I am, dear Sir,
Your obliged friend,
WILLIAM YONGE.
Shiffnall,
May 1, 1785.
CASE I.
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 æther and confect. card. aa ʒi to be repeated as the symptoms should require it. He continued to be affected with slighter returns of the dyspnœa 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 ʒiss balsam peruv. was given occasionally to alleviate the paroxysms of dyspnœa.
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, æther, with other medicines of the same kind, were now used, but without success. The effects of opium and venæfection 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 œdematous.
On the 15th of November a blister was laid over the sternum, and ʒiss 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 ʒi 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. ℈ss.
Spec. Aromatic. ℈i. sp. lav. c. f. pilul. no. x. capiat i. nocte maneque, et alternis diebus sensim augeatur dosin.