About the middle of the year 1784 a lady aged 48, returned from
London, to her native air in Shropshire, under symptoms of complicated
disease. It was your opinion that the plethoric state, consequent to
that period, when menstruation first begins to cease, had under
various appearances, laid the foundation of that deplorable state
which now presented itself. The skin was universally of a pale, leaden
colour; her person much emaciated, and her strength so reduced, as to
disable her from walking without support. The appetite fluctuating,
the digestion impaired so much, that solids passed the intestines with
little appearance of solution: She had generally eight or ten alvine
evacuations every day, and without this number, febrile symptoms,
attended with severe vertiginous affection, and vomiting regularly
ensued. The stools were of a pale ash colour. The urine generally
pale, and at first in due quantity. The region of the stomach had a
tense feel, without soreness: the feet and ancles oedematous, her
sleep was uncertain: the pulse varying between 94 and 100, and feeble,
except upon the approach of the menstrual periods, which were now only
marked by its increased strength, and exacerbation of other febrile
symptoms. Emetics, saline medicines, and gentle aperients were
necessary to alleviate these. Six grains of ipecac, operated with
sufficient power, and half a grain of calomel would have purged with
great violence.
From the time of her arrival till the middle of _August_, mercury had
been continued in various forms, and in doses such as the irritable
state of her stomach and bowels would admit of. Spirit. nitri dulc.;
sal. tartar, squill, and cantharides were alternately employed as
diuretics, but without success, to retard the progress of an universal
anasarca which was then advanced to such degree and accompanied by so
great debility, and other dreadful concomitants, as to threaten a
speedy and fatal catastrophe.
On the 16th of _August_ you first saw her, and directed thus.
R. Mercur. cinerei gr. ii.
Fol. Digital, purpur. pulv. [Symbol: scruple]i. f. mass. in
pill. no. xvi. dividend.--sumat unam hora meridiana,
iterumque hora quinta pomeridiana quotidie.
Capiat lixivii saponac. gutt. L. in haust. juscul. sine sale
parati omni nocte.
On the 20th the flow of urine began to increase, and she continued the
medicine in the same dose until the 20th of _September_, discharging
from six to eight pints of water each day for the first week, and
which quantity gradually diminished as she became empty. During this
period she complained not of any sickness, except from the lixivium,
which was after the first dose reduced to 20 drops; and her appetite
and strength increased daily, though it was evident that no bile had
yet flowed into the bowels, nor was the digestion at all improved. The
anasarcous appearances being then removed, the Digitalis was omitted,
and pills, composed of mercur. cinereus, aloes, and sal tartari
directed twice a day, with [Symbol: dram]i. of vin. chalybeat. in
infus. amar. simpl.
Her amendment in other respects proceeded slowly, but regularly, from
that time until the 9th of October; when the state of plethora again
recurring, with its usual attendant symptoms, [Symbol: ounce]iv. of
blood were taken from the arm; and this was upon the same occasion,
repeated in the following month, with manifest good consequences;
though in both instances the colour of the blood, as flowing from the
vein could hardly be called red, and the coagulum was as weak in its
cohesion as possible. The state of the stomach and bowels was by this
time greatly improved, in common with other parts of the system; but
no intromission of bile had yet happened: the hardness about the
hypogastric region, though less, continued in a considerable degree,
and you ordered pills of mercury rubbed down, and rust of iron, to be
taken twice a day, with a decoction of dandelion and sal sodae.
A cataplasm of linseed was applied every night over the stomach and
right side; and, with little deviation from this plan, she continued
to the end of the year, improving in her general health, but the
hepatic affection yet remaining. It was then determined to try the
effects of electricity, and gentle shocks were passed through the body
daily, and as nearly as could be through the liver, in various
directions.
On the fifth day there was reason to think that some gall had been
secreted and poured out, and this became every day more evident; but
it flowed only in small quantity, and irregularly into the bowels, as
appeared from the faeces being partially tinged by it.
In _February_ the lady left this neighbourhood, and though
convalescent, yet so nearly well as to promise us the satisfaction of
seeing her perfectly restored.
_June_ 29. The bile is now secreted in pretty good quantity, her
appetite is perfectly good, her strength equal to almost any degree of
exercise, and her health in general better than it has been for some
years.