An Account Of The Foxglove And Some Of Its Medical Uses Part 3

30th. This day Dr. Darwin saw her, and directed a continuation of the medicines last prescribed.

_August_ 1st. I found the patient perfectly free from every appearance of dropsy, her breath quite easy, her appet.i.te much improved, but still very weak. Having some suspicion of a diseased liver, I directed pills of soap, rhubarb, tartar of vitriol, and calomel to be taken twice a day, with a neutral saline draught.

9th. We visited our patient together, and repeated the draughts directed on the 26th of _June_, with the addition of tincture of bark, and also ordered pills of aloes, guiac.u.m, and sal martis to be taken if costive.

_September_ 10th. From this time the management of the case fell entirely under my direction, and perceiving symptoms of effusion going forwards, I desired that a solution of merc. subl. corr. might be given twice a day.

19th. The increase of the dropsical symptoms now made it necessary to repeat the Digitalis. The dried leaves were used in infusion, and the water was presently evacuated, as before.

It is now almost nine years since the Digitalis was first prescribed for this lady, and notwithstanding I have tried every preventive method I could devise, the dropsy still continues to recur at times; but is never allowed to increase so as to cause much distress, for she occasionally takes the infusion and relieves herself whenever she chooses. Since the first exhibition of that medicine, very small doses have been always found sufficient to promote the flow of urine.

I have been more particular in the narrative of this case, partly because Dr. Darwin has related it rather imperfectly in the notes to his son's posthumous publication, trusting, I imagine, to memory, and partly because it was a case which gave rise to a very general use of the medicine in that part of Shrops.h.i.+re.

CASE V.

_December_ 10th. Mr. L----, aet. 35. Ascites and anasarca, the consequence of very intemperate living. After trying squill and other medicines to no purpose, I directed a decoction of the Fol. Digital.

recent. six drams to a pint; an eighth part to be taken every fourth hour. This made him sick, and produced a copious flow of urine, but not enough to remove all the dropsical symptoms. After a fortnight a stronger decoction was ordered, and, upon a third trial, as the winter advanced, it became necessary to use four ounces to the pint decoction; and thus he got free from all his complaints.

In _October_ 1777, in consequence of having pursued his intemperate mode of living, his dropsy returned, accompanied by evident marks of diseased viscera. A decoction of two drams of Fol. Digital. siccat. to a pint, once more removed the dropsy. He took a wine gla.s.s full thrice a day.

In _January_ 1778, I was desired to visit him again. I found he had gone on in his usual intemperate life, his countenance jaundiced, and the dropsy coming on apace. After giving some deobstruent medicines, I again directed the Digitalis, which again emptied the water; but he did not survive many weeks.

1777.

CASE VI.

_February_--. Mrs. M----, aet. 45. Ascites and anasarca, but not much otherwise diseased, and well enough to walk about the house, and see after her family affairs. I thought this a fair case for a trial of the Digitalis, and therefore directed a decoction of the fresh leaves, the stock of dried ones being exhausted. About a week afterwards, calling to see my patient, I was informed that she was dead; that the third day after my first visit she suddenly fell down, and expired.

Upon enquiry I found she had not taken any of the medicine; for the snow had lain so deep upon the ground, that the apothecary had not been able to procure it. Had the medicine been given in a case seemingly so favourable as this, and had the patient died under its use, is it not probable that the death would have been attributed to it?

CASE VII.

_February_ 11th. Mr. E----, of W----, aet. 61. Hydrothorax, ascites and anasarca, consequences of hard drinking. He had been attended for some time by a physician in his neighbourhood, who had treated his case with the usual remedies, but without affording him any relief; nor could I expect to succeed better by any other medicine than the Digitalis. The dried leaves were not to be had; and the green ones at this season being very uncertain in their strength, I ordered four ounces of the roots in a pint decoction, and directed three spoonfuls to be given every fourth hour, until it either excited nausea, or a free discharge of urine; both these effects took place nearly at the same time: he made a large quant.i.ty of water, the swellings subsided very considerably, and his breath became easy. Eight days afterwards he began upon a course of bitters and deobstruents. The dropsical symptoms soon increased again, but he had suffered so much from the severity of the sickness before, that he was neither willing to take, nor I to give the same medicine again.

