CASE Cx.x.xII.

_July_ 16th. Mr. B----, of W----, aet. 31. After a tertian ague of 12 months continuation, suffered great indisposition for 10 months more.

He chiefly complained of great straitness and pain in the hypochondriac region, very short breath, swelled legs, want of appet.i.te. He had been under the care of some very sensible pract.i.tioners, but his complaints increased, and he determined to come to Birmingham. I found him supported upright in his chair, by pillows, every attempt to lean back or stoop forward giving him the sensation of instantaneous suffocation. He said he had not been in bed for many weeks. His countenance was sunk and pale; his lips livid; his belly, thighs and legs very greatly swollen; hands and feet cold, the nails almost black, pulse 160 tremulous beats in a minute, but the pulsation in the carolid arteries was such as to be visible to the eye, and to shake his head so that he could not hold it still. His thirst was very great, his urine small in quant.i.ty, and he was disposed to purge. I immediately ordered a spoonful of the infusum Digitalis every six hours, with a small quant.i.ty of laudanum, to prevent its running off by stool, and decoction of leontodon taraxac.u.m to allay his thirst.

The next day he began to make water freely, and could allow of being put into bed, but was raised high with pillows. Omit the infusion.

That night he parted with six quarts of water, and the next night could lie down and slept comfortably. _July_ 21st. he took a mild mercurial bolus. On the 25th. the diuretic effects of the Digitalis having nearly ceased, he was ordered to take three grains of the pulv.

Digital. night and morning, for five days, and a draught with half an ounce of vin. chalyb. twice a day. _August_ 15th. He took a purge of calomel and jallap, and some swelling still remaining in his legs, the Digitalis infusion was repeated. The water having been thus entirely evacuated, he was ordered saline draughts with acetum scillitic.u.m and pills of salt of steel and extract of gentian. About a month after this, he returned home perfectly well.

CASE Cx.x.xIII.

_July_ 28th. Mr. A---- of W----, aet. 29, became dropsical towards the close of a pulmonary consumption. He was ordered 12 grains of pulv.

fol. cicutae and 1 of Digitalis twice a day. No remarkable effect took place.

CASE Cx.x.xIV.

_July_ 31. Mr. M----, aet 37. Hydrothorax. A single grain of fol.

Digital. pulv. taken every night for three weeks cured him. The medicine never made him sick, but increased his urine, which became clear; whereas before it had been high coloured and turbid.

CASE Cx.x.xV.

_August_ 6th. Mr. C---- of B----, aet. 42. Asthma and anasarca, the consequence of free living. He had been for some time under the care of an eminent physician of this place, but his complaints proving unusually obstinate, he consulted me. I directed an infusion of Digitalis to be taken every night, and a mixture with squill and tincture of cantharides twice every day. In about a week he became better, and continued daily mending. He has since enjoyed perfect health, having quitted a line of business which exposed him to drink too much.

CASE Cx.x.xVI.

_August_ 6th. Mr. M---- of C----, aet. 44. Ascites and anasarca, preceded by symptoms of the epileptic kind. He was ordered to take two grains of pulv. Digitalis every morning, and three every night; likewise a saline draught with syrup of squills, every day at noon.

His complaints soon yielded to this treatment, but in the month of November following he relapsed, and again asked my advice. The Digitalis alone was now prescribed, which proved as efficacious as in the first trial. He then took bitters twice a day, and vitriolic acid night and morning, and now enjoys good health.

Before the Digitalis was prescribed, he had taken jallap purges, soluble tartar, salt of steel, vitriol of copper, &c.

CASE Cx.x.xVII.

_August_ 10th. Mrs. W----, aet. 55. An anasarcous leg, and sciatica; full habit. After bleeding and a purge, a blister was applied in the manner recommended by Cotunnius; and two grains of fol. Digital. with fifteen of fol. cicutae were directed to be taken night and morning.

The medicine acted only as a diuretic; the pain and swelling of the limb gradually abated; and I have not heard of any return.

I must here bear witness to the efficacy of Cotunnius's method of blistering in the sciatica, having used it in a great number of cases, and generally with success.

CASE Cx.x.xVIII.

_August_ 16th. Mrs. A---- of S----, aet. 78. About the middle of Summer began to complain of short breath, great debility, and loss of appet.i.te. At this time there were evident marks of effusion in the thorax, and some swelling in the legs. The advanced age, the weakness, and other circ.u.mstances of this patient, precluded every idea of her recovery; but something was to be attempted. Squills and other remedies had been tried; I therefore directed pills with two or three grains of the pulv. Digitalis to be taken every night for six nights, and a saline draught with forty drops of acetum scillit. twice in the day. She took but few of the draughts, seldom more than half one at a time, for they purged her, and she disliked them. The pills she took regularly, and with the happiest effect, for she could lie down, her breath was very much relieved, and a degree of appet.i.te returned.

_Sept._ 4th, some return of her symptoms demanded the further use of diuretics. I was afraid to push the Digitalis in so hazardous a subject, and therefore directed tinct. amara with tinct. canthar. and pills of squill, seneka, salt of tartar and gum ammoniac. These medicines did not at all check the progress of the disease, and on the 26th it became necessary to give the Digitalis again. The pills were therefore repeated as before, and infus. amarum with fixed alkaly ordered to be taken twice a day. The event was as favorable as before; and from this time she had no considerable return of dropsy, but languished under various nameless symptoms, until the middle or end of November.

