_August_ 18th. Mr. B----, aet. 33. Pulmonary consumption and dropsy.

The Digitalis, and that failing, other diuretics were used, in hopes of gaining some relief from the distress occasioned by the dropsical symptoms; but none of them were effectual. He was then attended by another physician, and died in about two months.

CASE XVII.

_September_ 21st. Mrs. M---- W---- G----, aet. 50. An ovarium dropsy.

She took half a pint of Infus. Digitalis, which made her sick, but did not increase the quant.i.ty of urine. She was afterwards relieved by tapping.

CASE XVIII.

_October_ 28th. R---- W----, aet. 33. Ascites and universal anasarca; countenance quite pale and bloated; appet.i.te none, and the little food he forces down is generally rejected.

R. Fol. Digit. purp. siccat. ?iii.

Aq. bull. ?i. digere per horas duas, et colat. adde aq.

junip. comp. ?iii.

He was directed to take one ounce of this infusion every two hours until it should make him sick. This was on Wednesday. The fifth dose made him vomit. On Thursday afternoon he vomited again very freely, without having taken any more of the medicine. On Friday and Sat.u.r.day he made more water than he had done for a week before, and the swellings of his face and body were considerably abated. He was directed to omit all medicine so long as the urine continued to flow freely, and also to keep an account of the quant.i.ty he made in twenty-four hours.

These were his reports:

_October_ 31st. Sat.u.r.day, 5 half pints.

_November_ 1st. Sunday, 6 2d. Monday, 8 3d. Tuesday, 8 4th. Wednesday, 7 5th. Thursday, 8

On Wednesday he began to purge, and the purging still continues, but his appet.i.te is better than he has known it for a long time. No swelling remains but about his ancles, extending at night half way up his legs.

Omit all medicines at present.

7th. Sat.u.r.day, 7 half pints.

8th. Sunday, 8 9th. Monday, 6 10th. Tuesday, 6 11th. Wednesday, 6 12th. Thursday, 6

On Tuesday the 17th, some swelling still remained about his ancles, but he was in every other respect perfectly well.

He took a few more doses of the infusion, and no other medicine.

CASE XIX.

_December_ 8th. W---- B----, aet. 60. A hard drinker. Diseased viscera; ascites and anasarca. An infusion of Digitalis was directed, but it had no other effect than to make him sick.

1779.

In the beginning of this year we had many dropsies in children, who had suffered from the Scarlatina Anginosa; they all yielded very readily to the Digitalis, but in some the medicine purged, and then it did not prove diuretic, nor did it remove the dropsy until opium was joined with it, so as to prevent it purging.--I did not keep notes of these cases, but I do not recollect a single instance in which the Digitalis failed to effect a cure.

CASE XX.

_January_ 1st. Mr. H----. Hydrops Pectoris; legs and thighs prodigiously anasarcous; a very distressing sense of fulness and tightness across his stomach; urine in small quant.i.ty; pulse intermitting; breath very short.

He had taken various medicines, and been blistered, but without relief. His complaints continuing to increase, I directed an infusion of Digitalis, which made him very sick; acted powerfully as a diuretic, and removed all his symptoms.

About three months afterwards he was out upon a journey, and, after taking cold, was suddenly seized with difficulty of breathing, and violent palpitation of his heart: he sent for me, and I ordered the infusion as before, which very soon removed his complaints. He is now active and well; but, whenever he takes cold, finds some return of difficult breathing, which he soon removes by a dose or two of the infusion.

CASE XXI.

_January_ 5th. Mrs. M----, aet. 69. Hydrothorax, (called asthma) ascites and anasarca. I directed an infusion of Fol. Digital. siccat.

three drams to a pint; a small wine gla.s.s to be taken every third or fourth hour. It made her violently sick, acted powerfully as a diuretic, set her breath perfectly at liberty, and carried off the swelling of her legs; when she was nearly emptied, she became so languid, that I thought it necessary to order cordials, and a large blister to her back. Mr. Ward, who attended as her apothecary, tells me she had some return of her asthma in _June_ and _October_ following, which was each time removed by the same medicine.

CASE XXII.

_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 a.s.sistance 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 a.s.sistance 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 pract.i.tioners, how sudden and unexpected the deaths of dropsical patients sometimes happen, and how cautious we should be in a.s.signing 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 s.p.a.ce 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 quant.i.ty of water, and gradually became more rational. On the fifth day his appet.i.te 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, appet.i.te 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 a.s.sistance 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 quant.i.ty 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: