Medical Inquiries and Observations, Vol. 2 / The Second Edition, Revised and Enlarged by the Author

by Benjamin Rush

3. There are different opinions concerning the efficacy of foxglove in dropsies. From the cases related by Dr. Withering, it appears to have done good; but from those related by Dr. Lettsom[41] it seems to have done harm. I suspect the different accounts of those two gentlemen have arisen from their having given it in different states of the system, or perhaps from a difference in the quality of the plant from causes mentioned in another place[42]. I am sorry to add further, that after many trials of this medicine I have failed in most of the cases in which I have given it. I have discharged the water in three instances by it, but the disease returned, and my patients finally died. I can ascribe only one complete cure to its use, which was in the year 1789, in a young man in the Pennsylvania hospital, of five and thirty years of age, of a robust habit, and plethoric pulse.

Where medicines have once been in use, and afterwards fall into disrepute, as was the case with the foxglove, I suspect the cases in which they were useful, to have been either few or doubtful, and that the cases in which they had done harm, were so much more numerous and unequivocal, as justly to banish them from the materia medica.

V. Hard labour, or exercise in such a degree as to produce fatigue, have, in several instances, cured the dropsy. A dispensary patient, in this city, was cured of this disease by sawing wood. And a patient in an ascites under my care in the Pennsylvania hospital, had his belly reduced seven inches in circumference in one day, by the labour of carrying wood from the yard into the hospital. A second patient belonging to the Philadelphia dispensary was cured by walking to Lancaster, 66 miles from the city, in the middle of winter. The efficacy of travelling in this disease, in cold weather, is taken notice of by Dr. Monroe, who quotes a case from Dr. Holler, of a French merchant, who was cured of a dropsy by a journey from Paris to England, in the winter season. It would seem, that in these two cases, the cold co-operated as a sedative with the fatigue produced by labour or exercise, in reducing the tone of the arterial system.

VI. Low diet. I have heard of a woman who was cured of a dropsy by eating nothing but boiled beans for three weeks, and drinking nothing but the water in which they had been boiled. Many other cases of the good effects of low diet in dropsies are to be found in the records of medicine.

VII. Thirst. This cruel remedy acts by debilitating the system in two ways: 1st, by abstracting the stimulus of distention; and, 2dly, by preventing a supply of fresh water to replace that which is discharged by the ordinary emunctories of nature.

VIII. Fasting. An accidental circumstance, related by sir John Hawkins, in the life of Dr. Johnson, first led me to observe the good effects of fasting in the dropsy. If the fact alluded to stood alone under the present head of this essay, it would be sufficient to establish the existence of too much action, and the efficacy of debilitating remedies in certain dropsies. I am the more disposed to lay a good deal of stress upon this fact, as it was the clue which conducted me out of the labyrinth of empirical practice, in which I had been bewildered for many years, and finally led me to adopt the principles and practice which I am now endeavouring to establish. The passage which contains this interesting fact is as follows: “A few days after (says sir John) he [meaning Dr. Johnson] sent for me, and informed me, that he had discovered in himself the symptoms of a dropsy, and, indeed, his very much increased bulk, and the swollen appearance of his legs, seemed to indicate no less. It was on Thursday that I had this conversation with him; in the course thereof he declared, that he intended to devote the whole of the next day to fasting, humiliation, and such other devotional exercises as became a man in his situation. On the Saturday following I made him a visit, and, upon entering his room, I observed in his countenance such a serenity as indicated, that some remarkable crisis of his disease had produced a change in his feelings. He told me that, pursuant to the resolution he had mentioned to me, he had spent the preceding day in an abstraction from all worldly concerns; that to prevent interruption he had in the morning ordered Frank [his servant] not to admit any one to him, and, the better to enforce the charge, had added these awful words, for your master is preparing himself to die. He then mentioned to me, that in the course of this exercise he found himself relieved from the disease which had been growing upon him, and was becoming very oppressive, viz. the dropsy, by the gradual evacuation of water, to the amount of twenty pints, a like instance whereof he had never before experienced.” Sir John Hawkins ascribes this immense discharge of water to the influence of Dr. Johnson's prayers; but he neglects to take notice, that these prayers were answered, in this instance, as they are in many others, in a perfect consistence with the common and established laws of nature.

To satisfy myself that this discharge of water, in the case of Dr. Johnson, was produced by the fasting only, I recommended it, soon after I read the above account, to a gentlewoman whom I was then attending in an ascites. I was delighted with the effects of it. Her urine, which for some time before had not exceeded half a pint a-day, amounted to two quarts on the day she fasted. I repeated the same prescription once a week for several weeks, and each time was informed of an increase of urine, though it was considerably less in the last experiments than in the first. Two patients in an ascites, to whom I prescribed the same remedy, in the Pennsylvania hospital, the one in the winter of 1790, and the other in the winter of 1792, exhibited proofs in the presence of many of the students of the university, equally satisfactory of the efficacy of fasting in suddenly increasing the quantity of urine.

IX. Fear. This passion is evidently of a debilitating nature, and, therefore, it has frequently afforded an accidental aid in the cure of dropsies, of too much action. I suspect, that the fear of death, which was so distinguishing a part of the character of Dr. Johnson, added a good deal to the efficacy of fasting, in procuring the immense discharge of water before-mentioned. In support of the efficacy of fear simply applied, in discharging water from the body in dropsies, I shall mention the following facts.

In a letter which I received from Dr. John Pennington, dated Edinburgh, August 3, 1790, I was favoured with the following communication. “Since the conversation I had with you on the subject of the dropsy, I feel more and more inclined to adopt your opinion. I can furnish you with a fact which I learned from a Danish sailor, on my passage to this country, which is much in favour of your doctrine. A sailor in an ascites, fell off the end of the yard into the sea; the weather being calm, he was taken up unhurt, but, to use the sailor's own words, who told me the story, he was frightened half to death, and as soon as he was taken out of the water, he discharged a gallon of urine or more. A doctor on board ascribed this large evacuation to sea bathing, and accordingly ordered the man to be dipped in the sea every morning, much against his will, for, my informant adds, that he had not forgotten his fall, and that in four weeks he was perfectly well. I think this fact can only be explained on your principles. The sedative operation of fear was, no doubt, the cause of his cure.”

There is an account of an ascites being cured by a fall from an open chaise, recorded in the third volume of the Medical Memoirs, by M. Lowdell. I have heard of a complete recovery from dropsy, having suddenly followed a fall from a horse. In both these cases, the cures were probably the effects of fear.