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Title: An Account of the Foxglove and some of its Medical Uses - With Practical Remarks on Dropsy and Other Diseases
Author: Withering, William, 1741-1799
Language: English
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Copyright Status: Not copyrighted in the United States. If you live elsewhere check the laws of your country before downloading this ebook. See comments about copyright issues at end of book.

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                                  AN
                                ACCOUNT
                                OF THE
                               FOXGLOVE,
                                  AND
                       Some of its Medical Uses:
                                 WITH
           PRACTICAL REMARKS ON DROPSY, AND OTHER DISEASES.

                                  BY

                       WILLIAM WITHERING, M. D.

           Physician to the General Hospital at Birmingham.


                  _---- nonumque prematur in annum._

                                                HORACE.


                  BIRMINGHAM: PRINTED BY M. SWINNEY;
                                  FOR
          G. G. J. AND J. ROBINSON, PATERNOSTER-ROW, LONDON.
                             M,DCC,LXXXV.



                               PREFACE.


After being frequently urged to write upon this subject, and as often
declining to do it, from apprehension of my own inability, I am at
length compelled to take up the pen, however unqualified I may still
feel myself for the task.

The use of the Foxglove is getting abroad, and it is better the world
should derive some instruction, however imperfect, from my experience,
than that the lives of men should be hazarded by its unguarded
exhibition, or that a medicine of so much efficacy should be condemned
and rejected as dangerous and unmanageable.

It is now about ten years since I first began to use this medicine.
Experience and cautious attention gradually taught me how to use it.
For the last two years I have not had occasion to alter the modes of
management; but I am still far from thinking them perfect.

It would have been an easy task to have given select cases, whose
successful treatment would have spoken strongly in favour of the
medicine, and perhaps been flattering to my own reputation. But Truth
and Science would condemn the procedure. I have therefore mentioned
every case in which I have prescribed the Foxglove, proper or
improper, successful or otherwise. Such a conduct will lay me open to
the censure of those who are disposed to censure, but it will meet the
approbation of others, who are the best qualified to be judges.

To the Surgeons and Apothecaries, with whom I am connected in
practice, both in this town and at a distance, I beg leave to make
this public acknowledgment, for the assistance they so readily
afforded me, in perfecting some of the cases, and in communicating the
events of others.

The ages of the patients are not always exact, nor would the labour of
making them so have been repaid by any useful consequences. In a few
instances accuracy in that respect was necessary, and there it has
been attempted; but in general, an approximation towards the truth,
was supposed to be sufficient.

The cases related from my own experience, are generally written in the
shortest form I could contrive, in order to save time and labour. Some
of them are given more in detail, when particular circumstances made
such detail necessary; but the cases communicated by other
practitioners, are given in their own words.

I must caution the reader, who is not a practitioner in physic, that
no general deductions, decisive upon the failure or success of the
medicine, can be drawn from the cases I now present to him. These
cases must be considered as the most hopeless and deplorable that
exist; for physicians are seldom consulted in chronic diseases, till
the usual remedies have failed: and, indeed, for some years, whilst I
was less expert in the management of the Digitalis, I seldom
prescribed it, but when the failure of every other method compelled me
to do it; so that upon the whole, the instances I am going to adduce,
may truly be considered as cases lost to the common run of practice,
and only snatched from destruction, by the efficacy of the Digitalis;
and this in so remarkable a manner, that, if the properties of that
plant had not been discovered, by far the greatest part of these
patients must have died.

There are men who will hardly admit of any thing which an author
advances in support of a favorite medicine, and I allow they may have
some cause for their hesitation; nor do I expect they will wave their
usual modes of judging upon the present occasion. I could wish
therefore that such readers would pass over what I have said, and
attend only to the communications from correspondents, because they
cannot be supposed to possess any unjust predilection in favour of the
medicine: but I cannot advise them to this step, for I am certain they
would then close the book, with much higher notions of the efficacy of
the plant than what they would have learnt from me. Not that I want
faith in the discernment or in the veracity of my correspondents, for
they are men of established reputation; but the cases they have sent
me are, with some exceptions, too much selected. They are not upon
this account less valuable in themselves, but they are not the proper
premises from which to draw permanent conclusions.

I wish the reader to keep in view, that it is not my intention merely
to introduce a new diuretic to his acquaintance, but one which, though
not infallible, I believe to be much more certain than any other in
present use.

After all, in spite of opinion, prejudice, or error, TIME will fix the
real value upon this discovery, and determine whether I have imposed
upon myself and others, or contributed to the benefit of science and
mankind.

     _Birmingham, 1st July,_ 1785.



                             INTRODUCTION.


The Foxglove is a plant sufficiently common in this island, and as we
have but one species, and that so generally known, I should have
thought it superfluous either to figure or describe it; had I not more
than once seen the leaves of Mullein[1] gathered for those of
Foxglove. On the continent of Europe too, other species are found, and
I have been informed that our species is very rare in some parts of
Germany, existing only by means of cultivation, in gardens.

    [Footnote 1: Verbascum of Linnæus.]

Our plant is the _Digitalis purpurea_[2] of Linnæus. It belongs to the
2d order of the 14th class, or the DIDYNAMIA ANGIOSPERMIA. The
_essential characters_ of the genus are, _Cup with 5 divisions.
Blossom bell-shaped, bulging. Capsule egg-shaped, 2-celled._--LINN.

    [Footnote 2: The trivial name _purpurea_ is not a very happy
    one, for the blossoms though generally purple, are sometimes
    of a pure white.]

DIGITA'LIS _purpu'rea_. Little leaves of the empalement egg-shaped,
sharp. Blossoms blunt; the upper lip entire. LINN.

REFERENCES TO FIGURES. These are disposed in the order of comparative
excellence.

    _Rivini monopet. 104.
    Flora danica, 74, parts of fructification.
    Tournefort Institutiones. 73, A, E, L, M.
    Fuchsii Hist. Plant. 893, copied in
    Tragi stirp. histor. 889.
    J. Bauhini histor. Vol. ii. 812. 3, and
    Lonicera 74, 1.
    Blackwell. auct. 16.
    Dodonœi pempt. stirp. hist. 169, reprinted in
    Gerard emacul. 790, 1, and copied in
    Parkinson Theatr. botanic. 653, 1.
    Gerard, first edition, 646, 1.
    Histor. Oxon. Morison. V. 8, row 1. 1.
    Flor. danic. 74, the reduced figure._

_Blossom._ The bellying part on the inside sprinkled with spots like
little eyes. _Leaves_ wrinkled. LINN.

BLOSSOM. Rather tubular than bell-shaped, bulging on the under side,
purple; the narrow tubular part at the base, white. _Upper lip_
sometimes slightly cloven.

CHIVES. _Threads_ crooked, white. _Tips_ yellow.

POINTAL. _Seed-bud_ greenish. _Honey-cup_ at its base more yellow.
_Summit_ cloven.

S. VESS. _Capsule_ not quite so long as the cup.

ROOT. Knotty and fibrous.

STEM. About 4 feet high; obscurely angular; leafy.

LEAVES. Slightly but irregularly serrated, wrinkled; dark green above,
paler underneath. _Lower leaves_ egg-shaped; upper leaves
spear-shaped. _Leaf-stalks_ fleshy; bordered.

FLOWERS. Numerous, mostly growing from one side of the stem and
hanging down one over another. _Floral-leaves_ sitting, taper-pointed.
The numerous purple blossoms hanging down, mottled within; as wide and
nearly half as long as the finger of a common-sized glove, are
sufficient marks whereby the most ignorant may distinguish this from
every other British plant; and the leaves ought not to be gathered for
use but when the plant is in blossom.

PLACE. Dry, gravelly or sandy soils; particularly on sloping ground.
It is a biennial, and flowers from the middle of _June_ to the end of
_July_.

I have not observed that any of our cattle eat it. The root, the stem,
the leaves, and the flowers have a bitter herbaceous taste, but I
don't perceive that nauseous bitter which has been attributed to it.

       *       *       *       *       *

This plant ranks amongst the LURIDÆ, one of the Linnæan orders in a
natural system. It has for congenera, NICOTIANA, ATROPA, HYOSCYAMUS,
DATURA, SOLANUM, &c. so that from the knowledge we possess of the
virtues of those plants, and reasoning from botanical analogy, we
might be led to guess at something of its properties.

I intended in this place to have traced the history of its effects in
diseases from the time of Fuchsius, who first describes it, but I have
been anticipated in this intention by my very valuable friend, Dr.
Stokes of Stourbridge, who has lately sent me the following


            HISTORICAL VIEW of the Properties of Digitalis.

FUCHSIUS in his _hist. stirp._ 1542, is the first author who notices
it. From him it receives its name of DIGITALIS, in allusion to the
German name of _Fingerhut_, which signifies a finger-stall, from the
blossoms resembling the finger of a glove.

SENSIBLE QUALITIES. Leaves bitterish, very nauseous. LEWIS _Mat. med._
i. 342.

SENSIBLE EFFECTS. Some persons, soon after eating of a kind of
omalade, into which the leaves of this, with those of several other
plants, had entered as an ingredient, found themselves much
indisposed, and were presently after attacked with vomitings. DODONÆUS
_pempt._ 170.

It is a medicine which is proper only for strong constitutions, as it
purges very violently, and excites excessive vomitings. RAY. _hist._
767.

BOERHAAVE judges it to be of a poisonous nature, _hist. plant._ but
DR. ALSTON ranks it among those indigenous vegetables, “which, though
now disregarded, are medicines of great virtue, and scarcely inferior
to any that the Indies afford.” LEWIS _Mat. med._ i. _p._ 343.

Six or seven spoonfuls of the decoction produce nausea and vomiting,
and purge; not without some marks of a deleterious quality. HALLER
_hist. n._ 330 from _Aerial Infl. p._ 49, 50.


                 The following is an abridged ACCOUNT
                     of its EFFECTS upon TURKEYS.

M. SALERNE, a physician at Orleans, having heard that several turkey
pouts had been killed by being fed with Foxglove leaves, instead of
mullein, he gave some of the same leaves to a large vigorous turkey.
The bird was so much affected that he could not stand upon his legs,
he appeared drunk, and his excrements became reddish. Good nourishment
restored him to health in eight days.

Being then determined to push the experiment further, he chopped some
more leaves, mixed them with bran, and gave them to a vigorous turkey
cock which weighed seven pounds. This bird soon appeared drooping and
melancholy; his feathers stared, his neck became pale and retracted.
The leaves were given him for four days, during which time he took
about half a handful. These leaves had been gathered about eight days,
and the winter was far advanced. The excrements, which are naturally
green and well formed, became, from the first, liquid and reddish,
like those of a dysenteric patient.

The animal refusing to eat any more of this mixture which had done him
so much mischief, I was obliged to feed him with bran and water only;
but notwithstanding this, he continued drooping, and without appetite.
At times he was seized with convulsions, so strong as to throw him
down; in the intervals he walked as if drunk; he did not attempt to
perch, he uttered plaintive cries. At length he refused all
nourishment. On the fifth or sixth day the excrements became as white
as chalk; afterwards yellow, greenish, and black. On the eighteenth
day he died, greatly reduced in flesh, for he now weighed only three
pounds.

On opening him we found the heart, the lungs, the liver, and
gall-bladder shrunk and dried up; the stomach was quite empty, but not
deprived of its villous coat. _Hist. de l'Academ._ 1748. _p._ 84.

EPILEPSY.--“It hath beene of later experience found also to be
effectual against the falling sicknesse, that divers have been cured
thereby; for after the taking of the _Decoct. manipulor. ii. c.
polypod. quercin. contus. ℥iv. in cerevisia_, they that
have been troubled with it twenty-six years, and have fallen once in a
weeke, or two or three times in a moneth, have not fallen once in
fourteen or fifteen moneths, that is until the writing hereof.”

                                        _Parkinson_, _p._ 654.

SCROPHULA.--“The herb bruised, or the juice made up into an ointment,
and applied to the place, hath been found by late experience to be
availeable for the King's Evill.” PARK. p. 654.

Several hereditary instances of this disease said to have been cured
by it. AEREAL INFLUENCES, _p._ 49, 50, quoted by HALLER, _hist. n._
330.

A man with _scrophulous ulcers_ in various parts of the body, and
which in the right leg were so virulent that its amputation was
proposed, cured by _succ. express. cochl. i. bis intra xiv. dies, in
½ pintæ cerevisiæ calidæ_.

The leaves remaining after the pressing out of the juice, were applied
every day to the ulcers. _Pract. ess. p._ 40. quoted by MURRAY
_apparat. medicam. i. p._ 491.

A young woman with a _scrophulous tumour of the eye_, a remarkable
_swelling of the upper lip, and painful tumours of the joints of the
fingers_, much relieved; but the medicine was left off, on account of
its violent effects on the constitution. _Ib. p._ 42 quoted as above.

A man with _scrophulous tumour of the right elbow_, attended for three
years _with excruciating pains_, was nearly cured by four doses of the
juice taken once a month. _Ib. p._ 43. as above.

The physicians and surgeons of the Worcester Infirmary have employed
it in ointments and poultices with remarkable efficacy. _Ib. p._ 44.
It was recommended to them by Dr. Baylies of Evesham, now of Berlin,
as a remedy for this disease. Dr. Wall gave it a tryal, as well
externally as internally, but their experiments did not lead them to
observe any other properties in it, than those of a highly nauseating
medicine and drastic purgative.

WOUNDS. In considerable estimation for the healing all kinds of
wounds, _Lobel. adv._ 245.

Principally of use in ulcers, which discharge considerably, being of
little advantage in such as are dry. HULSE, in R. hist. 768.

DOCTOR BAYLIES, physician to his Prussian Majesty, informed me, when
at Berlin, that he employed it with great success in caries, and
obstinate sore legs.

DYSPNŒA _Pituitosa_ Sauvages i. 657.--“Boiled in water, or wine,
and drunken doth cut and consume the thicke toughnesse of grosse, and
slimie flegme, and naughtie humours. The same, or boiled with honied
water or sugar, doth scoure and clense the brest, ripeneth and
bringeth foorth tough and clammie flegme. It openeth also the stoppage
of the liver spleene and milt, and of the inwarde parts.” GERARDE
hist. ed. I p. 647.

“Whensoever there is need of a rarefying or extenuating of tough
flegme or viscous humours troubling the chest,--the decoction or juice
hereof made up with sugar or honey is availeable, as also to clense
and purge the body both upwards and downwards sometimes, of tough
flegme, and clammy humours, notwithstanding that these qualities are
found to bee in it, there are but few physitions in our times that put
it to these uses, but it is in a manner wholly neglected.”

                                                 PARKINSON, p. 654.

Previous to the year 1777, you informed me of the great success you
had met with in curing dropsies by means of the fol. Digitalis, which
you then considered as a more certain diuretic than any you had ever
tried. Some time afterwards, Mr. Russel, surgeon, of Worcester, having
heard of the success which had attended some cases in which you had
given it, requested me to obtain for him any information you might be
inclined to communicate respecting its use. In consequence of this
application, you wrote to me in the following terms.[3]

    [Footnote 3: See the extract from this letter at page 5.]

In a letter which I received from you in London, dated _September_ 29,
1778, you write as follows:--“I wish it was as easy to write upon the
Digitalis--I despair of pleasing myself or instructing others, in a
subject so difficult. It is much easier to write upon a disease than
upon a remedy. The former is in the hands of nature, and a faithful
observer, with an eye of tolerable judgment, cannot fail to delineate
a likeness. The latter will ever be subject to the whims, the
inaccuracies, and the blunders of mankind.”--

In my notes I find the following memorandum--“_February_ 20th, 1779,
gave an account of Doctor Withering's practice, with the precautions
necessary to its success, to the Medical Society at Edinburgh.”--In
the course of that year, the Digitalis was prescribed in the Edinburgh
Infirmary, by Dr. Hope, and in the following year, whilst I was Clerk
to Dr. Home, as Clinical Professor, I had a favourable opportunity of
observing its sensible effects.

In one case in which it was given properly at first, the urine began
to flow freely on the second day. On the third, the swellings began to
subside. The dose was then increased more than _quadruple_ in the
twenty-four hours. On the fifth day sickness came on, and much
purging, but the urine still increased though the pulse sunk to 50. On
the 7th day, a _quadruple_ dose of the infusion was ordered to be
taken every third hour, so as to bring on nausea again. The pulse fell
to forty-four, and at length to thirty-five in a minute. The patient
gradually sunk and died on the sixteenth day; but previous to her
death, for two or three days, her pulse rose to near one hundred.--It
is needless to observe to you, how widely the treatment of this case
differed from the method which you have found so successful.



                             OF THE PLATE.


The figure of the Foxglove, facing the Title Page, is copied by the
permission and under the inspection of Mr. Curtis, from his admirable
work, entitled FLORA LONDINENSIS. The accuracy of the drawings, the
beauty of the colouring, the full descriptions, the accurate specific
distinctions, and the uses of the different plants, cannot fail to
recommend that work to the patronage of all who are interested in the
encouragement of genius, or the promotion of useful knowledge.

       *       *       *       *       *

                             EXPLANATION.

     Fig. 1. The Empalement.

     Fig. 2, 3, 4. Four CHIVES two long and two short. TIPS at
     first large, turgid, oval, touching at bottom, of a
     yellowish colour, and often spotted; lastly changing both
     their form and situation in a singular manner.

     Fig. 5, 6, 7. SEED-BUD rather conical, of a yellow green
     colour. _Shaft_ simple. _Summit_ cloven.

     Fig. 8. _Honey-cup_ a gland, surrounding the bottom of the
     Seed-bud.

     Fig. 9. SEED-VESSEL, a pointed oval _Capsule_, of two cells
     and two valves, the lowermost valve splitting in two.

     Fig. 10. SEEDS numerous, blackish, small, lopped at each
     end.



   AN ACCOUNT OF THE INTRODUCTION of FOXGLOVE INTO MODERN PRACTICE.


As the more obvious and sensible properties of plants, such as colour,
taste, and smell, have but little connexion with the diseases they are
adapted to cure; so their peculiar qualities have no certain
dependence upon their external configuration. Their chemical
examination by fire, after an immense waste of time and labour, having
been found useless, is now abandoned by general consent. Possibly
other modes of analysis will be found out, which may turn to better
account; but we have hitherto made only a very small progress in the
chemistry of animal and vegetable substances. Their virtues must
therefore be learnt, either from observing their effects upon insects
and quadrupeds; from analogy, deduced from the already known powers of
some of their congenera, or from the empirical usages and experience
of the populace.

The first method has not yet been much attended to; and the second can
only be perfected in proportion as we approach towards the discovery
of a truly natural system; but the last, as far as it extends, lies
within the reach of every one who is open to information, regardless
of the source from whence it springs.

It was a circumstance of this kind which first fixed my attention on
the Foxglove.

In the year 1775, my opinion was asked concerning a family receipt for
the cure of the dropsy. I was told that it had long been kept a secret
by an old woman in Shropshire, who had sometimes made cures after the
more regular practitioners had failed. I was informed also, that the
effects produced were violent vomiting and purging; for the diuretic
effects seemed to have been overlooked. This medicine was composed of
twenty or more different herbs; but it was not very difficult for one
conversant in these subjects, to perceive, that the active herb could
be no other than the Foxglove.

My worthy predecessor in this place, the very humane and ingenious Dr.
Small, had made it a practice to give his advice to the poor during
one hour in a day. This practice, which I continued until we had an
Hospital opened for the reception of the sick poor, gave me an
opportunity of putting my ideas into execution in a variety of cases;
for the number of poor who thus applied for advice, amounted to
between two and three thousand annually. I soon found the Foxglove to
be a very powerful diuretic; but then, and for a considerable time
afterwards, I gave it in doses very much too large, and urged its
continuance too long; for misled by reasoning from the effects of the
squill, which generally acts best upon the kidneys when it excites
nausea, I wished to produce the same effect by the Foxglove. In this
mode of prescribing, when I had so many patients to attend to in the
space of one, or at most of two hours, it will not be expected that I
could be very particular, much less could I take notes of all the
cases which occurred. Two or three of them only, in which the medicine
succeeded, I find mentioned amongst my papers. It was from this kind
of experience that I ventured to assert, in the Botanical Arrangement
published in the course of the following spring, that the Digitalis
purpurea “merited more attention than modern practice bestowed upon
it.”

I had not, however, yet introduced it into the more regular mode of
prescription; but a circumstance happened which accelerated that
event. My truly valuable and respectable friend, Dr. Ash, informed me
that Dr. Cawley, then principal of Brazen Nose College, Oxford, had
been cured of a Hydrops Pectoris, by an empirical exhibition of the
root of the Foxglove, after some of the first physicians of the age
had declared they could do no more for him. I was now determined to
pursue my former ideas more vigorously than before, but was too well
aware of the uncertainty which must attend on the exhibition of the
_root_ of a _biennial_ plant, and therefore continued to use the
_leaves_. These I had found to vary much as to dose, at different
seasons of the year; but I expected, if gathered always in one
condition of the plant, viz. when it was in its flowering state, and
carefully dried, that the dose might be ascertained as exactly as that
of any other medicine; nor have I been disappointed in this
expectation. The more I saw of the great powers of this plant, the
more it seemed necessary to bring the doses of it to the greatest
possible accuracy. I suspected that this degree of accuracy was not
reconcileable with the use of a _decoction_, as it depended not only
upon the care of those who had the preparation of it, but it was easy
to conceive from the analogy of another plant of the same natural
order, the tobacco, that its active properties might be impaired by
long boiling. The decoction was therefore discarded, and the
_infusion_ substituted in its place. After this I began to use the
leaves in _powder_, but I still very often prescribe the infusion.

Further experience convinced me, that the _diuretic_ effects of this
medicine do not at all depend upon its exciting a nausea or vomiting;
but, on the contrary, that though the increased secretion of urine
will frequently succeed to, or exist along with these circumstances,
yet they are so far from being friendly or necessary, that I have
often known the discharge of urine checked, when the doses have been
imprudently urged so as to occasion sickness.

If the medicine purges, it is almost certain to fail in its desired
effect; but this having been the case, I have seen it afterwards
succeed when joined with small doses of opium, so as to restrain its
action on the bowels.

In the summer of the year 1776, I ordered a quantity of the leaves to
be dried, and as it then became possible to ascertain its doses, it
was gradually adopted by the medical practitioners in the circle of my
acquaintance.

In the month of _November_ 1777, in consequence of an application from
that very celebrated surgeon, Mr. Russel, of Worcester, I sent him the
following account, which I choose to introduce here, as shewing the
ideas I then entertained of the medicine, and how much I was mistaken
as to its real dose.--“I generally order it in decoction. Three drams
of the dried leaves, collected at the time of the blossoms expanding,
boiled in twelve to eight ounces of water. Two spoonfuls of this
medicine, given every two hours, will sooner or later excite a nausea.
I have sometimes used the green leaves gathered in winter, but then I
order three times the weight; and in one instance I used three ounces
to a pint decoction, before the desired effect took place. I consider
the Foxglove thus given, as the most certain diuretic I know, nor do
its diuretic effects depend merely upon the nausea it produces, for in
cases where squill and ipecac. have been so given as to keep up a
nausea several days together, and the flow of urine not taken place, I
have found the Foxglove to succeed; and I have, in more than one
instance, given the Foxglove in smaller and more distant doses, so
that the flow of urine has taken place without any sensible affection
of the stomach; but in general I give it in the manner first
mentioned, and order one dose to be taken after the sickness
commences. I then omit all medicines, except those of the cordial kind
are wanted, during the space of three, four, or five days. By this
time the nausea abates, and the appetite becomes better than it was
before. Sometimes the brain is considerably affected by the medicine,
and indistinct vision ensues; but I have never yet found any permanent
bad effects from it.”--

“I use it in the Ascites, Anasarca, and Hydrops Pectoris; and so far
as the removal of the water will contribute to cure the patient, so
far may be expected from this medicine: but I wish it not to be tried
in ascites of female patients, believing that many of these cases are
dropsies of the ovaria; and no sensible man will ever expect to see
these encysted fluids removed by any medicine.”

“I have often been obliged to evacuate the water repeatedly in the
same patient, by repeating the decoction; but then this has been at
such distances of time as to allow of the interference of other
medicines and a proper regimen, so that the patient obtains in the end
a perfect cure. In these cases the decoction becomes at length so very
disagreeable, that a much smaller quantity will produce the effect,
and I often find it necessary to alter its taste by the addition of
Aq. Cinnam. sp. or Aq. Juniper. composita.”

“I allow, and indeed enjoin my patients to drink very plentifully of
small liquors through the whole course of the cure; and sometimes,
where the evacuations have been very sudden, I have found a bandage as
necessary as in the use of the trochar.”--

Early in the year 1779, a number of dropsical cases offered themselves
to my attention, the consequences of the scarlet fever and sore throat
which had raged so very generally amongst us in the preceding year.
Some of these had been cured by squills or other diuretics, and
relapsed; in others, the dropsy did not appear for several weeks after
the original disease had ceased: but I am not able to mention many
particulars, having omitted to make notes. This, however, is the less
to be regretted, as the symptoms in all were very much alike, and they
were all without an exception cured by the Foxglove.

This last circumstance encouraged me to use the medicine more
frequently than I had done heretofore, and the increase of practice
had taught me to improve the management of it.

In _February_ 1779, my friend, Dr. Stokes, communicated to the Medical
Society at Edinburgh the result of my experience of the Foxglove; and,
in a letter addressed to me in _November_ following, he says, “Dr.
Hope, in consequence of my mentioning its use to my friend, Dr.
Broughton, has tried the Foxglove in the Infirmary with success.” Dr.
Stokes also tells me that Dr. Hamilton cured Dropsies with it in the
year 1781.

I am informed by my very worthy friend Dr. Duncan, that Dr. Hamilton,
who learnt its use from Dr. Hope, has employed it very frequently in
the Hospital at Edinburgh. Dr. Duncan also tells me, that the late
very ingenious and accomplished Mr. Charles Darwin, informed him of
its being used by his father and myself, in cases of Hydrothorax, and
that he has ever since mentioned it in his lectures, and sometimes
employed it in his practice.

At length, in the year 1783, it appeared in the new edition of the
Edinburgh Pharmacopœia, into which, I am told, it was received in
consequence of the recommendation of Dr. Hope. But from which, I am
satisfied, it will be again very soon rejected, if it should continue
to be exhibited in the unrestrained manner in which it has heretofore
been used at Edinburgh, and in the enormous doses in which it is now
directed in London.

In the following cases the reader will find other diseases besides
dropsies; particularly several cases of consumption. I was induced to
try it in these, from being told, that it was much used in the West of
England, in the Phthisis Pulmonalis, by the common people. In this
disease, however, in my hands, it has done but little service, and yet
I am disposed to wish it a further trial, for in a copy of Parkinson's
Herbal, which I saw about two years ago, I found the following
manuscript note at the article Digitalis, written, I believe, by a Mr.
Saunders, who practised for many years with great reputation as a
surgeon and apothecary at Stourbridge, in Worcestershire.

“Consumptions are cured infallibly by weak decoction of Foxglove
leaves in water, or wine and water, and drank for constant drink. Or
take of the juice of the herb and flowers, clarify it, and make a fine
syrup with honey, of which take three spoonfuls thrice in a day, at
physical hours. The use of these two things of late has done, in
consumptive cases, great wonders. But be cautious of its use, for it
is of a vomiting nature. In these things begin sparingly, and increase
the dose as the patient's strength will bear, least, instead of a
sovereign medicine, you do real damage by this infusion or syrup.”

The precautions annexed to his encomiums of this medicine, lead one to
think that he has spoken from his own proper experience.

