THE

MEDICAL REPOSITORY,

AND

KEVIEW OF AMERICAN PUBLICATIONS

ON

MEDICINE, SURGERY;

AND THE

AUXILIARY BRANCHES OF PHILOSOPHY.

CONDUCTED EY

SAMUEL L. MITCHILL, M.D. F.R.S.E.

One of the Physicians of the General Hospital, Representative in Congress for the City of New- York, Secretary to the Agricultural Society, &c

AND

EDWARD MILLER, M. D.

Our great quantity of books looks like superfluity ; which, hc*wever, is not to be remedied by ill 1 1 iiiiny limn in ill Mil) hut by publishing more good

ones, that, likc^iW^e^uft \^Io^p migljt^jNiqur the serpents of the en- chanters. _

Lord Bacon.

VOL. V.

NEW-YORK:

Printed and sold by T. & J. SfVORDS, Printers to the Faculty of Physio of Columbia CoUege, No. 99 and 160 Pearl-itrcct,

1802.

C'jPt -RlGUT SECURED.

*

MEDICAL REPOSITORY.

Vol. V.— No. t. ARTICLE t.

Case of Hydrophobia: Communicated by Dr. Philip Sync Physick, of Phxladtlfhias to Dr. Miller.

ON the 28th of April, 1801, I was desired to visit Samuel York, a black boy, sixteen years of age, servant to Mr. George Thompson. — The account I received of his ill- ness was, that the day before, towards evening, he complained of not feeling well; in consequence of which he took a draught of chamomile tea, and went to bed. Next morning he awoke in a considerable perspiration, and being thirsty, he rose earlier than usual, and went down stairs for a drink of water, but, in attempting to swallow it, his head was invo- luntarily thrown back from the cup: after this, he returned to bed, and his breakfast was sent to him, but he refused to take any. His mistress prepared some sage tea, and intreated him to drink some of it: his answer was, that, to oblige her, he would take one tea-spoonful; and this, with great diffi- culty, he accomplished. In the course of the day he was per- suaded to take four or five tea spoonfuls more into his mouth, most of whicli he Was unable to swallow.

My first visit to him was at about half past eight in the evening of the second day of his disease. I found him uneasy and restless, throwing himself about in every direction, and talking incessantly. On being asked what was the matter, he complained of his throat, of a burning sensation in his sto- mach, and said he was thirsty ; he thought he could drink a gallon of water, but tliat whenever he attempted to swallow, he felt a pain in his throat, " that seemed as if it would take his breath away."

Not suspecting the nature of his complaint at first, I exa- mined his throat, supposing I should find it considerably in.-. Vol.V. A

2 Case of Hydrophobia.

flimed ; he objected strongly to this examination, and woul<f scarcely allow the handle of a spoon to enter his mouth, to hold down his tongue. With some difficulty I obtained a view of his fauces, and found them entirely free from inflammation. I new offered him some water in a glass. He took it into his hand, but as soon as it was within a foot of his mouth, jerked back his head convulsively, and his countenance expressed marks of great horror. Notwithstanding this, he was pre- vailed upon to repeat the attempt, which produced similar ef- fects. He now desired a lime to be brought him ; the juice of which he squeezed into a spoon, and sipped down, with great difficulty, a small quantity of it.

His pulse was full, hard, and preternaturally frequent — his skin hot and dry — bowels had not been opened for two days — ^xvj. of blood were taken from his arm, and an antimonial emetic ordered. The small quantity of it which he was able to take, vomited him once, and procured two stools.

Third day (29th April), 9 A. M. Has passed a very restless, uneasy night, without any sleep. All his symptoms continue, and his dread of water seems augmented. Some milk was offered him, which was equally offensive : indeed, he appears much distressed when any thing whatever is suddenly presented to him. In taking out my handkerchief, it happened to fly be- fore his face, and this produced the same convulsive motion: of his neck and throat as the sight of water. He objected to having the window open, on account of a stream of arr which rendered him uneasy.

Sixteen ounces of blood were taken from his arm. About one o'clock, he was visited by Dr. Rush, and he directed him to be bled again. At this bleeding he lost § xiv. — § ij. of strong mercurial ointment were rubbed upon his skin, and four grains of calomel, in pills, ordered, which, however, he was unable to take.

