DEAR SIR,
During my residence in the Birmingham General Hospital, I had frequent opportunities of seeing the great effects of the Digitalis in dropsy.
As the exhibition of it was in the following instances immediately under your own direction, I have drawn them up for your inspection, previous to your publishing upon that excellent diuretic. Of its efficacy in dropsy I have considerable evidence in my possession, but consider myself not at liberty to send you any other cases except those you had yourself the conduct of. The Digitalis is a very valuable acquisition to medicine; and, I trust, it will cease to be dreaded when it is well understood.
I am, Sir, your obedient, And very humble servant, W. BAYLEY.
CASE CLXI.
Mary Hollis, aged 62, was admitted an out patient of the Birmingham General Hospital _February_ 12th, 1784, labouring under all the effects of hydrothorax; her dread of suffocation during sleep was so great, that she always reposed in an elbow chair. She was directed to take two grains of Digitalis in powder every night and morning, and for a few days found great relief; but, on the eighth day, as she had complained of sickness, and had been considerably purged, she was ordered to desist taking any more of her powders. On the 14th day she was ordered an ounce of the following infusion twice in a day: R. Fol.
Digital. purp. sicc. ?iss. aq. bullient. ?ss. digere per semi-horam, colaturae adde tinct. aromatic ?i. This infusion did not purge, but sometimes excited nausea, though not sufficient to prevent her from continuing its use. She grew gradually better, and on the 6th of _May_ was discharged perfectly cured. The diuretic effects of the Digitalis were in this instance immediate.
CASE CLXII.
Edward James, aet. 21. Admitted _March_ 20th, 1784. Complained of great difficulty of breathing, pain in his head, and tightness about the stomach, with a trifling swelling of his legs. Ordered pil. scillit.
?i. ter de die. On the third day his legs much more swelled, his breathing more difficult, and in every respect worse; his pulse very small and quick, complained when he turned in bed, of something like water rolling from one side of the thorax to the other. A remarkable blueness about the mouth and eyes, and purged considerably from the pil. scill. Ordered to omit the pills and to take ?i. of infus.
Digitalis every eight hours; the proportion ?iss. to eight ounces of water and ?i. of aq. n. m. sp.--7th Day, The infusion had neither purged, nor vomited him: he only complained once or twice of giddiness. His belly was now very hard, rather black on the right side the navel, and his legs amazingly swelled. Ordered a bolus with rhubarb and calomel, to be taken in the morning, and ?ii. julep salin.
c.u.m tinct. canthar. gutt. forty ter die.--12th Day, nearly in the same state, except his breathing which was somewhat more difficult, being now obliged to have his head considerably raised. Persistat--From this day to the 32d day he became hourly worse. His belly which at first was only hard, now evidently contained a large quant.i.ty of water, his legs were more swelled, and a large sphacelated sore appeared upon each outer ancle. Respiration was so much obstructed, that he was obliged to sit quite upright to prevent suffocation. He made very little water, not more than eight ounces in a day and a night, and was much emaciated. Ordered his purging bolus again, and ?ii. of a mixture with sal diuretic, ?ss. to ?xii. three times in a day, and a poultice with ale grounds to his legs.
54th day. To this period there was not the least probability of his existing; his legs and thighs were one continued blubber, his thorax quite flat, and his belly so large that it measured within one inch as much as a woman"s in this Hospital the day she was tapped, and from whom twenty seven pounds of coagulable lymph were taken. He made about three ounces of water in twenty-four hours: his p.e.n.i.s and s.c.r.o.t.u.m were astonishingly swelled, and no discharge from the sores upon his legs.
Ordered to take a pill with two grains of powdered Foxglove night and morning. For a few days no sensible effect, but about the 60th day he complained of being continually giddy, and had some little pain in his stomach. He now made much more water, and dared to sleep. His appet.i.te which through the whole of his illness had been very bad, was also better. 66th day. Breathing very much relieved, the quant.i.ty of water he made was three chamber pots full in a day and a night, each pot containing two quarts and four ounces, moderately full. Ordered to continue his pills, and his legs which were very flabby, to be rolled.
69th day. His belly nearly reduced to its natural size, still made a prodigious quant.i.ty of water, his appet.i.te very good, habit of body rather lax, and his complexion ruddy. On the 2d of _June_, being still rather weak, he was ordered decoct. cort. ?ii. ter de die; and on the 12th was discharged from this Hospital perfectly cured.
W. BAYLEY.
Mr. Bayley"s respectful compliments to Doctor Withering: he sends the case of Edward James, which he believes is pretty correct. He laments not having it in his power to send the measure of his belly, having unfortunately, mislaid the tape: he heard from James yesterday, and he is perfectly well.
_General Hospital, August 5, 1784._
CASE CLXIII.
On the 26th _February_, 1785, Sarah Ford, aged 42, was admitted an out-patient of the Birmingham General Hospital: she complained of considerable pain in her chest, and great difficulty of breathing, her face was much swelled and her thighs and legs were anasarcous. She had extreme difficulty in making water, and with many painful efforts she did not void more than six ounces in twenty-four hours. She had been in this situation about six weeks, during which time she had taken ammoniac.u.m, olibanum, and large quant.i.ties of squills, without any other effect than frequent sickness. Upon her commencing an Hospital patient, the following medicine was exhibited. R. gum ammoniac ?ii.
pulv. fol. Digital. purp. ?ii. sp. lavand. comp. ut fiat pil. 40. cap.
ii. nocte maneque. She continued the use of these pills for a few days, without any sensible effect. On the eighth day her breathing was much relieved, her legs and thighs were not so much swelled, and in a day and a night she made five pints of water. By the 12th day her legs and thighs were nearly reduced to their natural size. She continued to make water in large quant.i.ties, and had lost her pain in the thorax. To the 20th of _March_, she made rapid advances towards health, when not a symptom of disease remaining, she was discharged.
