_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,[4] 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.
[Footnote 4: Then resident at Lichfield, now at Derby.]
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. purae [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.