At 4 P. M. I invited Doctors Mease and De Wees to see him with me: — His pulse now intermitted irregularly, and was tense. At this time | xx. more blood were drawn ; by which the force of his pulse was considerably reduced, and it was made very frequent. His stomach became sick, and he called for something to puke in : the nurse carried a chamber- pot suddenly before his face, which caused him to start back as if gasping for breath ; he knocked it out of her hand with great violence, and broke it to pieces against the opposite wall of the room. He spits very frequently a small quantity of thick vvliite saliva— he was persuaded to attempt to swallow

Case of Hydrophobia. 5

it, but this occasioned him a return of the spasms — has had one watery stool to-day.

Nine o'clock, P. M. It has been ascertained beyond a doubt, that this boy was bitten in the foot by a mad dog about five weeks since ; the dog bit also a maid servant the same morning, and snapped at a third. The uneasiness of my pa- tient to-night is as great as ever, though he has been able to take several tea-spoonfuls of water — not, however, without having the spasms excited each time : says he is better — pulse very frequent and tense. Several medical gentlemen visited him this evening : he complained of great uneasiness from hav- ing six persons at once in his room — was bled ^ xn- — aI"ter which he became fainty, and spat up much frothy, viscid saliva, which appeared almost to choak him. He now insisted on getting out of bed.

It was intended to apply sinapisms to his throat and legs, and blisters to his thighs; but, before they could be prepared, Jiedied suddenly at 10 o'clock, as if suffocated.

Next morning (30th), at 10 o'clock, leave was obtained to open the body. The pharynx, larynx, and trachea were first examined. They appeared in a natural state, quite free from in- flammation. On the inside of the trachea, one part appeared ra- ther more red than the rest. The abdomen was next opened ; externally the viscera of a natural appearance — the stomach considerably distended with air; when cut open, was found- nearly empty. Some small specks of a brownish coloured mucus adhered to its inner surface, at the great curvature, near the pylorus. On removing this mucus, the villous membrane under it exhibited a very faint red colour, hardly amounting to inflammation. The gall-bladder contained natural bile.

In the thorax were observed no marks of disease. The lungs were found free from adhesions, and in every respect perfectly natural

Reflecting on the symptoms which took place in the case above related, it appeared to me, that the dread of water arose chiefly from the convulsive or spasmodic contraction of the muscles of the glottis, which rendered the patient unable to breathe, and involved him in all the horror of impending suf- focation. When asked why he could not drink^ he answered, tnat whenever he attempted to swallow any thing, it " took his breath away."

Perhaps the reason why swallowing liquids is more difficult to such patients than swallowing solids, is, that in the former case the glottis must be completely closed by the action of itt»

4 Case of Hydrophobia.

muscles, whereas, in swallowing solids, the epiglottis is pushed down mechanically, so as to cover that aperture as much as is- necessary, and, of course, little, if any muscular action is re- quisite. Now, in this disease, whatever occasions the muscles- of the glottis to contract, will excite spasmodic action in them, owing to their diseased disposition, and hence a danger of suf- focation is experienced, which eventually takes place from this cause.

The black boy, whose case I have related, was unable to ^wallow his saliva without having the spasms excited, which induced him to spit it out continually. To this constant spit- ting I attribute the burning sensation, which he felt at an early period of his disease ; and I have myself experienced it from a similar cause.*

Will not this circumstance, together with the irritation ■which excessive thirst must occasion in the stomach, suffici- ently account for the slight inflammation observed in this or- gan on dissection? We know, that in animals, starved to. death, the stomach is found much inflamed, and it must be re- membered, that want of drink is far more intolerable than want of food.

Under the influence of these opinions, I am disposed to be- lieve, that Tracheotomy would have saved my patient, at least for a time, if it had not altogether prevented the fatal termina- tion of the disease. Probably, had this operation been per- formed, he would have been able to swallow drink and me- dicine ; because there was no action in the pharynx or oeso- phagus preventing deglutition, when the patient could sum- mon resolution sufficient to attempt it.

I cannot suppose that the spasms of the muscles in hydro- phobia would be attended with much danger to life, were it not for their influence in suspending respiration y because we see, occasionally, more muscles in other parts of the body af- fected with spasm, without any risk whatever being incur- red by the patient, even though they may continue many days. It is possihle, however, that the inflammation of the stomach, excited by excessive thirst, may also be a cause of death. Cases are recorded of persons afflicted with hydropho-

* In the year 1793, when at the City Hospital, being apprehensive of inconvenience from swallowing my saliva (supposing it to be contaminated with the nauseous effluvia of the sick), I made it a constant practice to spit it our — in consequence of which, 1 was distressed with a burning sensation in my stomach, that forced me to desist from this practice to procure relief. Of this I made several experiments, so as to ascertain it beyond a doubt; and ny friend and colleague, Dr. Cooper, experienced the same.

