19.--Makes fifteen pints of water: sweats at night.

21.--Makes seventeen pints of water; has twitchings of his limbs in a morning, and pains of his legs: he now takes a dram of rosin for a dose, and continues the opium.

23.--Water more coloured, and reduced to sixteen pints, and he thinks has a brackish taste.

26.--Water reduced to fourteen pints.

28.--Water thirteen pints: he continues the opium, and takes four scruples of the rosin for a dose.

February 1.--Water twelve pints.

4.--Water eleven pints: twitchings less; takes five scruples for a dose.

8.--Water ten pints: has had many stools.

12.--Appet.i.te less: purges very much.

After this the rosin either purged him, or would not stay on his stomach; and he gradually relapsed nearly to his former condition, and in a few months sunk under the disease.

October 3, Mr. Hughes evaporated two quarts of the water, and obtained from it four ounces and half of a hard and brittle saccharine ma.s.s, like treacle which had been some time boiled. Four ounces of blood, which he took from his arm with design to examine it, had the common appearances, except that the serum resembled cheese-whey; and that on the evidence of four persons, two of whom did not know what it was they tasted, _the serum had a saltish taste_.

From hence it appears, that the saccharine matter, with which the urine of these patients so much abounds, does not enter the blood-vessels like the nitre and asparagus mentioned above; but that the process of digestion resembles the process of the germination of vegetables, or of making barley into malt; as the vast quant.i.ty of sugar found in the urine must be made from the food which he took (which was double that taken by others), and from the fourteen pints of small beer which he drank. And, secondly, as the serum of the blood was not sweet, the chyle appears to have been conveyed to the bladder without entering the circulation of the blood, since so large a quant.i.ty of sugar, as was found in the urine, namely, twenty ounces a day, could not have previously existed in the blood without being perceptible to the taste.

November 1. Mr. Hughes dissolved two drams of nitre in a pint of a decoction of the roots of asparagus, and added to it two ounces of tincture of rhubarb: the patient took a fourth part of this mixture every five minutes, till he had taken the whole.--In about half an hour he made eighteen ounces of water, which was very manifestly tinged with the rhubarb; the smell of asparagus was doubtful.

He then lost four ounces of blood, the serum of which was not so opake as that drawn before, but of a yellowish cast, as the serum of the blood usually appears.

Paper, dipped three or four times in the tinged urine and dried again, did not scintillate when it was set on fire; but when the flame was blown out, the fire ran along the paper for half an inch; which, when the same paper was unimpregnated, it would not do; nor when the same paper was dipped in urine made before he took the nitre, and dried in the same manner.

Paper, dipped in the serum of the blood and dried in the same manner as in the urine, did not scintillate when the flame was blown out, but burnt exactly in the same manner as the same paper dipped in the serum of blood drawn from another person.

This experiment, which is copied from a letter of Mr. Hughes, as well as the former, seems to evince the existence of another pa.s.sage from the intestines to the bladder, in this disease, besides that of the sanguiferous system; and coincides with the curious experiment related in section the third, except that the smell of the asparagus was not here perceived, owing perhaps to the roots having been made use of instead of the heads.

The rising in the throat of this patient, and the twitchings of his limbs, seem to indicate some similarity between the diabetes and the hysteric disease, besides the great flow of pale urine, which is common to them both.

Perhaps if the mesenteric glands were nicely inspected in the dissections of these patients; and if the thoracic duct, and the larger branches of the lacteals, and if the lymphatics, which arise from the bladder, were well examined by injection, or by the knife, the cause of diabetes might be more certainly understood.

The opium alone, and the opium with the rosin, seem much to have served this patient, and might probably have effected a cure, if the disease had been slighter, or the medicine had been exhibited, before it had been confirmed by habit during the seven months it had continued. The increase of the quant.i.ty of water on beginning the large doses of rosin was probably owing to his omitting the morning doses of opium.

V. _The Phaenomena of Dropsies explained._

I. Some inebriates have their paroxysms of inebriety terminated by much pale urine, or profuse sweats, or vomiting, or stools; others have their paroxysms terminated by stupor, or sleep, without the above evacuations.

The former kind of these inebriates have been observed to be more liable to diabetes and dropsy; and the latter to gout, gravel, and leprosy. Evoe!

attend ye baccha.n.a.lians! start at this dark train of evils, and, amid your immodest jests, and idiot laughter, recollect,

Quem Deus vult perdere, prius dementat.

In those who are subject to diabetes and dropsy, the absorbent vessels are naturally more irritable than in the latter; and by being frequently disturbed or inverted by violent stimulus, and by their too great sympathy with each other, they become at length either entirely paralytic, or are only susceptible of motion from the stimulus of very acrid materials; as every part of the body, after having been used to great irritations, becomes less affected by smaller ones. Thus we cannot distinguish objects in the night, for some time after we come out of a strong light, though the iris is presently dilated; and the air of a summer evening appears cold, after we have been exposed to the heat of the day.

