Part 8

R. Pulv. scillæ gr. iii. Jalap gr. x. syr. rosar. solut. tinct. senn. aa [Symbol: dram]ii. aq. menth. v. simpl. [Symbol: ounce]iss. m. mane sumend.

R. pulv. scillæ [Symbol: scruple]i. G. ammoniac, sapon. venet. aa [Symbol: dram]iss. syr. q. s. f. pilul. 42 cap. iii. nocte maneque.

On the 7th found her worse, and the swelling increased; the urine about [Symbol: ounce]x in the twenty-four hours.

R. Fol. siccat. Digital. [Symbol: dram]iii. coque in. aq. fontan. [Symbol: ounce]xii. ad [Symbol: ounce]vi. cola et adde. aq. juniper. comp. [Symbol: ounce]ii. sacchar. alb. [Symbol: ounce]ss. m. cap. cochlear. i. larg. 4tis horis.

She took about three parts of the medicine before any effect took place. The first was sickness, succeeded by a considerable discharge of urine. She continued the medicine till the whole was consumed, which caused a good deal of sickness for three or four days.

I saw her again on the 12th. The quantity of urine was much increased, and the swelling diminished. Pulse and breathing better.

R. Fol. sicc. Digital. G. assafetid. aa [Symbol: dram]i. calomel. pp. gr. x. sp. lavand. comp. q. s. fiat pilul. xxxii. cap. ii. omni nocte horâ somni.

A plentiful discharge of urine attended the use of these pills, and she got perfectly free from her dropsical complaints.

_March_ 15th she was delivered: had a good labour, was treated as is usual, except in not having her breasts drawn, not intending see should suckle her child, being in so reduced a state. Continued going on well till the 18th, when she was seized with very violent pains across her loins, at times so violent as to make her cry out as much as labour pains. Enema cathartic. Fot. papav. applied to the part.

R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s. fiat pilul. vi. capt. i. 2da quaque horâ durante dolore.

R. Julep, e camphor, sp. minder. aa [Symbol: ounce]ii. capt. cochlear, i. larg. post singul. pilul.

19th. Breathing short, unable to lie down, very irregular low pulse scarcely to be felt, fainty, and a universal cold sweat: no appetite nor thirst, spasmodic pains at times across the loins very violent, but not so frequent as on the preceding day.

R. Gum ammoniac, assafetid. aa [Symbol: dram]i. camphor. gr. xii. fiat pilul. 24. capt. ii. 3tia quaque horâ in cochlear. ii. mixtur. seq.

R. Balsam. peruv. [Symbol: dram]iii. mucilag. G. arab. q. s. flor. zinci g. vi. aq. menth. simp. [Symbol: pound]ss. m.

Applic. Emp. vesicat. femorib. internis.

R. Sp. vol. foetid. elixir. paregor. balsam. Traumatic. aa [Symbol: dram]iii. capt. cochlear. parv. urgente languore.

20th. Much the same; makes very little water, and the legs begin to swell.--Applic. Emp. e pice burgund. lumbis.

23d. The swelling very much increased.--Capt. gutt. xv. acet. scillitic. ter die in two spoonfuls of the following mixture.

R. Infus. baccar. juniper, [Symbol: ounce]vi. tinct. amar. tinct. stomachic. aa [Symbol: ounce]i. m.

25th. Much the same.

28th. The swelling considerably increased, in other respects very much the same.

30th. Breathing very bad, with cough and pain across the sternum, unable to lie down, legs, thighs, and body very much swelled, urine not more than four or five ounces in the twenty-four hours; hot and feverish, with thirst.

Applic. Emp. vesicat. stomacho et sterno.

R. G. assafetid. [Symbol: scruple]ii. pulv. jacob. [Symbol: scruple]i. rad. scill. recent. gr. xii. extract. thebaic. gr. iv. f. pilul. xvi. cap. iv. omni nocte.

R. Sal. nitr. sal. diuretic. aa [Symbol: dram]ii. pulv. e contrayerv. comp. [Symbol: dram]i. sacchar. [Symbol: ounce]i. emuls. commun. [Symbol: pound]i. aq. cinnam. simpl. [Symbol: ounce]i. m. capt. cochlear. iv. ter die.

