Part 5

CASE II.

January 14th. A poor man labouring under an ascites and anasarca, was directed to take a decoction of Digitalis every four hours. It purged him smartly, but did not relieve him. An opiate was now ordered with each dose of the medicine, which then acted upon the kidneys very freely, and he soon lost all his complaints.

CASE III.

March 15th. A poor boy, about nine years of age, was brought for my advice. His countenance was pale, his pulse quick and feeble, his body greatly emaciated, except his belly, which was very large, and, upon examination, contained a fluid. The case had been considered as arising from worms. He was directed to take the decoction of Digitalis night and morning. It operated as a diuretic, never made him sick, and he got well without any other medicine.

CASE IV.

July 25th. Mrs. H----, of A----, near N----, between forty and fifty years of age, a few weeks ago, after some previous indisposition, was attacked by a severe cold shivering fit, succeeded by fever; great pain in her left side, shortness of breath, perpetual cough, and, after some days, copious expectoration. On the 4th of June, Dr. Darwin, was called to her. I have not heard what was then done for her, but, between the 15th of June, and 25th of July, the Doctor, at his different visits, gave her various medicines of the deobstruent, tonic, antispasmodic, diuretic, and evacuant kinds.

On the 25th of July I was desired to meet Dr. Darwin at the lady's house. I found her nearly in a state of suffocation; her pulse extremely weak and irregular, her breath very short and laborious, her countenance sunk, her arms of a leaden colour, clammy and cold. She could not lye down in bed, and had neither strength nor appetite, but was extremely thirsty. Her stomach, legs, and thighs were greatly swollen; her urine very small in quantity, not more than a spoonful at a time, and that very seldom. It had been proposed to scarify her legs, but the proposition was not acceded to.

She had experienced no relief from any means that had been used, except from ipecacoanha vomits; the dose of which had been gradually increased from 15 to 40 grains, but such was the insensible state of her stomach for the last few days, that even those very large doses failed to make her sick, and consequently purged her. In this situation of things I knew of nothing likely to avail us, except the Digitalis: but this I hesitated to propose, from an apprehension that little could be expected from any thing; that an unfavourable termination would tend to discredit a medicine which promised to be of great benefit to mankind, and I might be censured for a prescription which could not be countenanced by the experience of any other regular practitioner. But these considerations soon gave way to the desire of preserving the life of this valuable woman, and accordingly I proposed the Digitalis to be tried; adding, that I sometimes had found it to succeed when other, even the most judicious methods, had failed. Dr. Darwin very politely, acceded immediately to my proposition, and, as he had never seen it given, left the preparation and the dose to my direction. We therefore prescribed as follows:

R. Fol. Digital. purp. recent. [Symbol: ounce]iv. coque ex Aq. fontan. puræ [Symbol: pound]iss ad [Symbol: pound]i. et cola. R. Decoct. Digital. [Symbol: ounce]iss. Aq. Nuc. Moschat. [Symbol: dram]ii. M. fiat. haust. 2dis horis sumend.

The patient took five of these draughts, which made her very sick, and acted very powerfully upon the kidneys, for within the first twenty-four hours she made upwards of eight quarts of water. The sense of fulness and oppression across her stomach was greatly diminished, her breath was eased, her pulse became more full and more regular, and the swellings of her legs subsided.

26th. Our patient being thus snatched from impending destruction, Dr. Darwin proposed to give her a decoction of pareira brava and guiacum shavings, with pills of myrrh and white vitriol; and, if costive, a pill with calomel and aloes. To these propositions I gave a ready assent.

30th. This day Dr. Darwin saw her, and directed a continuation of the medicines last prescribed.

August 1st. I found the patient perfectly free from every appearance of dropsy, her breath quite easy, her appetite much improved, but still very weak. Having some suspicion of a diseased liver, I directed pills of soap, rhubarb, tartar of vitriol, and calomel to be taken twice a day, with a neutral saline draught.

