From the time of her arrival till the middle of _August_, mercury had been continued in various forms, and in doses such as the irritable state of her stomach and bowels would admit of. Spirit. nitri dulc.; sal. tartar, squill, and cantharides were alternately employed as diuretics, but without success, to r.e.t.a.r.d the progress of an universal anasarca which was then advanced to such degree and accompanied by so great debility, and other dreadful concomitants, as to threaten a speedy and fatal catastrophe.

On the 16th of _August_ you first saw her, and directed thus.

R. Mercur. cinerei gr. ii.

Fol. Digital, purpur. pulv. ?i. f. ma.s.s. in pill. no. xvi.

dividend.--sumat unam hora meridiana, iterumque hora quinta pomeridiana quotidie.

Capiat lixivii saponac. gutt. L. in haust. juscul. sine sale parati omni nocte.

On the 20th the flow of urine began to increase, and she continued the medicine in the same dose until the 20th of _September_, discharging from six to eight pints of water each day for the first week, and which quant.i.ty gradually diminished as she became empty. During this period she complained not of any sickness, except from the lixivium, which was after the first dose reduced to 20 drops; and her appet.i.te and strength increased daily, though it was evident that no bile had yet flowed into the bowels, nor was the digestion at all improved. The anasarcous appearances being then removed, the Digitalis was omitted, and pills, composed of mercur. cinereus, aloes, and sal tartari directed twice a day, with ?i. of vin. chalybeat. in infus. amar.

simpl.

Her amendment in other respects proceeded slowly, but regularly, from that time until the 9th of October; when the state of plethora again recurring, with its usual attendant symptoms, ?iv. of blood were taken from the arm; and this was upon the same occasion, repeated in the following month, with manifest good consequences; though in both instances the colour of the blood, as flowing from the vein could hardly be called red, and the coagulum was as weak in its cohesion as possible. The state of the stomach and bowels was by this time greatly improved, in common with other parts of the system; but no intromission of bile had yet happened: the hardness about the hypogastric region, though less, continued in a considerable degree, and you ordered pills of mercury rubbed down, and rust of iron, to be taken twice a day, with a decoction of dandelion and sal sodae.

A cataplasm of linseed was applied every night over the stomach and right side; and, with little deviation from this plan, she continued to the end of the year, improving in her general health, but the hepatic affection yet remaining. It was then determined to try the effects of electricity, and gentle shocks were pa.s.sed through the body daily, and as nearly as could be through the liver, in various directions.

On the fifth day there was reason to think that some gall had been secreted and poured out, and this became every day more evident; but it flowed only in small quant.i.ty, and irregularly into the bowels, as appeared from the faeces being partially tinged by it.

In _February_ the lady left this neighbourhood, and though convalescent, yet so nearly well as to promise us the satisfaction of seeing her perfectly restored.

_June_ 29. The bile is now secreted in pretty good quant.i.ty, her appet.i.te is perfectly good, her strength equal to almost any degree of exercise, and her health in general better than it has been for some years.

CASE III.

Mr. W----, aged--. In _June_, 1782, was affected with slight difficulty in respiration, upon taking exercise or lying down in bed.

These symptoms increased gradually until the end of _July_, when he complained of sense of weight and uneasiness about the prcordia; loss of appet.i.te; and costiveness. The urine was small in quant.i.ty, and high coloured; his pulse feeble, and intermitting; he breathed with difficulty when in bed, and slept little. After the exhibition of an emetic, and an opening medicine of rhubarb, sena, and sal tartari, he was directed to take half a dram of squill pill, pharm. Edinburg.

night and morning, with ?ss sal. sodae in ?iss. infus. amar. simpl.

twice a day; and these medicines were continued during ten days, without any sensible effect. A blister was then applied to the sternum, and six grains of calomel given in the evening. The symptoms were now increased very considerably, in every particular; and the following infusion was subst.i.tuted for the former medicines.

R. Fol. Digital. purpur. ?iii.

Cort. limon. ?ii. infund.

Aq. bullient. ?i. per hor. 2 et cola. sumat cochl. i. primo mane et repet. omni hora.

Sometime in the night considerable nausea occurred, and the following day he began to make water in great quant.i.ty, which he continued to do for three or four days. The pulse in a few hours became regular, slower, and stronger, and, in the course of a week, all the symptoms entirely vanished, and an electuary of cort. peruvian, sal martis, and spec. aromatic. confirmed his cure.

In _February_, 1784, this gentleman had a relapse of his disease, from which he again soon recovered by the same means, and is now perfectly well.

CASE IV.

G---- A----, a husbandman, aged 57. Was in the year 1782 affected with a slight, but constant pain in his breast, with difficult respiration.

His countenance was yellow; the abdomen swelled, and hard; his urine high coloured, and in small quant.i.ty; appet.i.te and sleep little.

Complained of frequent nausea, and of sudden profuse sweatings, which seemed for a short time to relieve the dyspna.

After the exhibition of an emetic, six grains of calomel were given, with a purge of jalap in the morning, and repeated in a few days, with some appearance of advantage. He was then directed to take some pills of squill, soap, and rhubarb, with a draught twice a day, consisting of infus. amar. simp. and sal tartari. The skin soon became clearer and the pain in his breast considerably diminished. But every other circ.u.mstance remaining the same, and a fluctuation in the belly being now more evident, the infusion of Digitalis as prescribed in case third, was given in the dose of one ounce twice a day.

On the 5th day the effects were apparent, and he continued his medicine for a fortnight without nausea, making four or five pints of water every night, but little in the day, and gradually losing the symptoms of his disease.