Perhaps this patient might have been saved, if I had been well acquainted with the management and real doses of the medicine, which was certainly in this instance made very much too strong; and notwithstanding the caution to stop the further exhibition when certain effects should take place, it seems the quant.i.ty previously swallowed was sufficient to distress him exceedingly.

CASE VIII.

_March_ 11th. Mrs. H----, aet. 32. A few days after a tedious labour, had her legs and thighs swelled to a very great degree; pale and semi-transparent,[5] with pain in both groins. After a purge of calomel and rhubarb, ung. merc. was ordered to be rubbed upon the groins, and the following decoction was directed:

R. Fol. Digital. purp. recent. ?ii.

Aq. purae. ?i. coque ad ?iss et colatur. adde.

Aq. cinn. sp. ?iv. M. capiat. cyath. vinos. parv. bis quotidie.

The decoction presently increased the secretion of urine, and abated the distension of the legs: in a fortnight the swelling was gone; but some days after leaving her bed, her legs swelled again about the ancles, which was removed by another bottle of the decoction on the 21st of _April_.

[Footnote 5: This disease has lately been well described by Mr. White, of Manchester.]

CASE IX.

_March_ 29th. Mr. G----, aet. 47. Very much deformed; asthma of several years continuance, but now dropsical to a great degree. Took several medicines without relief, and then tried the Digitalis, but with no better success.

CASE X.

_April_ 10th. G--G----, aet. 70. Asthma and anasarca. Took a decoction of the fresh leaves of the Digitalis, which produced violent sickness, but no immediate evacuation of water. After the sickness had ceased altogether, the urine began to flow copiously, and he was cured.

CASE XI.

_July_ 10th. Mr. M---- of T----, aet. 54. A very hard drinker; had been affected since _November_ last with ascites and anasarca, for which he had taken several medicines without benefit. A decoction of the recent leaves of the Digitalis was then directed, an ounce and half to a pint, one eighth of which I ordered to be given every fourth hour. A few doses brought on great nausea, indistinct vision, and a great flow of urine, so as presently to empty him of all the dropsical water.

Indeed the evacuation was so rapid and so complete, that it became necessary to apply a bandage round the belly, and to support him with cordials.

In something more than a year and a half, his dropsy returned, but the Digitalis did not then succeed to our wishes. In _August_, 1779, he was tapped, and lived afterwards only about five weeks.

For more particulars, see the extract of a letter from Mr. Lyon.

CASE XII.

_September_ 12th. Miss C---- of T----, aet 48. An ovarium dropsy, and anasarcous legs and thighs. For three months in the beginning of this year she had been under the care of Dr. Darwin, who at different times had given her blue vitriol, elaterium, and calomel; decoction of pareira brava, and guiac.u.m wood, with tincture of cantharides; oxymel of squills, decoction of parsley roots, &c. Finding no relief, she discontinued the use of medicines, until the urgency of her symptoms induced her to ask my advice about the end of _August_. She was greatly emaciated, and had almost a total loss of appet.i.te. I first tried small doses of Merc. sublim. corr. in solution, with decoction of burdock roots, and blisters to the thighs. No advantage attending the use of this plan, I directed a decoction of Fol. Digit. a dram and half to a pint; one ounce to be taken twice a day. It presently reduced the anasarcous swellings, but made no alteration in the distension of the abdomen.

CASE XIII.

_October_ 9th. Mrs. B----, aet. 40. An ovarium dropsy. Took a decoction of Digitalis without effect. Her life was preserved for some years by repeated tapping.

1778.

CASE XIV.

_February_ 8th. Mr. R---- of K----. Had formerly suffered much from gout, and lived very intemperately. Jaundiced countenance; ascites; legs and thighs greatly swollen; appet.i.te none; extremely weak; confined to his bed. Had taken many medicines from his apothecary without advantage. I ordered him decoction of Digitalis, and a cordial; but he survived only a few days.

CASE XV.

_March_ 13th. Mr. M----, aet. 54. A thorax greatly deformed; asthma through the winter, succeeded by dropsy in belly and legs. Pulse very small; face leaden coloured; cough almost continual. Decoction of seneka was directed, and small doses of Dover's powder at night.

17th. Gum-ammoniac and squill, with elixir paregor. at night.--26th, Squill and decoction of seneka.--30th, His complaints still increasing, decoction of Digitalis was then directed, which relieved him in a few days; but his complaints returned again, and he died in the month of _June_.

CASE XVI.