9th. We visited our patient together, and repeated the draughts directed on the 26th of June, with the addition of tincture of bark, and also ordered pills of aloes, guiacum, and sal martis to be taken if costive.

September 10th. From this time the management of the case fell entirely under my direction, and perceiving symptoms of effusion going forwards, I desired that a solution of merc. subl. corr. might be given twice a day.

19th. The increase of the dropsical symptoms now made it necessary to repeat the Digitalis. The dried leaves were used in infusion, and the water was presently evacuated, as before.

It is now almost nine years since the Digitalis was first prescribed for this lady, and notwithstanding I have tried every preventive method I could devise, the dropsy still continues to recur at times; but is never allowed to increase so as to cause much distress, for she occasionally takes the infusion and relieves herself whenever she chooses. Since the first exhibition of that medicine, very small doses have been always found sufficient to promote the flow of urine.

I have been more particular in the narrative of this case, partly because Dr. Darwin has related it rather imperfectly in the notes to his son's posthumous publication, trusting, I imagine, to memory, and partly because it was a case which gave rise to a very general use of the medicine in that part of Shropshire.

CASE V.

December 10th. Mr. L----, Æt. 35. Ascites and anasarca, the consequence of very intemperate living. After trying squill and other medicines to no purpose, I directed a decoction of the Fol. Digital. recent. six drams to a pint; an eighth part to be taken every fourth hour. This made him sick, and produced a copious flow of urine, but not enough to remove all the dropsical symptoms. After a fortnight a stronger decoction was ordered, and, upon a third trial, as the winter advanced, it became necessary to use four ounces to the pint decoction; and thus he got free from all his complaints.

In October 1777, in consequence of having pursued his intemperate mode of living, his dropsy returned, accompanied by evident marks of diseased viscera. A decoction of two drams of Fol. Digital. siccat. to a pint, once more removed the dropsy. He took a wine glass full thrice a day.

In January 1778, I was desired to visit him again. I found he had gone on in his usual intemperate life, his countenance jaundiced, and the dropsy coming on apace. After giving some deobstruent medicines, I again directed the Digitalis, which again emptied the water; but he did not survive many weeks.

1777.

CASE VI.

February--. Mrs. M----, Æt. 45. Ascites and anasarca, but not much otherwise diseased, and well enough to walk about the house, and see after her family affairs. I thought this a fair case for a trial of the Digitalis, and therefore directed a decoction of the fresh leaves, the stock of dried ones being exhausted. About a week afterwards, calling to see my patient, I was informed that she was dead; that the third day after my first visit she suddenly fell down, and expired. Upon enquiry I found she had not taken any of the medicine; for the snow had lain so deep upon the ground, that the apothecary had not been able to procure it. Had the medicine been given in a case seemingly so favourable as this, and had the patient died under its use, is it not probable that the death would have been attributed to it?

CASE VII.

February 11th. Mr. E----, of W----, Æt. 61. Hydrothorax, ascites and anasarca, consequences of hard drinking. He had been attended for some time by a physician in his neighbourhood, who had treated his case with the usual remedies, but without affording him any relief; nor could I expect to succeed better by any other medicine than the Digitalis. The dried leaves were not to be had; and the green ones at this season being very uncertain in their strength, I ordered four ounces of the roots in a pint decoction, and directed three spoonfuls to be given every fourth hour, until it either excited nausea, or a free discharge of urine; both these effects took place nearly at the same time: he made a large quantity of water, the swellings subsided very considerably, and his breath became easy. Eight days afterwards he began upon a course of bitters and deobstruents. The dropsical symptoms soon increased again, but he had suffered so much from the severity of the sickness before, that he was neither willing to take, nor I to give the same medicine again.

Perhaps this patient might have been saved, if I had been well acquainted with the management and real doses of the medicine, which was certainly in this instance made very much too strong; and notwithstanding the caution to stop the further exhibition when certain effects should take place, it seems the quantity previously swallowed was sufficient to distress him exceedingly.