Part 27

CASE II.

R---- Howgate, a man much addicted to intemperance, particularly in the use of spirituous liquors, Æt. 60, was admitted into the Hospital near Birmingham, May 17, 1783. He complained of difficulty of breathing, attended with cough, particularly troublesome on lying down; drowsiness and frequent dozing, from which he was roused by startings, accompanied with great anxiety and oppression about the breast; oedematous swellings of the legs; constant desire to make water, which he passed with difficulty, and only by drops; pulse weak and irregular; body rather costive; face much emaciated; no appetite for food.--Cap. pil. scil. iii. ter in die.

May 20th. The pills have had no effect.--Cap. mistur. c. Decoct. Digital. &c. cochl. ii. larg. 3tia quaque hora, ad 3tiam vicem.

May 21st. Made near two quarts of water in the night, without being in the least sick. He continued the use of the mixture three times in the day till the 30th, and made about three pints of water daily, by which means the swellings were entirely taken away; and his other complaints so much relieved, that on the 6th of June he was dismissed free from complaint, except a slight cough. But returning to his old course of life, he hath had frequent attacks of his disorder, which have been always removed by using the Digitalis.

Extract of a letter from Mr. LYON, Surgeon, at Tamworth.

--Mr. Moggs was about 54 years of age, his disease a dropsy of the abdomen, attended with anasarcous swellings of the limbs, &c. brought on by excessive drinking. I believe the first symptoms of the disease appeared the beginning of November, 1776; the medicines he took before you saw him, were squills in different forms, sal diureticus and calomel, but without any good effect; he begun the Digitalis on the 10th of July 1777; a few doses of it caused a giddiness in the head, and almost deprived him of sight, with very great nausea, but very little vomiting, after which a considerable flow of urine ensued, and in a very short time, a very little water remained either in the cavity of the abdomen, or the membrana adiposa, but he remained excessive weak, with a fluttering pulse at the rate of 150 or frequently 160 in a minute; he kept pretty free from water for upwards of twelve months; it then collected, and neither the Digitalis nor any other medicine would carry it off. I tapped him the 2d of August 1779 in the usual place, and took some gallons of water from him, but he very soon filled again, and as he had a very large rupture, a considerable quantity of the water lodged in the scrotum, and could not be got away by tapping in the usual place. I therefore (on the 28th of the same month) made an incision into the lower part of the scrotum, and drained off all the water that way, but he was so very much reduced, that he died the 8th or 9th of September following, which was about two years and two months after he first begun the Digitalis.

I have had several dropsical patients relieved, and some perfectly recovered by the Digitalis, since you attended Mr. Moggs, but as I did not take any notes or make any memorandums of them, cannot give you any of them.

Communications from Dr. STOKES, Physician, in Stourbridge.

Dear SIR,

I accept with pleasure your invitation to communicate what I know respecting the properties of Digitalis; and if an account of what others had discovered before you, with a detail of my own experience, shall be allowed the merit of at least a well meant acknowledgment, for the early communication you were so kind to make me, of the valuable properties you had found in it; I shall consider my time as well employed. A knowledge of what has been already done is the best ground work of future experiment; on which account I have been the more full on this subject, in hopes that given with the cautions which you mean to lay down in the cure of dropsies, it may prove alike useful in that of other diseases, one of which stands foremost among the opprobria of medicine.

CASE I.

Mrs. M----. Orthopnea, pain, and excessive oppression at the bottom of the sternum. Pulse irregular, with frequent intermissions. Appetite very much impaired. Legs anasarcous.

Empl. vesicator. pectori dolent. Infus. Digital. e [Symbol: dram]iii. ad. aq. &c. [Symbol: ounce]viii. cochl. j. o. h. donec nausea excitetur vel diuresis satis copiosa proveniat.

I ordered it of the above strength, and to be repeated often, on account of the great emergency of the case, but the nausea excited by the first dose prevented its being given at such short intervals. A 3d dose I found had been given, which was followed by vomitings. All her complaints gradually abated, but in about a fortnight recurred, notwithstanding the use of infus. amar. &c.

Dec. 2. Infus. Digit. e. [Symbol: dram]iss ad aq. &c. [Symbol: ounce]viii. cochl. ii. horis &c. u. a.

Complaints gradually abated, swellings of the legs nearly gone down.

About a month afterwards you was desired to visit this patient.

1785.

CASE.

Jan. 5th. Mrs. M----, Æt. 48. Hydrothorax and anasarcous legs, of eight months duration. She had taken jallap, squill, salt of tartar, and various other medicines. I found her in a very reduced state, and therefore directed only a grain and half of the Pulv. Digital. to be given night and morning. This in a few days encreased the secretion of urine, removed her difficulty of breathing, and reduced the swelling of her legs, without any disturbance to her system.

Three months afterwards, a severe attack of gout in her legs and arms, removing to her head, she died.

Dr. Stokes had an opportunity of examining the dead body, and I had the satisfaction to learn from him, that there did not appear to have been any return of the dropsy.]

On the examination of the body I noticed, among others, the following appearances.

About ¾ oz. of bloody water flowed out, on elevating the upper half of the scull, and a small quantity also was found at the base.

BRAIN. Blood-vessels turgid with blood, and many of those of considerable size distended with air.

A very slight watery effusion between the Pia Mater and Tunica arachnoidea. About ¾ oz. of watery fluid in the lateral ventricles.

THORAX. In the left cavity about 4 oz. of bloody serum; in the right but little. Lungs, the hinder parts loaded with blood. Adhesions of each lobe to the pleura. Pericardium containing but a very small quantity of fluid. Heart containing no coagula of blood. Valves of the Aorta of a cartilaginous texture, as if beginning to ossify.

Abdominal Viscera natural, and a profusion of Fat under the integuments of the abdomen and thorax, in the former to the thickness of an inch and upwards, and in very considerable quantity on the mesentery, omentum, kidneys, &c.