I have lately been told, that a person in the neighbourhood of
Warwick, possesses a famous family receipt for the dropsy, in which
the Foxglove is the active medicine; and a lady from the western part
of Yorkshire assures me, that the people in her country often cure
themselves of dropsical complaints by drinking Foxglove tea. In
confirmation of this, I recollect about two years ago being desired to
visit a travelling Yorkshire tradesman. I found him incessantly
vomiting, his vision indistinct, his pulse forty in a minute. Upon
enquiry it came out, that his wife had stewed a large handful of green
Foxglove leaves in half a pint of water, and given him the liquor,
which he drank at one draught, in order to cure him of an asthmatic
affection. This good woman knew the medicine of her country, but not
the dose of it, for her husband narrowly escaped with his life.

It is probable that this rude mode of exhibiting the Foxglove has been
more general than I am at present aware of; but it is wonderful that
no author seems to have been acquainted with its effects as a
diuretic.



                                CASES,

                In which the Digitalis was given by the
                       Direction of the Author.


                                 1775.

It was in the course of this year that I began to use the Digitalis in
dropsical cases. The patients were such as applied at my house for
advice gratis. I cannot pretend to charge my memory with particular
cases, or particular effects, and I had not leisure to make notes.
Upon the whole, however, it may be concluded, that the medicine was
found useful, or I should not have continued to employ it.


                                CASE I.

_December_ 8th. A man about fifty years of age, who had formerly been
a builder, but was now much reduced in his circumstances, complained
to me of an asthma which first attacked him about the latter end of
autumn. His breath was very short, his countenance was sunken, his
belly large; and, upon examination, a fluctuation in it was very
perceptible. His urine for some time past had been small in quantity.
I directed a decoction of Fol. Digital. recent. which made him very
sick, the sickness recurring at intervals for several days, during
which time he made a large quantity of water. His breath gradually
drew easier, his belly subsided, and in about ten days he began to
eat with a keen appetite. He afterwards took steel and bitters.


                                 1776.

                               CASE II.

_January_ 14th. A poor man labouring under an ascites and anasarca,
was directed to take a decoction of Digitalis every four hours. It
purged him smartly, but did not relieve him. An opiate was now ordered
with each dose of the medicine, which then acted upon the kidneys very
freely, and he soon lost all his complaints.


                               CASE III.

_March_ 15th. A poor boy, about nine years of age, was brought for my
advice. His countenance was pale, his pulse quick and feeble, his body
greatly emaciated, except his belly, which was very large, and, upon
examination, contained a fluid. The case had been considered as
arising from worms. He was directed to take the decoction of Digitalis
night and morning. It operated as a diuretic, never made him sick, and
he got well without any other medicine.


                               CASE IV.

_July_ 25th. Mrs. H----, of A----, near N----, between forty and fifty
years of age, a few weeks ago, after some previous indisposition, was
attacked by a severe cold shivering fit, succeeded by fever; great
pain in her left side, shortness of breath, perpetual cough, and,
after some days, copious expectoration. On the 4th of _June_, Dr.
Darwin,[4] was called to her. I have not heard what was then done for
her, but, between the 15th of _June_, and 25th of _July_, the Doctor,
at his different visits, gave her various medicines of the
deobstruent, tonic, antispasmodic, diuretic, and evacuant kinds.

    [Footnote 4: Then resident at Lichfield, now at Derby.]

On the 25th of _July_ I was desired to meet Dr. Darwin at the lady's
house. I found her nearly in a state of suffocation; her pulse
extremely weak and irregular, her breath very short and laborious, her
countenance sunk, her arms of a leaden colour, clammy and cold. She
could not lye down in bed, and had neither strength nor appetite, but
was extremely thirsty. Her stomach, legs, and thighs were greatly
swollen; her urine very small in quantity, not more than a spoonful at
a time, and that very seldom. It had been proposed to scarify her
legs, but the proposition was not acceded to.

She had experienced no relief from any means that had been used,
except from ipecacoanha vomits; the dose of which had been gradually
increased from 15 to 40 grains, but such was the insensible state of
her stomach for the last few days, that even those very large doses
failed to make her sick, and consequently purged her. In this
situation of things I knew of nothing likely to avail us, except the
Digitalis: but this I hesitated to propose, from an apprehension that
little could be expected from any thing; that an unfavourable
termination would tend to discredit a medicine which promised to be
of great benefit to mankind, and I might be censured for a
prescription which could not be countenanced by the experience of any
other regular practitioner. But these considerations soon gave way to
the desire of preserving the life of this valuable woman, and
accordingly I proposed the Digitalis to be tried; adding, that I
sometimes had found it to succeed when other, even the most judicious
methods, had failed. Dr. Darwin very politely, acceded immediately to
my proposition, and, as he had never seen it given, left the
preparation and the dose to my direction. We therefore prescribed as
follows:

    R. Fol. Digital. purp. recent. ℥iv. coque ex Aq. fontan. puræ
    ℔iss ad ℔i. et cola.
    R. Decoct. Digital. ℥iss.
    Aq. Nuc. Moschat. ʒii. M. fiat. haust. 2dis horis sumend.

The patient took five of these draughts, which made her very sick, and
acted very powerfully upon the kidneys, for within the first
twenty-four hours she made upwards of eight quarts of water. The sense
of fulness and oppression across her stomach was greatly diminished,
her breath was eased, her pulse became more full and more regular, and
the swellings of her legs subsided.

26th. Our patient being thus snatched from impending destruction, Dr.
Darwin proposed to give her a decoction of pareira brava and guiacum
shavings, with pills of myrrh and white vitriol; and, if costive, a
pill with calomel and aloes. To these propositions I gave a ready
assent.

30th. This day Dr. Darwin saw her, and directed a continuation of the
medicines last prescribed.

_August_ 1st. I found the patient perfectly free from every appearance
of dropsy, her breath quite easy, her appetite much improved, but
still very weak. Having some suspicion of a diseased liver, I directed
pills of soap, rhubarb, tartar of vitriol, and calomel to be taken
twice a day, with a neutral saline draught.

9th. We visited our patient together, and repeated the draughts
directed on the 26th of _June_, with the addition of tincture of bark,
and also ordered pills of aloes, guiacum, and sal martis to be taken
if costive.

_September_ 10th. From this time the management of the case fell
entirely under my direction, and perceiving symptoms of effusion going
forwards, I desired that a solution of merc. subl. corr. might be
given twice a day.

19th. The increase of the dropsical symptoms now made it necessary to
repeat the Digitalis. The dried leaves were used in infusion, and the
water was presently evacuated, as before.

It is now almost nine years since the Digitalis was first prescribed
for this lady, and notwithstanding I have tried every preventive
method I could devise, the dropsy still continues to recur at times;
but is never allowed to increase so as to cause much distress, for she
occasionally takes the infusion and relieves herself whenever she
chooses. Since the first exhibition of that medicine, very small doses
have been always found sufficient to promote the flow of urine.

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.


                              CASE VIII.

_March_ 11th. Mrs. H----, Æt. 32. A few days after a tedious labour,
had her legs and thighs swelled to a very great degree; pale and
semi-transparent,[5] with pain in both groins. After a purge of
calomel and rhubarb, ung. merc. was ordered to be rubbed upon the
groins, and the following decoction was directed:

    R. Fol. Digital. purp. recent. ℥ii.
    Aq. puræ. ℔i. coque ad ℔iss et colatur. adde.
    Aq. cinn. sp. ℥iv. M. capiat. cyath. vinos. parv. bis
    quotidie.

The decoction presently increased the secretion of urine, and abated
the distension of the legs: in a fortnight the swelling was gone; but
some days after leaving her bed, her legs swelled again about the
ancles, which was removed by another bottle of the decoction on the
21st of _April_.

    [Footnote 5: This disease has lately been well described by
    Mr. White, of Manchester.]


                               CASE IX.

_March_ 29th. Mr. G----, Æt. 47. Very much deformed; asthma of several
years continuance, but now dropsical to a great degree. Took several
medicines without relief, and then tried the Digitalis, but with no
better success.


                                CASE X.

_April_ 10th. G--G----, Æt. 70. Asthma and anasarca. Took a decoction
of the fresh leaves of the Digitalis, which produced violent sickness,
but no immediate evacuation of water. After the sickness had ceased
altogether, the urine began to flow copiously, and he was cured.


                               CASE XI.

_July_ 10th. Mr. M---- of T----, Æt. 54. A very hard drinker; had been
affected since _November_ last with ascites and anasarca, for which he
had taken several medicines without benefit. A decoction of the recent
leaves of the Digitalis was then directed, an ounce and half to a
pint, one eighth of which I ordered to be given every fourth hour. A
few doses brought on great nausea, indistinct vision, and a great flow
of urine, so as presently to empty him of all the dropsical water.
Indeed the evacuation was so rapid and so complete, that it became
necessary to apply a bandage round the belly, and to support him with
cordials.

In something more than a year and a half, his dropsy returned, but the
Digitalis did not then succeed to our wishes. In _August_, 1779, he
was tapped, and lived afterwards only about five weeks.

For more particulars, see the extract of a letter from Mr. Lyon.


                               CASE XII.

_September_ 12th. Miss C---- of T----, Æt 48. An ovarium dropsy, and
anasarcous legs and thighs. For three months in the beginning of this
year she had been under the care of Dr. Darwin, who at different times
had given her blue vitriol, elaterium, and calomel; decoction of
pareira brava, and guiacum wood, with tincture of cantharides; oxymel
of squills, decoction of parsley roots, &c. Finding no relief, she
discontinued the use of medicines, until the urgency of her symptoms
induced her to ask my advice about the end of _August_. She was
greatly emaciated, and had almost a total loss of appetite. I first
tried small doses of Merc. sublim. corr. in solution, with decoction
of burdock roots, and blisters to the thighs. No advantage attending
the use of this plan, I directed a decoction of Fol. Digit. a dram and
half to a pint; one ounce to be taken twice a day. It presently
reduced the anasarcous swellings, but made no alteration in the
distension of the abdomen.


                              CASE XIII.

_October_ 9th. Mrs. B----, Æt. 40. An ovarium dropsy. Took a decoction
of Digitalis without effect. Her life was preserved for some years by
repeated tapping.


                                 1778.

                               CASE XIV.

_February_ 8th. Mr. R---- of K----. Had formerly suffered much from
gout, and lived very intemperately. Jaundiced countenance; ascites;
legs and thighs greatly swollen; appetite none; extremely weak;
confined to his bed. Had taken many medicines from his apothecary
without advantage. I ordered him decoction of Digitalis, and a
cordial; but he survived only a few days.


                               CASE XV.

_March_ 13th. Mr. M----, Æt. 54. A thorax greatly deformed; asthma
through the winter, succeeded by dropsy in belly and legs. Pulse very
small; face leaden coloured; cough almost continual. Decoction of
seneka was directed, and small doses of Dover's powder at night.

17th. Gum-ammoniac and squill, with elixir paregor. at night.--26th,
Squill and decoction of seneka.--30th, His complaints still
increasing, decoction of Digitalis was then directed, which relieved
him in a few days; but his complaints returned again, and he died in
the month of _June_.


                               CASE XVI.

_August_ 18th. Mr. B----, Æt. 33. Pulmonary consumption and dropsy.
The Digitalis, and that failing, other diuretics were used, in hopes
of gaining some relief from the distress occasioned by the dropsical
symptoms; but none of them were effectual. He was then attended by
another physician, and died in about two months.


                              CASE XVII.

_September_ 21st. Mrs. M---- W---- G----, Æt. 50. An ovarium dropsy.
She took half a pint of Infus. Digitalis, which made her sick, but did
not increase the quantity of urine. She was afterwards relieved by
tapping.


                              CASE XVIII.

_October_ 28th. R---- W----, Æt. 33. Ascites and universal anasarca;
countenance quite pale and bloated; appetite none, and the little food
he forces down is generally rejected.

    R. Fol. Digit. purp. siccat. ʒiii.
    Aq. bull. ℔i. digere per horas duas, et colat. adde aq.
    junip. comp. ℥iii.

He was directed to take one ounce of this infusion every two hours
until it should make him sick. This was on Wednesday. The fifth dose
made him vomit. On Thursday afternoon he vomited again very freely,
without having taken any more of the medicine. On Friday and Saturday
he made more water than he had done for a week before, and the
swellings of his face and body were considerably abated. He was
directed to omit all medicine so long as the urine continued to flow
freely, and also to keep an account of the quantity he made in
twenty-four hours.

These were his reports:

    _October_ 31st. Saturday,   5 half pints.
    _November_ 1st. Sunday,     6
               2d. Monday,      8
               3d. Tuesday,     8
               4th. Wednesday,  7
               5th. Thursday,   8

On Wednesday he began to purge, and the purging still continues, but
his appetite is better than he has known it for a long time. No
swelling remains but about his ancles, extending at night half way up
his legs.

Omit all medicines at present.

               7th. Saturday,   7½ half pints.
               8th. Sunday,     8
               9th. Monday,     6¾
              10th. Tuesday,    6½
              11th. Wednesday,  6
              12th. Thursday,   6¼

On Tuesday the 17th, some swelling still remained about his ancles,
but he was in every other respect perfectly well.

He took a few more doses of the infusion, and no other medicine.


                               CASE XIX.

_December_ 8th. W---- B----, Æt. 60. A hard drinker. Diseased viscera;
ascites and anasarca. An infusion of Digitalis was directed, but it
had no other effect than to make him sick.


                                 1779.

In the beginning of this year we had many dropsies in children, who
had suffered from the Scarlatina Anginosa; they all yielded very
readily to the Digitalis, but in some the medicine purged, and then it
did not prove diuretic, nor did it remove the dropsy until opium was
joined with it, so as to prevent it purging.--I did not keep notes of
these cases, but I do not recollect a single instance in which the
Digitalis failed to effect a cure.


                               CASE XX.

_January_ 1st. Mr. H----. Hydrops Pectoris; legs and thighs
prodigiously anasarcous; a very distressing sense of fulness and
tightness across his stomach; urine in small quantity; pulse
intermitting; breath very short.

He had taken various medicines, and been blistered, but without
relief. His complaints continuing to increase, I directed an infusion
of Digitalis, which made him very sick; acted powerfully as a
diuretic, and removed all his symptoms.

About three months afterwards he was out upon a journey, and, after
taking cold, was suddenly seized with difficulty of breathing, and
violent palpitation of his heart: he sent for me, and I ordered the
infusion as before, which very soon removed his complaints. He is now
active and well; but, whenever he takes cold, finds some return of
difficult breathing, which he soon removes by a dose or two of the
infusion.


                               CASE XXI.

_January_ 5th. Mrs. M----, Æt. 69. Hydrothorax, (called asthma)
ascites and anasarca. I directed an infusion of Fol. Digital. siccat.
three drams to a pint; a small wine glass to be taken every third or
fourth hour. It made her violently sick, acted powerfully as a
diuretic, set her breath perfectly at liberty, and carried off the
swelling of her legs; when she was nearly emptied, she became so
languid, that I thought it necessary to order cordials, and a large
blister to her back. Mr. Ward, who attended as her apothecary, tells
me she had some return of her asthma in _June_ and _October_
following, which was each time removed by the same medicine.


                              CASE XXII.

_January_ 11th. Mr. H----, Æt. 59. Ascites and general anasarca. A
large corpulent man, and a hard drinker: he had repeatedly suffered
under complaints of this kind, but had been always relieved by the
judicious assistance of Dr. Ash. In the present instance, however, not
finding relief as usual from the prescriptions of my worthy friend, he
sent for me; after examining into his situation, and informing myself
what had been done to relieve him, I was satisfied that the Digitalis
was the only medicine from which I had any thing to hope. It was
therefore directed; but another patient requiring my assistance at a
distance from town, I desired he would not begin the medicine before I
returned, which would be early on the third day; for I was well aware
of the difficulties before me, and that he would inevitably sink under
too rapid an evacuation of the water. On my return I was informed,
that the preceding evening, as he sat on his chair, his head sunk upon
his breast, and he died.

This case, as well as case VI. is mentioned with a view to demonstrate
to younger practitioners, how sudden and unexpected the deaths of
dropsical patients sometimes happen, and how cautious we should be in
assigning causes for effects.


                              CASE XXIII.

_August_ 31st. Mr. C----, Æt. 57. Diseased viscera, jaundice, ascites
and anasarca. After trying calomel, saline draughts, jallap purges,
chrystals of tartar, pills of gum ammoniac, squills, and soap, sal
succini, eleterium, &c. infusion of Digitalis was directed, which
removed all his urgent symptoms, and he recovered a pretty good state
of health.


                              CASE XXIV.

_September_ 11th. I was desired to visit Mr. L----, Æt. 63; a middle
sized man; rather thin; not habitually intemperate; found him in bed,
where he had been for three days. He was in a state of furious
insanity, and had been gradually losing his reason for ten days
before, but was not outrageous the first week; his apothecary had
given him ten grains of emetic tartar, a dram of ipecacoanha, and an
ounce of tincture of jallap, in the space of a few hours, which
scarcely made him sick, and only occasioned a stool or two; upon
enquiring into the usual state of his health, I was told that he had
been troubled with some difficulty of breathing for thirty years past,
but for the nine last years this complaint had increased, so that he
was often obliged to sit up the greater part of the night; and, for
the last year, the sense of suffocation was so great, when he lay
down, that he often sat up for a week together. His father died of an
asthma before he was fifty. A few years ago, at an election, where he
drank more than usual, his head was affected as now, but in a slighter
degree, and his asthmatic symptoms vanished; and now, notwithstanding
he has been several days in bed, he feels not the least difficulty in
breathing.

Apprehending that the insanity might be owing to the same cause which
had heretofore occasioned the asthma, and that this cause was water; I
ordered a decoction of the Fol. siccat Digital, three drams to half a
pint; three spoonfuls to be taken every third hour: the fourth dose
made him sick; the medicine was then stopped; the sickness continued
at intervals, more or less, for four days, during which time he made a
great quantity of water, and gradually became more rational. On the
fifth day his appetite began to return, and the sickness ceased, but
the flow of urine still continued.

A week afterwards I saw him again, and examined him particularly; his
head was then perfectly rational, appetite very good, breath quite
easy, permitting him to lie down in bed without inconvenience, makes
plenty of water, coughs a little, and expectorates freely. He took no
other medicine, except a little rhubarb when costive.


                               CASE XXV.

_September_ 15th. Mr. J. R----, Æt. 50. Subject to an asthmatical
complaint for more than twenty years, but was this year much worse
than usual, and symptoms of dropsy appeared. In _July_ he took G.
ammon. squill and seneka, with infus. amarum and fossil alkaly. In
_August_, infusum amar. with vin. chalyb. and at bed-time pil. styr.
and squill. His complaints increasing, the squill was pushed as far as
could be borne, but without any good effect. _September_ 15th, an
infusion of Digitalis was directed, but he died the next morning.


                              CASE XXVI.

_September_ 18th. Mrs. R----, Æt. 30. After a severe child-bearing,
found both her legs and thighs swelled to the utmost stretch of the
skin. They looked pale, and almost transparent. The case being similar
to that related at No. VIII. I determined upon a similar method of
treatment; but as this patient had an inflammatory sore throat also, I
wished to get that removed first, and in three or four days it was
done. I then directed an infusion of Digitalis, which soon increased
the urinary secretion, and reduced the swellings, without any
disturbance of her stomach.

A few days after quitting her bed and coming down stairs, some degree
of swelling in her legs returned, which was removed by calomel, an
opening electuary, and the application of rollers.


                              CASE XXVII.

_October_ 7th. Mr. F----, a little man, with a spine and thorax
greatly deformed; for more than a year past had complained of
difficult respiration, and a sense of fulness about his stomach; these
complaints increasing, his abdomen gradually enlarged, and a
fluctuation in it became perceptible. He had no anasarca, no
appearance of diseased viscera, and no great paucity of urine. Purges
and diuretics of different kinds affording him no relief, my
assistance was desired. After trying squill medicines without effect,
he was ordered to take Pulv. fol. Digital. in small doses. These
producing no sensible effect, the doses were gradually increased until
nausea was excited; but there was no alteration in the quantity of
urine, and consequently no relief to his complaints. I then advised
tapping, but he would not hear of it; however, the distress occasioned
by the increasing fulness of his belly at length compelled him to
submit to the operation on the 20th of _November_. It was necessary to
draw off the water again upon the following days:

          _December_ the 8th.
             -- --      27th.
    1780. _February_ the 4th.
             -- --       23d.
          _March_ the    9th.

During the intervals, no method I could think of was omitted to
prevent the return of the disease, but nothing seemed to avail. In the
operation of _February_ 23d, his strength was so much reduced, that
the water was not entirely removed; and on the 9th of March, before
his belly was half emptied, notwithstanding the most judicious
application of bandage, his debility was so great, that it was judged
prudent to stop. After being placed in bed, the faintness and sickness
continued; severe rigors ensued, and violent vomiting; these
vomitings continued through the night, and in the intervals he lay in
a state nearly approaching to syncope. The next day I found him with
nearly the same symptoms, but remarked that the quantity of fluid he
had thrown up was very much more than what he had taken, and that his
abdomen was considerably fallen; in the course of two or three days
more, he discharged the whole of the effused fluid; his strength and
appetite gradually returned, and he was in all respects much better
than he had been before the last operation.

Some time afterwards, his belly began to fill again, and he again
applied to me; upon an accurate examination, I judged the quantity of
fluid might then be about four or five quarts. Nature had pointed out
the true method of cure in this case; I therefore ordered him to bed,
and directed ipecacoanha vomits to be given night and morning: in two
or three days the whole of the water was removed by vomiting, for he
never purged, nor was the quantity of his urine increased; his
appetite and strength gradually returned; he never had any further
relapse, and is now an active healthy man. I must leave the reader to
make his own reflections on this singular case.


                                 1780.

                             CASE XXVIII.

_January_ 11th. Captain V----, Æt. 42. Had suffered much from residing
in hot climates, and drinking very freely, particularly rum in large
quantity. He had tried many physicians before I saw him, but nothing
relieved him. I found him greatly emaciated, his countenance of a
brownish yellow; no appetite, extremely low, distressing fulness
across his stomach; legs and thighs greatly swollen; pulse quick, and
very feeble; urine in small quantity. As he had evidently only a few
days to live, I ordered him nothing but a solution of sal diureticus
in cinnamon water, slightly acidulated with syrup of lemons. This
medicine effecting no change, and his symptoms becoming daily more
distressing, I directed an infusion of Digitalis. A few doses
occasioned a copious flow of urine, without sickness or any other
disturbance. The medicine was discontinued; and the next day the urine
continuing to be secreted very plentifully, he lost his most
distressing complaints, was in great spirits, and ate a pretty good
dinner. In the evening, as he was conversing chearfully with some
friends, he stooped forwards, fell from his chair, and died instantly.
Had he been in bed, I think there is reason to believe this fatal
syncope, if such it was, would not have happened.


                              CASE XXIX.

_February_ 6th. Mr. H----, Æt. 63. A corpulent man; had suffered much
from gout, which for the last year or two had formed very imperfectly.
He had now symptoms of water in his chest, his belly and his legs. An
infusion of Digitalis removed these complaints, and after being
confined for the greater part of the winter, he was well enough to get
abroad again. In the course of a month the dropsical symptoms
returned, and were again removed by the same medicine. Bitters and
tonics were now occasionally prescribed, but his debility gradually
increased, and he died some time afterwards; but the dropsy never
returned.


                               CASE XXX.

_February_ 17th. Mr. D----, Æt. 50. Ascites and anasarca, with
symptoms of phthisis. He had been a very hard drinker. The infusum
Digitalis removed his dropsical symptoms, and he was sufficiently
recovered to take a journey; but as the spring advanced, the
consumptive symptoms increased, and he died soon afterwards, perfectly
emaciated.


                              CASE XXXI.

_March_ 5th. I was desired to visit Mrs. H----, a very delicate woman,
who after a severe lying-in, had her legs and thighs swollen to a very
great degree; pale and semi-transparent. I found her extremely faint,
her pulse very small and slow; vomiting violently, and frequently
purging. She was attended by a gentleman who had seen me give the
Digitalis in a similar case of swelled legs after a lying-in (see Case
XXVI.) about six months before. He had not considered that this
patient was delicate, the other robust; nor had he attended to stop
the exhibition of the medicine when its effects began to take place.
The great distress of her situation was evidently owing to the
imprudent and unlimited use of the Digitalis. I was very apprehensive
for her safety; ordered her cordials and volatiles; a free supply of
wine, chamomile tea with brandy for common drink, and blisters. The
next day the situation of things was much the same, but with all this
disturbance no increased secretion of urine. The same methods were
continued; an opiate ordered at night, and liniment. volatile upon
flannel applied to the groins, as she now complained of great pain in
those parts. The third day the nausea was less urgent, the vomitings
less frequent, the pulse not so slow. Camphorated spirit, with caustic
volatile alkaly, was applied to the stomach, emulsion given for common
drink, and the same medicines repeated. From this time, the intervals
became gradually longer between the fits of vomiting, the flow of
urine increased, the swellings subsided, the appetite returned, and
she recovered perfectly.


                              CASE XXXII.

_March_ 16th. Mr. D----, Æt. 70. A paralytic stroke had for some weeks
past impaired the use of his left side, and he complained much of his
breath, and of a straitness across his stomach; at length, an anasarca
and ascites appearing, I had no doubt as to the cause of the former
symptoms; but, upon account of his advanced age, and the paralytic
affection, I hesitated to give the Digitalis, and therefore tried the
other usual modes of practice, until at length his breath would not
permit him to lie down in bed, and his other symptoms increased so
rapidly as to threaten a speedy dissolution. In this dilemma I
ventured to prescribe an infusion of the Fol. siccat. Digital. which
presently excited a copious flow of urine, and made him very sick; a
strong infusion of chamomile flowers, with brandy, relieved the
sickness, but the diuretic effects of the Digitalis continuing, his
dropsy was removed, and his breathing became easy. The palsy remained
nearly in the same state. He lived until _August_ 1782, and without
any return of the dropsy.


                             CASE XXXIII.

_March_ 18th. Miss S----, Æt. 5. Hydrocephalus internus. As the case
did not yield to calomel, when matters were nearly advanced to
extremities, it occurred to me to try the Infusum Digitalis; a few
doses of which were given, but had no sensible effect.


                              CASE XXXIV.

_March_ 19th. A young lady, soon after the birth of an illegitimate
child, became insane. After being near a month under my care,
swellings of her legs, which at first had been attributed to weakness,
extended to her thighs and belly; her urine became foul, and small in
quantity, and the insanity remained nearly the same. As it had been
very difficult to procure evacuations by any means, I ordered half an
ounce of Fol. Digital. siccat. in a pint infusion, and directed two
spoonfuls to be given every two hours: this had the desired effect;
the dropsy and the insanity disappeared together, and she had
afterwards no other medicine but some aperient pills to take
occasionally.


                              CASE XXXV.

_April_ 12th. Mr. R----, Æt. 32. For the last three or four years had
had more or less of what was considered as asthma;--it appeared to me
Hydrothorax. I directed an infusion of Digitalis, which presently
removed his complaints. In _June_ following he had a relapse, and took
two grains of the Pulv. fol. Digit. three times a day, which cured him
after taking forty grains, and he has never had a return.


                              CASE XXXVI.

_May_ 15th. Mrs. H----, Æt. 40. A spasmodic asthma, attended with
symptoms of effusion. An infusion of Digitalis relieved her very
considerably, and she lived four years afterwards without any relapse.


                             CASE XXXVII.

_May_ 26th. R---- B----, Æt. 12. Scrophulous, consumptive, and at
length anasarcous. Took Infus. Digital. without advantage. Died the
_July_ following.


                             CASE XXXVIII.

_June_ 4th. Mrs. S----, of W----, Æt 49. Ascites and anasarca. Had
taken many medicines; first from her apothecary, afterwards by the
direction of a very judicious and very celebrated physician, but
nothing retarded the increase of the dropsy. I first saw her along
with the physician mentioned above, on the 14th of _May_; we directed
an electuary of chrystals of tartar, and Seltzer water for common
drink; this plan failing, as others had done before, we ordered the
Infus. Digital. which in a few days nearly removed the dropsy. I then
left her to the care of her physician; but her constitution was too
much impaired to admit of restoration to health, and I understand she
died a few weeks afterwards.


