Part 26

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.

This is the second time that I have relieved this patient by the infusion of Foxglove. I used the same proportion of the fresh leaves the first time as I did of the dried ones the last. The violent vomiting which followed the use of the infusion made with the dried leaves, did not take place with the fresh though she took near a pint made with the same proportion of the herb fresh gathered.

REMARKS.

The above is a very instructive case, as it teaches us how small a quantity of the infusion was necessary to effect every desirable purpose. At first sight it may appear from the concluding paragraph, that the green leaves ought to be preferred to the dried ones, as being so much milder in their operation; but let it be noticed, that the same quantity of infusion was prepared from the same weight of the green as of the dried leaves, and consequently, as will appear hereafter, the infusion with the dried leaves was five times the strength of that before prepared from the green ones. We need not wonder, therefore, that the effects of the former were so disagreeable, when the dose was five times greater than it ought to have been. But what makes this matter still more obvious, is the mistake mentioned at first, of two tea spoonfuls only being given for a dose. Now a tea spoonful, containing about a fourth or a fifth part of the contents of a table spoon, the dose then given, was very nearly the same as that which had before been taken of the infusion of the green leaves, and it produced precisely the same effects for it increased the urinary discharge, without exciting the violent vomiting.

Letter from Doctor JOHNSTONE, Physician, in Birmingham.

Dear SIR,

The following cases are selected from many others in which I have given the Digitalis purpurea; and from repeated experience of its efficacy after other diuretics have failed. I can recommend it as an effectual, and when properly managed, a safe medicine.

I am, &c. E. JOHNSTONE.

Birmingham, May 26, 1785.

March 8th, 1783, I was called to attend Mr. G----, a gentleman of a robust habit, who had led a regular and temperate life, Æt. 68. He was affected with great difficulty of respiration, and cough particularly troublesome on attempting to lie down, oedematous swellings of the legs and thighs, abdomen tense and sore on being pressed, pain striking from the pit of the stomach to the back and shoulders; almost constant nausea, especially after taking food, which he frequently threw up; water thick and high-coloured, passed with difficulty and in small quantity; body costive; pulse natural; face much emaciated, eyes yellow and depressed. He had been subject to cough and difficulty of breathing in the winter for several years; and about four years before this time, after being exposed to cold, was suddenly deprived of his speech and the use of the right side, which he recovered as the warm weather came on; but since that time had been remarkably costive, and was in every respect much debilitated. He first perceived his legs swell about a year ago; by the use of medicines and exercise, the swellings subsided during the summer, but returned on the approach of winter, and gradually increased to the state in which I found them, notwithstanding he had used different preparations of squills and a great variety of other diuretic medicines. I ordered the following mixture.

R. Foliorum Digitalis purpur. recent. [Symbol: dram]iii. decoque ex aq. fontan. [Symbol: ounce]xii ad [Symbol: ounce]vi colaturæ adde Tinctur. aromatic.

Syr. zinzib. aa [Symbol: ounce]i. m. capt. cochl. duo larga secunda quaque hora ad quartam vicem nisi prius nausea supervenerit.

March 9th. He took four doses of the mixture without being in the least sick, and made, during the night upwards of two quarts of natural coloured water.

10th. Took the remainder of the mixture yesterday afternoon and evening, and was sick for a short time, but made nearly the same quantity of water as before, the swellings are considerably diminished, his appetite increased, but he is still costive.

R. Argent, viv. balsam peruv. aa [Symbol: dram]ss tere ad extinctionem merc. et adde gum. ammon. [Symbol: scruple]iii aloes socotorin. [Symbol: dram]ss rad. scil. recent. [Symbol: scruple]ss syr. simpl. q. s. f. mass. in pil. xxxii divid. cap. iii. bis in die.

14th. Continues to make water freely. The swellings of his legs have gradually decreased; soreness and tension of the abdomen considerably less.

Omittant. pil. cap. mistur. c. decoct. Digitalis. &c. 3tia quaque hora ad 3tiam vicem.

15th. Made a pint and a half of water last night, without being in the least sick, and is in every respect considerably better. Repet. Pillul. ut antea.

21st. Makes water as usual when in health, and the swellings are entirely gone.

R. Infus. amar. [Symbol: ounce]v. tinctur. Rhei spirit. [Symbol: ounce]ii. spirit vitriol. dulc. [Symbol: dram]ii. syr. zinzib. [Symbol: dram]vi. m. cap. cochl. iii. larg. ter in die.

He soon gained sufficient strength to enable him to go a journey, and returned home in much better health than he had been from the time he was affected with the paralytic stroke, and excepting some return of his asthmatic complaint in the winter, hath continued so ever since.