CASE CXVI.

_June_ 24th. Mrs. B----, aet. 40. A puerperal fever, and swelled legs and thighs. The fever not yielding to the usual practice, I directed an Infusion of Fol. Digitalis. It proved diuretic; the swellings subsided, but the fever continued, and a few days afterwards a diarrha coming on, she died.

CASE CXVII.

_July_ 22d. Mr. F----, aet. 48. A strong man, of a florid complexion, in consequence of intemperance became dropsical, with symptoms of diseased viscera, great dyspna, a very troublesome cough, and total loss of appet.i.te. He took mild mercurials, pills of soap, rhubarb, and tartar of vitriol, with soluble tartar and dulcified spirits of nitre in barley water. After a reasonable trial of this plan, he took squill every six hours, and a solution of a.s.safetida and gum ammoniac, to ease his breathing: finding no relief, I gave him chrystals of tartar with ginger; but his remaining health and strength daily declined, and he was not at all benefited by the medicines. I was averse to the use of Digitalis in this case, judging from what I had seen in similar instances of tense fibre, that it would not act as a diuretic. I therefore once more directed squill, with decoction of seneka and sal sodae; but it was inefficacious. His strength being much broken down, I then ordered gum ammoniac, with small doses of opium, and infusum amarum, continuing the squill at intervals. At length I was urged to give the Digitalis, and considering the case as desperate, I agreed to do it. The event was as I expected; no increase in the urine took place; and the medicine being still continued, his pulse became slow, and he apparently sunk under its sedative effects.

He was neither purged nor vomited; and had the Digitalis either been omitted altogether, or suspended upon its first effects upon the pulse being observed, he might perhaps have existed a week longer.

CASE CXVIII.

_July_ 26th. Mr. W----, of W----, aet. 47. Phthisis pulmonalis, jaundice, ascites, and swelled legs. As it was probable that the only relief I could give in a case so circ.u.mstanced, would be by carrying off the effused fluids. I tried squill and fixed alkaly; and these failing, I ordered the Infusum Digitalis. This had the desired effect, and, I believe, prolonged his life a few weeks.

CASE CXIX.

_August_ 15th. Mrs. C----, aet. 60. Ascites, anasarca, diseased viscera, paucity of urine, and total loss of appet.i.te. These complaints had heretofore existed repeatedly, and had been removed by deobstruent and diuretic medicines; but in this attack the symptoms were suffered to exist a longer time and in a greater degree, before a.s.sistance was sought for. The remedies that used to relieve her were now exhibited to no purpose. Mild mercurials, soap, rhubarb, and squill were tried; but she grew rapidly worse. Saline draughts with acetum scillitic.u.m seemed for a few days to check the progress of her complaint, but they soon lost their effect, and diarrha ensued upon every attempt to increase the frequency of the dose. Draughts with Infus. Digital. were then directed to be taken twice a day. The effect was a powerful action on the kidneys, and a reduction of the swellings, but without sickness. A degree of appet.i.te returned, but still the tendency to diarrha existed, and kept her weak. Tonic medicines were then tried, but without advantage, and in a month it was necessary to have recourse to the Digitalis again. It was directed in a half pint mixture; an ounce to be taken thrice in twenty-four hours. On the 2d day, finding her symptoms very much relieved, she took in the absence of her nurse, nearly a double dose of the medicine. The consequence was great sickness, languor continuing for several days, and almost a total stop to the secretion of urine, from the time the sickness commenced.

The case now became totally unmanageable in my hands, and, after a fortnight, I was dismissed, and another physician called in; but she did not long survive.

This was not the first, nor the last instance, in which I have seen too large a dose of the medicine, defeat the very purpose for which it was directed.

CASE CXX.

_August_ 22d. Mrs. S----, aet. 36. Extreme faintiness; anasarcous legs and thighs; great difficulty of breathing, troublesome cough, frequent chilly fits succeeded by hot ones; night sweats, and a tendency to diarrha. Apprehensive that the more urgent symptoms were caused by water in the lungs, I directed an Infusion of Digitalis, with an ounce of diacodium to the half pint to prevent it purging, a wine gla.s.s full to be taken every night at bed-time, and a mixture with confect. cardiac. and pulv. ipecac. to be given in small doses after every loose stool.

On the fourth day she was better in all respects; had made a large quant.i.ty of water and did not purge. In a few days more she lost all her complaints, except the cough, which gradually left her, without any further a.s.sistance.

I was agreeably deceived in the event of this case, for I expected after the water was removed, to have had a phthisis to contend with.

CASE CXXI.

_August_ 25th. T---- W----, Esq; aet, 50. A free liver, diseased viscera, belly very tense, and much swollen; fluctuation perceptible, but the swelling circ.u.mscribed; pulse 132. This gentleman was under the care of my very worthy friend Dr. Ash, who, having tried various modes of cure to no purpose, asked me if I thought the Digitalis would answer in this case. I replied that it would not, for I had never seen it effectual where the swelling appeared very tense and circ.u.mscribed.

It was tried however, but did not lessen the swelling. I mention this case, to introduce the above remark, and also to point out the great effect the Digitalis has upon the action of the heart; for the pulse came down to 96. He was afterwards tapped, and continued, for some time under our joint attendance, but the pulse never became quicker, nor did the swelling return.

CASE CXXII.

_September_ 7th. Mr. L----, aet. 43. After several severe attacks of ill formed gout, attended for some time past with jaundice and other symptoms of diseased viscera, the consequences of intemperate living, was sent to Buxton; from whence he returned in three weeks with ascites and anasarca. Under this complicated load of disease, I prescribed repeatedly without advantage, and at length gave him the Digitalis, which carried off the more obvious symptoms of dropsy; but the jaundice, loss of appet.i.te, diseased viscera, &c. rendered his recovery impossible.

1784.

CASE CXXIII.

_February_ 12th. Mrs. C----, aet. 54. A strong short woman of a florid complexion; complained of great fullness across the region of the stomach; short breath, a troublesome cough, loss of appet.i.te, paucity of urine; and had a brownish yellow tinge on her skin and in her eyes.

She dated these complaints from a fall she had through a trap door about the beginning of winter. From the beginning of January to this time, she had been repeatedly let blood, had taken calomel purges with jallap; pills of soap, rhubarb and calomel; saline julep with acet. scillit. nitrous decoction, garlic, mercury rubbed down, infus.

amarum purg. &c. After the failure of medicines so powerful, and seemingly so well adapted, and during the use of which all the symptoms continued to increase, it was evident that a favourable event could not be expected. However, I tried the infusum Digitalis, but it did nothing. I then gave her pills of quicksilver, soap and squill, with decoction of dandelion, and after some time, chrystals of tartar with ginger. Nothing succeeded to our wishes, and the increase of orthopna compelled me occasionally to relieve her by drastic purges, but these diminished her strength, more in proportion than they relieved her symptoms. Tincture of cantharides, sal diureticus and various other means were occasionally tried, but with very little effect, and she died towards the end of March.

CASE CXXIV.

_March_ 31st. Miss W----, aet. 60. Had been subject to peripneumonic affections in the winter. She had now total loss of appet.i.te, very great debility, difficult breathing; much cough, a considerable degree of expectoration, and a paucity of urine. She had been blooded, taken soap, a.s.saf. and squill, afterwards a.s.saf. and ammon. with acet.

scillit.: but all her complaints increasing, a blister was applied to her back, and the Digitalis infusion directed to be taken every night.

The effect was an increased secretion of urine, a considerable relief to her breath, and some return of appet.i.te; but soon afterwards she became hectic, spat purulent matter, and died in a few weeks.

CASE CXXV.

