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. G----, a gentleman of a
robust habit, who had led a regular and temperate life, AEt. 68. He was
affected with great difficulty of respiration, and cough particularly
troublesome on attempting to lie down, oedematous 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. [Symbol: dram]iii.
decoque ex aq. fontan. [Symbol: ounce]xii ad [Symbol:
ounce]vi colaturae adde Tinctur. aromatic.
Syr. zinzib. aa [Symbol: ounce]i. 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 [Symbol: dram]ss tere ad
extinctionem merc. et adde gum. ammon. [Symbol: scruple]iii aloes
socotorin. [Symbol: dram]ss rad. scil. recent. [Symbol: scruple]ss
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. [Symbol: ounce]v. tinctur. Rhei spirit.
[Symbol: ounce]ii. spirit vitriol. dulc. [Symbol: dram]ii.
syr. zinzib. [Symbol: dram]vi. 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.