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 oftendeclining to do it, from apprehension of my own inability, I am atlength compelled to take up the pen, however unqualified I may stillfeel myself for the task. 

The use of the Foxglove is getting abroad, and it is better the worldshould derive some instruction, however imperfect, from my experience, than that the lives of men should be hazarded by its unguardedexhibition, or that a medicine of so much efficacy should be condemnedand 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 ofmanagement; but I am still far from thinking them perfect. 

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

To the Surgeons and Apothecaries, with whom I am connected inpractice, both in this town and at a distance, I beg leave to makethis public acknowledgment, for the assistance they so readilyafforded me, in perfecting some of the cases, and in communicating theevents of others. 

The ages of the patients are not always exact, nor would the labour ofmaking them so have been repaid by any useful consequences. In a fewinstances accuracy in that respect was necessary, and there it hasbeen 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 theshortest form I could contrive, in order to save time and labour. Someof them are given more in detail, when particular circumstances madesuch detail necessary; but the cases communicated by otherpractitioners, are given in their own words. 

I must caution the reader, who is not a practitioner in physic, thatno general deductions, decisive upon the failure or success of themedicine, can be drawn from the cases I now present to him. Thesecases must be considered as the most hopeless and deplorable thatexist; for physicians are seldom consulted in chronic diseases, tillthe usual remedies have failed: and, indeed, for some years, whilst Iwas less expert in the management of the Digitalis, I seldomprescribed it, but when the failure of every other method compelled meto 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 thatplant had not been discovered, by far the greatest part of thesepatients must have died. 

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

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

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

 _Birmingham, 1st July, _ 1785. 

 INTRODUCTION. 

The Foxglove is a plant sufficiently common in this island, and as wehave but one species, and that so generally known, I should havethought it superfluous either to figure or describe it; had I not morethan once seen the leaves of Mullein[1] gathered for those ofFoxglove. On the continent of Europe too, other species are found, andI have been informed that our species is very rare in some parts ofGermany, 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 the2d 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 comparativeexcellence. 

 _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 likelittle 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 leavesspear-shaped. _Leaf-stalks_ fleshy; bordered. 

FLOWERS. Numerous, mostly growing from one side of the stem andhanging down one over another. _Floral-leaves_ sitting, taper-pointed. The numerous purple blossoms hanging down, mottled within; as wide andnearly half as long as the finger of a common-sized glove, aresufficient marks whereby the most ignorant may distinguish this fromevery other British plant; and the leaves ought not to be gathered foruse 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 Idon't perceive that nauseous bitter which has been attributed to it. 

 * * * * *

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

I intended in this place to have traced the history of its effects indiseases from the time of Fuchsius, who first describes it, but I havebeen 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 noticesit. From him it receives its name of DIGITALIS, in allusion to theGerman name of _Fingerhut_, which signifies a finger-stall, from theblossoms 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 ofomalade, into which the leaves of this, with those of several otherplants, had entered as an ingredient, found themselves muchindisposed, and were presently after attacked with vomitings. DODONÆUS_pempt. _ 170. 

It is a medicine which is proper only for strong constitutions, as itpurges very violently, and excites excessive vomitings. RAY. _hist. _767. 

BOERHAAVE judges it to be of a poisonous nature, _hist. Plant. _ butDR. ALSTON ranks it among those indigenous vegetables, “which, thoughnow disregarded, are medicines of great virtue, and scarcely inferiorto 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 turkeypouts had been killed by being fed with Foxglove leaves, instead ofmullein, 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 nourishmentrestored him to health in eight days. 

Being then determined to push the experiment further, he chopped somemore leaves, mixed them with bran, and gave them to a vigorous turkeycock which weighed seven pounds. This bird soon appeared drooping andmelancholy; his feathers stared, his neck became pale and retracted. The leaves were given him for four days, during which time he tookabout half a handful. These leaves had been gathered about eight days, and the winter was far advanced. The excrements, which are naturallygreen 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 himso 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 himdown; in the intervals he walked as if drunk; he did not attempt toperch, he uttered plaintive cries. At length he refused allnourishment. On the fifth or sixth day the excrements became as whiteas chalk; afterwards yellow, greenish, and black. On the eighteenthday he died, greatly reduced in flesh, for he now weighed only threepounds. 

On opening him we found the heart, the lungs, the liver, andgall-bladder shrunk and dried up; the stomach was quite empty, but notdeprived of its villous coat. _Hist. De l'Academ. _ 1748. _p. _ 84. 

EPILEPSY. --“It hath beene of later experience found also to beeffectual against the falling sicknesse, that divers have been curedthereby; for after the taking of the _Decoct. Manipulor. Ii. C. Polypod. Quercin. Contus. ℥iv. In cerevisia_, they thathave been troubled with it twenty-six years, and have fallen once in aweeke, or two or three times in a moneth, have not fallen once infourteen 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 beavaileable for the King's Evill. ” PARK. P. 654. 

Several hereditary instances of this disease said to have been curedby it. AEREAL INFLUENCES, _p. _ 49, 50, quoted by HALLER, _hist. N. _330. 

A man with _scrophulous ulcers_ in various parts of the body, andwhich in the right leg were so virulent that its amputation wasproposed, cured by _succ. Express. Cochl. I. Bis intra xiv. Dies, in½ pintæ cerevisiæ calidæ_. 

The leaves remaining after the pressing out of the juice, were appliedevery 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 thefingers_, much relieved; but the medicine was left off, on account ofits violent effects on the constitution. _Ib. P. _ 42 quoted as above. 

A man with _scrophulous tumour of the right elbow_, attended for threeyears _with excruciating pains_, was nearly cured by four doses of thejuice taken once a month. _Ib. P. _ 43. As above. 

The physicians and surgeons of the Worcester Infirmary have employedit 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 wellexternally as internally, but their experiments did not lead them toobserve any other properties in it, than those of a highly nauseatingmedicine and drastic purgative. 

WOUNDS. In considerable estimation for the healing all kinds ofwounds, _Lobel. Adv. _ 245. 

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

DOCTOR BAYLIES, physician to his Prussian Majesty, informed me, whenat Berlin, that he employed it with great success in caries, andobstinate sore legs. 

DYSPNŒA _Pituitosa_ Sauvages i. 657. --“Boiled in water, or wine, and drunken doth cut and consume the thicke toughnesse of grosse, andslimie flegme, and naughtie humours. The same, or boiled with honiedwater or sugar, doth scoure and clense the brest, ripeneth andbringeth foorth tough and clammie flegme. It openeth also the stoppageof the liver spleene and milt, and of the inwarde parts. ” GERARDEhist. Ed. I p. 647. 