There are no cells in the body, where dropsy may not be produced, if the lymphatics cease to absorb that mucilaginous fluid, which is perpetually deposited in them, for the purpose of lubricating their surfaces.

If the lymphatic branch, which opens into the cellular membrane, either does its office imperfectly, or not at all; these cells become replete with a mucilaginous fluid, which, after it has stagnated some time in the cells, will coagulate over the fire; and is erroneously called water. Wherever the seat of this disease is, (unless in the lungs or other pendent viscera) the mucilaginous liquid above mentioned will subside to the most depending parts of the body, as the feet and legs, when those are lower than the head and trunk; for all these cells have communications with each other.

When the cellular absorbents are become insensible to their usual irritations, it most frequently happens, but not always, that the cutaneous branch of absorbents, which is strictly a.s.sociated with them, suffers the like inability. And then, as no water is absorbed from the atmosphere, the urine is not only less diluted at the time of its secretion, and consequently in less quant.i.ty and higher coloured: but great thirst is at the same time induced, for as no water is absorbed from the atmosphere to dilute the chyle and blood, the lacteals and other absorbent vessels, which have not lost their powers, are excited into more constant or more violent action, to supply this deficiency; whence the urine becomes still less in quant.i.ty, and of a deeper colour, and turbid like the yolk of an egg, owing to a greater absorption of its thinner parts. From this stronger action of those absorbents, which still retain their irritability, the fat is also absorbed, and the whole body becomes emaciated. This increased exertion of some branches of the lymphatics, while others are totally or partially paralytic, is resembled by what constantly occurs in the hemiplagia; when the patient has lost the use of the limbs on one side, he is incessantly moving those of the other; for the moving power, not having access to the paralytic limbs, becomes redundant in those which are not diseased.

The paucity of urine and thirst cannot be explained from a greater quant.i.ty of mucilaginous fluid being deposited in the cellular membrane: for though these symptoms have continued many weeks, or even months, this collection frequently does not amount to more than very few pints. Hence also the difficulty of promoting copious sweats in anasarca is accounted for, as well as the great thirst, paucity of urine, and loss of fat; since, when the cutaneous branch of absorbents is paralytic, or nearly so, there is already too small a quant.i.ty of aqueous fluid in the blood: nor can these torpid cutaneous lymphatics be readily excited into retrograde motions.

Hence likewise we understand, why in the ascites, and some other dropsies, there is often no thirst, and no paucity of urine; in these cases the cutaneous absorbents continue to do their office.

Some have believed, that dropsies were occasioned by the inability of the kidneys, from having only observed the paucity of urine; and have thence laboured much to obtain diuretic medicines; but it is daily observable, that those who die of a total inability to make water, do not become dropsical in consequence of it: Fernelius mentions one, who laboured under a perfect suppression of urine during twenty days before his death, and yet had no symptoms of dropsy. Pathol. 1. vi. c. 8. From the same idea many physicians have restrained their patients from drinking, though their thirst has been very urgent; and some cases have been published, where this cruel regimen has been thought advantageous: but others of nicer observation are of opinion, that it has always aggravated the distresses of the patient; and though it has abated his swellings, yet by inducing a fever it has hastened his dissolution. See Transactions of the College, London, vol. ii. p. 235. Cases of Dropsy by Dr. G. Baker.

The cure of anasarca, so far as respects the evacuation of the acc.u.mulated fluid, coincides with the idea of the retrograde action of the lymphatic system. It is well known that vomits, and other drugs, which induce sickness or nausea; at the same time that they evacuate the stomach, produce a great absorption of the lymph acc.u.mulated in the cellular membrane. In the operation of a vomit, not only the motions of the stomach and duodenum become inverted, but also those of the lymphatics and lacteals, which belong to them; whence a great quant.i.ty of chyle and lymph is perpetually poured into the stomach and intestines, during the operation, and evacuated by the mouth. Now at the same time, other branches of the lymphatic system, viz. those which open on the cellular membrane, are brought into more energetic action, by the sympathy above mentioned, and an increase of their absorption is produced.

Hence repeated vomits, and cupreous salts, and small doses of squill or foxglove, are so efficacious in this disease. And as drastic purges act also by inverting the motions of the lacteals; and thence the other branches of lymphatics are induced into more powerful natural action, by sympathy, and drink up the fluids from all the cells of the body; and by their anastomoses, pour them into the lacteal branches; which, by their inverted actions, return them into the intestines; and they are thus evacuated from the body:--these purges also are used with success in discharging the acc.u.mulated fluid in anasarca.

II. The following cases are related with design to ascertain the particular kinds of dropsy in which the digitalis purpurea, or common foxglove, is preferable to squill, or other evacuants, and were first published in 1780, in a pamphlet ent.i.tled Experiments on mucilaginous and purulent Matter, &c.

