Chapter 10

Matth. D----, Æt. 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 [Symbol: dram]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 dyspnoea, with pain in his stomach, which were soon removed by a repetition 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, [Symbol: dram]iss. to [Symbol: ounce]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 quantity 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.

Mr. H----, a publican, aged about 48 years, sent for me in _March_, 1778. He complained of a cough, shortness of breathing, which prevented him from laying down in bed; his belly, thighs and legs very much distended with water; the quantity of urine made at a time seldom exceeded a spoonful. I requested him to get some of the Digitalis, and as they had no proper weights in the house, I told them to put as much of the fresh leaves as would weigh down a guinea, into half a pint of boiling water; to let it stand till cold, then to pour off the clear liquor, and add a glass of gin to it, and to take three table spoonfuls every third hour, until it had some sensible effect upon him.

Before he had taken all the infusion, the quantity of urine made increased, (he therefore left off taking it), and it continued to do so until all the water was evacuated. His breathing became much better, his cough abated, though it never quite left him; he being for some time before asthmatic. By taking some tonic pills he continued quite well until the next spring, when he had a return of his complaint, which was carried off by the same means. Two years after, he had a third attack, and this also gave way to the medicine. Last year he died of a pleurisy.

I am, &c. JER. VAUX

Moor-Street, 8th May, 1785.

P. S. You must well recollect the case of Mrs. F----.--It was "a general dropsy--every time she took the medicine its effects were similar, viz. The discharge of urine came on gradually at first, increased afterwards, and the whole of the water both in the belly, legs, &c. was perfectly evacuated. Although the effects were only temporary, they were exceedingly agreeable to the patient, making her time much more comfortable."--(_See Case_ XLIII.)

A Letter from Mr. WAINWRIGHT, Surgeon, in Dudley.

Dear SIR,

It gives me great pleasure to find you intend to publish your observations on the Digitalis purpurea.

Several years are now elapsed since you communicated to me the high opinion you entertained of the diuretic qualities of this noble plant. To ensure success, due attention was recommended to its _preparation_, its _dose_, and its _effects_ upon the system.

I always gave the infusion of the dried leaves; the dose the same as in the prescriptions returned. If the medicine operated on the stomach or bowels, it was thought prudent to forbear. When the kidneys began to perform their proper functions, and the urine to be discharged, a continuance of its farther use was unnecessary.

These remarks you made in the case of the first patient for whom you prescribed the Digitalis in our neighbourhood, and I have found them all necessary at this present period. From the _decided_ good effects that followed from its use, in those cases where the most powerful remedies had failed, I was soon convinced it was a most valuable addition to the materia medica.

The want of a certain diuretic, has long been one of the desiderata of medicine. The Digitalis is undoubtedly at the head of that class, and will seldom, if properly administered, disappoint the expectation. I can speak with the more confidence, having, in an extensive practice, been a happy witness to its good qualities.

For several years, I have given the infusion in a variety of cases, where there was a deficiency in the secretion of the urine, with the greatest success. In recent obstructions, I do not recollect many failures. In anasarcous diseases, and in the anasarca, when combined with the ascites; in swellings of the limbs, and in diseases of the chest, when there was the greatest reason to believe an accumulation of serum, the most beneficial consequences have followed from its use.

Had I been earlier acquainted with your intention to publish an account of the Digitalis, I could have transmitted some cases, which might have served to corroborate these assertions: but I am convinced the Digitalis needs not my assistance to procure a favorable reception. Its own merit will ensure success, more than a hundred recited cases.

I could wish those gentlemen who intend to make use of this plant, to collect it in a hot dry day, when the petals fall, and the seed-vessels begin to swell.

The leaves kept to the second year are weaker, and their diuretic qualities much diminished. It will therefore be necessary to gather the plant fresh every season.

These cautions are unnecessary to the accurate botanist, who well knows, that a plant in the spring, though more succulent and full of juices, is destitute of those qualities which may be expected when that plant has attained its full vigour, and the seed-vessels begin to be manifest. But for want of attention to these particulars, its virtues may be thought exaggerated, or doubtful, if beneficial consequences do not always flow from its use. There are diseases it cannot cure; and in several of those patients in this town, who first took the Digitalis by your orders, there was the most positive proof of the viscera being unsound. In these desperate cases it often procured a plentiful flow of urine, and palliated a disease which medicine could not remove.

At a remote distance, physicians are seldom applied to for advice in trifling disorders. Many remedies have been tried without relief, and the disease is generally obstinate or confirmed.--It would not be fair to try the merits of the Digitalis in this scale. It might often fail of promoting the end desired. I flatter myself the reputation of this plant will be equal to its merit, and that it will meet with a candid reception.

