UNITED STATES OF AMERICA V . . FOUNDED 1836 WASHINGTON, D. C. Bl9574 See Page 43 3999 OBSERVATIONS MEDICAL AND DOMESTIC MANAGEMENT THE CONSUMPTIVE; ON THE POWERS OF DIGITALIS PURPUREA; THE CURE OF SCHROPHULA. BY [/ THOMAS BEDDOES, JIT. D. WQ TROY: rrtlNTED BY 0. PENNIMAN AND CO. SO.'.n BT THEM AT THE TROV BOOKSTORE, AND BV RICHARDS AND BUSS, UTICA. I So3. ADVERTISEMENT. JL HE flighteft acquaintance with our moft mod- ern medical literature is fufficient to fhew that the attention of the practitioners of phyfic has been, of late years, excited in an extraordinary degree towards the cure of confumption. An accurate comparifon of teftimonies will, I believe, convince the impartial examiner that this care has not been beftowed in vain; and he who reforts to experi- encej and has opportunity to obferve all the grada- tions of phthifis from the firft diftincl: appearances of enlarging tubercles to the la ft ftage of pulmo- nary ulceration, will be cenvinced that the prac- tice, which has been recommended by the author of the following Obfervations in common with pther phyficians, is highly efficacious both in pro- 4 during the diminution of fuffering, where it cannot pr,fcrve life, and in preferving life, where every other method would be unavailing. The proofs of this afTertion are daily accumulat- ing ; and the number of the fceptical is, I appre- hend, daily leffening. The voice, however, of ftaunch contradiction is not unfrequently heard. In fpite of the fuUeft and moft accurate reports, confirmed by the judgment of more than one med- ical practitioner, and authenticated by the name of the patient, we find anonymous writers venturing to pronounce that there is as yet no evidence of any cure of confirmed confumption. An anonymous wri- ter is good for nothing as a witnefs. He has no other way of invalidating teftimony, but by mew- ing the inconfiftency between the circumftances of the narrative themfelves, or between thofe circum- ftances and the deduced opinion. But although this has not been even attempted, it is probable that the wide circulation of certain periodical pub- lications, in which thefe hazarded decifions may be read, has rendered them mifchievous. For the treatment of confumption, however, a great deal more remains to.be done than to add to the mafs of unexceptionable evidence, lately pro- duced. No uniform method, and no fingle med- 5 icine is capable of effecting a cure in all the cafes, referred to any one denomination of difeafe. If this were not directly proved by experience, it might be inferred from that endlefs diverfity in the fufceptibility to firft impreffions and in frcoii- dary or aiTociated motions, which may be obferved in different individuals. This will be a ftanding reafon for feeking fubftitutes and auxiliary means in medicine, till the promife of that happy uni- formity, by which fome have ventured to footh the prefent miferies of our afflicted and unequal race, (hall be realized., In phthifical complaints, difference of conflitu- tion has peculiar influence upon the event. Thefe complaints affect all claffes, though not all in equal proportion. And that clafs, among which their vie- tims have hitherto been the moft numerous, will probably* be that in which the treatment, lately fo much canvaffed, will, when unajfified, mojl frequently fail. Upon thofe whofe experience is large enough to put this pro- portion to the teft, partial fuccefs, if they find it true, fhould operate only as an incentive to more itrenuous endeavours. In thefe endeavours we muft follow fome fort of analogy. Hence I confidered it as ufeful to inves- tigate the powers of digitalis, which, with regard A 2 6 to the inhabitants of this ifland is becoming nearly the moft important article of the Materia Medico. The reader will find that I have endeavoured to bring a variety of facts to bear upon the queftion concerning its operation, which hitherto has been much too fuperficially confidered, however confi- dently it may have been pronounced upon. I hope I have in fome meafure fucceedied in fixing its me- dicinal character. Let me, however, be understood as fiying this in relation to the dimnefs of our views in directing remedies and the grofTnefs of our conceptions concerning their virtues. Thofe who with fufficient knowledge of inorganic philo- fophy have fteadily contemplated the animal ma- chinery, muft be fatisfied of our incompetence to any thing better than remote conjectures concern- ing organic action. Of courfe, we can have no clear connected acquaintance with the nature of any difeafe or any medicine. What I have to fay on fcrophula, not appearing in the form of confumption, is limply practical. I write in recommendation of a remedy, neither dis- covered by myfelf nor unknown to medical (partic- ularly foreign) authors, but certainly not fufficient- ly valued in this country. I fhall of courfe be de- firous to learn how it fucceeds with my brethren, but I confefs I fhall not wait for their reports with 7 any great anxiety. The article in queftion requires much lefs patience in its adminiftration than dig- italis : and I have found it in a confiderable num- ber of the moft unpromifing cafes one of the moft certain of remedies. I expect therefore that it will. be allowed to take its ftation in the Materia Med- ico with little oppofition. Where it fails, we may have recourfe to- various fubftitutes} ftrictly analo- gous. I confider it as a great advantage that I have been fo often permitted to name the perfons whofc cafes I defcribe. In the fciences, an examination, proceeding upon fixed principles, and very often internaLevidence alone, is fufficient to determine the value of matter newly offered to the public. But in medicine, in which the facts are incapable of arrangement, and which is confequently no fcience, extraneous marks of authenticity are equally defirable to reader and writer. It is therefore worth while to obferve, that although in all the following inftances the au- thor exercifed his judgment refpedting the nature of the complaint, in none Scarcely did he ftand fin- gle; and, moft commonly, feveral medical men had feen the patient, and were perfectly agreed concerning this particular. 8 I did not find it eafy to Separate what is defign- ed for different readers. The unprofeffional may confider part of the following pages as an appendix to my EfTay on Confumption. I was not indeed extremely folicitous to make fuch a Separation. The better people are informed concerning medical practice, the lefs will they intermeddle :. the lefs frequently alfo will they be the dupes of the crafty and inert part of the faculty, and the more readily will they co-operate with thofe, who Spare neither their faculties nor their credit in behalf of the Sick. CONSIDERATIONS ON A MODIFIED ATMOSPHERE, JN CONSUMPTIVE CASES. JL HE effects of temperature, though important in all difeafes, and, in Some, of primary importance, have hitherto received but flight attention. Of courfe, the means of applying heat and cold; gen- erally or partially, have been very imperfectly pro- vided for medical ufe. This fatal' negligence will continue till public opinion, grown more enlight- ened, fhall oblige medical practitioners, in a much greater degree than is at prefent cufromary, to fore- go eafe or emolument in confideration of the ad- vantage of the fick. The phyfician (whofe profef- fion, as it is Sometimes carried on, is the lazieft of all poflible occupations) receives his fee juft as well without troubling himSelf about any operofe regu- lations. The apothecary has not yet invented the IO art of difpenfng heat and cold.* The friends of invalids are not unfrequently unapprized of the im- portance of thefe meafures; or they are indolent or parfimonious, or difpofed to confider every thing, not comprehended within the ordinary rou- tine of practice, with averfion. When any beyond mere houfehold means, which are Seldom originally provided with much regard to the accommodation of the fick, are to be em- ployed for the regulation of temperature, it is ob- vious that the confent of the friends muft be ob- tained. There is another reafon for wifhing them to have a conviction of the utility of fuch atten- tions. The fuperintendance of the means muft in great meafure be confided to them j and where he does not meet with intelligent co-operation, much more where he is counteracted, the phyfician will * No college of phyficians has yet enjoined an ice-houfe as a neceflary appendage to the apothecary's fhop ; though the public might advantageoufly forego a confiderable proportion of the rare exotic articles in any exifting pharmacopoeia for the fake of fo vulgar a domeftic production as ice. When men are better inllruiStcd in the laws of their own nature, they will be lefs eager about ice as a luxury than as a powerful iaftrument of health. Public ice-houfes will be conftructed in our cities, towns, and villages. Had ice been at hand and properly ufed during the burning fummer of 1800, many of thofe who were cut ofT by liver and bowel difeafes would have efcaped ua- hurt. n Seldom find his beft endeavours in flow* and dan- gerous difeafes fucceed. The hiftory of the fmall pox affords one very ftriking example of the neceffity of attending to the ftate of the atmofphere. Sydenham has a re- markable obfervation, tending to Shew the utility of avoiding the heat of the bedclothes in pleurify: and whoever will fteadily purfue the cold regimen in inflammations of the cheft, and probably in all others, will find his care well rewarded. Two of my medical friends, without communication, have afcertained that a rheumatic fever, fuch as is im- perfectly cured by fudorifics in Several weeks, yields in two or three days to cold. During the prefent war, the ableft phyfician*. in the fervice of the French republic, at leaft among thofe who are pub- * Dr. J. F. L. Lentin, (' Mediziiiifcbe Bemerkungen auf einer Rnfe-, Berlin, 1800) after mentioning the excellent regulations voted for the French hofpitals, and the wretched ftate into which jthey fell under Robefpierre, add^ " Notwithstanding all thefe " wants and hindrances, the Men* hofpital is diilinguifhedby " the order that is preferved in it, and by the excellent treat- " ment of the lick. This is, however, folely to be afcribed to " the worthy phyfician in chief. The genius of Wedekind, " which is fully adequate to fuch an inftitution, fupplies what " is wanting, regulates the whole, animates thofe who are fub- " ordinate to him with his own fpirit, fets afide all obftacles, " and fecures to the fick attendance and fuccour." " He was " treating rheumatifm with cooling means ; and afcertained, " that patients of this defcription found thcmfelves well in 3 12 licly known, has been accuftomed to place his rheu- matic patients with advantage in a ftream of air. Within the laft twenty years, a remedy for fever, which was before an entire defideratum, appears to have been found in the application of cold to the Surface of the body. In time, the proper gradua- tion of this remedy will be difcovered, fo as to adapt it to all the variety of cafes. In confumption, the effect of temperature is not doubtful. Steady warmth creates an exemption in favour of thofe who would become its prey in a variable climate. The diverfity of our own Seafons makes a difference in the frequency of the difeafe.* Cafual obfervation evinces, that in many inftances the cough is much aggravated on refpiring a colder air. A perfuafion has long prevailed, that refidence in hotter countries is beneficial to Britifh invalids ; and the principle feems perfectly juft, though in fixing their deftination it appears to be moft grofs- ly mifapplied. , Thefe confideratiorJs have induced the author to pay all the attention, he was allowed to pay, to temperature ; but he has never dared to truft his phthiiical patients to warmth alone ; hence he has " very cold air, and even in a draught of air. The fuccefs of " his method was ftriking upon the whole. Moft patients were, M in a few days, in a ftate of conv;.lefcence." Ss. 13. ij, * Eflay on confumption. Ed. ad. pp. iz—32. *3 none of thofe pure experiments to relate which ?rc So defirable, but So difficult to obtain, in medicine. In the courfe of his obfervations, however, the ef- fect of temperature was fufficiently diftinct. I fhall firft deScribe the few cafes in which the Sole or principal reliance was placed upon heated and otherwife modified air. In daring to commit narratives of this caft to the prefs, I feel that I am preparing a feaft for thofe who refort to ridicule, if not as the teft of truth, yet as the fupreme de- light of rational and immortal minds. But I hope too to intereft thofe whom no ludicrous accefTories can prevent from viewing with complacency the firft awkward and unfteady advances towards an uSeful object. ^ircumflances previous to Oclober, 1799, which influ- enced the author in his fubfequent proceedings. The more obvious means of enabling invalids to refpire an atmofphere permanently modified, of a regular temperature, and at all likely to improve the condition of pulmonary ulcers, offered no great choice. Refidence in a cow-houfe Seemed by far the Simpleft, fafefc, and leaft difagreeable among the expedients actually adopted. And partly from rumour, and partly from the peculiar point of view in which I took up the treatment of the difeafe, I have long been in the habit of recommending it. B 14 - Nor is it without extreme regret that I now look back upon the number of inftances in which my recommendation failed. Not unfrequentiy did I forfeit the good opinion of my patient. Some- times the expence was felt as an infuperable bar : fometimes the patient's mental torpor* flood in the way •, and at others the exertion neceffary on the part of the friends defeated the fcheme. Arainft this and other experiments, merely as experiments, I have found people prepoffeffed much more rarely than I expected ; and requiring the curb rather than the fpur. A gentleman in the laft ftage of confumption, i. e. with diarrhoea and fwelled legs in addition to the other fymptoms, mortified by the refufal of the J mafter of a lodging houfe to admit cows into it, " quitted Clifton; and after a journey of three weeks, fi executed the plan, greatly to his relief, though not to his recoverv. * This happy paflive ftate has often (particularly in phthi- fical girls) excited my aftoniilimcnt. One would fuppofe, that linding themfelves grow worfe, week after week, and month i after month, they would lliut the door in the teeth of their unferviceable medical attendants. Yet in nineteen cafes out of twenty, they are almoft to the laft g«ifp, ready to fwallow naufeous drugs to the meaiure of the with of the moft drench- ing apothecary, and difpofcd to be lulled by the equivocating confolations of the iliallowv.fi: phyuciun. *5 • About three years ago, an Irifh lady went to a confiderable expence in fitting up a cow apartment. But a mob of females, who could by no means bring themfelves to fancy the Scheme, having un- happily got intelligence of the time when the cows were to be driven through a certain pafTage, afTem- bied at its mouth, and feared the animals fo much, that their paffionate owner, notwithstanding the extravagant price for which he had bargained, refufed the patient their ufe on any terms. She herfelf, in difguft, fet out the following day for Dublin, where in a few weeks fhe died. Of this ludicroufly brutal fcene, my friend, J. Hare, ESq. M. P. was a Spectator.* • * Thefe petty circumftances are related to fortify thofe who would do good in any uiiufual way, againft the difgufts they are deftined to devour. In general they may be allured, that as in the prefent inftance, perfeverance will finally conquer. Laft year, a ftable, known not to be occupied by its ordi- nary tenants, Was anxioufly wiilied for, in order to give a con- £iimptive perfon a chance for his life. On application by the patient's brother, the owner protefted " he would do any thing " to ferve him. But" (I copy the words of a note I received on the occafion) " there is a monkey in the ftable, and a great " many potatoes, which muft not be removed." Left this ftory, which has not been kept fecret, fliould bring reproach upon the gentleman owner of the ftable, as deficient in feeling for his fellow-creatures, it may be right to fubjoin the follow- ing vindication : Tie- Monkey and his Hejt. 'Tis nature's fecond law to ferve a brother : And apes alt right in cheriilung each other. i6 It was, however, in confequence of this abortive attempt, that my idea of trying the cow-houSe be- came ftrengthened into an unalterable refolution. On the morning of the day when the lady and the cows were to be lodged together, I called on Mr. Hare, and told him I was about a project, which he, perhaps, would think as abfurd as many thought my former medical projects. After I had explained myfelf, he related to me an inftance fo ftriking in its circumftances, as to imprefs me with a flronger perfuafion of the efficacy of the cow- houfe plan, efpecially as he is well acquainted with the party. For my farther Satisfaction, he pro- cured for me a narrative from the patient herfelf, which is publifhed in French in the fourth part of my conftderations en airs, (Johnfon) and is now, I think, become important enough to be reproduced \ in an Englifh drefs. For want of a tranflation it has, perhaps, been lefs noticed than a report, So interesting by its candour, its accuracy, and by its refult, deferves to be. NARRATIVE OF MADAME ----- " After a mifcarriage at three months, during which I took little care of myfelf, and after which there remained a dilcharge of blood for Several weeks, I fell into a confumption. It began with a Short dry cough, attended by Sight feverifhneSs. r7 This I neglected, ftili continuing to go out, to keep late hours, and in every thing to live in a manner too agitated for my ftate of health, which daily declined. At length I Spit blood mixed with pu- rulent matter. My legs Swelled. Though not quite irregular, I was much diSordered, the quan- tity being very Small and the quality bad. I had loft my fleep; and being as ill as pofiible, I had feveral confultations of the firft phyficians in Paris* The refult of thefe was, that the complaint was concluded to be too far advanced to leave any hope of a cure. They prefcribed afTes' milk, and exerciSe on horfeback, which laft I was too weak to take. I was nineteen. I beheld my end approach with deep diSmay. One day when I was bewailing mySelf, a very fenfible friend of mine paid me a vifit. In the midft of his condolence he recom- mended me to follow his advice. Since all the. faculty abandon you, faid he, let me bring, you a man who is treated here as a charlatan, becaufe he is not known ; but who, in my opinion, is a man of merit. He brought him. I Spit blood in clots. I was in Such violent pain, and'my fever was So high, that I cried cut, waving my hard, All ! if there is yet time, Save me ! He promised to do all in his power ; but I heard him Say, in a low voic°, that it was very late. This did not reduce my B 2 18 fever. He made me promife to follow his orders exactly, how painful foever they might be. I af- Sured him I would obey him implicitly, and I kept my word. Fie put me, in fpite of my fever, into g a warm bath, quite clofe to my bed. I remained ^ in, three quarters of an hour, which quieted me a j good deal. They put me to bed much more tran- quil, and I had fome hours fleep, which convinced me that I was much better. The next morning he put a blifter, fix inches long, and four broad, upon my cheft, which made me Suffer a great deal, with very little advantage. My extreme thinneSs made it much more pain- ful ; he removed it and placed it between my fhoul- ders, where I had it four months. Net finding that it had the defired effect, he gave orders for a ftable, with three cows, to be prepared for me. This was done in lefs than twenty-Sour hours, in a coach-houSe belonging to my houSe. They broke> open a window, and contrived Stalls for three cows. A wooden railing, high enough to lean up- on, was all that Separated me from the cows. My bed was placed upon planks, about one foot from the ground, the better to let the filth run under. Thefe planks were purpoSely ill joined, that the vapour might penetrate ; and it was So Strong, that every thing white which was brought in, became reddilh in a very Short time. My apartment was r9 divided into two rooms ; that which I lived in was pretty large ; and in it Avas a bed, without cur- tains, furrounded by a gauze blind, fuch as they ufe in Italy for the fame purpofe, which is to keep away the flies, which always abound in ftables, and are particularly infupportable during illneSs; a wood- en table, two Straw chairs, without cufhions, bare walls; Such was my chamber. ' There was a Sort of antichamber for the woman who took care of the cows. My Surgeon and waiting maid lodged, over head. I had two different bells, to calF them at pleaSure.. Here I remained nine months without interminion, with the exception of a few rides in a clofe carriage, the horSes not going be- yond a walk over the pavement, becaufe of the iumbling, which hurt me terribly... I forgot to fay that my. blifters never mattered but in the ftable, but that to keep them running it was necefiary to apply frefh blistering ointment every two or three days. At firft this weakened me much •, but the hope of recovery kept up my fpirits. I already fpit lefs blood; foon the expectora- tion was but tinged ; afterwards the matter be- came daily lefs grcfs; the legs ceafed Swelling af- ter being a week in the Stable. The firft month I was regular, but the quantity Small; the next it was a little more copious, and went on contiuu-*- 29 ally improving. From the moment I entered the ftable I renounced every fpecies of food, except milk. Affes' milk at five o'clock in the morning, which before I was obliged to dilute with fpring water, paffed in the ftable without any- addition. I had to inhale, morning and evening, the milk juft drawn from the cows. Ail day I drank no- thing elfe, but rice milk in the morning, well boiled and fkimmed; nothing elfe. I did not even tafte bread for nine months. Indeed I had the good fortune not to wifh for any thing elfe. People came to fee me as an object of curiofity, and they found me fo much changed, that they thought it was all over with me. The Duchefs of Orleans paid me a vifit, and after my recovery She recommended Dr. Saiffert to the Duke, which was the" means of making his fortune. From the moment of my convaleScence, every body was ea- ger to conSult him, and in general found he an- fwered their expectations.