Salutary Effects of Salivation in Consumption. B

feia for several days, who, some short time before death, were able to drink freely — probably such persons, after the cessation of the spasms, die of inflammation of the stomach.

After tracheotomy has been performed, it is likely that bleed-r ing, blisters, and mercury, would answer the purpose of remov- ing spasms, or any inflammation which may have taken place.

ARTICLE II.

^Account of tlie Salutary Effects of a Salivation, atulalso of Tonic Remedies, in Pulmonary Consump- tion : In three Letters to Dr. Edward Miller, By

. Benjamin Rush, M. D. Professor of the Institutes of Medicine and of Clinical Practice in tlie University of Pennsylvania , &c.

BETTER I.

Dear Sir,

ON the 17th of December, 1800, William Kaims, a sailor, aged about 26 years, was admitted into die Pennsylva- nia Hospital, in the second stage of Pulmonary Consump-* tion, Several of this man's relations had died of that disease. As his pulse was active, I ordered eight ounces of blood to be? drawn from his arm the day but one after his admission, and the same quantity to be taken five days afterwards. I directed hjm to live chiefly upon milk and vegetables, and to take a medicine, known in our hospital by the name of " Antimo- nial Powder," composed of fifteen grains of nitre, a sixth part of a grain of tartarized antimony, and half a grain of calomel, three times a day. Contrary to my intentions, sixteen doses of this powder brought on a salivation, the effects of which were as unexpected as they were agreeable. It suddenly put a stop to his cough, and removed every other symptom of his pul- monary disease. rITie salivation continued, without any addi- tional doses of calomel, for ten days. I looked with a good deal of apprehension for a return of his consumptive symptoms litter the spitting had ceased, but happily w ithout finding them. In a week after his mouth and throat recovered from die mer- curial disease ; and he earnestly solicited his discharge, as a vessel was about to sail from our port, in which he was anxious to enter as a sailor. He was accordingly discharged, as cureu? on the 10th of January, 1801 .

6 Salutary Effects of Salivation in Consumption.

On the 17 th of January, 1801, William Poole, aged twen- ty-three years, formerly a merchant's clerk, was admitted into our hospital, in the third, or apparently the last stage of the disease which has been mentioned; His cough was distressing, especially in the nights. He was much emaciated, and had frequent chills, with constant sweats: his pulse forbad bleed- ing. Encouraged by the accidental cure just related, I pre- scribed for him the antimonial powder, and ordered mercurial ointment to be applied to his sides and breast, in order to excite a salivation. In a few days I was highly gratified, by hearing him complain of swelled gums, and great pains in his teeth. From this time, his cough, fever, chills and sweats left him. To obviate the weakness and want of appetite induced by his disease, I ordered him to take an infusion of columbo root, with elixir of vitriol, and to drink freely of wine and porter with his aliment, which I directed to be of a cordial nature, and from which he found great benefit. The salivary glands were not affected by the mercury in this patient; an effect of it which experience has taught me not to be essential in all cases to its salutary operation, in abstracting disease from internal and vital parts of the body. After this man recovered from his pulmo- nary symptoms, he was attacked by an obstinate and distress- ing rheumatism in one of his legs, which yielded to blisters, and the usual remedies for that form of disease. He was dis- charged, cured, on the second of last May.

It was not in the winter 1801 that I first combated pulmo- nary consumption with mercury. I had frequently, many years ago, attempted to cure it by a salivation, but without be- ing able to excite it. The late Dr. Thomas Bond, of this city, I have been informed, was equally unsuccessful with myself, in his attempts to cure this disease by the same revolutionary remedy. The knowledge that has been acquired by the more extensive and familiar use of mercury since our first pestilential year, 1793, has, I hope, taught me the cause of our failures. It was probably given before the morbid action of the blood-vessels was reduced by blood-letting and low diet; or, 2dly. After the suppurative action in the lungs was so far advanced, as to prevent the action of the mercury predominat- ing over it. Mr. Bogue takes notice of the failure of mercury to excite a salivation in the diseases of the liver from the same cause. Perhaps a third cause of our want of success may be derived from our having given the mercury, after all the exci- tability of the system (on which medicines act) had been wholly expended ; or, 4thly, from our not giving it with some

Salutary Effects of Salivation in Consumption. 1

other medicine, calculated, by its previous or accompanying stimulus, to prepare the system for its impression upon die mouth or salivary glands ; or, lastly, from our not giving it in a form, as in the antimonial powder, in which it is dirru3ed through the mouth in the act of swallowing it.