_April_ 2d. Much the same, no increase of urine.

3d. Breathing much relieved by the blister, which runs profusely. Repeated the medicines, and continued them till the

12th. The cough very bad, pulse irregular, swelling much increased, urine in very small quantity, not at all increased; great lowness and fainting. She desired to have some of the pills which relieved her so much when with child. I was almost afraid to give them, but the inefficacy of the other medicines gave me no hopes of a cure from continuing them, which made me venture to comply with her request.

R. Fol. siccat. Digital. G. assafetid. aa [Symbol: dram]i. sp. lavand. comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node cap. pilul. e styrace gr. vi.

17th. Considerable increase of urine.

21st. Swelling a good deal diminished; urine near four pints in twenty-four hours, which is more than double the quantity she drinks.

Applic. Emp. vesicat. femoribus internis.

The Digitalis pills and opiate at bed-time continued. Takes a tea cup of cold chamomile tea every morning.

25th. Swelling much diminished, makes plenty of water, appetite much mended, cough and breathing better. She omitted the medicine for three days; the urine began to diminish, the swelling and shortness of breathing worse. On repeating it for two days, the discharge was again augmented, and a diminution of the swelling succeeded. She has continued the pills ever since till the 14th of _May_; the dropsical symptoms and cough are entirely gone, the water is in sufficient quantity, her strength is recovered, and she has a good appetite. All she now complains of is a weight across her stomach, which is worse at times, and she thinks, unless it can be removed, she shall have a return of her dropsy.

Extract of a Letter from Doctor FOWLER, Physician, at Stafford.

I understand you are going to publish on the Digitalis, which I am glad to hear, for I have long wished to see your ideas in print about it, and I know of no one (from the great attention you have paid to the subject) qualified to treat on it but yourself. There are gentlemen of the faculty who give verbal directions to poor patients, for the preparing and taking of an infusion or decoction of the green plant. Would one suppose that such gentlemen had ever attended to the nature and operation of a sedative power on the functions, _particularly_ the _vital_? Is not such a vague and unscientific mode of proceeding putting a two edged sword into the the hands of the ignorant, and the most likely method to damn the reputation of any very active and powerful medicine? And is it not more than probable that the _neglect_ of adhereing to a _certain_ and _regular_ preparation of the nicotiana, and the _want_ (of what you _emphatically_ call) a _practicable_ dose, have been the chief causes of the once rising reputation of that noted plant being damned above a century ago? In short, the Digitalis is beginning to be used in dropsies, (although some patients are said to go off suddenly under its administration) somewhat in the style of broom ashes; and, in my humble opinion, the public, at this very instant, stand in great need of your _precepts_, _guards_, and _cautions_ towards the safe and successful use of such a powerful sedative diuretic; and I have no doubt of your minute attention to those particulars, from a regard to the good and welfare of mankind, as well as to your own reputation with respect to that medicine.

I remember an officer in the Staffordshire militia, who died here of a dropsy five years ago. The Digitalis relieved him a number of times in a wonderful manner, so that in all probability he might have obtained a radical cure, if he would have refrained from hard drinking. I understood it was first ordered for him by a medical gentleman, and its sedative effects proved so mild, and diuretic operation so powerful, that he used to prepare it afterwards for himself, and would take it with as little ceremony as he would his tea. It is said, that he was so certain of its successful operation, that he would boast to his bacchanalian companions, when much swelled, you shall see me in two days time quite another man.

CASES communicated by Mr. J. FREER, jun. Surgeon, in Birmingham.

CASE I.

_Nov._ 1780. Mary Terry, aged 60. Had been subject to asthma for several years; after a severe fit of it her legs began to swell, and the quantity of urine to diminish. In six weeks she was much troubled with the swellings in her thighs and abdomen, which decreased very little when she lay down: she made not quite a pint of water in the twenty-four hours. I ordered her to take two spoonfuls of the infusion of Foxglove every three hours. By the time she had taken eight doses her urine had increased to the quantity of two quarts in the day and night, but as she complained of nausea, and had once vomited, I ordered the use of the medicine to be suspended for two days. The nausea being then removed, she again had recourse to it, but at intervals of six hours. The urine continued to discharge freely, and in three weeks she was perfectly cured of her swellings.