- But I ought to tell the fervices he rendered me : all my dreffings were done by him or in his prtfence •, he viiited me five or fix times a day, to confule and encourage me to bear my Suiilrings with patience. In Short he Saved me, r.t the expenSe of my hair onlv, which all fell off, and which he mede me Suave. It was neceffary to repair my foreteeth, which I had neglected dm ing my illneSs; and I was abSo- 21 Iutely forbid to play upon the harp, which had made my breath very Short; but what is all this in comparilon with liSe ? It was Some months be- fore my ftomach could bear its ordinary food •, and it was with four crout, very fimply dreffed, and a little bark in wine at night, and Venice treacle that I perfectly re-eftablifhed it.. My nerves remained irritable for. a long time ;-. but all this difappeared in lefs them a year : and I am become quite a Strong woman.. The two prin- cipal injunctions of my phyfician were thefe: to. ouard againft blood-letting and cold, which I did, as much as pofiible -, but this climate is damp, and in Spite of my precautions I was Subject to colds. At this moment, while I am writing, I have a violent cold, with a bliiter at my cheft. I am now thirty-nx. I am not So Strong as I was at nineteen ; but Sor all that I fhall weather it out very well. AiTes' milk, quieting medicines, a blifter, which muft not be Suffered to riSe.too much, becauSe of the irritation; no wine or tea •,. a great deal of barley water, diluted with milk and a Srdh egg, taken rafting in the morning ; and. cxercife on horSeback in fine weather. I am well convinced, that with this regimen conSumptive people might always get well. When the cough is violent, the mouth ought to be moiftened ; a. o-lafs of barlev-writer is enough. This does not Hi t> . 22 ..< heavy on the ftomach, as moft fyrups do; and I \ always found myfelf relieved by it. A great deal of camphor and opium ought to be put into the blifter, that it may occafion as little irritation as pofiible. In anfwer to the queftions of your friend, Dr. Beddoes, I can affure him that I had night-fweats almoft always, and fhiverings more or lefs flight, followed by heats, more or lefs violent, which con- *; tinued long after I was in my ftable, and left me only in confequence of my bliftersJ' A fenior prince of the blood, with whom I had an interview at the Hotwells, on the fubject of his health a few years ago, underftanding that I wifh- ed to give the plan defcribed in the preceding let- "fl ter a fair trial, informed me that, he was acquainted with the writer. Fie added, " that he knew fome. I emigrants of distinction rcfides, who had been cur- ed of confirmed confumptions, in the fame manner, by Dr. Saiffert."' On the paffage of the prefent Duke of Orleans and his brothers through Clifton, laft winter, the '# Count de B'eaujolois was feized with pneumonia, which gave me an opportunity of learning from '5 thefe gentlemen, that Dr. Saiffert was well under- I Stood to have Succeeded in various acknowledged caSes of confumption. Eut on account of their age, at the time, they could give no particulars. 23 Cafes treated under the author s infpeclioiu CASE I. MRS. FINCH, daughter to Dr. Jofeph Prieftly, had, for many years, greatly fuffered from weak- nefs of ftomach and exceflive mufcular debility. It was often a fevere trial to her to fit upright for above half an hour. The recumbent pofture al- ways afforded great relief. I faw her firft at the clofe of the Summer, in 1799. Some months be- fore the origin of the complaint for which fhe con- sulted me, Mrs. Finch had undertaken to Superin- tend the education of a few young ladies ; an oc- cupation which, efpecially confidering the earneft- nefs with which fhe carried it on, requires much exertion of the voice. The following letter will explain Mrs. Finch's ftate for fome time before I faw her. On her ar- rival at Clifton, fhe told me fhe had been much alarmed by a pulmonary haemorrhage on the jour- ney. The expectoration was completely purulent, and amounted generally to Several ounces in twen- ty-four hours. She had regular chills, heats, and profufe nocturnal perforations, particularly about the lower extremities. Her iiulh and Strength had 24 rapidly declined. It was remarkable, that the pulfe was Seldom above 76 ; but though in frequen- cy it varied fo little from the healthy ftandard, it had a range of force inconfiftent with health, and was in this refpect highly feverifh. Several times, with a view to its comparative Strength, I examin- ed it in the morning and after dinner ; in the af- ternoon, (when the fkin was alfo too hot) I Sound it full, bounding, and altogether different from what it had been in the earlier part of the day. In Mrs. Finch's family there had been many martyrs to confumption. Two aunts had died of it •, and her mother, who died of a fever, had been fubjedt to a cough and profufe pulmonary hsemor» phages. JMr. Burr's account of Mrs. Finch's cafe. Dear Doctor, I am forry that I have been fo long prevented from replying to your requeft respecting Mrs. Finch. Excepting in the infidious mode oS its at- tack, and the almoft total abfence of vafcular fever during the whole time that fhe was my patient, I recollect nothing in this cafe different from the tifual progrefs of pulmonary confumptlons. There were occafional acceflions of dySpnoea, from real £5 or Suppofed colds, attended with Shivering and in- creafed expectoration ; and thefe were followed by flattering remiffions and fanguine hopes. The dif- eafe was not preceded by general fever, or any marked local inflammation, but I believe, had ar- rived, at what is ufually ftyled the Second ftage of phthifis, the expectoration of pus, before even She herfelf fufpected that fhe was fcrioufly unwell, or thought it neceilary to apply for medical aid. The quantity of matter expectorated in any given time, was never accurately afcertained •, it varied exceed- ingly, and was often affected by caufes that cannot well be explained. I ftated to you in a former let- ter the effects of the digitalis, of opium, of myrrh, and of ether in this cafe, and certain affections of the ftomach, that rendered it necefiary to alternate and vary the ufe of them. Since that time the cafe has been under your own management : and I have no doubt of your having concluded with me, that all the known remedies for confumption have but little power in mitigating the fymptoms, and none in producing a cure of lungs fo difeaSed. ft appeared to me, according to the beft rules of medical calculation of which I am profeffed, that in a few months Mrs. Finch muft have fallen a victim to a cruel malady, from which our art could not deliver her. C 26 It gives me the fincereft pleafure, that the cow- houfe has fo completely fufpended the progrefs, and removed, for the prefent, every ferious Symp- tom of this once hopelefs cafe. I am, Dear Doctor, Your's refpectfully, JOHN BARR. Bi.-nJngham, Dec. 19, 1799. To Dr. Beddoes. I had been informed that digitalis, in fmaH dofes, had produced diSagreeable effects, without the SmalleSt advantage. Mrs. Finch Suffered me, repeatedly, to Satisfy myfelf on this point; and I found, for the firft time, what I have oftener than once obferved Since, that a Single drop of the fatu- rated tincture, taken three times a day, produced languor and fqueamifhnefs, without abating, the cough, expectoration, or hectic fymptoms. After this difcovery, I informed Mrs. Finch, and her brother,-Mr. Jofeph Prieftly, that in my opinion, to feem to place the SmalleSt reliance on medicine, would be to encourage a fatal deluilon ; and that there only remained the choice between a Sea voyage and (what might appear a very extravagant propoSal) conftant refidence with cows. Mrs. Finch aiked me which alternative I Should prefer 17 in her fituation. I told her, undoubtedly refidence with cows. I Shall afterwards explain, why I hope little from failing in cafes like her'a. After a fhort consideration, She acceded to the propofal, and never afterwards Shrunk from its execution, or be- trayed a fingle fign of impatience during her long confinement. A ftable adjoining to one of the houfes in GIou- eefter Row, Clifton, twenty feet long, fourteen wide, and nine high, with a Snail recefs, was en- gaged ; and a Space Sufficient to contain a moder- ate bed, with a little room to place a table and move about, was partitioned off;y and this part was raifed, by coarfe boards, a few inches above the ground of the ftable. Two cows were firft placed in the other part of the building, for a few days before Mrs. Finch took up her abode in it. The complete journal of this cafe would furnifh materials Sor a book of moderate fize. It will, however, be fufficient to defcribe the remarkable changes in Mrs. Finch's feelings, and in the fymp- toms. The firft night fhe had been cporcSed in her breathing, and the next day I prevailed upon her to apply a blifter to the cheft, though fhe predict- ed that it would exhauft her, without producing any good effect. The following night there was little or no oppreffion; and the air henceforward 2.8 became in the higheft degree grateful, or as Mrs. Finch termed it, balfamic. The night Sweats abat- ed, and foon ceafed altogether. Within about a week from her entrance, fhe was obliged to fleep a night out of' the cow-houfe, on account of fome alteration. That night the hectic Symptoms, and particularly the perfpiration,. returned. In about fix weeks fhe flept, for the fame rea- fon, three nights in a common apartment. The night fweats had now long fince ceafed,. nor did they return the two firft nights; but the third the I lower extremities were bathed in perfpiration. j The air of the apartment was kept three degrees higher than that of the cow-houfe ; but the breath- J ing was laborious, and instantaneous relief took | place on returning to the cow-houfe. On a third SubSeouent removal into the lodging houSe, for ; about a week, no fign of relapfe occurred. i I had been endeavouring to perfuade a gentle- | man, who had rcfided two or three winters at Lif- bon without the fmalleft advantage, to try the cow- houfe, rather than return to Portugal. He was ] curious to have a ftatement of Mrs.. Finch's feel- ings. I have pre Served the note fhe wrote on that • occafion. It was about a fortnight after her entry • into her humble abode. The account is as fol- lows : 29 " Mrs. Finch's compliments to Mr.-----, fhe can affure him that fhe has found a cow-houfe a much more comfortable abode than fhe had form- ed an idea of." " During the nights, particularly, fhe has expe- rienced a genial warmth, which has relieved oppref- fton on the chef, taken off reftleffnefs, and given a feeling fhe cannot better deScribe, than by Saying it is, as if nourifhment was conveyed through the pores of the fkin. So different have been her feelings from thofe of the laft fix months, that fhe Should' reluctantly change her apartment for the nigh, however fhe might wiSh.a cleaner and more cheer- ful one for the day. " Cow-houfe, Off. 8."- The fymptoms gradually abated. In ten weeks there was no veftige of hectic fever ; and the cough and expectoration ceafed entirely for days together. The expectoration would return, at longer and longer intervals, in a quantity not exceeding the bulk uf a garden pea. But whenever there was the fmalleft quantity of expectoration, (and it now took place only in the morning) it never failed to be preceded by diftinct febrile rigor ; and the chill was never felt without fubfequent expectoration. From the beginning of Autumn, 1799? Mrs, Finch lived in the cow-houfe for about fix months, with the exception .of a Sew days. + c 2 The following particulars are owing to Mr. 1 Finch's hourly and affiduous attention: " There were two cows for one month ; three the remainder. There was a fmall ftove in the part where Mrs. Finch flept, which was ufed for two months near- ly half the day ; afterwards, only in extreme froft, or on the room being damp, which from its low j fituation it was fubject to be. The degrees of heat were, for two months, from 60 to 65 -, afterwards 6$ to 70; but in general 1 68, or to the heat moft agreeable to Mrs. Finch's feelings. The cows were allowed very little ftraw for a month or fix weeks ; nor was their ftanding clean- ed. Afterwards they had plenty of ftraw, and. 1 their beds were kept tolerably dry. "I The cows' wet had all along a naufeous effect. i The cows' horns were noify, efpecially in the J night. Young cows, without horns, would be M moft defirable, and Such as are young in calf. Hay of the beft quality, and the freeft from duft, ' was found preferable on all accounts. The ftraw fhould be dry and clean. The cows were watered twice a day, not fo Spar- ingly as might have been. The better the hay, trie lefs water neceffary. Halters to tie with, preferable to chains. 3T The mafter cow to ftand firft to the left; The windows were ill placed ; they fhould face to the fouth. They had a northern afpect, on ac- count of the cohveniency of communicating with the houSe. If the patient's apartment could be on a low floor, above the cows, would not many difagree- able circumftances be avoided ?" I was at firft apprehenfive of excefs of warmth, • and my anxiety on this head, together with that of Mr. Jofeph Prieftley, probably retarded Mrs. Finch's recovery at firft. During the fubfequent period, careful attention to circumftances induced me to requeft, that in regulating the temperature no Standard might be regarded but the feelings at the moment, and for fome time afterwards. In a paper lying before me, Mrs. Finch fays, "I always felt beft when the thermometer was at 68° or 700; and when there was a medium between exceffive damp and the too dry heat of a conftant ftove. The ftove, lighted in the morning, to dry a little of the moifture collected during the night, was pleafanteft to my feelings." Succeffive generations of flies were a confider- able nuifance ; and the cordage and other parts of the bed were fpeedily rotted. The vapours were evidently alkaline. They gave nobody cold. 32 No attendant indeed fuffered from a longer or fhorter continuance in a medium fo much warmer than the atmofphere. One lady, who fpent the greateft part of many days with Mrs. Finch, was greatly relieved from the pains of a chronic rheu- matiSm. After leaving the cow-houfe, Mrs. Finch lived ] for fome time in common apartments, kept more j than ufually warm. In May, 1800, I recommend- ed it to her to try the effect of Sailing, againft a fu- ture emergency. The following letter, I thought, gave me a right to congratulate myfelf, on the. preference I had given to the cow-houfe. > » Birmingham, June 4, 1800. ■ "I wrote to Mrs. D---—, defiring her to in- m form you of the event of our firft little voyage, which fatigued me very much. I recovered by a 1 reft of fome days, and then we proceeded, by gen- I tie ftages, to Tenby. From thence we failed to 1 Cardiff, when the ficknefs and cold again threw I me back, and I required Some days to recruit. We then had a delightful journey by Shepton. Slow 1 travelling has been of fervice to me ; but what benefit I am to receive from a voyage muft he from, I a long one, as fhort trips by Sea have evidently hurt me. " Believe me your refpectful «S. FINCH." 33 In a letter, dated Auguft 15, Mrs. Finch writes: "' I am happy in being able to fay, that my cheft continues perfectly well; and from the difference of my feelings now, and fome years back, I am more than ever a friend to the cows. I avoid colds and night air ; and by rides in the country am anxious to brace myfelf againft winter, without the neceflity of a fea voyage. Mr. Barr thinks, if no unpleafant fymptoms appear in autumn, double windows, and confinement to two rooms upftairs, properly regulated, will fuffice next winter, with- out change of climate, and I hope you will be of the fame opinion." After this date, for many months I continued to receive, either directly or indirectly, the moft fa- vourable accounts of the ftate of this interesting patient. During the whole winter Mrs. Finch confined herfelf to an apartment, artificially heated, and con- tinued to enjoy entire freedom, from pulmonary complaints till March, 1801, when fhe got a vio- lent catarrh, respecting the conSequences of which I entertain fome apprehenfions. She thus de- fcribes her fituation, in a letter, bearing date "Bordefley, March 29, 1801. " I fhould haye anfwered your letter before, but I have been too ill to write, with fpafms fimilar to my former attacks; only now they have chiefly 34 been in my bowels, attended with retchings, and on my breath, which is by fits very bad. My cold, which you are fo kind as to inquire after, was at- tended at firft with So great a diScharge of thick- ened phlegm, as I think, by weakening me, to be; the chief caufe of my prefent SpaSms. I have a trifling cough remaining, and am very weak, not being able to keep long off the bed. " Till this ill fated cold I had paffed the winter with great credit to the cow-houfe, the air of which I ftill prefer to my warm room, though it is. of a good fize, an,d lies to the fun.!' 35 CASE II. J\ YOUNG perfon, with purulent expectoration, rrapid pulfe, and violent hectic fever, on whom the tincture of digitalis had been tried in vain, hear- ing of Mrs. Finch's amendment, confented to try the fame expedient. The firft night fhe was con- fiderably oppreffed in her breathing. This op- preflion immediately abated ; the hectic Symp- toms rapidly declined. The Strong rigors and drenching night Sweats never afterwards returned. This young perfon was ferioufly affected with a nervous complaint, not anfwering to the uSual appearance either of hyfterics, epilepSy, or cata- lepSy. At uncertain times, but ofteneft about midday, a degree of torpor, with cold extremities, came on and rofe to perfect infenfibility, without convul- sions or Spafms. Great dofes of opium fometimes prevented and fometimes leflened this Seizure. On the whole, it was neither better nor worfe in the cow-houfe than it had been elfewhere. It contin- ued till near the death of the patient. Conjoin- ed probably with this nervous complaint, there ex- isted an almoft intolerable thirft fsitis frigida,) of which I wiiked to attempt the mitigation by falted meat and fpices; but the imperious feeling prevent- ed compliance with this .propofal. The patient was conftantly accuftomed to fwallow immenfe quantities of cold water, even at a time when the whole fyfrem was of a death like coldnefs. Neverthelefs, for about three weeks the pulmo- nary Symptoms continued to abate; and an in- creafe of flefh and Strength was maniSeffc. About this time a number of moral caufes be- gan to operate in the moft unfavourable manner. Various correspondents Spoke of the difgrace of be- ing in fuch a Situation. This mortified the pa- tient ; and inftead of that perfect content which was felt at firft, the pity received produced a per- \ fiiafion, that the fituation was really one much to be pitied. The affections oS the heart now became a Source ■ of torment. The irreSolution cS the neareft rela- tions, whether to change the treatment (as under thefe circumftances was advifed) continually tan- talized the patient. The temper grew obftinate and peevifh. No arguments could fometimes pro- duce conSormity to directions. The affufion of cold water, in cafe of evening heats, was often pre- ceded by an hour's fretting. During this period the patient was finking. Af- * ter long hefitation a removal took place, and the cafe foon ended fatally. 