“Whensoever there is need of a rarefying or extenuating of toughflegme or viscous humours troubling the chest, --the decoction or juicehereof made up with sugar or honey is availeable, as also to clenseand purge the body both upwards and downwards sometimes, of toughflegme, and clammy humours, notwithstanding that these qualities arefound to bee in it, there are but few physitions in our times that putit 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 youhad met with in curing dropsies by means of the fol. Digitalis, whichyou then considered as a more certain diuretic than any you had evertried. Some time afterwards, Mr. Russel, surgeon, of Worcester, havingheard of the success which had attended some cases in which you hadgiven it, requested me to obtain for him any information you might beinclined to communicate respecting its use. In consequence of thisapplication, 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 theDigitalis--I despair of pleasing myself or instructing others, in asubject so difficult. It is much easier to write upon a disease thanupon a remedy. The former is in the hands of nature, and a faithfulobserver, with an eye of tolerable judgment, cannot fail to delineatea likeness. The latter will ever be subject to the whims, theinaccuracies, 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 precautionsnecessary to its success, to the Medical Society at Edinburgh. ”--Inthe course of that year, the Digitalis was prescribed in the EdinburghInfirmary, by Dr. Hope, and in the following year, whilst I was Clerkto Dr. Home, as Clinical Professor, I had a favourable opportunity ofobserving its sensible effects. 

In one case in which it was given properly at first, the urine beganto flow freely on the second day. On the third, the swellings began tosubside. The dose was then increased more than _quadruple_ in thetwenty-four hours. On the fifth day sickness came on, and muchpurging, but the urine still increased though the pulse sunk to 50. Onthe 7th day, a _quadruple_ dose of the infusion was ordered to betaken every third hour, so as to bring on nausea again. The pulse fellto forty-four, and at length to thirty-five in a minute. The patientgradually sunk and died on the sixteenth day; but previous to herdeath, for two or three days, her pulse rose to near one hundred. --Itis needless to observe to you, how widely the treatment of this casediffered from the method which you have found so successful. 

 OF THE PLATE. 

The figure of the Foxglove, facing the Title Page, is copied by thepermission and under the inspection of Mr. Curtis, from his admirablework, entitled FLORA LONDINENSIS. The accuracy of the drawings, thebeauty of the colouring, the full descriptions, the accurate specificdistinctions, and the uses of the different plants, cannot fail torecommend that work to the patronage of all who are interested in theencouragement 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 areadapted to cure; so their peculiar qualities have no certaindependence upon their external configuration. Their chemicalexamination by fire, after an immense waste of time and labour, havingbeen found useless, is now abandoned by general consent. Possiblyother modes of analysis will be found out, which may turn to betteraccount; but we have hitherto made only a very small progress in thechemistry of animal and vegetable substances. Their virtues musttherefore be learnt, either from observing their effects upon insectsand quadrupeds; from analogy, deduced from the already known powers ofsome of their congenera, or from the empirical usages and experienceof the populace. 

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

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

In the year 1775, my opinion was asked concerning a family receipt forthe cure of the dropsy. I was told that it had long been kept a secretby an old woman in Shropshire, who had sometimes made cures after themore regular practitioners had failed. I was informed also, that theeffects produced were violent vomiting and purging; for the diureticeffects seemed to have been overlooked. This medicine was composed oftwenty or more different herbs; but it was not very difficult for oneconversant in these subjects, to perceive, that the active herb couldbe 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 duringone hour in a day. This practice, which I continued until we had anHospital opened for the reception of the sick poor, gave me anopportunity of putting my ideas into execution in a variety of cases;for the number of poor who thus applied for advice, amounted tobetween two and three thousand annually. I soon found the Foxglove tobe a very powerful diuretic; but then, and for a considerable timeafterwards, I gave it in doses very much too large, and urged itscontinuance too long; for misled by reasoning from the effects of thesquill, which generally acts best upon the kidneys when it excitesnausea, I wished to produce the same effect by the Foxglove. In thismode of prescribing, when I had so many patients to attend to in thespace of one, or at most of two hours, it will not be expected that Icould be very particular, much less could I take notes of all thecases which occurred. Two or three of them only, in which the medicinesucceeded, I find mentioned amongst my papers. It was from this kindof experience that I ventured to assert, in the Botanical Arrangementpublished in the course of the following spring, that the Digitalispurpurea “merited more attention than modern practice bestowed uponit. ”

I had not, however, yet introduced it into the more regular mode ofprescription; but a circumstance happened which accelerated thatevent. My truly valuable and respectable friend, Dr. Ash, informed methat Dr. Cawley, then principal of Brazen Nose College, Oxford, hadbeen cured of a Hydrops Pectoris, by an empirical exhibition of theroot of the Foxglove, after some of the first physicians of the agehad declared they could do no more for him. I was now determined topursue my former ideas more vigorously than before, but was too wellaware 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 differentseasons of the year; but I expected, if gathered always in onecondition of the plant, viz. When it was in its flowering state, andcarefully dried, that the dose might be ascertained as exactly as thatof any other medicine; nor have I been disappointed in thisexpectation. The more I saw of the great powers of this plant, themore it seemed necessary to bring the doses of it to the greatestpossible accuracy. I suspected that this degree of accuracy was notreconcileable with the use of a _decoction_, as it depended not onlyupon the care of those who had the preparation of it, but it was easyto conceive from the analogy of another plant of the same naturalorder, the tobacco, that its active properties might be impaired bylong boiling. The decoction was therefore discarded, and the_infusion_ substituted in its place. After this I began to use theleaves in _powder_, but I still very often prescribe the infusion. 

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

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

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

In the month of _November_ 1777, in consequence of an application fromthat very celebrated surgeon, Mr. Russel, of Worcester, I sent him thefollowing account, which I choose to introduce here, as shewing theideas I then entertained of the medicine, and how much I was mistakenas to its real dose. --“I generally order it in decoction. Three dramsof the dried leaves, collected at the time of the blossoms expanding, boiled in twelve to eight ounces of water. Two spoonfuls of thismedicine, given every two hours, will sooner or later excite a nausea. I have sometimes used the green leaves gathered in winter, but then Iorder three times the weight; and in one instance I used three ouncesto a pint decoction, before the desired effect took place. I considerthe Foxglove thus given, as the most certain diuretic I know, nor doits diuretic effects depend merely upon the nausea it produces, for incases where squill and ipecac. Have been so given as to keep up anausea several days together, and the flow of urine not taken place, Ihave found the Foxglove to succeed; and I have, in more than oneinstance, given the Foxglove in smaller and more distant doses, sothat the flow of urine has taken place without any sensible affectionof the stomach; but in general I give it in the manner firstmentioned, and order one dose to be taken after the sicknesscommences. I then omit all medicines, except those of the cordial kindare wanted, during the space of three, four, or five days. By thistime the nausea abates, and the appetite becomes better than it wasbefore. Sometimes the brain is considerably affected by the medicine, and indistinct vision ensues; but I have never yet found any permanentbad effects from it. ”--

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

“I have often been obliged to evacuate the water repeatedly in thesame patient, by repeating the decoction; but then this has been atsuch distances of time as to allow of the interference of othermedicines and a proper regimen, so that the patient obtains in the enda perfect cure. In these cases the decoction becomes at length so verydisagreeable, that a much smaller quantity will produce the effect, and I often find it necessary to alter its taste by the addition ofAq. Cinnam. Sp. Or Aq. Juniper. Composita. ”

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

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

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

In _February_ 1779, my friend, Dr. Stokes, communicated to the MedicalSociety 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 theyear 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 inthe Hospital at Edinburgh. Dr. Duncan also tells me, that the latevery ingenious and accomplished Mr. Charles Darwin, informed him ofits being used by his father and myself, in cases of Hydrothorax, andthat he has ever since mentioned it in his lectures, and sometimesemployed it in his practice. 

