_August_ 17th. T---- B----, Esq. of K----, aet. 46. Jaundice, dropsy, and great hardness in the region of the liver. Infusion of Digitalis carried off all the effusion, and afterwards a course of deobstruent and tonic medicines removed his other complaints.

CASE XLIX.

_August_ 23d. Mr. C----, aet. 58. (The person mentioned at Case XXIII.) He had continued free from dropsy until within the last six weeks; his appet.i.te was now totally gone, his strength extremely reduced, and the yellow of his jaundice changed to a blackish hue. The Digitalis was now tried in vain, and he died shortly afterwards.

CASE L.

_August_ 24th. Mrs. W----, aet. 39. Anasarcous legs and symptoms of hydrothorax, consequent to a tertian ague. Three grains of Pulv.

Digitalis, given every fourth hour, occasioned a very copious flow of urine, and she got well without any other medicine.

CASE LI.

_August_ 28th. Mr. J---- H----, aet. 27. In consequence of very free living, had an ascites and swelled legs. I ordered him to take two grains of Fol. Digital. pulv. every two hours, until it produced some effect; a few doses caused a plentiful secretion of urine, but no sickness, or purging: in six days the swellings disappeared, and he has since remained in good health.

CASE LII.

_September_ 27th. Mr. S----, aet. 45. Had been long in an ill state of health, from what had been supposed an irregular gout, was greatly emaciated, had a sallow complexion, no appet.i.te, costive bowels, quick and feeble pulse. The cause of his complaints was involved in obscurity; but I suspected the poison of lead, and was strengthened in this suspicion, upon finding his wife had likewise ill health, and, at times, severe attacks of colic; but the answers to my enquiries seemed to prove my suspicions fruitless, and, amongst other things, I was told the pump was of wood. He had lately suffered extremely from difficult breathing, which I thought owing to anasarcous lungs; there was also a slight degree of pale swelling in his legs. Pulv. fol.

Digital. made into pills, with gum ammoniac and aromatic species, soon relieved his breathing. Attempts were then made to a.s.sist him in other respects, but with little good effect, and some months afterwards he died, with every appearance of a worn out const.i.tution.

About two years after this gentleman's death, I was talking to a pump-maker, who, in the course of conversation, mentioned the corrosion of leaden pumps, by some of the water in this town, and instanced that at the house of Mr. S----, which he had replaced with a wooden one about three years before. The lead, he said, was eaten away, so as to be very thin in some places, and full of holes in others;--this accidental information explained the mystery.

The deleterious effects of lead seem to be considerably modified by the const.i.tution of the patient; for in some families only one or two individuals shall suffer from it, whilst the rest receive it with impunity. In the spring of the year 1776, I was desired to visit Mrs.

H----, of S---- Park, who had repeatedly been attacked with painful colics, and had suffered much from insuperable costiveness; I suspected lead to be the cause of her complaints, but was unable to trace by what means it was taken. She was relieved by the usual methods; but, a few months afterwards, I was desired to see her again: her sufferings were the same as before, and notwithstanding every precaution to guard against costiveness, she was never in perfect health, and seldom escaped severe attacks twice or thrice in a year; she had also frequent pains in her joints. I could not find any traces of similar complaints either in Mr. H----, the children, or the servants. Mrs. H----was a water drinker, and seldom tasted any fermented liquor. The pump was of wood, as I had been informed upon my first visit. Her health continued nearly in the same state for two or three years more, but she always found herself better if she left her own house for any length of time. At length it occurred to me, that though the pump was a wooden one, the piston might work in lead. I therefore ordered the pump rods to be drawn up, and upon examination with a magnifying gla.s.s, found the leather of the piston covered with an infinite number of very minute shining particles of lead. Perhaps in this instance the metal was so minutely divided by abrasion, as to be mechanically suspended in the water. The lady was directed to drink the water of a spring, and never to swallow that from the pump. The event confirmed my suspicions, for she gradually recovered a good state of health, lost the obstinate costiveness, and has never to this day had any attack of the colic.

CASE LIII.

_September_ 28th. Mrs. J----, aet. 70. Ascites and very thick anasarcous legs and thighs, total loss of strength and appet.i.te.

Infusion of Digitalis was given, but, as had been prognosticated, with no good effect.

CASE LIV.

_September_ 30th. Mr. A----, aet. 57. A strong man; hydrothorax and swelled legs; in other respects not unhealthful. He was directed to take two grains of the Pulv. fol. Digit. made into a pill with gum ammoniac. Forty grains thus taken at intervals, effected a cure by increasing the quant.i.ty of urine, and he has had no relapse.

CASE LV.

_November_ 2d. Mr. P---- of T----, aet. 42. A very strong man, drank a great quant.i.ty of strong ale, and was much exposed to alterations of heat and cold. About the end of summer found himself short winded, and lost his appet.i.te. The dyspna gradually increased, he got a most distressing sense of tightness across his stomach, his urine was little, and high coloured, and his legs began to swell; his pulse slender and feeble. From the 20th of _September_ I frequently saw him, and observed a gradual and regular increase of all his complaints, notwithstanding the use of the most powerful medicines I could prescribe. He took chrystals of tartar, seneka, gum ammoniac, saline draughts, emetics, tinct. of cantharides, spirits of nitre dulcified, squills in all forms, volatile alkaly, calomel, Dover's powder, &c.