37 CASE III. J\. Gentleman who had been under the care of refpectable practitioners at Manchester, arrived here in that ftate in which it is uncertain whether ex- iftence is likely to be protracted Sor a Sew weeks or a few months. In addition to the ordinary Symptoms of confumption, he complained of colli- quative diarrhoea and cedematous Swellings of the feet. His brother, who defired that fome new plan fhould be tried, Since medicine had been So long uSed in vain, forwarded, with the utmoSt ac- tivity, the preparations neceffary for entering info the cow-houfe. Here, for the firft week, confid- erable relief was obtained •, but no change took place on which rational hopes of recovery could be founded. The Swelling of the feet went off, and did not return till the patient was removed from the cow-houfe. The diarrhoea was alfo checked. After a trial of Several weeks, the patient, in compliance with the recommendation of a friend, Submitted to the trial oS a Sea voyage, in the courfe of which, on being landed in SomeifetShire, he died. It has been already intimated, that imme.ii- ately on the patient's quitting the cow-houfe, a re- turn of the oedematous Swellings took place. D 33 CASE IV. jf\ Gentleman belonging to the navy, greatly reduced by cough, purulent expectoration, and hectic fever, placed himfelf under my care in the ! autumn of 1799. For many weeks i treated him J with tincture of digitalis, cicuta, opium, hyofcya- 1 mus and fquill; but no check was given to the j complaint. Mrs. Finch's encouraging example in- duced him to make trial of the effect of the cow- , houfe. Here he continued for above three months^! His hectic fymptoms by degrees difappeared. His Strength increaSed. It happened that his taylori meaSured him immediately before and immediately! after his confinement. On comparifon it was afc< certained, that the circumference of his body had increafed three inches. His limbs had thickened. in proportion. Some cough and expectoration re- mained when he ventured back into common life. This was in April, too early a feafon. He continued, however, to improve in health, and now confiders himSelf as a perfon with a delicate cheft; not an invalid. According to the rate of his decline before be- coming a fellow lodger with cows, he could fcarceii ly have furvived to the period of his enlargement, 39 if his diSeaSe had been left to purSue its courSe. The atmoSphere of the cow-houfe produced a change confiderable enough to Suffer his consti- tution to recruit. This could not have happened without a Salutary change in the ftate of the lungs, for I have never known the fmalleft acceflion of flefh during the progrefs of phthifical pulmonary ulceration. In this cafe, therefore, I conclude, that the patient was indebted to his confinement for a long reprieve, at leaft, from the grave. The plan had not power enough, or was net allowed time enough, to reftore the lungs to a perfectly healthy ftate. 4° CASE V. IN OT being able to perfuade myfelf that the favourable effects produced upon phthifical invalids in a cow-houSe are owing to any cauSe but to tem- perature and to the gaffes, given out by the fer- , menting mafs of vegetable and animal fubftances, i in the following inftance I excluded the cows, re- taining all the other parts of the plan.* A patient with purulent expectoration, often tinged with blood, and the attendant hectic fever, who had already fuffered greatly during the pre- ceding winter, and had a little recruited in the Summer, feemed, notwithftanding the exhibition of digitalis, to be finking with great rapidity at the clofe of autumn, 1799. No other refource occur- ring, I propofed to him to pafj the winter months in a place where he Should have the chance of be- nefit from a warm temperature, and from exhala- tions Similar to thoSe in the cow-houSe. A ftable with two Stalls was chofen for the trial. One Stall was filled very full of the materials ufed * Alkaline vapour, fulphurated hydrogene gas, carbonic acid gas were very confpicuous in their effects. The nature and proportion of thefe galles require further examination. 41 by gardeners for hotbeds. In the other the pa- tient's bed was placed. While the hotbed was in ftrong fermentation, the temperature of the place was about 64, and the patient felt relieved. Occafional fupplies of the foil of cow-houfes and ftables were added, as the firft hotbed funk j and as the winter advanced, and the warmth from the fermenting mafs decreafed, the ftable became too cold, and it was neceffary to introduce a ftove. At 6o° and below, the fymp- toms became more fevere; 700 was an agreeable temperature to the patient, though he could well bear a much higher. His diforder foon ceafed to make progrefs, but was not entirely fubdued, dur- ing a confinement from November till March. The obfervations made upon the cafe immediately preceding, are almoft literally applicable to the pre- Sent. Impatience of folitude, and the patient's de- iire of returning to his labour, cut Short the trial. But he was preServed from the effect oS the winter, which probably would have been fatal, and entered upon the fpring with increafe of ftrength and flefh, ;t:d \\hh his difeafe diminished in proportion. D 2 42 CASE VI. J\ Lady, upwards of fifty years of age, had la- boured under all the fymptoms of confirmed con- fumption. The expectoration, when I firft faw her, amounted to many ounces ; and confifted of pus, with a large proportion of mucus. The bow- els were in a ftate of great laxity •, and a very flight caufe fufficed to produce a colliquative diarrhoea. Her Situation gave her friends the idea of immi- nent diffolution. Digitalis, and other medicines, at firft produced no beneficial effect under my administration. As it feemed to me hopelefs to propoSe refidence in a cow-houSe, I adviSed that the patient Should live during the winter, in a room fitted up So as to en- Sure the command of a fteady high temperature. This advice was followed. Double doors and double windows were added to a bed-room. The •fire-place was bricked up round the flue of a caft iron ftove, for giving oat heated air. One of the fides of the ftove was pierced, fo as to receive one end of an iron tube, the other end of which paffed .through the wall of the apartment, by which means the fuel was confumed by a current of external air. The iron tube was fuppliecl ATJth a regulator, 43 by which the Supply of air to the fire-place of the ftove could be checked when the fuel burned too brifkly. The plate fronting the title will aflift the read- er's conception, if the preceding defcription of this very fimple apparatus Should be in any part ob- fcure. The patient, whofe existence feemed within a few weeks, if not a few days, of its clofe, was foon fenfibly better. She kept the temperature up to near 700, and the digitalis in fmall quantities, (with opiates and Spice, and acids after a time) was con- tinued as before her confinement. In about fix weeks the hectic fymptoms v had fubfided ; the pulfe, at different times between twelve o'clock and four in the afternoon, was from 70 to 80. There was an acceflion oS flefh and Strength. The cough and expectoration greatly decreaSed. From Janu- ary till April fhe was in a very comfortable and cheerful ftate. But her hectic fymptoms now be- gan to re-appear : her cough increafed. She con- tinued in the warm apartments till May, 1800. From this time her health declined ; and after keeping her room a very few days, fhe died at the end of February, 1801. I had two other confumptlve patients, who lived with cows for about three weeks each. One felt much relief at. firft; but the approach of winter 44 reduced the temperature 'of each place, during the latter days of their refidence, as low as 540. The patients were now difagreeably affected by the cold; and their friends, rather than be at the expence of the meafures necefiiry for producing fufiicient warmth, removed them : and I believe both di- ed. 45 CASE VII. JL HIS was not, in any refpect, a pulmonary af- fection ; but it Shewed, decisively, the effect o£ temperature. A gentleman, who, probably from anxiety* or mental exertion, had long been declin- ing in flefh and Strength, was reduced to an alarm- ing ftate of emaciation. No organic affection whatever could be difcovered. The fkin was dry, and the patient Suffered extremely Srom cold. The diftreSs Srom weak digeftion was exceflive. A di- et, confuting in part of vegetables, occafioned at this period, as it had for fome time before, an in- ordinate flow of urine. The urine was not faccha- rine, but had the odour, often obfervable in cafes of indigeftion.. Innumerable remedies, principally with a view to Strengthen the ftomach, or to dif- lodge worms, had been ufelefsly adminiftered. It appeared to me probable, that no phyfical power was So likely to operate favourably, as continued warmth. By its effect on the fkin, I expected both to obviate a certain clafs of unpleafant SeriSa- * This is a much more common caufe of atrophy than I had fuppofed from medical writings. At leaft I have feen a con- fiderable number of fuch cafes clearly marked in their origin, 46 tions, and to improve the digeftion. In both ways fome imprefnon might be made on this hypochon- driacal atrophy. I was not diSappointed. The pa- tient had a building, like a Square hollow monu- > ment, erected in the middle of a large room, with an arm going into the chimney, which was bricked up round the flue. A large ftove was placed loofe- within the Structure. Double doors and double windows were added. The greater part of the room was at a temperature of near feventy degrees. At the end of a month, the patient preferred the fteady warmth of the Weft-Indies with power of locomotion, to- confinement. On quitting his room he was found to have increafed fenfibly in flefh and Strength. The hands, which before look- 1 ed Skinny and bloodlefs, had now a healthy appear- j ance, when held up againft the light. Flefh had been gained, and the blood-veffels appeared much better filled. The moft remarkable circumftance J is, that on the journey from Briftol to Falmouth, during the coldeft weather oS the early fpring of 1800, the patient felt perfectly comfortable as to warmth, and even travelled a good part of the way , with his chaife-window down ; whereas it is cer- 1 tain, there would before have been no end to pre- cautions for fencing againft the external air. This obfervation feems to coincide with an opinion very generally entertained, that ftrangers from the tro- 47 pical countries refift the cold of the firft Englifh winter better than the natives. Indeed no proof fell under my notice, of the prejudicial effect of continuing a longer or fhorter time in any of thefe heated rooms. No inftance of an attendant's tak- ing cold came to my knowledge ; and had fuch an occurrence happened, it could hardly have ef- caped me. The friends of the confumptive will, I truft, find thefe examples particularly deferring of their no- tice. In moft cafes, the bufineSs" of prefcribing and Swallowing medicines, whether neceffary or not, .goes on Smoothly enough, except when it happens that the phyfician is counteracted by fome member of the family ; the vulgar deception of toffing doc- tor's fluff out at the window being rarely practifed. But when new and troublefome meafures are to be taken, no fuccefs can be expected where the friends of an invalid do not go hand in hand with his phy- £cian. It will Strike the fuperficial, that in feveral of the preceding cafes no complete cure was effected; and undoubtedly the reporter muft Sincerely .la- ment that he was not throughout fuccefsful. The Succefs he had in one inftance, rendered his fenfe of difappointment in another more poignant. But when it is remembered that the fituation of the parties, fo alarming on account of the nature of the 48 difeafe, was rendered altogether defperate by its degree,* and by the failure of the moft powerful remedies, the means of preferring the fmalleft pro- portion of lives will deferve to be accounted an ac- quifition to humanity. Another way of calculating thefe events is in- deeed generally adopted. Deaths which would happen in the courfe of nature, deaths which would equally happen under the routine, are imputed to him who has the courage to recur to new mea- fures. Thus of two cafes of advanced confump- tion, let one be treated with plenty of phyfic ; let a modified atmofphere be adopted in the other; if both terminate fatally, the event in the firft in- ftance fhall be imputed to the dilbrder ; in the SepJ| ond to the new Scheme. Flence thoSe diSeaSes^ againft which Society ought to combine all its for- ces of wealth and fcience, have no auxiliary So Sor- * By perfons, who, feeing the benefit actually arifing from refidence with cows, were d.firous that no handle fliould be i given for that fort of declamation, which occupies the idle and the fhallow at a place like Clifton, I was warmly reprobated : for having to do with cafes fuch as Nos. III. and VI. Doubt- lefs the wheels of life were here broken, and it was ufelefs to apply oil to the fragments. Eut two principles fliould be held in view by medical men : i. To give a patient every poffible chance, and even to fupply him with a fupport to reft his hopes upon. 2. To afcertain (what can never be predicted) the lim- j its of every medicinal power. 49 midable as our profeffional routine. As long as this fhall maintain its prefcriptive right; and it fhall be a reproach to fetch the neceffary means of health from the remoteft corner of nature, if there they can be found, fo long will great improvements in the art of medicine be prevented, becaufe fear of ruinous cenfure will deprefs the talents of the medical philofopher to the level of thofe of the medical intriguer. And as to the confumptive, it will make little difference whether they be confid- ed to the fole charge of the nurfe, or the doctor be joined to her as an affociate. The annals of" mankind would offer no example of merit more tranfeendant than his upon whofe tomb it might jufily be inScribed: H. L. A PHYSICIAN, WHO HAVING MAINTAINED A LONG STRUGGLE AGAINST MEDICAL ROUTINE, AT LAST SUBDUED THAT HOMICIDE MONSTER, AND CONCLUDED HIS LABOURS, BY GIVING INVENTIVE GENIUS THE FULL I-r.LEDCr.I OF THE MEDICAL PROFESSION. The advantage to the patient from living in an artificially heated room at home, deferves to be E 5° compared with a refidepce in Portugal or Madeira. If invalids would go to Egypt, or Bengal, or the Weft-Indies, I fliould prefer due warmth with free- dom of motion to confinement. But the climate oY Portugal * is either fo variable or cold, and that of Madeira in fact fo little falutary to the phthifi- cal, that I fliould have no hefitation, in my own cwic, in preferring the regular artificial heat that r ;n So eafily be commanded at home. Whether licit excited by the Sun be not preferable to the artificial, was a fcruple ftarted by Mr. Billingfley. ft has keen anfwered by his own experience, as will he rekted below, as well as by that of others. The .nticle of economy Speaks for itfelf. The comforts of a Lifbon refidence are pretty well underftood-, though whether at large in Portugal, or clofetted in a cow-houfe, the feelings of convalefcence would ; render either fituation Supportable. The degree of benefit arifing from artificial warmth, in -thefe consumptive cafes, cannot be aS- dened. It was occasionally evident enough, that a certain tcritperature was indiSpenSable, as without it the patients became Stationary or loft rround. ConverSdy it was proved in, Mrs. Finch, that at- ■' mofoheric air, merely heated, was inadequate to ' relic S « I'fT-iy on Confumption. To the proofs that are tliere giv- en, many additional sic now hi my pj;;i.lB-.;n. 5* The principle on which I conceive the cow-houfe tapours to have acted is well understood in the treatment of ulcers 5 certain applications difpofmg them to heal. And what way is there, upon which we can depend, of making applications to pulmo- nary ulcers, but that which gaffes or vapours offer to us ? I ftill prefume that the prefence of the cows is by no means effential; nor do I doubt, but that in Some ftates of pulmonary ulceration thefe vapours will be hurtful.. When they arofe in great quan- tities from Stirring the fermenting materials, they were found to be fo. It will be a ftrong recom- mendation to the further trial of the power of thefe vapours, if my Statement Should convince a certain number of patients or practitioners, that upon them depends the fole benefit. Veffels con- taining the fermentable fubftances could eafily be introduced into a warm apartment; the former as eafily be regulated by covers, and the veffels re- moved entirely, the moment the exhalations ap- peared to diSagree. I regret having no report to make on the Sub- ject: of that complaint, which, throughout the cold feafon, proves the Scourge of fo many of our coun- trymen advanced in life; I mean the catarrhus feni- lis, which fhews itfelf in a moft diftrefling cough, and a large expectoration of mucus. I am certain 52 that an effect upon the mucous membrane, which Should amount only to flight alleviation of the fymptoms of confumption, would completely SuS- pend thoSe of catarrhus fenilis; and from all the facts taken together, I am not afraid to promife Suf- ferers from this complaint moft effential benefit. The confinement need not be rigorous ; they might Sreely enjoy the fine gleams of winter ; and expoSure during foul weather, is not enjoyment, but its oppofite. Without doubt, when men fhall ceafe to be content with receiving fiaughter, fam- ine and peftilence, as the recompence for their per- nicious admiration of political adventurers, and the power of Society Shall be employed for the good of Society, edifices, putting to fhame the monuments of ancient art, will riSe in every inhoSpitable cli- mate ; and theSe cenfervatories of old age, Scarcely Subjecting their inhabitants to privation, will af- ford them complete Shelter againft the inclemen- cies of the Seafons. S3 Cafes where the ufe cf medicine and artificial warmth were begun at the fame time. John Billingsley, Efq. of Afhwicke Grove, So- merSetfhire, had complained of a Short cough, in the beginning of the winter of 1799, and 1800. This continued, and began by degrees to be accom- panied by feverifh feelings. Afterwards expecto- ration took place. All thefe complaints went on, increafing in regular progreffion, till March, 1800, when I firft faw Mr. Bjllingfley. I found him, in the evening, with a pulfe at about 120 in a minute, complaining of cough, pains in the cheft, difficulty of breathing, chills, heats, and moft profufe nocturnal perfpirations. The expectoration amounted to Se- ven ounces in twenty-four hours, and confifted of purulent matter,, largely intermixed with mucus. Mr. Biilingfley was cxccfllvely reduced in Strength, and much emaciated. - Had it been left to my choice, as influenced by my expectations refpecting the event, I fhould cer- tainly have declined the care" of a perfon, to whom the eyes of people in this part cf England are So generally turned. To his two medical friends, Mr. Perkins and Mr. Hill, as alfo to his family I Stated, that he ap- t 2 54 peared to me verging faft towards the laft extre- mity, if the cafe were not already defperate. ' To himSelf, at their defire, I explained as well as I was able, the nature and probable comparative efficiency of the meafures that might be adopted for his recovery. I told him that I had no expec- tation from any medicine but digitalis, occasionally aflifted by other articles of the materia medica,- but that I was by no means willing to truft to medicine alone. The auxiliary means I had in view were of two kinds : a room, fimply heated to above 6o°; ©r a heated atmofphere, impregnated with the ex- halations of the cow-houfe. A third, and in my opinion the only plan remaining, was a long fea voyage. This Mr. Billingfley at once abfolutely rejected, adding, that he fliould prefer the tempe- rated room; but apprehended that he was too weak to bear removal to Clifton, a diftance of about twenty miles. It was finally concluded that the attempt fhould be mdde, and that a room fliould he fitted up, nearly as described in cafe VI., only that in the prefent inftance two communicating rooms were chofen in preference to one ; the ftove Supplying .hot air being placed in the bed-room, and a com- mon fire occasionally made in the fitting room. The ftove, as in all the other caSes, except the cow- houfe cafes, was one of thofe called empyreal Sieves. S5 It was twelve inches-Square; and the expence of boring a hole to receive the air-pipe, and clofing the apertures in the door, added to eleven guineas, the original price, amounted to about fourteen pounds. It was found eafy to keep up the fire all night ; and during the whole twenty-four hours, the moft perfect equality of temperature could be maintain- ed. The heat moft agreeable to Mr. Billingfley was from 60 to 65°. He began to take ten drops of Saturated tincture of digitalis, twice a day, two or three days before taking poffeflion of his apartments. In nine days the chills, heats^ nocturnal perfpirations, and cough were fenfibly abated. The appetite had greatly improved. The pulfe had fallen to about 90 in a minute. In a fortnight Mr. Billingfley found himfeif much ftronger. He never took for a dofe above eighteen drops- of the tincture of digitalis, and fometimes only two dofes a day ; to the laft of which was ufually added from twelve to twenty drops of the tincture of opium, or cdrreSponding quantities of camphorated tincture oS opium. It may be remarked, that Mr. Billingfley's Strength, appetite, and Spirits, improved at an equal rate. At no time did he experience the SmalleSt diSagreeable SenSation, either from his confinement or his medicine. 