I ordered it of the above strength, and to be repeated often, on account of the great emergency of the case, but the nausea excited by the first dose prevented its being given at such short intervals. A 3d dose I found had been given, which was followed by vomitings. All her complaints gradually abated, but in about a fortnight recurred, notwithstanding the use of infus. amar. &c.

_Dec. 2. Infus. Digit. e. ?iss ad aq. &c. ?viii. cochl. ii.

horis &c. u. a._

Complaints gradually abated, swellings of the legs nearly gone down.

About a month afterwards you was desired to visit this patient.[9]

[Footnote 9: For reasons a.s.signed at p. 100, I did not intend to introduce any case, occurring under my own inspection, in the course of the present year; but it may be satisfactory to continue the history of this disease, as Dr. Stokes's narrative would otherwise be incomplete.

1785.

CASE.

_Jan._ 5th. Mrs. M----, aet. 48. Hydrothorax and anasarcous legs, of eight months duration. She had taken jallap, squill, salt of tartar, and various other medicines. I found her in a very reduced state, and therefore directed only a grain and half of the Pulv. Digital. to be given night and morning.

This in a few days encreased the secretion of urine, removed her difficulty of breathing, and reduced the swelling of her legs, without any disturbance to her system.

Three months afterwards, a severe attack of gout in her legs and arms, removing to her head, she died.

Dr. Stokes had an opportunity of examining the dead body, and I had the satisfaction to learn from him, that there did not appear to have been any return of the dropsy.]

On the examination of the body I noticed, among others, the following appearances.

About oz. of b.l.o.o.d.y water flowed out, on elevating the upper half of the scull, and a small quant.i.ty also was found at the base.

BRAIN. Blood-vessels turgid with blood, and many of those of considerable size distended with air.

A very slight watery effusion between the _Pia Mater_ and _Tunica arachnoidea_. About oz. of watery fluid in the _lateral ventricles_.

THORAX. In the left cavity about 4 oz. of b.l.o.o.d.y serum; in the right but little. Lungs, the hinder parts loaded with blood. Adhesions of each lobe to the pleura. _Pericardium_ containing but a very small quant.i.ty of fluid. _Heart_ containing no coagula of blood. _Valves of the Aorta_ of a cartilaginous texture, as if beginning to ossify.

_Abdominal Viscera_ natural, and a profusion of _Fat_ under the integuments of the abdomen and thorax, in the former to the thickness of an inch and upwards, and in very considerable quant.i.ty on the mesentery, omentum, kidneys, &c.

OBS. The intermitting pulse should seem to have been owing to effusions of water in some of the cavities of the breast, as it disappeared on the removal of the waters.

CASE II.

Mrs. C---- of K----, aet. 80. Orthopna, with sense of oppression about the prcordia. Unable to lie down in bed for some nights past. Anasarca of the lower extremities. Urine very scanty. Complaints of six weeks standing. Had taken _sal. diuret. c. ol. junip.--Calom.

c. jalap, et gambog.--Et ol. junip. c. ol. Terebinth._ without effect.

_Feb._ 7. _Infus. Digital. e. ?iii. ad aq. &c. ?viii. cochl. ii. 4tis horis._ Ordered to drink largely of _infus. baccar. junip._ The third dose produced great nausea which continued ten hours, during which time the urine made was about a quart. The next day her apothecary directed her to begin again with it. The second dose produced vomiting. During the next twenty hours she made two quarts of water, about four times as much as she drank.

From this time she took no more of the _infus. Digital._ but continued the _inf. bacc. junip._ until about _March_ 2d, when all the swellings were gone down, her respiration perfectly free, and she herself quite restored to her former state of health. On the 29th she had an attack of jaundice which was some time after removed; since which she has enjoyed a good state of health, excepting that for some little time past her ancles have been slightly dematous, which will I trust soon yield to strengthening medicines.

CASE III.

Mrs. M---- G----, aet. 64. Has had sore legs for these thirty-four years past. Orthopna. Sense of oppression at the prcordia.

Pulse intermitting. Legs anasarcous. Urine scanty, high-coloured.

