Part 37

§ 20. This combination is very frequent, and, I believe, may always be cured by the Digitalis.

§ 21. Dropsies in the chest either with or without anasarcous limbs, are much more curable than those of the belly. Probably because the abdominal viscera are more frequently diseased in the latter than in the former cases.

INSANITY.

§ 22. I apprehend this disease to be more frequently connected with serous effusion than has been commonly imagined.

§ 23. Where appearances of anasarca point out the true cause of the complaint, as in cases XXIV. and XXXIV. the happiest effects may be expected from the Digitalis; and men of more experience than myself in cases of insanity, will probably employ it successfully in other less obvious circumstances.

NEPHRITIS CALCULOSA.

§ 24. We have had sufficient evidence of the efficacy of the Foxglove in removing the Dysuria and other symptoms of this disease; but probably it is not in these cases preferable to the tobacco.

OVARIUM DROPSY.

§ 25. This species of encysted dropsy is not without difficulty distinguishable from an ascites; and yet it is necessary to distinguish them, because the two diseases require different treatment and because the probality of a cure is much greater in one than in the other.

§ 26. The ovarium dropsy is generally slow in its progress; for a considerable time the patient though somewhat emaciated, does not lose the appearance of health, and the urine flows in the usual quantity. It is seldom that the practitioner is called in early enough to distinguish by the feel on which side the cyst originated, and the patients do not attend to that circumstance themselves. They generally menstruate regularly in the incipient state of the disease, and it is not until the pressure from the sac becomes very great, that the urinary secretion diminishes. In this species of dropsy, the patients, upon being questioned, acknowledge even from a pretty early date, pains in the upper and inner parts of the thighs, similar to those which women experience in a state of pregnancy. These pains are for a length of time greater in one thigh than in the other, and I believe it will be found that the disease originated on that side.

§ 27. The ovarium dropsy defies the power of medicine. It admits of relief, and sometimes of a cure, by tapping. I submit to the consideration of practitioners, how far we may hope to cure this disease by a seton or a caustic.--In the LXIst case the patient was too much reduced, and the disease too far advanced to allow of a cure by any method; but it teaches us that a caustic may be used with safety.

§ 28. When tapping becomes necessary, I always advise the adoption of the waistcoat bandage or belt, invented by the late very justly celebrated Dr. Monro, and described in the first volume of the Medical Essays. I also enjoin my patients to wear this bandage afterwards, from a persuasion that it retards the return of the disease. The proper use of bandage, when the disorder first discovers itself, certainly contributes much to prevent its increase.

OVARIUM DROPSY with ANASARCA.

§ 29. The anasarca does not appear until the encysted dropsy is very far advanced. It is then probably caused by weakness and pressure. The Digitalis removes it for a time.

PHTHISIS PULMONALIS.

§ 30. This is a very increasing malady in the present day. It is no longer limited to the middle part of life: children at five years of age die of it, and old people at sixty or seventy. It is not confined to the flat-chested, the fair-skinned, the blue eyed, the light-haired, or the scrophulous: it often attacks people with full chests, brown skins, dark hair and eyes, and those in whose family no scrophulous taint can be traced. It is certainly infectious. The very strict laws still existing in Italy to prevent the infection from consumptive patients, were probably not enacted originally without a sufficient cause. We seem to be approaching to that state which first made such restrictions necessary, and in the further course of time, the disease will probably fall off again, both in virulency and frequency.

§ 31. The younger part of the female sex are liable to a disease very much resembling a true consumption, and from which it is difficult to distinguish it; but this disease is curable by steel and bitters. A criterion of true phthisis has been sought for in the state of the teeth; but the exceptions to that rule are numerous. An unusual dilatation of the pupil of the eye, is the most certain characteristic.

§ 32. Sydenham asserts, that the bark did not more certainly cure an intermittent, than riding did a consumption. We must not deny the truth of an assertion, from such authority, but we must conclude that the disease was more easily curable a century ago than it is at present.

§ 33. If the Digitalis is no longer useful in consumptive cases, it must be that I know not how to manage it, or that the disease is more fatal than formerly; for it would be hard to deny the testimony cited at page 9. I wish others would undertake the enquiry.

§ 34. When phthisis is accompanied with anasarca, or when there is reason to suspect hydrothorax, the Digitalis will often relieve the sufferings, and prolong the life of the patient.

§ 35. Many years ago, during an attendance upon Mr. B----, of a consumptive family, and himself in the last stage of a phthisis; after he was so ill as to be confined to his chamber, his breathing became so extremely difficult and distressing, that he wished rather to die than to live, and urged me warmly to devise some mode to relieve him. Suspecting serous effusion to be the cause of this symptom, and he being a man of sense and resolution, I fully explained my ideas to him, and told him what kind of operation might afford him a chance of relief; for I was then but little acquainted with the Digitalis. He was earnest for the operation to be tried, and with the assistance of Mr. Parrott, a very respectable surgeon of this place, I got an opening made between the ribs upon the lower and hinder part of the thorax. About a pint of fluid was immediately discharged, and his breath became easy. This fluid coagulated by heat.

After some days a copious purulent discharge issued from the opening, his cough became less troublesome, his expectoration less copious, his appetite and strength returned, he got abroad, and the wound, which became very troublesome, was allowed to heal.

He then undertook a journey to London; whilst there he became worse: returned home, and died consumptive some weeks afterwards.

PUERPERAL ANASARCA.

§ 36. This disease admits of an easy and certain cure by the Digitalis.

§ 37. This species of dropsy may originate from other causes than child birth. In the beginning of last March, a gentleman at Wolverhampton desired my advice for very large and painful swelled legs and thighs. He was a temperate man, not of a dropsical habit, had great pain in his groins, and attributed his complaints to a fall from his horse. He had taken diuretics, and the strongest drastic purgatives with very little benefit. Considering the anasarca as caused by the diseased inguinal glands, I ordered common poultice and mercurial ointment to the groins, three grains of pulv. fol. Digitalis night and morning, and a cooling diuretic decoction in the day-time. He soon lost his pain, and the swellings gradually subsided.

THE END.

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