5*5 When he had been under this treatment for a little more than tliree weeks, he propofed to go to Afhwicke Grove, on condition that the weather was fine, for a fingle night. The reafon for this journey being important, my fcruples were over- ruled. He performed it with the moft perfect eafe and impunity •, and from that time took an airing during the funny part of feveral fine days. This is an important fact, as it Shews that the danger is lefs than might be apprehended, from pafling into a lower temperature from a higher, to which a perfon with a difeaSed breaft has been for fome time accuftomed.. Such precautions as warming, to an unuSual de- gree, the apartments which might be uSed for fit- ting or fleeping, were of courfe employed : and the ! cooler air after funfet was avoided. Still, howev- er, JJlr. Billingfley, during his abfence, muft have ] been immerfed in an atmofphere 20 ° colder than that cf his apartments. After a confinement of about fix weeks, the hectic fever being entirely Subdued, the cough and- expectoration much reduced, Mr. Billingfley quit- ted his confinement. He perfevered for Several weeks longer in the uSe cf digitalis, and entirely; recovered in all refpects. The recovery, as far as the experience of near a year, including a whole 57 winter paffed without any particular precautions, can juftify an opinion, appears to be permanent. No inconvenience whatever was felt from expo- fure to the common atmofphere. A lady, twenty-two years of age,, with narrow cheft, prominent Shoulders, and hereditary diSpo- fition to consumption, after a fhort cough of many weeks continuance, and flight irregular feverifh feelings, began to expectorate purulent matter, and to complain of confiderable fhiverings in the even- ing, Succeeded by a dry burning Skin, and profufe night perfpirations. She could not lie on one fide, and her flefh and ftrength declined with the great- eft rapidity. Fearing that digitalis alone, which had been tri- ed, but as I thought not with fufficient attention to the dofe in a delicate conftitution, would fail to produce a cure, I infifted upon the necefHty of a temperated atmofphere •> and my remonftrances Succeeded. By means of four drops of tinc'rure of digitalis* thrice a day at firft, and afterwards from fix to eight, ^beyond which I never could rife, without languor, inappetence, or ficknefs) the progrefs of the difeafe was SenSibly arrefted in about three weeks. In five weeks the heftic fever had nearly fubfided; the expectoration and cough were great- 58 ly lefiened 5 and by aftual meafurement of the arm, an increafe of flefh was afcertained. In three weeks more the complaint was fo far abated, that the patient fpent the greater part of the fine days of April out of doors; and by de- grees returned to the ufe of common air. Ail the fymptoms of the difeafe diSappearedL and they have not Since returned. k Two other patients, under the fame treatment*,, experienced the fame happy effect. It was remark- ed by all thefe patients, that the ftillnefs of the air became much more agreeable than the cur- rents, and the unequal application of the heat from a common open fire.. The moft agreeable temperature was found in thefe latter inftances to be about 650*. A gentleman of black hair and dark complex- j ion, who had loft feveral brothers and fifters bjM eonfiimption, and was himfelf greatly reduced by that variety cf \he difeaSe which is called galloping j confumption, entered into temperated apartments, at the Same time taking digitalis, with opium occa- sionally. The heat of the rooms, in conformity with his fenfations, was from 66 to 700. But there took place no abatement of the hectic fever, or of any other Symptom. The diSorder continu- 59 ed to hold eXaftly the fame progrefs as before his confinement: and the cafe foon terminated fatally. This gentleman had it in his power to pafs into an artificially heated, cow-houfe, as before defcrib- ed; and for fevered days he fat in it many hours, but without the SmalleSt relief* A tall, Slender female, of conformation Striking- ly phthifical, and fcrophulous complexion, had for four years laboured more or lefs under complaints of the chcft. From the account which I received I concluded, that tubercles had exifted in the lungs during this whole period : but that from acciden- tal caufes they had fluctuated, as may often be obServed, between an active and a dormant ftate. For an entire twelvemonth before I was con Sui- ted fhe had been under the care of various medi- cal attendants, Irifh and Engiifh. For four months ■She had expectorated purulent matter, and was in all refpects hectic and reduced. She likewife had a continual tendency to diarrhoea, which probably was the reafon why the night Sweats were not confrant or profufe. The hitter half of September, i Soo, and the be- ffinnin'" of October, I treated her with gentle dofes of digitalis, in conjunction with opium, and the chalk mixture, and fuch ether aflr'uigents as the ftate of the bowels perpetually demanded. 6o This plan was altogether unavailing. The be* ginning of the third of October fhe removed into temperated apartments. In thefe the chills and heats, which were the heftic fymptoms by which She had been principally affected, foon abated. The pulfe, from 112, funk to between 70 and 8o°. The bowels became regular. In three weeks the expeftoration was reduced one half, and the night Sweats Seldom appeared. She Selt a very manifeft increafe of Strength ; and thofe who faw her agreed in opinion that fhe had gained flefh. About the middle of November this lady, hert hufband, and a Servant maid, Suddenly complained of head-ache and feverifh fymptoms. Hi ere was at this time, in the fame houii., a perfon ill of a contagious fever; and to infection, from this Source, the three perfons above mentioned imputed their attack, which in neither cafe affumed the form of continued typhus, though the Symptoms of the Ser- vant, in particular, were Such as we obferve in ty- phus, cut Short by cnucics. From this period my confumptive patient Slowly declined ; and in January fhe died, without Suffer*.,; ing much, except at tiint.; during the latter Stage, from ihortneSi of breath. Mrs. H. a iady of fair florid complexion arid! light eyes, came under my care early in autumn, 6i 1800, with advanced tubercular confumption, as distinctly marked as in any of the preceding cafes. By guarded dofes of tinfture of digitalis, largely combined with tinfture of opium, and occafional- ly of columbo and fquills, in a way hereafter to be defcribed, the complaint was confiderably redu- ced, the hectic fymptoms now not appearing at all, or being Slight; the expectoration reduced from fix ounces in twenty-four hours to one and a half. Under thefe favourable circumftances, the Sud- den death of an abfent only child produced a tem- porary indifference to life, and fuch a defire of leaving my neighbourhood, as could not long be refifted. During the fhort remainder of the patient's con- tinuance under my immediate care, I prevailed up- on her not to abandon her medicines ; and the ftorm of Sorrow was not obferved to increaSe, or diS- proportionally to diminish the conSumptive Symp- toms. They continued, however, regularly to de- creaSe till fhe left Clifton. The journey home, which occupied between three and 'four days, took place in unfavourable weather. Mrs. H. was for at leaft a fortnight with- out medicine •, and it appeared from the intelli- gence tranfmitted to me at the end of this time, F 62 "that the complaint had rifen again to nearly its former height. My advice was to continue the Same plan of medical treatment, with all its varia- tions ; and above every thing, to retire for the whole winter into apartments, artificially warmed to between 60 and 700. The medicines were refumed upon this recom- mendation, and very diligently continued. To the part of my advice refpefting temperature, that fort -of attention was paid which reminded me of the] common faying about half meafures. From this time the patient fell under the care of Mr. Bryant, a veteran practitioner of South Molton, in Devonshire. Through him I learn, that the apartments in which Mrs. H. lived were only common apartments, and, in faft, much infe-j rior to common apartments in general, for the houfe being an old one, much cold came in through the windows ; in confequence of which, the pa- tient was, at .times, feized with catarrh; and, as Mr. B. informs me, " every increafe of the com- " plaint hath clofely followed wet ftormy weather." On the 6th of February, 1800, this gentleman re- ported " the cough much leffened ; no night " fweats j bowels regular ; menftruation proper ; " Spirits and appetite good •, expeftoration leSs and «' leSs prevalent. She has gained flefh. Pulfe fel- i( dom above-84. Two grains and a half of opi- 63. K um," * he continues, " procure a fufficient quan- a tity of fleep. The tinftures of digitalis and opi- " um, in infufion of columbo, have been given, fo ft as to occafion a flight naufea in four or five days; " then difcontinued till the naufea went off. She " has not exceeded fix drops of the tinfture for a " dofe. Let this cafe end how it will, I will ven- " ture to affert, that your method hath done more " for Mrs. H. .than all the old plans put together » " and I verily believe, if the whole of your fyftem " was complied with, a great proportion of pulmo- « nary affeftions would be cured." April the 21 ft I was informed, " that latterly, from fix to eight drops of tinfture of digitalis and opium, mixed in the proportion of 120 drops of the former to 60 of the latter, had been taken three times a day, with two and a half grains of opium at night; that the cough was nearly gone ; that the-expeftoration was little, and fcarcely purulent, with confiderable increaSe of Strength and Spirits ; good nights j pulSe about 86." Since the 13th inftant, however, the Symptoms have increaSed •, hence the termina- tion of a cafe, fo far advanced above eight months - ago, and which, in a patient of feeble habit, has ever fince exhibited So remarkable a conflift be- tween medicine and difeafe, continues yet in fome meafure uncertain. * I had reqncfted that the opium might be gradually raifcd to this dofe. 64 i One afthmatic patient under my care confined, himfelf for a few weeks in temperated apartments, not very conveniently fitted up, as from the difpo- fition of the rooms the effeft of the ftove did not Sufficiently reach the bedchamber. No beneficial effeft followed. I am forry I have no cafes to relate of catarrhus fenilis, or that affection of the lungs which renders eld people in winter fo liable to a conftant fevere cough, and profufe fecretion of mucus. My ob- servations, I think, juftify me in recommending warmed apartments in this difeaSe with the greateft confidence. The confinement need not be cloSe. The foregoing examples fufficiently Shew that the open air might be freely enjoyed during the beft part of the milder days of winter. To be expofed to fevere weather would not be enjoyment, but its oppcilce. From fufferers of this clafs it would be no valid objeftion, that fo large a proportion of the preced- ing cafes terminated fatally at laft. An effefly amounting to very flight alleviation in confump- tion, would give a perfon labouring under catar- rhus fenilis the feelings of health; and pcrfever- anxe, for one or two winters, would probably go far towards removing the complaint. Befides, in regard to confumption itfelf, thefe cafes are, in re- ality, more encouraging than would appear without 65 attention to the degree of difeafe. All the patients had been long ill; they had already baffled the perfevering efforts of medical practitioners ; no confiderable relief was expefted for them, much lefs a cure. They are not to be considered as tak- en promiScuoufly from the main body, but as be- ) longing to the forlorn hope, of the confurnptive. I expefted to hear complaints of difagreeablc Smells from the iron ftove •, and had this been the cafe, I fhould have recommended rufting the out- fide by a weak acid, by which I fhould have expect- ed to correct, in part, the unpleafant effeft arifing from the gas given out by caft iron at a low tem- perature. For the prevention of the Smell arifing from combuftible particles that are apt to fettle up- on the ftove, preventing their accumulation feems • the only effectual means, unlefs a cafe were to be contrived for the body. But thefe inconveniences were not felt. At fo high a temperature, as that to which my patients were continually expoSed, the increafe of heftic fever might be apprehended. But the firft and greateft effect appeared, in moft inftances, to be a reduction of the whole heftic Symptoms. Whether by prevention of the cold fit, the affocia- ted ftates were alfo prevented, as feems to be the cafe in vernal interueittents from the increafing F 2 66 warmth of the feafon, I leave to the decifion of others. In all fituations appropriate meafures fhould be taken to counteract the heftic febrile movements. In the cold fit, where that is diftinft, hot water with fpice and opiates, (as camphorated tinfture of opium) fhould be adminiftered on the very accef- fion. In the hot part of the paroxyfm you fhould have recourfe to "the affufion of tepid water, or to the immerfion of the hands, and feet, when burn- ing, into cold water for a Short time. But where the heat of the body is greater than that of the ex- tremities, it is better to keep the hands and feet warm, and to take fuccefiive draughts of cold wa- ter, or cold faline mixture, in an effervefcent ftate. Small portions of ice cream or water ice, I think preferable. Two teafpoonfuls of ice will often be Sufficient.. The whole of one of the glaffes, ufual- ly fold at the confectioners, is often fufficient to fu- perinduce chillinefs. Unmelted jelly, prepared without wiue, is no contemptible fubftitute for ice. During its folution, it produces the fame effect in an inferior degree. Taken when a patient has felt cold, it has appeared to me to bring on rigors; and, according to a rule of general application, it fliould always be taken warm, when the patient feels cold and vice versa. So true is it, that the mcreft trifle is, in fome conftitutions, fufiicient to turn the balance of action ! 67 According to* my experience, an uncertain ftate of the bowels need not be regarded as an obftacle to the ufe of cold water or ice. Patients have ap- peared never lefs inclined to diarrhoea than during the hot fit; and if care be taken not to reduce them below the natural ftandard, little hazard will be incurred. And I do not perceive, why applying cold externally, fhould be much lefs injurious in this refpeft.* Removal into a colder atmofphere will Subdue the heat of fome fever fits; getting out of bed for a fhort time amounts to the fame thing. Nor is there danger of taking cold, or of any other mif- chief, provided the means of refrigeration be not carried to an extreme. * Probably the tertian type of hectic fever fometimes arife3 from certain accidental coincidences between a chilly ftate and the application of cold, or cold producing means. ON THE FOWER AND AGENCY OF DIGITALIS. J\ LMOST two years ago, in the firft edition of a popular traft, I faid : " //; cafes of pulmonary dif- " eafe, where the prefnce of tubercles was indicated by u every fymptom, and where they feemed ready to break " out into open ulcers, I have verified the efficacy of " digitalis ; and I daily fee many patients advancing (f towards recovery, with fo firm a pace, that I hope t( confumption will henceforward be as regularly cured " by the foxglove, as ague by the Peruvian bark. Could " we obtain a fingle auxiliary for the foxglove, " fuch as we have in many fubitances for. the bark, " I fhould expeft that not one cafe in five would " terminate as ninety-nine in an hundred have " hitherto terminated. But I believe a majority of " cafes will yield to fimple foxglove. It is evident « that no new cafes need be fuffered to advance 7° "' beyond the firft ftage, without the application of " this medicine ; and few into it." Could fre- quency of quotation give importance to the fenti- ments of a medical writer, that part of the preced-- ing paffage which is diftinguifhed by Italics, might, for its ftanding, vie with any aphorifm of Hippo- crates. But it has commonly been mifquoted at Second or third hand, and to this day, in Spite of alteration in a fubfequent edition, it continues-to be held up to public anhnadverfion as a Sally of extravagance. In regard to the frequency of SucceSsful exhibi- tion, the author never dreamt of comparing digi* «] talis to bark. Fie had merely in view the refult of its continued administration, where it does Succeed'; and perceiving that it would have been better to contraft its gradual operation (which alone he then had in view, as is evident from the words "with fo firm a pace," and the whole context) with that of mercury in venereal complaints, (as Somebody, he believes, had done before) he correfted himfelf as Soon, as he had opportunity. The proportion of cures is quire a different point; upon which he exprefies his belief immediately afterwards. And when cafes of tubercular confumption, not advanc- ed to the ulcerative ftage, are comprehended in the account, (a condition which he exprefsly in- cludes in his eftimate) and no peculiar difadvanta- 7i ■■ges of fituation in life counteract the remedy, he Still thinks that he has not overrated its virtues. Within three years I have Seen many Scores of ■phthifical invalids from among the poorer claffes. I have always had, cloSe at hand, a number of op- ulent patients of the fame defcription. Each clafs •has, in faft, lain before me, almoft as conveniently for comparifon, as the objects of his attention lie :before a fchoiar occupied in collating a fet of man- ufcripts. In general, where I had all pofiible evi- dence of the exiftence of tubercles, the exhibition of digitalis has been perfeftly fuccefsful. If I Spe- cify that it has fucceeded in three fuch cafes out of five, I believe I much underrate the proportion of favourable events. With regard to the poor, who apply for relief in ficknefs, there exifts a perpetual caufe of uncertainty. Their attendance Slackens as their health improves; and they are apt to difap- pear upon complete recovery ; nor is it always eafy to find them out by enquiry. In the richer clafs I have found the proportion of' fortunate cafes more confiderable than I have ftated; and where digitalis alone fails, Succefs is fometimes obtained by helps, of which I fhall Speak before quitting the fubjeft. When ulceration has fucceeded to interior dis- organization, the greater difficulty of cure has ap- peared to me very Scrongly marked. Why this 72 fhould be, is eafily