                              CASE XXXIX.

_June_ 13th. Mr. P----, Æt. 35. A very hard drinker, was attacked with
a severe hæmoptoe, which was followed by ascites and anasarca. He had
every appearance of diseased viscera, and his urine was small in
quantity. The powder and the infusion of Digitalis were given at
different times, but without the desired effect. Other medicines were
tried, but in vain. Tapping prolonged his existence a few weeks, and
he died early in the following autumn.


                               CASE XL.

_June_ 27th. Mr. W----, Æt. 37. An apparently asthmatic affection,
gradually increasing for three or four years, which not yielding to
the usual remedies, he took the infusion of Digitalis. Two or three
doses made him very sick; but he thought his breathing relieved. After
one week he took it again, and was so much better as to want no other
medicine.

In the course of the following winter he became hectic, and died
consumptive about a year afterwards.


                               CASE XLI.

_July_ 6th. Mr. E----, Æt. 57. Hydrothorax and anasarca; his breath so
short that he could not lie down. After a trial of squill, fixed
alkaly, and dulcified spirit of nitre, I directed Pulv. Digital. gr.
2, thrice a day. In four days he was able to come down stairs; in
three days more no appearance of disease remained; and under the use
of aromatics and small doses of opium, he soon recovered his strength.


                              CASE XLII.

_July_ 7th. Miss H---- of T----, Æt. 39. In the last stage of a
phthisis pulmonalis became dropsical. She took the Digitalis without
being relieved.


                              CASE XLIII.

_July_ 9th. Mrs. F----, Æt. 70. A chearful, strong, healthy woman; but
for a few years back had experienced a degree of difficult breathing
when in exercise. In the course of the last year her legs swelled, and
she felt great fulness about her stomach. These symptoms continued
increasing very fast, notwithstanding several attempts made by a very
judicious apothecary to relieve her. The more regular practitioner
failing, she had recourse to a quack, who I believe plied her very
powerfully with Daphne laureola, or some drastic purge of that kind. I
found her greatly reduced in strength, her belly and lower extremities
swollen to an amazing size, her urine small in quantity, and her
appetite greatly impaired. For the first fortnight of my attendance
blisters were applied, solution of fixed alkaly, decoction of seneka
with vitriolic æther, chrystals of tartar, squill and cordial
medicines were successively exhibited, but with no advantage. I then
directed Pulv. Fol. Digital. two grains every four hours. After taking
eighteen grains, the urine began to increase. The medicine was then
stopped. The discharge of urine continued to increase, and in five or
six days the whole of the dropsical water passed off, without any
disturbance to the stomach or bowels. As the distension of the belly
had been very great, a swathe was applied, and drawn gradually tighter
as the water was evacuated. As no pains were spared to prevent the
return of the dropsy, and as the best means I could devise proved
unequal to my wishes, both in this and in some other cases, I shall
take the liberty to point out the methods I tried at different times
in as concise a manner as possible, for the knowledge of what will not
do, may sometimes assist us to discover what will.

     1780.

     _July_ 18th. Infusum amarum, steel, Seltzer water.

     _September_ 22d. Neutral saline draughts, with tinct.
     canthar.

     26th. Pills of soap, garlic and millepedes.

     30th. The same pills, with infusum amarum.

     _October_ 11th. Pills of aloes, assafetida, and sal martis,
     in the day-time, and mercury rubbed down, at night.

     _December_ 21st. The accumulation of water now required a
     repetition of the Digitalis. It was directed in infusion, a
     dram and half to eight ounces, and an ounce and half given
     every fourth hour, until its effects began to appear. The
     water was soon carried off.

     30th. Sal diuretic. twice a day. To eat preserved garlic
     frequently.


     1781.

     _February_ 1st. Pills of calomel, squill and gum ammoniac.

     3d. Infusion of Digitalis repeated, and after the water was
     carried off, Dover's powder was tried as a sudorific.

     _March_ 18th. Infus. Digital. repeated.

     26th. Pills of sal martis and aromatic species, with infusum
     amarum.

     _May_ 5th. Being feverish; James's powder and saline
     draughts.

     10th. Laudanum every night, and an opening tincture to
     obviate costiveness.

     24th. Infus. Digitalis, one ounce only every fourth hour,
     which soon procured a perfect evacuation of the water.

     _August_ 11th. Infus. Digitalis.

     _October_ 19th. An emetic, and fol. Cicut. pulv. ten grains
     every six hours.

     _November_ 8th. A mercurial bolus at bed-time.

     16th. Infus. Digitalis.

     _December_ 23d. An emetic--Pills of seneka and gum
     ammoniac--Vitriolic acid in every thing she drinks.

     25th. Squill united to small doses of opium.


     1782.

     _January_ 2d. A troublesome cough--Syrup of garlic and
     oxymel of squills. A blister to the back.

     4th. Tincture of cantharides and paregoric elixir.

     28th. Infus. Digitalis, half an ounce every morning, and one
     ounce every night, was now sufficient to empty her.

     _March_ 26th. Infus. Digitalis; and when emptied, vitriol of
     copper twice a day.

     _April_ 1st. A cordial mixture for occasional use.

     Two months afterwards a purging came on, which every now and
     then returned, inducing great weakness--her appetite failed,
     and she died in _July_.


                              INTERVALS.

     From _July_ 9th, 1780, to _December_ 21st, 171 days.
     From _December_ 21st to _February_ 3d, 1781, 34 days.
     From _February_ 3d to _March_ 18th, 44 days.
     From _March_ 18th to _May_ 24th, 66 days.
     From _May_ 24th to _August_ 11th, 79 days.
     From _August_ 11th to _November_ 16th, 98 days.
     From _November_ 16th to _January_ 28th, 1782, 74 days.
     From _January_ 28th to _March_ 26th, 57 days.

None of the accumulations of water were at all equal to that which
existed when I first saw her, for finding so easy a mode of relief,
she became impatient under a small degree of pressure, and often
insisted upon taking her medicine sooner than I thought it necessary.
After the 26th of _March_ the degree of effusion was inconsiderable,
and at the time of her death very trifling, being probably carried off
by the diarrhœa.


                              CASE XLIV.

_July_ 12th. Mr. H----, of A----, Æt. 60. In the last stage of a life
hurried to a termination by free living, dropsical symptoms became the
most distressing. He wished to take the Digitalis. It was given, but
afforded no relief.


                               CASE XLV.

_July_ 13th. Mr. S----, Æt. 49. Asthma, or rather hydrothorax,
anasarca, and symptoms of a diseased liver. He was directed to take
two grains of Pulv. fol. Digital. every two hours, until it produced
some effect. It soon removed the dropsical and asthmatic affections,
and steel, with Seltzer water, restored him to health.


                              CASE XLVI.

_August_ 6th. Mr. L----, Æt. 35. Ascites and anasarca. Pulv. Digital.
grains three, repeated every fourth hour, until he had taken two
scruples, removed every appearance of dropsy in a few days. He was
then directed to take solution of merc. sublimat. and soon recovered
his health and strength.


                              CASE XLVII.

_August_ 16th. Mr. G----, of W----, Æt. 86. Asthma of many years
duration, and lately an incipient anasarca, with a paucity of urine.
He had never lived intemperately, was of a chearful disposition, and
very sensible: for some years back had lost all relish for animal
food, and his only support had been an ounce or two of bread and
cheese, or a small slice of seed-cake, with three or four pints of
mild ale, in the twenty-four hours. After trying chrystals of tartar,
fixed alkaly, squills, &c. I directed three grains of Pulv. fol.
Digital. made into pills, with G. ammoniac, to be given every six
hours; this presently occasioned copious discharges of urine, removed
his swellings, and restored him to his usual standard of health.


                             CASE XLVIII.

_August_ 17th. T---- B----, Esq. of K----, Æt. 46. Jaundice, dropsy,
and great hardness in the region of the liver. Infusion of Digitalis
carried off all the effusion, and afterwards a course of deobstruent
and tonic medicines removed his other complaints.


                              CASE XLIX.

_August_ 23d. Mr. C----, Æt. 58. (The person mentioned at Case XXIII.)
He had continued free from dropsy until within the last six weeks; his
appetite was now totally gone, his strength extremely reduced, and the
yellow of his jaundice changed to a blackish hue. The Digitalis was
now tried in vain, and he died shortly afterwards.


                                CASE L.

_August_ 24th. Mrs. W----, Æt. 39. Anasarcous legs and symptoms of
hydrothorax, consequent to a tertian ague. Three grains of Pulv.
Digitalis, given every fourth hour, occasioned a very copious flow of
urine, and she got well without any other medicine.


                               CASE LI.

_August_ 28th. Mr. J---- H----, Æt. 27. In consequence of very free
living, had an ascites and swelled legs. I ordered him to take two
grains of Fol. Digital. pulv. every two hours, until it produced some
effect; a few doses caused a plentiful secretion of urine, but no
sickness, or purging: in six days the swellings disappeared, and he
has since remained in good health.


                               CASE LII.

_September_ 27th. Mr. S----, Æt. 45. Had been long in an ill state of
health, from what had been supposed an irregular gout, was greatly
emaciated, had a sallow complexion, no appetite, costive bowels, quick
and feeble pulse. The cause of his complaints was involved in
obscurity; but I suspected the poison of lead, and was strengthened in
this suspicion, upon finding his wife had likewise ill health, and, at
times, severe attacks of colic; but the answers to my enquiries seemed
to prove my suspicions fruitless, and, amongst other things, I was
told the pump was of wood. He had lately suffered extremely from
difficult breathing, which I thought owing to anasarcous lungs; there
was also a slight degree of pale swelling in his legs. Pulv. fol.
Digital. made into pills, with gum ammoniac and aromatic species, soon
relieved his breathing. Attempts were then made to assist him in other
respects, but with little good effect, and some months afterwards he
died, with every appearance of a worn out constitution.

About two years after this gentleman's death, I was talking to a
pump-maker, who, in the course of conversation, mentioned the
corrosion of leaden pumps, by some of the water in this town, and
instanced that at the house of Mr. S----, which he had replaced with a
wooden one about three years before. The lead, he said, was eaten
away, so as to be very thin in some places, and full of holes in
others;--this accidental information explained the mystery.

The deleterious effects of lead seem to be considerably modified by
the constitution of the patient; for in some families only one or two
individuals shall suffer from it, whilst the rest receive it with
impunity. In the spring of the year 1776, I was desired to visit Mrs.
H----, of S---- Park, who had repeatedly been attacked with painful
colics, and had suffered much from insuperable costiveness; I
suspected lead to be the cause of her complaints, but was unable to
trace by what means it was taken. She was relieved by the usual
methods; but, a few months afterwards, I was desired to see her again:
her sufferings were the same as before, and notwithstanding every
precaution to guard against costiveness, she was never in perfect
health, and seldom escaped severe attacks twice or thrice in a year;
she had also frequent pains in her joints. I could not find any traces
of similar complaints either in Mr. H----, the children, or the
servants. Mrs. H----was a water drinker, and seldom tasted any
fermented liquor. The pump was of wood, as I had been informed upon my
first visit. Her health continued nearly in the same state for two or
three years more, but she always found herself better if she left her
own house for any length of time. At length it occurred to me, that
though the pump was a wooden one, the piston might work in lead. I
therefore ordered the pump rods to be drawn up, and upon examination
with a magnifying glass, found the leather of the piston covered with
an infinite number of very minute shining particles of lead. Perhaps
in this instance the metal was so minutely divided by abrasion, as to
be mechanically suspended in the water. The lady was directed to drink
the water of a spring, and never to swallow that from the pump. The
event confirmed my suspicions, for she gradually recovered a good
state of health, lost the obstinate costiveness, and has never to this
day had any attack of the colic.


                              CASE LIII.

_September_ 28th. Mrs. J----, Æt. 70. Ascites and very thick
anasarcous legs and thighs, total loss of strength and appetite.
Infusion of Digitalis was given, but, as had been prognosticated, with
no good effect.


                               CASE LIV.

_September_ 30th. Mr. A----, Æt. 57. A strong man; hydrothorax and
swelled legs; in other respects not unhealthful. He was directed to
take two grains of the Pulv. fol. Digit. made into a pill with gum
ammoniac. Forty grains thus taken at intervals, effected a cure by
increasing the quantity of urine, and he has had no relapse.


                               CASE LV.

_November_ 2d. Mr. P---- of T----, Æt. 42. A very strong man, drank a
great quantity of strong ale, and was much exposed to alterations of
heat and cold. About the end of summer found himself short winded, and
lost his appetite. The dyspnœa gradually increased, he got a most
distressing sense of tightness across his stomach, his urine was
little, and high coloured, and his legs began to swell; his pulse
slender and feeble. From the 20th of _September_ I frequently saw him,
and observed a gradual and regular increase of all his complaints,
notwithstanding the use of the most powerful medicines I could
prescribe. He took chrystals of tartar, seneka, gum ammoniac, saline
draughts, emetics, tinct. of cantharides, spirits of nitre dulcified,
squills in all forms, volatile alkaly, calomel, Dover's powder, &c.
Blisters and drastic purgatives were tried, interposing salt of steel
and gentian. I had all along felt a reluctance to prescribe the
Digitalis in this case, from a persuasion that it would not succeed.
At length I was compelled to it, and directed one grain to be given
every two hours until it should excite nausea. This it did; but, as I
expected, it did no more. The reason of this belief will be mentioned
hereafter. Five days after this last trial I gave him assafetida in
large quantity, flattered by a hope that his extreme sufferings from
the state of his respiration, might perhaps arise in part from spasm,
but my hopes were in vain. I now thought of using an infusion of
tobacco, and prescribed the following:

    R. Fol. Nicotian. incis. ʒii.
    Aq. bull. ℔ss.
    Sp. Vini rectif. ℥i digere per horam.

I directed a spoonful of this to be given every two hours until it
should vomit. This medicine had no better effect than the former ones,
and he died some days afterwards.


                               CASE LVI.

_November_ 6th. Mr. H----, Æt. 47. In the last stage of a phthisis
pulmonalis, suffered much from dyspnœa, and anasarca. Squill
medicines gave no relief. Digitalis in pills, with gum ammon. purged
him, but opium being added, that effect ceased, and he continued to be
relieved by them as long as he lived.


                              CASE LVII.

_November_ 16th. Mrs. F----, Æt. 53. In _August_ last was suddenly
seized with epileptic fits, which continued to recur at uncertain
intervals. Her belly had long been larger than natural, but without
any perceptible fluctuation. Her legs and thighs swelled very
considerably the beginning of this month, and now there was evidently
water in the abdomen. The medicines hitherto in vain directed against
the epileptic attacks, were now suspended, and two grains of the Pulv.
fol. Digital. directed to be taken every six hours. The effects were
most favourable, and the dropsical symptoms were soon removed by
copious urinary discharges.

The attacks of epilepsy ceased soon afterwards. In _February_, 1781,
there was some return of the swellings, which were soon removed, and
she now enjoys very good health. Does not the narrative of this case
throw light upon the nature of the epilepsy which sometimes attacks
women, soon after the cessation of the menstrual flux?


                                 1781.

                              CASE LVIII.

_January_ 1st. Mrs. G----, of H----, Æt. 62. Ascites and very large
hard legs. After trying various medicines, under the direction of a
very able physician, I ordered her to take one grain of Pulv.
Digital. every six hours, but it produced no effect. Other Medicines
were then tried to as little purpose. About the end of _February_, I
directed an infusion of the Fol. Digital. but with no better success.
Other methods were thought of, but none proved efficacious, and she
died a few weeks afterwards.


                               CASE LIX.

_January_ 3d. Mrs. B----, Æt. 53. Ascites, anasarca, and jaundice.
After a purge of calomel and jallap, was ordered the Infusion of
Digitalis: it acted kindly as a diuretic, and greatly reduced her
swellings. Other medicines were then administered, with a view to her
other complaints, but to no purpose, and she died about a month
afterwards.


                               CASE LX.

_January_ 14th. Mr. B----, of D----. Jaundice and ascites, the
consequences of great intemperance. Extremely emaciated; his tongue
and fauces covered with apthous crusts, and his appetite gone. He
first took tincture of cantharides with infusum amarum, then vitriolic
salts, and various other medicines without relief; Infusum Digitalis
was given afterwards, but was equally unsuccessful.


                               CASE LXI.

_February_ 2d. I was desired by the late learned and ingenious Dr.
Groome, to visit Miss S----, a young lady in the last state of
emaciation from a dropsy. Every probable means to relieve her had been
attempted by Dr. Groome, but to no purpose; and she had undergone the
operation of the paracentesis repeatedly. The Doctor knew, he said,
that I had cured many cases of dropsy, by the Digitalis, after other
more usual methods had been attempted without success, and he wished
this lady to try that medicine under my direction; after examining the
patient, and enquiring into the history of the disease, I was
satisfied that the dropsy was encysted, and that no medicine could
avail. The Digitalis, however, was directed, and she took it, but
without advantage. She had determined not to be tapped again, and
neither persuasion, nor distress from the distension, could prevail
upon her: I at length proposed to make an opening into the sac, by
means of a caustic, which was done under the judicious management of
Mr. Wainwright, surgeon, at Dudley. The water was evacuated without
any accident, and the patient afterwards let it out herself from time
to time as the pressure of it became troublesome, until she died at
length perfectly exhausted.

_Query._ Is there not a probability that this method, assisted by
bandage, might be used so as to effect a cure, in the earlier stages
of ovarium dropsy?


                              CASE LXII.

_February_ 27th. Mrs. O----, of T----, Æt. 52, with a constitution
worn out by various complicated disorders, at length became
dropsical. The Digitalis was given in small doses, in hopes of
temporary benefit, and it did not fail to fulfil our expectations.


                              CASE LXIII.

_March_ 16th. Mrs. P----, Æt. 47. Great debility, pale countenance,
loss of appetite, legs swelled, urine in small quantity. A dram of
Fol. siccat. Digital. in a half pint infusion was ordered, and an
ounce of this infusion directed to be taken every morning. Myrrh and
steel were given at intervals. Her urine soon increased, and the
symptoms of dropsy disappeared.


                              CASE LXIV.

_March_ 18th. Mr. W----, in the last stage of a pulmonary consumption
became dropsical. The Digitalis was given, but without any good
effect.


                               CASE LXV.

_April_ 6th. Mr. B----, Æt. 63. For some years back had complained of
being asthmatical, and was not without suspicion of diseased viscera.
The last winter he had been mostly confined to his house; became
dropsical, lost his appetite, and his skin and eyes turned yellow. By
the use of medicines of the deobstruent class he became less
discoloured, and the hardness about his stomach seemed to yield; but
the ascites and anasarcous symptoms increased so as to oppress his
breathing exceedingly. Alkaline salts, and other diuretics failing of
their effects, I ordered him to take an infus. of Digitalis. It
operated so powerfully that it became necessary to support him with
cordials and blisters, but it freed him from the dropsy, and his
breath became quite easy. He then took soap, rhubarb, tartar of
vitriol, and steel, and gradually attained a good state of health,
which he still continues to enjoy.


                              CASE LXVI.

_April_ 8th. Mr. B----, Æt. 60. A corpulent man, with a stone in his
bladder, from which at times his sufferings are extreme. He had been
affected with what was supposed to be an asthma, for several years by
fits, but through the last winter his breath had been much worse than
usual; universal anasarca came on, and soon afterwards an ascites. Now
his urine was small in quantity and much saturated, the dysuria was
more dreadful than ever; his breath would not allow him to lie in bed,
nor would the dysuria permit him to sleep; in this distressful
situation, after having used other medicines to little purpose, I
directed an infusion of Digitalis to be given. When the quantity of
urine became more plentiful, the pain from his stone grew easier; in a
few days the dropsy and asthma disappeared, and he soon regained his
usual strength and health. Every year since, there has been a tendency
to a return of these complaints, but he has recourse to the infusion,
and immediately removes them.


                              CASE LXVII.

_April_ 24th. Mr. M----, of C----, Æt. 57. Asthma, anasarca, jaundice,
and great hardness and straitness across the region of the stomach.
After a free exhibition of neutral draughts, alkaline salt, &c. the
dropsy and difficult breathing remaining the same, he took Infusum
Digitalis, which removed those complaints. He never lost the hardness
about his stomach, but enjoyed very tolerable health for three years
afterwards, without any return of the dropsy.


                             CASE LXVIII.

_April_ 25th. Mrs. J----, Æt. 42. Phthisis pulmonalis and anasarcous
legs and thighs. She took the Infusum Digitalis without effect. Myrrh
and steel, with fixed alkaly, were then ordered, but to no purpose.


                              CASE LXIX.

_May_ 1st. Master W----, of St----, Æt. 6. I found him with every
symptom of hydrocephalus internus. As it was yet early in the disease,
in consequence of ideas which will be mentioned hereafter, I directed
six ounces of blood to be immediately taken from the arm; the temporal
artery to be opened the succeeding day; the head to be shaven, and six
pints of cold water to be poured upon it every fourth hour, and two
scruples of strong mercurial ointment to be rubbed into the legs
every day. Five days afterwards, finding the febrile symptoms very
much abated, and judging the remaining disease to be the effect of
effusion, I directed a scruple of Fol. Digital. siccat. to be infused
in three ounces of water, and a table spoonful of the infusion to be
given every third or fourth hour, until its action should be someway
sensible. The effect was, an increased secretion of urine; and the
patient soon recovered.


                               CASE LXX.

_May_ 3d. Mrs. B----, Æt. 59. Ascites and anasarca, with strong
symptoms of diseased viscera. Infusum Digitalis was at first
prescribed, and presently removed the dropsy. She was then put upon
saline draughts and calomel. After some time she became feverish: the
fever proved intermittent, and was cured by the bark.


                              CASE LXXI.

_May_ 3d. Mr. S----, Æt. 48. A strong man, who had lived
intemperately. For some time past his breath had been very short, his
legs swollen towards evening, and his urine small in quantity. Eight
ounces of the Infus. Digitalis caused a considerable flow of urine;
his complaints gradually vanished, and did not return.


                              CASE LXXII.

_May_ 24th. Joseph B----, Æt. 50. Ascites, anasarca, and jaundice,
from intemperate living. Infusion of Digitalis produced nausea, and
lowered the frequency of the pulse; but had no other sensible effects.
His disorder continued to increase, and killed him about two months
afterwards.


                             CASE LXXIII.

_June_ 29th. Mr. B----, Æt. 60. A hard drinker; afflicted with asthma,
jaundice, and dropsy. His appetite gone; his water foul and in small
quantity. Neutral saline mixture, chrystals of tartar, vinum
chalybeat. and other medicines had been prescribed to little
advantage. Infusion of Fol. Digitalis acted powerfully as a diuretic,
and removed the most urgent of his complaints, viz. the dropsical and
asthmatical symptoms.

The following winter his breathing grew bad again, his appetite
totally failed, and he died, but without any return of the ascites.


                              CASE LXXIV.

_June_ 29th. Mr. A----, Æt. 58. Kept a public house and drank very
hard. He had symptoms of diseased viscera, jaundice, ascites, and
anasarca. After taking various deobstruents and diuretics, to no
purpose, he was ordered the Infusion of Digitalis: a few doses
occasioned a plentiful flow of urine, relieved his breath, and reduced
his swellings; but, on account of his great weakness, it was judged
imprudent to urge the medicine to the entire evacuation of the water.
He was so much relieved as to be able to come down stairs and to walk
about, but his want of appetite and jaundice continuing, and his
debility increasing, he died in about two months.


                              CASE LXXV.

_July_ 18th. Mrs. B----, Æt. 46. A little woman, and very much
deformed. Asthmatical for many years. For several months past had been
worse than usual; appetite totally gone, legs swollen, sense of great
fulness about her stomach, countenance fallen, lips livid, could not
lie down.

The usual modes of practice failing, the Digitalis was tried, but with
no better success, and in about a month she died; not without
suspicion of her death having been accelerated a few days, by her
taking half a grain of opium. This may be a caution to young
practitioners to be careful how they venture upon even small doses of
opium in such constitutions, however much they may be urged by the
patient to prescribe something that may procure a little rest and
ease.


                              CASE LXXVI.

_August_ 12th. Mr. L----, Æt. 65, the person whose Case is recorded at
No. XXIV, had a return of his insanity, after near two years perfect
health. He was extremely reduced when I saw him, and the medicine
which cured him before was now administered without effect, for his
weakness was such that I did not dare to urge it.


                             CASE LXXVII.

_September_ 10th. Mr. V----, of S----, Æt. 47. A man of strong fibre,
and the remains of a florid complexion. His disease an ascites and
swelled legs, the consequence of a very free course of life; he had
been once tapped, and taken much medicine before I saw him. The
Digitalis was now directed: it lowered his pulse, but did not prove
diuretic. He returned home, and soon after was tapped again, but
survived the operation only a few hours.


                             CASE LXXVIII.

_September_ 25th. Mr. O----, of M----, Æt. 63. Very painful and
general swellings in all his limbs, which had confined him mostly to
his bed since the preceding winter; the swellings were uniform, tense,
and resisting, but the skin not discoloured. After trying guiacum and
Dover's powder without advantage. I directed Infusion of Digitalis. It
acted on the kidneys, but did net relieve him. It is not easy to say
what the disease was, and the patient living at a distance, I never
learnt the future progress or termination of it.


                              CASE LXXIX.

_September_ 26th. Mr. D----, Æt. 42, a very sensible and judicious
surgeon at B----, in Staffordshire, laboured under ascites and very
large anasarcous legs, together with indubitable symptoms of diseased
viscera. Having tried the usual diuretics to no purpose, I directed a
scruple of Fol. Digital siccat. in a four ounce infusion, a table
spoonful to be taken twice a day. The second bottle wholly removed his
dropsy, which never returned.


                              CASE LXXX.

_September_ 27th. Mrs. E----, Æt. 42. A fat sedentary woman; after a
long illness, very indistinctly marked; had symptoms of enlarged liver
and dropsy. In this case I was happy in the assistance of Dr. Ash.
Digitalis was once exhibited in small doses, but to no better purpose
than many other medicines. She suffered great pain in the abdomen for
several weeks, and after her death, the liver, spleen, and kidneys
were found of a pale colour, and very greatly enlarged, but the
quantity of effused fluid in the cavity was not more than a pint.


                              CASE LXXXI.

_October_ 28th. Mr. B----, Æt. 33. Had drank an immense quantity of
mild ale, and was now become dropsical. He was a lusty man, of a pale
complexion: his belly large, and his legs and thighs swollen to an
enormous size. I directed the Infusion of Digitalis, which in ten days
completely emptied him. He was then put upon the use of steel and
bitters, and directed to live temperately, which I believe he did, for
I saw him two years afterwards in perfect health.


                             CASE LXXXII.

_November_ 14th. Mr. W----, of T----, Æt. 49. A lusty man, with an
asthma and anasarca. He had taken several medicines by the direction
of a very judicious apothecary, but not getting relief as he had been
accustomed to do in former years, he came under my direction. For the
space of a month I tried to relieve him by fixed alkaly, seneka,
Dover's powder, gum ammoniac, squill, &c. but without effect. I then
directed Infusion of Digitalis, which soon increased the flow of urine
without exciting nausea, and in a few days removed all his
complaints.


                                 1782.

                             CASE LXXXIII.

_January_ 23d. Mr. Q----, Æt. 74. A stone in his bladder for many
years; dropsical for the last three months. Had taken at different
times soap with squill and gum ammoniac; soap lees; chrystals of
tartar, oil of juniper, seneka, jallap, &c. but the dropsical symptoms
still increased, and the dysuria from the stone became very urgent. I
now directed a dram of the Fol. Digit. siccat. in a half pint
infusion, half an ounce to be given every six hours. This presently
relieved the dysuria, and soon removed the dropsy, without any
disturbance to his system.


