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.
CASE V.
December 10th. Mr. L——, Æt. 35. Ascites and anasarca, the consequence of very intemperate living. After trying squill and other medicines to no purpose, I directed a decoction of the Fol. Digital. recent. six drams to a pint; an eighth part to be taken every fourth hour. This made him sick, and produced a copious flow of urine, but not enough to remove all the dropsical symptoms. After a fortnight a stronger decoction was ordered, and, upon a third trial, as the winter advanced, it became necessary to use four ounces to the pint decoction; and thus he got free from all his complaints.
In October 1777, in consequence of having pursued his intemperate mode of living, his dropsy returned, accompanied by evident marks of diseased viscera. A decoction of two drams of Fol. Digital. siccat. to a pint, once more removed the dropsy. He took a wine glass full thrice a day.
In January 1778, I was desired to visit him again. I found he had gone on in his usual intemperate life, his countenance jaundiced, and the dropsy coming on apace. After giving some deobstruent medicines, I again directed the Digitalis, which again emptied the water; but he did not survive many weeks.
1777.
CASE VI.
February—. Mrs. M——, Æt. 45. Ascites and anasarca, but not much otherwise diseased, and well enough to walk about the house, and see after her family affairs. I thought this a fair case for a trial of the Digitalis, and therefore directed a decoction of the fresh leaves, the stock of dried ones being exhausted. About a week afterwards, calling to see my patient, I was informed that she was dead; that the third day after my first visit she suddenly fell down, and expired. Upon enquiry I found she had not taken any of the medicine; for the snow had lain so deep upon the ground, that the apothecary had not been able to procure it. Had the medicine been given in a case seemingly so favourable as this, and had the patient died under its use, is it not probable that the death would have been attributed to it?
CASE VII.
February 11th. Mr. E——, of W——, Æt. 61. Hydrothorax, ascites and anasarca, consequences of hard drinking. He had been attended for some time by a physician in his neighbourhood, who had treated his case with the usual remedies, but without affording him any relief; nor could I expect to succeed better by any other medicine than the Digitalis. The dried leaves were not to be had; and the green ones at this season being very uncertain in their strength, I ordered four ounces of the roots in a pint decoction, and directed three spoonfuls to be given every fourth hour, until it either excited nausea, or a free discharge of urine; both these effects took place nearly at the same time: he made a large quantity of water, the swellings subsided very considerably, and his breath became easy. Eight days afterwards he began upon a course of bitters and deobstruents. The dropsical symptoms soon increased again, but he had suffered so much from the severity of the sickness before, that he was neither willing to take, nor I to give the same medicine again.
Perhaps this patient might have been saved, if I had been well acquainted with the management and real doses of the medicine, which was certainly in this instance made very much too strong; and notwithstanding the caution to stop the further exhibition when certain effects should take place, it seems the quantity previously swallowed was sufficient to distress him exceedingly.