CASE II.

_December_, 1782. A poor woman, who had been afflicted with an ague during the whole of her pregnancy, and for two months with dropsical swellings of the feet, legs, thighs, abdomen, and labia pudenda; was at the expiration of the seventh month taken in labour. On the day after her delivery the ague returned, with so much violence as to endanger her life. As soon as the fit left her, I began to give her the red bark in substance, which had the desired effect of preventing another paroxysm. She continued to recover her health for a fortnight, but did not find any diminution in the swellings; her legs were now so large as to oblige her to keep constantly on the bed, and she made very little water. I ordered her the infusion of Foxglove three times a day, which, on the third day, produced a very copious discharge of urine, without any sickness; she continued the use of it for ten days, and was then able to walk. Having lost all her swellings, and no complaint remaining but weakness, the bark and steel compleated the cure.

Extract of a Letter from Doctor JONES, Physician, in Lichfield.

Anxious to procure authentic accounts from the patients, to whom I gave the Foxglove, I have unavoidably been delayed in answering your last favour. However, I hope the delay will be made up by the efficacy of the plant being confirmed by the enquiry. Long cases are tedious, and seldom read, and as seldom is it necessary to describe every symptom; for every case would be a history of dropsy. I shall therefore content myself with specifying the nature of the disease, and when the dropsy is attended with any other affection shall notice it.

Two years have scarcely elapsed since I first employed the Digitalis; and the success I have had has induced me to use it largely and frequently.

CASE I.

Ann Willott, 50 years of age, became a patient of the Dispensary on the 11th of April 1783. She then complained of an enlargement of the abdomen, difficulty of breathing, particularly when lying, and costiveness. She passed small quantities of high-coloured urine; and had an evident fluctuation in the belly. Her legs were oedematous. Chrystals of tartar, squills, &c. had no effect. The 13th of _June_ she took two spoonfuls of a decoction of Foxglove, containing three drams of the dry leaves, in eight ounces, three times a day. Her urine soon increased, and in a few days she passed it freely, which continued, and her breath returned.

CASE II.

Mr. ----, 45 years of age, had been long subject to dropsical swellings of the legs, and made little water. Two spoonfuls of the same decoction twice a day, soon relieved him.

CASE III.

Mrs. ----, aged 70 years. A lady frequently afflicted with the gout, and an asthmatical cough. After a long continuance of the latter, she had a great diminution of urine, and considerable difficulty of breathing, particularly on motion, or when lying. Her body was much bound. There was, however, no apparent swelling. She took three spoonfuls of an aperient decoction of forty-five grains in six ounces and a half, every other morning. The urine was plentiful those days, and her breathing much relieved. In two or three weeks after the use of it she was perfectly restored. The purgative medicine neither increased the urine, nor relieved the breathing, till the Foxglove was added.

This spring she long laboured with the gout in her stomach, which terminated in a fit in her hand. During the whole of this tedious illness, of nearly three months, she passed little urine, and her breathing was again short.

She took the same preparation of Foxglove without any diuretic effect, and afterwards two and three grains of the powder twice a day with as little. The dulcified spirits of vitriol, however, quickly promoted the urinary secretion.

CASE IV.

Mr. C----, 46 years of age, had dropsical swellings of the legs, and passed little urine. He took the decoction with three drams, and was soon relieved.

CASE V.

Lady----, took three grains of the dried leaves twice a day, for swelled legs, and scantiness of urine, without effect.

CASE VI.

Mrs. Slater, aged 36 years. For dropsy of the belly and legs, and scantiness of urine, of several weeks standing, took three grains of the powder twice a day, and was quite restored in ten days. She took many medicines without effect.

CASE VII.

Mrs. P----, in her 70th year, took three grains of the powder twice a day, for scantiness of urine, and swelled legs, without effect.

CASE VIII.

Ann Winterleg, in her 26th year, had dropsical swellings of the legs, and passed little urine: she was relieved by two drams, in an eight ounce decoction.

CASE IX.

William Brown, aged 76. In the last stage of dropsy of the belly and legs, found a considerable increase of his urine by a decoction of Foxglove, but it was not permanent.