At length, in the year 1783, it appeared in the new edition of theEdinburgh Pharmacopœia, into which, I am told, it was received inconsequence of the recommendation of Dr. Hope. But from which, I amsatisfied, it will be again very soon rejected, if it should continueto be exhibited in the unrestrained manner in which it has heretoforebeen used at Edinburgh, and in the enormous doses in which it is nowdirected in London. 

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

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

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

I have lately been told, that a person in the neighbourhood ofWarwick, possesses a famous family receipt for the dropsy, in whichthe Foxglove is the active medicine; and a lady from the western partof Yorkshire assures me, that the people in her country often curethemselves of dropsical complaints by drinking Foxglove tea. Inconfirmation of this, I recollect about two years ago being desired tovisit a travelling Yorkshire tradesman. I found him incessantlyvomiting, his vision indistinct, his pulse forty in a minute. Uponenquiry it came out, that his wife had stewed a large handful of greenFoxglove 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 asthmaticaffection. This good woman knew the medicine of her country, but notthe dose of it, for her husband narrowly escaped with his life. 

It is probable that this rude mode of exhibiting the Foxglove has beenmore general than I am at present aware of; but it is wonderful thatno author seems to have been acquainted with its effects as adiuretic. 

 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 indropsical cases. The patients were such as applied at my house foradvice gratis. I cannot pretend to charge my memory with particularcases, or particular effects, and I had not leisure to make notes. Upon the whole, however, it may be concluded, that the medicine wasfound useful, or I should not have continued to employ it. 

 CASE I. 

_December_ 8th. A man about fifty years of age, who had formerly beena builder, but was now much reduced in his circumstances, complainedto me of an asthma which first attacked him about the latter end ofautumn. His breath was very short, his countenance was sunken, hisbelly large; and, upon examination, a fluctuation in it was veryperceptible. His urine for some time past had been small in quantity. I directed a decoction of Fol. Digital. Recent. Which made him verysick, the sickness recurring at intervals for several days, duringwhich time he made a large quantity of water. His breath graduallydrew easier, his belly subsided, and in about ten days he began toeat 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. Itpurged him smartly, but did not relieve him. An opiate was now orderedwith each dose of the medicine, which then acted upon the kidneys veryfreely, and he soon lost all his complaints. 

 CASE III. 

_March_ 15th. A poor boy, about nine years of age, was brought for myadvice. His countenance was pale, his pulse quick and feeble, his bodygreatly emaciated, except his belly, which was very large, and, uponexamination, contained a fluid. The case had been considered asarising from worms. He was directed to take the decoction of Digitalisnight and morning. It operated as a diuretic, never made him sick, andhe got well without any other medicine. 

 CASE IV. 

_July_ 25th. Mrs. H----, of A----, near N----, between forty and fiftyyears of age, a few weeks ago, after some previous indisposition, wasattacked by a severe cold shivering fit, succeeded by fever; greatpain 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 forher, but, between the 15th of _June_, and 25th of _July_, the Doctor, at his different visits, gave her various medicines of thedeobstruent, 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'shouse. I found her nearly in a state of suffocation; her pulseextremely weak and irregular, her breath very short and laborious, hercountenance sunk, her arms of a leaden colour, clammy and cold. Shecould not lye down in bed, and had neither strength nor appetite, butwas extremely thirsty. Her stomach, legs, and thighs were greatlyswollen; her urine very small in quantity, not more than a spoonful ata time, and that very seldom. It had been proposed to scarify herlegs, 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 graduallyincreased from 15 to 40 grains, but such was the insensible state ofher stomach for the last few days, that even those very large dosesfailed to make her sick, and consequently purged her. In thissituation of things I knew of nothing likely to avail us, except theDigitalis: but this I hesitated to propose, from an apprehension thatlittle could be expected from any thing; that an unfavourabletermination would tend to discredit a medicine which promised to beof great benefit to mankind, and I might be censured for aprescription which could not be countenanced by the experience of anyother regular practitioner. But these considerations soon gave way tothe desire of preserving the life of this valuable woman, andaccordingly I proposed the Digitalis to be tried; adding, that Isometimes had found it to succeed when other, even the most judiciousmethods, had failed. Dr. Darwin very politely, acceded immediately tomy proposition, and, as he had never seen it given, left thepreparation and the dose to my direction. We therefore prescribed asfollows:

 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, andacted very powerfully upon the kidneys, for within the firsttwenty-four hours she made upwards of eight quarts of water. The senseof fulness and oppression across her stomach was greatly diminished, her breath was eased, her pulse became more full and more regular, andthe 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 guiacumshavings, with pills of myrrh and white vitriol; and, if costive, apill with calomel and aloes. To these propositions I gave a readyassent. 

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

_August_ 1st. I found the patient perfectly free from every appearanceof dropsy, her breath quite easy, her appetite much improved, butstill very weak. Having some suspicion of a diseased liver, I directedpills of soap, rhubarb, tartar of vitriol, and calomel to be takentwice a day, with a neutral saline draught. 

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

_September_ 10th. From this time the management of the case fellentirely under my direction, and perceiving symptoms of effusion goingforwards, I desired that a solution of merc. Subl. Corr. Might begiven twice a day. 

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

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

I have been more particular in the narrative of this case, partlybecause Dr. Darwin has related it rather imperfectly in the notes tohis son's posthumous publication, trusting, I imagine, to memory, andpartly because it was a case which gave rise to a very general use ofthe medicine in that part of Shropshire. 

 CASE V. 

_December_ 10th. Mr. L----, Æt. 35. Ascites and anasarca, theconsequence of very intemperate living. After trying squill and othermedicines to no purpose, I directed a decoction of the Fol. Digital. Recent. Six drams to a pint; an eighth part to be taken every fourthhour. This made him sick, and produced a copious flow of urine, butnot enough to remove all the dropsical symptoms. After a fortnight astronger decoction was ordered, and, upon a third trial, as the winteradvanced, it became necessary to use four ounces to the pintdecoction; and thus he got free from all his complaints. 

In _October_ 1777, in consequence of having pursued his intemperatemode of living, his dropsy returned, accompanied by evident marks ofdiseased viscera. A decoction of two drams of Fol. Digital. Siccat. Toa pint, once more removed the dropsy. He took a wine glass full thricea day. 

In _January_ 1778, I was desired to visit him again. I found he hadgone on in his usual intemperate life, his countenance jaundiced, andthe dropsy coming on apace. After giving some deobstruent medicines, Iagain directed the Digitalis, which again emptied the water; but hedid not survive many weeks. 

 1777. 

 CASE VI. 

_February_--. Mrs. M----, Æt. 45. Ascites and anasarca, but not muchotherwise diseased, and well enough to walk about the house, and seeafter her family affairs. I thought this a fair case for a trial ofthe 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 thethird day after my first visit she suddenly fell down, and expired. Upon enquiry I found she had not taken any of the medicine; for thesnow had lain so deep upon the ground, that the apothecary had notbeen able to procure it. Had the medicine been given in a caseseemingly so favourable as this, and had the patient died under itsuse, is it not probable that the death would have been attributed toit?

