Chapter 7

_Nov._ 8th. Mr. G----, Æt. 35. In the last stage of a phthisis pulmonalis, was attacked with a most urgent and painful difficulty of breathing. Suspecting this distress might arise from watery effusion in the chest, I gave him Digitalis, which relieved him considerably; and during the remainder of his life his breath never became so bad again.

CASE CXLIX.

_Nov._ 13th. Mrs. A---- of W----h----, Æt. 68. One of those rare cases in which no urine is secreted. It proved as refractory as usual to remedies, and not having ever succeeded in the cure of this disease, I determined to try the Digitalis. It was given in infusion, and, after a few doses, the secretion of a small quantity of urine seemed to justify the attempt. The next day, however, the secretion ceased, nor could it be excited again, tho' at last the medicine was pushed so as to occasion sickness, which continued at intervals for three days.

CASE CL.

_Nov._ 20th. Mrs. B----, Æt. 28. In the last stage of a pulmonary consumption became dropsical. I directed three grains of the pulv. Digital. to be taken daily, one in the morning, and two at night. She took twenty grains without any sensible effect.

CASE CLI.

_Nov._ 23d. Master W----, Æt. 7. Supposed hydrocephalus internus. A grain of pulv. fol. Digitalis was directed night and morning. After three days, no sensible effects taking place, it was omitted, and the mercurial plan of treatment adopted. The child lived near five months afterwards. Upon dissection near four ounces of water were found in the ventricles of the brain.

CASE CLII.

_Nov._ 26th. Mrs. W----, Æt. 65. I had attended this lady last winter in a very severe peripneumony, from which she narrowly escaped with her life. When the cold season advanced this winter, she perceived a difficulty in breathing, which gradually became more and more troublesome. I found her much harassed by a cough, which occasioned her to expectorate a little: the least motion increased her dyspnoea; she could not lie down in bed; her legs were considerably swelled, her urine small in quantity. I directed two grains of pulv. Digitalis made into a pill with gum ammoniac, to be taken every night, and to promote expectoration, a squill mixture twice in the day. Her urine in five days became clear and copious, and in a fortnight more she lost all her complaints, except a cough, for which she took the lac ammoniacum.

It is not improbable that the squill might have some share in this cure.

CASE CLIII.

_December_ 7th. Mr. H----, Æt. 42. A large sat man, very subject to gravelly complaints. After an attack in the usual manner, continued to feel numbness in his lower limbs, and a sense of weight across his loins. I directed infusum Digitalis to be given every six hours. Six ounces made him sick, and he took no more. The next day his urine increased, a good deal of sand passed with it, and he lost his disagreeable feels, but the sickness did not entirely cease before the fourth day from its commencement.

CASE CLIV.

_December_ 27th. Mr. B----, of H----, Æt. 55. Symptoms of hydrothorax, at first obscurely, afterwards more distinctly marked. Many things were tried, but the squill alone gave relief. At length this failed. About the third month of the disease, a grain of pulv. Digital. was ordered to be taken night and morning. This produced the happiest effects. In _March_ following he had some slight symptoms of relapse, which were soon removed by the same medicine, and he now enjoys good health. For a more particular narrative see case the first, communicated by Mr. Yonge.

CASE CLV.

_December_ 31st. Mrs. B----, of E----, Æt. 50. An ovarium dropsy of long continuance. She took three grains of pulv. Digital. every night at bed time, for a fortnight, but without any effect.

CASE CLVI.

A poor man in this town, after his kidneys had ceased to secrete urine for several days, was seized with hickup, fits of vomiting, and transient delirium. After examination I was satisfied the disease was the same as that mentioned at CXLIX. A very experienced apothecary having tried various methods to relieve him, I despaired of any success, but determined to try the Digitalis. It was accordingly given in infusion. At first it checked the vomitings, but did not occasion any secretion of urine.

1785.

The cases which have occurred to me in the course of this year, are numerous; but as the events of some of them are not yet sufficiently ascertained, I think it better to with-hold them at present.

HOSPITAL CASES, Under the Direction of the Author.

The four following cases were drawn out at my request by Mr. Cha. Hinchley, late apothecary to the Birmingham Hospital. They are all the Hospital cases for which the Digitalis was prescribed by me, whilst he continued in that office.

CASE CLVII.

_March_ 15th, 1780. John Butler, Æt. 30. Asthma and swelled legs. He was directed to take myrrh and steel every day, and three spoonfuls of infusum Digitalis every night. On the 8th of April he was discharged, cured of the swellings and something relieved of his asthmatic affections.

CASE CLVIII.

_November_ 18th, 1780. Henry Warren, Æt. 60. This man had a general anasarca and ascites, and was moreover so asthmatic, that, neither being able to sit in a chair nor lie in bed, he was obliged constantly to walk about, or to lean forward against a window or table. You prescribed for him thus.

R. Aq. cinn. spt. [Symbol: ounce]iv. Oxymel. scillit. Syr. scillit. aa. [Symbol: ounce]i. m. cap. cochlear. larg. sexta quaque horâ.

This medicine producing no increased discharge of urine, on the 25th you ordered the infusion of Digitalis, two spoonfuls every four hours. After taking this for thirty six hours, his urine was discharged in very great quantity; his breath became easy, and the swellings disappeared in a few days, though he took no more of the medicine. On the 2d of _December_ he was ordered myrrh and lac ammoniacum, which he continued until the 23d, when he was discharged cured, and is now in good health.

CASE CLIX.

_November_ 3d, 1781. Mary Crockett, Æt. 40. Ascites and universal anasarca. For one week she took sal. diureticus and tincture of cantharides, but without advantage. On the 10th you directed the infusion of Digitalis, a dram and half to half a pint, an ounce to be taken every fourth hour. Before this quantity was quite finished, the urine began to be discharged very copiously. The medicine was then stopped as you had directed. On the 15th, being costive, she took a jallap purge, and on the 24th she was discharged cured.

CASE CLX.

_March_ 16th, 1782. Mary Bird, Æt. 61. Great fullness about the stomach; diseased liver, and anasarcous legs and thighs. For the first week squill was tried in more forms than one, but without advantage. On the 22d she began with the Digitalis, which presently removed all the swelling.

She was then put upon the use of aperient medicines and tonics, and on the first of _August_ was discharged perfectly cured.

* * * * *

The three following Cases were drawn up and communicated to me by Mr. Bayley, who succeeded Mr. Hinchley as apothecary to the Hospital at Birmingham:

Shiffnall, April 26th, 1785. DEAR SIR,

During my residence in the Birmingham General Hospital, I had frequent opportunities of seeing the great effects of the Digitalis in dropsy. As the exhibition of it was in the following instances immediately under your own direction, I have drawn them up for your inspection, previous to your publishing upon that excellent diuretic. Of its efficacy in dropsy I have considerable evidence in my possession, but consider myself not at liberty to send you any other cases except those you had yourself the conduct of. The Digitalis is a very valuable acquisition to medicine; and, I trust, it will cease to be dreaded when it is well understood.

I am, Sir, your obedient, And very humble servant, W. BAYLEY.

CASE CLXI.

Mary Hollis, aged 62, was admitted an out patient of the Birmingham General Hospital _February_ 12th, 1784, labouring under all the effects of hydrothorax; her dread of suffocation during sleep was so great, that she always reposed in an elbow chair. She was directed to take two grains of Digitalis in powder every night and morning, and for a few days found great relief; but, on the eighth day, as she had complained of sickness, and had been considerably purged, she was ordered to desist taking any more of her powders. On the 14th day she was ordered an ounce of the following infusion twice in a day: R. Fol. Digital. purp. sicc. [Symbol: dram]iss. aq. bullient. [Symbol: pound]ss. digere per semi-horam, colaturæ adde tinct. aromatic [Symbol: ounce]i. This infusion did not purge, but sometimes excited nausea, though not sufficient to prevent her from continuing its use. She grew gradually better, and on the 6th of _May_ was discharged perfectly cured. The diuretic effects of the Digitalis were in this instance immediate.

CASE CLXII.

Edward James, Æt. 21. Admitted _March_ 20th, 1784. Complained of great difficulty of breathing, pain in his head, and tightness about the stomach, with a trifling swelling of his legs. Ordered pil. scillit. [Symbol: scruple]i. ter de die. On the third day his legs much more swelled, his breathing more difficult, and in every respect worse; his pulse very small and quick, complained when he turned in bed, of something like water rolling from one side of the thorax to the other. A remarkable blueness about the mouth and eyes, and purged considerably from the pil. scill. Ordered to omit the pills and to take [Symbol: ounce]i. of infus. Digitalis every eight hours; the proportion [Symbol: dram]iss. to eight ounces of water and [Symbol: ounce]i. of aq. n. m. sp.--7th Day, The infusion had neither purged, nor vomited him: he only complained once or twice of giddiness. His belly was now very hard, rather black on the right side the navel, and his legs amazingly swelled. Ordered a bolus with rhubarb and calomel, to be taken in the morning, and [Symbol: ounce]ii. julep salin. cum tinct. canthar. gutt. forty ter die.--12th Day, nearly in the same state, except his breathing which was somewhat more difficult, being now obliged to have his head considerably raised. Persistat--From this day to the 32d day he became hourly worse. His belly which at first was only hard, now evidently contained a large quantity of water, his legs were more swelled, and a large sphacelated sore appeared upon each outer ancle. Respiration was so much obstructed, that he was obliged to sit quite upright to prevent suffocation. He made very little water, not more than eight ounces in a day and a night, and was much emaciated. Ordered his purging bolus again, and [Symbol: ounce]ii. of a mixture with sal diuretic, [Symbol: ounce]ss. to [Symbol: ounce]xii. three times in a day, and a poultice with ale grounds to his legs.

54th day. To this period there was not the least probability of his existing; his legs and thighs were one continued blubber, his thorax quite flat, and his belly so large that it measured within one inch as much as a woman's in this Hospital the day she was tapped, and from whom twenty seven pounds of coagulable lymph were taken. He made about three ounces of water in twenty-four hours: his penis and scrotum were astonishingly swelled, and no discharge from the sores upon his legs. Ordered to take a pill with two grains of powdered Foxglove night and morning. For a few days no sensible effect, but about the 60th day he complained of being continually giddy, and had some little pain in his stomach. He now made much more water, and dared to sleep. His appetite which through the whole of his illness had been very bad, was also better. 66th day. Breathing very much relieved, the quantity of water he made was three chamber pots full in a day and a night, each pot containing two quarts and four ounces, moderately full. Ordered to continue his pills, and his legs which were very flabby, to be rolled.

69th day. His belly nearly reduced to its natural size, still made a prodigious quantity of water, his appetite very good, habit of body rather lax, and his complexion ruddy. On the 2d of _June_, being still rather weak, he was ordered decoct. cort. [Symbol: ounce]ii. ter de die; and on the 12th was discharged from this Hospital perfectly cured.

W. BAYLEY.

Mr. Bayley's respectful compliments to Doctor Withering: he sends the case of Edward James, which he believes is pretty correct. He laments not having it in his power to send the measure of his belly, having unfortunately, mislaid the tape: he heard from James yesterday, and he is perfectly well.

_General Hospital, August 5, 1784._

CASE CLXIII.

On the 26th _February_, 1785, Sarah Ford, aged 42, was admitted an out-patient of the Birmingham General Hospital: she complained of considerable pain in her chest, and great difficulty of breathing, her face was much swelled and her thighs and legs were anasarcous. She had extreme difficulty in making water, and with many painful efforts she did not void more than six ounces in twenty-four hours. She had been in this situation about six weeks, during which time she had taken ammoniacum, olibanum, and large quantities of squills, without any other effect than frequent sickness. Upon her commencing an Hospital patient, the following medicine was exhibited. R. gum ammoniac [Symbol: dram]ii. pulv. fol. Digital. purp. [Symbol: scruple]ii. sp. lavand. comp. ut fiat pil. 40. cap. ii. nocte maneque. She continued the use of these pills for a few days, without any sensible effect. On the eighth day her breathing was much relieved, her legs and thighs were not so much swelled, and in a day and a night she made five pints of water. By the 12th day her legs and thighs were nearly reduced to their natural size. She continued to make water in large quantities, and had lost her pain in the thorax. To the 20th of _March_, she made rapid advances towards health, when not a symptom of disease remaining, she was discharged.

COMMUNICATIONS FROM CORRESPONDENTS.

London, Norfolk-street, May 31st, 1785.

SIR,

I had the favour of your letter last week; and I shall be very happy if I can give you any intelligence relating to the Foxglove, that can answer the purpose in which you are so laudably engaged.

It is true that my brother, the late Dr. Cawley, was greatly relieved, and his life, perhaps, prolonged for a year, by a decoction of the Foxglove root; but why it had not a more lasting effect, it is necessary I should tell you that he had all the signs of a distempered viscera, long before any watery swellings appeared; it was manifest that his dropsy was merely symptomatic, and he could therefore only from time to time have any relief from medicine. In the year 1776, he returned from London to Oxon. having consulted several physicians at the former place, and Dr. Vivian at the latter, but without any success; and he was then told of a carpenter at Oxon. that had been cured of a Hydrops pectoris by the Foxglove root, and as he was a younger, and in other respects an healthy man, his cure, I believe, remains a perfect one.

I did not attend my brother whilst he took the medicine, and therefore I cannot speak precisely to the operation of it; but I remember, by his letters, that he was dreadfully sick and ill for several days before the secretion of urine came on, but which it did do to a great degree; relieved his breath, and greatly lessened the swelling in his legs and thighs; but the two instances I have lately seen in this part of the world, are much stronger proofs of the efficacy of it than my brother's case.

I am, &c. ROBERT CAWLEY.

N. B. Whenever I have another opportunity of giving the Foxglove, it shall be in small doses:--In which I should hope it might succeed, although it might be more slowly. If you should try it with success, I should be glad to know what mode you made use of.

Dr. Cawley's prescription.

R. Rad. Digital. purpur. siccat. et contus. [Symbol: ounce]ii.

Coque ex aq. font. [Symbol: pound]ii. ad [Symbol: pound]i. colat. liquor. adde aq. junip. comp. [Symbol: ounce]ii.

Mell. anglic [Symbol: ounce]i. m. sumat cochl. iv. omni nocte h. s. et mane.

--I have elsewhere remarked, that when the Digitalis has been properly given, and the diuretic effects produced, that an accidental over-dose bringing on sickness, has stopped the secretion of urine. In the present instance it likewise appears, that violent sickness may be excited, and continue for several days without being accompanied by a flow of urine; and it is probable that the latter circumstance did not take place, until the severity of the former abated. If Dr. Cawley had not had a constitution very retentive of life, I think he must have died from the enormous doses he took; and he probably would have died previous to the augmentation of the urinary discharge. For if the root from which his medicine was prepared, was gathered in its active state, he did not take at each dose less than _twelve_ times the quantity a strong man ought to have taken. Shall we wonder then that patients refuse to repeat such a medicine, and that practitioners tremble to prescribe it? Were any of the active and powerful medicines in daily use to be given in doses _twelve_ times greater than they are, and these doses to be repeated without attention to the effects, would not the patients die, and the medicines be condemned as dangerous and deleterious?--Yet such has been the fate of Foxglove!

A Letter to the Author, from Mr. BODEN, Surgeon, at Broseley, in Shropshire.

Broseley, 25th May, 1785. Dear SIR,

Have inclosed the prescriptions that contained the fol. Digital. which I gave to Thomas Cooke and Thomas Roberts.

Thomas Cooke, Æt. 49, had been ill about two or three weeks. When I saw him he had no appetite, and a constant thirst: a fullness and load in the stomach: the thighs, legs and hands, much swell'd, and the face and throat in a morning; was costive, and made but little water, which was high coloured; the pulse very weak, and his breath exceeding bad. _June_ 17th. R. Argent, viv [Symbol: dram]i. cons. cynosbat. [Symbol: scruple]ii. fol. Digital. pulv. gr. xv. f. pil. xxiv. capt. ii. omni nocte horâ decubitus. He was likewise purged by a bolus of argent. viv. jallap, Digit. elaterium and calomel, which was repeated on the fourth day, to the third time. From _June_ 17th to the 29th, the symptoms were mostly removed, making water freely, and having plenty of stools; in a week after he was perfectly well, and remains so ever since. The cure was finished by steel and bitters.

Thomas Roberts, Æt. 40, had a deformed chest, was obliged to be almost in an erect posture when in bed; the other symptoms were nearly the same as Cooke's. _August_ 3d. The pills prescribed _June_ 17th for Cooke.--17th. A purging bolus of jalap and Digitalis, once a week. He continued the medicines till the latter end of _August_, when he got very well; but the complaint returned in _Jan._ worse than before. He is now much better, but I have great reason to believe the liver to be diseased.

I am, with the greatest respect,

Your very obliged humble servant,

DANIEL BODEN.

P. S. The second patient, on his relapse, took Digitalis again, combined with other things.

CASE communicated by Mr. CAUSER, Surgeon, at Stourbridge, Worcestershire.

Mr. P---- of H---- M----, in the parish of Kingswinford, aged about 60; had been a strong healthy, robust, corpulent man; worked hard early in life at edge-tool making, and drank freely of strong malt liquor; for many years had been subject to gout in the extremities; for a few years past had been very asthmatic, and the gout in the extremities gradually decreased. When I first saw him, which was _Sept._ 12, 1779, his legs were anasarcous, his belly much swelled, and an evident fluctuation of water. His breathing very bad, an irregular pulse, and unable to lie down. His easiest posture was standing with his body leaning over a chair, in which situation he would continue many hours together, labouring for breath, with the sweat trickling down his face very profusely; the urine in very small quantity. Diuretics of every kind I could think of were used with very little or no advantage. Blisters applied to the legs relieved very considerably for a time, but by no means could I increase the urinary discharge. Warm stomachic medicines were given, and at the same time sinapisms applied to the feet, in hopes of enticing gout to the extremities, but without any good effect.--_November_ 22d. The swelling considerably increasing, an emetic of acet. scillitic. was given, which acted very violently, and increased the urinary discharge considerably. He continued better and worse, using different kinds of diuretic and expectorating medicines until _September_ 1781, when the disease was so much worse, I did not expect he could live many days. The acet. scillitic. was repeated, a table spoonful every half hour, till it acted briskly upwards and downwards; but without increasing the urinary discharge.--On the 17th of _September_ I infused [Symbol: dram]iii. of the fol. Digitalis in [Symbol: ounce]vi. of boiling water, for four hours; then strained it, and added [Symbol: ounce]i. of tinct. aromatica.--On the 18th he began by taking one spoonful, which he was to repeat every half hour, till it made him very sick, unless giddiness, loss of sight, or any other disagreeable effect took place. I had never given the medicine before, and had prepared him to expect the operation to be very severe. I saw him again on the 21st; he had taken the medicine regularly, till the whole quantity was consumed, without perceiving the least effect of any kind from it, and continued well till the evening of the following day, when a little sickness took place, which increased, but never so as to occasion either vomiting or purging, but a surprising discharge of urine. The saliva increased so as to run out of his mouth, and a watery discharge from his eyes; these discharges continued, with a continual sickness, till the swelling was totally gone, which happened in three or four days. He afterwards took steel and bitters; and continued very comfortably, without any return of his dropsy, until the 7th of _April_ 1782, when he was seized with an epidemic cough, which was very frequent with us at that time. His swellings now returned very rapidly, with the greatest difficulty in breathing, and he died in a few days. Blisters and expectorating medicines were used on this last return.

Extract of a Letter from Mr. CAUSER.

Mrs. S----, the subject of the following Case, was as ill as it is possible for woman to be and recover; from the inefficacy of the medicines used, I am convinced no medicine would have saved her but the Digitalis. I never saw so bad a case recovered; and it shews, that in the most reduced state of body, the medicine in small doses, will prove safe and efficacious.

N. B. The Digitalis, in pills, never occasioned the least sickness. She took two boxes of them.

CASE.

_January_ 2d, 1785. Mrs. S----, of W----, near Kidderminster, aged 38, has been affected with dropsical swellings of her legs and thighs, about six weeks, which have gradually grown worse; has now great difficulty in breathing, which is much increased on moving; a very irregular, intermittent pulse, urine in very small quantity, and in the seventh month of her pregnancy: a woman of very delicate constitution, with tender lungs from her infancy and very subject to long continued coughs.