 34 days.
From _February_ 3d to _March_ 18th, 44 days.
From _March_ 18th to _May_ 24th, 66 days.
From _May_ 24th to _August_ 11th, 79 days.
From _August_ 11th to _November_ 16th, 98 days.
From _November_ 16th to _January_ 28th, 1782, 74 days.
From _January_ 28th to _March_ 26th, 57 days.

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 of _March_ the degree of effusion was inconsiderable, and at the time of her death very trifling, being probably carried off by the diarrhoea.

CASE XLIV.

_July_ 12th. Mr. H----, of A----, AEt. 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.

CASE XLV.

_July_ 13th. Mr. S----, AEt. 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.

CASE XLVI.

_August_ 6th. Mr. L----, AEt. 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.

CASE XLVII.

_August_ 16th. Mr. G----, of W----, AEt. 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 had lost 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.

CASE XLVIII.

_August_ 17th. T---- B----, Esq. of K----, AEt. 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.

CASE XLIX.

_August_ 23d. Mr. C----, AEt. 58. (The person mentioned at Case 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.

CASE L.

_August_ 24th. Mrs. W----, AEt. 39. Anasarcous legs and symptoms of hydrothorax, consequent to 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.

CASE LI.

_August_ 28th. Mr. J---- H----, AEt. 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.

CASE LII.

_September_ 27th. Mr. S----, AEt. 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 seldom escaped 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.

CASE LIII.

_September_ 28th. Mrs. J----, AEt. 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.

CASE LIV.

_September_ 30th. Mr. A----, AEt. 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.

CASE LV.

_November_ 2d. Mr. P---- of T----, AEt. 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 dyspnoea 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 of _September_ I 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:

R. Fol. Nicotian. incis. [Symbol: dram]ii.
Aq. bull. [Symbol: pound]ss.
Sp. Vini rectif. [Symbol: ounce]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.

CASE LVI.

_November_ 6th. Mr. H----, AEt. 47. In the last stage of a phthisis pulmonalis, suffered much from dyspnoea, 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.

CASE LVII.

_November_ 16th. Mrs. F----, AEt. 53. In _August_ last 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. In _February_, 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?

1781.

CASE LVIII.

_January_ 1st. Mrs. G----, of H----, AEt. 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 of _February_, 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.

CASE LIX.

_January_ 3d. Mrs. B----, AEt. 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.

CASE LX.

_January_ 14th. 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.

CASE LXI.

_February_ 2d. I was desired by the late learned and ingenious Dr. Groome, to visit Miss S----, a young 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?

CASE LXII.

_February_ 27th. Mrs. O----, of T----, AEt. 52, with a constitution worn out by various complicated disorders, 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.

CASE LXIII.

_March_ 16th. Mrs. P----, AEt. 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.

CASE LXIV.

_March_ 18th. Mr. W----, in the last stage of a pulmonary consumption became dropsical. The Digitalis was given, but without any good effect.

CASE LXV.

_April_ 6th. Mr. B----, AEt. 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 breathing exceedingly. 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.

CASE LXVI.

_April_ 8th. Mr. B----, AEt. 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.

CASE LXVII.

_April_ 24th. Mr. M----, of C----, AEt. 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.

CASE LXVIII.

_April_ 25th. Mrs. J----, AEt. 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.

CASE LXIX.

_May_ 1st. Master W----, of St----, AEt. 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 mercurial ointment 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.

CASE LXX.

_May_ 3d. Mrs. B----, AEt. 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.

CASE LXXI.

_May_ 3d. Mr. S----, AEt. 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.

CASE LXXII.

_May_ 24th. Joseph B----, AEt. 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.

CASE LXXIII.

_June_ 29th. Mr. B----, AEt. 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.

CASE LXXIV.

_June_ 29th. Mr. A----, AEt. 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.

CASE LXXV.

_July_ 18th. Mrs. B----, AEt. 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.

CASE LXXVI.

_August_ 12th. Mr. L----, AEt. 65, the person whose Case is recorded at No. 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.

CASE LXXVII.

_September_ 10th. Mr. V----, of S----, AEt. 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.

CASE LXXVIII.

_September_ 25th. Mr. O----, of M----, AEt. 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 not easy to say what the disease was, and the patient living at a distance, I never learnt the future progress or termination of it.

CASE LXXIX.

_September_ 26th. Mr. D----, AEt. 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.

CASE LXXX.

_September_ 27th. Mrs. E----, AEt. 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.

CASE LXXXI.

_October_ 28th. Mr. B----, AEt. 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.

CASE LXXXII.

_November_ 14th. Mr. W----, of T----, AEt. 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.

1782.

CASE LXXXIII.

_January_ 23d. Mr. Q----, AEt. 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.

CASE LXXXIV.

_January_ 27th. Mr. D----, AEt. 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.

CASE LXXXV.

_January_ 28th. Mr. D----, AEt. 35. A publican and a hard drinker. Ascites, anasarca, diseased viscera, and slight attacks of haemoptoe. 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.

CASE LXXXVI.

_January_ 29th. Mrs. O----, of D----, AEt. 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.

CASE LXXXVII.

_January_ 31st. Mr. T----, of A----, AEt. 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.

CASE LXXXVIII.

_January_ 31st. Mrs. J----, of S----, AEt. 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.

CASE LXXXIX.

_February_ 2d. Mr. B----, AEt. 73. An universal dropsy. He took various medicines, and Digitalis in small doses, but without any good effect.

CASE XC.

_February_ 24th. Master M----, of W----, AEt. 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 one half pint infusion, which made no alteration in his complaint.

CASE XCI.

_March_ 6th. Mr. H----, AEt. 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 sodae 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.

CASE XCII.

_May_ 10th. Mrs. P----, AEt. 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.

CASE XCIII.

_May_ 22d. Mr. O----, of B----, AEt. 61. A very large man, and a free liver; after an attack of hemiplegia 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.

CASE XCIV.

_July_ 5th. Mr. C----, of W----, AEt. 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.

CASE XCV.

_March_ 6th. Mrs. W----, AEt. 36. In the last stage of a pulmonary consumption, took the Infus. Digitalis, but without any advantage.

CASE XCVI.

_August_ 20th. Mr. P----, AEt. 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.

CASE XCVII.

_September_ 24th. Mrs. R----, of B----, AEt. 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 at No. VIII. XXVI, and XXXI. 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.

CASE XCVIII.