comprehended from general • analogy : its full illustration, by tracing the diver- sity of animal aftions Step by ftep, I relinquifh to thofe who may think they nnderftand the nature of phthifical ulceration, and the effeft of the particu- lar fituation which the ulcers occupy. Entire fail- ure has appeared to me, on the one hand, moft fre- quent in the^eedieft poor ; and on the other, in thofe females of higher life, who, from tranfmitted feeblenefs, and the want of air and exercife, of wholefome hunger and digeftion, appear more like the Shadows of human beings, than Substantial compounds of flefh, blood, and bone. And as one mean for the conciliation of contradiftory testi- monies, refpefting the effeft of digitalis in confirm- ed or ulcerated confumption, I adhere to the opin- ion expreffed in the If'tjl-country Contributions, 1799, PP- 534-—S> vu- th-t robuftneSs of constitution is peculiarly Savourable to the action of digitalis in this difeafe. Of this opinion I find the ampleft confirmation in Some reports by other phvficians., and particular- ly in a very interesting paper from Dr. Magennis, of the R. N. Hoipital at Plymouth, containing an ac- count cf Seventy-two caSes o£ incipient or confirmed confumption in Seamen and marines, treated with digitalis. OS theSe it appears that twenty-five, with ulcerated lungs, recovered; and fifteen from the 71 Stage previous to ulceration. Moreover, thirteen of the Seventy-two, in an early ftage of ulceration, were difcharged, greatly relieved ; and nine in the previous ftage. In ten cafes the medicine failed; but in fome of thefe it gave considerable relief. In fome it was continued but from ten days to three weeks; in others a cure feemed nearly cer- tain, but was judged to be prevented by the fetting in of cold weather. So that one is almoft tempt- ed to fuppofe, that by the ufe of auxiliary means, and by fubfequent care, almoft every one of thefe invalids would have been radically cured of phthi- sis. Of the cafes defcribed at large in this paper, fome particulars are very ftriking. J. Smith, for example, is faid to have been "reduced to the " loweft ftate of debility, although twelve months " before of Herculean powers. The moment I " faw this man, I pronounced it a loft cafe." The expeftoration was a pint and a half in twenty-four hours. He had every fymptom of the difeafe "in " its laft and moft aggravated ftage." Yet in a- bout fix weeks he was difcharged, cured. Of James Wallace's recovery, the moft diftftnt hope was not entertained. The phyfician consid- ered him as "m a cadaverous or femiputrefcent " ftate at the commencement." His difeafe feems to have been forming for fome years. He was G 74 recievedinto the hofpital on the 14th of Septem- ber, and difcharged, cured, on the 28th of No- vember following. Of William White, the author afks, " why he " was kept fo long on board Ship, in fuch a deplo- j "rable ftate?" adding, "that Soon after his recep- ' " tion he was invalided as an heftic patient, there " being little hope, at the time, of his ever leaving " the ward in a living ftate." (P. & med. Journ. ■ v. 201. & j-.) Yet this patient recovered. Between feafaring men, and the mafs of phthi- I Sical invalids from families above the neceffity of .1 labour, there is evidently no comparifon in point of I bodily vigour. Again, marines and Sailors have, I I SuppoSe, over the unembodied poor, the advantage i of a better Supply of the neceffaries of life, efpecial- ly in the cannibal times which have been brought i upon this country. In naval hofpitajs they are doubtlefs better attended and better flieltered, than the loweft order in their oftentimes wretched a- bodes. As far, therefore, as thefe fafts admit of any conclufion, I think myfelf juftified in repeating, what I have of late years been conftantly endeav- ouring to enSorce, that as a perSon is more robuft, he will have the better chance not only of efcaping consumption, but alSo of being cured of that dif- eafe by digitalis. I 75 From the cafes which have fallen under my own notice, I fhall Seleft Such as I think remarkable on account of fome circumftance relating to the pa- tient, or the degree of difeafe, or the previous treat- ment. I forbear relating numerous inftances of the power of digitalis in incipient or unconfirmed confumption. The particularly fevere cafe of which I gave an account in the Wefl'-country. Contributions, p. 537, yielded perfeftly to digitalis in tinfture tak- en in water, without an atom of any other drug; and now, at the end of two years, the patient is well. In three young women; I doubted whether the complaint was not chlorofis; but finding prepara- tions of iron aggravate the cough, I prefcribed digitalis with perfeft Succefs. Sometimes I have round lymphatic glands Swollen and fore on the outfide of the thorax, at the time when I judged pulmonary tubercles to exift in an active ftate. The infant boy, (four months old) of Adjutant Sweeting, of the Somerfetfhire Supplementary mi- litia, had been expoSed to Severe cold in travelling. The child, in conSequence, had a cough,( which went on increafing for three weeks before I vifited it. Its mother now complained of its having a fe- vere cough, with wheezing, and regular daily Suc- eeflions of cold, heat, and fweats; and of its not being able .to bear a particular decumbent pofture, without ftrong fits of coughing. She added, that 1 it was fenfibly falling away. The pulSe had an ; immeasurable velocity. The well known exiftence of tubercles in the lungs of infants, and the perfeft regularity of the heftic fever in this child, (a circumftance not be- longing to catarrh) led me to confider this as a cafe j of true phthifis. I advifed tincture of digitalis, in the quantity of half a drop at firft, three times a day ; and as the infant bore this perfeftly well, I doubled the dofe. In four days the heftic fever was diminished ; and in a week the cough had be- come manifeftly lefs violent. The pulSe alSo was greatly reduced. Bilious vomiting was not unffequently produced, as appeared by the medicine; but it did not occa- fion that continuance of deadly ficknefs which adults experience,* for the child's appetite feemed improved in the intervals. The tinfture was of courfe, fufpended when the ficknefs was fevere. In five weeks, under the continuance of this plan, the diforder was removed. At its clofe aph- thae became very troublefome, but difappeared after the application of honey of rofes, with borax. A year afterwards I had an opportunity of learning * Adults, however, will fometimes-eat with appetite between the fits of ficknefs, and even while naufcated by digitalis. 77 that the child had fuffered no relapfe ; and now, at the end of two full years, I have reafon to be- lieve, that it has continued free from pulmonary diforder. Two other children, under a year old, and one of three months, affected with Symptoms exceed- ingly fimilar, have fallen under my care; and equal Succefs attended the fame plan of treatment. G 2 7s DR. BRIGGS's CASE. Paper put into Dr. Beddoes' a And the night of the 19th, was tolerable ; cough- I ed lefs; and though the Shivering came on as uSu- al, upon the whole I felt my Self better. 2oth, Left Slough, and reached Speenhall about * five o'clock, much fatigued. Went to bed imme- diately ; had no cold fit; drank plentifully of fa- line mixture, and had a tolerable night. Pulfe from 115 to 120. 21 ft, Reached Chippenham, much fatigued, and went to bed"; a tolerable 1 night j coughed lefs;, expectoration considerable, I «5 and mixed with blood. 22d, Reached the Hot Wells, went to bed early, much fatigued. Tins day I eat the leg of a chicken, with Something like appetite ; had a good night; drank freely of Saline mixture. 23d, Cough moderate; expefto- ration confiderable, but free from blood; a good night. Monday March 24, called in Dr. Beddoes. When he faw me I was entremely emaciated, and had not the power, for many days previous to his feeing me, of Speaking above a whifper, though my cough and feverifh fymptoms were confiderably abated. No appetite, and great di- minution of Strength. Pulfe between no and 112. Dr. Beddoes advifed not to drink the Hot Well waters. He prefcribed xx drops of tinfture of digitalis three times a day. In lefs than twen- ty-four hours my pulfe was reduced to 85. 25th, Had an uncommon good night ; repeated the draughts, and the pulfe reduced to 75. Cough moderate, and expeftoration Somewhat decreafed 5 quantity of urine increafed confiderably. 26th, Dr. Beddoes difcovered a variablenefi in my pulfe, and repeated the draughts, with cnly ten drops of tinfture of digitalis thrice a day. 27th, Good night, Strength returning^ and appetite increafing; pulfe from 70 to 74 ; repeat draughts as yefterday. 28th, Good night, all Symptoms better than yefter- day; pulSe 6S ; repeat draughts twice a day, with' H 85 tinfture of digitalis drops xiii. 29th, Still improv- ing in every refpeft; continue to expectorate a confiderable quantity oS a thick glary phlegm, with afh coloured Specks ; pulSe 68. 30th, In all re- Spefts as yefterday ; cough entirely fubfided ; re-? peat draughts twice a day. 31ft, Continue getting better ; pulfe 76 ; repeat draughts, with fixteen drops of tinfture of digitalis twice a d^.y. This evening and night I found the pulfe vary confider* ably, but never above 76. Night reftlefs, felt my- felf hot, and much laffitude. April ift, Dr. Bed- does difcovered a variablenefs in the pulfe, and re- duced the tincture of digitalis to gtt viij bis die. 2d, Had a very good night; pulSe between 68 and 74 ; repeat draughts twice a day. This day being very mild, walked on the terrace for a few minutes* and enjoyed the frefh air the firft time Since the 4th of March. 3d, Entirely free of cough ; ex- peftoration more moderate, though ftill glary, with afh coloured Specks ; pulfe between 64 and 70 Sleep uncommonly well ; eat heartily of any thing three times a day; repeat medicines as yefterday. 4th, Mending Slowly ; repeat medicines ; pulfe about 70. 5th, Ditto. 6th, Ditto. 7th, Repeat medicines, with tinfture of digitalis drops vj twice. a day. 8th, Repeat medicines, with tinfture of digitalis drops x twice a day; pulfe about 74 ; take exerciSe when the weather permits. 9th, rulfe re- 8; duced to 60 ; repeat medicines, with eight drop3- twice. 1 ith, Repeat medicine, with drops ix twice. I2thj Ditto. 13th, Pulfe as low as C5 ; omit me- dicine. 14th, Pulfe 74 ; x drops twice ; Strength returning, and appetite good. 15th, Walked up to Clifton, morning ; and evening returned tired in the legs, breathing quite free; expeftoration very moderate ; pulfe 70. After returning from my walk in the evening, pulfe increafed to 88 : remain- quiet on the fofa for an hour, it fell to 74. Re- peat medicines. 16th, Repeat medicines, wiih eight drops. 17th, Ditto. 18th, Ditto. 19th, Ditto. 20th, Ditto. I now considered myfelf ;is perfectly recovered : every hour increasing in Strength and fiefh. I continued the medicines Sor at leaft two months, and repeated them at an inter- val of two months for twenty-five or thirty days, then defifted two months, and repeatad the digita- lis again. In the month oS February, 1801, 1 caught cold, and a violent cough was the conSe- quence. It increaSed for eight or nine days, and was attended with violent fpafmedic affection of the diaphragm. I again had recourfe to the digi- talis, in quantity' two grains a day. In two or three days the fpafmodic affection ceafed, and the cough, in a very few days, entirely left me. Notwith- ftanding which, I continued the ufe of the digitalis for more than a month. I am now as ftrong, ftout 88 and healthy as ever I was. I am fully pcrfuaded that I owe my recovery to the digitalis, on both occafions. I fhall ever gratefully acknowledge my- felf indebted to Dr. Beddoes, for his advice and unremitting attention to me during my fevere ilk nefs. JOFIN BRIGGS, M. D.. Bath, April n,. i So i. I do not know whether there will be any differ- ence of opinion with regard to the title to which the preceding fymptoms ought, to be referred., I cannot conceive fo much pain and fever without. diforganization ; and, probably, tubercles had formed, or were forming. The cafe would furely have run on to a fatal termination; for that alle- viation which the journey produced, could not pof- fibly, I believe, have been permanent; and it was no more than often takes place, after, a journey, in ■ the moft confirmed and moft diftinft cafes * of tu- I bercular phthifis. Dr. Briggs's report fufficiently. announces the prefence of cough, pain in the cheft, 1 hemorrhage, breathleffnefs, and heftic fever, with * I have often availed myfelf of this fact. Airings produce little or no advantage ; but fome patients, by being made to travel as many miles every d:.y as if they were on a journey, efcape, in great meafure, the cough and nedtic fever. 89 expeftoration. And this expeftoration certainly appeared to me of a very fufpicious nature. The danger of a return of hemorrhage was, I underftand, infifted upon, as an objeftion to Dr. Briggs's removal from town. I believe fuch objec- tion to be totally unfounded. In hsemoptyfis and pulmonary haemorrhages, I never obferved any bad confequence from travelling in a carriage : on the contrary, I have repeatedly known thefe difcharg- es to flop on a journey, though previoufly they had, for many days, occurred at leaft once in twen- ty-four hours. MR. CHARLES TORIN, JET. 22, OF a thin habit and dark complexion, with dark hair, after fpitting blood, was troubled with cough, purulent expectoration, chills, heats, and night Sweats, with difficulty of lying down on one fide, and a pulfe at 112: he had loft flefh and Strength progreffively. Before coming to the Flot Wells, in January, 1800, he had been under the care of a very fafh- ionable phyfician, by whom he was kept on the moft Slender diet, and by whoSe order I underftood H 2 90 him to have taken acid and neutral Saline medi- ' cines, without any benefit whatever. After exam- ination of a patient fd far reduced, in whofe family alfo the difeafe under which he laboured had com- mitted great ravages, I conceived very flight hopes of fuccefs. The tincture of digitalis was however i prefcribed, and perfevered in, with variations of the dofe, very nearly the fame as in the preceding ■. cafe. Opium was alfo given, in about the quantity of a grain at night. The fymptoms, in a fortnight, were fenfibry lefs fevere ; the heftic fever, Soon afterwards was en- tirely removed. In fix weeks Mr. Charles Torin left the Hot Wells, nearly reftored to his natural ftrength, and, with no Symptom of his former complaint, except a little expeftoration. This, on continuing the di-. gitalis two months longer, gave way. At the end of above a twelvemonth I faw my patient, perfectly well; and in this ftate he failed for the Eaft-Indies about a month ago. MRS. J. OF HARLEY-STREET, LONDON, OF Slender make, with brown hair and eyes, was {sized with a difcharge of blood from the lungs ; after which, notwithftanding bloodletting. 9i, and other m°ans, flie had a continued coughi with heftic fever, breathleffnefs, purulent expeftoration^ lofs of flefh and ftrength. In this ftate flie con- tinued for four months, under.the care of a very fafh'ionable phyfician in London, by whom repeat- ed fmall bleedings, and a Strictly abftemious diet, with many medicines, were ordered. Mrs. J. continued all this time in a ftate of mif- erable languor, her difeafe making fenfible progreSss At laft flie was Sent.to the Hot Wells. Here, on a return of, the pulmonary haemor- rhage, to the amount of about three ounces, I found her (in the laft week of April, 1799) '*n t^ie ^ ftage of confumption, her feet having become cedeT mat-ous. The tinfture of digitalis was ordered; fhe took it, under my infpeftion, in dofes of from five to ten drops, and the difeafe gradually decreafed. In five weeks-Mrs. J. was no longer heftic. Of the complaints under which I originally found her la- bouring, there remained only a Slight cough, with a Small, degree of expeftoration, ftill apparently pu- rulent. In a Short time She left the Hot Wells, in a ftate of rapid convalefcence; and continuing the digitalis, recovered. a tolerable fhare of health. During that unfavourable Summer (1799) and the enfuing winter, fhe took frequent colds, which, under the ufe of digitalis, went off without Serious damage. In the hot weather of 1800, fhe had a flight re- turn of pulmonary haemorrhage, and had recourfe to the digitalis. No bad confequences followed. In March, 1801, fhe has had a very fevere ca- tarrh ; but it has gone off without more injury than would have taken place in a perfon not pre- viously phthifical. This day, April 27, 1801, at the end of two years, I have had an interview with Mrs. J. and I can difcover no veftige of a ferious pulmonary ail- ment. There is, occafionally, a morning Secretion of phlegm, among which are interfperfed dark Specks, fuch as we frequently fee when the glands of the mucous membrane fecrete more than its lymphatics abforb. Mrs. J. herfelf is of opinion, that her health and ftrength have regularly improv- ed upon the whole, Since Spring, 1799. In the reports of phyficians concerning difeafes of long continuance, it is a common fault that they drop the Story too Soon, leaving the intelligent reader uncertain whether the long eftabiiShed hab- its of morbid aftion may not have returned after the apparent recovery. I have kept a watchful eye ■ over a variety of invalids, and I could relate a number of inftances where fucrefs has been as ftriking and as permanent as in thofe immediately preceding. In delicate young women, affected: 93 with- tubercles not ulcerated, where my advice to continue the remedy, with occafional intervals, for fome months after the removal of the fymptoms, has been? neglefted, I have known relapfes happen. But health has always been reftored by the Same means ; and the diSorder, as far as I yet know, finally fub-. dued. Vigilance and exertion on a juft alarm, are never more neceffary than after recovery from any fort of phthifical ailment. In the preceding cafes, I not only permitted but- enjoined a full diet. It gave me the greateft fatis- faftion, to hear from my patients, that they relifli- ed animal food twice a day, or once in the day and" once in the night. The principle upon which t have advifed this regimen is very fimple. Since digitalis fucceeds worft with the puny and the ne-, ceflitous, and beft with the robuft and the well fed, I conceived that a generous diet, by bringing the constitution- towards the moft favourable State, would give the greateft chance of recovery. I fup-. pofed alfo, that Simply tuberculated and tubercu- lato ulcerated lungs, are in a condition, analogous, to other parts affefted with ftrophula. As to the precautions which we find recommended on ac-. count of the ftrufture and Situation of the lungs, experience feems to me to Shew, that they are high- ly exaggerated, at lsaft, if not. altogether chimeric cal. In addition to animal food, I often allowed 94 fermented liquors, but under certain limitations; If any particular fermented liquor, or if all kinds, produced coughing and heat of the fkin, they were' prohibited. I alfo recommended wine, (or wine and water) at any time rather than after a full meal. A full meal generally produces conftitution- al afticn enough, or more than enough, in which- latter cafe, the quantity of food taken at one time fliould be diminished. In the forepart of the day languor and coldnefs will often occur, efpecially where an invalid fafts too long, and then vinous liquor may be taken with advantage.. There are* however, I apprehend, ftates of inci- pient phthifis, in which pneumonic inflammation coincides with the formation or progrefs of tuber- cles. In thefe ftates, the lefs fevere pneumonia of weak fubjefts lays the foundation for flow tubercu- lar confumption, juft as pneumonia, in its more: violent form, terminates, when ill treated, in con- fumption with large, quickly fuppurating abfceffes. Where fuch a complication as that above mention- ed, exifts, low living feems indifpenfable, and ought* to be perfevered in till that inflammatory aftion, which does not necefTarily precede confumption, ceafes, but no longer. The following curious cafe is one in which I fhould confider a ftrift regimen as effential, even abstractedly from any affection of the.liver. It was 95 laid before me In thefe terms, by Mr. Yonge, Sur* ,geon at Shifnal, Shropshire.. " I write to requeft your advice for----------r, whom I am come here (viz. into Middlefex) to fee. His fituation you will, I hope, be able to under- ftand from the following narrative. I muft firft in- form you, that two years ago the patient Suffered un- der an attack fomewhat fimilar to the prefent. He was left by it in a heftic ftate, lefs fevere than that which he at prefent labours under. This (Feb. 19, 1801) is the twenty-fifth day fince his difeafe com- menced with fymptoms of common catarrhal fe- ver, not particularly violent. Under the treat- ment adopted they did not fubfide, nor much in- creaSe, during the firft week. The cough was not fevere, but, as he Says,fliort and frequent in the begin- ning, and the breathing contracted. He was not bled, •On Sunday, the eighteenth day, I arrived here, when the patient was in the Sollowing fituation x PulSe 108 ; Skin hot and dry ; tongue oS a brown colour along the centre, but yellow about the edges; urine rather high coloured ; countenance aduft, and his features contrafted ; Short though not frequent cough, but the refpiration quick, and performed within very narrow limits : yet he was at the fame time, able to refpire fully, and without pain. He was then (and had been almoft from the commencement of his difeaSe) accuftomed I 95 to have two or three pui-ging ftools every day and 1 night, very bilious and oftenfive. -His ftrength very \ much impaired, and his flefh waSted. In Short, he 1 appeared under circumftances which very com- g| monly attend fevers of the low kind, and for which, I believe,*this had been miftaken, bark hav- ing been tried, with opium, wine, &c.; and in- deed one very deceitful fymptom occurred, in the *- 1 courfe, and at an early Stage of this difeafe; this | I was a kind of aftion fomewhat refembling fubful-1 tus, but in a greater degree than ever I have Seenf it in typhus ; and the trembling of the hands wasf- So great, that he was unable to carry a teafpoon to | j his month. The circumftances which feemed to, oppofe the idea of its being a low fever, were the abfence of delirium ; the ftrength of the pulfe; regular;exacerbations of the febrile fymptoms, ac^ companied with flufhed Sace and great heat, once i in twelve hours ; and the regular progrefs of the \ bilious Secretion and difcharge, without additional debility. I need not be more particular upon this j part of the progrefs. The difmiffion of wine and opiinh, and the ufe of fmall dofes of calomel, has at once relieved the patient in fome refpefts, and fixed our opinion. The difeafe has certainly, I be- j lieve, been purely inflammatory, and the cheft and liver alone materially affefted ; but the former especially, and thence alone is danger to be appre- hended. 