I have said nothing of the state of the lungs in the above pa- tients, previous to the healthy and happy change induced in them by the salivation. It is probable they were affected with tubercles or ulcers ; both of which, I believe, have been cured by other remedies besides mercury ; but if those consequences of pulmonary consumption did not exist, such a preternatural secretion and excretion of morbid matter had taken place in the lungs, as would have produced death as certainly as tuber- cles or ulcers when not opposed by medicine.

It is remarkable, that we have limited a salivation to an in- flammation of the liver, as improperly as we have limited blood-letting to a pain in the side. There is no more reason why the former should not be prescribed as generally in dis- eases of all the internal and vital organs, than that the latter should not be used in diseases of great morbid action in every part of die body.

The success of this new mode of attacking pulmonary con- sumption will depend very much upon the time and manner of applying it. How long, and how often have blood-letting, bark, opium, and blisters deceived us in the most simple cases, by our not regulating our prescriptions of them by the stage of the diseases in which they were indicated, or by the varying states of the system ? It is from ignorance, or inattention to these two circumstances, that we so often see such different issues of diseases from the use of the same remedies in the hands of different physicians.

I have only to add to my letter, that a patient should not be considered as safe or free from danger, after the removal of the cough, fever, and other symptoms of consumption, by means of a salivation. The general weakness which predis- posed to it, should be obviated by journies, sea voyages, a long course of tonics, and a total abstraction of all its remote and exciting causes.

From, dear Sir, your sincere friend,

BENJAMIN RUSH.

Philadelphia, March 18, 1801.

IS Salutary Effects of Salivation in Consumption,

LETTER II.

Dear Sir,

SOON after writing the above letter, an event occurred which made it necessary for me to delay sending it. William Kairns (whose case I have related), in his passage down the Delaware, in the month of February, caught a severe coldj from being detained several weeks by the ice. He was sent back to our hospital on the second of March, where he died on the 29th of April following. Dr. Parke, who succeeded me in attending the hospital, politely attempted to relieve hint at my request by a salivation, but without success. If the death of this man should lead physicians to be more careful in enjoining their patients, after the cure of a pulmonary af, fection, to obviate the return of it, by avoiding all the remote and exciting causes of a relapse, and to use such remedies as are best calculated to remove the remaining debility of the sys* tern, it will not have occurred in vain. I have lately seen Poole and was delighted to find him in good health, and fine Spirits. He had gained not only flesh, but fat.

Within the course of the present month, I have arrested this formidable disease, by gently touching the mouth with calo- mel, in two young ladies in our city, who were affected with alarming catarrhs, which had supervened previous debility of a long standing. They are both now riding in the country, by my advice, in order to remove the debility from their systems, which was the forerunner of their disease.

Dr. Stewart, an intelligent young physician of this city, has lately put into my hands, the history of a case of a Mrs. Corn-* vil, a woman of five and twenty years of age, whom he had cured in the spring of 1799, of a confirmed pulmonary con-* Gumption, by means of a salivation of five weeks continuance. The salivation* he remarks, was sometimes interrupted by a diarrhoea, and by great morbid excitement in the blood ves- sels, but was always restored by cheeking the former, by means of laudanum, and reducing the latter, by means of blood-let - ting. The Doctor concludes his letter, which is dated May 1 2th of the present year, by saying, " Mrs. Cornvil is now free of all pulmonary complaints, and has (since her cure) become the mother of a fine healthy child." Dr. Physick in- forms me, he has salivated two patients in consumptions, with success, and has hopes of curing a third, now under his care, by the same remedy. Thus have we made one more impres- sion upon a most formidable and distressing disease. Let u$

Safutaiy Effects of Stirmitants in Consumption. 9

hot despair; and when we speak of an incurable disease, let lis always remember, that we only express the imperfection of Our knowledge in medicine.

From, dear Sir, your friend,

BENJAMIN RUSH.

Philadelphia, May 20, 1S01.

LETTER nr.

Dear Sir,

FN my last letters, I mentioned the effects of a salivation irf pulmonary consumption. The subject of the present letter shall be, the effects of tonic remedies in that stage of con- sumption which forbids the use of depleting remedies, and m which mercury is ineffectual, from the exhausted state of the excitability of the system.