Cadell. London. Other cases of dropsy, treated with digitalis, were afterwards published by Dr. Darwin in the Medical Transactions, vol. iii.

in which there is a mistake in respect to the dose of the powder of foxglove, which should have been from five grains to one, instead of from five grains to ten.

_Anasarca of the Lungs._

1. A lady, between forty and fifty years of age, had been indisposed some time, was then seized with cough and fever, and afterwards expectorated much digested mucus. This expectoration suddenly ceased, and a considerable difficulty of breathing supervened, with a pulse very irregular both in velocity and strength; she was much distressed at first lying down, and at first rising; but after a minute or two bore either of those att.i.tudes with ease. She had no pain or numbness in her arms; she had no hectic fever, nor any cold shiverings, and the urine was in due quant.i.ty, and of the natural colour.

The difficulty of breathing was twice considerably relieved by small doses of ipecacuanha, which operated upwards and downwards, but recurred in a few days: she was then directed a decoction of foxglove, (digitalis purpurea) prepared by boiling four ounces of the fresh leaves from two pints of water to one pint; to which was added two ounces of vinous spirit: she took three large spoonfuls of this mixture every two hours, till she had taken it four times; a continued sickness supervened, with frequent vomiting, and a copious flow of urine: these evacuations continued at intervals for two or three days, and relieved the difficulty of breathing--She had some relapses afterwards, which were again relieved by the repet.i.tion of the decoction of foxglove.

2. A gentleman, about sixty years of age, who had been addicted to an immoderate use of fermented liquors, and had been very corpulent, gradually lost his strength and flesh, had great difficulty of breathing, with legs somewhat swelled, and a very irregular pulse. He was very much distressed at first lying down, and at first rising from his bed, yet in a minute or two was easy in both those att.i.tudes. He made straw-coloured urine in due quant.i.ty, and had no pain or numbness of his arms.

He took a large spoonful of the decoction of foxglove, as above, every hour, for ten or twelve successive hours, had incessant sickness for about two days, and pa.s.sed a large quant.i.ty of urine; upon which his breath became quite easy, and the swelling of his legs subsided; but as his whole const.i.tution was already sinking from the previous intemperance of his life, he did not survive more than three or four months.

_Hydrops Pericardii._

3. A gentleman of temperate life and sedulous application to business, between thirty and forty years of age, had long been subject, at intervals, to an irregular pulse: a few months ago he became weak, with difficulty of breathing, and dry cough. In this situation a physician of eminence directed him to abstain from all animal food and fermented liquor, during which regimen all his complaints increased; he now became emaciated, and totally lost his appet.i.te; his pulse very irregular both in velocity and strength; with great difficulty of breathing, and some swelling of his legs; yet he could lie down horizontally in his bed, though he got little sleep, and pa.s.sed a due quant.i.ty of urine, and of the natural colour: no fullness or hardness could be perceived about the region of the liver; and he had no pain or numbness in his arms.

One night he had a most profuse sweat all over his body and limbs, which quite deluged his bed, and for a day or two somewhat relieved his difficulty of breathing, and his pulse became less irregular: this copious sweat recurred three or four times at the intervals of five or six days, and repeatedly alleviated his symptoms.

He was directed one large spoonful of the above decoction of foxglove every hour, till it procured some considerable evacuation: after he had taken it eleven successive hours he had a few liquid stools, attended with a great flow of urine, which last had a dark tinge, as if mixed with a few drops of blood: he continued sick at intervals for two days, but his breath became quite easy, and his pulse quite regular, the swelling of his legs disappeared, and his appet.i.te and sleep returned.

He then took three grains of white vitriol twice a day, with some bitter medicines, and a grain of opium with five grains of rhubarb every night; was advised to eat flesh meat, and spice, as his stomach would bear it, with small beer, and a few gla.s.ses of wine; and had issues made in his thighs; and has suffered no relapse.

4. A lady, about fifty years of age, had for some weeks great difficulty of breathing, with very irregular pulse, and considerable general debility: she could lie down in bed, and the urine was in due quant.i.ty and of the natural colour, and she had no pain or numbness of her arms.

She took one large spoonful of the above decoction of foxglove every hour, for ten or twelve successive hours; was sick, and made a quant.i.ty of pale urine for about two days, and was quite relieved both of the difficulty of breathing, and the irregularity of her pulse. She then took a grain of opium, and five grains of rhubarb, every night, night, for many weeks; with some slight chalybeate and bitter medicines, and has suffered no relapse.

_Hydrops Thoracis._

5. A tradesman, about fifty years of age, became weak and short of breath, especially on increase of motion, with pain in one arm, about the insertion of the biceps muscle. He observed he sometimes in the night made an unusual quant.i.ty of pale water. He took calomel, alum, and peruvian bark, and all his symptoms increased: his legs began to swell considerably; his breath became more difficult, and he could not lie down in bed; but all this time he made a due quant.i.ty of straw-coloured water.