97 'At this time the patient has only one Stool a day, asxi ftill full of frefh bile, and purging. He coughs mere, and expeftorates mucus, with fome appa- k- Ptly purulent matter, and a very flight tinge of blood. The refpiration is ftill Short, but without .ia. .1. Pulfe varying from 108 to 90. He per- ries towards morning and during his fleep; fe- verifh exacerbations, with flufhed Sace, once in twelve hours, and pretty regular ; tongue clearer ; Ik t of the fkin confiderable ; ftrength and appe- tite improving. His State, in Short, if we except ike bilious evacuations, exhibits only decided and lev ere heftic, and impending phthifis. He is at prefent taking one grain of digitalis every eight hours, with ten of myrrh, and faline draughts ev- ery now and then. « W. Y." had nothing to recommend but a ftrift ad- herence to the exhibicion of digitalis, with calo- i, if the Scate of the liver fliould feem to re- quire this, and attention to the heat of the fkin. On the 27th of February I recieved the following intelligence from my friend, Mr. Yonge. •'< On the night of that day on which I wrote h :, our patient had an effufion of arterial blood from his lungs, and another about twelve hours af. crwards, but not more than a table Spoonful in I 93 the whole. I bled him each time, to the amount < of four ounces, and applied a blifter to the Ster- num, where, however, he had no pain or uneafi- nefs. The blood was curled, and with as tough a cruft as I have ever feen. He has been Since going on much better; and, I think, he bids as fair for recovery, as he did at leaft in his former illnefs." A phyfician of great celebrity being now called' in, advifed the repetition of bleeding on any return of the haemorrhage ; but recommended the diScon-. tinuance of the digitalis. But partly from a con-' lideratlon of its effefts in this cafe, and partly from^ my earneft recommendation, this medicine was perfevered in ; " and I think," fays my correfpon* dent, " with advantage. The excefs of bilious fe- 4< cretion has fubfided, and the evacuations are « natural. The patient is yet decidedly heftic; '* but all the Symptoms milder, and the pulSe "» " flower." The patient continued to do well, and in a Sort- night undertook a long journey. " From the ufe " of digitalis alone," fays Mr. Y. « his convalef- " cence was uncommonly rapid ; and as fairly to " be attributed to the remedy as in any cafe I have " ever feen. At the commencement of our jour- " ney he was almoft entirely free from cough ; had " no expeftoration or night Sweats ; Slept Soundly, 99 « and eat heartily. Fie then difcontinued his me- « dicine ; and in the courfe of four days travelling, « inftead of deriving advantage * from the exercife, " he became worfe, inafmuch as the night perfpi- " rations returned, the pulfe quickened, and he " again began to cough and Spit. Since our arrival " he has uSed the digitalis, and is again recover- « ing." In the courSe of five weeks I learned, from the fame authority, that under the ufe of digitalis " the " patient had become wholly free from every fymp- " torn.of difeafe. His pulSe. only continued above " the uSual healthy Standard ; and to a habit of « uncommon irritability alone is this deviation to « be imputed." By ever, lb gradual an increafe, I have feldom been able to carry the dofe beyond fifty drops a day of the Saturated tinfture of digitalis; and pa- tients in a more opulent condition, have, very of- ten indeed, found twenty drops at two dofes as much as could be borne, without oppreflive lan- *In a fubfequent letter Mr. Y. fays, « I dire&ed him to dlf- " continue his medicine, in the expectation that travelling 140 '* miles might fubftitute a new and ufcful action in trie fyftem. " But the event anfwered not my hope; for without any de- " ficiency of ftrength in the patient, or any untoward accident "on the road, he gradually experienced fome return of his " colliquative fweats, cough and expectoration, with great ac- " celeration of his pulfe." ICO guor, fickneSs, head-ache, or Some other difagueea- ble effeft. Befide Mrs. Finch, a lady in the houfe of Peter : Hoare, Efq. of New Park, Somerfetfhire, another in that of Mrs. Bigge, of Benton Hall, Northum- • berland, and feveral other adult patients, have found a Single drop, once, twice, or thrice a day, fufiicient. In the lady at Mr. P. Hoare's five drops at a dofe produced fickneSs, u ithr languor ; while a fingle * drop, taken at moft three times a day, reduced the pulfe from above ioo to the healthy Standard, and \ removed a nervous atrophy. I have known feveral;] perfons bear a teafpoonful of the fame tinfture thrice a day, without inconvenience ; and one individual, affected with quotidian ague, took a hundred drops thrice, and fometimes four times a day, without more effeft than the Spirit might produce in one ; unaccuftomed to fermented liquors. In the Weft-country Contributions, (p. 532) I , have related a cafe, in which the pulfe being at 80, in a fitting pofture and regular, it would, upon the patient lying along the Sofa, foon fall to 60, and J become irregular; inftantly returning to its former j regularity and frequency if the patient fat up again. 1 Of this obfervation I have frequently availed my- 1 felf, to afcertain the firft operation of digitalis on j the fyftem. And where it is defirable to flop Short I of difagreeable feelings,a comparison fhould be made J roi of the ftate of the pulfe in the two poftures. W*e fhall Sometimes find a greater than natural differ- ence in the frequency and ftrength, without irre- gularity. In a child of feven years old I have obServed an inftantaneous change from 130 regular to 70 ir- regular. Dr. Crawford, phyfician at Bath, lately mentioned to me a very ftriking inftance in a per- fon not five feet eight inches high, of a difference of 45 pulfatioiK under the ufe of digitalis, between the decumbent and the fitting poftures.* *' The whole cafe deferves record. It is related in the fol- lowing letter : " The fymptoms under which ray patient, who is a medical man, laboured, were fuch as are generally fuppofed character- ise of hectic fever, viz. increafed frequency of pulfe in the evening, amounting generally to 120 in a minute, attended ■with fits of chillinefs, fucceeded by augmented heat; and as the morning approached, profufe perfpiration. Total want of appetite, and much debility, accompanied the preceding fymp- toms. Thefe complaints were fubfequent to an inflammatory affection of the liver. In this fituation recourfe was had to the digitalis, and with complete fuccefs ; for after taking about twenty-five grains, the patient perceived his fymptoms to yield,, and health was in a fhort time reftored. The circumftance, however, which, during the exhibition of digitalis, more par- ticularly excited our attention, was the remarkable difference in the frequency of the pulfe, between the decumbent and fit- ting pofture. On the fecond morning after the exhibition of the medicine, (two grains having been given the preceding night) the patient was not a little alarmed at finding his pulfe I 2. 102 This, however, is not univerfal. In a medical confumptive patient, five feet nine inches high, (Mr. R. Allen, furgeon of H. M. S. Orion)- the contrary obtains. " There are," he obferves, " two " things about me very odd. The firft is, if at u any time of the day I lie down on a bed, with " my pulfe fo low as 50, it will become full and " increafe to 70 or 75." This aceleratlon may, I fuppofe, be attributed to the particular fituation of fo low as 45 in a minute; on fitting up in bed, however, he was aftonifhed to find it immediately rife to 90. This remark- able difference was obferved for feveral mornings ; but as the fymptotns began to yield, the digitalis ceafed to produce fo much effect upon the pulfe, and the difference -from change of pofture was not noticed. It may be faid, thaj the alarm from the flownefs of the pulfe acted as a ftimulus in producing the increafed frequency when the patient fat up ; buJt that this was not the caufe, is evident from the experiment having been tri- ed with the fame effect, on feveral mornings, when no mental agitation exifted. A fimilar effect, in confequence of the exhi- bition of digit?lis, is, I believe, mentioned in one of the num- bers of the Medical and Phylical Journal. The circumftaace of change of pofture altering the number of pulfations, has, as you well know, been completely afcertained by Dr. MacdoDr ald. In his experiments, as far as I recollect, twenty pulfa- tions were the greateft increafe from the erect pofture; but in the cafe which I have juft mentioned, the effect was almoft double. From the fact which I have mentioned, I think we may draw this practical conclufion, that when we exhibit the foxglove, we ought to attend very minutely to its effects.on the puifc, when the patient is in bed; for if we truft to an exam- to3 Some diforganized part of the lungs. On request- ing farther information, I learned, " that in the " morning, after a whole night's continuance in the de- " cumbent pofture, the pulfe is at itsloweft." It would feem, therefore, that after the parts have accom- modated themfelves to the decumbent pofture, the ufual proportion of aftion occurs. When the mild exhibition of digitalis produces no good effect, and the patient is not greatly re- duced, I" have occafionally found it ufeful to ad- minifter it in naufeating or-in Sickening dofes. In a few cafes the purulent expeftoration has been lefiened at every ficknefs, and under the ufe of in- termediate fmall, dofes has failed to return to its former -quantify.. I have very frequently employed digitalis exter- nally ; but never alone. I am not, therefore, able to fpeak with confidence of the effefts of this man- ner of ufing it. In cafes where the common mode fails, I purpofe to try friction vigoroufly, and hope inatibn after he has. rifen, we may be induced to pufh the me- dicine farther, and by fo doing, run the hazard of finking the pulfe beyond the point compatible with life. " Wifhing you every fuccefs in your unremitting exertioas in the caufe of medical fcience, " I am, &c. &c. « STEWART CRAWFORD. " Bath, April 13, 1801. « To Dr. Beddoes." 104 fometimes to Succeed. I imagine Some analogy' of operation between ficknefs from digitalis and ficknefs from failing. The perfons, in whom I have Seen confumption confiderably mitigated, and the very few whom I have known perfeftly cured, by a fea voyage, have not, any of them, belonged to. the more puny division of the confumptive. And I apprehend delicate females, affefted by this difeafe, rarely experience great relief from fea ficknefs. I do not, however, feel myfelf entitled to advance an opinion on this point. I merely offer a conjecture, principally wifhing to excite the attention of obfervers. On comparing the accounts of failure and fuc- cefs, it may be afked, whether there does not exifi fome different pulmonary complaint, in which foxglove fuc- ceeds, while it fails in true confumption ? The query is too obvious to efcape any one who has opportu- nities of obfervation, and incitements to refleftion. But hefitation in the face of full evidence, is not lefs difcreditable to the judgment, than being pofi- tive without proof; and I do not fcruple to affirm, that the fuppofition of two difrinft fpecies of pul- monary difeafe, having certain fymptoms in com- mon, and hitherto confounded under the name of 'phthifts pulmcnalis, in one only of which digitalis operates as a remedy, is altogether groundlefs. In a variety of SucceSsSul cafes, conformation, habit, 10$ the hiftory of the family, as well as aftual morbid fymptoms, have indicated tubercles * in the lungs* There is alfo a gradation of efficacy of digitalis. It will fometimes mitigate the fymptoms, and near- ly fuipend the difeafe for a time, without ultimate- ly, producing a cure. It is fometimes, as hitherto, adminiftered, altogether inefficacious. When foxglove is deficient in operation, Ihave found the conjunftion of opium in large dofes, of bitters and fquills, powerful auxiliaries. I have often joined with it hyofcyamus and cicuta. Mr. Allen, whom I have already mentioned^ having laboured for fome time under cough, pain of the breaft, expeftoration, andhectic fever, took tinfture of digitalis thrice a day, in dofes, gradu- * I by no means hold t-Aercular and fcrophulous to be iden- tical. In fubjects not only without any mark of fcrophula, but of conftitution totally different from the fcrophulous, I have feen tubercles. From tubercles in the lungs- no age or temperament is exempt, though they do not infeft all alike. In fome fubjects they are probably difperfed, by the benefit of nature, foon after their formation.. In fome they continue al- ways or long quiefcent; in others they run quickly into fup- puration. It is not, perliaps, of fuch mighty confequence whether effufions or preternatural productions, ftimulating to phthifical ulceration, have the tubercular form or not. Per- haps chemiftry, when fo improved as to have juft pretenfions to decide in pathological queftions, will detect as wide differ- ences between tubercles of the lungs, as it has detected be- tween calculi of the urinary bladder, io6 ally Increafed, till he reached twenty-five drops thrice a day. It had no manner of effeft on his pulfe, and did not fenfibly alleviate any one of his fymptoms, the fediment only in the urine totally' difappearing in three days, under its ufe. Mr. Allen then took at my requeft, a teafpoon- ful of the following tinfture : tinfture of columbo, three drachms ; compound t. of cinnamon, two drachms ; of opium, one drachm and a half; add- ing to each dofe three drops of tinfture of fquills for one of digitalis, till he came to half the dofe of digitalis formerly taken alone.. In a week, the dofe of tincture of digitalis being thirteen drops,, and of fquill thirty-nine drops, the pulfe was redu- ced to 50. For further illuftration I add an extract from the journal of a cafe, in which digitalis in Simple tinfture and decoftion, having produced no good' j effeft, the heftic fever, cough, and expeftoration, were gradually diminished, by a more complicated plan of prescription. " September 12. Cough and pulfe much redu- '•■ ced Since the increaSe of the opium. No night j Sweats; expeftoration lefs. To take the two fol- j lowing pills, if the flight naufea of which the pa- j tient complains this morning, goes: entirely off.; Qtherwife only one; 107 R. Pulv : digitalis purpur : gr. |- Opii pur : gr. ifs. Succ: fpiffat: cicutse gr. iv. mut fiant pi- lulae ij. h. fumendae. Sept. 13. P. 68. Scarce any naufea this morn- ing ; and the fame in other refpefts. R. Pulv: digital: purpur : gr. i. Opii pur: gr. ii. Succi cicut: fpiffat: gr. vi. m ut fiant pilulx iij. h. s. fumenda;. R. Pulv : digital: purpur : grfs. Piluke ftyrac. c. gr. iifs. Succi cicut: fpiffat: gr. iv. m ut fiant pilulse iij. crafs mane fumendse. Sept. 14. Expeftoration lefs ; cough little; no night fweat; repeat the morning pills, with a grain of powder of digitalis, at 4 P. M.; and likewife to- morrow morning, if no ficknefs occurs : alfo, at bedtime, with the addition of a grain and a half of opium. Sept. 15. Pulfe 60 ; fome dry heat of the Skin 1, about 7 P. M. No Senfible night perfpiration. Repeat the pills as before, three times a day, add- ing to each dofe two grains of antimonial powder. io8 Sept. i<5. No heat of the fkin yefterday eve- ning. Slight bilious vomiting immediately after awaking this morning, without remaining naufea. P. 44. Expeftoration fenfibly diminished. R. Infus: gentian : compos : Aq:-menth: pip: ana §fs. Tinftur: digital: purpur : gtt. xx. m Capiat dimidiam partem hora quarta pomeridiana : ^alteram eras mane. *R. Pulv: digital: pu-. pur : grfs, Pilul: fciil: Opii pur : ana gr. ij. Succi cicul: fpiffat: gr. vii. m et divide in pilulas iv. h. s. fumendas. Sept. 17. Expectoration not a fourth part of what it was a fortnight ago. P. 58. Cough lit- tle ; no chills, heats or fweats. Can lie, with little inconvenience, on the left fide." I have Seen Several instances, where the fymp- toms oS conSumption having refifted the fulleft courfe of digitalis, yielded to a plan fimilar to thofe exemplified above. When digitalis has failed altogether in incipient confumption, I have occasionally found calomel 109 succeed in a few inftances. The following is one of the moft remarkable : Mifs J. W. fair, puny, narrow chefted and tall, • for fome time complained of a fhort dry cough. She is almoft every evening fenfible of flying chills, iceeded by a hot and parched fkin. In the >rning the cheft is commonly moift. She can- t lie on the right Side without cough and Short- iefs of breath. For Some time before the cough v as noticed, Mifs J. W. was uncommonly languid ud fubjeft to flufhings, especially after dinner. .iiie became out of breath on going up ftairs. Her fiefh has gradually wafte/h She is ftill regu- r; but the catamenia are deficient in quantitv. me parent and two fifters, I am told, have died " mSumptive. After the uSelefs exhibition of digitalis for three weeks, (within which time if this medicine does not produce fome alleviation, it feldom fucceeds at tfl) I determined to make a cautious trial of mer- curials. Their ufe in complaints fomewhat analo- gous, as in enlargement of the mefenteric glands with heftic fever, induced me to expeft benefit in 3 cafe where I perceived heftic fever, and believed pulropnary tubercles to exift. In the objeftions of the older medical writers to mercurials in phthifis, \ could not feel any force. I prefcribed, therefore, half a grain of calomel twice a day, and fometimes K no a grain, when the bowels did not threaten to be- come difordered. In about a fortnight the cough and heftic fever were greatly abated. Perfeverance for another week, with augmented dofes, produced a flight inflammation of the gums ; and now the cough ceafed almoft altogether, and the fever fub- fided. The medicine was continued more Sparing- ly for five weeks longer. The diforder gave way completely ; and during a year and a quarter the \ patient has had no Sign of a relapfe.