_January_ 2d, 1785. Mrs. S----, of W----, 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. scillae gr. iii.
Jalap gr. x. syr. rosar. solut. tinct. senn. aa [Symbol:
dram]ii. aq. menth. v. simpl. [Symbol: ounce]iss. m. mane
sumend.
R. pulv. scillae [Symbol: scruple]i. G. ammoniac, sapon.
venet. aa [Symbol: dram]iss. syr. q. s. f. pilul. 42 cap.
iii. nocte maneque.
On the 7th found her worse, and the swelling increased; the urine
about [Symbol: ounce]x in the twenty-four hours.
R. Fol. siccat. Digital. [Symbol: dram]iii. coque in. aq.
fontan. [Symbol: ounce]xii. ad [Symbol: ounce]vi. cola et
adde. aq. juniper. comp. [Symbol: ounce]ii. sacchar. alb.
[Symbol: ounce]ss. 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 [Symbol: dram]i.
calomel. pp. gr. x. sp. lavand. comp. q. s. fiat pilul.
xxxii. cap. ii. omni nocte hora 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 hora durante dolore.
R. Julep, e camphor, sp. minder. aa [Symbol: ounce]ii. 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 [Symbol: dram]i. camphor. gr. xii. fiat
pilul. 24. capt. ii. 3tia quaque hora in cochlear. ii.
mixtur. seq.
R. Balsam. peruv. [Symbol: dram]iii. mucilag. G. arab. q. s.
flor. zinci g. vi. aq. menth. simp. [Symbol: pound]ss. m.
Applic. Emp. vesicat. femorib. internis.
R. Sp. vol. foetid. elixir. paregor. balsam. Traumatic. aa
[Symbol: dram]iii. capt. cochlear. parv. urgente languore.
20th. Much the same; makes very little water, and the legs begin to
swell.--Applic. Emp. e pice burgund. lumbis.
23d. The swelling very much increased.--Capt. gutt. xv. acet.
scillitic. ter die in two spoonfuls of the following mixture.
R. Infus. baccar. juniper, [Symbol: ounce]vi. tinct. amar. tinct.
stomachic. aa [Symbol: ounce]i. 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. [Symbol: scruple]ii. pulv. jacob. [Symbol:
scruple]i. rad. scill. recent. gr. xii. extract. thebaic. gr.
iv. f. pilul. xvi. cap. iv. omni nocte.
R. Sal. nitr. sal. diuretic. aa [Symbol: dram]ii. pulv. e
contrayerv. comp. [Symbol: dram]i. sacchar. [Symbol: ounce]i.
emuls. commun. [Symbol: pound]i. aq. cinnam. simpl. [Symbol: ounce]i.
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 [Symbol: dram]i. 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.