 CASE VII. 

_February_ 11th. Mr. E----, of W----, Æt. 61. Hydrothorax, ascites andanasarca, consequences of hard drinking. He had been attended for sometime by a physician in his neighbourhood, who had treated his casewith the usual remedies, but without affording him any relief; norcould I expect to succeed better by any other medicine than theDigitalis. The dried leaves were not to be had; and the green ones atthis season being very uncertain in their strength, I ordered fourounces of the roots in a pint decoction, and directed three spoonfulsto be given every fourth hour, until it either excited nausea, or afree discharge of urine; both these effects took place nearly at thesame time: he made a large quantity of water, the swellings subsidedvery considerably, and his breath became easy. Eight days afterwardshe began upon a course of bitters and deobstruents. The dropsicalsymptoms soon increased again, but he had suffered so much from theseverity 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 wellacquainted with the management and real doses of the medicine, whichwas certainly in this instance made very much too strong; andnotwithstanding the caution to stop the further exhibition whencertain effects should take place, it seems the quantity previouslyswallowed 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 andsemi-transparent, [5] with pain in both groins. After a purge ofcalomel and rhubarb, ung. Merc. Was ordered to be rubbed upon thegroins, 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 abatedthe distension of the legs: in a fortnight the swelling was gone; butsome days after leaving her bed, her legs swelled again about theancles, which was removed by another bottle of the decoction on the21st 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 severalyears continuance, but now dropsical to a great degree. Took severalmedicines without relief, and then tried the Digitalis, but with nobetter success. 

 CASE X. 

_April_ 10th. G--G----, Æt. 70. Asthma and anasarca. Took a decoctionof the fresh leaves of the Digitalis, which produced violent sickness, but no immediate evacuation of water. After the sickness had ceasedaltogether, 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 beenaffected since _November_ last with ascites and anasarca, for which hehad taken several medicines without benefit. A decoction of the recentleaves of the Digitalis was then directed, an ounce and half to apint, one eighth of which I ordered to be given every fourth hour. Afew doses brought on great nausea, indistinct vision, and a great flowof urine, so as presently to empty him of all the dropsical water. Indeed the evacuation was so rapid and so complete, that it becamenecessary to apply a bandage round the belly, and to support him withcordials. 

In something more than a year and a half, his dropsy returned, but theDigitalis did not then succeed to our wishes. In _August_, 1779, hewas 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, andanasarcous legs and thighs. For three months in the beginning of thisyear she had been under the care of Dr. Darwin, who at different timeshad given her blue vitriol, elaterium, and calomel; decoction ofpareira brava, and guiacum wood, with tincture of cantharides; oxymelof squills, decoction of parsley roots, &c. Finding no relief, shediscontinued the use of medicines, until the urgency of her symptomsinduced her to ask my advice about the end of _August_. She wasgreatly emaciated, and had almost a total loss of appetite. I firsttried small doses of Merc. Sublim. Corr. In solution, with decoctionof burdock roots, and blisters to the thighs. No advantage attendingthe use of this plan, I directed a decoction of Fol. Digit. A dram andhalf to a pint; one ounce to be taken twice a day. It presentlyreduced the anasarcous swellings, but made no alteration in thedistension of the abdomen. 

 CASE XIII. 

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

 1778. 

 CASE XIV. 

_February_ 8th. Mr. R---- of K----. Had formerly suffered much fromgout, 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 apothecarywithout advantage. I ordered him decoction of Digitalis, and acordial; but he survived only a few days. 

 CASE XV. 

_March_ 13th. Mr. M----, Æt. 54. A thorax greatly deformed; asthmathrough the winter, succeeded by dropsy in belly and legs. Pulse verysmall; face leaden coloured; cough almost continual. Decoction ofseneka 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 stillincreasing, decoction of Digitalis was then directed, which relievedhim in a few days; but his complaints returned again, and he died inthe 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 hopesof gaining some relief from the distress occasioned by the dropsicalsymptoms; but none of them were effectual. He was then attended byanother 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 didnot increase the quantity of urine. She was afterwards relieved bytapping. 

 CASE XVIII. 

_October_ 28th. R---- W----, Æt. 33. Ascites and universal anasarca;countenance quite pale and bloated; appetite none, and the little foodhe 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 hoursuntil it should make him sick. This was on Wednesday. The fifth dosemade him vomit. On Thursday afternoon he vomited again very freely, without having taken any more of the medicine. On Friday and Saturdayhe made more water than he had done for a week before, and theswellings of his face and body were considerably abated. He wasdirected to omit all medicine so long as the urine continued to flowfreely, and also to keep an account of the quantity he made intwenty-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, buthis appetite is better than he has known it for a long time. Noswelling remains but about his ancles, extending at night half way uphis 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 ithad no other effect than to make him sick. 

 1779. 

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

 CASE XX. 

_January_ 1st. Mr. H----. Hydrops Pectoris; legs and thighsprodigiously anasarcous; a very distressing sense of fulness andtightness across his stomach; urine in small quantity; pulseintermitting; breath very short. 

He had taken various medicines, and been blistered, but withoutrelief. His complaints continuing to increase, I directed an infusionof Digitalis, which made him very sick; acted powerfully as adiuretic, and removed all his symptoms. 

About three months afterwards he was out upon a journey, and, aftertaking cold, was suddenly seized with difficulty of breathing, andviolent palpitation of his heart: he sent for me, and I ordered theinfusion as before, which very soon removed his complaints. He is nowactive and well; but, whenever he takes cold, finds some return ofdifficult breathing, which he soon removes by a dose or two of theinfusion. 

 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 orfourth hour. It made her violently sick, acted powerfully as adiuretic, set her breath perfectly at liberty, and carried off theswelling of her legs; when she was nearly emptied, she became solanguid, that I thought it necessary to order cordials, and a largeblister to her back. Mr. Ward, who attended as her apothecary, tellsme 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. Alarge corpulent man, and a hard drinker: he had repeatedly sufferedunder complaints of this kind, but had been always relieved by thejudicious assistance of Dr. Ash. In the present instance, however, notfinding relief as usual from the prescriptions of my worthy friend, hesent for me; after examining into his situation, and informing myselfwhat had been done to relieve him, I was satisfied that the Digitaliswas the only medicine from which I had any thing to hope. It wastherefore directed; but another patient requiring my assistance at adistance from town, I desired he would not begin the medicine before Ireturned, which would be early on the third day; for I was well awareof the difficulties before me, and that he would inevitably sink undertoo 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 uponhis breast, and he died. 

This case, as well as case VI. Is mentioned with a view to demonstrateto younger practitioners, how sudden and unexpected the deaths ofdropsical patients sometimes happen, and how cautious we should be inassigning causes for effects. 

 CASE XXIII. 

_August_ 31st. Mr. C----, Æt. 57. Diseased viscera, jaundice, ascitesand anasarca. After trying calomel, saline draughts, jallap purges, chrystals of tartar, pills of gum ammoniac, squills, and soap, salsuccini, eleterium, &c. Infusion of Digitalis was directed, whichremoved all his urgent symptoms, and he recovered a pretty good stateof health. 