Blisters and drastic purgatives were tried, interposing salt of steel and gentian. I had all along felt a reluctance to prescribe the Digitalis in this case, from a persuasion that it would not succeed.

At length I was compelled to it, and directed one grain to be given every two hours until it should excite nausea. This it did; but, as I expected, it did no more. The reason of this belief will be mentioned hereafter. Five days after this last trial I gave him a.s.safetida in large quant.i.ty, flattered by a hope that his extreme sufferings from the state of his respiration, might perhaps arise in part from spasm, but my hopes were in vain. I now thought of using an infusion of tobacco, and prescribed the following:

R. Fol. Nicotian. incis. ?ii.

Aq. bull. ?ss.

Sp. Vini rectif. ?i digere per horam.

I directed a spoonful of this to be given every two hours until it should vomit. This medicine had no better effect than the former ones, and he died some days afterwards.

CASE LVI.

_November_ 6th. Mr. H----, aet. 47. In the last stage of a phthisis pulmonalis, suffered much from dyspna, and anasarca. Squill medicines gave no relief. Digitalis in pills, with gum ammon. purged him, but opium being added, that effect ceased, and he continued to be relieved by them as long as he lived.

CASE LVII.

_November_ 16th. Mrs. F----, aet. 53. In _August_ last was suddenly seized with epileptic fits, which continued to recur at uncertain intervals. Her belly had long been larger than natural, but without any perceptible fluctuation. Her legs and thighs swelled very considerably the beginning of this month, and now there was evidently water in the abdomen. The medicines. .h.i.therto in vain directed against the epileptic attacks, were now suspended, and two grains of the Pulv.

fol. Digital. directed to be taken every six hours. The effects were most favourable, and the dropsical symptoms were soon removed by copious urinary discharges.

The attacks of epilepsy ceased soon afterwards. In _February_, 1781, there was some return of the swellings, which were soon removed, and she now enjoys very good health. Does not the narrative of this case throw light upon the nature of the epilepsy which sometimes attacks women, soon after the cessation of the menstrual flux?

1781.

CASE LVIII.

_January_ 1st. Mrs. G----, of H----, aet. 62. Ascites and very large hard legs. After trying various medicines, under the direction of a very able physician, I ordered her to take one grain of Pulv.

Digital. every six hours, but it produced no effect. Other Medicines were then tried to as little purpose. About the end of _February_, I directed an infusion of the Fol. Digital. but with no better success.

Other methods were thought of, but none proved efficacious, and she died a few weeks afterwards.

CASE LIX.

_January_ 3d. Mrs. B----, aet. 53. Ascites, anasarca, and jaundice.

After a purge of calomel and jallap, was ordered the Infusion of Digitalis: it acted kindly as a diuretic, and greatly reduced her swellings. Other medicines were then administered, with a view to her other complaints, but to no purpose, and she died about a month afterwards.

CASE LX.

_January_ 14th. Mr. B----, of D----. Jaundice and ascites, the consequences of great intemperance. Extremely emaciated; his tongue and fauces covered with apthous crusts, and his appet.i.te gone. He first took tincture of cantharides with infusum amarum, then vitriolic salts, and various other medicines without relief; Infusum Digitalis was given afterwards, but was equally unsuccessful.

CASE LXI.

_February_ 2d. I was desired by the late learned and ingenious Dr.

Groome, to visit Miss S----, a young lady in the last state of emaciation from a dropsy. Every probable means to relieve her had been attempted by Dr. Groome, but to no purpose; and she had undergone the operation of the paracentesis repeatedly. The Doctor knew, he said, that I had cured many cases of dropsy, by the Digitalis, after other more usual methods had been attempted without success, and he wished this lady to try that medicine under my direction; after examining the patient, and enquiring into the history of the disease, I was satisfied that the dropsy was encysted, and that no medicine could avail. The Digitalis, however, was directed, and she took it, but without advantage. She had determined not to be tapped again, and neither persuasion, nor distress from the distension, could prevail upon her: I at length proposed to make an opening into the sac, by means of a caustic, which was done under the judicious management of Mr. Wainwright, surgeon, at Dudley. The water was evacuated without any accident, and the patient afterwards let it out herself from time to time as the pressure of it became troublesome, until she died at length perfectly exhausted.

_Query._ Is there not a probability that this method, a.s.sisted by bandage, might be used so as to effect a cure, in the earlier stages of ovarium dropsy?

CASE LXII.

_February_ 27th. Mrs. O----, of T----, aet. 52, with a const.i.tution worn out by various complicated disorders, at length became dropsical. The Digitalis was given in small doses, in hopes of temporary benefit, and it did not fail to fulfil our expectations.