A Gentleman aged 49, on the night of the 21st of August, 1784, awaked
with a sense of suffocation, which obliged him to rise up suddenly in
bed. I found him complaining of difficult respiration, particularly on
lying down; the countenance pale, and the pulse smaller and quicker
than usual. Some brandy and water having been given, the symptoms
gradually abated, so that he slept in a half recumbent posture. The
following day he expressed a sense of anxiety and weight in the chest,
attended by quicker breathing upon motion of the body. That evening an
emetic of ipecacoanha was given, and afterwards a draught, with
vitriolic aether and confect. card. aa [Symbol: dram]i to be repeated as the
symptoms should require it. He continued to be affected with slighter
returns of the dyspnoea at irregular intervals, until _September_ 15th,
when upon a more severe attack, the emetic was repeated. He now
recollected some slight pain in his arms which had affected him
previous to this last seizure, and was disposed to consider his
complaint as rheumatic. Pills with gum ammoniac. gum guaiac. and
antimonial powder were directed, with infus. amar. simpl. twice a day.
The bowels were regulated by aperient pills of pulv. jalap. aloes and
sal. tartar. and [Symbol: dram]iss balsam peruv. was given occasionally to
alleviate the paroxysms of dyspnoea.
From this period until the beginning of November, little amendment or
variation happened, except that respiration became more permanently
difficult, and particularly oppressed upon motion, nor was it relieved
by the expectoration of a mucous discharge, which now increased
considerably. Squills, musk, ol. succini, aether, with other medicines
of the same kind, were now used, but without success. The effects of
opium and venaefection were tried. The appetite diminished, and his
sleep became short and disturbed. He sometimes slept lying upon his
back, but generally upon his left side. The urine which had hitherto
been of good colour, and sufficient quantity, now became diminished,
and lateritious; and the ancles oedematous.
On the 15th of _November_ a blister was laid over the sternum, and
[Symbol: dram]iss of oxymel scillitic. was given every eight hours.
On the 18th, a more copious discharge of urine took place; the
swelling of the feet soon disappeared, and the respiration became
gradually relieved.
On the 30th [Symbol: dram]i tinct. cantharidum twice a day in pyrmont
water, with pills of ammoniac, sal tartar. et extract. gentian. were
substituted, but
On the 7th of _December_, from some symptoms of relapse, the oxymel
was used as before, and continued to be taken until the 27th, in doses
as large as could be dispensed with on account of the great nausea
which attended its exhibition: The urine was made in the quantity of
four or five pints each day, during the whole time; the quantity then
drank being seldom more than three pints. But now the sickness being
exceedingly depressing, the strength failing, and the diuretic effects
beginning to cease, the following prescription was directed.
R. Fol. Digitalis purpur. pulv. [Symbol: scruple]ss.
Spec. Aromatic. [Symbol: scruple]i. sp. lav. c. f. pilul. no.
x. capiat i. nocte maneque, et alternis diebus sensim
augeatur dosin.
In three days the effect of this medicine became visible, and when the
dose of the Digitalis had been increased to six grains per day, the
flow of urine generally amounted to seven pints every twenty-four
hours. Not the least sickness, nor any other disagreeable symptom
supervened, though he persevered in this plan until the end of
_January_ at which time the dyspnoea was removed, and he has
continued gradually to regain his flesh, strength, and appetite,
without any relapse.