Thomas Beddoes to Samuel Foart Simmons, as Editor of Medical Facts and Observations, 14 July 1793
The following case may perhaps be instructive to practitioners the first time they meet with a difficulty of the same kind. A person, much emaciated and enfeebled, and labouring under anasarca and hydrothorax, took, by mistake, from two to four doses of an infusion of digitalis, more than were ordered for him. He had nausea during a considerable part of Tuesday night, which, by 10 o’clock on Wednesday morning, had increased so much, that every five or ten minutes he threw up a small quantity of bile, with the most dreadful retchings that can be imagined.
I had once, while I was a student of medicine, seen a much stronger patient destroyed by digitalis; but the practice of the physician who had the management of the case was exceedingly feeble and fluctuating. He only administered some slight opiates, a little port wine, and effervescing draughts.
From the weakness of my patient, and the terrible effects always produced by digitalis, when improperly administered, I entertained very slight hopes of his recovery. I resolved, however, to attempt something towards his relief. For a short time I hesitated between opium and brisk emetics, (of white vitriol and mustard seed, for instance) which last, I hoped, might change the action of the stomach and liver, induced by the digitalis. I determined in favour of opium, of which I ordered three grains to be given at two doses; one immediately, and the other at the end of an hour; and afterwards fifteen drops of tincture of opium, every hour, in port wine, till the patient should fall asleep.
He dosed a good deal in the evening, and the vomitings had become less frequent by Thursday morning, occurring never oftener than once in half an hour, and sometimes only every hour and a half. The patient slept between each fit of sickness, and always awaked with nausea.
I gave him now sixty drops of tinct. opii by clyster, and three doses of 8 grains of pulv. ipecac, comp. made into pills with extract, cicut. to be taken at the interval of two hours between each dose, and ordered the clyster to be repeated in the evening.
During the night he perspired copiously, always awaking sick; the sicknesses more infrequent, but sometimes attended with singultus.
On Friday he ceased to vomit bile; and as he seemed entirely under the influence of opium, no medicines were prescribed on that day.
Saturday – he had drank toast and water during the night, which agreed well with his stomach. He had no sickness this day; he had been able to lie down ever since Wednesday, which he had been utterly unable to do before, and his feet only swelled a little towards night. He now began to eat with a very keen appetite, and drank almost half a bottle of wine a day; he had before led a very abstemious life. The bark in substance, with aromatics, was ordered for him, and he took about half an ounce every other day, for four times. The swelling of his legs, towards night, went off, and he has now, for some time, been perfectly well.
This case shows that opiates may be freely administered to a person poisoned by digitalis. I dare not draw any bolder conclusion from a single case, but I would pursue the same plan of treatment under a similar emergency.
P.S. The pulse did not come down below sixty; perhaps the opium counteracted the effect of the digitalis.
Bristol Hot Wells,
July 14, 1793.
Published: as ‘An Account of the Good Effects of Opium in the Case of a Person Poisoned by Digitalis, Communicated in a Letter to Dr. Simmons, by Thomas Beddoes, M. D.’, Medical Facts and Observations, 5 (1794), 17–20