CASE X.

Mr. ----, -- years of age, and of very gross habit of body, became highly dropsical, and took various medicines, without effect. One ounce of the decoction, with three drams of the dry leaves in eight ounces, twice or three times a day, increased his urine prodigiously. He was evidently better, but a little attendant nausea overcame his resolution, and in the course of some weeks afterwards he fell a victim to his obstinacy.

CASE XI.

Mrs. Smith, about 50 years of age, after a tedious illness of many weeks, had a jaundice, and became dropsical in the legs. Two spoonfuls of the decoction, with three drams twice a day, increased her urine, and abated the swelling.

CASE XII.

Widow Chatterton, about 60 years of age. Took the decoction in the same way for dropsy of the legs, with little effect.

CASE XIII.

---- Genders, about thirty-four years of age, was delivered of three children, and became dropsical of the abdomen. She passed little or no urine, had constant thirst, and no appetite. She took two spoonfuls of an eight ounce decoction, with three drams twice a day. By the time she had finished the bottle, (which must have been on the fourth day,) she had evacuated all her water, and could go about. Her appetite increased with every dose, and she recovered without farther help.

CASE XIV.

Miss M---- M----, in her 20th year. Had been infirm from her cradle, and, after various sufferings, had an astonishing oedematous swelling of one leg and thigh, of many weeks standing. She passed little or no urine, and had all her other complaints. She took 2 spoonfuls of an eight oz. decoction of two drams, twice a day. Her urine immediately increased; and, on the third day, the swelling had entirely subsided.

CASE XV.

Mr. P----, 65 years of age, and of a full habit of body. Had lived freely in his youth, and for many years led rather an inactive life. His health was much impaired several months, and he had a considerable distention, and evident fluctuation in the abdomen, and a very great oedema of the legs and thighs. His breathing was very short, and rather laborious, appetite bad, and thirst considerable. His belly was bound, and he passed very small quantities of high-coloured urine, that deposited a reddish matter. He had taken medicines some time, and, I believe, the Digitalis; and had been better.

A blister was applied to the upper and inside of each thigh; he took two spoonfuls of the decoction, with three drams of the dry leaves, two or three times a day; and some opening physic occasionally.

He lived at a considerable distance, and I did not visit him a second time; but I was well informed, about ten days or a fortnight afterwards, that his urine increased amazingly upon taking the decoction, and that the water was entirely evacuated.

CASE XVI.

Mrs. G----, aged 50 years. After being long ailing, had a large collection of water in the abdomen and lower extremities. Her urine was high-coloured, in small quantities, and had a reddish sediment. She took the decoction of Digitalis, squills, &c. without any effect. The chrystals of tartar, however, cured her speedily.

CASE XVII.

Mr. ----, about 50 years of age, complained of great tension and pain across the abdomen, and of loss of appetite; his urine, he thought, was less than usual, but the difference was so trifling he could speak with no certainty: his belly seemed to fluctuate. Among other things he tried the Foxglove leaves dried, twice a day; and, although it appeared to afford him relief, yet the effect was not permanent.

CASE XVIII.

Mr. W----, aged between 60 and 70 years; and rather corpulent: was considerably dropsical, both of the belly and legs, and his urine in small quantities. Three grains of the dry leaves, twice a day, evacuated the water in less than a fortnight.

CASE XIX.

Sarah Taylor, 40 years of age, was admitted into the Dispensary for dropsy of the abdomen and legs; and was relieved by the Decoctum digitalianum.

CASE XX.

Lydia Smith, aged 60. Dispensary. Laboured many years under an asthma, and became dropsical. She took the decoction without effect.

CASE XXI.

John Leadbeater, aged 15 years. Had a quotidian intermittent, which was removed by the humane assistance of an amiable young lady. His intermittent was soon attended by a very considerable ascites; for which he became a patient of the Dispensary. He took a decoction of Foxglove night and morning. His urine increased immediately, and he lost all his complaints in four days.

CASE XXII.

William Millar, aged 50 years. Admitted into the Dispensary for a tertian ague, and general dropsy. The dropsy continuing after the ague was removed, and his urine being still passed in small quantities; he took the powdered leaves, and recovered his health in five days.