 CASE XXIV. 

_September_ 11th. I was desired to visit Mr. L----, Æt. 63; a middlesized man; rather thin; not habitually intemperate; found him in bed, where he had been for three days. He was in a state of furiousinsanity, and had been gradually losing his reason for ten daysbefore, but was not outrageous the first week; his apothecary hadgiven him ten grains of emetic tartar, a dram of ipecacoanha, and anounce of tincture of jallap, in the space of a few hours, whichscarcely made him sick, and only occasioned a stool or two; uponenquiring into the usual state of his health, I was told that he hadbeen troubled with some difficulty of breathing for thirty years past, but for the nine last years this complaint had increased, so that hewas often obliged to sit up the greater part of the night; and, forthe last year, the sense of suffocation was so great, when he laydown, that he often sat up for a week together. His father died of anasthma before he was fifty. A few years ago, at an election, where hedrank more than usual, his head was affected as now, but in a slighterdegree, and his asthmatic symptoms vanished; and now, notwithstandinghe has been several days in bed, he feels not the least difficulty inbreathing. 

Apprehending that the insanity might be owing to the same cause whichhad heretofore occasioned the asthma, and that this cause was water; Iordered a decoction of the Fol. Siccat Digital, three drams to half apint; three spoonfuls to be taken every third hour: the fourth dosemade him sick; the medicine was then stopped; the sickness continuedat intervals, more or less, for four days, during which time he made agreat quantity of water, and gradually became more rational. On thefifth day his appetite began to return, and the sickness ceased, butthe flow of urine still continued. 

A week afterwards I saw him again, and examined him particularly; hishead was then perfectly rational, appetite very good, breath quiteeasy, permitting him to lie down in bed without inconvenience, makesplenty of water, coughs a little, and expectorates freely. He took noother medicine, except a little rhubarb when costive. 

 CASE XXV. 

_September_ 15th. Mr. J. R----, Æt. 50. Subject to an asthmaticalcomplaint for more than twenty years, but was this year much worsethan 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 ascould be borne, but without any good effect. _September_ 15th, aninfusion 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 theskin. They looked pale, and almost transparent. The case being similarto that related at No. VIII. I determined upon a similar method oftreatment; but as this patient had an inflammatory sore throat also, Iwished to get that removed first, and in three or four days it wasdone. I then directed an infusion of Digitalis, which soon increasedthe urinary secretion, and reduced the swellings, without anydisturbance of her stomach. 

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

 CASE XXVII. 

_October_ 7th. Mr. F----, a little man, with a spine and thoraxgreatly deformed; for more than a year past had complained ofdifficult respiration, and a sense of fulness about his stomach; thesecomplaints increasing, his abdomen gradually enlarged, and afluctuation in it became perceptible. He had no anasarca, noappearance of diseased viscera, and no great paucity of urine. Purgesand diuretics of different kinds affording him no relief, myassistance was desired. After trying squill medicines without effect, he was ordered to take Pulv. Fol. Digital. In small doses. Theseproducing no sensible effect, the doses were gradually increased untilnausea was excited; but there was no alteration in the quantity ofurine, and consequently no relief to his complaints. I then advisedtapping, but he would not hear of it; however, the distress occasionedby the increasing fulness of his belly at length compelled him tosubmit to the operation on the 20th of _November_. It was necessary todraw 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 toprevent the return of the disease, but nothing seemed to avail. In theoperation of _February_ 23d, his strength was so much reduced, thatthe water was not entirely removed; and on the 9th of March, beforehis belly was half emptied, notwithstanding the most judiciousapplication of bandage, his debility was so great, that it was judgedprudent to stop. After being placed in bed, the faintness and sicknesscontinued; severe rigors ensued, and violent vomiting; thesevomitings continued through the night, and in the intervals he lay ina state nearly approaching to syncope. The next day I found him withnearly the same symptoms, but remarked that the quantity of fluid hehad thrown up was very much more than what he had taken, and that hisabdomen was considerably fallen; in the course of two or three daysmore, he discharged the whole of the effused fluid; his strength andappetite gradually returned, and he was in all respects much betterthan he had been before the last operation. 

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

 1780. 

 CASE XXVIII. 

_January_ 11th. Captain V----, Æt. 42. Had suffered much from residingin hot climates, and drinking very freely, particularly rum in largequantity. He had tried many physicians before I saw him, but nothingrelieved him. I found him greatly emaciated, his countenance of abrownish yellow; no appetite, extremely low, distressing fulnessacross his stomach; legs and thighs greatly swollen; pulse quick, andvery feeble; urine in small quantity. As he had evidently only a fewdays to live, I ordered him nothing but a solution of sal diureticusin cinnamon water, slightly acidulated with syrup of lemons. Thismedicine effecting no change, and his symptoms becoming daily moredistressing, I directed an infusion of Digitalis. A few dosesoccasioned a copious flow of urine, without sickness or any otherdisturbance. The medicine was discontinued; and the next day the urinecontinuing to be secreted very plentifully, he lost his mostdistressing complaints, was in great spirits, and ate a pretty gooddinner. In the evening, as he was conversing chearfully with somefriends, he stooped forwards, fell from his chair, and died instantly. Had he been in bed, I think there is reason to believe this fatalsyncope, if such it was, would not have happened. 

 CASE XXIX. 

_February_ 6th. Mr. H----, Æt. 63. A corpulent man; had suffered muchfrom 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. Aninfusion of Digitalis removed these complaints, and after beingconfined for the greater part of the winter, he was well enough to getabroad again. In the course of a month the dropsical symptomsreturned, and were again removed by the same medicine. Bitters andtonics were now occasionally prescribed, but his debility graduallyincreased, and he died some time afterwards; but the dropsy neverreturned. 

 CASE XXX. 

_February_ 17th. Mr. D----, Æt. 50. Ascites and anasarca, withsymptoms of phthisis. He had been a very hard drinker. The infusumDigitalis removed his dropsical symptoms, and he was sufficientlyrecovered to take a journey; but as the spring advanced, theconsumptive symptoms increased, and he died soon afterwards, perfectlyemaciated. 

 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 verygreat degree; pale and semi-transparent. I found her extremely faint, her pulse very small and slow; vomiting violently, and frequentlypurging. She was attended by a gentleman who had seen me give theDigitalis in a similar case of swelled legs after a lying-in (see CaseXXVI. ) about six months before. He had not considered that thispatient was delicate, the other robust; nor had he attended to stopthe exhibition of the medicine when its effects began to take place. The great distress of her situation was evidently owing to theimprudent and unlimited use of the Digitalis. I was very apprehensivefor her safety; ordered her cordials and volatiles; a free supply ofwine, chamomile tea with brandy for common drink, and blisters. Thenext day the situation of things was much the same, but with all thisdisturbance no increased secretion of urine. The same methods werecontinued; an opiate ordered at night, and liniment. Volatile uponflannel applied to the groins, as she now complained of great pain inthose parts. The third day the nausea was less urgent, the vomitingsless frequent, the pulse not so slow. Camphorated spirit, with causticvolatile alkaly, was applied to the stomach, emulsion given for commondrink, and the same medicines repeated. From this time, the intervalsbecame gradually longer between the fits of vomiting, the flow ofurine increased, the swellings subsided, the appetite returned, andshe recovered perfectly. 