* * A reiV.lt, as flrikingly oppofite as can be conceived, has lately occurred to me," in the cafe of a lady in the family of Anthony Galwey, Efq. of Carrick Caftle, Ireland. One of her phyficians, Dr. Ryan of Kilkenny, favoured me with the fol- ' lowing hiftory of this lady. " About,a month elapfed from " the time fhe'hegan to cough till it was thought neceffary to " confult me. I found her with a conftant teazing cough, un- u attended by expectoration. Her breathing was opprefredt] " and fhe complained of wheezing: this fvmptom, and the " cough, were much aggravated by lying on one fide in parti- " cuiar. Some perfpiration was perceptible every morning. " Her pulfe was fmall, quick, and hard. It increafed in fre- " quency every evening. All thefe fymptoms fhewing the '• lungs to be materially injured, I had recourfe to all themeth-V * J ii u' ods I have found effectual in preventing the formation of " matter. She was bled in fmall quantities, ?nd had bliflers " applied to different parts of the thorax ; at the fame time be- ■" ing reftricted to a milk and vegetable diet. Still finding the '" alarming fymptoms not likely to yield to this plan exelu- '' lively, I.ordered a medicine, which I have found highly Vr.i- •*' tary in the early ftage of phthifis pulmonalis, and before aft)' Ill F have fometimes given the hydrargyria cum creta, and fometimes the fimple mercurial pill inftead of calomel, without any variation in the effeft. And I have of late often joined one or the other with digitalis.. " pus appears in the expectoration ; I mean mercury. Mrs. "-----—, however, is one of the cafes, in which calomel united. " with opium, camphor and James's powder, has failed. On " this account, and from the increafe of the hectic fever, I am " very apprehenfive that a ftate of purulencry has taken place." Between the date to- which this' account refers, and Mrs. ------'s arrival at the Hot Wells, the difeafe had greatly in- creafed. The hectic fever, particularly its perfpiratcry ftage, had become extremely violent ; the wheezing troublefome ; the breathleffnefs excefhve ; the expectoration purulent, not copious, but moulded into denfe globules; the pulfe 135. I immediately prefcribed digitalis, with a moderate opiate at night; and the pulfe now not being hard, the patient was defired to proceed, by quick gradations, to a full diet of animal food. In about nine days the pulfe had funk to the natural ftandard; and in double that time, the night perfpirations Were all that remained of the hectic fever: pulfe fubfided ; and in fix weeks, of a courfe, in which the digitalis was man- aged fo as to keep below an operative dofe, and indeed never exceeded thirty-fix drops in twenty-four hours, they nearly difappeared. It took near four months to put an end to the wheezing and purulent expectoration, and to enable the pa- tient to lie comfortably on the left fide. The patient has now recovered her flefh, and is as near well as pofhble; but the digitalis will be continued fome time. During the laft two months mercurials have been added to digitalis, to expedite the cure; but as they very fcon difturbed the bowels, they have always been foon dropped. 113 There Is a ftate of confirmed confumption, in which, if an auxiliary to digitalis of given opera- tion could be difcovered, fome lives would be Sav- ed. The ftate I allude to- is of this nature. In Some instances, when the foxglove has removed the heftic fever, and greatly reduced the expeftoration and cough, the decline fhall become almoft imper- ceptible ; the patient frequently appearing chlo- rotic,* but being really phthifical, as the event moft commonly, and fometimes diffeftion has evin- ced. During this almoft ftationary period, the or- gans of fanguification appear inert; and the deficient \ production of blood (into which the chyle is pro- bably converted in the lungs). Sufficiently accounts. for that confumption of the body which denominates the diforder. This defeft of fanguification ex- > plains the emaciating procefs, when there is no ex- | cefs of action either in the capillaries or other parts. I of the vafcular fyftem, nor any apparent drain or elfe lefs evacuation than exifts in cafes where there * In young tcdies chlorous is too apt to be fucceeded by con- fumption. It wo aid fave fome difgraeeful, and what is worfe, f fome fatal miftakes, if the chance of this fucceflion were kept in view. However convinced that the prefent fymptoms may be referred to chlorofis, the phyficiaq fnould take care how *M he pronounces the cl-fl nifoLtely fo.ft. It is not difficult to enun- tiate an opinion, fo as to induce the friends of a patient not to | withdraw their folicitude altogether, till the danger of pulmtv nary complaint vanilhes. JI3 is no emaciation. Thofe principles which enter into new combinations during mufcular contrac- tion, being derived from the blood, and blood not being formed in fufficient quantity, the fubftance of the body will be wafted by the mere vitil move- ments". Neither will the fat be replaced as faft as it'is abforbed ; and fo of other parts. In phthi- fical children, where the attraftions on which growth (or longitudinal extenfion of parts) de- pends, do not ceafe, though probably folids very different in constitution from the healthy folids are formed, it fhould feem that emaciation ought to go on with peculiar rapidity, if other circum- ftances were alike. In the fituation above mentioned, the conjunc- tion of preparations of iron with digitalis is a very obvious idea. I fhall not aflert that fuch combi- nation is abfolutely unavailing ; but in feveral in- stances in which I haye tried it, I have not Seen decifive good effefts. Perhaps, hi the deScribed condition oS the Syftem, chalybeates do not excite - the uninjured parts of the lungs to increafed acti- vity in forming blood, which feems the procefs wanted. Perhaps warmth, or air impregnated with- Stimulating particles, may anfwer; and with the- chance of preventing feverifhnefs by digitalis, oxy- gen gas I think deferves a trial. In one well mark- ed inftance of the chlorziic variety of confumption K 2 ii4 arrefted by digitalis, where chalybeates proved in no degree ferviceable, I wiflied to put the powers of oxygen to the teft. But the too great refigna- tion of the patient to her fate, and the want of zeal in her friends, fruftrated the defign. Under the almoft total fufpenfion of phthifieai difeafe in another patient, to whom I mentioned the refpiration of oxygen and travelling,* as two •. poffiole means of determining the lungs to more vigorous aftion, the latter was preferred. I may , hereafter be able to fpeak of the power of. oxygen from experience. Mode in which digitalis operates. * J OF the medical cyclopaedia, imperfeft as it is ■ throughout, no department has, I think, been {6 | unfuccefsfully laboured, as that to which the pre- j. Sent head belongs. „ The treatment of particular articles has appear- ed to me as little philofophical as the arrangement I of the whole ; nor have I been able to contemplate* j without difmay, either the barren wafte prefented ■ by many extenfive treatifes, or the holt of partici- * This is the only conjecture concerning the manner in which change of air acts, in which, after much confideration, J I can acquiefce. Change of air operates in no complaint with ■ more certain advantage than in chin cough. This fact points I directly to an alteration upon the organ immediately difeaftd. ■ "5 pies, of which language has been plundered, to perplex the maieriamedica. I will not prefume t9 fay, that no dexterity has been Shewn in that Shuffling and cutting, of terms- which has employ- ed, fo many hands; but I cannot perceive what great winnings it has brought home to ftudents, or practitioners of phytic. The moft profitable courfe, in my opinion, would be to fettle in what a knowledge of the op- eration of any medicine may confift ; and then to compare this idea with our aftual attainments. At preSent I can only enuntiate an opinion, rer Serving full difcuflicn to a future occafion. To whatever organ medicinal application is made, I confider the applied. fubftance as- a chemical com* pound. The organs themfelves I confider like- wife as chemical compounds, extremely variable, and of a peculiar nature for. the time being. We know that certain changes in thofe organic com- pounds, which are firft affefted, will produce Suc- ceflive changes in connected parts, till perhaps the whole Srame undergoes a change in its compofir tion, and. consequently in its aftions. Some ef- fefts of thefe changes will be manifeft; others more obfcure; and others not afcertainable by any of our prefent methods of obfervation. There is nothing in all this peculiar to the belng3 which we ufually denominate organized. Altera* n6 tions in any body will produce alterations in a feries of adjacent bodies to an indefinite extent. The changes produced by the burning of a candle, may be traced far into the fublunary fyftem; and by help of pretty clofe analogies, they may i be purfued into a more remote region of the uni- verfe. In organized bodies, if fecondary effefts are more hidden or more fenfible than in moft others, this is owing to the clofe conneftion of their members, and' to the eafily variable conftitu- tion of each member. By virtue of their connec- tion, the members of the galvanic piles, at prefent known, feem to influence one another as readily i as the bodily organs ; but being fimilarly conftitu- 1 ted, there is prefented no diverfity but in the de- gree of operation. J The fyftem here Sketched, I know, cannot be rigoroufly demonstrated. He who pretends to de- I monftrate it, muft come provided with a complete 1 lift of the principles of organic bodies, and this is but the firft ftep. But it does not, like the un- 1 proved and unneceffary hypothefis of a vital princi- ple, run counter to the moft accepted rule of phi- 1 lofophizing. It is a fyftem in which the perfons- of reflection muft, to a certain degree, acquiefce; becaufe, by giving an idea of the immenfe difficul- ties that Stand between us and the philofophy of organized beings, it accounts for .the nonexistence j 117 of meclical fcience. Nor is this all: it confers in- eftimable advantages in the practice of medicine. For muft it not be impoffible for the phyfician who, in the true fenfe of his ignorance, has prof- trated his underftanding, with a kind of religious awe, before the vast unknown that refides in the fanftuary of living nature, muft it not be impofli- ble for a mind fo tutored to difcard, unexamined, any instrument of healing ? Such a mind.bids fair, * likewife, to be always fertile in refources. Where- > as the flave of routine and falfe fyftem will contin- ually be in danger, either of blindly overlooking, or ftupidly rejecting the means that would mofo effectually relieve thofe who are crying out to him for help. i According to the above principle, the inventory of our data towards eftimating the aftion of medi- cinal fubftances, is foon. taken. It is confeffed that their intricate constitution, in fcarce any inftance,. lias been unravelled. This is probably the cafe I with all, even metallic preparations, in their rela- \ tion to the animal economy.. Again, we can fcarce be faid" to have advanced a I ftep in vital chemiftry. We are not acquainted with the conftitution cf any one organ in any one of its conditions. We know nothing of the differ- } ence between the feveral conditions compatible with \ life. How, therefore, the recipient and the re- nS ceived body modify each other in the firft inftance,, , remains a perfeft myftery. Nor are we better in- formed as to many of the confequences of the pri- mary modifications. Of fome, our fenfes may oc- casionally inform us; and would inform us of more if they were more affiduoufly and advantageoufly applied. But we fhall moft grofsly deceive our-- felves, if we imagine that fuch obfervations as we: at prefent take, can ever amount to a theory or- - fyftematical body of facts.. They are, perhaps, al- ways remote effefts, and therefore, relatively to us,, uncertain; the more remote, the more uncertain;. becaufe, of.the parts progreffively affefted, if any- one, unknown to the obferver, be in a different ftate at; different times, or in different perfons, the effeft that has previoufly taken place, and is again M expefted, may fail to appear. Our judgment, how- | ever, refpefting the character of medical agents 1 muft abide by effefts, thus remote and uncertain. m The State of the pulfe confequent upon the re- I ception of a given fubftance into the ftomach, is j one of the effefts of which I am fpeaking. How then is the pulfe affefted by digitalis in determi- nate circumftances ? In endeavouing to afcertain 1 this, I did not affume, and have always been far from affuming, the Brunonlan principles. I was prepared to perceive an inferior aftion, without the intervention of. a greater of any kind, and indepen- ii9 - CASE II.. \ JVllSS M. S-----, daughter of a late chief ma- giftrate in a neighbouring great city, afforded a ve- ry ftriking inftance of the power of the muriate of ^ lime, and excited the moft melancholy reflections concerning the fate of children, entrusted, as they ; moftly are, to thofe inferior bufy practitioners of medicine, who have neither information concern- ing improvements in that art, nor power of reflec- tion enough to correct themfelves, by dint of their 3 own frequent and deftruftive errors. This young lady, aged. 13, had a very dilated pupil and Slender make, in addition to perfonal ap- pearances, nearly the fame as thofe mentioned in- the laft cafe. I found her with unequally protu- berant belly, which became remarkably large, as ^ well as tenfe in the evening ; flie had wafted limbs,. frequent loofe ftools, hectic fever, feet oedematous at night, Short cough, and difficult refpiration. She had been under the care of a fafhionable( apothecary, who had condemned. her to a diet Strictly vegetable. He had lately propoSed—I can affure the Sceptical reader, that the family confifts oS perSons of the faireft reputation, who all agreed. in afferting, that this Achilles of an. apothecary 141 had propofed—to fubjeft a patient fo extremely reduced, labouring under fo well marked a difeafe of debility, to a fmall bleeding, in order that he might fee if her blood were inflamed! I was in time to arreft the deadly Stroke of the lancet. In three days after beginning to take twenty drops of muriate of lime, which dofe was gradu- ally raifed to Sixty drops, the purging ceafed. The appetite for animal food foon became ftrong, but natural. In nine days the feet ceafed to fwell; the heftic fymptoms decreafed ; the cough difap- peared in the courfe of the third week. In five weeks the forearm, accurately meafured round the thickeft part, had^ gained full three quarters of an inch; and. at the end of the fixth week no ap- pearance of difeafe remained. In cafes like this, the cure of the diforder has not been the only refult of the treatment. By perfevering in the ufe of the medicine for Some months, and by a full diet of animal food, the conftitution has become far more robuft than it probably ever would have been in the natural courfe of things, if no fuch fevere diforder. had occurred. 142 CASE III.. J\ BOY, of eleven years, with a very fcrophu- lous afpeft, was brought to me._ I.found his Sub- maxillary glands enlarged.. The mufcular debili- ty, under a florid appearance, was exceflive. He could not lift a.weight at arm's length, which in a healthy bGy of. eight years, did not require an ef- fort. On placing him upon his hands and knees, and then laying a load of twenty pounds, with a broad, bafe, upon his loins, he complained of pain.. A two months courfe of muriate of lime, to which, as in other cafes, a few drops of muriatic acid were added, to make it more palatable, ef- fefted a reduction of the fwoln glands, rendered. his flefh firm, and enabled him to Support infinite- ly more exertion without fatigue. He could now bear Seventy pounds upon his loins, without any. inconvenience ; and I did not wifh to load him to the. extent of his ability. *43 CASE IV. 1_jAST fpring a young lady was placed under my care, on examining whofe fituation I was ftruck with defpondency. The intelligent reader will per- ceive from theSubSequent account, for the firft part •of which I am indebted to the father of my patient, Thomas Jolines, Efq. M. P. of Hafod, Cardigan- Shire, that I had ample caufe for this feeling. " 1795. M. J. had a worm complaint. The '*' apothecary destroyed the worms, but was Said to 1 ■** have left their exuvise behind, probably from \ " want of purging phyfic. " 1796. In the fpring carried her to London 3 1 " put her under Dr. P----'s care. He gave her " very ftrong calomel medicines, which carried , " away every thing. On her return, her aunt Eli- " za perceived fhe could not walk fo well as ufual." " In September, Mrs. "H. William's maid per- ! « ceived a distortion of the Spine. I was at Car- « digan aSSizes. On my return Sent for Dr. Davies. I " He faid there had been difcovered a cure by L '" Pott, viz. fetons or iffues.in the back. He made " two iffues by the cauftic of lime."' " Dr. Davies faid, Jones's Spinal ftays were good l "" things, and wrote to him for a pair; which, I *< however, were never put on." 1*44 j " Mr. L----, furgeon in London, came to Ab- jj " eryftwkh, from thence here. He approved of ! « the iffues; but faid they muft be enlarged. He " enlarged them with cauftic, fo that each held « nine beans. The patient fuffered .very much. ^ " In the beginning of winter we went to Bath, " where Mr. L----came to fee her twice. He " faid nothing could do but the iffues. She was | " under Mr.