                             CASE LXXXIV.

_January_ 27th. Mr. D----, Æt. 86. The debility of age and dropsical
legs had long oppressed him. A few weeks before his death his
breathing became very short, he could not lie down in bed, and his
urine was small in quantity. A wine glass of a weak Infusion of
Digitalis, warmed with aromatics, was ordered to be taken twice a day.
It afforded a temporary relief, but he did not long survive.


                              CASE LXXXV.

_January_ 28th. Mr. D----, Æt. 35. A publican and a hard drinker.
Ascites, anasarca, diseased viscera, and slight attacks of hæmoptoe.
A dram of Fol. Digital. sicc. in a half pint infusion, of which one
ounce was given night and morning, proved diuretic and removed his
dropsy. He then took medicines calculated to relieve his other
complaints. The dropsy did not return during my attendance upon him,
which was three or four weeks. A quack then undertook to cure him with
blue vitriol vomits, but as I am informed, he presently sunk under
that rough treatment.


                             CASE LXXXVI.

_January_ 29th. Mrs. O----, of D----, Æt. 53. A constant and
distressing palpitation of her heart, with great debility. From a
degree of anasarca in her legs I was led to suspect effusion in the
Pericardium, and therefore directed Digitalis, but it produced no
benefit. She then took various other medicines with the same want of
success, and about ten months afterwards died suddenly.


                             CASE LXXXVII.

_January_ 31st. Mr. T----, of A----, Æt. 81. Great difficulty of
breathing, so that he had not lain in bed for the last six weeks, and
some swelling in his legs. These complaints were subsequent to a very
severe cold, and he had still a troublesome cough. He told me that at
his age he did not look for a cure, but should be glad of relief, if
it could be obtained without taking much medicine. I directed an
Infusion of Digitalis, a dram to eight ounces, one spoonful to be
taken every morning, and two at night. He only took this quantity; for
in four days he could lie down, and soon afterwards quitted his
chamber. In a month he had a return of his complaints, and was
relieved as before.


                            CASE LXXXVIII.

_January_ 31st. Mrs. J----, of S----, Æt. 67. A lusty woman, of a
florid complexion, large belly, and very thick legs. She had been kept
alive for some years by the discharge from ulcers in her legs; but the
sores now put on a very disagreeable livid appearance, her belly grew
still larger, her breath short, her pulse feeble, and she could not
take nourishment. Several medicines having been given in vain, the
Digitalis was tried, but with no better effect; and in about a month
she died.


                             CASE LXXXIX.

_February_ 2d. Mr. B----, Æt. 73. An universal dropsy. He took various
medicines, and Digitalis in small doses, but without any good effect.


                               CASE XC.

_February_ 24th. Master M----, of W----, Æt. 10. An epilepsy of some
years continuance, which had never been interrupted by any of the
various methods tried for his relief. The Digitalis was given for a
few days, but as he lived at a distance, so that I could not attend to
its effects, he only took one half pint infusion, which made no
alteration in his complaint.


                               CASE XCI.

_March_ 6th. Mr. H----, Æt. 62. A very hard drinker, and had twice had
attacks of apoplexy. He had now an ascites, was anasarcous, and had
every appearance of a diseased liver. Small doses of calomel, Dover's
powder, infusum amarum, and sal sodæ palliated his symptoms for a
while; these failing; blisters, squills, and cordials were given
without effect. A weak Infusion of Digitalis, well aromatised, was
then directed to be given in small doses. It rather seemed to check
than to increase the secretion of urine, and soon produced sickness.
Failing in its usual effect, the medicine was no longer continued; but
every thing that was tried proved equally inefficacious, and he did
not long survive.


                              CASE XCII.

_May_ 10th. Mrs. P----, Æt. 40. Spasmodic asthma of many years
continuance, which had frequently been relieved by ammoniacum,
squills, &c. but these now failing in their wonted effects, an Infus.
of Fol. Digitalis was tried, but it seemed rather to increase than
relieve her symptoms.


                              CASE XCIII.

_May_ 22d. Mr. O----, of B----, Æt. 61. A very large man, and a free
liver; after an attack of hemiplegia early in the spring, from which
he only partially recovered, became dropsical. The dropsy occupied
both legs and thighs, and the arm of the affected side. I directed an
Infusion of Digitalis in small doses, so as not to affect his stomach.
The swellings gradually subsided, and in the course of the summer he
recovered perfectly from the palsy.


                              CASE XCIV.

_July_ 5th. Mr. C----, of W----, Æt. 28. Had drank very freely both of
ale and spirits; and in consequence had an ascites, very large legs,
and great fulness about the stomach. He was ordered to take the
Infusion of Digitalis night and morning for a few days, and then to
keep his bowels open with chrystals of tartar. The first half pint of
infusion relieved him greatly; after an interval of a fortnight it was
repeated, and he got well without any other medicine, only continuing
the chrystals of tartar occasionally. I forgot to mention that this
gentleman, before I saw him, had been for two months under the care of
a very celebrated physician, by whose direction he had taken
mercurials, bitters, squills, alkaline salts, and other things, but
without much advantage.


                               CASE XCV.

_March_ 6th. Mrs. W----, Æt. 36. In the last stage of a pulmonary
consumption, took the Infus. Digitalis, but without any advantage.


                              CASE XCVI.

_August_ 20th. Mr. P----, Æt. 43. In the year 1781 he had a severe
peripneumony, from which he recovered with difficulty. At the date of
this, when he first consulted me, the symptoms of hydrothorax were
pretty obvious. I directed a purge, and then the Infusum Digitalis,
three drams to half a pint, one ounce to be taken every four hours. It
made him sick, and occasioned a copious discharge of urine. His
complaints immediately vanished, and he remains in perfect health.


                              CASE XCVII.

_September_ 24th. Mrs. R----, of B----, Æt. 35, the mother of many
children. After her last lying in, three months ago, had that kind of
swelling in one of her legs which is mentioned at No. VIII. XXVI, and
XXXI. A considerable degree of swelling still remained; the limb was
heavy to her feeling, and not devoid of pain. I directed a bolus of
five grains of Pulv. Digitalis, and twenty-five of crude quicksilver
rubbed down, with conserve of cynosbat. to be taken at bed-time, and
afterwards an Infusion of red bark and Fol. Digitalis to be taken
twice a day. There was half an ounce of bark and half a dram of the
leaves in a pint infusion: the dose two ounces.

The leg soon began to mend, and two pints of the infusion finished the
cure.


                             CASE XCVIII.

_September_ 25th. Mr. R----, Æt. 60. Complained to me of a sickness
after eating, and for some weeks past he had thrown up all his food,
soon after he had swallowed it. He had taken various medicines, but
found benefit from none, and had tried various kinds of diet. He was
now very thin and weak; but had a good appetite. As several very
probable methods had been prescribed, and as the usual symptoms of
organic disease were absent, I determined to give him a spoonful of
the Infusion of Digitalis twice a day; made by digesting two drams of
the dried leaves in half a pint of cinnamon water. From the time he
began to take this medicine he suffered no return of his complaint,
and soon recovered his flesh and his strength.

It should be observed, that I had frequently seen the Digitalis remove
sickness, though prescribed for very different complaints.


                              CASE XCIX.

_September_ 30th. Mrs. A----, Æt. 38. Hydrothorax and anasarca. Her
chest was very considerably deformed. One half pint of the Digitalis
Infusion entirely cured her.


                                CASE C.

_September_ 30th. Mr. R----, of W----, Æt. 47. Hydrothorax and
anasarca. An Infusion of Digitalis was directed, and after the
expected effects from that should take place, sixty drops of tincture
of cantharides twice a day. As he was costive, pills of aloes and
steel were ordered to be taken occasionally.

This plan succeeded perfectly. About a month afterwards he had some
rheumatic affections, which were removed by guiacum.


                               CASE CI.

_October_ 2d. Mrs. R----, Æt. 60. Diseased viscera; ascites and
anasarca. Had taken various deobstruent and diuretic medicines to
little purpose. The Digitalis brought on a nausea and languor, but had
no effect on the kidneys.


                               CASE CII.

_October_ 12th. Mr. R----, Æt. 41. A publican, and a hard drinker. His
legs and belly greatly swollen; appetite gone, countenance yellow,
breath very short, and cough troublesome. After a vomit I gave him
calomel, saline draughts, steel and bitters, &c. He had taken the more
usual diuretics before I saw him. As the dropsical symptoms increased,
I changed his medicines for pills made of soap, containing two grains
of Pulv. fol. Digital, in each dose, and, as he was costive, two
grains of jallap. He took them twice a day, and in a week was free
from every appearance of dropsy. The jaundice soon afterwards
vanished, and tonics restored him to perfect health.


                              CASE CIII.

_October_ 12th. Mr. B----, Æt. 39. Kept a public house, drank very
freely, and became dropsical; he complained also of rheumatic pains. I
directed Infusion of Digitalis, half an ounce twice a day. In eight
days the swellings in his legs and the fulness about his stomach
disappeared. His rheumatic affections were cured by the usual methods.


                               CASE CIV.

_October_ 22d. Master B----, Æt. 3. Ascites and universal anasarca.
Half a grain of Fol. Digital. siccat. given every six hours, produced
no effect; probably the medicine was wasted in giving. An infusion of
the dried leaf was then tried, a dram to four ounces, two tea
spoonfuls for a dose; this soon increased the flow of urine to a very
great degree, and he got perfectly well.


                               CASE CV.

_October_ 30th. Mr. G----, of W----, Æt. 88. The gentleman mentioned
in No. XLVII. His complaints and manner of living the same as there
mentioned. I ordered an Infusion of the Digitalis, a dram and half to
half a pint; one ounce to be taken twice a day; which cured him in a
short time.

On _March_ the 23d, 1784, he sent for me again. His complaints were
the same, but he was much more feeble. On this account I directed a
dram of the Fol. Digitalis to be infused for a night in four ounces of
spirituous cinnamon water, a spoonful to be taken every night. This
had not a sufficient effect; therefore, on the 22d of _April_, I
ordered the infusion prescribed two years before, which soon removed
his complaints.

He died soon afterwards, fairly worn out, in his ninetieth year.


                               CASE CVI.

_November_ 2d. Mr. S----, of B----h----, Æt. 61. Hydrothorax and
swelled legs. Squills were given for a week in very full doses, and
other modes of relief attempted; but his breathing became so bad, his
countenance so livid, his pulse so feeble, and his extremities so
cold, that I was apprehensive upon my second visit that he had not
twenty-four hours to live. In this situation I gave him the Infusum
Digitalis stronger than usual, viz. two drams to eight ounces. Finding
himself relieved by this, he continued to take it, contrary to the
directions given, after the diuretic effects had appeared.

The sickness which followed was truly alarming; it continued at
intervals for many days, his pulse sunk down to forty in a minute,
every object appeared green to his eyes, and between the exertions of
reaching he lay in a state approaching to syncope. The strongest
cordials, volatiles, and repeated blisters barely supported him. At
length, however, he did begin to emerge out of the extreme danger into
which his folly had plunged him; and by generous living and tonics, in
about two months he came to enjoy a perfect state of health.


                              CASE CVII.

_November_ 19th. Master S----, Æt. 8. Ascites and anasarca. A dram of
Fol. Digitalis in a six ounce infusion, given in doses of a spoonful,
effected a perfect cure, without producing nausea.


                                 1783.

The reader will perhaps remark, that from the middle of _January_ to
the first of _May_, not a single case occurs, and that the amount of
cases is likewise less than in the preceding or ensuing years; to
prevent erroneous conjectures or conclusions, it may be expedient to
mention, that the ill state of my own health obliged me to retire from
business for some time in the spring of the year, and that I did not
perfectly recover until the following summer.


                              CASE CVIII.

_January_ 15th. Mrs. G----, Æt. 57. A very fat woman; has been
dropsical since _November_ last; with symptoms of diseased viscera.
Various remedies having been taken without effect, an Infusion of
Digitalis was directed twice a day, with a view to palliate the more
urgent symptoms. She took it four days without relief, and as her
recovery seemed impossible it was urged no farther.


                               CASE CIX.

_May_ 1st. Mrs. D----, Æt. 72. A thin woman, with very large
anasarcous legs and thighs; no appetite and general debility. After a
month's trial of cordials and diuretics of different kinds, the
surgeon who had scarified her legs apprehended they would mortify; she
had very great pain in them, they were very red and black by places,
and extremely tense. It was evident that unless the tension could be
removed, gangrene must soon ensue. I therefore gave her Infusum
Digitalis, which increased the secretion of urine by the following
evening, so that the great tension began to abate, and together with
it the pain and inflammation. She was so feeble that I dared not to
urge the medicine further, but she occasionally took it at intervals
until the time of her death, which happened a few weeks afterwards.


                               CASE CX.

_May_ 18th. I was desired to prescribe for Mary Bowen, a poor girl at
Hagley. Her disease appeared to me to be an ovarium dropsy. In other
respects she was in perfect health. I directed the Digitalis to be
given, and gradually pushed so as to affect her very considerably. It
was done; but the patient still carries her big belly, and is
otherwise very well.


                               CASE CXI.

_May_ 25th. Mr. G----, Æt. 28. In the last stage of a pulmonary
consumption of the scrophulous kind, took an Infusion of Digitalis,
but without any advantage.


                              CASE CXII.

_May_ 31st. Mr. H----, Æt 27. In the last stage of a phthisis
pulmonalis became dropsical. He took half a pint of the Infusum
Digitalis in six days, but without any sensible effect.


                              CASE CXIII.

_June_ 3d. Master B----, of D----, Æt. 6. With an universal anasarca,
had an extremely troublesome cough. An opiate was given to quiet the
cough at night, and 2 tea spoonfuls of Infus. Digit. were ordered
every six hours. The dropsy was presently removed; but the cough
continued, his flesh wasted, his strength failed, and some weeks
afterwards he died tabid.


                              CASE CXIV.

_June_ 19th. Mrs. L----, Æt. 28. A dropsy in the last stage of a
phthisis. Infusum Digitalis was tried to no purpose.


                               CASE CXV.

_June_ 20th. Mrs. H----, Æt. 46. A very fat, short woman; had suffered
severely through the last winter and spring from what had been called
asthma; but for some time past an universal anasarca prevailed, and
she had not lain down for several weeks. After trying vitriolic acid,
tincture of cantharides, squills, &c. without advantage, she took half
a pint of Infus. Digitalis in three days. In a week afterwards the
dropsical symptoms disappeared, her breath became easy, her appetite
returned, and she recovered perfect health. The infusion neither
occasioned sickness nor purging.


                              CASE CXVI.

_June_ 24th. Mrs. B----, Æt. 40. A puerperal fever, and swelled legs
and thighs. The fever not yielding to the usual practice, I directed
an Infusion of Fol. Digitalis. It proved diuretic; the swellings
subsided, but the fever continued, and a few days afterwards a
diarrhœa coming on, she died.


                              CASE CXVII.

_July_ 22d. Mr. F----, Æt. 48. A strong man, of a florid complexion,
in consequence of intemperance became dropsical, with symptoms of
diseased viscera, great dyspnœa, a very troublesome cough, and
total loss of appetite. He took mild mercurials, pills of soap,
rhubarb, and tartar of vitriol, with soluble tartar and dulcified
spirits of nitre in barley water. After a reasonable trial of this
plan, he took squill every six hours, and a solution of assafetida and
gum ammoniac, to ease his breathing: finding no relief, I gave him
chrystals of tartar with ginger; but his remaining health and strength
daily declined, and he was not at all benefited by the medicines. I
was averse to the use of Digitalis in this case, judging from what I
had seen in similar instances of tense fibre, that it would not act as
a diuretic. I therefore once more directed squill, with decoction of
seneka and sal sodæ; but it was inefficacious. His strength being much
broken down, I then ordered gum ammoniac, with small doses of opium,
and infusum amarum, continuing the squill at intervals. At length I
was urged to give the Digitalis, and considering the case as
desperate, I agreed to do it. The event was as I expected; no increase
in the urine took place; and the medicine being still continued, his
pulse became slow, and he apparently sunk under its sedative effects.
He was neither purged nor vomited; and had the Digitalis either been
omitted altogether, or suspended upon its first effects upon the
pulse being observed, he might perhaps have existed a week longer.


                             CASE CXVIII.

_July_ 26th. Mr. W----, of W----, Æt. 47. Phthisis pulmonalis,
jaundice, ascites, and swelled legs. As it was probable that the only
relief I could give in a case so circumstanced, would be by carrying
off the effused fluids. I tried squill and fixed alkaly; and these
failing, I ordered the Infusum Digitalis. This had the desired effect,
and, I believe, prolonged his life a few weeks.


                              CASE CXIX.

_August_ 15th. Mrs. C----, Æt. 60. Ascites, anasarca, diseased
viscera, paucity of urine, and total loss of appetite. These
complaints had heretofore existed repeatedly, and had been removed by
deobstruent and diuretic medicines; but in this attack the symptoms
were suffered to exist a longer time and in a greater degree, before
assistance was sought for. The remedies that used to relieve her were
now exhibited to no purpose. Mild mercurials, soap, rhubarb, and
squill were tried; but she grew rapidly worse. Saline draughts with
acetum scilliticum seemed for a few days to check the progress of her
complaint, but they soon lost their effect, and diarrhœa ensued
upon every attempt to increase the frequency of the dose. Draughts
with Infus. Digital. were then directed to be taken twice a day. The
effect was a powerful action on the kidneys, and a reduction of the
swellings, but without sickness. A degree of appetite returned, but
still the tendency to diarrhœa existed, and kept her weak. Tonic
medicines were then tried, but without advantage, and in a month it
was necessary to have recourse to the Digitalis again. It was directed
in a half pint mixture; an ounce to be taken thrice in twenty-four
hours. On the 2d day, finding her symptoms very much relieved, she
took in the absence of her nurse, nearly a double dose of the
medicine. The consequence was great sickness, languor continuing for
several days, and almost a total stop to the secretion of urine, from
the time the sickness commenced.

The case now became totally unmanageable in my hands, and, after a
fortnight, I was dismissed, and another physician called in; but she
did not long survive.

This was not the first, nor the last instance, in which I have seen
too large a dose of the medicine, defeat the very purpose for which it
was directed.


                               CASE CXX.

_August_ 22d. Mrs. S----, Æt. 36. Extreme faintiness; anasarcous legs
and thighs; great difficulty of breathing, troublesome cough, frequent
chilly fits succeeded by hot ones; night sweats, and a tendency to
diarrhœa. Apprehensive that the more urgent symptoms were caused
by water in the lungs, I directed an Infusion of Digitalis, with an
ounce of diacodium to the half pint to prevent it purging, a wine
glass full to be taken every night at bed-time, and a mixture with
confect. cardiac. and pulv. ipecac. to be given in small doses after
every loose stool.

On the fourth day she was better in all respects; had made a large
quantity of water and did not purge. In a few days more she lost all
her complaints, except the cough, which gradually left her, without
any further assistance.

I was agreeably deceived in the event of this case, for I expected
after the water was removed, to have had a phthisis to contend with.


                              CASE CXXI.

_August_ 25th. T---- W----, Esq; Æt, 50. A free liver, diseased
viscera, belly very tense, and much swollen; fluctuation perceptible,
but the swelling circumscribed; pulse 132. This gentleman was under
the care of my very worthy friend Dr. Ash, who, having tried various
modes of cure to no purpose, asked me if I thought the Digitalis would
answer in this case. I replied that it would not, for I had never seen
it effectual where the swelling appeared very tense and circumscribed.
It was tried however, but did not lessen the swelling. I mention this
case, to introduce the above remark, and also to point out the great
effect the Digitalis has upon the action of the heart; for the pulse
came down to 96. He was afterwards tapped, and continued, for some
time under our joint attendance, but the pulse never became quicker,
nor did the swelling return.


                              CASE CXXII.

_September_ 7th. Mr. L----, Æt. 43. After several severe attacks of
ill formed gout, attended for some time past with jaundice and other
symptoms of diseased viscera, the consequences of intemperate living,
was sent to Buxton; from whence he returned in three weeks with
ascites and anasarca. Under this complicated load of disease, I
prescribed repeatedly without advantage, and at length gave him the
Digitalis, which carried off the more obvious symptoms of dropsy; but
the jaundice, loss of appetite, diseased viscera, &c. rendered his
recovery impossible.


                                 1784.

                             CASE CXXIII.

_February_ 12th. Mrs. C----, Æt. 54. A strong short woman of a florid
complexion; complained of great fullness across the region of the
stomach; short breath, a troublesome cough, loss of appetite, paucity
of urine; and had a brownish yellow tinge on her skin and in her eyes.
She dated these complaints from a fall she had through a trap door
about the beginning of winter. From the beginning of January to this
time, she had been repeatedly let blood, had taken calomel purges
with jallap; pills of soap, rhubarb and calomel; saline julep with
acet. scillit. nitrous decoction, garlic, mercury rubbed down, infus.
amarum purg. &c. After the failure of medicines so powerful, and
seemingly so well adapted, and during the use of which all the
symptoms continued to increase, it was evident that a favourable event
could not be expected. However, I tried the infusum Digitalis, but it
did nothing. I then gave her pills of quicksilver, soap and squill,
with decoction of dandelion, and after some time, chrystals of tartar
with ginger. Nothing succeeded to our wishes, and the increase of
orthopnœa compelled me occasionally to relieve her by drastic
purges, but these diminished her strength, more in proportion than
they relieved her symptoms. Tincture of cantharides, sal diureticus
and various other means were occasionally tried, but with very little
effect, and she died towards the end of March.


                              CASE CXXIV.

_March_ 31st. Miss W----, Æt. 60. Had been subject to peripneumonic
affections in the winter. She had now total loss of appetite, very
great debility, difficult breathing; much cough, a considerable degree
of expectoration, and a paucity of urine. She had been blooded, taken
soap, assaf. and squill, afterwards assaf. and ammon. with acet.
scillit.: but all her complaints increasing, a blister was applied to
her back, and the Digitalis infusion directed to be taken every night.
The effect was an increased secretion of urine, a considerable relief
to her breath, and some return of appetite; but soon afterwards she
became hectic, spat purulent matter, and died in a few weeks.


                              CASE CXXV.

_April_ 12th. Mrs. H----, of L----, Æt. 61. In _December_ last this
Lady, then upon a visit in London, was attacked with severe symptoms
of peripneumony. She was treated as an asthmatic patient, but finding
no relief, she made an effort to return to her home to die. In her way
through this place, the latter end of December, I was desired to see
her. By repeated bleedings, blisters, and other usual methods, she was
so far relieved, that she wished to remain under my care. After a
while she began to spit matter and became hectic. With great
difficulty she was kept alive during the discharge of the abscess, and
about the end of March she had swelled legs, and unequivocal symptoms
of dropsy in the chest. Other diuretics failing, on the 12th of April
I was induced to give her the Digitalis in small doses. The relief was
great and effectual. After an interval of fifteen days, some swellings
still remaining in the legs, I repeated the medicine, and with such
good effect, that she lost all her complaints, got a keen appetite,
recovered her strength, and about the end of May undertook a journey
of fifty miles to her own home, where she still remains in perfect
health.


                              CASE CXXVI.

_April_ 17th. Mr. F----, Æt. 59. A very fat man, and a free liver; had
long been subject to what was called asthma, particularly in the
winter. For some weeks past his legs swelled, he had great sense of
fullness across his stomach; a severe cough; total loss of appetite,
thirst great, urine sparing, his breath so difficult that he had not
lain down in bed for several nights. Calomel, gum ammoniac, tincture
of cantharides, &c. having been given in vain, I ordered two grains of
pulv. fol. Digitalis made into pills, with aromatic species and syrup,
to be given every night. On the third day his urine was less turbid;
on the fourth considerably increased in quantity, and in ten days more
he was free from all complaints, and has since had no relapse.


                             CASE CXXVII.

_May_ 7th. Miss K----, Æt. 8. After a long continued ague, became
hectic and dropsical. Her belly was very large, and she had a total
loss of appetite. Half a grain of fol. Digital, pulv. with 2 gr. of
merc. alcalis. were ordered night and morning, and an infusion of bark
and rhubarb with steel wine to be given in the day time. Her belly
began to subside in a few days, and she was soon restored to health.
Two other children in the family, affected nearly in the same way, had
died, from the parents being persuaded that an ague in the spring was
healthful and should not be stopped.--I know not how far the recovery
in this case may be attributed to the Digitalis, but the child was so
near dying that I dared not trust to any less efficacious diuretic.


                             CASE CXXVIII.

_June_ 13th. Mr. C----, Æt. 45. A fat man, had formerly drank hard,
but not latterly: last March began to complain of difficult breathing,
swelled legs, full belly, but without fluctuation, great thirst, no
appetite; urine thick and foul; complection brownish yellow. Mercurial
medicines, diuretics of different kinds, and bitters, had been trying
for the last three months, but with little advantage. I directed two
grains of the fol. Digital. in powder to be taken every night, and
infus. amar. with tinct. sacr. twice a day. In three days the quantity
of his urine increased, in ten or twelve days all his symptoms
disappeared, and he has had no relapse.


                              CASE CXXIX.

_June_ 17th. Mr. N----, of W----, Æt. 54. A large man, of a pale
complexion; had been subject to severe fits of asthma for some years,
but now worse than usual. The intermitting pulse, the great
disturbance from change of posture, and the swelled legs induced me to
conclude that the exacerbation of his old complaint was occasioned by
serous effusion. I directed pills with a grain and half of the pulv.
Digital. to be taken every night, and as he was costive, jallap made a
part of the composition. He was also directed to take mustardseed
every morning and a solution of assafetida twice in the day. The
effect of this plan was perfectly to our wishes, and in a short time
he recovered his usual health. About half a year afterwards he died
apoplectic.


                              CASE CXXX.

_Mary_ B----. A young unmarried woman. Her disease appeared to me a
dropsy of the right ovarium. She took an infusion of Digitalis, but,
as I expected with no good effect. She is still, I am informed nearly
in the same state.


                              CASE CXXXI.

_July_ 12th. Mrs. A----, of C----, Æt. 56. After a series of
indispositions for several years, became dropsical; and had long been
confined to her chamber, unable to lie down or to walk. She was so
feeble, her legs so much swelled, her breath so short, and the
symptoms of diseased viscera so strong, that I dared not to entertain
hopes of a cure; but wishing to relieve her more urgent symptoms,
directed quicksilver rubbed down and fol. Digital. pulv. to be made
into pills: the dose, containing two grains of the latter, to be given
night and morning. She was also ordered to take a draught with a dram
of æther twice a day, and to have scapulary issues. Her breath was so
much relieved, that she was able soon afterwards to come down stairs;
but her constitution was too much broken to admit of a recovery.


                             CASE CXXXII.

_July_ 16th. Mr. B----, of W----, Æt. 31. After a tertian ague of 12
months continuation, suffered great indisposition for 10 months more.
He chiefly complained of great straitness and pain in the
hypochondriac region, very short breath, swelled legs, want of
appetite. He had been under the care of some very sensible
practitioners, but his complaints increased, and he determined to come
to Birmingham. I found him supported upright in his chair, by pillows,
every attempt to lean back or stoop forward giving him the sensation
of instantaneous suffocation. He said he had not been in bed for many
weeks. His countenance was sunk and pale; his lips livid; his belly,
thighs and legs very greatly swollen; hands and feet cold, the nails
almost black, pulse 160 tremulous beats in a minute, but the pulsation
in the carolid arteries was such as to be visible to the eye, and to
shake his head so that he could not hold it still. His thirst was very
great, his urine small in quantity, and he was disposed to purge. I
immediately ordered a spoonful of the infusum Digitalis every six
hours, with a small quantity of laudanum, to prevent its running off
by stool, and decoction of leontodon taraxacum to allay his thirst.
The next day he began to make water freely, and could allow of being
put into bed, but was raised high with pillows. Omit the infusion.
That night he parted with six quarts of water, and the next night
could lie down and slept comfortably. _July_ 21st. he took a mild
mercurial bolus. On the 25th. the diuretic effects of the Digitalis
having nearly ceased, he was ordered to take three grains of the pulv.
Digital. night and morning, for five days, and a draught with half an
ounce of vin. chalyb. twice a day. _August_ 15th. He took a purge of
calomel and jallap, and some swelling still remaining in his legs, the
Digitalis infusion was repeated. The water having been thus entirely
evacuated, he was ordered saline draughts with acetum scilliticum and
pills of salt of steel and extract of gentian. About a month after
this, he returned home perfectly well.