 CASE XXXII. 

_March_ 16th. Mr. D----, Æt. 70. A paralytic stroke had for some weekspast impaired the use of his left side, and he complained much of hisbreath, and of a straitness across his stomach; at length, an anasarcaand ascites appearing, I had no doubt as to the cause of the formersymptoms; but, upon account of his advanced age, and the paralyticaffection, I hesitated to give the Digitalis, and therefore tried theother usual modes of practice, until at length his breath would notpermit him to lie down in bed, and his other symptoms increased sorapidly as to threaten a speedy dissolution. In this dilemma Iventured to prescribe an infusion of the Fol. Siccat. Digital. Whichpresently excited a copious flow of urine, and made him very sick; astrong infusion of chamomile flowers, with brandy, relieved thesickness, but the diuretic effects of the Digitalis continuing, hisdropsy was removed, and his breathing became easy. The palsy remainednearly in the same state. He lived until _August_ 1782, and withoutany return of the dropsy. 

 CASE XXXIII. 

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

 CASE XXXIV. 

_March_ 19th. A young lady, soon after the birth of an illegitimatechild, 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 inquantity, and the insanity remained nearly the same. As it had beenvery difficult to procure evacuations by any means, I ordered half anounce of Fol. Digital. Siccat. In a pint infusion, and directed twospoonfuls to be given every two hours: this had the desired effect;the dropsy and the insanity disappeared together, and she hadafterwards no other medicine but some aperient pills to takeoccasionally. 

 CASE XXXV. 

_April_ 12th. Mr. R----, Æt. 32. For the last three or four years hadhad more or less of what was considered as asthma;--it appeared to meHydrothorax. I directed an infusion of Digitalis, which presentlyremoved his complaints. In _June_ following he had a relapse, and tooktwo grains of the Pulv. Fol. Digit. Three times a day, which cured himafter taking forty grains, and he has never had a return. 

 CASE XXXVI. 

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

 CASE XXXVII. 

_May_ 26th. R---- B----, Æt. 12. Scrophulous, consumptive, and atlength anasarcous. Took Infus. Digital. Without advantage. Died the_July_ following. 

 CASE XXXVIII. 

_June_ 4th. Mrs. S----, of W----, Æt 49. Ascites and anasarca. Hadtaken many medicines; first from her apothecary, afterwards by thedirection of a very judicious and very celebrated physician, butnothing retarded the increase of the dropsy. I first saw her alongwith the physician mentioned above, on the 14th of _May_; we directedan electuary of chrystals of tartar, and Seltzer water for commondrink; this plan failing, as others had done before, we ordered theInfus. Digital. Which in a few days nearly removed the dropsy. I thenleft her to the care of her physician; but her constitution was toomuch impaired to admit of restoration to health, and I understand shedied a few weeks afterwards. 

 CASE XXXIX. 

_June_ 13th. Mr. P----, Æt. 35. A very hard drinker, was attacked witha severe hæmoptoe, which was followed by ascites and anasarca. He hadevery appearance of diseased viscera, and his urine was small inquantity. The powder and the infusion of Digitalis were given atdifferent times, but without the desired effect. Other medicines weretried, but in vain. Tapping prolonged his existence a few weeks, andhe 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 tothe usual remedies, he took the infusion of Digitalis. Two or threedoses made him very sick; but he thought his breathing relieved. Afterone week he took it again, and was so much better as to want no othermedicine. 

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

 CASE XLI. 

_July_ 6th. Mr. E----, Æt. 57. Hydrothorax and anasarca; his breath soshort that he could not lie down. After a trial of squill, fixedalkaly, and dulcified spirit of nitre, I directed Pulv. Digital. Gr. 2, thrice a day. In four days he was able to come down stairs; inthree days more no appearance of disease remained; and under the useof 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 aphthisis pulmonalis became dropsical. She took the Digitalis withoutbeing relieved. 

 CASE XLIII. 

_July_ 9th. Mrs. F----, Æt. 70. A chearful, strong, healthy woman; butfor a few years back had experienced a degree of difficult breathingwhen in exercise. In the course of the last year her legs swelled, andshe felt great fulness about her stomach. These symptoms continuedincreasing very fast, notwithstanding several attempts made by a veryjudicious apothecary to relieve her. The more regular practitionerfailing, she had recourse to a quack, who I believe plied her verypowerfully with Daphne laureola, or some drastic purge of that kind. Ifound her greatly reduced in strength, her belly and lower extremitiesswollen to an amazing size, her urine small in quantity, and herappetite greatly impaired. For the first fortnight of my attendanceblisters were applied, solution of fixed alkaly, decoction of senekawith vitriolic æther, chrystals of tartar, squill and cordialmedicines were successively exhibited, but with no advantage. I thendirected Pulv. Fol. Digital. Two grains every four hours. After takingeighteen grains, the urine began to increase. The medicine was thenstopped. The discharge of urine continued to increase, and in five orsix days the whole of the dropsical water passed off, without anydisturbance to the stomach or bowels. As the distension of the bellyhad been very great, a swathe was applied, and drawn gradually tighteras the water was evacuated. As no pains were spared to prevent thereturn of the dropsy, and as the best means I could devise provedunequal to my wishes, both in this and in some other cases, I shalltake the liberty to point out the methods I tried at different timesin as concise a manner as possible, for the knowledge of what will notdo, 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 whichexisted when I first saw her, for finding so easy a mode of relief, she became impatient under a small degree of pressure, and ofteninsisted 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 offby the diarrhœa. 

 CASE XLIV. 

_July_ 12th. Mr. H----, of A----, Æt. 60. In the last stage of a lifehurried to a termination by free living, dropsical symptoms became themost distressing. He wished to take the Digitalis. It was given, butafforded 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 taketwo grains of Pulv. Fol. Digital. Every two hours, until it producedsome 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 twoscruples, removed every appearance of dropsy in a few days. He wasthen directed to take solution of merc. Sublimat. And soon recoveredhis health and strength. 

 CASE XLVII. 

_August_ 16th. Mr. G----, of W----, Æt. 86. Asthma of many yearsduration, and lately an incipient anasarca, with a paucity of urine. He had never lived intemperately, was of a chearful disposition, andvery sensible: for some years back had lost all relish for animalfood, and his only support had been an ounce or two of bread andcheese, or a small slice of seed-cake, with three or four pints ofmild 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 sixhours; this presently occasioned copious discharges of urine, removedhis 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 Digitaliscarried off all the effusion, and afterwards a course of deobstruentand 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; hisappetite was now totally gone, his strength extremely reduced, and theyellow of his jaundice changed to a blackish hue. The Digitalis wasnow tried in vain, and he died shortly afterwards. 

 CASE L. 

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

 CASE LI. 

