An Account of the Foxglove and some of its Medical Uses by William Withering (best book series to read .TXT) ๐
[Footnote 3: See the extract from this letter at page 5.]
In a letter which I received from you in London, dated September 29, 1778, you write as follows:--"I wish it was as easy to write upon the Digitalis--I despair of pleasing myself or instructing others, in a subject so difficult. It is much easier to write upon a disease than upon a remedy. The former is in the hands of nature, and a faithful observer, with an eye of tolerable judgment, cannot fail to delineate a like
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Mrs. Sโโ, 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. Sโโ, of Wโโ, 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.
R. Pulv. scillรฆ gr. iii.
Jalap gr. x. syr. rosar. solut. tinct. senn. aa สii. aq. menth. v. simpl. โฅiss. m. mane sumend.
R. pulv. scillรฆ โi. G. ammoniac, sapon. venet. aa สiss. syr. q. s. f. pilul. 42 cap. iii. nocte maneque.
On the 7th found her worse, and the swelling increased; the urine about โฅx in the twenty-four hours.
R. Fol. siccat. Digital. สiii. coque in. aq. fontan. โฅxii. ad โฅvi. cola et adde. aq. juniper. comp. โฅii. sacchar. alb. โฅss. m. cap. cochlear. i. larg. 4tis horis.
She took about three parts of the medicine before any effect took place. The first was sickness, succeeded by a considerable discharge of urine. She continued the medicine till the whole was consumed, which caused a good deal of sickness for three or four days.
I saw her again on the 12th. The quantity of urine was much increased, and the swelling diminished. Pulse and breathing better.
R. Fol. sicc. Digital. G. assafetid. aa สi. calomel. pp. gr. x. sp. lavand. comp. q. s. fiat pilul. xxxii. cap. ii. omni nocte horรข somni.
A plentiful discharge of urine attended the use of these pills, and she got perfectly free from her dropsical complaints.
March 15th she was delivered: had a good labour, was treated as is usual, except in not having her breasts drawn, not intending see should suckle her child, being in so reduced a state. Continued going on well till the 18th, when she was seized with very violent pains across her loins, at times so violent as to make her cry out as much as labour pains. Enema cathartic. Fot. papav. applied to the part.
R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s. fiat pilul. vi. capt. i. 2da quaque horรข durante dolore.
R. Julep, e camphor, sp. minder. aa โฅii. capt. cochlear, i. larg. post singul. pilul.
19th. Breathing short, unable to lie down, very irregular low pulse scarcely to be felt, fainty, and a universal cold sweat: no appetite nor thirst, spasmodic pains at times across the loins very violent, but not so frequent as on the preceding day.
R. Gum ammoniac, assafetid. aa สi. camphor. gr. xii. fiat pilul. 24. capt. ii. 3tia quaque horรข in cochlear. ii. mixtur. seq.
R. Balsam. peruv. สiii. mucilag. G. arab. q. s. flor. zinci g. vi. aq. menth. simp. โss. m.
Applic. Emp. vesicat. femorib. internis.
R. Sp. vol. fลtid. elixir. paregor. balsam.
Traumatic. aa สiii. capt. cochlear. parv. urgente languore.
20th. Much the same; makes very little water, and the legs begin to swell.โApplic. Emp. e pice burgund. lumbis.
23d. The swelling very much increased.โCapt. gutt. xv. acet. scillitic. ter die in two spoonfuls of the following mixture.
R. Infus. baccar. juniper, โฅvi. tinct. amar. tinct. stomachic. aa โฅi. m.
25th. Much the same.
28th. The swelling considerably increased, in other respects very much the same.
30th. Breathing very bad, with cough and pain across the sternum, unable to lie down, legs, thighs, and body very much swelled, urine not more than four or five ounces in the twenty-four hours; hot and feverish, with thirst.
Applic. Emp. vesicat. stomacho et sterno.
R. G. assafetid. โii. pulv. jacob. โi. rad. scill. recent. gr. xii. extract. thebaic. gr. iv. f. pilul. xvi. cap. iv. omni nocte.
R. Sal. nitr. sal. diuretic. aa สii. pulv. e contrayerv. comp. สi. sacchar. โฅi. emuls. commun. โi. aq. cinnam. simpl. โฅi. m. capt. cochlear. iv. ter die.
April 2d. Much the same, no increase of urine.
3d. Breathing much relieved by the blister, which runs profusely. Repeated the medicines, and continued them till the
12th. The cough very bad, pulse irregular, swelling much increased, urine in very small quantity, not at all increased; great lowness and fainting. She desired to have some of the pills which relieved her so much when with child. I was almost afraid to give them, but the inefficacy of the other medicines gave me no hopes of a cure from continuing them, which made me venture to comply with her request.