                             CASE CXXXIII.

_July_ 28th. Mr. A---- of W----, Æt. 29, became dropsical towards the
close of a pulmonary consumption. He was ordered 12 grains of pulv.
fol. cicutæ and 1 of Digitalis twice a day. No remarkable effect took
place.


                             CASE CXXXIV.

_July_ 31. Mr. M----, Æt 37. Hydrothorax. A single grain of fol.
Digital. pulv. taken every night for three weeks cured him. The
medicine never made him sick, but increased his urine, which became
clear; whereas before it had been high coloured and turbid.


                              CASE CXXXV.

_August_ 6th. Mr. C---- of B----, Æt. 42. Asthma and anasarca, the
consequence of free living. He had been for some time under the care
of an eminent physician of this place, but his complaints proving
unusually obstinate, he consulted me. I directed an infusion of
Digitalis to be taken every night, and a mixture with squill and
tincture of cantharides twice every day. In about a week he became
better, and continued daily mending. He has since enjoyed perfect
health, having quitted a line of business which exposed him to drink
too much.


                             CASE CXXXVI.

_August_ 6th. Mr. M---- of C----, Æt. 44. Ascites and anasarca,
preceded by symptoms of the epileptic kind. He was ordered to take two
grains of pulv. Digitalis every morning, and three every night;
likewise a saline draught with syrup of squills, every day at noon.
His complaints soon yielded to this treatment, but in the month of
November following he relapsed, and again asked my advice. The
Digitalis alone was now prescribed, which proved as efficacious as in
the first trial. He then took bitters twice a day, and vitriolic acid
night and morning, and now enjoys good health.

Before the Digitalis was prescribed, he had taken jallap purges,
soluble tartar, salt of steel, vitriol of copper, &c.


                             CASE CXXXVII.

_August_ 10th. Mrs. W----, Æt. 55. An anasarcous leg, and sciatica;
full habit. After bleeding and a purge, a blister was applied in the
manner recommended by Cotunnius; and two grains of fol. Digital. with
fifteen of fol. cicutæ were directed to be taken night and morning.
The medicine acted only as a diuretic; the pain and swelling of the
limb gradually abated; and I have not heard of any return.

I must here bear witness to the efficacy of Cotunnius's method of
blistering in the sciatica, having used it in a great number of cases,
and generally with success.


                            CASE CXXXVIII.

_August_ 16th. Mrs. A---- of S----, Æt. 78. About the middle of Summer
began to complain of short breath, great debility, and loss of
appetite. At this time there were evident marks of effusion in the
thorax, and some swelling in the legs. The advanced age, the weakness,
and other circumstances of this patient, precluded every idea of her
recovery; but something was to be attempted. Squills and other
remedies had been tried; I therefore directed pills with two or three
grains of the pulv. Digitalis to be taken every night for six nights,
and a saline draught with forty drops of acetum scillit. twice in the
day. She took but few of the draughts, seldom more than half one at a
time, for they purged her, and she disliked them. The pills she took
regularly, and with the happiest effect, for she could lie down, her
breath was very much relieved, and a degree of appetite returned.
_Sept._ 4th, some return of her symptoms demanded the further use of
diuretics. I was afraid to push the Digitalis in so hazardous a
subject, and therefore directed tinct. amara with tinct. canthar. and
pills of squill, seneka, salt of tartar and gum ammoniac. These
medicines did not at all check the progress of the disease, and on the
26th it became necessary to give the Digitalis again. The pills were
therefore repeated as before, and infus. amarum with fixed alkaly
ordered to be taken twice a day. The event was as favorable as before;
and from this time she had no considerable return of dropsy, but
languished under various nameless symptoms, until the middle or end of
November.


                             CASE CXXXIX.

_Aug._ 16th. Mrs. P---- of S----, Æt. 50. For a particular account of
this patient, see Mr. Yonge's second Case.


                               CASE CXL.

_Sept._ 20th. B---- B----, Esq. A true spasmodic asthma of many years
continuance. After every method of relief had failed; both under my
management, and also under the direction of several of the ablest
physicians of this kingdom; I was induced to give him an infusion of
the Digitalis. It was continued until nausea came on, but procured no
relief.


                              CASE CXLI.

_October_ 5th. Mr. R----, Æt. 43. _(The patient mentioned at No.
102.)_ He had pursued his former mode of life, and had now a return of
his complaints, with evident marks of diseased viscera. His belly not
very large, but uncommonly tense. From this circumstance I did not
expect the Digitalis to succeed, and therefore tried for some time to
relieve him by the saline julep, with acet. scillitic. jallap,
mercury, syrup of squill, with aq. cinnam. decoction of Dandelion,
&c.; but these being administered without advantage, I was driven to
the Digitalis. As he was very weak and much emaciated, I only gave two
grains night and morning for five days. As no increase of urine took
place, I used alkaline salt with tinct. cantharides:--This proving
equally unsuccessful, on the 18th, I directed two ounces of the
infusum Digitalis night and morning. This was continued until nausea
took place, but the kidney secretion was not increased. Squill with
opium, deobstruents of different kinds, sublimate solution, fixed
alkaly, tobacco infusion, were now successively tried, but with the
same want of success. The fullness of his belly made it necessary to
tap him, and by repeating this operation he continued alive to the end
of the year.


                              CASE CXLII.

_October_ 19th. Mrs. R----, of B----, Æt. 47. Supposed Asthma, of
eighteen months duration. She had kept her room for four months, and
could not lie down without great disturbance; was very thin, and had
totally lost all inclination for food. She was directed to take two
gr. of pulv. fol. Digital. night and morning for five days, and
infusum amarum, at the hours of eleven and five. In the course of a
week she was much relieved, and could remain in bed all night. After a
few days interval she took the Digitalis for five days more, and was
soon after that well enough to come down stairs and conduct her family
affairs.

In _April_ 1785, she had a slight return, but not such as to confine
her to her chamber. She experienced the same relief from the same
medicine, but continuing it for seven days without interruption, it
excited nausea.


                             CASE CXLIII.

_October_ 28th. Mr. A----, subject to nephritis calculosa: After an
attack of that kind, had still a troublesome sense of weight about his
loins, now and then rising to pain, and a degree of dysuria, together
with a want of appetite. These symptoms not readily yielding to the
usual methods of treatment, I directed an infusion of Digitalis. The
fourth dose caused a copious flow of urine; the sixth made him sick,
and he was more or less sick at times for three days; but felt no more
of his complaints.

I don't believe it is at all necessary to bring on sickness in these
cases, but an unexpected absence from town prevented me from seeing
him time enough to stop the exhibition of the medicine.


                              CASE CXLIV.

_October_ 31st. Mrs. C----, of W----, Æt. 67. Asthma, and very thick
hard legs of long continuance. The last month or two her breath worse
than usual, her belly swollen, her thighs anasarcous, and her urine in
small quantity. After trying garlic, squill, and purgatives without
advantage, I directed the Digital. Infus. After taking about five
ounces, her urine from thick and turbid, changed to clear and amber
coloured, its quantity considerably increased, and her breathing easy.
Contrary to my orders, but impelled by the relief she had found, she
finished the remaining three ounces of the infusion, which made her
very sick, and the free flow of urine immediately ceased. No medicine
was administered for a fortnight, during which time her complaints
increased. I then directed an infusion of tobacco, which affected her
head, but did not increase her urine. She had recourse again to the
Digitalis infusion, which once more removed the fulness of the belly,
reduced the swellings of her thighs, and relieved her breath, but had
no effect upon her legs.


                              CASE CXLV.

_Nov._ 2d. Miss B---- of C----, Æt. 22. A very evident fluctuation in
the abdomen, which was considerably distended, whilst the rest of her
frame was greatly emaciated. The presence of cough, hectic fever, and
other circumstances, made it probable that this apparent ascites was
caused by a purulent, and not a watery effusion. However it was
possible I might be mistaken; the Digitalis was therefore given, but
without any advantage.

The further progress of the disease confirmed my first opinion, and
she died consumptive.


                              CASE CXLVI.

_Nov._ 4th. Mr. P---- of M----, Æt. 40. Subject to troublesome
nephritic complaints, and after the last attack did not recover, or
void the gravelly concretions as usual, a sense of weight across his
loins continuing very troublesome. The usual medicines failing to
relieve him, I ordered four grains of pulv. Digital. to be taken every
other night for a week, and fifteen grains of mild fixed vegetable
alkaly to be swallowed twice a day in barley water. He soon lost all
his complaints; but we must not in this case too hastily attribute the
cure to the Digitalis, as the alkaly has also been found a very useful
medicine in similar disorders.


                             CASE CXLVII.

_Nov._ 4th. Mr. B---- of N----, Æt. 60. Had been much subject to gout,
but his constitution being at length unable to form regular fits, he
became dropsical. Pulv. fol. Digital. in doses of two or three grains,
at bed-time, gave him some relief, but did not perfectly empty him.
About three months afterwards he had occasion to take it again; but it
then produced no effect, and he was so debilitated that it was not
urged further.


                             CASE CXLVIII.

_Nov._ 8th. Mr. G----, Æt. 35. In the last stage of a phthisis
pulmonalis, was attacked with a most urgent and painful difficulty of
breathing. Suspecting this distress might arise from watery effusion
in the chest, I gave him Digitalis, which relieved him considerably;
and during the remainder of his life his breath never became so bad
again.


                              CASE CXLIX.

_Nov._ 13th. Mrs. A---- of W----h----, Æt. 68. One of those rare cases
in which no urine is secreted. It proved as refractory as usual to
remedies, and not having ever succeeded in the cure of this disease, I
determined to try the Digitalis. It was given in infusion, and, after
a few doses, the secretion of a small quantity of urine seemed to
justify the attempt. The next day, however, the secretion ceased, nor
could it be excited again, tho' at last the medicine was pushed so as
to occasion sickness, which continued at intervals for three days.


                               CASE CL.

_Nov._ 20th. Mrs. B----, Æt. 28. In the last stage of a pulmonary
consumption became dropsical. I directed three grains of the pulv.
Digital. to be taken daily, one in the morning, and two at night. She
took twenty grains without any sensible effect.


                               CASE CLI.

_Nov._ 23d. Master W----, Æt. 7. Supposed hydrocephalus internus. A
grain of pulv. fol. Digitalis was directed night and morning. After
three days, no sensible effects taking place, it was omitted, and the
mercurial plan of treatment adopted. The child lived near five months
afterwards. Upon dissection near four ounces of water were found in
the ventricles of the brain.


                              CASE CLII.

_Nov._ 26th. Mrs. W----, Æt. 65. I had attended this lady last winter
in a very severe peripneumony, from which she narrowly escaped with
her life. When the cold season advanced this winter, she perceived a
difficulty in breathing, which gradually became more and more
troublesome. I found her much harassed by a cough, which occasioned
her to expectorate a little: the least motion increased her
dyspnœa; she could not lie down in bed; her legs were considerably
swelled, her urine small in quantity. I directed two grains of pulv.
Digitalis made into a pill with gum ammoniac, to be taken every night,
and to promote expectoration, a squill mixture twice in the day. Her
urine in five days became clear and copious, and in a fortnight more
she lost all her complaints, except a cough, for which she took the
lac ammoniacum.

It is not improbable that the squill might have some share in this
cure.


                              CASE CLIII.

_December_ 7th. Mr. H----, Æt. 42. A large sat man, very subject to
gravelly complaints. After an attack in the usual manner, continued to
feel numbness in his lower limbs, and a sense of weight across his
loins. I directed infusum Digitalis to be given every six hours. Six
ounces made him sick, and he took no more. The next day his urine
increased, a good deal of sand passed with it, and he lost his
disagreeable feels, but the sickness did not entirely cease before the
fourth day from its commencement.


                              CASE CLIV.

_December_ 27th. Mr. B----, of H----, Æt. 55. Symptoms of hydrothorax,
at first obscurely, afterwards more distinctly marked. Many things
were tried, but the squill alone gave relief. At length this failed.
About the third month of the disease, a grain of pulv. Digital. was
ordered to be taken night and morning. This produced the happiest
effects. In _March_ following he had some slight symptoms of relapse,
which were soon removed by the same medicine, and he now enjoys good
health. For a more particular narrative see case the first,
communicated by Mr. Yonge.


                               CASE CLV.

_December_ 31st. Mrs. B----, of E----, Æt. 50. An ovarium dropsy of
long continuance. She took three grains of pulv. Digital. every night
at bed time, for a fortnight, but without any effect.


                              CASE CLVI.

A poor man in this town, after his kidneys had ceased to secrete urine
for several days, was seized with hickup, fits of vomiting, and
transient delirium. After examination I was satisfied the disease was
the same as that mentioned at CXLIX. A very experienced apothecary
having tried various methods to relieve him, I despaired of any
success, but determined to try the Digitalis. It was accordingly
given in infusion. At first it checked the vomitings, but did not
occasion any secretion of urine.


                                 1785.

The cases which have occurred to me in the course of this year, are
numerous; but as the events of some of them are not yet sufficiently
ascertained, I think it better to with-hold them at present.



                            HOSPITAL CASES,
                  Under the Direction of the Author.


The four following cases were drawn out at my request by Mr. Cha.
Hinchley, late apothecary to the Birmingham Hospital. They are all the
Hospital cases for which the Digitalis was prescribed by me, whilst he
continued in that office.


                              CASE CLVII.

_March_ 15th, 1780. John Butler, Æt. 30. Asthma and swelled legs. He
was directed to take myrrh and steel every day, and three spoonfuls of
infusum Digitalis every night. On the 8th of April he was discharged,
cured of the swellings and something relieved of his asthmatic
affections.


                             CASE CLVIII.

_November_ 18th, 1780. Henry Warren, Æt. 60. This man had a general
anasarca and ascites, and was moreover so asthmatic, that, neither
being able to sit in a chair nor lie in bed, he was obliged constantly
to walk about, or to lean forward against a window or table. You
prescribed for him thus.

    R. Aq. cinn. spt. ℥iv.
    Oxymel. scillit.
    Syr. scillit. aa. ℥i. m. cap. cochlear. larg. sexta quaque
    horâ.

This medicine producing no increased discharge of urine, on the 25th
you ordered the infusion of Digitalis, two spoonfuls every four hours.
After taking this for thirty six hours, his urine was discharged in
very great quantity; his breath became easy, and the swellings
disappeared in a few days, though he took no more of the medicine. On
the 2d of _December_ he was ordered myrrh and lac ammoniacum, which he
continued until the 23d, when he was discharged cured, and is now in
good health.


                              CASE CLIX.

_November_ 3d, 1781. Mary Crockett, Æt. 40. Ascites and universal
anasarca. For one week she took sal. diureticus and tincture of
cantharides, but without advantage. On the 10th you directed the
infusion of Digitalis, a dram and half to half a pint, an ounce to be
taken every fourth hour. Before this quantity was quite finished, the
urine began to be discharged very copiously. The medicine was then
stopped as you had directed. On the 15th, being costive, she took a
jallap purge, and on the 24th she was discharged cured.


                               CASE CLX.

_March_ 16th, 1782. Mary Bird, Æt. 61. Great fullness about the
stomach; diseased liver, and anasarcous legs and thighs. For the
first week squill was tried in more forms than one, but without
advantage. On the 22d she began with the Digitalis, which presently
removed all the swelling.

She was then put upon the use of aperient medicines and tonics, and on
the first of _August_ was discharged perfectly cured.

       *       *       *       *       *

    The three following Cases were drawn up and communicated to
    me by Mr. Bayley, who succeeded Mr. Hinchley as apothecary to
    the Hospital at Birmingham:


                                    Shiffnall, April 26th, 1785.
    DEAR SIR,

During my residence in the Birmingham General Hospital, I had frequent
opportunities of seeing the great effects of the Digitalis in dropsy.
As the exhibition of it was in the following instances immediately
under your own direction, I have drawn them up for your inspection,
previous to your publishing upon that excellent diuretic. Of its
efficacy in dropsy I have considerable evidence in my possession, but
consider myself not at liberty to send you any other cases except
those you had yourself the conduct of. The Digitalis is a very
valuable acquisition to medicine; and, I trust, it will cease to be
dreaded when it is well understood.

                                     I am, Sir, your obedient,
                                        And very humble servant,
                                                      W. BAYLEY.


                              CASE CLXI.

Mary Hollis, aged 62, was admitted an out patient of the Birmingham
General Hospital _February_ 12th, 1784, labouring under all the
effects of hydrothorax; her dread of suffocation during sleep was so
great, that she always reposed in an elbow chair. She was directed to
take two grains of Digitalis in powder every night and morning, and
for a few days found great relief; but, on the eighth day, as she had
complained of sickness, and had been considerably purged, she was
ordered to desist taking any more of her powders. On the 14th day she
was ordered an ounce of the following infusion twice in a day: R. Fol.
Digital. purp. sicc. ʒiss. aq. bullient. ℔ss. digere per semi-horam,
colaturæ adde tinct. aromatic ℥i. This infusion did not purge, but
sometimes excited nausea, though not sufficient to prevent her from
continuing its use. She grew gradually better, and on the 6th of _May_
was discharged perfectly cured. The diuretic effects of the Digitalis
were in this instance immediate.


                              CASE CLXII.

Edward James, Æt. 21. Admitted _March_ 20th, 1784. Complained of great
difficulty of breathing, pain in his head, and tightness about the
stomach, with a trifling swelling of his legs. Ordered pil. scillit.
℈i. ter de die. On the third day his legs much more swelled, his
breathing more difficult, and in every respect worse; his pulse very
small and quick, complained when he turned in bed, of something like
water rolling from one side of the thorax to the other. A remarkable
blueness about the mouth and eyes, and purged considerably from the
pil. scill. Ordered to omit the pills and to take ℥i. of infus.
Digitalis every eight hours; the proportion ʒiss. to eight ounces of
water and ℥i. of aq. n. m. sp.--7th Day, The infusion had neither
purged, nor vomited him: he only complained once or twice of
giddiness. His belly was now very hard, rather black on the right side
the navel, and his legs amazingly swelled. Ordered a bolus with
rhubarb and calomel, to be taken in the morning, and ℥ii. julep salin.
cum tinct. canthar. gutt. forty ter die.--12th Day, nearly in the same
state, except his breathing which was somewhat more difficult, being
now obliged to have his head considerably raised. Persistat--From this
day to the 32d day he became hourly worse. His belly which at first
was only hard, now evidently contained a large quantity of water, his
legs were more swelled, and a large sphacelated sore appeared upon
each outer ancle. Respiration was so much obstructed, that he was
obliged to sit quite upright to prevent suffocation. He made very
little water, not more than eight ounces in a day and a night, and was
much emaciated. Ordered his purging bolus again, and ℥ii. of a mixture
with sal diuretic, ℥ss. to ℥xii. three times in a day, and a poultice
with ale grounds to his legs.

54th day. To this period there was not the least probability of his
existing; his legs and thighs were one continued blubber, his thorax
quite flat, and his belly so large that it measured within one inch as
much as a woman's in this Hospital the day she was tapped, and from
whom twenty seven pounds of coagulable lymph were taken. He made about
three ounces of water in twenty-four hours: his penis and scrotum were
astonishingly swelled, and no discharge from the sores upon his legs.
Ordered to take a pill with two grains of powdered Foxglove night and
morning. For a few days no sensible effect, but about the 60th day he
complained of being continually giddy, and had some little pain in his
stomach. He now made much more water, and dared to sleep. His appetite
which through the whole of his illness had been very bad, was also
better. 66th day. Breathing very much relieved, the quantity of water
he made was three chamber pots full in a day and a night, each pot
containing two quarts and four ounces, moderately full. Ordered to
continue his pills, and his legs which were very flabby, to be rolled.

69th day. His belly nearly reduced to its natural size, still made a
prodigious quantity of water, his appetite very good, habit of body
rather lax, and his complexion ruddy. On the 2d of _June_, being still
rather weak, he was ordered decoct. cort. ℥ii. ter de die; and on the
12th was discharged from this Hospital perfectly cured.

                                                      W. BAYLEY.


     Mr. Bayley's respectful compliments to Doctor Withering: he
     sends the case of Edward James, which he believes is pretty
     correct. He laments not having it in his power to send the
     measure of his belly, having unfortunately, mislaid the
     tape: he heard from James yesterday, and he is perfectly
     well.

     _General Hospital, August 5, 1784._


                             CASE CLXIII.

On the 26th _February_, 1785, Sarah Ford, aged 42, was admitted an
out-patient of the Birmingham General Hospital: she complained of
considerable pain in her chest, and great difficulty of breathing, her
face was much swelled and her thighs and legs were anasarcous. She had
extreme difficulty in making water, and with many painful efforts she
did not void more than six ounces in twenty-four hours. She had been
in this situation about six weeks, during which time she had taken
ammoniacum, olibanum, and large quantities of squills, without any
other effect than frequent sickness. Upon her commencing an Hospital
patient, the following medicine was exhibited. R. gum ammoniac ʒii.
pulv. fol. Digital. purp. ℈ii. sp. lavand. comp. ut fiat pil. 40. cap.
ii. nocte maneque. She continued the use of these pills for a few
days, without any sensible effect. On the eighth day her breathing was
much relieved, her legs and thighs were not so much swelled, and in a
day and a night she made five pints of water. By the 12th day her
legs and thighs were nearly reduced to their natural size. She
continued to make water in large quantities, and had lost her pain in
the thorax. To the 20th of _March_, she made rapid advances towards
health, when not a symptom of disease remaining, she was discharged.



                  COMMUNICATIONS FROM CORRESPONDENTS.


                                       London, Norfolk-street,
                                                 May 31st, 1785.

SIR,

I had the favour of your letter last week; and I shall be very happy
if I can give you any intelligence relating to the Foxglove, that can
answer the purpose in which you are so laudably engaged.

It is true that my brother, the late Dr. Cawley, was greatly relieved,
and his life, perhaps, prolonged for a year, by a decoction of the
Foxglove root; but why it had not a more lasting effect, it is
necessary I should tell you that he had all the signs of a distempered
viscera, long before any watery swellings appeared; it was manifest
that his dropsy was merely symptomatic, and he could therefore only
from time to time have any relief from medicine. In the year 1776, he
returned from London to Oxon. having consulted several physicians at
the former place, and Dr. Vivian at the latter, but without any
success; and he was then told of a carpenter at Oxon. that had been
cured of a Hydrops pectoris by the Foxglove root, and as he was a
younger, and in other respects an healthy man, his cure, I believe,
remains a perfect one.

I did not attend my brother whilst he took the medicine, and therefore
I cannot speak precisely to the operation of it; but I remember, by
his letters, that he was dreadfully sick and ill for several days
before the secretion of urine came on, but which it did do to a great
degree; relieved his breath, and greatly lessened the swelling in his
legs and thighs; but the two instances I have lately seen in this part
of the world, are much stronger proofs of the efficacy of it than my
brother's case.

                                               I am, &c.
                                                  ROBERT CAWLEY.

N. B. Whenever I have another opportunity of giving the Foxglove, it
shall be in small doses:--In which I should hope it might succeed,
although it might be more slowly. If you should try it with success, I
should be glad to know what mode you made use of.


                      Dr. Cawley's prescription.

    R. Rad. Digital. purpur. siccat. et contus. ℥ii.

    Coque ex aq. font. ℔ii. ad ℔i. colat. liquor. adde aq. junip.
    comp. ℥ii.

    Mell. anglic ℥i. m. sumat cochl. iv. omni nocte h. s. et
    mane.

--I have elsewhere remarked, that when the Digitalis has been properly
given, and the diuretic effects produced, that an accidental over-dose
bringing on sickness, has stopped the secretion of urine. In the
present instance it likewise appears, that violent sickness may be
excited, and continue for several days without being accompanied by a
flow of urine; and it is probable that the latter circumstance did not
take place, until the severity of the former abated. If Dr. Cawley had
not had a constitution very retentive of life, I think he must have
died from the enormous doses he took; and he probably would have died
previous to the augmentation of the urinary discharge. For if the root
from which his medicine was prepared, was gathered in its active
state, he did not take at each dose less than _twelve_ times the
quantity a strong man ought to have taken. Shall we wonder then that
patients refuse to repeat such a medicine, and that practitioners
tremble to prescribe it? Were any of the active and powerful medicines
in daily use to be given in doses _twelve_ times greater than they
are, and these doses to be repeated without attention to the effects,
would not the patients die, and the medicines be condemned as
dangerous and deleterious?--Yet such has been the fate of Foxglove!


     A Letter to the Author, from Mr. BODEN, Surgeon, at Broseley,
                            in Shropshire.

                                       Broseley, 25th May, 1785.
     Dear SIR,

Have inclosed the prescriptions that contained the fol. Digital. which
I gave to Thomas Cooke and Thomas Roberts.

Thomas Cooke, Æt. 49, had been ill about two or three weeks. When I
saw him he had no appetite, and a constant thirst: a fullness and load
in the stomach: the thighs, legs and hands, much swell'd, and the face
and throat in a morning; was costive, and made but little water, which
was high coloured; the pulse very weak, and his breath exceeding bad.
_June_ 17th. R. Argent, viv ʒi. cons. cynosbat. ℈ii. fol. Digital.
pulv. gr. xv. f. pil. xxiv. capt. ii. omni nocte horâ decubitus. He
was likewise purged by a bolus of argent. viv. jallap, Digit.
elaterium and calomel, which was repeated on the fourth day, to the
third time. From _June_ 17th to the 29th, the symptoms were mostly
removed, making water freely, and having plenty of stools; in a week
after he was perfectly well, and remains so ever since. The cure was
finished by steel and bitters.

Thomas Roberts, Æt. 40, had a deformed chest, was obliged to be almost
in an erect posture when in bed; the other symptoms were nearly the
same as Cooke's. _August_ 3d. The pills prescribed _June_ 17th for
Cooke.--17th. A purging bolus of jalap and Digitalis, once a week. He
continued the medicines till the latter end of _August_, when he got
very well; but the complaint returned in _Jan._ worse than before. He
is now much better, but I have great reason to believe the liver to be
diseased.

                            I am, with the greatest respect,

                             Your very obliged humble servant,

                                                   DANIEL BODEN.

P. S. The second patient, on his relapse, took Digitalis again,
combined with other things.



       CASE communicated by Mr. CAUSER, Surgeon, at Stourbridge,
                            Worcestershire.


Mr. P---- of H---- M----, in the parish of Kingswinford, aged about
60; had been a strong healthy, robust, corpulent man; worked hard
early in life at edge-tool making, and drank freely of strong malt
liquor; for many years had been subject to gout in the extremities;
for a few years past had been very asthmatic, and the gout in the
extremities gradually decreased. When I first saw him, which was
_Sept._ 12, 1779, his legs were anasarcous, his belly much swelled,
and an evident fluctuation of water. His breathing very bad, an
irregular pulse, and unable to lie down. His easiest posture was
standing with his body leaning over a chair, in which situation he
would continue many hours together, labouring for breath, with the
sweat trickling down his face very profusely; the urine in very small
quantity. Diuretics of every kind I could think of were used with very
little or no advantage. Blisters applied to the legs relieved very
considerably for a time, but by no means could I increase the urinary
discharge. Warm stomachic medicines were given, and at the same time
sinapisms applied to the feet, in hopes of enticing gout to the
extremities, but without any good effect.--_November_ 22d. The
swelling considerably increasing, an emetic of acet. scillitic. was
given, which acted very violently, and increased the urinary discharge
considerably. He continued better and worse, using different kinds of
diuretic and expectorating medicines until _September_ 1781, when the
disease was so much worse, I did not expect he could live many days.
The acet. scillitic. was repeated, a table spoonful every half hour,
till it acted briskly upwards and downwards; but without increasing
the urinary discharge.--On the 17th of _September_ I infused ʒiii. of
the fol. Digitalis in ℥vi. of boiling water, for four hours; then
strained it, and added ℥i. of tinct. aromatica.--On the 18th he began
by taking one spoonful, which he was to repeat every half hour, till
it made him very sick, unless giddiness, loss of sight, or any other
disagreeable effect took place. I had never given the medicine before,
and had prepared him to expect the operation to be very severe. I saw
him again on the 21st; he had taken the medicine regularly, till the
whole quantity was consumed, without perceiving the least effect of
any kind from it, and continued well till the evening of the following
day, when a little sickness took place, which increased, but never so
as to occasion either vomiting or purging, but a surprising discharge
of urine. The saliva increased so as to run out of his mouth, and a
watery discharge from his eyes; these discharges continued, with a
continual sickness, till the swelling was totally gone, which happened
in three or four days. He afterwards took steel and bitters; and
continued very comfortably, without any return of his dropsy, until
the 7th of _April_ 1782, when he was seized with an epidemic cough,
which was very frequent with us at that time. His swellings now
returned very rapidly, with the greatest difficulty in breathing, and
he died in a few days. Blisters and expectorating medicines were used
on this last return.


                 Extract of a Letter from Mr. CAUSER.

Mrs. S----, the subject of the following Case, was as ill as it is
possible for woman to be and recover; from the inefficacy of the
medicines used, I am convinced no medicine would have saved her but
the Digitalis. I never saw so bad a case recovered; and it shews, that
in the most reduced state of body, the medicine in small doses, will
prove safe and efficacious.

N. B. The Digitalis, in pills, never occasioned the least sickness.
She took two boxes of them.


                                 CASE.

_January_ 2d, 1785. Mrs. S----, of W----, near Kidderminster, aged 38,
has been affected with dropsical swellings of her legs and thighs,
about six weeks, which have gradually grown worse; has now great
difficulty in breathing, which is much increased on moving; a very
irregular, intermittent pulse, urine in very small quantity, and in
the seventh month of her pregnancy: a woman of very delicate
constitution, with tender lungs from her infancy and very subject to
long continued coughs.

    R. Pulv. scillæ gr. iii.
    Jalap gr. x. syr. rosar. solut. tinct. senn. aa
    ʒii. aq. menth. v. simpl. ℥iss. m. mane sumend.

    R. pulv. scillæ ℈i. G. ammoniac, sapon. venet. aa ʒiss. syr.
    q. s. f. pilul. 42 cap. iii. nocte maneque.

On the 7th found her worse, and the swelling increased; the urine
about ℥x in the twenty-four hours.

    R. Fol. siccat. Digital. ʒiii. coque in. aq. fontan. ℥xii. ad
    ℥vi. cola et adde. aq. juniper. comp. ℥ii. sacchar. alb. ℥ss.
    m. cap. cochlear. i. larg. 4tis horis.

She took about three parts of the medicine before any effect took
place. The first was sickness, succeeded by a considerable discharge
of urine. She continued the medicine till the whole was consumed,
which caused a good deal of sickness for three or four days.

I saw her again on the 12th. The quantity of urine was much increased,
and the swelling diminished. Pulse and breathing better.

    R. Fol. sicc. Digital. G. assafetid. aa ʒi. calomel. pp. gr.
    x. sp. lavand. comp. q. s. fiat pilul. xxxii. cap. ii. omni
    nocte horâ somni.

A plentiful discharge of urine attended the use of these pills, and
she got perfectly free from her dropsical complaints.

_March_ 15th she was delivered: had a good labour, was treated as is
usual, except in not having her breasts drawn, not intending see
should suckle her child, being in so reduced a state. Continued going
on well till the 18th, when she was seized with very violent pains
across her loins, at times so violent as to make her cry out as much
as labour pains. Enema cathartic. Fot. papav. applied to the part.

    R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s. fiat
    pilul. vi. capt. i. 2da quaque horâ durante dolore.

    R. Julep, e camphor, sp. minder. aa ℥ii. capt. cochlear, i.
    larg. post singul. pilul.

19th. Breathing short, unable to lie down, very irregular low pulse
scarcely to be felt, fainty, and a universal cold sweat: no appetite
nor thirst, spasmodic pains at times across the loins very violent,
but not so frequent as on the preceding day.

    R. Gum ammoniac, assafetid. aa ʒi. camphor. gr. xii. fiat
    pilul. 24. capt. ii. 3tia quaque horâ in cochlear. ii.
    mixtur. seq.

    R. Balsam. peruv. ʒiii. mucilag. G. arab. q. s. flor. zinci
    g. vi. aq. menth. simp. ℔ss. m.

    Applic. Emp. vesicat. femorib. internis.

    R. Sp. vol. fœtid. elixir. paregor. balsam. Traumatic. aa
    ʒiii. capt. cochlear. parv. urgente languore.

20th. Much the same; makes very little water, and the legs begin to
swell.--Applic. Emp. e pice burgund. lumbis.

23d. The swelling very much increased.--Capt. gutt. xv. acet.
scillitic. ter die in two spoonfuls of the following mixture.

    R. Infus. baccar. juniper, ℥vi. tinct. amar. tinct.
    stomachic. aa ℥i. m.

25th. Much the same.

28th. The swelling considerably increased, in other respects very much
the same.

30th. Breathing very bad, with cough and pain across the sternum,
unable to lie down, legs, thighs, and body very much swelled, urine
not more than four or five ounces in the twenty-four hours; hot and
feverish, with thirst.

    Applic. Emp. vesicat. stomacho et sterno.

    R. G. assafetid. ℈ii. pulv. jacob. ℈i. rad. scill. recent.
    gr. xii. extract. thebaic. gr. iv. f. pilul. xvi. cap. iv.
    omni nocte.

    R. Sal. nitr. sal. diuretic. aa ʒii. pulv. e contrayerv.
    comp. ʒi. sacchar. ℥i. emuls. commun. ℔i. aq. cinnam. simpl.
    ℥i. m. capt. cochlear. iv. ter die.

_April_ 2d. Much the same, no increase of urine.

3d. Breathing much relieved by the blister, which runs profusely.
Repeated the medicines, and continued them till the

12th. The cough very bad, pulse irregular, swelling much increased,
urine in very small quantity, not at all increased; great lowness and
fainting. She desired to have some of the pills which relieved her so
much when with child. I was almost afraid to give them, but the
inefficacy of the other medicines gave me no hopes of a cure from
continuing them, which made me venture to comply with her request.

    R. Fol. siccat. Digital. G. assafetid. aa ʒi. sp. lavand.
    comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node
    cap. pilul. e styrace gr. vi.

17th. Considerable increase of urine.

21st. Swelling a good deal diminished; urine near four pints in
twenty-four hours, which is more than double the quantity she drinks.

    Applic. Emp. vesicat. femoribus internis.

The Digitalis pills and opiate at bed-time continued. Takes a tea cup
of cold chamomile tea every morning.

25th. Swelling much diminished, makes plenty of water, appetite much
mended, cough and breathing better. She omitted the medicine for three
days; the urine began to diminish, the swelling and shortness of
breathing worse. On repeating it for two days, the discharge was again
augmented, and a diminution of the swelling succeeded. She has
continued the pills ever since till the 14th of _May_; the dropsical
symptoms and cough are entirely gone, the water is in sufficient
quantity, her strength is recovered, and she has a good appetite. All
she now complains of is a weight across her stomach, which is worse at
times, and she thinks, unless it can be removed, she shall have a
return of her dropsy.


                Extract of a Letter from Doctor FOWLER,
                        Physician, at Stafford.

I understand you are going to publish on the Digitalis, which I am
glad to hear, for I have long wished to see your ideas in print about
it, and I know of no one (from the great attention you have paid to
the subject) qualified to treat on it but yourself. There are
gentlemen of the faculty who give verbal directions to poor patients,
for the preparing and taking of an infusion or decoction of the green
plant. Would one suppose that such gentlemen had ever attended to the
nature and operation of a sedative power on the functions,
_particularly_ the _vital_? Is not such a vague and unscientific mode
of proceeding putting a two edged sword into the the hands of the
ignorant, and the most likely method to damn the reputation of any
very active and powerful medicine? And is it not more than probable
that the _neglect_ of adhereing to a _certain_ and _regular_
preparation of the nicotiana, and the _want_ (of what you
_emphatically_ call) a _practicable_ dose, have been the chief causes
of the once rising reputation of that noted plant being damned above
a century ago? In short, the Digitalis is beginning to be used in
dropsies, (although some patients are said to go off suddenly under
its administration) somewhat in the style of broom ashes; and, in my
humble opinion, the public, at this very instant, stand in great need
of your _precepts_, _guards_, and _cautions_ towards the safe and
successful use of such a powerful sedative diuretic; and I have no
doubt of your minute attention to those particulars, from a regard to
the good and welfare of mankind, as well as to your own reputation
with respect to that medicine.

I remember an officer in the Staffordshire militia, who died here of a
dropsy five years ago. The Digitalis relieved him a number of times in
a wonderful manner, so that in all probability he might have obtained
a radical cure, if he would have refrained from hard drinking. I
understood it was first ordered for him by a medical gentleman, and
its sedative effects proved so mild, and diuretic operation so
powerful, that he used to prepare it afterwards for himself, and would
take it with as little ceremony as he would his tea. It is said, that
he was so certain of its successful operation, that he would boast to
his bacchanalian companions, when much swelled, you shall see me in
two days time quite another man.


                  CASES communicated by Mr. J. FREER,
                     jun. Surgeon, in Birmingham.


                                CASE I.

_Nov._ 1780. Mary Terry, aged 60. Had been subject to asthma for
several years; after a severe fit of it her legs began to swell, and
the quantity of urine to diminish. In six weeks she was much troubled
with the swellings in her thighs and abdomen, which decreased very
little when she lay down: she made not quite a pint of water in the
twenty-four hours. I ordered her to take two spoonfuls of the infusion
of Foxglove every three hours. By the time she had taken eight doses
her urine had increased to the quantity of two quarts in the day and
night, but as she complained of nausea, and had once vomited, I
ordered the use of the medicine to be suspended for two days. The
nausea being then removed, she again had recourse to it, but at
intervals of six hours. The urine continued to discharge freely, and
in three weeks she was perfectly cured of her swellings.


                               CASE II.

_December_, 1782. A poor woman, who had been afflicted with an ague
during the whole of her pregnancy, and for two months with dropsical
swellings of the feet, legs, thighs, abdomen, and labia pudenda; was
at the expiration of the seventh month taken in labour. On the day
after her delivery the ague returned, with so much violence as to
endanger her life. As soon as the fit left her, I began to give her
the red bark in substance, which had the desired effect of preventing
another paroxysm. She continued to recover her health for a fortnight,
but did not find any diminution in the swellings; her legs were now so
large as to oblige her to keep constantly on the bed, and she made
very little water. I ordered her the infusion of Foxglove three times
a day, which, on the third day, produced a very copious discharge of
urine, without any sickness; she continued the use of it for ten days,
and was then able to walk. Having lost all her swellings, and no
complaint remaining but weakness, the bark and steel compleated the
cure.


                Extract of a Letter from Doctor JONES,
                       Physician, in Lichfield.

Anxious to procure authentic accounts from the patients, to whom I
gave the Foxglove, I have unavoidably been delayed in answering your
last favour. However, I hope the delay will be made up by the efficacy
of the plant being confirmed by the enquiry. Long cases are tedious,
and seldom read, and as seldom is it necessary to describe every
symptom; for every case would be a history of dropsy. I shall
therefore content myself with specifying the nature of the disease,
and when the dropsy is attended with any other affection shall notice
it.

Two years have scarcely elapsed since I first employed the Digitalis;
and the success I have had has induced me to use it largely and
frequently.


                                CASE I.

Ann Willott, 50 years of age, became a patient of the Dispensary on
the 11th of April 1783. She then complained of an enlargement of the
abdomen, difficulty of breathing, particularly when lying, and
costiveness. She passed small quantities of high-coloured urine; and
had an evident fluctuation in the belly. Her legs were œdematous.
Chrystals of tartar, squills, &c. had no effect. The 13th of _June_
she took two spoonfuls of a decoction of Foxglove, containing three
drams of the dry leaves, in eight ounces, three times a day. Her urine
soon increased, and in a few days she passed it freely, which
continued, and her breath returned.


                               CASE II.

Mr. ----, 45 years of age, had been long subject to dropsical
swellings of the legs, and made little water. Two spoonfuls of the
same decoction twice a day, soon relieved him.


                               CASE III.

Mrs. ----, aged 70 years. A lady frequently afflicted with the gout,
and an asthmatical cough. After a long continuance of the latter, she
had a great diminution of urine, and considerable difficulty of
breathing, particularly on motion, or when lying. Her body was much
bound. There was, however, no apparent swelling. She took three
spoonfuls of an aperient decoction of forty-five grains in six ounces
and a half, every other morning. The urine was plentiful those days,
and her breathing much relieved. In two or three weeks after the use
of it she was perfectly restored. The purgative medicine neither
increased the urine, nor relieved the breathing, till the Foxglove was
added.

This spring she long laboured with the gout in her stomach, which
terminated in a fit in her hand. During the whole of this tedious
illness, of nearly three months, she passed little urine, and her
breathing was again short.

She took the same preparation of Foxglove without any diuretic effect,
and afterwards two and three grains of the powder twice a day with as
little. The dulcified spirits of vitriol, however, quickly promoted
the urinary secretion.


                               CASE IV.

Mr. C----, 46 years of age, had dropsical swellings of the legs, and
passed little urine. He took the decoction with three drams, and was
soon relieved.


                                CASE V.

Lady----, took three grains of the dried leaves twice a day, for
swelled legs, and scantiness of urine, without effect.


                               CASE VI.

Mrs. Slater, aged 36 years. For dropsy of the belly and legs, and
scantiness of urine, of several weeks standing, took three grains of
the powder twice a day, and was quite restored in ten days. She took
many medicines without effect.


                               CASE VII.

Mrs. P----, in her 70th year, took three grains of the powder twice a
day, for scantiness of urine, and swelled legs, without effect.


                              CASE VIII.

Ann Winterleg, in her 26th year, had dropsical swellings of the legs,
and passed little urine: she was relieved by two drams, in an eight
ounce decoction.


                               CASE IX.

William Brown, aged 76. In the last stage of dropsy of the belly and
legs, found a considerable increase of his urine by a decoction of
Foxglove, but it was not permanent.


                                CASE X.

Mr. ----, -- years of age, and of very gross habit of body, became
highly dropsical, and took various medicines, without effect. One
ounce of the decoction, with three drams of the dry leaves in eight
ounces, twice or three times a day, increased his urine prodigiously.
He was evidently better, but a little attendant nausea overcame his
resolution, and in the course of some weeks afterwards he fell a
victim to his obstinacy.


                               CASE XI.

Mrs. Smith, about 50 years of age, after a tedious illness of many
weeks, had a jaundice, and became dropsical in the legs. Two spoonfuls
of the decoction, with three drams twice a day, increased her urine,
and abated the swelling.


                               CASE XII.

Widow Chatterton, about 60 years of age. Took the decoction in the
same way for dropsy of the legs, with little effect.


                              CASE XIII.

---- Genders, about thirty-four years of age, was delivered of three
children, and became dropsical of the abdomen. She passed little or no
urine, had constant thirst, and no appetite. She took two spoonfuls of
an eight ounce decoction, with three drams twice a day. By the time
she had finished the bottle, (which must have been on the fourth day,)
she had evacuated all her water, and could go about. Her appetite
increased with every dose, and she recovered without farther help.


                               CASE XIV.

Miss M---- M----, in her 20th year. Had been infirm from her cradle,
and, after various sufferings, had an astonishing œdematous
swelling of one leg and thigh, of many weeks standing. She passed
little or no urine, and had all her other complaints. She took 2
spoonfuls of an eight oz. decoction of two drams, twice a day. Her
urine immediately increased; and, on the third day, the swelling had
entirely subsided.


                               CASE XV.

Mr. P----, 65 years of age, and of a full habit of body. Had lived
freely in his youth, and for many years led rather an inactive life.
His health was much impaired several months, and he had a considerable
distention, and evident fluctuation in the abdomen, and a very great
œdema of the legs and thighs. His breathing was very short, and
rather laborious, appetite bad, and thirst considerable. His belly was
bound, and he passed very small quantities of high-coloured urine,
that deposited a reddish matter. He had taken medicines some time,
and, I believe, the Digitalis; and had been better.

A blister was applied to the upper and inside of each thigh; he took
two spoonfuls of the decoction, with three drams of the dry leaves,
two or three times a day; and some opening physic occasionally.

He lived at a considerable distance, and I did not visit him a second
time; but I was well informed, about ten days or a fortnight
afterwards, that his urine increased amazingly upon taking the
decoction, and that the water was entirely evacuated.


                               CASE XVI.

Mrs. G----, aged 50 years. After being long ailing, had a large
collection of water in the abdomen and lower extremities. Her urine
was high-coloured, in small quantities, and had a reddish sediment.
She took the decoction of Digitalis, squills, &c. without any effect.
The chrystals of tartar, however, cured her speedily.


                              CASE XVII.

Mr. ----, about 50 years of age, complained of great tension and pain
across the abdomen, and of loss of appetite; his urine, he thought,
was less than usual, but the difference was so trifling he could speak
with no certainty: his belly seemed to fluctuate. Among other things
he tried the Foxglove leaves dried, twice a day; and, although it
appeared to afford him relief, yet the effect was not permanent.


                              CASE XVIII.

Mr. W----, aged between 60 and 70 years; and rather corpulent: was
considerably dropsical, both of the belly and legs, and his urine in
small quantities. Three grains of the dry leaves, twice a day,
evacuated the water in less than a fortnight.


                               CASE XIX.

Sarah Taylor, 40 years of age, was admitted into the Dispensary for
dropsy of the abdomen and legs; and was relieved by the Decoctum
digitalianum.


                               CASE XX.

Lydia Smith, aged 60. Dispensary. Laboured many years under an asthma,
and became dropsical. She took the decoction without effect.


                               CASE XXI.

John Leadbeater, aged 15 years. Had a quotidian intermittent, which
was removed by the humane assistance of an amiable young lady. His
intermittent was soon attended by a very considerable ascites; for
which he became a patient of the Dispensary. He took a decoction of
Foxglove night and morning. His urine increased immediately, and he
lost all his complaints in four days.


                              CASE XXII.

William Millar, aged 50 years. Admitted into the Dispensary for a
tertian ague, and general dropsy. The dropsy continuing after the ague
was removed, and his urine being still passed in small quantities; he
took the powdered leaves, and recovered his health in five days.


                              CASE XXIII.

Ann Wakelin, 10 years of age. Had for several weeks a dropsy of the
belly after an ague. She took a decoction of Foxglove, which removed
all complaint by the fourth day.


                              CASE XXIV.

Ann Meachime; a Dispensary patient. Had an ascites and scantiness of
urine. She took the powder of Foxglove, and evacuated all her water
in three days.

It may not be improper to observe, 1st. That various diuretics had
long been given in many of these cases before I was consulted. And,
2dly. That the exhibition of the Foxglove was but seldom attended with
sickness.


                               REMARKS.

These Cases, thus liberally communicated by my friend, Dr. Jones, are
more acceptable, as they seem to contain a faithful abstract from his
notes, both of the unsuccessful as well as the successful Cases.

     The following Tabular View of them will give us some Idea of
     the efficacy of the Medicine.

    Anasarca                            7 Cases   Cured     3
                                                  Relieved  1
                                                  Failed    3
    Ascites                             5 Cases   Cured     4
                                                  Relieved  1
    Œdematous leg                       1 Case    Cured     1
    Ascites and anasarca                7 Cases   Cured     4
                                                  Relieved  2
                                                  Failed    1
    Asthma and dropsy                   1 Case    Failed    1
    Hydrothorax and gout                1 Case    Cured     1
    ----, ascites and anasarca--        2 Cases   Cured     2


                A CASE of Anasarca communicated by Mr.
                    JONES, Surgeon, in Birmingham.

     Dear SIR,

Having lately experienced the diuretic powers of the Foxglove, in a
case of anasarca; I do myself the pleasure of communicating a short
history of the treatment to you.

                                                I am, &c.
                                                       W. JONES.

         Birmingham,
     May 17th, 1785.

My patient, Mrs. C----, who is in her 51st year, had the following
symptoms, viz. alternate swelling of the legs and abdomen, a little
cough, shortness of breath in a morning, thirst, weak pulse, and her
urine, which was so small in quantity as seldom to amount to half a
pint in twenty-four hours, deposited a clay-coloured sediment.

_April_ 16th, 1785, I directed the following form:

    R. Fol. Digitalis siccat. ʒii.
    Aq. fontanæ bullient. ℥viii. f. infus. et cola.
    Sumat cochl. larga iii. o. n. et mane.

On the 17th she had taken twice of the infusion, and though by mistake
only two tea spoonfuls for a dose, yet the quantity of urine was
increased to about a pint in the twenty-four hours. She was then
directed to take two table spoonfuls night and morning. And.

On the 18th, a degree of nausea was produced. A pint and half of urine
was made in the last twenty-four hours. During the time above
specified she had two or three stools every day. The infusion was now
omitted.

On the 19th the swelling of the legs was removed. A degree of nausea
took place in the morning, and increased so much during the day, that
she vomited up all her food and medicine. As she was very low, and
complained of want of appetite, a cordial julep was directed to be
taken occasionally, as well as red port and water, mint tea, &c. She
informed me that whatever she took generally staid about an hour
before it came up again, and that the mint tea staid longest on the
stomach. The vomiting decreased gradually, and ceased on the 22d. The
discharge of urine remained considerable during the three following
days, but its quantity was not measured.

22d. A dose of neutral saline julep was directed to be taken every
fourth hour.

On the 23d she complained of thirst, and thought the discharge of
urine not so copious as on the preceding days, therefore the saline
julep was continued every fourth hour, with the addition of thirty
drops of the following medicine:

    R. Aceti scillitic. ʒvi.
    Tinct. aromat. ʒii.
    Tinct. thebaic. gutt. xx. m.

The bowels have been kept open from the 19th, by the occasional use of
emollient injections.

On the 24th the legs were much swelled again; she complained of
languor and a degree of nausea. The discharge of urine increased a
little since the 23d. Her pulse was low and her tongue white. The
urine, which had been rendered clear by the infusion of Foxglove, now
deposited a whitish sediment.

On the 25th her appetite began to return, the swelling of the legs
diminished, and she thought herself much relieved. The urine was
considerable in quantity, and clear.

On the 26th she was thirsty and languid. The swelling was removed; the
quantity of urine discharged in the last twenty-four hours was about a
pint. She continued to mend from this time, and is now in good health.

A giddiness of the head, more or less remarkable at times, was
observed to follow the use of the Foxglove, and it lasted nine or ten
days.

This is the second time that I have relieved this patient by the
infusion of Foxglove. I used the same proportion of the fresh leaves
the first time as I did of the dried ones the last. The violent
vomiting which followed the use of the infusion made with the dried
leaves, did not take place with the fresh though she took near a pint
made with the same proportion of the herb fresh gathered.


                               REMARKS.

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, Æt. 68. He was
affected with great difficulty of respiration, and cough particularly
troublesome on attempting to lie down, œdematous 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. ʒiii. decoque ex aq.
    fontan. ℥xii ad ℥vi colaturæ adde Tinctur. aromatic.
    Syr. zinzib. aa ℥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 ʒss tere ad extinctionem
    merc. et adde gum. ammon. ℈iii aloes socotorin. ʒss rad.
    scil. recent. ℈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. ℥v. tinctur. Rhei spirit. ℥ii. spirit
    vitriol. dulc. ʒii. syr. zinzib. ʒvi. 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.


                               CASE II.

R---- Howgate, a man much addicted to intemperance, particularly in
the use of spirituous liquors, Æt. 60, was admitted into the Hospital
near Birmingham, _May_ 17, 1783. He complained of difficulty of
breathing, attended with cough, particularly troublesome on lying
down; drowsiness and frequent dozing, from which he was roused by
startings, accompanied with great anxiety and oppression about the
breast; œdematous swellings of the legs; constant desire to make
water, which he passed with difficulty, and only by drops; pulse weak
and irregular; body rather costive; face much emaciated; no appetite
for food.--Cap. pil. scil. iii. ter in die.[6]

    [Footnote 6: R. Rad. scil. recent. sapon. castiliens. pulv.
    Rhei opt. aa. ℈i. ol. junip. gutt. xvi. syr. bals. q. s. f.
    mass. in pil. xxiv. divid.]

_May_ 20th. The pills have had no effect.--Cap. mistur. c.[7] Decoct.
Digital. &c. cochl. ii. larg. 3tia quaque hora, ad 3tiam vicem.

    [Footnote 7: Prepared in the same manner as in the former
    case.]

_May_ 21st. Made near two quarts of water in the night, without being
in the least sick. He continued the use of the mixture three times in
the day till the 30th, and made about three pints of water daily, by
which means the swellings were entirely taken away; and his other
complaints so much relieved, that on the 6th of June he was dismissed
free from complaint, except a slight cough. But returning to his old
course of life, he hath had frequent attacks of his disorder, which
have been always removed by using the Digitalis.


                  Extract of a letter from Mr. LYON,
                         Surgeon, at Tamworth.

--Mr. Moggs was about 54 years of age, his disease a dropsy of the
abdomen, attended with anasarcous swellings of the limbs, &c. brought
on by excessive drinking. I believe the first symptoms of the disease
appeared the beginning of November, 1776; the medicines he took before
you saw him, were squills in different forms, sal diureticus and
calomel, but without any good effect; he begun the Digitalis on the
10th of July 1777; a few doses of it caused a giddiness in the head,
and almost deprived him of sight, with very great nausea, but very
little vomiting, after which a considerable flow of urine ensued, and
in a very short time, a very little water remained either in the
cavity of the abdomen, or the membrana adiposa, but he remained
excessive weak, with a fluttering pulse at the rate of 150 or
frequently 160 in a minute; he kept pretty free from water for upwards
of twelve months; it then collected, and neither the Digitalis nor
any other medicine would carry it off. I tapped him the 2d of August
1779 in the usual place, and took some gallons of water from him, but
he very soon filled again, and as he had a very large rupture, a
considerable quantity of the water lodged in the scrotum, and could
not be got away by tapping in the usual place. I therefore (on the
28th of the same month) made an incision into the lower part of the
scrotum, and drained off all the water that way, but he was so very
much reduced, that he died the 8th or 9th of _September_ following,
which was about two years and two months after he first begun the
Digitalis.

I have had several dropsical patients relieved, and some perfectly
recovered by the Digitalis, since you attended Mr. Moggs, but as I did
not take any notes or make any memorandums of them, cannot give you
any of them.


                    Communications from Dr. STOKES,
                      Physician, in Stourbridge.

     Dear SIR,

I accept with pleasure your invitation to communicate what I know
respecting the properties of _Digitalis_; and if an account of what
others had discovered before you,[8] with a detail of my own
experience, shall be allowed the merit of at least a well meant
acknowledgment, for the early communication you were so kind to make
me, of the valuable properties you had found in it; I shall consider
my time as well employed. A knowledge of what has been already done is
the best ground work of future experiment; on which account I have
been the more full on this subject, in hopes that given with the
cautions which you mean to lay down in the cure of dropsies, it may
prove alike useful in that of other diseases, one of which stands
foremost among the _opprobria_ of medicine.

    [Footnote 8: See this account in the Introduction.]


                                CASE I.

Mrs. M----. Orthopnea, pain, and excessive oppression at the bottom of
the sternum. Pulse irregular, with frequent intermissions. Appetite
very much impaired. Legs anasarcous.

    _Empl. vesicator. pectori dolent._
    _Infus. Digital. e ʒiii. ad. aq. &c. ℥viii. cochl. j. o. h.
    donec nausea excitetur vel diuresis satis copiosa proveniat._

I ordered it of the above strength, and to be repeated often, on
account of the great emergency of the case, but the nausea excited by
the first dose prevented its being given at such short intervals. A 3d
dose I found had been given, which was followed by vomitings. All her
complaints gradually abated, but in about a fortnight recurred,
notwithstanding the use of infus. amar. &c.

    _Dec. 2. Infus. Digit. e. ʒiss ad aq. &c. ℥viii. cochl. ii.
    horis &c. u. a._

Complaints gradually abated, swellings of the legs nearly gone down.

About a month afterwards you was desired to visit this patient.[9]

    [Footnote 9: For reasons assigned at p. 100, I did not intend
    to introduce any case, occurring under my own inspection, in
    the course of the present year; but it may be satisfactory to
    continue the history of this disease, as Dr. Stokes's
    narrative would otherwise be incomplete.


                                 1785.

                                 CASE.

    _Jan._ 5th. Mrs. M----, Æt. 48. Hydrothorax and anasarcous
    legs, of eight months duration. She had taken jallap, squill,
    salt of tartar, and various other medicines. I found her in a
    very reduced state, and therefore directed only a grain and
    half of the Pulv. Digital. to be given night and morning.
    This in a few days encreased the secretion of urine, removed
    her difficulty of breathing, and reduced the swelling of her
    legs, without any disturbance to her system.

    Three months afterwards, a severe attack of gout in her legs
    and arms, removing to her head, she died.

    Dr. Stokes had an opportunity of examining the dead body, and
    I had the satisfaction to learn from him, that there did not
    appear to have been any return of the dropsy.]

On the examination of the body I noticed, among others, the following
appearances.

About ¾ oz. of bloody water flowed out, on elevating the upper half
of the scull, and a small quantity also was found at the base.

BRAIN. Blood-vessels turgid with blood, and many of those of
considerable size distended with air.

A very slight watery effusion between the _Pia Mater_ and _Tunica
arachnoidea_. About ¾ oz. of watery fluid in the _lateral
ventricles_.

THORAX. In the left cavity about 4 oz. of bloody serum; in the right
but little. Lungs, the hinder parts loaded with blood. Adhesions of
each lobe to the pleura. _Pericardium_ containing but a very small
quantity of fluid. _Heart_ containing no coagula of blood. _Valves of
the Aorta_ of a cartilaginous texture, as if beginning to ossify.

_Abdominal Viscera_ natural, and a profusion of _Fat_ under the
integuments of the abdomen and thorax, in the former to the thickness
of an inch and upwards, and in very considerable quantity on the
mesentery, omentum, kidneys, &c.

OBS. The intermitting pulse should seem to have been owing to
effusions of water in some of the cavities of the breast, as it
disappeared on the removal of the waters.


                               CASE II.

Mrs. C---- of K----, Æt. 80. Orthopnœa, with sense of oppression
about the prœcordia. Unable to lie down in bed for some nights
past. Anasarca of the lower extremities. Urine very scanty. Complaints
of six weeks standing. Had taken _sal. diuret. c. ol. junip.--Calom.
c. jalap, et gambog.--Et ol. junip. c. ol. Terebinth._ without effect.

_Feb._ 7. _Infus. Digital. e. ʒiii. ad aq. &c. ℥viii. cochl. ii. 4tis
horis._ Ordered to drink largely of _infus. baccar. junip._ The third
dose produced great nausea which continued ten hours, during which
time the urine made was about a quart. The next day her apothecary
directed her to begin again with it. The second dose produced
vomiting. During the next twenty hours she made two quarts of water,
about four times as much as she drank.

From this time she took no more of the _infus. Digital._ but continued
the _inf. bacc. junip._ until about _March_ 2d, when all the swellings
were gone down, her respiration perfectly free, and she herself quite
restored to her former state of health. On the 29th she had an attack
of jaundice which was some time after removed; since which she has
enjoyed a good state of health, excepting that for some little time
past her ancles have been slightly œdematous, which will I trust
soon yield to strengthening medicines.


                               CASE III.

Mrs. M---- G----, Æt. 64. Has had sore legs for these thirty-four
years past. Orthopnœa. Sense of oppression at the prœcordia.
Pulse intermitting. Legs anasarcous. Urine scanty, high-coloured.

    _Infus. Digital. c. ʒiss ad aq. bull. ℥viii. cochl. ii. 4tis
    horis._

Took six doses, when nausea was excited. Urine a quart during the
course of the night. The flow of urine continued, and complaints
relieved. Sal. Mart. c. extr. gent. and afterwards with the addition
of extr. cort. for which last ingredient she had a predilection,
confirmed the cure.

On the same day the next year I was called in to her for a similar
train of symptoms, excepting that the pulse was but just perceptibly
irregular.

    _Infus. Digital. u. a. præscript._

The directions on the phial not being attended to, _two doses of it
were given after a nausea had been excited_, which, with occasional
vomitings, became exceedingly oppressive. A saline draught, given in
Dr. Hulme's method, a draught _sal. c. c. gr. xii. c. conf. card. gr.
x._ produced no immediate effect, but the nausea gradually abating,
inf. bacc. junip. was ordered; but this appeared to augment it, and a
great propensity to sleep coming on, I directed _sal. c. c. conf.
card, aa gr. viii. 4tis horis_, which removed the unpleasant symptoms
and _myrrh. c. sal. mart._ completed the cure. During the use of the
above medicines, the urine was augmented, and the pulmonary complaints
removed, even before the nausea left her; and the sores of her legs
which were much inflamed before she began with the infus. Digital. in
a day's time assumed a much healthier appearance, and on her other
complaints going off, they shewed a greater tendency to heal than she
had ever observed in them for twenty years before. This instance is a
very pleasing confirmation of the experience of Hulse and Dr. Baylies,
and of the advantage to be derived from a medicine, which, while it
helps to heal the ulcers, removes that from the constitution which
often renders the healing of them improper.

In one case in which I ordered it, the infusion, instead of digesting
three hours as I had directed, was suffered to stand upon the leaves
all night. The consequence was that the first dose produced
considerable nausea.

The two following cases, with which I have been favoured by a
physician very justly eminent, convince me of the necessity there is
that every one who discovers a new medicine, or new virtues in an old
one, should, in announcing such discoveries, publish to the world the
exact manner in which he exhibits such medicines, with all the
precautions necessary to obtain the promised success.

    In these (says my correspondent) “the infusion was given in
    small doses, repeated every hour or two, till a nausea was
    raised, when it was omitted for a day or perhaps two, and
    then repeated in the same manner.

    “An ASCITES emptied by it, but filled again very speedily,
    though _its use was never discontinued_, and who afterwards
    found no salutary effects from it. Ended fatally.

    “In an ANASARCA it sometimes increased the quantity of urine,
    and abated the swelling, but which as often returned in as
    great a degree as before, though _the medicine was still
    given_, and always increased in quantity so as to excite
    nausea. Ended fatally.

    “I have tried it in many other cases, but found very little
    difference in the success attending it.”

May we not be allowed to conjecture that the inefficacy of _its
continued use_ is owing to its narcotic property gradually diminishing
the irritability of the muscular fibres of the absorbents, or possibly
of the whole vascular system, and thus adding to that weakened action
which seems to be the cause of the generality of dropsies, which leads
us to caution the medical experimenter against trying it, at least
_against its continued use, even in small doses_, in other diseases of
diminished energy, as continued fever, palsy, &c.

             I remain with the greatest truth,

                       Your obliged and affectionate friend,

                                                JONATHAN STOKES.

     Stourbridge,
     May 17, 1785.


    The three following Hospital Cases, which Dr. STOKES had an
    opportunity of observing, are related as instances of bad
    practice, and tend to demonstrate how necessary it is when
    one physician adopts the medicine of another, that he should
    also at first rigidly adopt his method.


                                CASE I.

Esther K----, Æt. 33. General anasarca, ascites, and dyspnœa, of
seven months duration.

_Decoct. c Digit. ʒiv. c. aq. ℔i. coquend. ad ℔ss. cap. ℥i. 2dis.
horis._ 1st DAY. 4th dose made her sick. 2d DAY. The first dose she
took to-day produced vomiting.

3d DAY. _Minuatur dosis ad ℥ss._ This stayed upon her
stomach, but produced an almost constant sickness. Stools more
frequent, water scarce sensibly increased; and her swellings not at
all reduced.

4th DAY. _Cap. Calomel. gambog. scill. &c._

OBS. Sufficient time was not allowed to observe its effects, neither
was the patient enjoined the free use of diluents. The disease
terminated fatally.


                               CASE II.

William T----, Æt. 42. Ascites, with cough and dyspnœa. Abdomen
very much distended. The rest of his body highly emaciated. Urine
thick, high coloured, and in very small quantity.

    _Decoct. Digit. (u. in Esther K----,) 4tis horis._

1st DAY of taking it. The 4th dose produced sickness.

2d. Vomiting after the second dose.

10th. Urine increased to ℔vi.

11th. Flow of urine continues. Abdomen quite flaccid.

12th. Abdomen not diminished.

15th: A smart purging came on, and the flow of urine diminished.

23d. Belly much bound. Took a cathart. powder, which was followed by a
diminution of the abdomen.

29th. To take a cathart. powder every 4th morning, continuing the
decoct. Digit.

32d. Urine exceedingly scanty.

35th. _Vin. scill. ℥ss. o. m. &c._ This produced
diuretic effects.

44th. Tapped. Terminated fatally.

OBS. Here the medicine was _continued till it ceased to produce
diuretic effects_; and these effects were not aided by any
strengthening remedies.


                               CASE III.

George R----, Æt. 52. Ascites, general anasarca, and dyspnœa. His
legs so greatly distended that it was with great difficulty he could
draw the one after the other.

    _Infus. Digital. ʒiiiss. ad. aq. ℔ss. cap. ℥i. altern. horis
    donec nauseam excitaverit._ _Rep. 3tiis diebus. tempore
    intermedio cap. sol. guaic. ℥i. ter in die ex inf. sinap._

1st DAY of taking it. Became sickish towards night.

2d DAY. Made a great quantity of water during the night, and spat up a
great deal of watery phlegm. The first dose he took in the morning has
produced a sickness which has continued all day, but he has never
vomited.

3d. DAY. The change in his appearance so great as to make it difficult
to conceive him to be the same person. Instead of a large corpulent
man, he appeared tall, thin, and rather aged. Breathes freely, and can
walk up and down stairs without inconvenience.

4th DAY. _Decoct. bacc. junip. and cyder for common drink._

6th DAY. A second course of his medicine produced a flow of urine
almost as plentiful as the former, though he drank little or nothing
at the time. In a day or two after he walked to some distance.

12th DAY. _Pot. purgans illico._

14th DAY. _Pot. purg. c. jalap. ʒss. 4tis diebus._
          _Infus. Dig. 3tiis diebus._

17th DAY. _R. Gamb. gr. iii. calom. gr. ii. camph.
          gr. i. syr. simpl. fiat pil. o. n. sum._
          _Infus. Digit. 3tiis diebus._

21st DAY. Made an out-patient. The super-abundant flow of urine
continued for the first three days after his last course; but since,
the flow of saliva has been nearly equal to that of urine.

The smalls of his legs not quite reduced, and are fuller at night. He
has shrunk round the middle from four feet two inches to three feet
six inches; and in the calves of his legs, from seventeen inches to
thirteen and a half.[10]


    [Footnote 10: In the three last recited cases, the medicine
    was directed in doses quite too strong, and repeated too
    frequently. If Esther K---- could have survived the extreme
    sickness, the diuretic effects would probably have taken
    place, and, from her time of life, I should have expected a
    recovery. Wm. T---- seems to have been a bad case, and I
    think would not have been cured under any management. G.
    R---- certainly possessed a good constitution, or he must
    have shared the fate of the other two.]

OBS. The waters were here very successfully evacuated, but as you
remarked to me, on communicating the case to you at the time, tonic
medicines should have been given, to second the ground that had been
gained, instead of weakening the patient by drastic purgatives.


                   A CASE from Mr. SHAW, Surgeon, at
             Stourbridge.--Communicated by Doctor STOKES.

Matth. D----, Æt. 71. Tall and thin. Disease a general anasarca, with
great difficulty of breathing. The lac ammoniac. somewhat relieved his
breath; but the swellings increased, and his urine was not augmented.
I considered it as a lost case, but having seen the good effects of
the Digitalis, as ordered by Dr. Stokes in the case of Mrs. G----, I
gave him one spoonful of an infusion of ʒii to half a pint, twice a
day. His breath became much easier, his urine increased considerably,
and the swellings gradually disappeared; since which his health has
been pretty good, except that about three weeks ago, he had a slight
dyspnœa, with pain in his stomach, which were soon removed by a
repetition of the same medicine.

Mr. Shaw likewise informs me, that he has removed pains in the stomach
and bowels, by giving a spoonful of the infusion, ʒiss. to ℥viii.
morning and night.


            A Letter from Mr. VAUX, Surgeon, in Birmingham.

     Dear SIR,

I send you the two following cases, wherein the Digitalis had very
powerful and sensible effects, in the cure of the different patients.


                                CASE I.

Mrs. O---- of L---- street, in this town, aged 28, naturally of a
thin, spare habit, and her family inclinable to phthisis, sent for me
on the 11th of June, 1779, at which time she complained of great pain
in her side, a constant cough, expectorated much, which sunk in water;
had colliquative sweats and frequent purging stools; the lower
extremities and belly full of water, and from the great difficulty she
had in breathing, I concluded there was water in the chest also. The
quantity of water made at a time for three weeks before I saw her,
never amounted to more than a tea-cup full, frequently not so much.
Finding her in so alarming a situation, I gave it as my opinion she
could receive no benefit from medicine, and requested her not to take
any; but she being very desirous of my ordering her something, I
complied, and sent her a box of gum pills with squills, and a mixture
with salt of tartar: these medicines she took until the sixteenth,
without any good effects: the water in her legs now began to exsude
through the skin, and a small blister on one of her legs broke.
Believing she could not exist much longer, unless an evacuation of the
water could be procured; after fully informing her of her situation,
and the uncertainty of her surviving the use of the medicine, I
ventured to propose her taking the Digitalis, which she chearfully
agreed to. I accordingly sent her a pint mixture, made as under, of
the fresh leaves of the Digitalis. Three drams infused in one pint of
boiling water, when cold strained off, without pressing the leaves,
and two ounces of the strong juniper water added to it: of this
mixture she was ordered four table spoonfuls every third hour, till it
either made her sick, purged her, or had a sensible effect on the
kidneys. This mixture was sent on the seventeenth, and she began
taking it at noon on the eighteenth. At one o'clock the following
morning I was called up, and informed she was dying. I immediately
attended her, and was agreeably surprised to find their fright arose
from her having fainted, in consequence of the sudden loss of twelve
quarts of water she had made in about two hours. I immediately applied
a roller round her belly, and, as soon as they could be made, 2
others, which were carried from the toes quite up the thighs. The
relief afforded by these was immediate; but the medicine now began to
affect her stomach so much, that she kept nothing on it many minutes
together. I ordered her to drink freely of beef tea, which she did,
but kept it on her stomach but a very short time. A neutral draught in
a state of effervescence was taken to no good purpose: She therefore
continued the beef tea, and took no other medicine for five days,
when her sickness went off: her cough abated, but the pain in her side
still continuing, I applied a blister which had the desired effect:
her urine after the first day flowed naturally. Her cure was
compleated by the gum pills with steel and the bitter infusion. It
must be observed she never had any collection of water afterwards.

It affords me great pleasure to inform you that she is now living, and
has since had four children; all of whom, I think I may justly say,
are indebted to the Digitalis for their existence.

There appears in this case a striking proof of the utility of emetics
in some kinds of consumptions, as it appears to me the dropsy was
brought on by the cough, &c. and I believe these were cured by the
continual vomitings, occasioned by the medicine.


                                CASE II.

Mr. H----, a publican, aged about 48 years, sent for me in _March_,
1778. He complained of a cough, shortness of breathing, which
prevented him from laying down in bed; his belly, thighs and legs very
much distended with water; the quantity of urine made at a time seldom
exceeded a spoonful. I requested him to get some of the Digitalis, and
as they had no proper weights in the house, I told them to put as much
of the fresh leaves as would weigh down a guinea, into half a pint of
boiling water; to let it stand till cold, then to pour off the clear
liquor, and add a glass of gin to it, and to take three table
spoonfuls every third hour, until it had some sensible effect upon
him.

Before he had taken all the infusion, the quantity of urine made
increased, (he therefore left off taking it), and it continued to do
so until all the water was evacuated. His breathing became much
better, his cough abated, though it never quite left him; he being for
some time before asthmatic. By taking some tonic pills he continued
quite well until the next spring, when he had a return of his
complaint, which was carried off by the same means. Two years after,
he had a third attack, and this also gave way to the medicine. Last
year he died of a pleurisy.

                                                  I am, &c.
                                                       JER. VAUX

     Moor-Street, 8th May,
     1785.

P. S. You must well recollect the case of Mrs. F----.--It was “a
general dropsy--every time she took the medicine its effects were
similar, viz. The discharge of urine came on gradually at first,
increased afterwards, and the whole of the water both in the belly,
legs, &c. was perfectly evacuated. Although the effects were only
temporary, they were exceedingly agreeable to the patient, making her
time much more comfortable.”--(_See Case_ XLIII.)


                     A Letter from Mr. WAINWRIGHT,
                          Surgeon, in Dudley.

     Dear SIR,

It gives me great pleasure to find you intend to publish your
observations on the Digitalis purpurea.

Several years are now elapsed since you communicated to me the high
opinion you entertained of the diuretic qualities of this noble plant.
To ensure success, due attention was recommended to its _preparation_,
its _dose_, and its _effects_ upon the system.

I always gave the infusion of the dried leaves; the dose the same as
in the prescriptions returned. If the medicine operated on the stomach
or bowels, it was thought prudent to forbear. When the kidneys began
to perform their proper functions, and the urine to be discharged, a
continuance of its farther use was unnecessary.

These remarks you made in the case of the first patient for whom you
prescribed the Digitalis in our neighbourhood, and I have found them
all necessary at this present period. From the _decided_ good effects
that followed from its use, in those cases where the most powerful
remedies had failed, I was soon convinced it was a most valuable
addition to the materia medica.

The want of a certain diuretic, has long been one of the desiderata of
medicine. The Digitalis is undoubtedly at the head of that class, and
will seldom, if properly administered, disappoint the expectation. I
can speak with the more confidence, having, in an extensive practice,
been a happy witness to its good qualities.

For several years, I have given the infusion in a variety of cases,
where there was a deficiency in the secretion of the urine, with the
greatest success. In recent obstructions, I do not recollect many
failures. In anasarcous diseases, and in the anasarca, when combined
with the ascites; in swellings of the limbs, and in diseases of the
chest, when there was the greatest reason to believe an accumulation
of serum, the most beneficial consequences have followed from its use.

Had I been earlier acquainted with your intention to publish an
account of the Digitalis, I could have transmitted some cases, which
might have served to corroborate these assertions: but I am convinced
the Digitalis needs not my assistance to procure a favorable
reception. Its own merit will ensure success, more than a hundred
recited cases.

I could wish those gentlemen who intend to make use of this plant, to
collect it in a hot dry day, when the petals fall, and the
seed-vessels begin to swell.

The leaves kept to the second year are weaker, and their diuretic
qualities much diminished. It will therefore be necessary to gather
the plant fresh every season.

These cautions are unnecessary to the accurate botanist, who well
knows, that a plant in the spring, though more succulent and full of
juices, is destitute of those qualities which may be expected when
that plant has attained its full vigour, and the seed-vessels begin to
be manifest. But for want of attention to these particulars, its
virtues may be thought exaggerated, or doubtful, if beneficial
consequences do not always flow from its use. There are diseases it
cannot cure; and in several of those patients in this town, who first
took the Digitalis by your orders, there was the most positive proof
of the viscera being unsound. In these desperate cases it often
procured a plentiful flow of urine, and palliated a disease which
medicine could not remove.

At a remote distance, physicians are seldom applied to for advice in
trifling disorders. Many remedies have been tried without relief, and
the disease is generally obstinate or confirmed.--It would not be fair
to try the merits of the Digitalis in this scale. It might often fail
of promoting the end desired. I flatter myself the reputation of this
plant will be equal to its merit, and that it will meet with a candid
reception.

As there is no pleasure equal to relieving the miseries and distresses
of our fellow-creatures, I hope you will long enjoy that peculiar
felicity.

Permit me to return my thankful acknowledgments, for your free
communication of a medicine, by which means, through the blessing of
providence, I have been enabled to restore health and happiness to
many miserable objects.

                                           I am, &c.
                                                 Yours,
                                                  J. WAINWRIGHT.

     Dudley, April 26th,
     1785.


                     CASE of Mr. WARD, Surgeon, in
                   Birmingham.--Related by himself.

In _September_, 1782, I was seized with a difficulty of breathing, and
oppression in my chest, in consequence of taking cold from being
called out in the night. My tongue was foul; my urine small in
quantity; my breath laborious and distressing on the slightest
exercise. I tried the medicines most generally recommended, such as
emetics, blisters, lac ammoniacum, oxymel of squills, &c. but finding
little or no relief, I consulted Dr. Withering, who advised me to try
the following prescription.

    R. Fol. Digital. purp. siccat. ʒiss.
    Aq. bullientis ℥iv.
    Aq. cinn. sp. ℥ss. digere per horas quatuor, et colaturæ
    capiat cochlear. i. nocte maneque.

He also desired me to take fifty drops of tincture of cantharides
three or four times a day.

After taking eight ounces of the infusion, and about twelve drams of
the drops, I was perfectly cured, and have had no return since. The
medicine did not occasion sickness or vertigo, nor had they any other
sensible effect than in changing the appearance, and increasing the
quantity of the urine, and rendering the tongue clean. After the last
dose or two indeed, I had a little nausea, which was immediately
removed by a small glass of brandy.

     Birmingham, 1st July, 1785.


                    Communications from Mr. YONGE,
                  Surgeon, in Shiffnall, Shropshire.

     Dear SIR,

I have great satisfaction in complying with your just claim, by
transcribing outlines of the subsequent cases, for insertion in your
long requested tract on the Digitalis purpurea. The two first of these
you will easily recollect, the cures having been conducted immediately
under your own management, and the whole may add to that weight of
evidence which long experience enables you to adduce of the efficacy
of that valuable medicine. I have recited the only instances of its
failure which occur to me, but many other, though successful cases,
wherein its utility might seem dubious, and also the accounts received
from people whose accuracy might be suspected, I shall not for obvious
reasons trouble you with.

                                      I am, dear Sir,
                                        Your obliged friend,
                                                  WILLIAM YONGE.

     Shiffnall,
     _May_ 1, 1785.


                                CASE I.

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 a pale yellow colour. The
abdomen was swelled and hard; his appetite little, and he complained
of a violent and constant palpitation of the heart, which prevented
him from sleeping. The urine pale, and in small quantity. The pulse
exceedingly strong, and rebounding; beating 114 to 120 strokes every
minute. He suffered violent pain of his head, and was very feeble and
emaciated. After bleeding, and the use of gentle aperient medicines,
he continued to take the infusion of Digitalis for some days, without
any sensible effect. Other diuretics were tried to as little purpose.
Repeated bleeding had no effect in diminishing the violent action of
the heart. He died in January following, under complicated symptoms of
phthisis and ascites.


                               CASE VI.

A man aged 57, who had lived freely in the summer of 1784, became
affected with œdematous swelling of his legs, for which he was
advised to drink Fox Glove Tea. He took a four ounce bason of the
infusion made strong with the green leaves, every morning for four
successive days.

On the 5th he was suddenly seized with faintness and cold sweatings. I
found him with a pale countenance, complaining of weakness, and of
pain, with a sense of great heat in his stomach and bowels. The
swelling of the legs was entirely gone, he having evacuated urine in
very large quantities for the two preceding days. He was affected with
frequent diarrhœa. The pulse was very quick and small, and his
extremities cold.

A small quantity of broth was directed to be given him every half
hour, and blisters were applied to the ancles, by which his symptoms
became gradually alleviated, and he recovered perfectly in the space
of three weeks; except a relapse of the anasarca, for which the
Digitalis was afterwards successfully employed, in small doses,
without any disagreeable consequence.


                               CASE VII.

S---- D----, a middle aged single woman, was affected in the year
eighty-one, with a painful rigidity and slight inflammation of the
integuments on the left side, extending from the ear to the shoulder.
In every other particular she was healthy. The use of warm
fomentations, and opium, with two or three doses of mercurial physic,
afforded her ease and the inflammation disappeared, but was succeeded
by an œdematous swelling of the part, which very gradually extended
along the arm, and downward to the breast, back, and belly. Friction,
electricity and mercurial ointment were amongst the number of
applications unsuccessfully employed to relieve her for the space of
three months, during which time she continued in good general health.

In _November_ she became ascitic, passing small quantities of urine,
and soon afterwards a sudden dyspnœa gave occasion to suppose an
effusion of water in the thorax. The Digitalis, squills, and
cantharides were given in very considerable doses without effect. She
died the latter end of December following.


                              CASE VIII.

W---- C----, a collier aged 58, was attacked in the spring of 1783
with a tertian ague, which he attributed to cold, by sleeping in a
coal pit, and from which he recovered in a few days, except a
swelling of the lower extremities, which had appeared about that time,
and gradually increased for two or three months. The legs and thighs
were greatly enlarged and œdematous. His belly was swelled, but no
fluctuation perceptible. He made small quantities of high coloured
water. The appetite bad, and pulse feeble. He had taken many medicines
without relief, and was now so reduced in strength, as to sit up with
difficulty. An infusion of the Digitalis was directed for him, in the
proportion of one ounce of the fresh leaves to a pint of water, two
ounces to be taken three times a day, until the stomach or bowels
became affected. Upon the exhibition of the sixth dose, nausea
supervened, and continued to oppress him at intervals for two or three
days, during which he passed large quantities of pale urine. The
swelling, assisted by moderate bandage rapidly diminished, and without
any repetition of his medicine, at the expiration of sixteen days, he
returned to his labour perfectly recovered.



            OF THE PREPARATIONS and DOSES, OF THE FOXGLOVE.


Every part of the plant has more or less of the same bitter taste,
varying, however, as to strength, and changing with the age of the
plant and the season of the year.

ROOT.--This varies greatly with the age of the plant. When the stem
has shot up for flowering, which it does the second year of its
growth, the root becomes dry, nearly tasteless, and inert.

Some practitioners, who have used the root, and been so happy as to
cure their patients without exciting sickness, have been pleased to
communicate the circumstance to me as an improvement in the use of the
plant. I have no doubt of the truth of their remarks, and I thank
them. But the case of Dr. Cawley puts this matter beyond dispute. The
fact is, they have fortunately happened to use the root in its
approach to its inert state, and consequently have not over dosed
their patients. I could, if necessary, bring other proof to shew that
the root is just as capable as the leaves, of exciting nausea.

STEM.--The stem has more taste than the root has, in the season the
stem shoots out, and less taste than the leaves. I do not know that it
has been particularly selected for use.

LEAVES.--These vary greatly in their efficacy at different seasons of
the year, and, perhaps, at different stages of their growth; but I am
not certain that this variation keeps pace with the greater or lesser
intensity of their bitter taste.