_August_ 28th. Mr. J---- H----, Æt. 27. In consequence of very freeliving, had an ascites and swelled legs. I ordered him to take twograins of Fol. Digital. Pulv. Every two hours, until it produced someeffect; a few doses caused a plentiful secretion of urine, but nosickness, or purging: in six days the swellings disappeared, and hehas since remained in good health. 

 CASE LII. 

_September_ 27th. Mr. S----, Æt. 45. Had been long in an ill state ofhealth, from what had been supposed an irregular gout, was greatlyemaciated, had a sallow complexion, no appetite, costive bowels, quickand feeble pulse. The cause of his complaints was involved inobscurity; but I suspected the poison of lead, and was strengthened inthis suspicion, upon finding his wife had likewise ill health, and, attimes, severe attacks of colic; but the answers to my enquiries seemedto prove my suspicions fruitless, and, amongst other things, I wastold the pump was of wood. He had lately suffered extremely fromdifficult breathing, which I thought owing to anasarcous lungs; therewas also a slight degree of pale swelling in his legs. Pulv. Fol. Digital. Made into pills, with gum ammoniac and aromatic species, soonrelieved his breathing. Attempts were then made to assist him in otherrespects, but with little good effect, and some months afterwards hedied, with every appearance of a worn out constitution. 

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

The deleterious effects of lead seem to be considerably modified bythe constitution of the patient; for in some families only one or twoindividuals shall suffer from it, whilst the rest receive it withimpunity. In the spring of the year 1776, I was desired to visit Mrs. H----, of S---- Park, who had repeatedly been attacked with painfulcolics, and had suffered much from insuperable costiveness; Isuspected lead to be the cause of her complaints, but was unable totrace by what means it was taken. She was relieved by the usualmethods; but, a few months afterwards, I was desired to see her again:her sufferings were the same as before, and notwithstanding everyprecaution to guard against costiveness, she was never in perfecthealth, and seldom escaped severe attacks twice or thrice in a year;she had also frequent pains in her joints. I could not find any tracesof similar complaints either in Mr. H----, the children, or theservants. Mrs. H----was a water drinker, and seldom tasted anyfermented liquor. The pump was of wood, as I had been informed upon myfirst visit. Her health continued nearly in the same state for two orthree years more, but she always found herself better if she left herown house for any length of time. At length it occurred to me, thatthough the pump was a wooden one, the piston might work in lead. Itherefore ordered the pump rods to be drawn up, and upon examinationwith a magnifying glass, found the leather of the piston covered withan infinite number of very minute shining particles of lead. Perhapsin this instance the metal was so minutely divided by abrasion, as tobe mechanically suspended in the water. The lady was directed to drinkthe water of a spring, and never to swallow that from the pump. Theevent confirmed my suspicions, for she gradually recovered a goodstate of health, lost the obstinate costiveness, and has never to thisday had any attack of the colic. 

 CASE LIII. 

_September_ 28th. Mrs. J----, Æt. 70. Ascites and very thickanasarcous legs and thighs, total loss of strength and appetite. Infusion of Digitalis was given, but, as had been prognosticated, withno good effect. 

 CASE LIV. 

_September_ 30th. Mr. A----, Æt. 57. A strong man; hydrothorax andswelled legs; in other respects not unhealthful. He was directed totake two grains of the Pulv. Fol. Digit. Made into a pill with gumammoniac. Forty grains thus taken at intervals, effected a cure byincreasing 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 agreat quantity of strong ale, and was much exposed to alterations ofheat and cold. About the end of summer found himself short winded, andlost his appetite. The dyspnœa gradually increased, he got a mostdistressing sense of tightness across his stomach, his urine waslittle, and high coloured, and his legs began to swell; his pulseslender 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 couldprescribe. He took chrystals of tartar, seneka, gum ammoniac, salinedraughts, 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 steeland gentian. I had all along felt a reluctance to prescribe theDigitalis in this case, from a persuasion that it would not succeed. At length I was compelled to it, and directed one grain to be givenevery two hours until it should excite nausea. This it did; but, as Iexpected, it did no more. The reason of this belief will be mentionedhereafter. Five days after this last trial I gave him assafetida inlarge quantity, flattered by a hope that his extreme sufferings fromthe state of his respiration, might perhaps arise in part from spasm, but my hopes were in vain. I now thought of using an infusion oftobacco, 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 itshould 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 phthisispulmonalis, suffered much from dyspnœa, and anasarca. Squillmedicines gave no relief. Digitalis in pills, with gum ammon. Purgedhim, but opium being added, that effect ceased, and he continued to berelieved by them as long as he lived. 

 CASE LVII. 

_November_ 16th. Mrs. F----, Æt. 53. In _August_ last was suddenlyseized with epileptic fits, which continued to recur at uncertainintervals. Her belly had long been larger than natural, but withoutany perceptible fluctuation. Her legs and thighs swelled veryconsiderably the beginning of this month, and now there was evidentlywater in the abdomen. The medicines hitherto in vain directed againstthe epileptic attacks, were now suspended, and two grains of the Pulv. Fol. Digital. Directed to be taken every six hours. The effects weremost favourable, and the dropsical symptoms were soon removed bycopious urinary discharges. 

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

 1781. 

 CASE LVIII. 

_January_ 1st. Mrs. G----, of H----, Æt. 62. Ascites and very largehard legs. After trying various medicines, under the direction of avery able physician, I ordered her to take one grain of Pulv. Digital. Every six hours, but it produced no effect. Other Medicineswere then tried to as little purpose. About the end of _February_, Idirected an infusion of the Fol. Digital. But with no better success. Other methods were thought of, but none proved efficacious, and shedied 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 ofDigitalis: it acted kindly as a diuretic, and greatly reduced herswellings. Other medicines were then administered, with a view to herother complaints, but to no purpose, and she died about a monthafterwards. 

 CASE LX. 

_January_ 14th. Mr. B----, of D----. Jaundice and ascites, theconsequences of great intemperance. Extremely emaciated; his tongueand fauces covered with apthous crusts, and his appetite gone. Hefirst took tincture of cantharides with infusum amarum, then vitriolicsalts, and various other medicines without relief; Infusum Digitaliswas 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 ofemaciation from a dropsy. Every probable means to relieve her had beenattempted by Dr. Groome, but to no purpose; and she had undergone theoperation of the paracentesis repeatedly. The Doctor knew, he said, that I had cured many cases of dropsy, by the Digitalis, after othermore usual methods had been attempted without success, and he wishedthis lady to try that medicine under my direction; after examining thepatient, and enquiring into the history of the disease, I wassatisfied that the dropsy was encysted, and that no medicine couldavail. The Digitalis, however, was directed, and she took it, butwithout advantage. She had determined not to be tapped again, andneither persuasion, nor distress from the distension, could prevailupon her: I at length proposed to make an opening into the sac, bymeans of a caustic, which was done under the judicious management ofMr. Wainwright, surgeon, at Dudley. The water was evacuated withoutany accident, and the patient afterwards let it out herself from timeto time as the pressure of it became troublesome, until she died atlength perfectly exhausted. 

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

 CASE LXII. 