COMMUNICATIONS FROM CORRESPONDENTS.
London, Norfolk-street, May 31st, 1785.
SIR,
I had the favour of your letter last week; and I shall be very happy if I can give you any intelligence relating to the Foxglove, that can answer the purpose in which you are so laudably engaged.
It is true that my brother, the late Dr. Cawley, was greatly relieved, and his life, perhaps, prolonged for a year, by a decoction of the Foxglove root; but why it had not a more lasting effect, it is necessary I should tell you that he had all the signs of a distempered viscera, long before any watery swellings appeared; it was manifest that his dropsy was merely symptomatic, and he could therefore only from time to time have any relief from medicine. In the year 1776, he returned from London to Oxon. having consulted several physicians at the former place, and Dr. Vivian at the latter, but without any success; and he was then told of a carpenter at Oxon. that had been cured of a Hydrops pectoris by the Foxglove root, and as he was a younger, and in other respects an healthy man, his cure, I believe, remains a perfect one.
I did not attend my brother whilst he took the medicine, and therefore I cannot speak precisely to the operation of it; but I remember, by his letters, that he was dreadfully sick and ill for several days before the secretion of urine came on, but which it did do to a great degree; relieved his breath, and greatly lessened the swelling in his legs and thighs; but the two instances I have lately seen in this part of the world, are much stronger proofs of the efficacy of it than my brother"s case.
I am, &c.
ROBERT CAWLEY.
N. B. Whenever I have another opportunity of giving the Foxglove, it shall be in small doses:--In which I should hope it might succeed, although it might be more slowly. If you should try it with success, I should be glad to know what mode you made use of.
Dr. Cawley"s prescription.
R. Rad. Digital. purpur. siccat. et contus. ?ii.
Coque ex aq. font. ?ii. ad ?i. colat. liquor. adde aq. junip.
comp. ?ii.
Mell. anglic ?i. m. sumat cochl. iv. omni nocte h. s. et mane.
--I have elsewhere remarked, that when the Digitalis has been properly given, and the diuretic effects produced, that an accidental over-dose bringing on sickness, has stopped the secretion of urine. In the present instance it likewise appears, that violent sickness may be excited, and continue for several days without being accompanied by a flow of urine; and it is probable that the latter circ.u.mstance did not take place, until the severity of the former abated. If Dr. Cawley had not had a const.i.tution very retentive of life, I think he must have died from the enormous doses he took; and he probably would have died previous to the augmentation of the urinary discharge. For if the root from which his medicine was prepared, was gathered in its active state, he did not take at each dose less than _twelve_ times the quant.i.ty a strong man ought to have taken. Shall we wonder then that patients refuse to repeat such a medicine, and that pract.i.tioners tremble to prescribe it? Were any of the active and powerful medicines in daily use to be given in doses _twelve_ times greater than they are, and these doses to be repeated without attention to the effects, would not the patients die, and the medicines be condemned as dangerous and deleterious?--Yet such has been the fate of Foxglove!
A Letter to the Author, from Mr. BODEN, Surgeon, at Broseley, in Shropshire.
Broseley, 25th May, 1785.
Dear SIR,
Have inclosed the prescriptions that contained the fol. Digital. which I gave to Thomas Cooke and Thomas Roberts.
Thomas Cooke, aet. 49, had been ill about two or three weeks. When I saw him he had no appet.i.te, and a constant thirst: a fullness and load in the stomach: the thighs, legs and hands, much swell"d, and the face and throat in a morning; was costive, and made but little water, which was high coloured; the pulse very weak, and his breath exceeding bad.
_June_ 17th. R. Argent, viv ?i. cons. cynosbat. ?ii. fol. Digital.
pulv. gr. xv. f. pil. xxiv. capt. ii. omni nocte hora decubitus. He was likewise purged by a bolus of argent. viv. jallap, Digit.
elaterium and calomel, which was repeated on the fourth day, to the third time. From _June_ 17th to the 29th, the symptoms were mostly removed, making water freely, and having plenty of stools; in a week after he was perfectly well, and remains so ever since. The cure was finished by steel and bitters.
Thomas Roberts, aet. 40, had a deformed chest, was obliged to be almost in an erect posture when in bed; the other symptoms were nearly the same as Cooke"s. _August_ 3d. The pills prescribed _June_ 17th for Cooke.--17th. A purging bolus of jalap and Digitalis, once a week. He continued the medicines till the latter end of _August_, when he got very well; but the complaint returned in _Jan._ worse than before. He is now much better, but I have great reason to believe the liver to be diseased.
I am, with the greatest respect,
Your very obliged humble servant,
DANIEL BODEN.
P. S. The second patient, on his relapse, took Digitalis again, combined with other things.
CASE communicated by Mr. CAUSER, Surgeon, at Stourbridge, Worcestershire.