CASE Cx.x.xIX.

_Aug._ 16th. Mrs. P---- of S----, aet. 50. For a particular account of this patient, see Mr. Yonge's second Case.

CASE CXL.

_Sept._ 20th. B---- B----, Esq. A true spasmodic asthma of many years continuance. After every method of relief had failed; both under my management, and also under the direction of several of the ablest physicians of this kingdom; I was induced to give him an infusion of the Digitalis. It was continued until nausea came on, but procured no relief.

CASE CXLI.

_October_ 5th. Mr. R----, aet. 43. _(The patient mentioned at No.

102.)_ He had pursued his former mode of life, and had now a return of his complaints, with evident marks of diseased viscera. His belly not very large, but uncommonly tense. From this circ.u.mstance I did not expect the Digitalis to succeed, and therefore tried for some time to relieve him by the saline julep, with acet. scillitic. jallap, mercury, syrup of squill, with aq. cinnam. decoction of Dandelion, &c.; but these being administered without advantage, I was driven to the Digitalis. As he was very weak and much emaciated, I only gave two grains night and morning for five days. As no increase of urine took place, I used alkaline salt with tinct. cantharides:--This proving equally unsuccessful, on the 18th, I directed two ounces of the infusum Digitalis night and morning. This was continued until nausea took place, but the kidney secretion was not increased. Squill with opium, deobstruents of different kinds, sublimate solution, fixed alkaly, tobacco infusion, were now successively tried, but with the same want of success. The fullness of his belly made it necessary to tap him, and by repeating this operation he continued alive to the end of the year.

CASE CXLII.

_October_ 19th. Mrs. R----, of B----, aet. 47. Supposed Asthma, of eighteen months duration. She had kept her room for four months, and could not lie down without great disturbance; was very thin, and had totally lost all inclination for food. She was directed to take two gr. of pulv. fol. Digital. night and morning for five days, and infusum amarum, at the hours of eleven and five. In the course of a week she was much relieved, and could remain in bed all night. After a few days interval she took the Digitalis for five days more, and was soon after that well enough to come down stairs and conduct her family affairs.

In _April_ 1785, she had a slight return, but not such as to confine her to her chamber. She experienced the same relief from the same medicine, but continuing it for seven days without interruption, it excited nausea.

CASE CXLIII.

_October_ 28th. Mr. A----, subject to nephritis calculosa: After an attack of that kind, had still a troublesome sense of weight about his loins, now and then rising to pain, and a degree of dysuria, together with a want of appet.i.te. These symptoms not readily yielding to the usual methods of treatment, I directed an infusion of Digitalis. The fourth dose caused a copious flow of urine; the sixth made him sick, and he was more or less sick at times for three days; but felt no more of his complaints.

I don't believe it is at all necessary to bring on sickness in these cases, but an unexpected absence from town prevented me from seeing him time enough to stop the exhibition of the medicine.

CASE CXLIV.

_October_ 31st. Mrs. C----, of W----, aet. 67. Asthma, and very thick hard legs of long continuance. The last month or two her breath worse than usual, her belly swollen, her thighs anasarcous, and her urine in small quant.i.ty. After trying garlic, squill, and purgatives without advantage, I directed the Digital. Infus. After taking about five ounces, her urine from thick and turbid, changed to clear and amber coloured, its quant.i.ty considerably increased, and her breathing easy.

Contrary to my orders, but impelled by the relief she had found, she finished the remaining three ounces of the infusion, which made her very sick, and the free flow of urine immediately ceased. No medicine was administered for a fortnight, during which time her complaints increased. I then directed an infusion of tobacco, which affected her head, but did not increase her urine. She had recourse again to the Digitalis infusion, which once more removed the fulness of the belly, reduced the swellings of her thighs, and relieved her breath, but had no effect upon her legs.

CASE CXLV.

_Nov._ 2d. Miss B---- of C----, aet. 22. A very evident fluctuation in the abdomen, which was considerably distended, whilst the rest of her frame was greatly emaciated. The presence of cough, hectic fever, and other circ.u.mstances, made it probable that this apparent ascites was caused by a purulent, and not a watery effusion. However it was possible I might be mistaken; the Digitalis was therefore given, but without any advantage.

The further progress of the disease confirmed my first opinion, and she died consumptive.

CASE CXLVI.

_Nov._ 4th. Mr. P---- of M----, aet. 40. Subject to troublesome nephritic complaints, and after the last attack did not recover, or void the gravelly concretions as usual, a sense of weight across his loins continuing very troublesome. The usual medicines failing to relieve him, I ordered four grains of pulv. Digital. to be taken every other night for a week, and fifteen grains of mild fixed vegetable alkaly to be swallowed twice a day in barley water. He soon lost all his complaints; but we must not in this case too hastily attribute the cure to the Digitalis, as the alkaly has also been found a very useful medicine in similar disorders.

CASE CXLVII.

_Nov._ 4th. Mr. B---- of N----, aet. 60. Had been much subject to gout, but his const.i.tution being at length unable to form regular fits, he became dropsical. Pulv. fol. Digital. in doses of two or three grains, at bed-time, gave him some relief, but did not perfectly empty him.

About three months afterwards he had occasion to take it again; but it then produced no effect, and he was so debilitated that it was not urged further.