As there is no pleasure equal to relieving the miseries and distresses of our fellow-creatures, I hope you will long enjoy that peculiar felicity.

Permit me to return my thankful acknowledgments, for your free communication of a medicine, by which means, through the blessing of providence, I have been enabled to restore health and happiness to many miserable objects.

I am, &c. Yours, J. WAINWRIGHT.

Dudley, April 26th, 1785.

CASE of Mr. WARD, Surgeon, in Birmingham.--Related by himself.

In _September_, 1782, I was seized with a difficulty of breathing, and oppression in my chest, in consequence of taking cold from being called out in the night. My tongue was foul; my urine small in quantity; my breath laborious and distressing on the slightest exercise. I tried the medicines most generally recommended, such as emetics, blisters, lac ammoniacum, oxymel of squills, &c. but finding little or no relief, I consulted Dr. Withering, who advised me to try the following prescription.

R. Fol. Digital. purp. siccat. [Symbol: dram]iss. Aq. bullientis [Symbol: ounce]iv. Aq. cinn. sp. [Symbol: ounce]ss. digere per horas quatuor, et colaturæ capiat cochlear. i. nocte maneque.

He also desired me to take fifty drops of tincture of cantharides three or four times a day.

After taking eight ounces of the infusion, and about twelve drams of the drops, I was perfectly cured, and have had no return since. The medicine did not occasion sickness or vertigo, nor had they any other sensible effect than in changing the appearance, and increasing the quantity of the urine, and rendering the tongue clean. After the last dose or two indeed, I had a little nausea, which was immediately removed by a small glass of brandy.

Birmingham, 1st July, 1785.

Communications from Mr. YONGE, Surgeon, in Shiffnall, Shropshire.

Dear SIR,

I have great satisfaction in complying with your just claim, by transcribing outlines of the subsequent cases, for insertion in your long requested tract on the Digitalis purpurea. The two first of these you will easily recollect, the cures having been conducted immediately under your own management, and the whole may add to that weight of evidence which long experience enables you to adduce of the efficacy of that valuable medicine. I have recited the only instances of its failure which occur to me, but many other, though successful cases, wherein its utility might seem dubious, and also the accounts received from people whose accuracy might be suspected, I shall not for obvious reasons trouble you with.

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 [Symbol: dram]i to be repeated as the symptoms should require it. He continued to be affected with slighter returns of the dyspnoea 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 [Symbol: dram]iss balsam peruv. was given occasionally to alleviate the paroxysms of dyspnoea.

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 oedematous.

On the 15th of _November_ a blister was laid over the sternum, and [Symbol: dram]iss 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 [Symbol: dram]i 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. [Symbol: scruple]ss. Spec. Aromatic. [Symbol: scruple]i. sp. lav. c. f. pilul. no. x. capiat i. nocte maneque, et alternis diebus sensim augeatur dosin.

In three days the effect of this medicine became visible, and when the dose of the Digitalis had been increased to six grains per day, the flow of urine generally amounted to seven pints every twenty-four hours. Not the least sickness, nor any other disagreeable symptom supervened, though he persevered in this plan until the end of _January_ at which time the dyspnoea was removed, and he has continued gradually to regain his flesh, strength, and appetite, without any relapse.

CASE II.

About the middle of the year 1784 a lady aged 48, returned from London, to her native air in Shropshire, under symptoms of complicated disease. It was your opinion that the plethoric state, consequent to that period, when menstruation first begins to cease, had under various appearances, laid the foundation of that deplorable state which now presented itself. The skin was universally of a pale, leaden colour; her person much emaciated, and her strength so reduced, as to disable her from walking without support. The appetite fluctuating, the digestion impaired so much, that solids passed the intestines with little appearance of solution: She had generally eight or ten alvine evacuations every day, and without this number, febrile symptoms, attended with severe vertiginous affection, and vomiting regularly ensued. The stools were of a pale ash colour. The urine generally pale, and at first in due quantity. The region of the stomach had a tense feel, without soreness: the feet and ancles oedematous, her sleep was uncertain: the pulse varying between 94 and 100, and feeble, except upon the approach of the menstrual periods, which were now only marked by its increased strength, and exacerbation of other febrile symptoms. Emetics, saline medicines, and gentle aperients were necessary to alleviate these. Six grains of ipecac, operated with sufficient power, and half a grain of calomel would have purged with great violence.