Some who have been habituated to the use of the recent leaves, tell
me, that they answer their purpose at every season of the year; and I
believe them, notwithstanding I myself have found very great
variations in this respect. The solution of this difficulty is
obvious. They have used the leaves in such large proportion, that the
doses have been sufficient, or more than sufficient, even in their
most inefficacious state. _The Leaf-stalks_ seem, in their sensible
properties, to partake of an intermediate state between the leaves and
the stem.

FLOWERS.--The petals, the chives, and the pointal have nearly the
taste of the leaves, and it has been suggested to me, by a very
sensible and judicious friend, that it might be well to fix on the
flower for internal use. I see no objection to the proposition; but I
have not tried it.

SEEDS.--These I believe are equally untried.

From this view of the different parts of the plant, it is sufficiently
obvious why I still continue to prefer the leaves.

These should be gathered after the flowering stem has shot up, and
about the time that the blossoms are coming forth.

The leaf-stalk and mid-rib of the leaves should be rejected, and the
remaining part should be dried, either in the sun-shine, or on a tin
pan or pewter dish before a fire.

If well dried, they readily rub down to a beautiful green powder,
which weighs something less than one-fifth of the original weight of
the leaves. Care must be taken that the leaves be not scorched in
drying, and they should not be dried more than what is requisite to
allow of their being readily reduced to powder.

I give to adults, from one to three grains of this powder twice a day.
In the reduced state in which physicians generally find dropsical
patients, four grains a day are sufficient. I sometimes give the
powder alone; sometimes unite it with aromatics, and sometimes form it
into pills with a sufficient quantity of soap or gum ammoniac.

If a liquid medicine be preferred, I order a dram of these dried
leaves to be infused for four hours in half a pint of boiling water,
adding to the strained liquor an ounce of any spirituous water. One
ounce of this infusion given twice a day, is a medium dose for an
adult patient. If the patient be stronger than usual, or the symptoms
very urgent, this dose may be given once in eight hours; and on the
contrary in many instances half an ounce at a time will be quite
sufficient. About thirty grains of the powder or eight ounces of the
infusion, may generally be taken before the nausea commences.

The ingenuity of man has ever been fond of exerting itself to vary the
forms and combinations of medicines. Hence we have spirituous, vinous,
and acetous tinctures; extracts hard and soft, syrups with sugar or
honey, &c. but the more we multiply the forms of any medicine, the
longer we shall be in ascertaining its real dose. I have no lasting
objection however to any of these formulæ except the extract, which,
from the nature of its preparation must ever be uncertain in its
effects; and a medicine whose fullest dose in substance does not
exceed three grains, cannot be supposed to stand in need of
condensation.

It appears from several of the cases, that when the Digitalis is
disposed to purge, opium may be joined with it advantageously; and
when the bowels are too tardy, jalap may be given at the same time,
without interfering with its diuretic effects; but I have not found
benefit from any other adjunct.

From this view of the doses in which the Digitalis really ought to be
exhibited, and from the evidence of many of the cases, in which it
appears to have been given in quantities six, eight, ten or even
twelve times more than necessary, we must admit as an inference either
that this medicine is perfectly safe when given as I advise, or that
the medicines in daily use are highly dangerous.



                     EFFECTS, RULES, and CAUTIONS.


The Foxglove when given in very large and quickly-repeated doses,
occasions sickness, vomiting, purging, giddiness, confused vision,
objects appearing green or yellow; increased secretion of urine, with
frequent motions to part with it, and sometimes inability to retain
it; slow pulse, even as slow as 35 in a minute, cold sweats,
convulsions, syncope, death.[11]

    [Footnote 11: I am doubtful whether it does not sometimes
    excite a copious flow of saliva.--See cases at pages 115,
    154, and 155.]

When given in a less violent manner, it produces most of these effects
in a lower degree; and it is curious to observe, that the sickness,
with a certain dose of the medicine, does not take place for many
hours after its exhibition has been discontinued; that the flow of
urine will often precede, sometimes accompany, frequently follow the
sickness at the distance of some days, and not unfrequently be checked
by it. The sickness thus excited, is extremely different from that
occasioned by any other medicine; it is peculiarly distressing to the
patient; it ceases, it recurs again as violent as before; and thus it
will continue to recur for three or four days, at distant and more
distant intervals.

These sufferings of the patient are generally rewarded by a return of
appetite, much greater than what existed before the taking of the
medicine.

But these sufferings are not at all necessary; they are the effects of
our inexperience, and would in similar circumstances, more or less
attend the exhibition of almost every active and powerful medicine we
use.

Perhaps the reader will better understand how it ought to be given,
from the following detail of my own improvement, than from precepts
peremptorily delivered, and their source veiled in obscurity.

At first I thought it necessary _to bring on and continue the
sickness, in order to ensure the diuretic effects_.

I soon learnt that the nausea being once excited, it was unnecessary
to repeat the medicine, as it was certain to recur frequently, at
intervals more or less distant.

Therefore my patients were ordered _to persist until the nausea came
on, and then to stop_. But it soon appeared that the diuretic effects
would often take place first, and sometimes be checked when the
sickness or a purging supervened.

The direction was therefore enlarged thus--_Continue the medicine
until the urine flows, or sickness or purging take place_.

I found myself safe under this regulation for two or three years; but
at length cases occurred in which the pulse would be retarded to an
alarming degree, without any other preceding effect.

The directions therefore required an additional attention to the state
of the pulse, and it was moreover of consequence not to repeat the
doses too quickly, but to allow sufficient time for the effects of
each to take place, as it was found very possible to pour in an
injurious quantity of the medicine, before any of the signals for
forbearance appeared.

_Let the medicine therefore be given in the doses, and at the
intervals mentioned above:--let it be continued until it either acts
on the kidneys, the stomach, the pulse, or the bowels; let it be
stopped upon the first appearance of any one of these effects_, and I
will maintain that the patient will not suffer from its exhibition,
nor the practitioner be disappointed in any reasonable expectation.

If it purges, it seldom succeeds well.

The patients should be enjoined to drink very freely during its
operation. I mean, they should drink whatever they prefer, and in as
great quantity as their appetite for drink demands. This direction is
the more necessary, as they are very generally prepossessed with an
idea of drying up a dropsy, by abstinence from liquids, and fear to
add to the disease, by indulging their inclination to drink.

In cases of ascites and anasarca; when the patients are weak, and the
evacuation of the water rapid; the use of proper bandage is
indispensably necessary to their safety.

If the water should not be wholly evacuated, it is best to allow an
interval of several days before the medicine be repeated, that food
and tonics maybe administered; but truth compels me to say, that the
usual tonic medicines have in these cases very often deceived my
expectations.

From some cases which have occurred in the course of the present year,
I am disposed to believe that the Digitalis may be given in small
doses, viz. two or three grains a day, so as gradually to remove a
dropsy, without any other than mild diuretic effects, and without any
interruption to its use until the cure be compleated.

If inadvertently the doses of the Foxglove should be prescribed too
largely, exhibited too rapidly, or urged to too great a length; the
knowledge of a remedy to counteract its effects would be a desirable
thing. Such a remedy may perhaps in time be discovered. The usual
cordials and volatiles are generally rejected from the stomach;
aromatics and strong bitters are longer retained; brandy will
sometimes remove the sickness when only slight; I have sometimes
thought small doses of opium useful, but I am more confident of the
advantage from blisters. Mr. Jones (_Page_ 135) in one case, found
mint tea to be retained longer than other things.



                       CONSTITUTION of PATIENTS.


Independent of the degree of disease, or of the strength or age of the
patient, I have had occasion to remark, that there are certain
constitutions favourable, and others unfavourable to the success of
the Digitalis.

From large experience, and attentive observation, I am pretty well
enabled to decide _a priori_ upon this matter, and I wish to enable
others to do the same: but I feel myself hardly equal to the
undertaking. The following hints, however, aiding a degree of
experience in others, may lead them to accomplish what I yet can
describe but imperfectly.

It seldom succeeds in men of great natural strength, of tense fibre,
of warm skin, of florid complexion, or in those with a tight and cordy
pulse.

If the belly in ascites be tense, hard, and circumscribed, or the
limbs in anasarca solid and resisting, we have but little to hope.

On the contrary, if the pulse be feeble or intermitting, the
countenance pale, the lips livid, the skin cold, the swollen belly
soft and fluctuating, or the anasarcous limbs readily pitting under
the pressure of the finger, we may expect the diuretic effects to
follow in a kindly manner.

In cases which foil every attempt at relief, I have been aiming, for
some time past, to make such a change in the constitution of the
patient, as might give a chance of success to the Digitalis.

By blood-letting, by neutral salts, by chrystals of tartar, squills,
and occasional purging, I have succeeded, though imperfectly. Next to
the use of the lancet, I think nothing lowers the tone of the system
more effectually than the squill, and consequently it will always be
proper, in such cases, to use the squill; for if that fail in its
desired effect, it is one of the best preparatives to the adoption of
the Digitalis.

A tendency to paralytic affections, or a stroke of the palsy having
actually taken place, is no objection to the use of the Digitalis;
neither does a stone existing in the bladder forbid its use.
Theoretical ideas of sedative effects in the former, and apprehensions
of its excitement of the urinary organs in the latter case, might
operate so as to make us with-hold relief from the patient; but
experience tells me, that such apprehensions are groundless.



                              INFERENCES.


To prevent any improper influence, which the above recitals of the
efficacy of the medicine, aided by the novelty of the subject, may
have upon the minds of the younger part of my readers, in raising
their expectations to too high a pitch, I beg leave to deduce a few
inferences, which I apprehend the facts will fairly support.

I. That the Digitalis will not universally act as a diuretic.

II. That it does do so more generally than any other medicine.

III. That it will often produce this effect after every other probable
method has been fruitlessly tried.

IV. That if this fails, there is but little chance of any other
medicine succeeding.

V. That in proper doses, and under the management now pointed out, it
is mild in its operation, and gives less disturbance to the system,
than squill, or almost any other active medicine.

VI. That when dropsy is attended by palsy, unsound viscera, great
debility, or other complication of disease, neither the Digitalis, nor
any other diuretic can do more than obtain a truce to the urgency of
the symptoms; unless by gaining time, it may afford opportunity for
other medicines to combat and subdue the original disease.

VII. That the Digitalis may be used with advantage in every species of
dropsy, except the encysted.

VIII. That it may be made subservient to the cure of diseases,
unconnected with dropsy.

IX. That it has a power over the motion of the heart, to a degree yet
unobserved in any other medicine, and that this power may be converted
to salutary ends.



         PRACTICAL REMARKS ON DROPSY, AND SOME OTHER DISEASES.


The following remarks consist partly of matter of fact, and partly of
opinion. The former will be permanent; the latter must vary with the
detection of error, or the improvement of knowledge. I hazard them
with diffidence, and hope they will be examined with candour; not by a
contrast with other opinions, but by an attentive comparison with the
phœnomena of disease.


                               ANASARCA.

§ 1. The anasarca is generally curable when seated in the
sub-cutaneous cellular membrane, or in the substance of the lungs.

§ 2. When the abdominal viscera in general are greatly enlarged, which
they sometimes are, without effused fluid in the cavity of the
abdomen; the disease is incurable. After death, the more solid viscera
are found very large and pale. If the cavity contains water, that
water may be removed by diuretics.

§ 3. In swollen legs and thighs, where the resistance to pressure is
considerable, the tendency to transparency in the skin not obvious,
and where the alteration of posture occasions but little alteration in
the state of distension, the cure cannot be effected by diuretics.

Is this difficulty of cure occasioned by spissitude in the effused
fluids, by want of proper communication from cell to cell, or is the
disease rather caused by a morbid growth of the solids, than by an
accumulation of fluid?

Is not this disease in the limbs similar to that of the viscera (§ 2)?

§ 4. Anasarcous swellings often take place in palsied limbs, in arms
as well as legs; so that the swelling does not depend merely upon
position.

§ 5. Is there not cause to suspect that many dropsies originate from
paralytic affections of the lymphatic absorbents? And if so, is it not
probable that the Digitalis, which is so effectual in removing dropsy,
may also be used advantageously in some kinds of palsy?


                               ASCITES.

§ 6. If existing alone, (_i. e._) without accompanying anasarca, is in
children curable; in adults generally incurable by medicines. Tapping
may be used here with better chance for success than in more
complicated dropsies. Sometimes cured by vomiting.


                         ASCITES and ANASARCA.

§ 7. Incurable if dependant upon irremediably diseased viscera, or on
a gouty constitution, so debilitated, that the gouty paroxysms no
longer continue to be formed.

In every other situation the disease yields to diuretics and tonics.


                  ASCITES, ANASARCA, and HYDROTHORAX.

§ 8. Under this complication, though the symptoms admit of relief, the
restoration of the constitution can hardly be hoped for.


                                ASTHMA.

§ 9. The true spasmodic asthma, a rare disease--is not relieved by
Digitalis.

§ 10. In the greater part of what are called asthmatical cases, the
real disease is anasarca of the lungs, and is generally to be cured by
diuretics. (See § 1.) This is almost always combined with some
swelling of the legs.

§ 11. There is another kind of asthma, in which change of posture does
not much affect the patient. I believe it to be caused by an
infarction of the lungs. It is incurable by diuretics; but it is often
accompanied with a degree of anasarca, and so far it admits of relief.

Is not this disease similar to that in the limbs at (§3,) and also to
that of the abdominal viscera at (§2.)?


                         ASTHMA and ANASARCA.

§ 12. If the asthma be of the kind mentioned at (§§ 9 and 11,)
diuretics can only remove the accompanying anasarca. But if the
affection of the breath depends also upon cellular effusion, as it
mostly does, the patient may be taught to expect a recovery.


                          ASTHMA and ASCITES.

§ 13. A rare combination, but not incurable if the abdominal viscera
are sound. The asthma is here most probably of the anasarcous kind (§
10;) and this being seldom confined to the lungs only, the disease
generally appears in the following form.


                    ASTHMA, ASCITES, and ANASARCA.

§ 14. The curability of this combination will depend upon the
circumstances mentioned in the preceding section, taking also into the
account the strength or weakness of the patient.


                               EPILEPSY.

§ 15. In epilepsy dependant upon effusion, the Digitalis will effect a
cure; and in the cases alluded to, the dropsical symptoms were
unequivocal. It has not had a sufficient trial in my hands, to
determine what it can do in other kinds of epilepsy.


                            HYDATID DROPSY.

§ 16. This may be distinguished from common ascites, by the want of
evident fluctuation. It is common to both sexes. It does not admit of
a cure either by tapping or by medicine.


                            HYDROCEPHALUS.

§ 17. This disease, which has of late so much attracted the attention
of the medical world, I believe, originates in inflammation; and that
the water found in the ventricles of the brain after death, is the
consequence, and not the cause of the illness.

It has seldom happened to me to be called upon in the earlier stages
of this complaint, and the symptoms are at first so similar to those
usually attendant upon dentition and worms, that it is very difficult
to pronounce decidedly upon the real nature of the disease; and it is
rather from the failure of the usual modes of relief, than from any
other more decided observation, that we at length dare to give it a
name.

At first, the febrile symptoms are sometimes so unsteady, that I have
known them mistaken for the symptoms of an intermittent, and the cure
attempted by the bark.

In the more advanced stages, the diagnostics obtrude themselves upon
our notice, and put the situation of the patient beyond a doubt. But
this does not always happen. The variations of the pulse, so
accurately described by the late Dr. Whytt, do not always ensue. The
dilatation of the pupils, the squinting, and the aversion to light, do
not universally exist. The screaming upon raising the head from the
pillow or the lap, and the flushing of the cheeks, I once considered
as affording indubitable marks of the disease; but in a child which I
sometime since attended with Dr. Ash, the pulse was uniformly about
85, (except during the first week, before we had the care of the
patient.) The child never shewed any aversion to the light; never had
dilated pupils, never squinted, never screamed when raised from the
lap or taken out of the bed, nor did we observe any remarkable
flushing of the cheeks; and the sleep was quiet, but sometimes
moaning.

Frequent vomiting existed from the first, but ceased for several days
towards the conclusion. One or two worms came away during the illness,
and it was all along difficult to purge the child. Three days before
death, the right side became slightly paralytic, and the pupil of that
eye somewhat dilated.

After death, about two ounces and a half of water were found in the
ventricles of the brain, and the vessels of the dura mater were turgid
with blood.

If I am right as to the nature of hydrocephalus, that it is at first
dependant upon inflammation, or congestion; and that the water in the
ventricles is a consequence, and not a cause of the disease; the
curative intentions ought to be extremely different in the first and
the last stages.

It happens very rarely that I am called to patients at the beginning,
but in two instances wherein I was called at first, the patients were
cured by repeated topical bleedings, vomits, and purges.

Some years ago I mentioned these opinions, and the success of the
practice resulting from them, to Dr. Quin, now physician at Dublin.
That gentleman had lately taken his degree, and had chosen
hydrocephalus for the subject of his thesis in the year 1779. In this
very ingenious essay, which he gave me the same morning, I was much
pleased to find that the author had not only held the same ideas
relative to the nature of the disease, but had also confirmed them by
dissections.

In the year 1781, another case in the first stage demanded my
attention. The reader is referred back to Case LXIX for the
particulars.

I have not yet been able to determine whether the Digitalis can or
cannot be used with advantage in the second stage of the
hydrocephalus. In Case XXXIII. the symptoms of death were at hand; in
Case LXIX. the practice, though successful, was too complicated, and
in Case CLI. the medicine was certainly stopped too soon.

When we consider what enormous quantities of mercury may be used in
this complaint, without affecting the salivary glands, it seems
probable that other parts may be equally insensible to the action of
their peculiar stimuli, and therefore that the Digitalis ought to be
given in much larger doses in this, than in other diseases.


                             HYDROTHORAX.

§ 18. Under this name I also include the dropsy of the pericardium.

The intermitting pulse, and pain in the arms, sufficiently distinguish
this disease from asthma, and from anasarcous lungs.

It is very universally cured by the Digitalis.

§ 19. I lately met with two cases which had been considered and
treated as angina pectoris. They both appeared to me to be cases of
hydrothorax. One subject was a clergyman, whose strength had been so
compleatly exhausted by the continuance of the disease, and the
attempts to relieve it, that he did not survive many days. The other
was a lady, whose time of life made me suspect effusion. I directed
her to take small doses of the pulv. Digitalis, which in eight days
removed all her complaints. This happened six months ago, and she
remains perfectly well.


                       HYDROTHORAX and ANASARCA.

§ 20. This combination is very frequent, and, I believe, may always be
cured by the Digitalis.

§ 21. Dropsies in the chest either with or without anasarcous limbs,
are much more curable than those of the belly. Probably because the
abdominal viscera are more frequently diseased in the latter than in
the former cases.


                               INSANITY.

§ 22. I apprehend this disease to be more frequently connected with
serous effusion than has been commonly imagined.

§ 23. Where appearances of anasarca point out the true cause of the
complaint, as in cases XXIV. and XXXIV. the happiest effects may be
expected from the Digitalis; and men of more experience than myself in
cases of insanity, will probably employ it successfully in other less
obvious circumstances.


                         NEPHRITIS CALCULOSA.

§ 24. We have had sufficient evidence of the efficacy of the Foxglove
in removing the Dysuria and other symptoms of this disease; but
probably it is not in these cases preferable to the tobacco.[12]

    [Footnote 12: See an original and valuable treatise by Dr.
    Fowler, entitled, _Medical Reports of the Effects of
    Tobacco_.]


                            OVARIUM DROPSY.

§ 25. This species of encysted dropsy is not without difficulty
distinguishable from an ascites; and yet it is necessary to
distinguish them, because the two diseases require different treatment
and because the probality of a cure is much greater in one than in the
other.

§ 26. The ovarium dropsy is generally slow in its progress; for a
considerable time the patient though somewhat emaciated, does not lose
the appearance of health, and the urine flows in the usual quantity.
It is seldom that the practitioner is called in early enough to
distinguish by the feel on which side the cyst originated, and the
patients do not attend to that circumstance themselves. They generally
menstruate regularly in the incipient state of the disease, and it is
not until the pressure from the sac becomes very great, that the
urinary secretion diminishes. In this species of dropsy, the patients,
upon being questioned, acknowledge even from a pretty early date,
pains in the upper and inner parts of the thighs, similar to those
which women experience in a state of pregnancy. These pains are for a
length of time greater in one thigh than in the other, and I believe
it will be found that the disease originated on that side.

§ 27. The ovarium dropsy defies the power of medicine. It admits of
relief, and sometimes of a cure, by tapping. I submit to the
consideration of practitioners, how far we may hope to cure this
disease by a seton or a caustic.--In the LXIst case the patient was
too much reduced, and the disease too far advanced to allow of a cure
by any method; but it teaches us that a caustic may be used with
safety.

§ 28. When tapping becomes necessary, I always advise the adoption of
the waistcoat bandage or belt, invented by the late very justly
celebrated Dr. Monro, and described in the first volume of the Medical
Essays. I also enjoin my patients to wear this bandage afterwards,
from a persuasion that it retards the return of the disease. The
proper use of bandage, when the disorder first discovers itself,
certainly contributes much to prevent its increase.


                     OVARIUM DROPSY with ANASARCA.

§ 29. The anasarca does not appear until the encysted dropsy is very
far advanced. It is then probably caused by weakness and pressure. The
Digitalis removes it for a time.


                         PHTHISIS PULMONALIS.

§ 30. This is a very increasing malady in the present day. It is no
longer limited to the middle part of life: children at five years of
age die of it, and old people at sixty or seventy. It is not confined
to the flat-chested, the fair-skinned, the blue eyed, the
light-haired, or the scrophulous: it often attacks people with full
chests, brown skins, dark hair and eyes, and those in whose family no
scrophulous taint can be traced. It is certainly infectious. The very
strict laws still existing in Italy to prevent the infection from
consumptive patients, were probably not enacted originally without a
sufficient cause. We seem to be approaching to that state which first
made such restrictions necessary, and in the further course of time,
the disease will probably fall off again, both in virulency and
frequency.

§ 31. The younger part of the female sex are liable to a disease very
much resembling a true consumption, and from which it is difficult to
distinguish it; but this disease is curable by steel and bitters. A
criterion of true phthisis has been sought for in the state of the
teeth; but the exceptions to that rule are numerous. An unusual
dilatation of the pupil of the eye, is the most certain
characteristic.[13]

    [Footnote 13: Many years ago I communicated to my friend, Dr.
    Percival, an account of some trials of breathing fixed air in
    consumptive cases. The results were published by him in the
    second Vol. of his very useful Essays Medical and
    Experimental, and have since been copied into other
    publications. I take this opportunity of acknowledging that I
    suspect myself to have been mistaken in the nature of the
    disease there mentioned to have been cured. I believe it was
    a case of _Vomica_, and not a true _Phthisis_ that was cured.
    The Vomica is almost always curable. The fixed air corrects
    the smell of the matter, and very shortly removes the hectic
    fever. My patients not only inspire it, but I keep large jars
    of the effervescing mixture constantly at work in their
    chambers.]

§ 32. Sydenham asserts, that the bark did not more certainly cure an
intermittent, than riding did a consumption. We must not deny the
truth of an assertion, from such authority, but we must conclude that
the disease was more easily curable a century ago than it is at
present.

§ 33. If the Digitalis is no longer useful in consumptive cases, it
must be that I know not how to manage it, or that the disease is more
fatal than formerly; for it would be hard to deny the testimony cited
at page 9. I wish others would undertake the enquiry.

§ 34. When phthisis is accompanied with anasarca, or when there is
reason to suspect hydrothorax, the Digitalis will often relieve the
sufferings, and prolong the life of the patient.

§ 35. Many years ago, during an attendance upon Mr. B----, of a
consumptive family, and himself in the last stage of a phthisis; after
he was so ill as to be confined to his chamber, his breathing became
so extremely difficult and distressing, that he wished rather to die
than to live, and urged me warmly to devise some mode to relieve him.
Suspecting serous effusion to be the cause of this symptom, and he
being a man of sense and resolution, I fully explained my ideas to
him, and told him what kind of operation might afford him a chance of
relief; for I was then but little acquainted with the Digitalis. He
was earnest for the operation to be tried, and with the assistance of
Mr. Parrott, a very respectable surgeon of this place, I got an
opening made between the ribs upon the lower and hinder part of the
thorax. About a pint of fluid was immediately discharged, and his
breath became easy. This fluid coagulated by heat.

After some days a copious purulent discharge issued from the opening,
his cough became less troublesome, his expectoration less copious, his
appetite and strength returned, he got abroad, and the wound, which
became very troublesome, was allowed to heal.

He then undertook a journey to London; whilst there he became worse:
returned home, and died consumptive some weeks afterwards.


                          PUERPERAL ANASARCA.

§ 36. This disease admits of an easy and certain cure by the
Digitalis.

§ 37. This species of dropsy may originate from other causes than
child birth. In the beginning of last _March_, a gentleman at
Wolverhampton desired my advice for very large and painful swelled
legs and thighs. He was a temperate man, not of a dropsical habit, had
great pain in his groins, and attributed his complaints to a fall from
his horse. He had taken diuretics, and the strongest drastic
purgatives with very little benefit. Considering the anasarca as
caused by the diseased inguinal glands, I ordered common poultice and
mercurial ointment to the groins, three grains of pulv. fol. Digitalis
night and morning, and a cooling diuretic decoction in the day-time.
He soon lost his pain, and the swellings gradually subsided.


                               THE END.



                                BOOKS,

                 Printed for G. G. J. and J. ROBINSON,
                 Booksellers, Paternoster-Row, London.

                           AN ACCOUNT OF THE
                    Scarlet Fever and Sore Throat,
                       Or, SCARLATINA ANGINOSA;

               Particularly as it appeared at BIRMINGHAM
                           in the Year 1778.

                      By WILLIAM WITHERING, M. D.

                             Price 1s. 6d.


                          Also, Price 2s. 6d.

                        Outlines of MINERALOGY,
                    Translated from the original of
                   Sir TORBERN BERGMAN; with NOTES,

                      By WILLIAM WITHERING, M. D.

           Member of the Royal Medical Society at Edinburgh.


          In the Spring of the Year 1786, will be published,
               by the same Author, a New Edition of the

                        BOTANICAL ARRANGEMENT.

        With very great Additions; in Three Vols. large Octavo.



                          TRANSCRIBER'S NOTES

Obvious printer's errors have been fixed. For the detailed list,
please see below. The frontispiece has been moved from the beginning
of the book to the section explaining it.


                             Errors fixed

page xvi--typo fixed: changed 'afterterwards' to 'afterwards'
page 029--typo fixed: changed 'apetite' to 'appetite'
page 043--typo fixed: removed an extra 'in' after 'and she died'
page 062--typo fixed: changed 'Dovers' to 'Dover's'
page 095--typo fixed: changed 'ef' to 'of' after 'whilst the rest'
page 098--typo fixed: changed 'harrassed' to 'harassed'
page 103--typo fixed: changed 'Shiffnal' to 'Shiffnall'
page 106--typo fixed: changed 'Fox-glove' to 'Foxglove'
page 110--typo fixed: changed 'suceed' to 'succeed'
page 111--typo fixed: changed 'atttention' to 'attention'
page 114--typo fixed: changed 'disgreeable' to 'disagreeable'
page 115--typo fixed: removed an extra 'the' in front of '7th of April'
page 123--typo fixed: changed 'susspended' to 'suspended'
page 135--typo fixed: changed 'vomitted' to 'vomited'
page 141--typo fixed: changed 'contiued' to 'continued'
page 148--typo fixed: changed 'præcordia' to 'prœcordia'
page 158--typo fixed: changed 'spoonfulls' to 'spoonfuls'
page 163--typo fixed: changed 'mecine' to 'medicine'
page 164--typo fixed: changed 'slighest' to 'slightest'
page 166--typo fixed: changed 'ipecacohana' to 'ipecacoanha'
page 170--typo fixed: changed 'meridiaana' to 'meridiana'
page 196--typo fixed: removed an extra 'the' in front of 'viscera'
page 200--typo fixed: removed an extra 'and' after 'from asthma'





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