----'s fubordinate care at Bath, who * « did not feem to think flie was going on well, yet " did not choofe to fpeak out." " Mr. Earle coming to Bath, he was confulted, ' "and faid every thing was going on well; though " to all our eyes flie feemed very indifferent." " Mr. L---- came again before we left Bath, « and laughed at the idea of Jones' ftays ; Said the "Sea-bathing would effectually cure her, and or- . " dered her to be plunged in, the firft warm day " after our arrival." " 1796. In the Summer we came to Abcryft- " with, and the Sea-bathing made her So very ill " and infirm, that on Dr. Davies being called in, " he declared that Jones muft be immediately Sent " Sor. He was So, and his ftays had not been put- *| " on an hour before flie could walk ; though be- " fore her legs were ufeleSs, and So inSenfible, that « to all appearance a paralytic affeftion had Seized " on them. *4S « 179.7. We returned to Hafod in the autumn. " We continued here, attended by Dr. Davies ; " but in the fpring a Swelling appeared, which all u the learned declared to be a Pfoas abfcefs, nay a " Surgeon wanted to open it direftly. But Dr. J. " E. Smith being here would have Dr. Davies " Sent for, and he would have Mr. Abernethy " come here^. He did fo, declared it a Pfoas ab- " fcefs, that was not yet ripe, but would be fo in " two months; when he would return." " All this year we continued very uneafy about- " this abfcefs." " 1798. Remained at Hafod, with various " hopes and fears. This abfcefs was difperfed, con- " trary to the declared opinion of-------■—, who " Sad it was impoffible. " Don't let law claim alone a glorious uncertain- " ty. " 1799. At Hafod, fometimes better, at others " worfe. Attended, however, by Jones with his " ftays, this as well as the fucceeding year." " 1800. Early in the year a fortunate pleuritic " fever feized her, which drove us to Briftol. The « reft you know; and thanks to you, under a moft " merciful Providence, flie is reftored." « T. J. " Hafod, M*y, i8o£." N 146 When I Saw MiSs J. I found, befides the curva- ture, a lymphatic gland in the arm, and a Submax- illary gland in Suppuration. The Strength was ex- ceffively reduced. At HaSod, I was told, She had not been able of late to come down to dinner once a month. The pulfe was 120. She had chills, heats, and regular night perfpirations. A Short dry cough was Sometimes heard; and upon the fmalleft exertion, and Sometimes without -this cauSe, difficulty of refpiration Supervened, So Severe, that I apprehended immediate diffolution. I conclud- ed, from inquiry into all the circumftances, that the chief caufe of this alarming dyfpnoea was the debility of the mufcles, concerned in refpiration. I fufpefted tubercles alfo. I knew nothing which I could oppofe to this formidable complaint with fo good a chance of fuc- cefs as the muriate of lime. I prefcribed it with fmall hope ; and when, in the courfe of three weeks, the family declared that every thing in Mifs J's manner indicated amendment, the continuance of almoit all the Symptoms, except the alarming his of breathleffneSs and the extreme debility, deter- red me from Sanctioning this opinion. But when, in about a month, I Saw that the ulcerated glands had healed, that the difficult breathing occurred no more, that there was a Senfible acceflion oS flefh and ftrength, I could not hefitate to believe, that '47 I" the morbid ftate of the fyftem had been Somewhat \ corrected. I Befides the muriate of lime, {about a drachm t thrice a day, in water, either acidulated with mu- riatic acid, or in weak infufion of columbo) Mifs J. took a few dofes occasionally, when opprefled by difficulty of breathing, of compound Spirit of eith- er, with camphorated tinfture of opium. One day only I ordered a few drops of tinfture of digitalis; | but on the occurrence of Some unfe.vourable appear- • , ances, probably not owing to digitalis, I relinquish- li ed that medicine. In fix weeks the change for the better, ir.fenfible V, ° V as it had been from day to day, became very Strik- ing upon the whole. Mifs J. walked up and down from Clifton to the Hot Wells, without incon- I venience. The pulfe had become from twelve to twenty Strokes in a minute lefs frequent than at | firft. The heftic fever was reduced to a flight Bioifture oft the fkin towards morning. The medicine, for the fake cf Security, h*s been [' continued, except for a few days at a time, above I a twelvemonth ; and there was a conftant improve- ment, till full health feemed reftored. No inter- ruption took place, except in December, from a few fevere fits of nervous head-ache, which had probably no conneftion with the other complaint, and feemed to be removed, either by the mineral 148 folution, or by a Sternutatory, to both of which re- courfe was had at the fame time. When the amendment was well afcertained and Steadily proceeding, it occurred to me that the cure might be expedited, by the external uSe of the muriate; and accordingly a bath for the feet and legs, confifting of a pint of that fait, and about three gallons of warm water, was ufed once a day, ?, for half an hour, for fome time. It is intended to perfevere in the ufe of the mu- riate for a confiderable time, but with longer in- $ tervals. No medicine has ever Shewn greater ef- ficacy ; and whatever power the muriate of lime may poffefs to improve the constitution, the patient will have the benefit of it. We cannot forget how liable females of this temperament are to pulmona- ry comphints. And though we hope that in the prefent inftance there is now no more than a com- mon rifk of confumption, yet, becaufe Some Signs of pulmonary tubercles appeared laft fpring, as well as in purluance of a general principle, we fhall not for a moment, relax our vigilance, in guarding againft fo great a difafter. This cafe, befides furnifliing evidence for a par- ticular medicine, appears to me to afford two or three inftruftive leffons. I. The recommendation of the cauftics was un- doubtedly proper j and had I been confulted I i 149 Should have thought it unjuftifiable, even though fully aware of the virtues of the calx muriata, not to have concurred in this propofal. It was alfo, I think, perfectly reafonable to enlarge them. But they were, in my opinion, moft injudicioufly per- fevered in. The pain and irritation they continu- ed to produce have left an almoft indelible impref- fion upon the imagination of the patient. As foon as I had acquired confidence in my own reafonings concerning thefe difcharges in the cafe 1 before me, I directed that what remained of them 1 might be dried up : from which no inconvenience | has refulted. Indeed, without waiting till 1800, from 1795 to 1797, might be deemed a trial long enough to give conviftion of their inutility. And I if it be allowed that they were fully tried, and found ufelefs, (for it would be too much to give them credit for curing the fuppofed lumbar abfcefs, Since they could not prevent it) the fact prefents an unanfwerable argument in favour of the opinion, that difference of refult in the treatment of the fick, often depends upon difference of fufceptibility and of affociation. The nature of the complaint ! was here too palpable to leave a doubt in the mind \ of any perfon converfant in Such Subjects. The [ difficulty of applying the diagnoftics of nofology is I fmall indeed, in compariSon with the difficulty of" divining fufceptibility, and developing affociations !: f N 2 15o If I might prefume to advife So ingenious and ufe- ful a body of men as the praftitioners of furgery, I would, above all things, recommend it to them to have regard to the eompafs and variety of nature, as manifefted in the human conftitution. Other- wife they will fometimes find themfelves in the con- dition of ignorant and impatient children, whofe meddling hands having deranged a curious piece of art, are next employed in trying to reftify it. So on they pufh with main force in one direftion, till it breaks. Whereas, had its conftruftion been humoured, a touch would have put it to rights. II. I hope that the deplorable effeft of the rafh prefcription of cold bathing, will not be loft upon the givers and receivers of medical advice. Noth- ing is fo dangerous to young weak perfons, labour* ing under glandular complaints or threatened with confumption. By what I have formerly faid againft this baneful practice, fome mifery has been preven- ted in the world ; and I have fince received ample proofs of the propriety of my doftrine. The following obfervation comes from a medical confumptive patient, by whom I have lately been applied to refpefting his health : " it is extremely » odd, that it Should never have ftruck me to men- " tion, in the original Statement of my fymptoms, " that previous to my firft attack, laft autumn, I « had bathed in Silt water for weeks. And from *5* «' my feelings, compared with your remarks on the " cold bath, I am Satisfied, that had I not done fo, M I fhould have enjoyed a ftate of health very dif- " ferent fr,om, what I now do." III. Medical men often afcribe an effect to a combination of caufes, and often, perhaps, miftak- enly. The paralyfis, however, of the lower extre- mities, fo quickly fubfequent to fearbathing, clear- ly fhews, that the torpor from the cold water ena- bled the preffure from diforganization to do that to which the latter caufe alone was inadequate. Again, when the preffure was partly removed by the machinej the nervous power returned to the lower limbs. IV. If any one can harbour a doubt concerning the ufe of taking the preffure of the head from off the vertebral column, it will furely be removed by the immediate effeft of the machine, which was So properly recommended in this cafe. 15s CASE V. J OHN POWELL, eight years of age, having loft the fight of one eye entirely, and almoft that of the other, by fcrophulous ophthalmia, was fo re- duced in ftrength as to be unable to ftand without , fupport. In a week after beginning to take twen- ty drops of muriate of lime in fugared water, and raifing the dofe to forty-five drops, he could Stand well without fupport. In three weeks more he has become able to walk a quarter of a mile, with- 5j out inconvenience, and feems rapidly regaining his ftrength. I briefly mention this incomplete cafe, as a proof of the great and rapid effeft of the rem- edy, where the difeafe ftrongly affects the mufcles. In diftinft lumbar abfcefs I have not had an op- portunity to try the calx muriata. But I have feen it anfwer well in large and deep fcrophulous abfceffes, accompanied by heftic fever. My adherence to. a fimple plan has not always- been fo Strict as to exclude calomel, digitalis, and vegetable tonics, as the decoftion of the bark of the broad leaved willow, for inftance, and other drugs. Some of thefe will, doubtlefs, be found to anfwer where the muriate oS lime Sails. But I be- lieve this will be found fuperior to any one of the l53 others ; and indeed, according to my prefent ex- perience, it is of more value than all others put together. Finding effefts fo beneficial from this medicine in fcrophula, it could not efcape me to inquire what would be its ufe in tubercular and in con- firmed confumption. I have paid much attention to this queftion ; and, I think, others will find their account in doing the fame. But before I fpeak at large, I choofe to accumulate more expe- rience with the muriate of lime alone. I think that it removed tubercles, which had formed fub- fequent to the attack of pneumonia in 1800, in the cafe of Mifs Johnes ; and that it produced this effect in the cafe of Mifs S-----, (Cafe II.) I am as certain as I ever was of any change, not im- mediately the objeft of perception. But as the complaint here fpread from the abdomen to the thorax, the tubercles might have been difperfed, in virtue of Sympathy with the mefenteric glands. I have Seen where the difeafed Salivary and lym- phatic glands returned to their natural ftate, un- der the uSe of the calx marietta, while the fymp- toms of confumption came on or increafed. But the fame thing may fometimes be obferved, inde- pendently of any remedy for fcrophula; and this fprins I had a. patient under my care, in whom the Sufferings from enlarged mefenteric glands fubfided *54 repeatedly upon the enlargement of the Salivary glands, and returned upon their detumefcence. The change of Seat of the moft fenfible part of the morbid aftion was as diftinft, though not fo rapid,, as in gout or rheumatifm. In Matter M. Pattifon, aged thirteen, much marked with the fmall-pox, and of fair complex- ion, light hair and eyes, the refpeftive effefts of digitalis and muriate of lime have been remarkable enough to deferve relation, though the cafe is ftill in progrefs. The diforder, I believe, was either occafioned or aggravated by (not merely bathing, but) dabbling long at a time in cold water; of the baneful effefts of which practice upon certain con- stitutions, it were to be wifhed that fchool-mafters were generally apprized. After a gradual falling off in health, M. P. was entrufted to a medical practitioner at Plymouth, to whom I owe the following fatisfaftory ftatement. " October 6, 1800, M. ?. was found to have frequent cough, Short catching breath, pain in the fide, heat and reftleffnefs at night, with perfpira- tion in- the morning. The febrile exacerbations- were ftrongly marked, but not regular in their re- currence ; pulfe feeble, no; pupil dilated; cheeks fubjeft to flufhing. Hence tubercles in the lungs and mefenteric indurations" (from appearances not defcribed) " were apprehended. On the loth of *55 March, after expofure to cold, he was confined to his bed, with a pulSe at 130, and increaSed pein of the fide. He took antimonials, with calomel, and had a blifter on the fide. On the 16th, after a flow of perfpiration, this aeceflion of difeafe left him debilitated, with a pulfe at 120, and a dry hufky cough. Eight drops of tinfture of fo i^love were adminiftered thrice a day, and increafed by the 2 2d to thirteen drops thrice a day, at fliort in- tervals. The pulfe ranged from 55 to 65, but was never ftationary for an hour together.* The heat and thirft were gone. He complained of intoler- able naufea and languor. Thefe went off on fub- ftituting Griffith's mixture for digitalis with wine and animal food. December 24, he pronounced himfelf free from complaint, and his Strength was returning." On going to a different part of the country, he experienced fome return of his complaint. An- other medical practitioner now judged his com- plaint to be tabes mefenterica alone, and no digitalis was given. * In the Weft-country Contributions may be found a nume- rical ftatement of the pulfe, under the full action of digitalis at different times of the day and night. I have fince always found equal variation : fo that what is commonly given as the rate of the pulfe, only holds of a particular part of the day ; or ei - I have met with patients of particular habit, which I do not believe. 156 " In February he returned to Plymouth, with fome degree of his former fymptoms. The digi- talis was given for fix days, with the fame bene- ficial effefts." The digitalis, however, was not at this time per- fevered in, probably on account of its fevere ope- ration. From the 6th to the 14th of March it was refumed, together with pills, confifting of equal portions of kali, myrrh, and vitriolated iron. On the arrival of this patient at the Hot Wells, en the 23d of March, 1801, he was extremely emaciated; too weak to drefs himfelf in a morn- ing, and very languid through the day. He could not walk above a few hundred yards at a time on plain ground without fatigue. Some days he had chills and heats; and almoft every night more or lefs of perfpiration. When I firft Saw him, there were no Symptoms of pulmonary tubercles in an aftive ftate, nor have any appeared fince ; that is to Say, he had no dry teazing cotgh ; he felt no pain in the cheft, no difficulty of breathing, except upon exertion, and then It evidently arofe from weaknefs ; no incon- venience from lying in any pofture. His pulfe was 120 ; and he was much fubjeft to flufliings. As he had had flimy and frothy ftools, as the belly was hard and tenfe towards night, as preffure on the abdomen gave pain, and as the emaciation lS7 inued, I judged this to be a cafe of tabes mefen- .'.; v u That there had been tubercles in the lungs, 1 inflamed ftate, the hiftory of the cafe appear- e". d me to prove;' and I believe that the medi- cines before taken had So far preferved the patient. .Lint they had not, in any degree, lefiened the fymp- rc s imputable to the mefenteric glands ; and be- sides the articles particularized above, Mrs. Patti- for tells me, that calomel was given at Callington tor this exprefs purpofe. The ufe of muriate of lime has increafed,the f.r.-ngth fo much, that the patient is now perfectly 3c i to walk from Clifton to. Briftol, and back a in. He rifes alert, and feels ftrong. all day. Thole who have noticed him are ftruck with his ii, proved appearance. There is no enlargement or. 1 vcdnefs of the belly,.nor pain upon preffure. The be vels are m a healthy ftate; the chills have en- ■ ely disappeared ; the night perfpirations have de- i - eafed to occasional moifture upon the. Skin in the morning. The pulfe is ftill too quick (about ioc) ■-. d there has not been an acquifition of flefli, pro- rtionate to his amendment in other refpefts. About five weeks ago, a caufe exciting vehement f ir, began to operate upon him, and this recurred ; -equently for above a fortnight* His progrefs was •. 'idently checked; and for prevention of the hec- :c fever, he had now fifteen drops a day of tinc- O »5* ture of digitalis. This was, perhajs, excefs of pre-» caution. But the patient had improved fo much, before the ufe of the digitalis, was r. Stationary during its exhibition, and has beer. 10 faft improv- ing again Since its discontinuance, as to make it ev- ident that he is folely indebted to the muriate of lime for all the benef4- he has received Since he has been under my care. It Seems to me equally certain, tfcpt the medicines he took before had made no impreflion on the difeafed mefenteric glands. The dofe of muriate has generally been from forty to Sixty drops. Eighty drops have produced qualms and fickneSs. Thefe feelings hare Sometimes appeared in oth- er patients, and I confider them as the fign of an over dofe. One patient, ill of tabes mefenterica, with other glandular affections, has baffled all my endeavours to administer this medicine. The pa-. tient is a girl of eight years of age. She has been greatly haraffed by, abdominal pains and ficknefs. The ficknefs was fo increafed by the fmalleft quan-» tity of the muriate, as to" render it impracticable to perfevere in its ufe. No vehicle could reconcile it to the ftomach. The external application produ- ced the fame inconveniences; and on attempting to give fome of the fubftitutes mentioned below, I was equally baffled. My propofal of a cauftic or J59 feton, on fome part of the abdomen, has not hith- erto been acceded to. The muric."' of lime can by no means be consid- ered as one of the more dangerous medicines. Yet from the analogy of barytes, and from its occasion- al naufeating effect, I fuppofed that in a Strong and concentrated dofe, it woulu produce a fatal action on the Stomach. To throw fome light upon this point, I reqitefted Mr. King to make tT ej following experiment. The account of it is his. " March 24th, half paft five P. M. I gave about three drachms and a half of calx muriata, undiluted, to- a tksg, about fix months oldi, about two hours and a half after he had. been fed*. It affefted him immediately with great violence, which appeared by quick breathing and fnorting, convulfive, but vain efforts to vomit, and a profufe Secretion of fa- liva. He often fell to the ground, but rofe again. About half an hour after taking the muriate he feemed expiring, and during the next half hour gradually recovering ; but would not take any wa- ter, though it was frequently offered him. He continued from that time lingering, and in about Six hours he died. " 25th, I opened this animal, and found the whole of the thoracic vifcera in a found ftate. The lungs and diaphragm, however, Were of a florid appear- ance, as might have been expected from the con- i6o vulfive efforts excited in the latter organ. The ftomach, externally had no appearance of morbid alteration. The liver alfo looked healthy ; the gall-bladder, and dufts Were turgid, with an abun- dance of bile, of the ufual tafte and colour, with many whitifh faeculae floating in it. ■ The contents of the ftomach, and the whole of the alimentary canal, were as might have been expefted in a healthy dog, except about twenty fmall tamiae which were found in the jejunum and upper part df the ilium. " The whole of the ftomach, in its greateft con- vexity, was unufuaHy thick. Towards the pylorus it appeared increafing in thicknefs rather beyond its healthy ftate, under fimilar distention. The villous coat was exceedingly bloodfhot, even a great way down into the fmall inteftines. In many parts it was almoft black, and converted into a gelatinous Slime, which could be taken off by the fingers with great eafe. Neither the chyme nor chyle feemed in the fmalleft degree altered, by the muriate of lime, being perfeftly infipid. The chyle was very abundant, and many of the abforbents turgid; but all the mefenteric glands were large and very hard, and the thoracic duft appeared to contain fcarcely any fluid. From the animal's emaciated ftate be- fore the experiment, it Should Seem that thefe glands were previously diSeaSed." i6i This experiment will induce the prudent prac- titioner to increafe the dofe with caution, and to dilute the medicine. Probably a drachm of the muriate fhould not be given in leSs than an ounce of water or other vehicle. One invalid, notwith- ftanding its difagreeable effeft on the palate and fauces, and in fpite of my remonstrances, took it undiluted. The ufe of the muriate of barytes in fcrophula has been a Subject of experiment for a number of years ; and though aware that the hiftory of that medicine, will, previous to trial, throw fome dif- favour on the muriate of lime,* I am not deterred from recommending it by that confideration. The combinations of the alkaline earths, and of the al- kalis with different acids, will readily occur as fub- ftitutes. Experiments on the effefts of ftrontian, in comparifon with barytes, Shew that the Salts of ftrontian may be very SaSely tried. The experience of old medical writers gives me Some faith in the Salts, which they So much recom- mend as deobftruents in affections of the lower belly. My faith is ftrengthened by another confideration. As purges they probably produce an aftion, which is propagated to the mefenteric glands : given in a *lofe too Small to produce any cathartic effeft, they will produce an aftion or excitement, which can be long Supported, as being followed by no debili- 162 ty; 7tn aftion which may be to purging what the cordial operation of fermented liquors is to intoxi- cation ; and by this the glands may be brought to a healthy ftate. It is certainly not by purging that muriate of lime cures taha. mesenteric^, or any other fcrophxrloos affection. I have fcaarce ever been obliged to leflen the dofe on "this account, but often to give aperi- ents under its uie. THE EN». FOR SALE, BY O. PENNIMAN & CO. JLT THE TROV BOOKSTORE, AITKEN's Elements of the Theory .and Praftice of Phyfic and Surgery, 2 vols. 8vo. Aitken's Principles, of Midwifery, with plates, 8vo. Effays on Fractures and Luxations Outlines of the theory and cure of Fever Alston's Materia Medica, 2 vols. 4to. American Herbal, i2mo. 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