CASE LII.
September 27th. Mr. S——, Æt. 45. Had been long in an ill state of health, from what had been supposed an irregular gout, was greatly emaciated, had a sallow complexion, no appetite, costive bowels, quick and feeble pulse. The cause of his complaints was involved in obscurity; but I suspected the poison of lead, and was strengthened in this suspicion, upon finding his wife had likewise ill health, and, at times, severe attacks of colic; but the answers to my enquiries seemed to prove my suspicions fruitless, and, amongst other things, I was told the pump was of wood. He had lately suffered extremely from difficult breathing, which I thought owing to anasarcous lungs; there was also a slight degree of pale swelling in his legs. Pulv. fol. Digital. made into pills, with gum ammoniac and aromatic species, soon relieved his breathing. Attempts were then made to assist him in other respects, but with little good effect, and some months afterwards he died, with every appearance of a worn out constitution.
About two years after this gentleman's death, I was talking to a pump-maker, who, in the course of conversation, mentioned the corrosion of leaden pumps, by some of the water in this town, and instanced that at the house of Mr. S——, which he had replaced with a wooden one about three years before. The lead, he said, was eaten away, so as to be very thin in some places, and full of holes in others;—this accidental information explained the mystery.
The deleterious effects of lead seem to be considerably modified by the constitution of the patient; for in some families only one or two individuals shall suffer from it, whilst the rest receive it with impunity. In the spring of the year 1776, I was desired to visit Mrs. H——, of S—— Park, who had repeatedly been attacked with painful colics, and had suffered much from insuperable costiveness; I suspected lead to be the cause of her complaints, but was unable to trace by what means it was taken. She was relieved by the usual methods; but, a few months afterwards, I was desired to see her again: her sufferings were the same as before, and notwithstanding every precaution to guard against costiveness, she was never in perfect health, and seldom escaped severe attacks twice or thrice in a year; she had also frequent pains in her joints. I could not find any traces of similar complaints either in Mr. H——, the children, or the servants. Mrs. H—— was a water drinker, and seldom tasted any fermented liquor. The pump was of wood, as I had been informed upon my first visit. Her health continued nearly in the same state for two or three years more, but she always found herself better if she left her own house for any length of time. At length it occurred to me, that though the pump was a wooden one, the piston might work in lead. I therefore ordered the pump rods to be drawn up, and upon examination with a magnifying glass, found the leather of the piston covered with an infinite number of very minute shining particles of lead. Perhaps in this instance the metal was so minutely divided by abrasion, as to be mechanically suspended in the water. The lady was directed to drink the water of a spring, and never to swallow that from the pump. The event confirmed my suspicions, for she gradually recovered a good state of health, lost the obstinate costiveness, and has never to this day had any attack of the colic.
CASE LIII.
September 28th. Mrs. J——, Æt. 70. Ascites and very thick anasarcous legs and thighs, total loss of strength and appetite. Infusion of Digitalis was given, but, as had been prognosticated, with no good effect.
CASE LIV.
September 30th. Mr. A——, Æt. 57. A strong man; hydrothorax and swelled legs; in other respects not unhealthful. He was directed to take two grains of the Pulv. fol. Digit. made into a pill with gum ammoniac. Forty grains thus taken at intervals, effected a cure by increasing the quantity of urine, and he has had no relapse.
CASE LV.
November 2d. Mr. P—— of T——, Æt. 42. A very strong man, drank a great quantity of strong ale, and was much exposed to alterations of heat and cold. About the end of summer found himself short winded, and lost his appetite. The dyspnœa gradually increased, he got a most distressing sense of tightness across his stomach, his urine was little, and high coloured, and his legs began to swell; his pulse slender and feeble. From the 20th of September I frequently saw him, and observed a gradual and regular increase of all his complaints, notwithstanding the use of the most powerful medicines I could prescribe. He took chrystals of tartar, seneka, gum ammoniac, saline draughts, emetics, tinct. of cantharides, spirits of nitre dulcified, squills in all forms, volatile alkaly, calomel, Dover's powder, &c. Blisters and drastic purgatives were tried, interposing salt of steel and gentian. I had all along felt a reluctance to prescribe the Digitalis in this case, from a persuasion that it would not succeed. At length I was compelled to it, and directed one grain to be given every two hours until it should excite nausea. This it did; but, as I expected, it did no more. The reason of this belief will be mentioned hereafter. Five days after this last trial I gave him assafetida in large quantity, flattered by a hope that his extreme sufferings from the state of his respiration, might perhaps arise in part from spasm, but my hopes were in vain. I now thought of using an infusion of tobacco, and prescribed the following: