An Account Of The Foxglove And Some Of Its Medical Uses Part 21

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 quant.i.ty 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 gla.s.s 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 quant.i.ty 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 n.o.ble 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 cla.s.s, 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 acc.u.mulation 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 a.s.sertions: but I am convinced the Digitalis needs not my a.s.sistance 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 dest.i.tute 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 quant.i.ty; my breath laborious and distressing on the slightest exercise. I tried the medicines most generally recommended, such as emetics, blisters, lac ammoniac.u.m, 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. ?iss.

Aq. bullientis ?iv.

Aq. cinn. sp. ?ss. digere per horas quatuor, et colaturae 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 quant.i.ty 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 gla.s.s 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 rec.u.mbent 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 aether and confect. card. aa ?i to be repeated as the symptoms should require it. He continued to be affected with slighter returns of the dyspna 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 ?iss balsam peruv. was given occasionally to alleviate the paroxysms of dyspna.

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, aether, with other medicines of the same kind, were now used, but without success. The effects of opium and venaefection were tried. The appet.i.te 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 quant.i.ty, now became diminished, and lateritious; and the ancles dematous.

On the 15th of _November_ a blister was laid over the sternum, and ?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 ?i tinct. cantharidum twice a day in pyrmont water, with pills of ammoniac, sal tartar. et extract. gentian. were subst.i.tuted, 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 quant.i.ty of four or five pints each day, during the whole time; the quant.i.ty 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. ?ss.

Spec. Aromatic. ?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 dyspna was removed, and he has continued gradually to regain his flesh, strength, and appet.i.te, 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 appet.i.te fluctuating, the digestion impaired so much, that solids pa.s.sed 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 quant.i.ty. The region of the stomach had a tense feel, without soreness: the feet and ancles dematous, 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.