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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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. สvi.
Tinct. aromat. สii.
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. Gโโ, a gentleman of a robust habit, who had led a regular and temperate life, รt. 68. He was affected with great difficulty of respiration, and cough particularly troublesome on attempting to lie down, ลdematous 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. สiii. decoque ex aq. fontan. โฅxii ad โฅvi colaturรฆ adde Tinctur. aromatic.
Syr. zinzib. aa โฅi. 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 สss tere ad extinctionem merc. et adde gum. ammon. โiii aloes socotorin. สss rad. scil. recent. โss 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. โฅv. tinctur. Rhei spirit. โฅii. spirit vitriol. dulc. สii. syr. zinzib. สvi. 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.
CASE II.Rโโ Howgate, a man much addicted to intemperance, particularly in the use of spirituous liquors, รt. 60, was admitted into the Hospital near Birmingham, May 17, 1783. He complained of difficulty of breathing, attended with cough, particularly troublesome on lying down; drowsiness and frequent dozing, from which he was roused by startings, accompanied with great anxiety and oppression about the breast; ลdematous swellings of the legs; constant desire to make water, which he passed with difficulty, and only by drops; pulse weak and irregular; body rather costive; face much emaciated; no appetite for food.โCap. pil. scil. iii. ter in die.[6]
May 20th. The pills have had no effect.โCap. mistur. c.[7] Decoct. Digital. &c. cochl. ii. larg. 3tia quaque hora, ad 3tiam vicem.
May 21st. Made near two quarts of water in the night, without being in the least sick. He continued the use of the mixture three times in the day till the 30th, and made about three pints of water daily, by which means the swellings were entirely taken away; and his other complaints so much relieved, that on the 6th of June he was dismissed free from complaint, except a slight cough. But returning to his old course of life, he hath had frequent attacks of his disorder, which have been always removed by using the Digitalis.
Extract of a letter from Mr. Lyon, Surgeon, at Tamworth.โMr. Moggs was about 54 years of age, his disease a dropsy of the abdomen, attended with anasarcous swellings of the limbs, &c. brought on by excessive drinking. I believe the first symptoms of the disease appeared the beginning of November, 1776; the medicines he took before you saw him, were squills in different forms, sal diureticus and calomel, but without any good effect; he begun the Digitalis on the 10th of July 1777; a few doses of it caused a giddiness in the head, and almost deprived him of sight, with very great nausea, but very little vomiting, after which a considerable flow of urine ensued, and in a very short time, a very little water remained either in the cavity of the abdomen, or the membrana adiposa, but he remained excessive weak, with a fluttering pulse at the rate of 150 or frequently 160 in a minute; he kept pretty free from water for upwards of twelve months; it then collected, and neither the Digitalis nor any other medicine would carry it off. I tapped him the 2d of August 1779 in the usual place, and took some gallons of water from him, but he very soon filled again, and as he had a very large rupture, a considerable quantity of the water lodged in the scrotum, and could not be got away by tapping in the usual place. I therefore (on the 28th of the same month) made an incision into the lower part of the scrotum, and drained off all the water that way, but he was so very much reduced, that he died the 8th or 9th of September following, which was about two years and two months after he first begun the Digitalis.
I have had several dropsical patients relieved, and some perfectly recovered by the Digitalis, since you attended Mr. Moggs, but as I did not take any notes or make any memorandums of them, cannot give you any of them.
Communications from Dr. Stokes, Physician, in Stourbridge.Dear Sir,
I accept with pleasure your invitation to communicate what I know respecting the properties of Digitalis; and if an account of what others had discovered before you,[8] with a detail of my own experience, shall be allowed the merit of at least a well meant acknowledgment, for the early communication you were so kind to make me, of the valuable properties you had found in it; I shall consider my time as well employed. A knowledge of what has been already done is the best ground work of future experiment; on which account I have been the more full on this subject, in hopes that given with the cautions which you mean to lay down in the cure of dropsies, it may prove alike useful in that of other diseases, one of which stands foremost among the opprobria of medicine.
CASE I.Mrs. Mโโ. Orthopnea, pain, and excessive oppression at the bottom of the sternum. Pulse irregular, with frequent intermissions. Appetite very much impaired. Legs anasarcous.
Empl. vesicator. pectori dolent.
Infus. Digital. e สiii. ad. aq. &c. โฅviii. cochl. j. o. h. donec nausea excitetur vel diuresis satis copiosa proveniat.
I ordered it of the above strength, and to be repeated often, on account of the great emergency of the case, but the nausea excited by the first dose prevented its being given at such short intervals. A 3d dose I found had been given, which was followed by vomitings. All her complaints gradually abated, but in about a fortnight recurred, notwithstanding the use of infus. amar. &c.
Dec. 2. Infus. Digit. e. สiss ad aq. &c. โฅviii. cochl. ii. horis &c. u. a.
Complaints gradually abated, swellings of the legs nearly gone down.
About a month afterwards you was desired to visit this patient.[9]
On the examination of the body I noticed, among others, the
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