An Account of the Foxglove and some of its Medical Uses by William Withering (bearly read books .TXT) 📖
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About ¾ oz. of bloody water flowed out, on elevating the upper half of the scull, and a small quantity also was found at the base.
Brain. Blood-vessels turgid with blood, and many of those of considerable size distended with air.
A very slight watery effusion between the Pia Mater and Tunica arachnoidea. About ¾ oz. of watery fluid in the lateral ventricles.
Thorax. In the left cavity about 4 oz. of bloody serum; in the right but little. Lungs, the hinder parts loaded with blood. Adhesions of each lobe to the pleura. Pericardium containing but a very small quantity of fluid. Heart containing no coagula of blood. Valves of the Aorta of a cartilaginous texture, as if beginning to ossify.
Abdominal Viscera natural, and a profusion of Fat under the integuments of the abdomen and thorax, in the former to the thickness of an inch and upwards, and in very considerable quantity on the mesentery, omentum, kidneys, &c.
Obs. The intermitting pulse should seem to have been owing to effusions of water in some of the cavities of the breast, as it disappeared on the removal of the waters.
CASE II.Mrs. C—— of K——, Æt. 80. Orthopnœa, with sense of oppression about the prœcordia. Unable to lie down in bed for some nights past. Anasarca of the lower extremities. Urine very scanty. Complaints of six weeks standing. Had taken sal. diuret. c. ol. junip.—Calom. c. jalap, et gambog.—Et ol. junip. c. ol. Terebinth. without effect.
Feb. 7. Infus. Digital. e. ʒiii. ad aq. &c. ℥viii. cochl. ii. 4tis horis. Ordered to drink largely of infus. baccar. junip. The third dose produced great nausea which continued ten hours, during which time the urine made was about a quart. The next day her apothecary directed her to begin again with it. The second dose produced vomiting. During the next twenty hours she made two quarts of water, about four times as much as she drank.
From this time she took no more of the infus. Digital. but continued the inf. bacc. junip. until about March 2d, when all the swellings were gone down, her respiration perfectly free, and she herself quite restored to her former state of health. On the 29th she had an attack of jaundice which was some time after removed; since which she has enjoyed a good state of health, excepting that for some little time past her ancles have been slightly œdematous, which will I trust soon yield to strengthening medicines.
CASE III.Mrs. M—— G——, Æt. 64. Has had sore legs for these thirty-four years past. Orthopnœa. Sense of oppression at the prœcordia. Pulse intermitting. Legs anasarcous. Urine scanty, high-coloured.
Infus. Digital. c. ʒiss ad aq. bull. ℥viii. cochl. ii. 4tis horis.
Took six doses, when nausea was excited. Urine a quart during the course of the night. The flow of urine continued, and complaints relieved. Sal. Mart. c. extr. gent. and afterwards with the addition of extr. cort. for which last ingredient she had a predilection, confirmed the cure.
On the same day the next year I was called in to her for a similar train of symptoms, excepting that the pulse was but just perceptibly irregular.
Infus. Digital. u. a. præscript.
The directions on the phial not being attended to, two doses of it were given after a nausea had been excited, which, with occasional vomitings, became exceedingly oppressive. A saline draught, given in Dr. Hulme's method, a draught sal. c. c. gr. xii. c. conf. card. gr. x. produced no immediate effect, but the nausea gradually abating, inf. bacc. junip. was ordered; but this appeared to augment it, and a great propensity to sleep coming on, I directed sal. c. c. conf. card, aa gr. viii. 4tis horis, which removed the unpleasant symptoms and myrrh. c. sal. mart. completed the cure. During the use of the above medicines, the urine was augmented, and the pulmonary complaints removed, even before the nausea left her; and the sores of her legs which were much inflamed before she began with the infus. Digital. in a day's time assumed a much healthier appearance, and on her other complaints going off, they shewed a greater tendency to heal than she had ever observed in them for twenty years before. This instance is a very pleasing confirmation of the experience of Hulse and Dr. Baylies, and of the advantage to be derived from a medicine, which, while it helps to heal the ulcers, removes that from the constitution which often renders the healing of them improper.
In one case in which I ordered it, the infusion, instead of digesting three hours as I had directed, was suffered to stand upon the leaves all night. The consequence was that the first dose produced considerable nausea.
The two following cases, with which I have been favoured by a physician very justly eminent, convince me of the necessity there is that every one who discovers a new medicine, or new virtues in an old one, should, in announcing such discoveries, publish to the world the exact manner in which he exhibits such medicines, with all the precautions necessary to obtain the promised success.
In these (says my correspondent) "the infusion was given in small doses, repeated every hour or two, till a nausea was raised, when it was omitted for a day or perhaps two, and then repeated in the same manner.
"An Ascites emptied by it, but filled again very speedily, though its use was never discontinued, and who afterwards found no salutary effects from it. Ended fatally.
"In an Anasarca it sometimes increased the quantity of urine, and abated the swelling, but which as often returned in as great a degree as before, though the medicine was still given, and always increased in quantity so as to excite nausea. Ended fatally.
"I have tried it in many other cases, but found very little difference in the success attending it."