_Infus. Digital. c. ?iss ad aq. bull. ?viii. cochl. ii. 4tis horis._

Took six doses, when nausea was excited. Urine a quart during the course of the night. The flow of urine continued, and complaints relieved. Sal. Mart. c. extr. gent. and afterwards with the addition of extr. cort. for which last ingredient she had a predilection, confirmed the cure.

On the same day the next year I was called in to her for a similar train of symptoms, excepting that the pulse was but just perceptibly irregular.

_Infus. Digital. u. a. praescript._

The directions on the phial not being attended to, _two doses of it were given after a nausea had been excited_, which, with occasional vomitings, became exceedingly oppressive. A saline draught, given in Dr. Hulme's method, a draught _sal. c. c. gr. xii. c. conf. card. gr.

x._ produced no immediate effect, but the nausea gradually abating, inf. bacc. junip. was ordered; but this appeared to augment it, and a great propensity to sleep coming on, I directed _sal. c. c. conf.

card, aa gr. viii. 4tis horis_, which removed the unpleasant symptoms and _myrrh. c. sal. mart._ completed the cure. During the use of the above medicines, the urine was augmented, and the pulmonary complaints removed, even before the nausea left her; and the sores of her legs which were much inflamed before she began with the infus. Digital. in a day's time a.s.sumed a much healthier appearance, and on her other complaints going off, they shewed a greater tendency to heal than she had ever observed in them for twenty years before. This instance is a very pleasing confirmation of the experience of Hulse and Dr. Baylies, and of the advantage to be derived from a medicine, which, while it helps to heal the ulcers, removes that from the const.i.tution which often renders the healing of them improper.

In one case in which I ordered it, the infusion, instead of digesting three hours as I had directed, was suffered to stand upon the leaves all night. The consequence was that the first dose produced considerable nausea.

The two following cases, with which I have been favoured by a physician very justly eminent, convince me of the necessity there is that every one who discovers a new medicine, or new virtues in an old one, should, in announcing such discoveries, publish to the world the exact manner in which he exhibits such medicines, with all the precautions necessary to obtain the promised success.

In these (says my correspondent) "the infusion was given in small doses, repeated every hour or two, till a nausea was raised, when it was omitted for a day or perhaps two, and then repeated in the same manner.

"An ASCITES emptied by it, but filled again very speedily, though _its use was never discontinued_, and who afterwards found no salutary effects from it. Ended fatally.

"In an ANASARCA it sometimes increased the quant.i.ty of urine, and abated the swelling, but which as often returned in as great a degree as before, though _the medicine was still given_, and always increased in quant.i.ty so as to excite nausea. Ended fatally.

"I have tried it in many other cases, but found very little difference in the success attending it."

May we not be allowed to conjecture that the inefficacy of _its continued use_ is owing to its narcotic property gradually diminishing the irritability of the muscular fibres of the absorbents, or possibly of the whole vascular system, and thus adding to that weakened action which seems to be the cause of the generality of dropsies, which leads us to caution the medical experimenter against trying it, at least _against its continued use, even in small doses_, in other diseases of diminished energy, as continued fever, palsy, &c.

I remain with the greatest truth,

Your obliged and affectionate friend,

JONATHAN STOKES.

Stourbridge, May 17, 1785.

The three following Hospital Cases, which Dr. STOKES had an opportunity of observing, are related as instances of bad practice, and tend to demonstrate how necessary it is when one physician adopts the medicine of another, that he should also at first rigidly adopt his method.

CASE I.

Esther K----, aet. 33. General anasarca, ascites, and dyspna, of seven months duration.

_Decoct. c Digit. ?iv. c. aq. ?i. coquend. ad ?ss. cap. ?i. 2dis.

horis._ 1st DAY. 4th dose made her sick. 2d DAY. The first dose she took to-day produced vomiting.

3d DAY. _Minuatur dosis ad ?ss._ This stayed upon her stomach, but produced an almost constant sickness. Stools more frequent, water scarce sensibly increased; and her swellings not at all reduced.