CASE XXIII.

Ann Wakelin, 10 years of age. Had for several weeks a dropsy of the belly after an ague. She took a decoction of Foxglove, which removed all complaint by the fourth day.

CASE XXIV.

Ann Meachime; a Dispensary patient. Had an ascites and scantiness of urine. She took the powder of Foxglove, and evacuated all her water in three days.

It may not be improper to observe, 1st. That various diuretics had long been given in many of these cases before I was consulted. And, 2dly. That the exhibition of the Foxglove was but seldom attended with sickness.

REMARKS.

These Cases, thus liberally communicated by my friend, Dr. Jones, are more acceptable, as they seem to contain a faithful abstract from his notes, both of the unsuccessful as well as the successful Cases.

The following Tabular View of them will give us some Idea of the efficacy of the Medicine.

Anasarca 7 Cases Cured 3 Relieved 1 Failed 3 Ascites 5 Cases Cured 4 Relieved 1 OEdematous leg 1 Case Cured 1 Ascites and anasarca 7 Cases Cured 4 Relieved 2 Failed 1 Asthma and dropsy 1 Case Failed 1 Hydrothorax and gout 1 Case Cured 1 ----, ascites and anasarca-- 2 Cases Cured 2

A CASE of Anasarca communicated by Mr. JONES, Surgeon, in Birmingham.

Dear SIR,

Having lately experienced the diuretic powers of the Foxglove, in a case of anasarca; I do myself the pleasure of communicating a short history of the treatment to you.

I am, &c. W. JONES.

Birmingham, May 17th, 1785.

My patient, Mrs. C----, who is in her 51st year, had the following symptoms, viz. alternate swelling of the legs and abdomen, a little cough, shortness of breath in a morning, thirst, weak pulse, and her urine, which was so small in quantity as seldom to amount to half a pint in twenty-four hours, deposited a clay-coloured sediment.

_April_ 16th, 1785, I directed the following form:

R. Fol. Digitalis siccat. [Symbol: dram]ii. Aq. fontanæ bullient. [Symbol: ounce]viii. f. infus. et cola. Sumat cochl. larga iii. o. n. et mane.

On the 17th she had taken twice of the infusion, and though by mistake only two tea spoonfuls for a dose, yet the quantity of urine was increased to about a pint in the twenty-four hours. She was then directed to take two table spoonfuls night and morning. And.

On the 18th, a degree of nausea was produced. A pint and half of urine was made in the last twenty-four hours. During the time above specified she had two or three stools every day. The infusion was now omitted.

On the 19th the swelling of the legs was removed. A degree of nausea took place in the morning, and increased so much during the day, that she vomited up all her food and medicine. As she was very low, and complained of want of appetite, a cordial julep was directed to be taken occasionally, as well as red port and water, mint tea, &c. She informed me that whatever she took generally staid about an hour before it came up again, and that the mint tea staid longest on the stomach. The vomiting decreased gradually, and ceased on the 22d. The discharge of urine remained considerable during the three following days, but its quantity was not measured.

22d. A dose of neutral saline julep was directed to be taken every fourth hour.

On the 23d she complained of thirst, and thought the discharge of urine not so copious as on the preceding days, therefore the saline julep was continued every fourth hour, with the addition of thirty drops of the following medicine:

R. Aceti scillitic. [Symbol: dram]vi. Tinct. aromat. [Symbol: dram]ii. Tinct. thebaic. gutt. xx. m.

The bowels have been kept open from the 19th, by the occasional use of emollient injections.

On the 24th the legs were much swelled again; she complained of languor and a degree of nausea. The discharge of urine increased a little since the 23d. Her pulse was low and her tongue white. The urine, which had been rendered clear by the infusion of Foxglove, now deposited a whitish sediment.

On the 25th her appetite began to return, the swelling of the legs diminished, and she thought herself much relieved. The urine was considerable in quantity, and clear.

On the 26th she was thirsty and languid. The swelling was removed; the quantity of urine discharged in the last twenty-four hours was about a pint. She continued to mend from this time, and is now in good health.

A giddiness of the head, more or less remarkable at times, was observed to follow the use of the Foxglove, and it lasted nine or ten days.