An Account Of The Foxglove And Some Of Its Medical Uses Part 5

_December_ the 8th.

-- -- 27th.

1780. _February_ the 4th.

-- -- 23d.

_March_ the 9th.

During the intervals, no method I could think of was omitted to prevent the return of the disease, but nothing seemed to avail. In the operation of _February_ 23d, his strength was so much reduced, that the water was not entirely removed; and on the 9th of March, before his belly was half emptied, notwithstanding the most judicious application of bandage, his debility was so great, that it was judged prudent to stop. After being placed in bed, the faintness and sickness continued; severe rigors ensued, and violent vomiting; these vomitings continued through the night, and in the intervals he lay in a state nearly approaching to syncope. The next day I found him with nearly the same symptoms, but remarked that the quant.i.ty of fluid he had thrown up was very much more than what he had taken, and that his abdomen was considerably fallen; in the course of two or three days more, he discharged the whole of the effused fluid; his strength and appet.i.te gradually returned, and he was in all respects much better than he had been before the last operation.

Some time afterwards, his belly began to fill again, and he again applied to me; upon an accurate examination, I judged the quant.i.ty of fluid might then be about four or five quarts. Nature had pointed out the true method of cure in this case; I therefore ordered him to bed, and directed ipecacoanha vomits to be given night and morning: in two or three days the whole of the water was removed by vomiting, for he never purged, nor was the quant.i.ty of his urine increased; his appet.i.te and strength gradually returned; he never had any further relapse, and is now an active healthy man. I must leave the reader to make his own reflections on this singular case.

1780.

CASE XXVIII.

_January_ 11th. Captain V----, aet. 42. Had suffered much from residing in hot climates, and drinking very freely, particularly rum in large quant.i.ty. He had tried many physicians before I saw him, but nothing relieved him. I found him greatly emaciated, his countenance of a brownish yellow; no appet.i.te, extremely low, distressing fulness across his stomach; legs and thighs greatly swollen; pulse quick, and very feeble; urine in small quant.i.ty. As he had evidently only a few days to live, I ordered him nothing but a solution of sal diureticus in cinnamon water, slightly acidulated with syrup of lemons. This medicine effecting no change, and his symptoms becoming daily more distressing, I directed an infusion of Digitalis. A few doses occasioned a copious flow of urine, without sickness or any other disturbance. The medicine was discontinued; and the next day the urine continuing to be secreted very plentifully, he lost his most distressing complaints, was in great spirits, and ate a pretty good dinner. In the evening, as he was conversing chearfully with some friends, he stooped forwards, fell from his chair, and died instantly.

Had he been in bed, I think there is reason to believe this fatal syncope, if such it was, would not have happened.

CASE XXIX.

_February_ 6th. Mr. H----, aet. 63. A corpulent man; had suffered much from gout, which for the last year or two had formed very imperfectly.

He had now symptoms of water in his chest, his belly and his legs. An infusion of Digitalis removed these complaints, and after being confined for the greater part of the winter, he was well enough to get abroad again. In the course of a month the dropsical symptoms returned, and were again removed by the same medicine. Bitters and tonics were now occasionally prescribed, but his debility gradually increased, and he died some time afterwards; but the dropsy never returned.

CASE x.x.x.

_February_ 17th. Mr. D----, aet. 50. Ascites and anasarca, with symptoms of phthisis. He had been a very hard drinker. The infusum Digitalis removed his dropsical symptoms, and he was sufficiently recovered to take a journey; but as the spring advanced, the consumptive symptoms increased, and he died soon afterwards, perfectly emaciated.

CASE x.x.xI.

_March_ 5th. I was desired to visit Mrs. H----, a very delicate woman, who after a severe lying-in, had her legs and thighs swollen to a very great degree; pale and semi-transparent. I found her extremely faint, her pulse very small and slow; vomiting violently, and frequently purging. She was attended by a gentleman who had seen me give the Digitalis in a similar case of swelled legs after a lying-in (see Case XXVI.) about six months before. He had not considered that this patient was delicate, the other robust; nor had he attended to stop the exhibition of the medicine when its effects began to take place.

The great distress of her situation was evidently owing to the imprudent and unlimited use of the Digitalis. I was very apprehensive for her safety; ordered her cordials and volatiles; a free supply of wine, chamomile tea with brandy for common drink, and blisters. The next day the situation of things was much the same, but with all this disturbance no increased secretion of urine. The same methods were continued; an opiate ordered at night, and liniment. volatile upon flannel applied to the groins, as she now complained of great pain in those parts. The third day the nausea was less urgent, the vomitings less frequent, the pulse not so slow. Camphorated spirit, with caustic volatile alkaly, was applied to the stomach, emulsion given for common drink, and the same medicines repeated. From this time, the intervals became gradually longer between the fits of vomiting, the flow of urine increased, the swellings subsided, the appet.i.te returned, and she recovered perfectly.

CASE x.x.xII.

_March_ 16th. Mr. D----, aet. 70. A paralytic stroke had for some weeks past impaired the use of his left side, and he complained much of his breath, and of a straitness across his stomach; at length, an anasarca and ascites appearing, I had no doubt as to the cause of the former symptoms; but, upon account of his advanced age, and the paralytic affection, I hesitated to give the Digitalis, and therefore tried the other usual modes of practice, until at length his breath would not permit him to lie down in bed, and his other symptoms increased so rapidly as to threaten a speedy dissolution. In this dilemma I ventured to prescribe an infusion of the Fol. siccat. Digital. which presently excited a copious flow of urine, and made him very sick; a strong infusion of chamomile flowers, with brandy, relieved the sickness, but the diuretic effects of the Digitalis continuing, his dropsy was removed, and his breathing became easy. The palsy remained nearly in the same state. He lived until _August_ 1782, and without any return of the dropsy.