_April_ 12th. Mrs. H----, of L----, aet. 61. In _December_ last this Lady, then upon a visit in London, was attacked with severe symptoms of peripneumony. She was treated as an asthmatic patient, but finding no relief, she made an effort to return to her home to die. In her way through this place, the latter end of December, I was desired to see her. By repeated bleedings, blisters, and other usual methods, she was so far relieved, that she wished to remain under my care. After a while she began to spit matter and became hectic. With great difficulty she was kept alive during the discharge of the abscess, and about the end of March she had swelled legs, and unequivocal symptoms of dropsy in the chest. Other diuretics failing, on the 12th of April I was induced to give her the Digitalis in small doses. The relief was great and effectual. After an interval of fifteen days, some swellings still remaining in the legs, I repeated the medicine, and with such good effect, that she lost all her complaints, got a keen appet.i.te, recovered her strength, and about the end of May undertook a journey of fifty miles to her own home, where she still remains in perfect health.

CASE CXXVI.

_April_ 17th. Mr. F----, aet. 59. A very fat man, and a free liver; had long been subject to what was called asthma, particularly in the winter. For some weeks past his legs swelled, he had great sense of fullness across his stomach; a severe cough; total loss of appet.i.te, thirst great, urine sparing, his breath so difficult that he had not lain down in bed for several nights. Calomel, gum ammoniac, tincture of cantharides, &c. having been given in vain, I ordered two grains of pulv. fol. Digitalis made into pills, with aromatic species and syrup, to be given every night. On the third day his urine was less turbid; on the fourth considerably increased in quant.i.ty, and in ten days more he was free from all complaints, and has since had no relapse.

CASE CXXVII.

_May_ 7th. Miss K----, aet. 8. After a long continued ague, became hectic and dropsical. Her belly was very large, and she had a total loss of appet.i.te. Half a grain of fol. Digital, pulv. with 2 gr. of merc. alcalis. were ordered night and morning, and an infusion of bark and rhubarb with steel wine to be given in the day time. Her belly began to subside in a few days, and she was soon restored to health.

Two other children in the family, affected nearly in the same way, had died, from the parents being persuaded that an ague in the spring was healthful and should not be stopped.--I know not how far the recovery in this case may be attributed to the Digitalis, but the child was so near dying that I dared not trust to any less efficacious diuretic.

CASE CXXVIII.

_June_ 13th. Mr. C----, aet. 45. A fat man, had formerly drank hard, but not latterly: last March began to complain of difficult breathing, swelled legs, full belly, but without fluctuation, great thirst, no appet.i.te; urine thick and foul; complection brownish yellow. Mercurial medicines, diuretics of different kinds, and bitters, had been trying for the last three months, but with little advantage. I directed two grains of the fol. Digital. in powder to be taken every night, and infus. amar. with tinct. sacr. twice a day. In three days the quant.i.ty of his urine increased, in ten or twelve days all his symptoms disappeared, and he has had no relapse.

CASE CXXIX.

_June_ 17th. Mr. N----, of W----, aet. 54. A large man, of a pale complexion; had been subject to severe fits of asthma for some years, but now worse than usual. The intermitting pulse, the great disturbance from change of posture, and the swelled legs induced me to conclude that the exacerbation of his old complaint was occasioned by serous effusion. I directed pills with a grain and half of the pulv.

Digital. to be taken every night, and as he was costive, jallap made a part of the composition. He was also directed to take mustardseed every morning and a solution of a.s.safetida twice in the day. The effect of this plan was perfectly to our wishes, and in a short time he recovered his usual health. About half a year afterwards he died apoplectic.

CASE Cx.x.x.

_Mary_ B----. A young unmarried woman. Her disease appeared to me a dropsy of the right ovarium. She took an infusion of Digitalis, but, as I expected with no good effect. She is still, I am informed nearly in the same state.

CASE Cx.x.xI.

_July_ 12th. Mrs. A----, of C----, aet. 56. After a series of indispositions for several years, became dropsical; and had long been confined to her chamber, unable to lie down or to walk. She was so feeble, her legs so much swelled, her breath so short, and the symptoms of diseased viscera so strong, that I dared not to entertain hopes of a cure; but wishing to relieve her more urgent symptoms, directed quicksilver rubbed down and fol. Digital. pulv. to be made into pills: the dose, containing two grains of the latter, to be given night and morning. She was also ordered to take a draught with a dram of aether twice a day, and to have scapulary issues. Her breath was so much relieved, that she was able soon afterwards to come down stairs; but her const.i.tution was too much broken to admit of a recovery.