An Account of the Foxglove and some of its Medical Uses, William Withering [reading eggs books txt] 📗
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I am, dear Sir,
Your obliged friend,
WILLIAM YONGE.
Shiffnall,
May 1, 1785.
A Gentleman aged 49, on the night of the 21st of August, 1784, awaked with a sense of suffocation, which obliged him to rise up suddenly in bed. I found him complaining of difficult respiration, particularly on lying down; the countenance pale, and the pulse smaller and quicker than usual. Some brandy and water having been given, the symptoms gradually abated, so that he slept in a half recumbent posture. The following day he expressed a sense of anxiety and weight in the chest, attended by quicker breathing upon motion of the body. That evening an emetic of ipecacoanha was given, and afterwards a draught, with vitriolic æther and confect. card. aa ʒi to be repeated as the symptoms should require it. He continued to be affected with slighter returns of the dyspnœa at irregular intervals, until September 15th, when upon a more severe attack, the emetic was repeated. He now recollected some slight pain in his arms which had affected him previous to this last seizure, and was disposed to consider his complaint as rheumatic. Pills with gum ammoniac. gum guaiac. and antimonial powder were directed, with infus. amar. simpl. twice a day. The bowels were regulated by aperient pills of pulv. jalap. aloes and sal. tartar. and ʒiss balsam peruv. was given occasionally to alleviate the paroxysms of dyspnœa.
From this period until the beginning of November, little amendment or variation happened, except that respiration became more permanently difficult, and particularly oppressed upon motion, nor was it relieved by the expectoration of a mucous discharge, which now increased considerably. Squills, musk, ol. succini, æther, with other medicines of the same kind, were now used, but without success. The effects of opium and venæfection were tried. The appetite diminished, and his sleep became short and disturbed. He sometimes slept lying upon his back, but generally upon his left side. The urine which had hitherto been of good colour, and sufficient quantity, now became diminished, and lateritious; and the ancles œdematous.
On the 15th of November a blister was laid over the sternum, and ʒiss of oxymel scillitic. was given every eight hours.
On the 18th, a more copious discharge of urine took place; the swelling of the feet soon disappeared, and the respiration became gradually relieved.
On the 30th ʒi tinct. cantharidum twice a day in pyrmont water, with pills of ammoniac, sal tartar. et extract. gentian. were substituted, but
On the 7th of December, from some symptoms of relapse, the oxymel was used as before, and continued to be taken until the 27th, in doses as large as could be dispensed with on account of the great nausea which attended its exhibition: The urine was made in the quantity of four or five pints each day, during the whole time; the quantity then drank being seldom more than three pints. But now the sickness being exceedingly depressing, the strength failing, and the diuretic effects beginning to cease, the following prescription was directed.
R. Fol. Digitalis purpur. pulv. ℈ss.
Spec. Aromatic. ℈i. sp. lav. c. f. pilul. no. x. capiat i. nocte maneque, et alternis diebus sensim augeatur dosin.
In three days the effect of this medicine became visible, and when the dose of the Digitalis had been increased to six grains per day, the flow of urine generally amounted to seven pints every twenty-four hours. Not the least sickness, nor any other disagreeable symptom supervened, though he persevered in this plan until the end of January at which time the dyspnœa was removed, and he has continued gradually to regain his flesh, strength, and appetite, without any relapse.
CASE II.About the middle of the year 1784 a lady aged 48, returned from London, to her native air in Shropshire, under symptoms of complicated disease. It was your opinion that the plethoric state, consequent to that period, when menstruation first begins to cease, had under various appearances, laid the foundation of that deplorable state which now presented itself. The skin was universally of a pale, leaden colour; her person much emaciated, and her strength so reduced, as to disable her from walking without support. The appetite fluctuating, the digestion impaired so much, that solids passed the intestines with little appearance of solution: She had generally eight or ten alvine evacuations every day, and without this number, febrile symptoms, attended with severe vertiginous affection, and vomiting regularly ensued. The stools were of a pale ash colour. The urine generally pale, and at first in due quantity. The region of the stomach had a tense feel, without soreness: the feet and ancles œdematous, her sleep was uncertain: the pulse varying between 94 and 100, and feeble, except upon the approach of the menstrual periods, which were now only marked by its increased strength, and exacerbation of other febrile symptoms. Emetics, saline medicines, and gentle aperients were necessary to alleviate these. Six grains of ipecac, operated with sufficient power, and half a grain of calomel would have purged with great violence.
From the time of her arrival till the middle of August, mercury had been continued in various forms, and in doses such as the irritable state of her stomach and bowels would admit of. Spirit. nitri dulc.; sal. tartar, squill, and cantharides were alternately employed as diuretics, but without success, to retard the progress of an universal anasarca which was then advanced to such degree and accompanied by so great debility, and other dreadful concomitants, as to threaten a speedy and fatal catastrophe.
On the 16th of August you first saw her, and directed thus.
R. Mercur. cinerei gr. ii.
Fol. Digital, purpur. pulv. ℈i. f. mass. in pill. no. xvi. dividend.—sumat unam hora meridiana, iterumque hora quinta pomeridiana quotidie.
Capiat lixivii saponac. gutt. L. in haust. juscul. sine sale parati omni nocte.
On the 20th the flow of urine began to increase, and she continued the medicine in the same dose until the 20th of September, discharging from six to eight pints of water each day for the first week, and which quantity gradually diminished as she became empty. During this period she complained not of any sickness, except from the lixivium, which was after the first dose reduced to 20 drops; and her appetite and strength increased daily, though it was evident that no bile had yet flowed into the bowels, nor was the digestion at all improved. The anasarcous appearances being then removed, the Digitalis was omitted, and pills, composed of mercur. cinereus, aloes, and sal tartari directed twice a day, with ʒi. of vin. chalybeat. in infus. amar. simpl.
Her amendment in other respects proceeded slowly, but regularly, from that time until the 9th of October; when the state of plethora again recurring, with its usual attendant symptoms, ℥iv. of blood were taken from the arm; and this was upon the same occasion, repeated in the following month, with manifest good consequences; though in both instances the colour of the blood, as flowing from the vein could hardly be called red, and the coagulum was as weak in its cohesion as possible. The state of the stomach and bowels was by this time greatly improved, in common with other parts of the system; but no intromission of bile had yet happened: the hardness about the hypogastric region, though less, continued in a considerable degree, and you ordered pills of mercury rubbed down, and rust of iron, to be taken twice a day, with a decoction of dandelion and sal sodæ.
A cataplasm of linseed was applied every night over the stomach and right side; and, with little deviation from this plan, she continued to the end of the year, improving in her general health, but the hepatic affection yet remaining. It was then determined to try the effects of electricity, and gentle shocks were passed through the body daily, and as nearly as could be through the liver, in various directions.
On the fifth day there was reason to think that some gall had been secreted and poured out, and this became every day more evident; but it flowed only in small quantity, and irregularly into the bowels, as appeared from the fæces being partially tinged by it.
In February the lady left this neighbourhood, and though convalescent, yet so nearly well as to promise us the satisfaction of seeing her perfectly restored.
June 29. The bile is now secreted in pretty good quantity, her appetite is perfectly good, her strength equal to almost any degree of exercise, and her health in general better than it has been for some years.
CASE III.Mr. W——, aged—. In June, 1782, was affected with slight difficulty in respiration, upon taking exercise or lying down in bed. These symptoms increased gradually until the end of July, when he complained of sense of weight and uneasiness about the prœcordia; loss of appetite; and costiveness. The urine was small in quantity, and high coloured; his pulse feeble, and intermitting; he breathed with difficulty when in bed, and slept little. After the exhibition of an emetic, and an opening medicine of rhubarb, sena, and sal tartari, he was directed to take half a dram of squill pill, pharm. Edinburg. night and morning, with ʒss sal. sodæ in ℥iss. infus. amar. simpl. twice a day; and these medicines were continued during ten days, without any sensible effect. A blister was then applied to the sternum, and six grains of calomel given in the evening. The symptoms were now increased very considerably, in every particular; and the following infusion was substituted for the former medicines.
R. Fol. Digital. purpur. ʒiii.
Cort. limon. ʒii. infund.
Aq. bullient. ℔i. per hor. 2 et cola. sumat cochl. i. primo mane et repet. omni hora.
Sometime in the night considerable nausea occurred, and the following day he began to make water in great quantity, which he continued to do for three or four days. The pulse in a few hours became regular, slower, and stronger, and, in the course of a week, all the symptoms entirely vanished, and an electuary of cort. peruvian, sal martis, and spec. aromatic. confirmed his cure.
In February, 1784, this gentleman had a relapse of his disease, from which he again soon recovered by the same means, and is now perfectly well.
CASE IV.G—— A——, a husbandman, aged 57. Was in the year 1782 affected with a slight, but constant pain in his breast, with difficult respiration. His countenance was yellow; the abdomen swelled, and hard; his urine high coloured, and in small quantity; appetite and sleep little. Complained of frequent nausea, and of sudden profuse sweatings, which seemed for a short time to relieve the dyspnœa.
After the exhibition of an emetic, six grains of calomel were given, with a purge of jalap in the morning, and repeated in a few days, with some appearance of advantage. He was then directed to take some pills of squill, soap, and rhubarb, with a draught twice a day, consisting of infus. amar. simp. and sal tartari. The skin soon became clearer and the pain in his breast considerably diminished. But every other circumstance remaining the same, and a fluctuation in the belly being now more evident, the infusion of Digitalis as prescribed in case third, was given in the dose of one ounce twice a day.
On the 5th day the effects were apparent, and he continued his medicine for a fortnight without nausea, making four or five pints of water every night, but little in the day, and gradually losing the symptoms of his disease.
In 1784, this person had a relapse, and was again cured by similar treatment.
CASE V.R—— H——, Aged 43. Towards the end of the year 1783, became affected with slight cough and expectoration of purulent matter. In December his skin became universally of
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