Part 20

March 15th, 1780. John Butler, Æt. 30. Asthma and swelled legs. He was directed to take myrrh and steel every day, and three spoonfuls of infusum Digitalis every night. On the 8th of April he was discharged, cured of the swellings and something relieved of his asthmatic affections.

CASE CLVIII.

November 18th, 1780. Henry Warren, Æt. 60. This man had a general anasarca and ascites, and was moreover so asthmatic, that, neither being able to sit in a chair nor lie in bed, he was obliged constantly to walk about, or to lean forward against a window or table. You prescribed for him thus.

R. Aq. cinn. spt. [Symbol: ounce]iv. Oxymel. scillit. Syr. scillit. aa. [Symbol: ounce]i. m. cap. cochlear. larg. sexta quaque horâ.

This medicine producing no increased discharge of urine, on the 25th you ordered the infusion of Digitalis, two spoonfuls every four hours. After taking this for thirty six hours, his urine was discharged in very great quantity; his breath became easy, and the swellings disappeared in a few days, though he took no more of the medicine. On the 2d of December he was ordered myrrh and lac ammoniacum, which he continued until the 23d, when he was discharged cured, and is now in good health.

CASE CLIX.

November 3d, 1781. Mary Crockett, Æt. 40. Ascites and universal anasarca. For one week she took sal. diureticus and tincture of cantharides, but without advantage. On the 10th you directed the infusion of Digitalis, a dram and half to half a pint, an ounce to be taken every fourth hour. Before this quantity was quite finished, the urine began to be discharged very copiously. The medicine was then stopped as you had directed. On the 15th, being costive, she took a jallap purge, and on the 24th she was discharged cured.

CASE CLX.

March 16th, 1782. Mary Bird, Æt. 61. Great fullness about the stomach; diseased liver, and anasarcous legs and thighs. For the first week squill was tried in more forms than one, but without advantage. On the 22d she began with the Digitalis, which presently removed all the swelling.

She was then put upon the use of aperient medicines and tonics, and on the first of August was discharged perfectly cured.

* * * * *

The three following Cases were drawn up and communicated to me by Mr. Bayley, who succeeded Mr. Hinchley as apothecary to the Hospital at Birmingham:

Shiffnall, April 26th, 1785. DEAR SIR,

During my residence in the Birmingham General Hospital, I had frequent opportunities of seeing the great effects of the Digitalis in dropsy. As the exhibition of it was in the following instances immediately under your own direction, I have drawn them up for your inspection, previous to your publishing upon that excellent diuretic. Of its efficacy in dropsy I have considerable evidence in my possession, but consider myself not at liberty to send you any other cases except those you had yourself the conduct of. The Digitalis is a very valuable acquisition to medicine; and, I trust, it will cease to be dreaded when it is well understood.

I am, Sir, your obedient, And very humble servant, W. BAYLEY.

CASE CLXI.

Mary Hollis, aged 62, was admitted an out patient of the Birmingham General Hospital February 12th, 1784, labouring under all the effects of hydrothorax; her dread of suffocation during sleep was so great, that she always reposed in an elbow chair. She was directed to take two grains of Digitalis in powder every night and morning, and for a few days found great relief; but, on the eighth day, as she had complained of sickness, and had been considerably purged, she was ordered to desist taking any more of her powders. On the 14th day she was ordered an ounce of the following infusion twice in a day: R. Fol. Digital. purp. sicc. [Symbol: dram]iss. aq. bullient. [Symbol: pound]ss. digere per semi-horam, colaturæ adde tinct. aromatic [Symbol: ounce]i. This infusion did not purge, but sometimes excited nausea, though not sufficient to prevent her from continuing its use. She grew gradually better, and on the 6th of May was discharged perfectly cured. The diuretic effects of the Digitalis were in this instance immediate.

CASE CLXII.