May we not be allowed to conjecture that the inefficacy of its continued use is owing to its narcotic property gradually diminishing the irritability of the muscular fibres of the absorbents, or possibly of the whole vascular system, and thus adding to that weakened action which seems to be the cause of the generality of dropsies, which leads us to caution the medical experimenter against trying it, at least against its continued use, even in small doses, in other diseases of diminished energy, as continued fever, palsy, &c.
I remain with the greatest truth,
Your obliged and affectionate friend,
JONATHAN STOKES.
Stourbridge,
May 17, 1785.
Esther K——, Æt. 33. General anasarca, ascites, and dyspnœa, of seven months duration.
Decoct. c Digit. ʒiv. c. aq. ℔i. coquend. ad ℔ss. cap. ℥i. 2dis. horis. 1st Day. 4th dose made her sick. 2d Day. The first dose she took to-day produced vomiting.
3d Day. Minuatur dosis ad ℥ss. This stayed upon her stomach, but produced an almost constant sickness. Stools more frequent, water scarce sensibly increased; and her swellings not at all reduced.
4th Day. Cap. Calomel. gambog. scill. &c.
Obs. Sufficient time was not allowed to observe its effects, neither was the patient enjoined the free use of diluents. The disease terminated fatally.
CASE II.William T——, Æt. 42. Ascites, with cough and dyspnœa. Abdomen very much distended. The rest of his body highly emaciated. Urine thick, high coloured, and in very small quantity.
Decoct. Digit. (u. in Esther K——,) 4tis horis.
1st Day of taking it. The 4th dose produced sickness.
2d. Vomiting after the second dose.
10th. Urine increased to ℔vi.
11th. Flow of urine continues. Abdomen quite flaccid.
12th. Abdomen not diminished.
15th: A smart purging came on, and the flow of urine diminished.
23d. Belly much bound. Took a cathart. powder, which was followed by a diminution of the abdomen.
29th. To take a cathart. powder every 4th morning, continuing the decoct. Digit.
32d. Urine exceedingly scanty.
35th. Vin. scill. ℥ss. o. m. &c. This produced diuretic effects.
44th. Tapped. Terminated fatally.
Obs. Here the medicine was continued till it ceased to produce diuretic effects; and these effects were not aided by any strengthening remedies.
CASE III.George R——, Æt. 52. Ascites, general anasarca, and dyspnœa. His legs so greatly distended that it was with great difficulty he could draw the one after the other.
Infus. Digital. ʒiiiss. ad. aq. ℔ss. cap. ℥i. altern. horis donec nauseam excitaverit. Rep. 3tiis diebus. tempore intermedio cap. sol. guaic. ℥i. ter in die ex inf. sinap.
1st Day of taking it. Became sickish towards night.
2d Day. Made a great quantity of water during the night, and spat up a great deal of watery phlegm. The first dose he took in the morning has produced a sickness which has continued all day, but he has never vomited.
3d. Day. The change in his appearance so great as to make it difficult to conceive him to be the same person. Instead of a large corpulent man, he appeared tall, thin, and rather aged. Breathes freely, and can walk up and down stairs without inconvenience.
4th Day. Decoct. bacc. junip. and cyder for common drink.
6th Day. A second course of his medicine produced a flow of urine almost as plentiful as the former, though he drank little or nothing at the time. In a day or two after he walked to some distance.
12th Day. Pot. purgans illico.
14th Day. Pot. purg. c. jalap. ʒss. 4tis diebus.
Infus. Dig. 3tiis diebus.
17th Day. R. Gamb. gr. iii. calom. gr. ii. camph. gr. i. syr. simpl. fiat pil. o. n. sum.
Infus. Digit. 3tiis diebus.
21st Day. Made an out-patient. The super-abundant flow of urine continued for the first three days after his last course; but since, the flow of saliva has been nearly equal to that of urine.
The smalls of his legs not quite reduced, and are fuller at night. He has shrunk round the middle from four feet two inches to three feet six inches; and in the calves of his legs, from seventeen inches to thirteen and a half.[10]
Obs. The waters were here very successfully evacuated, but as you remarked to me, on communicating the case to you at the time, tonic medicines should have been given, to second the ground that had been gained, instead of weakening the patient by drastic purgatives.
A CASE from Mr. Shaw, Surgeon, atStourbridge.—Communicated by Doctor Stokes.
Matth. D——, Æt. 71. Tall and thin. Disease a general anasarca, with great difficulty of breathing. The lac ammoniac. somewhat relieved his breath; but the swellings increased, and his urine was not augmented. I considered it as a lost case, but having seen the good effects of the Digitalis, as ordered by Dr. Stokes in the case of Mrs. G——, I gave him one spoonful of an infusion of ʒii to half a pint, twice a day. His breath became much easier, his urine increased considerably, and the swellings gradually disappeared; since which his health has been pretty good, except that about three weeks ago, he had a slight dyspnœa, with pain in his stomach, which were soon removed by a repetition of the same medicine.
Mr. Shaw likewise informs me, that he has removed pains in the stomach and bowels, by giving a spoonful of the infusion, ʒiss. to ℥viii. morning and night.
A Letter from Mr. Vaux, Surgeon, in Birmingham.Dear Sir,
I send you the two following cases, wherein the Digitalis had very powerful and sensible effects, in the cure of the different patients.
CASE I.Mrs. O—— of L——
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