CASE x.x.xIII.

_March_ 18th. Miss S----, aet. 5. Hydrocephalus internus. As the case did not yield to calomel, when matters were nearly advanced to extremities, it occurred to me to try the Infusum Digitalis; a few doses of which were given, but had no sensible effect.

CASE x.x.xIV.

_March_ 19th. A young lady, soon after the birth of an illegitimate child, became insane. After being near a month under my care, swellings of her legs, which at first had been attributed to weakness, extended to her thighs and belly; her urine became foul, and small in quant.i.ty, and the insanity remained nearly the same. As it had been very difficult to procure evacuations by any means, I ordered half an ounce of Fol. Digital. siccat. in a pint infusion, and directed two spoonfuls to be given every two hours: this had the desired effect; the dropsy and the insanity disappeared together, and she had afterwards no other medicine but some aperient pills to take occasionally.

CASE x.x.xV.

_April_ 12th. Mr. R----, aet. 32. For the last three or four years had had more or less of what was considered as asthma;--it appeared to me Hydrothorax. I directed an infusion of Digitalis, which presently removed his complaints. In _June_ following he had a relapse, and took two grains of the Pulv. fol. Digit. three times a day, which cured him after taking forty grains, and he has never had a return.

CASE x.x.xVI.

_May_ 15th. Mrs. H----, aet. 40. A spasmodic asthma, attended with symptoms of effusion. An infusion of Digitalis relieved her very considerably, and she lived four years afterwards without any relapse.

CASE x.x.xVII.

_May_ 26th. R---- B----, aet. 12. Scrophulous, consumptive, and at length anasarcous. Took Infus. Digital. without advantage. Died the _July_ following.

CASE x.x.xVIII.

_June_ 4th. Mrs. S----, of W----, aet 49. Ascites and anasarca. Had taken many medicines; first from her apothecary, afterwards by the direction of a very judicious and very celebrated physician, but nothing r.e.t.a.r.ded the increase of the dropsy. I first saw her along with the physician mentioned above, on the 14th of _May_; we directed an electuary of chrystals of tartar, and Seltzer water for common drink; this plan failing, as others had done before, we ordered the Infus. Digital. which in a few days nearly removed the dropsy. I then left her to the care of her physician; but her const.i.tution was too much impaired to admit of restoration to health, and I understand she died a few weeks afterwards.

CASE x.x.xIX.

_June_ 13th. Mr. P----, aet. 35. A very hard drinker, was attacked with a severe haemoptoe, which was followed by ascites and anasarca. He had every appearance of diseased viscera, and his urine was small in quant.i.ty. The powder and the infusion of Digitalis were given at different times, but without the desired effect. Other medicines were tried, but in vain. Tapping prolonged his existence a few weeks, and he died early in the following autumn.

CASE XL.

_June_ 27th. Mr. W----, aet. 37. An apparently asthmatic affection, gradually increasing for three or four years, which not yielding to the usual remedies, he took the infusion of Digitalis. Two or three doses made him very sick; but he thought his breathing relieved. After one week he took it again, and was so much better as to want no other medicine.

In the course of the following winter he became hectic, and died consumptive about a year afterwards.

CASE XLI.

_July_ 6th. Mr. E----, aet. 57. Hydrothorax and anasarca; his breath so short that he could not lie down. After a trial of squill, fixed alkaly, and dulcified spirit of nitre, I directed Pulv. Digital. gr.

2, thrice a day. In four days he was able to come down stairs; in three days more no appearance of disease remained; and under the use of aromatics and small doses of opium, he soon recovered his strength.

CASE XLII.

_July_ 7th. Miss H---- of T----, aet. 39. In the last stage of a phthisis pulmonalis became dropsical. She took the Digitalis without being relieved.

CASE XLIII.

_July_ 9th. Mrs. F----, aet. 70. A chearful, strong, healthy woman; but for a few years back had experienced a degree of difficult breathing when in exercise. In the course of the last year her legs swelled, and she felt great fulness about her stomach. These symptoms continued increasing very fast, notwithstanding several attempts made by a very judicious apothecary to relieve her. The more regular pract.i.tioner failing, she had recourse to a quack, who I believe plied her very powerfully with Daphne laureola, or some drastic purge of that kind. I found her greatly reduced in strength, her belly and lower extremities swollen to an amazing size, her urine small in quant.i.ty, and her appet.i.te greatly impaired. For the first fortnight of my attendance blisters were applied, solution of fixed alkaly, decoction of seneka with vitriolic aether, chrystals of tartar, squill and cordial medicines were successively exhibited, but with no advantage. I then directed Pulv. Fol. Digital. two grains every four hours. After taking eighteen grains, the urine began to increase. The medicine was then stopped. The discharge of urine continued to increase, and in five or six days the whole of the dropsical water pa.s.sed off, without any disturbance to the stomach or bowels. As the distension of the belly had been very great, a swathe was applied, and drawn gradually tighter as the water was evacuated. As no pains were spared to prevent the return of the dropsy, and as the best means I could devise proved unequal to my wishes, both in this and in some other cases, I shall take the liberty to point out the methods I tried at different times in as concise a manner as possible, for the knowledge of what will not do, may sometimes a.s.sist us to discover what will.

1780.