In 1784, this person had a relapse, and was again cured by similar treatment.

CASE V.

R---- H----, Aged 43. Towards the end of the year 1783, became affected with slight cough and expectoration of purulent matter. In December his skin became universally of a pale yellow colour. The abdomen was swelled and hard; his appet.i.te little, and he complained of a violent and constant palpitation of the heart, which prevented him from sleeping. The urine pale, and in small quant.i.ty. The pulse exceedingly strong, and rebounding; beating 114 to 120 strokes every minute. He suffered violent pain of his head, and was very feeble and emaciated. After bleeding, and the use of gentle aperient medicines, he continued to take the infusion of Digitalis for some days, without any sensible effect. Other diuretics were tried to as little purpose.

Repeated bleeding had no effect in diminishing the violent action of the heart. He died in January following, under complicated symptoms of phthisis and ascites.

CASE VI.

A man aged 57, who had lived freely in the summer of 1784, became affected with dematous swelling of his legs, for which he was advised to drink Fox Glove Tea. He took a four ounce bason of the infusion made strong with the green leaves, every morning for four successive days.

On the 5th he was suddenly seized with faintness and cold sweatings. I found him with a pale countenance, complaining of weakness, and of pain, with a sense of great heat in his stomach and bowels. The swelling of the legs was entirely gone, he having evacuated urine in very large quant.i.ties for the two preceding days. He was affected with frequent diarrha. The pulse was very quick and small, and his extremities cold.

A small quant.i.ty of broth was directed to be given him every half hour, and blisters were applied to the ancles, by which his symptoms became gradually alleviated, and he recovered perfectly in the s.p.a.ce of three weeks; except a relapse of the anasarca, for which the Digitalis was afterwards successfully employed, in small doses, without any disagreeable consequence.

CASE VII.

S---- D----, a middle aged single woman, was affected in the year eighty-one, with a painful rigidity and slight inflammation of the integuments on the left side, extending from the ear to the shoulder.

In every other particular she was healthy. The use of warm fomentations, and opium, with two or three doses of mercurial physic, afforded her ease and the inflammation disappeared, but was succeeded by an dematous swelling of the part, which very gradually extended along the arm, and downward to the breast, back, and belly. Friction, electricity and mercurial ointment were amongst the number of applications unsuccessfully employed to relieve her for the s.p.a.ce of three months, during which time she continued in good general health.

In _November_ she became ascitic, pa.s.sing small quant.i.ties of urine, and soon afterwards a sudden dyspna gave occasion to suppose an effusion of water in the thorax. The Digitalis, squills, and cantharides were given in very considerable doses without effect. She died the latter end of December following.

CASE VIII.

W---- C----, a collier aged 58, was attacked in the spring of 1783 with a tertian ague, which he attributed to cold, by sleeping in a coal pit, and from which he recovered in a few days, except a swelling of the lower extremities, which had appeared about that time, and gradually increased for two or three months. The legs and thighs were greatly enlarged and dematous. His belly was swelled, but no fluctuation perceptible. He made small quant.i.ties of high coloured water. The appet.i.te bad, and pulse feeble. He had taken many medicines without relief, and was now so reduced in strength, as to sit up with difficulty. An infusion of the Digitalis was directed for him, in the proportion of one ounce of the fresh leaves to a pint of water, two ounces to be taken three times a day, until the stomach or bowels became affected. Upon the exhibition of the sixth dose, nausea supervened, and continued to oppress him at intervals for two or three days, during which he pa.s.sed large quant.i.ties of pale urine. The swelling, a.s.sisted by moderate bandage rapidly diminished, and without any repet.i.tion of his medicine, at the expiration of sixteen days, he returned to his labour perfectly recovered.

OF THE PREPARATIONS and DOSES, OF THE FOXGLOVE.

Every part of the plant has more or less of the same bitter taste, varying, however, as to strength, and changing with the age of the plant and the season of the year.

ROOT.--This varies greatly with the age of the plant. When the stem has shot up for flowering, which it does the second year of its growth, the root becomes dry, nearly tasteless, and inert.

Some pract.i.tioners, who have used the root, and been so happy as to cure their patients without exciting sickness, have been pleased to communicate the circ.u.mstance to me as an improvement in the use of the plant. I have no doubt of the truth of their remarks, and I thank them. But the case of Dr. Cawley puts this matter beyond dispute. The fact is, they have fortunately happened to use the root in its approach to its inert state, and consequently have not over dosed their patients. I could, if necessary, bring other proof to shew that the root is just as capable as the leaves, of exciting nausea.

STEM.--The stem has more taste than the root has, in the season the stem shoots out, and less taste than the leaves. I do not know that it has been particularly selected for use.

LEAVES.--These vary greatly in their efficacy at different seasons of the year, and, perhaps, at different stages of their growth; but I am not certain that this variation keeps pace with the greater or lesser intensity of their bitter taste.

Some who have been habituated to the use of the recent leaves, tell me, that they answer their purpose at every season of the year; and I believe them, notwithstanding I myself have found very great variations in this respect. The solution of this difficulty is obvious. They have used the leaves in such large proportion, that the doses have been sufficient, or more than sufficient, even in their most inefficacious state. _The Leaf-stalks_ seem, in their sensible properties, to partake of an intermediate state between the leaves and the stem.

FLOWERS.--The petals, the chives, and the pointal have nearly the taste of the leaves, and it has been suggested to me, by a very sensible and judicious friend, that it might be well to fix on the flower for internal use. I see no objection to the proposition; but I have not tried it.