Edward James, Æt. 21. Admitted March 20th, 1784. Complained of great difficulty of breathing, pain in his head, and tightness about the stomach, with a trifling swelling of his legs. Ordered pil. scillit. [Symbol: scruple]i. ter de die. On the third day his legs much more swelled, his breathing more difficult, and in every respect worse; his pulse very small and quick, complained when he turned in bed, of something like water rolling from one side of the thorax to the other. A remarkable blueness about the mouth and eyes, and purged considerably from the pil. scill. Ordered to omit the pills and to take [Symbol: ounce]i. of infus. Digitalis every eight hours; the proportion [Symbol: dram]iss. to eight ounces of water and [Symbol: ounce]i. of aq. n. m. sp.--7th Day, The infusion had neither purged, nor vomited him: he only complained once or twice of giddiness. His belly was now very hard, rather black on the right side the navel, and his legs amazingly swelled. Ordered a bolus with rhubarb and calomel, to be taken in the morning, and [Symbol: ounce]ii. julep salin. cum tinct. canthar. gutt. forty ter die.--12th Day, nearly in the same state, except his breathing which was somewhat more difficult, being now obliged to have his head considerably raised. Persistat--From this day to the 32d day he became hourly worse. His belly which at first was only hard, now evidently contained a large quantity of water, his legs were more swelled, and a large sphacelated sore appeared upon each outer ancle. Respiration was so much obstructed, that he was obliged to sit quite upright to prevent suffocation. He made very little water, not more than eight ounces in a day and a night, and was much emaciated. Ordered his purging bolus again, and [Symbol: ounce]ii. of a mixture with sal diuretic, [Symbol: ounce]ss. to [Symbol: ounce]xii. three times in a day, and a poultice with ale grounds to his legs.

54th day. To this period there was not the least probability of his existing; his legs and thighs were one continued blubber, his thorax quite flat, and his belly so large that it measured within one inch as much as a woman's in this Hospital the day she was tapped, and from whom twenty seven pounds of coagulable lymph were taken. He made about three ounces of water in twenty-four hours: his penis and scrotum were astonishingly swelled, and no discharge from the sores upon his legs. Ordered to take a pill with two grains of powdered Foxglove night and morning. For a few days no sensible effect, but about the 60th day he complained of being continually giddy, and had some little pain in his stomach. He now made much more water, and dared to sleep. His appetite which through the whole of his illness had been very bad, was also better. 66th day. Breathing very much relieved, the quantity of water he made was three chamber pots full in a day and a night, each pot containing two quarts and four ounces, moderately full. Ordered to continue his pills, and his legs which were very flabby, to be rolled.

69th day. His belly nearly reduced to its natural size, still made a prodigious quantity of water, his appetite very good, habit of body rather lax, and his complexion ruddy. On the 2d of June, being still rather weak, he was ordered decoct. cort. [Symbol: ounce]ii. ter de die; and on the 12th was discharged from this Hospital perfectly cured.

W. BAYLEY.

Mr. Bayley's respectful compliments to Doctor Withering: he sends the case of Edward James, which he believes is pretty correct. He laments not having it in his power to send the measure of his belly, having unfortunately, mislaid the tape: he heard from James yesterday, and he is perfectly well.

General Hospital, August 5, 1784.

CASE CLXIII.

On the 26th February, 1785, Sarah Ford, aged 42, was admitted an out-patient of the Birmingham General Hospital: she complained of considerable pain in her chest, and great difficulty of breathing, her face was much swelled and her thighs and legs were anasarcous. She had extreme difficulty in making water, and with many painful efforts she did not void more than six ounces in twenty-four hours. She had been in this situation about six weeks, during which time she had taken ammoniacum, olibanum, and large quantities of squills, without any other effect than frequent sickness. Upon her commencing an Hospital patient, the following medicine was exhibited. R. gum ammoniac [Symbol: dram]ii. pulv. fol. Digital. purp. [Symbol: scruple]ii. sp. lavand. comp. ut fiat pil. 40. cap. ii. nocte maneque. She continued the use of these pills for a few days, without any sensible effect. On the eighth day her breathing was much relieved, her legs and thighs were not so much swelled, and in a day and a night she made five pints of water. By the 12th day her legs and thighs were nearly reduced to their natural size. She continued to make water in large quantities, and had lost her pain in the thorax. To the 20th of March, she made rapid advances towards health, when not a symptom of disease remaining, she was discharged.

COMMUNICATIONS FROM CORRESPONDENTS.

London, Norfolk-street, May 31st, 1785.