R. Fol. siccat. Digital. G. assafetid. aa สi. sp. lavand. comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node cap. pilul. e styrace gr. vi.
17th. Considerable increase of urine.
21st. Swelling a good deal diminished; urine near four pints in twenty-four hours, which is more than double the quantity she drinks.
Applic. Emp. vesicat. femoribus internis.
The Digitalis pills and opiate at bed-time continued. Takes a tea cup of cold chamomile tea every morning.
25th. Swelling much diminished, makes plenty of water, appetite much mended, cough and breathing better. She omitted the medicine for three days; the urine began to diminish, the swelling and shortness of breathing worse. On repeating it for two days, the discharge was again augmented, and a diminution of the swelling succeeded. She has continued the pills ever since till the 14th of May; the dropsical symptoms and cough are entirely gone, the water is in sufficient quantity, her strength is recovered, and she has a good appetite. All she now complains of is a weight across her stomach, which is worse at times, and she thinks, unless it can be removed, she shall have a return of her dropsy.
Extract of a Letter from Doctor Fowler,Physician, at Stafford.
I understand you are going to publish on the Digitalis, which I am glad to hear, for I have long wished to see your ideas in print about it, and I know of no one (from the great attention you have paid to the subject) qualified to treat on it but yourself. There are gentlemen of the faculty who give verbal directions to poor patients, for the preparing and taking of an infusion or decoction of the green plant. Would one suppose that such gentlemen had ever attended to the nature and operation of a sedative power on the functions, particularly the vital? Is not such a vague and unscientific mode of proceeding putting a two edged sword into the the hands of the ignorant, and the most likely method to damn the reputation of any very active and powerful medicine? And is it not more than probable that the neglect of adhereing to a certain and regular preparation of the nicotiana, and the want (of what you emphatically call) a practicable dose, have been the chief causes of the once rising reputation of that noted plant being damned above a century ago? In short, the Digitalis is beginning to be used in dropsies, (although some patients are said to go off suddenly under its administration) somewhat in the style of broom ashes; and, in my humble opinion, the public, at this very instant, stand in great need of your precepts, guards, and cautions towards the safe and successful use of such a powerful sedative diuretic; and I have no doubt of your minute attention to those particulars, from a regard to the good and welfare of mankind, as well as to your own reputation with respect to that medicine.
I remember an officer in the Staffordshire militia, who died here of a dropsy five years ago. The Digitalis relieved him a number of times in a wonderful manner, so that in all probability he might have obtained a radical cure, if he would have refrained from hard drinking. I understood it was first ordered for him by a medical gentleman, and its sedative effects proved so mild, and diuretic operation so powerful, that he used to prepare it afterwards for himself, and would take it with as little ceremony as he would his tea. It is said, that he was so certain of its successful operation, that he would boast to his bacchanalian companions, when much swelled, you shall see me in two days time quite another man.
CASES communicated by Mr. J. Freer,jun. Surgeon, in Birmingham. CASE I.
Nov. 1780. Mary Terry, aged 60. Had been subject to asthma for several years; after a severe fit of it her legs began to swell, and the quantity of urine to diminish. In six weeks she was much troubled with the swellings in her thighs and abdomen, which decreased very little when she lay down: she made not quite a pint of water in the twenty-four hours. I ordered her to take two spoonfuls of the infusion of Foxglove every three hours. By the time she had taken eight doses her urine had increased to the quantity of two quarts in the day and night, but as she complained of nausea, and had once vomited, I ordered the use of the medicine to be suspended for two days. The nausea being then removed, she again had recourse to it, but at intervals of six hours. The urine continued to discharge freely, and in three weeks she was perfectly cured of her swellings.
CASE II.December, 1782. A poor woman, who had been afflicted with an ague during the whole of her pregnancy, and for two months with dropsical swellings of the feet, legs, thighs, abdomen, and labia pudenda; was at the expiration of the seventh month taken in labour. On the day after her delivery the ague returned, with so much violence as to endanger her life. As soon as the fit left her, I began to give her the red bark in substance, which had the desired effect of preventing another paroxysm. She continued to recover her health for a fortnight, but did not find any diminution in the swellings; her legs were now so large as to oblige her to keep constantly on the bed, and she made very little water. I ordered her the infusion of Foxglove three times a day, which, on the third day, produced a very copious discharge of urine, without any sickness; she continued the use of it for ten days, and was then able to walk. Having lost all her swellings, and no complaint remaining but weakness, the bark and steel compleated the cure.
Extract of a Letter from Doctor Jones,Physician, in Lichfield.
Anxious to procure authentic accounts from the patients, to whom I gave the Foxglove, I have unavoidably been delayed in answering your last favour. However, I hope the delay will be made up by the efficacy of
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