From the time of her arrival till the middle of _August_, mercury had been continued in various forms, and in doses such as the irritable state of her stomach and bowels would admit of. Spirit. nitri dulc.; sal. tartar, squill, and cantharides were alternately employed as diuretics, but without success, to retard the progress of an universal anasarca which was then advanced to such degree and accompanied by so great debility, and other dreadful concomitants, as to threaten a speedy and fatal catastrophe.

On the 16th of _August_ you first saw her, and directed thus.

R. Mercur. cinerei gr. ii. Fol. Digital, purpur. pulv. [Symbol: scruple]i. f. mass. in pill. no. xvi. dividend.--sumat unam hora meridiana, iterumque hora quinta pomeridiana quotidie. Capiat lixivii saponac. gutt. L. in haust. juscul. sine sale parati omni nocte.

On the 20th the flow of urine began to increase, and she continued the medicine in the same dose until the 20th of _September_, discharging from six to eight pints of water each day for the first week, and which quantity gradually diminished as she became empty. During this period she complained not of any sickness, except from the lixivium, which was after the first dose reduced to 20 drops; and her appetite and strength increased daily, though it was evident that no bile had yet flowed into the bowels, nor was the digestion at all improved. The anasarcous appearances being then removed, the Digitalis was omitted, and pills, composed of mercur. cinereus, aloes, and sal tartari directed twice a day, with [Symbol: dram]i. of vin. chalybeat. in infus. amar. simpl.

Her amendment in other respects proceeded slowly, but regularly, from that time until the 9th of October; when the state of plethora again recurring, with its usual attendant symptoms, [Symbol: ounce]iv. of blood were taken from the arm; and this was upon the same occasion, repeated in the following month, with manifest good consequences; though in both instances the colour of the blood, as flowing from the vein could hardly be called red, and the coagulum was as weak in its cohesion as possible. The state of the stomach and bowels was by this time greatly improved, in common with other parts of the system; but no intromission of bile had yet happened: the hardness about the hypogastric region, though less, continued in a considerable degree, and you ordered pills of mercury rubbed down, and rust of iron, to be taken twice a day, with a decoction of dandelion and sal sodæ.

A cataplasm of linseed was applied every night over the stomach and right side; and, with little deviation from this plan, she continued to the end of the year, improving in her general health, but the hepatic affection yet remaining. It was then determined to try the effects of electricity, and gentle shocks were passed through the body daily, and as nearly as could be through the liver, in various directions.

On the fifth day there was reason to think that some gall had been secreted and poured out, and this became every day more evident; but it flowed only in small quantity, and irregularly into the bowels, as appeared from the fæces being partially tinged by it.

In _February_ the lady left this neighbourhood, and though convalescent, yet so nearly well as to promise us the satisfaction of seeing her perfectly restored.

_June_ 29. The bile is now secreted in pretty good quantity, her appetite is perfectly good, her strength equal to almost any degree of exercise, and her health in general better than it has been for some years.

CASE III.

Mr. W----, aged--. In _June_, 1782, was affected with slight difficulty in respiration, upon taking exercise or lying down in bed. These symptoms increased gradually until the end of _July_, when he complained of sense of weight and uneasiness about the proecordia; loss of appetite; and costiveness. The urine was small in quantity, and high coloured; his pulse feeble, and intermitting; he breathed with difficulty when in bed, and slept little. After the exhibition of an emetic, and an opening medicine of rhubarb, sena, and sal tartari, he was directed to take half a dram of squill pill, pharm. Edinburg. night and morning, with [Symbol: dram]ss sal. sodæ in [Symbol: ounce]iss. infus. amar. simpl. twice a day; and these medicines were continued during ten days, without any sensible effect. A blister was then applied to the sternum, and six grains of calomel given in the evening. The symptoms were now increased very considerably, in every particular; and the following infusion was substituted for the former medicines.

R. Fol. Digital. purpur. [Symbol: dram]iii. Cort. limon. [Symbol: dram]ii. infund. Aq. bullient. [Symbol: pound]i. per hor. 2 et cola. sumat cochl. i. primo mane et repet. omni hora.

Sometime in the night considerable nausea occurred, and the following day he began to make water in great quantity, which he continued to do for three or four days. The pulse in a few hours became regular, slower, and stronger, and, in the course of a week, all the symptoms entirely vanished, and an electuary of cort. peruvian, sal martis, and spec. aromatic. confirmed his cure.

In _February_, 1784, this gentleman had a relapse of his disease, from which he again soon recovered by the same means, and is now perfectly well.

CASE IV.