In the month of December, ] 800, Benjamin Parker, aged twenty-six years, was admitted into the Pennsylvania Hospital, mthe -last stage of pulmonary consumption. He was unable to sit up in his bed. His expectoration was copious and puru- lent, and his pulse weak and frequent. Widiout any, expec- tation of curing him, I prescribed a cordial stimulating diet, brandy toddy, liquid laudanum in small doses during the day, and from two to four grains of solid opium every night at bed time, and all chiefly with a view of smoothing his passage out of life. In my visits to the hospital after this prescription, I frequently passed his bed, without giving him the trouble of offering me his pulse. In the course of two weeks, Mr. Huch- inson, one of the apothecaries of the hospital, informed me,, with a smile, that Parker was much better. From this time I became more attentive to him, and had the pleasure of finding his countenance and pulse improving, and his cough lessening every day. By persevering in the use of the above remedies for six Weeks, he recovered his strength and flesh, and was discharged on die 23th of Fcbruiry, without a single symptom of pulmonary consumption. This man had been a private pa- tient of Dr. Caldwell before he was sent to our hospital. After his recovery, I asked the Doctor how long he thought he would live after he ceased to attend him ? He replied, " not more than two weeks/' I should have hesitated in communi- cating this case to you, had not every circumstance that has been relaten been witnessed by upwards of a hundred students of medicine who attended the practice of the hospital during the last winter. However extraordinary this cure may appear,

Vol. V. B

16 ffitri'c Acid fails to cure Venereal Disease.

it was not the first time I had seen similar good effects fro** tonic diet and medicines. I prescribed them for a sailor of the name of Prichard, in the spring of the year 1776, at his owa house, and left him afterwards, expecting he would live but a few weeks. In a few months I saw him seated on the bench of one of the gondolas, which were employed to defend Phi- ladelphia in the revolutionary war. We recollected each other. He informed me that he ate his allowance, did his duty as a gondolier, and slept every night in the open air upon a blanket under his bench. I saw him a year afterwards in the street in good health. Perhaps his exercise in rowing for several months on board the gondola, contributed to render his cure more complete.

If these two cases stood alone in the history of chronic dis- eases, they would be sufficient to teach us, never to abandon patients in cases apparently the most hopeless, without a part- ing efrbrt to relieve them. They show further, that the reme- dies which are calculated to lessen the pains which sometimes accompany the passage out of life, generally give the patient the best chance of recovery.

From, dear Sir, your friend,

BENJAMIN RUSH.

Philadelphia, June 19, 1801.

ARTICLE III.

Trials with Nitric Acid in Venereal Disorders, in which its Value therein is attempted to be ascertained: In a Letter from John R. B. Rodgers, M. D. and Professor of Midwifery and Clinical Medicine in Colwn^ bia College, to Ui\ Mitchill, dated New-York, Aprils, 1301.

i

Dear Sir,

WHEN I first heard of Nitric Acid having been used for the cure of Syphilis in Great- Britain, I determined to try it in the New- York 'Hospital, and in my private practice. During my attendance on the Hospital in the winter months, from De- cember 1797, to this spring, and elsewhere, I have directed it in a great variety of syphilitic and other cases. I generally began with fifty drops in a pint of water, with one ounce of syrup, to be

Nitric Acid fails to cure Venereal Disease* \ I

*aken in a day. This dose was increased to 3 iss. and very often <o 3 ij. and more, in a day. Of the several cases I shall parti- cularize but a few. in one syphilitic patient in the New- York Hospital, of recent infection, the prasputiuin penis had an ul- cer on its upper edge, of the size of a small sixpence j it was of sordid appearance — he had not taken any medicine for his com- plaint. The nitric acid was used in the dose of a drachm a day for four days, and then gradually increased to 3 ij. and continued at this latter dose for five or six days. The ulcer was treated only with common and mild dressings, to deter- mine more precisely the effect of the internal remedy on the ulcer. The sore extended itself daily, and, by the end of the first week, it had covered nearly one half of the prepuce. It was now judged necessary to apply something to arrest this ulceration. The phagedenic wash of the house was used, and the progress of the ulcer only impeded, but not completely stopped. After using the nitric acid for fourteen days from its first exhibition without effect, the patient was put on the use of the muriate of mercury, with a small quantity of opium, and the compound decoction of the woods. In five days after the commencement of this course, he was manifestly better, and in a month he was discharged, cured. This patient was of a sanguine temperament. A man, who lay in the next bed to the one we have just mentioned, had been long in the use of mercury — he had been terribly afflicted with syphilis — had a large open ulcer in his groin, from a buboe, and several ulce- rations in different parts of his body — had been salivated before his coming to the hospital — was languid and relaxed, and had a pallid countenance. I continued his use of mercury and opium some days, but his sores did not show any tendency to lieal, and he was evidently growing worse. I then put him on the use of nitric acid, and, in a week's time, his general health, was much advanced, his countenance was more florid and ani- mated, his muscles, which before were flabby and relaxed, be- came braced and firm; his ulcers and foulness of the skin were much diminished, and in a few weeks he was cured. — I should remark, that before we began the use of nitric acid, we suffered him to be four days without any medicine but his anodyne ; and that, although he had not shown any symptoms of ptyaiism before, or at the time of beginning the use of the acid, yet, in five days after we entered on its use, his mouth was very sore, and he spat freely. In several cases where there were ulcers of long continuance, blotches on the skin, and extensive her- petic affections, with pains increased when warm in bed, an4

