An Account Of The Foxglove And Some Of Its Medical Uses Part 20

4th DAY. _Cap. Calomel. gambog. scill. &c._

OBS. Sufficient time was not allowed to observe its effects, neither was the patient enjoined the free use of diluents. The disease terminated fatally.

CASE II.

William T----, aet. 42. Ascites, with cough and dyspna. Abdomen very much distended. The rest of his body highly emaciated. Urine thick, high coloured, and in very small quant.i.ty.

_Decoct. Digit. (u. in Esther K----,) 4tis horis._

1st DAY of taking it. The 4th dose produced sickness.

2d. Vomiting after the second dose.

10th. Urine increased to ?vi.

11th. Flow of urine continues. Abdomen quite flaccid.

12th. Abdomen not diminished.

15th: A smart purging came on, and the flow of urine diminished.

23d. Belly much bound. Took a cathart. powder, which was followed by a diminution of the abdomen.

29th. To take a cathart. powder every 4th morning, continuing the decoct. Digit.

32d. Urine exceedingly scanty.

35th. _Vin. scill. ?ss. o. m. &c._ This produced diuretic effects.

44th. Tapped. Terminated fatally.

OBS. Here the medicine was _continued till it ceased to produce diuretic effects_; and these effects were not aided by any strengthening remedies.

CASE III.

George R----, aet. 52. Ascites, general anasarca, and dyspna. His legs so greatly distended that it was with great difficulty he could draw the one after the other.

_Infus. Digital. ?iiiss. ad. aq. ?ss. cap. ?i. altern. horis donec nauseam excitaverit._ _Rep. 3tiis diebus. tempore intermedio cap. sol. guaic. ?i. ter in die ex inf. sinap._

1st DAY of taking it. Became sickish towards night.

2d DAY. Made a great quant.i.ty of water during the night, and spat up a great deal of watery phlegm. The first dose he took in the morning has produced a sickness which has continued all day, but he has never vomited.

3d. DAY. The change in his appearance so great as to make it difficult to conceive him to be the same person. Instead of a large corpulent man, he appeared tall, thin, and rather aged. Breathes freely, and can walk up and down stairs without inconvenience.

4th DAY. _Decoct. bacc. junip. and cyder for common drink._

6th DAY. A second course of his medicine produced a flow of urine almost as plentiful as the former, though he drank little or nothing at the time. In a day or two after he walked to some distance.

12th DAY. _Pot. purgans illico._

14th DAY. _Pot. purg. c. jalap. ?ss. 4tis diebus._ _Infus. Dig. 3tiis diebus._

17th DAY. _R. Gamb. gr. iii. calom. gr. ii. camph.

gr. i. syr. simpl. fiat pil. o. n. sum._ _Infus. Digit. 3tiis diebus._

21st DAY. Made an out-patient. The super-abundant flow of urine continued for the first three days after his last course; but since, the flow of saliva has been nearly equal to that of urine.

The smalls of his legs not quite reduced, and are fuller at night. He has shrunk round the middle from four feet two inches to three feet six inches; and in the calves of his legs, from seventeen inches to thirteen and a half.[10]

[Footnote 10: In the three last recited cases, the medicine was directed in doses quite too strong, and repeated too frequently. If Esther K---- could have survived the extreme sickness, the diuretic effects would probably have taken place, and, from her time of life, I should have expected a recovery. Wm. T---- seems to have been a bad case, and I think would not have been cured under any management. G.

R---- certainly possessed a good const.i.tution, or he must have shared the fate of the other two.]

OBS. The waters were here very successfully evacuated, but as you remarked to me, on communicating the case to you at the time, tonic medicines should have been given, to second the ground that had been gained, instead of weakening the patient by drastic purgatives.

A CASE from Mr. SHAW, Surgeon, at Stourbridge.--Communicated by Doctor STOKES.

Matth. D----, aet. 71. Tall and thin. Disease a general anasarca, with great difficulty of breathing. The lac ammoniac. somewhat relieved his breath; but the swellings increased, and his urine was not augmented.

I considered it as a lost case, but having seen the good effects of the Digitalis, as ordered by Dr. Stokes in the case of Mrs. G----, I gave him one spoonful of an infusion of ?ii to half a pint, twice a day. His breath became much easier, his urine increased considerably, and the swellings gradually disappeared; since which his health has been pretty good, except that about three weeks ago, he had a slight dyspna, with pain in his stomach, which were soon removed by a repet.i.tion of the same medicine.

Mr. Shaw likewise informs me, that he has removed pains in the stomach and bowels, by giving a spoonful of the infusion, ?iss. to ?viii.

morning and night.

A Letter from Mr. VAUX, Surgeon, in Birmingham.

Dear SIR,

I send you the two following cases, wherein the Digitalis had very powerful and sensible effects, in the cure of the different patients.

CASE I.

Mrs. O---- of L---- street, in this town, aged 28, naturally of a thin, spare habit, and her family inclinable to phthisis, sent for me on the 11th of June, 1779, at which time she complained of great pain in her side, a constant cough, expectorated much, which sunk in water; had colliquative sweats and frequent purging stools; the lower extremities and belly full of water, and from the great difficulty she had in breathing, I concluded there was water in the chest also. The quant.i.ty of water made at a time for three weeks before I saw her, never amounted to more than a tea-cup full, frequently not so much.

Finding her in so alarming a situation, I gave it as my opinion she could receive no benefit from medicine, and requested her not to take any; but she being very desirous of my ordering her something, I complied, and sent her a box of gum pills with squills, and a mixture with salt of tartar: these medicines she took until the sixteenth, without any good effects: the water in her legs now began to exsude through the skin, and a small blister on one of her legs broke.

Believing she could not exist much longer, unless an evacuation of the water could be procured; after fully informing her of her situation, and the uncertainty of her surviving the use of the medicine, I ventured to propose her taking the Digitalis, which she chearfully agreed to. I accordingly sent her a pint mixture, made as under, of the fresh leaves of the Digitalis. Three drams infused in one pint of boiling water, when cold strained off, without pressing the leaves, and two ounces of the strong juniper water added to it: of this mixture she was ordered four table spoonfuls every third hour, till it either made her sick, purged her, or had a sensible effect on the kidneys. This mixture was sent on the seventeenth, and she began taking it at noon on the eighteenth. At one o'clock the following morning I was called up, and informed she was dying. I immediately attended her, and was agreeably surprised to find their fright arose from her having fainted, in consequence of the sudden loss of twelve quarts of water she had made in about two hours. I immediately applied a roller round her belly, and, as soon as they could be made, 2 others, which were carried from the toes quite up the thighs. The relief afforded by these was immediate; but the medicine now began to affect her stomach so much, that she kept nothing on it many minutes together. I ordered her to drink freely of beef tea, which she did, but kept it on her stomach but a very short time. A neutral draught in a state of effervescence was taken to no good purpose: She therefore continued the beef tea, and took no other medicine for five days, when her sickness went off: her cough abated, but the pain in her side still continuing, I applied a blister which had the desired effect: her urine after the first day flowed naturally. Her cure was compleated by the gum pills with steel and the bitter infusion. It must be observed she never had any collection of water afterwards.

It affords me great pleasure to inform you that she is now living, and has since had four children; all of whom, I think I may justly say, are indebted to the Digitalis for their existence.

There appears in this case a striking proof of the utility of emetics in some kinds of consumptions, as it appears to me the dropsy was brought on by the cough, &c. and I believe these were cured by the continual vomitings, occasioned by the medicine.

CASE II.