12

Nitric Acid fails to cure Venereal Disease.

where mercury had been before given with little or no advant- age, the nitric acid was administered with the best and hap- piest effect ; but in many cases of recent syphilis (and several, of them occurring this last winter) , and chiefly in young and hearty men, the nitric acid, though given in different doses, and persevered in a considerable time, did not produce any good effect ; and in the same patients, the use of mercury t with our usual accompanying remedies, readily accomplished a cure.

Having seen, in the London Medical and Physical Journal of May last, an account of nitric acid and opium being suc- cessfully used in a case of dysentery, I tried it the last winter on a man just come from the State Prison, after a confinement of more than three years, and who had been nearly all that time sick — he came in with diarrhoea of long standing, ex- tremely emaciated and reduced in strength — abdomen much enlarged and tense, and evidently containing fluid — he had great thirst. The nitric acid and opium, as recommended by Mr. Hope, were administered, but with an increase of opium, according to the following prescription: viz. Gum. op. gr. iv. acid, nitric. 3 ij. — Aq. fontan. ^ iv.— capt.cochl. mag. 1. 4ta quaq. hora — He took, at the same time, wine, and had his abdomen frequently rubbed with warm oil. After a few days he passed urine profusely, and the swelling of his body was en- tirely removed, so as to permit one to feel his spleen and liver very distinctly and much enlarged — the thirst was but little re- lieved— his diarrhoea was, for a short time, checked — it, how- ever, soon returned, and he died. This prescription of Mr. Hope promises to be of service in old diarrhoeas of hot cli- mates, and in long protracted dysentery. I had used nitric acid as an auxiliary to digitalis before I saw an account of its being applied to that purpose in one of the Medical Journals. It was in the case of a young lady who had taken digitalis so as to affect her pulse very sensibly, and to induce a verti- ginous affection of the head. She was languid, and her coun- tenance pale, and her lips less red than usual. She had become disoxygenated. Nitric acid was given, and with advantage.

From what I have stated above, ;md from what I have wit- nessed in other cases, I am induced to believe, 1. That nitric acid is not to be relied on as an anti-syphilitic remedy, espe- cially in recent cases, and where the patient is of the sanguine temperament; but that it is of the greatest service in all debi- litated and disoxygenated constitutions, where, from the long u$$ of mercury, the system has taken on the habit of grm$

Consumption aired by Digitalis Purpurea. 13

irritability, and where the patient may be said to be mer- curialized. 2. Where there have been congestions in any part of the glandular system previous to the body being af- fected with syphilis, or where there is any tendency to scro- phula, and where the disease has affected the skin. 3. In all herpetic complaints, syphilitic or otherwise ; and in all cuta- neous diseases where the skin is in a state of indirect debility, as in inveterate psora, or after small-pox, measles, or scarla- tina, it is of service. 4. In ulcers and complaints of the throat of long continuance. 5. It is extremely well adapted to that state of languor and debility which patients are in re- turning from southern climates, and who have felt the effects of tropical fevers, of dysentery, and of long voyages. 6. In all those who have diseased livers and anasarca, either sepa- rate or combined, it is an excellent remedy. 7. It is also a good remedy in chlorosis. 8. From a case above cited, it is with opium a diuretic. Lastly. It does not appear to exert its good effects where the system is in much tone, or where that disposition obtains which is called inflammatory ; but where the body generally, or a particular part, has been much debilitated by the long exertion of disease or influence of medicines.

I am, with much esteem, Yours sincerely,

j< R. B. RODGERS.

ARTICLE IV.

4 Case of Pulmonary Consumption cured by the Ir<t- of the Digitalis Purpurea: In a Letter from John Spence, M.D. of Dumfries (Virg.J, to Dr. Mi tc hill, dated January 26, 1801.

June 18, 1800.

JAMES DRINAN, aged 31, a man of low stature, of a pale complexion, with a narrow chest, and dark coloured hair, and by trade a shoemaker, labours under a severe cough, attended with a copious expectoration of gross, yellow-co- loured matter, which smells very offensively. The cough at- tacks him frequently during the day, but is most troublesome during the night, and in the mornings: feels little pain in his breast or side except when he coughs : observes, when seized

14 Consumption cured by Digitalis Purpurea.

with a violent fit of coughing, that the matter he expectorate* towards the close of the fit is tinged with blood, and tastes saltish: says he can distinctly trace the matter coining up from the short ribs on the right side: complains of being fre- quently very chilly, particularly in the evenings ; and the chil- liness he experiences has been so remarkable, that a few days ago, when Fahrenheit's thermometer stood nearly as high as 90 in the shade, he was obliged to cover himself with a blan- ket. These chills are succeeded by a high fever and profuse sweats. His appetite is bad, tongue foul, pulse hard and strong, and varies from 80 to 100 strokes, and upwards, in the minute: urine hfgh-coloured: is of a very costive habit.

About the beginning of last month he was attacked with a pain in his right side, difficult breathing, and a very trouble- some cough. For these complaints he was bled and blistered twice — took cooling purges — James' fever powders — and, in every respect, pursued attentively the antiphlogistic course. All his symptoms were thereby relieved, excepting his cough, which was harassing. About the first of June he suddenly expectorated a great deal of matter, the odour of which was excessively disagreeable, insomuch that scarcely any person could stay in the room with him. On the tenth of the same month all his symptoms became worse, accompanied »with ri- gours, which were followed by fever and wasting sweats. — All this time he adhered rigidly to a low diet, living almost entirely on strawberries and milk, and rode out every day. When he rode he did not suffer his horse to go out of a walk or pace. He likewise, by the advice of a neighbour, drank a great deal of horehound tea. Notwithstanding, however, all his care, debility and emaciation of body became daily is ore alarming; and so restless were his nights, and so dis- tressing his cough, that he was obliged to have recourse to opiates in large doses. From these circumstances, as well as from his profuse sweats and great expectoration, he was so convinced that his dissolution was rapidly approaching, that he deliberately settled his affairs ; and he was the more dis- posed to give into this persuasion, as most of his relations had gone off, he said, in the same way.

He has resided several years in Dumfries (Virginia), and . conducted himself with great sobriety and industry, lie has, generally enjoyed good health, except that he has frequently beer) attacked with slight catarrhal affections; and then his cough, though troublesome, was never dangerous. — : Although a shoemaker by trade, he has not, for many years,. ,

Consumption cured by Digitalis Purpurea. 15

been engaged in the laborious part of that business; having a shop of his own, with a great number of journeymen, for whom his sole employment is to cut out work.

To-day I advised him to try the digitalis. He very cheer- fully embraced my proposal.

I directed him to begin with thirty drops of the saturated tincture in a wine-glassful of mint tea, and to repeat this dose every forenoon and afternoon. At the same time I directed him to ride out every morning if able, and still to adhere to the antiphlogistic regimen. He was likewise directed to keep his bowels open by means of aloetic pills.

Friday, June 20th. — He took his medicine yesterday a3 directed. No nausea excited by it, nor any change in his pulse.

To-day he took forty drops of the tincture, and soon after rode out, when, unfortunately, his horse ran off, and threw him ; in consequence of which he has been attacked with very sharp pains in his side, and a severe spitting of blood, for which he has been copiously bled.

Saturday, 2\st. — He has had a bad night: has expectorated a great deal of blood during the night ; and this morning, he says, he coughed up a vast quantity of corruption, of a most offensive nature. — As he feels no uneasiness from the drops, he insists upon taking them in much larger doses, observing that no time is to be lost.

Six o'clock P. M. Has taken eighty drops of the tincture twice to-day, without exciting nausea. His pulse, however, is now as low as 66 strokes in a minute.

Sunday, 22d. — Sweated profusely last night : slept ill : has coughed up a good deal of matter this morning.

Seven o'clock P. M. Has taken 100 drops twice to-day. No nausea : pulse about 60 : cough not so troublesome. Again rides out.

Monday, June 23d. — Six o'clock P. M. Having been obliged to visit a patient in the country to-day, he had the boldness to venture upon three doses of the tincture, an hun- dred and ten drops in each dose, in my absence. No nau- sea, however, was produced by the medicine , but he observed his pulse as low as 54 and 58. Says he has felt no pain in his side. His cough is easy ; but what he expectorates is still offensive.-*-Directed not to exceed 1 1 0 drops at a time.

Tuesday, 24th. — Seven o'clock P. M. Has taken two doses of 110 drops to-day. No nausea: pulse as yesterday: Bleeps better.

X£ Consumption cured by Digitalis Purpurea

Wednesday, June 25th. — Seven o'clock P. M. Took ll# drops half past eight o'clock this morning, and another dose half past twelve ; soon after which he felt very sick, and sent for me. I found him lying a-bed, complaining of great nau- sea ; and it was with difficulty he could prevent himself from puking. His skin was very cool, and his pulse beat precisely 45, and was full and soft; and, at this hour (seven o'clock in the evening), it continues to beat nearly the same number of strokes in the minute.

Friday, 21th. — Took no drops yesterday, as the nausea continued; and his pulse did not exceed 50. No fever nor sweat last night. Observes that he makes a great deal of water ; and, what he thinks extraordinary, from being of the colour of brine, it is now perfectly clear. His stools,- too, he observes, are so dry that they crumble to pieces like dry clay.

His diet still consists of milk and vegetables, and he in- dulges freely in ripe fruits.

Has been obliged to take opening pills frequently.

Saturday, 28th. — Slept well: has coughed very little this morning. Took only one dose of 100 drops of the tincture yesterday, which occasioned a distressing nausea all day, and kept his pulse low.

There is an eruption all over his body like the prickly heat.

Sunday, 29 th. — Has passed a good night. No return of any pain in his breast or side. Little cough : little expectora- tion, and not offensive.

Took three doses of the tincture yesterday, 100 drops in each dose, without immediately exciting nausea; but this morning he has been very sick at his stomach. Thinks this nausea relieved by drinking a little hyson tea ; and had a keen appetite for his breakfast, which is remarkable.

About half an hour before he got out of bed to-day he counted his pulse accurately, when it beat only 38 strokes in the minute; and at this hour (ten A. M.), though he hast been walking about, it beats exactly 50, and is very soft.

Omit the tincture to-day.

Tuesday, July 1st. — Has slept well the>c t wo nights. Con- tinues to mend. Rode eight miles this morning. Takes J 00 drops of the tincture once a-day, which keeps his pulse under 60. He is directed to ride out every morning, to avoid all* bodily exertions, to continue his vegetable diet, and to take the drops only every second or third day, or what is just suffi- cient to keep liis pulse moderate.

Mode of using Digitalis in Consumption.

July 20th. — He has been taking the fox-glove as directed, but rinds himself so entirely relieved from all his pectoral complaints that he begins to leave it off. From the 22d of June to this date his pulse has never exceeded 60, excepting at one time, when he imprudently engaged in very active ex- ercise.

November 1st — Since last report he has enjoyed perfect health. For ten weeks past he has taken none of the digi- talis, and now eats meat freely. Of late he has been re- markably drowsy, and says it requires some exertion to keep awake. Since he began the fox-glove he has taken no pre-, paration of opium — indeed, no other medicine except aloetic pills occasionally.

January 24/A, 1801. — He continues to enjoy good health, and, at present, is fatter than he has been for many years.

The tincture used in the above case was prepared as follows : Two ounces of fox-glove, nicely dried, were coarsely pow- dered, and infused, for forty-eight hours, in half a pint of French brandy, and then passed through filtering paper.

ARTICLE V.

Practical Remarks on the Use of Digitalis in Con- sumption. Bj/ Dr. Spence, in a Letter to * * * *

Sir, Dumfries, Dec. 14, 1800.

I SHALL submit to your consideration a short but candid view, divested as much as possible of technical terms, of my present mode of exhibiting the digitalis in cases of pulmonary consumption ; and, in doing so, for the sake of perspicuity, shall divide the disease into two periods — the incipient and ad- vanced stages — and add a few general observations.

I. In the incipient stage or" consumption, when there i,> considerable vigour of constitution, particularly if attended with active hsemorrhagy from the lungs, I push the use of the digitalis cautiously, but freely — that is, I try to reduce the puise under 60 strokes in a minute, and maintain this depres- sion for two or three weeks, notwithstanding there may be occasionally considerable and distressing nausea. At the same, time I advise a milk and vegetable diet, with gentle exerciser on horseback, or in a carriage, when the weather will permit, Vol. V. C

R Mode of using Digitalis in Consumption.

and the use of the swing-chair, for an hour at a time, twice or thrice