_February_ 27th. Mrs. O----, of T----, Æt. 52, with a constitutionworn out by various complicated disorders, at length becamedropsical. The Digitalis was given in small doses, in hopes oftemporary 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 ofFol. Siccat. Digital. In a half pint infusion was ordered, and anounce of this infusion directed to be taken every morning. Myrrh andsteel were given at intervals. Her urine soon increased, and thesymptoms of dropsy disappeared. 

 CASE LXIV. 

_March_ 18th. Mr. W----, in the last stage of a pulmonary consumptionbecame dropsical. The Digitalis was given, but without any goodeffect. 

 CASE LXV. 

_April_ 6th. Mr. B----, Æt. 63. For some years back had complained ofbeing asthmatical, and was not without suspicion of diseased viscera. The last winter he had been mostly confined to his house; becamedropsical, lost his appetite, and his skin and eyes turned yellow. Bythe use of medicines of the deobstruent class he became lessdiscoloured, and the hardness about his stomach seemed to yield; butthe ascites and anasarcous symptoms increased so as to oppress hisbreathing exceedingly. Alkaline salts, and other diuretics failing oftheir effects, I ordered him to take an infus. Of Digitalis. Itoperated so powerfully that it became necessary to support him withcordials and blisters, but it freed him from the dropsy, and hisbreath became quite easy. He then took soap, rhubarb, tartar ofvitriol, 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 hisbladder, from which at times his sufferings are extreme. He had beenaffected with what was supposed to be an asthma, for several years byfits, but through the last winter his breath had been much worse thanusual; universal anasarca came on, and soon afterwards an ascites. Nowhis urine was small in quantity and much saturated, the dysuria wasmore dreadful than ever; his breath would not allow him to lie in bed, nor would the dysuria permit him to sleep; in this distressfulsituation, after having used other medicines to little purpose, Idirected an infusion of Digitalis to be given. When the quantity ofurine became more plentiful, the pain from his stone grew easier; in afew days the dropsy and asthma disappeared, and he soon regained hisusual strength and health. Every year since, there has been a tendencyto 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. Thedropsy and difficult breathing remaining the same, he took InfusumDigitalis, which removed those complaints. He never lost the hardnessabout his stomach, but enjoyed very tolerable health for three yearsafterwards, without any return of the dropsy. 

 CASE LXVIII. 

_April_ 25th. Mrs. J----, Æt. 42. Phthisis pulmonalis and anasarcouslegs and thighs. She took the Infusum Digitalis without effect. Myrrhand 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 everysymptom of hydrocephalus internus. As it was yet early in the disease, in consequence of ideas which will be mentioned hereafter, I directedsix ounces of blood to be immediately taken from the arm; the temporalartery to be opened the succeeding day; the head to be shaven, and sixpints of cold water to be poured upon it every fourth hour, and twoscruples of strong mercurial ointment to be rubbed into the legsevery day. Five days afterwards, finding the febrile symptoms verymuch abated, and judging the remaining disease to be the effect ofeffusion, I directed a scruple of Fol. Digital. Siccat. To be infusedin three ounces of water, and a table spoonful of the infusion to begiven every third or fourth hour, until its action should be somewaysensible. The effect was, an increased secretion of urine; and thepatient soon recovered. 

 CASE LXX. 

_May_ 3d. Mrs. B----, Æt. 59. Ascites and anasarca, with strongsymptoms of diseased viscera. Infusum Digitalis was at firstprescribed, and presently removed the dropsy. She was then put uponsaline draughts and calomel. After some time she became feverish: thefever proved intermittent, and was cured by the bark. 

 CASE LXXI. 

_May_ 3d. Mr. S----, Æt. 48. A strong man, who had livedintemperately. For some time past his breath had been very short, hislegs swollen towards evening, and his urine small in quantity. Eightounces 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, andlowered the frequency of the pulse; but had no other sensible effects. His disorder continued to increase, and killed him about two monthsafterwards. 

 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 smallquantity. Neutral saline mixture, chrystals of tartar, vinumchalybeat. And other medicines had been prescribed to littleadvantage. Infusion of Fol. Digitalis acted powerfully as a diuretic, and removed the most urgent of his complaints, viz. The dropsical andasthmatical symptoms. 

The following winter his breathing grew bad again, his appetitetotally 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 veryhard. He had symptoms of diseased viscera, jaundice, ascites, andanasarca. After taking various deobstruents and diuretics, to nopurpose, he was ordered the Infusion of Digitalis: a few dosesoccasioned a plentiful flow of urine, relieved his breath, and reducedhis swellings; but, on account of his great weakness, it was judgedimprudent 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 walkabout, but his want of appetite and jaundice continuing, and hisdebility increasing, he died in about two months. 

 CASE LXXV. 

_July_ 18th. Mrs. B----, Æt. 46. A little woman, and very muchdeformed. Asthmatical for many years. For several months past had beenworse than usual; appetite totally gone, legs swollen, sense of greatfulness about her stomach, countenance fallen, lips livid, could notlie down. 

The usual modes of practice failing, the Digitalis was tried, but withno better success, and in about a month she died; not withoutsuspicion of her death having been accelerated a few days, by hertaking half a grain of opium. This may be a caution to youngpractitioners to be careful how they venture upon even small doses ofopium in such constitutions, however much they may be urged by thepatient to prescribe something that may procure a little rest andease. 

 CASE LXXVI. 

_August_ 12th. Mr. L----, Æt. 65, the person whose Case is recorded atNo. XXIV, had a return of his insanity, after near two years perfecthealth. He was extremely reduced when I saw him, and the medicinewhich cured him before was now administered without effect, for hisweakness 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 andswelled legs, the consequence of a very free course of life; he hadbeen once tapped, and taken much medicine before I saw him. TheDigitalis was now directed: it lowered his pulse, but did not provediuretic. He returned home, and soon after was tapped again, butsurvived the operation only a few hours. 

 CASE LXXVIII. 

_September_ 25th. Mr. O----, of M----, Æt. 63. Very painful andgeneral swellings in all his limbs, which had confined him mostly tohis bed since the preceding winter; the swellings were uniform, tense, and resisting, but the skin not discoloured. After trying guiacum andDover's powder without advantage. I directed Infusion of Digitalis. Itacted on the kidneys, but did net relieve him. It is not easy to saywhat the disease was, and the patient living at a distance, I neverlearnt the future progress or termination of it. 

 CASE LXXIX. 

_September_ 26th. Mr. D----, Æt. 42, a very sensible and judicioussurgeon at B----, in Staffordshire, laboured under ascites and verylarge anasarcous legs, together with indubitable symptoms of diseasedviscera. Having tried the usual diuretics to no purpose, I directed ascruple of Fol. Digital siccat. In a four ounce infusion, a tablespoonful to be taken twice a day. The second bottle wholly removed hisdropsy, which never returned. 

 CASE LXXX. 

_September_ 27th. Mrs. E----, Æt. 42. A fat sedentary woman; after along illness, very indistinctly marked; had symptoms of enlarged liverand dropsy. In this case I was happy in the assistance of Dr. Ash. Digitalis was once exhibited in small doses, but to no better purposethan many other medicines. She suffered great pain in the abdomen forseveral weeks, and after her death, the liver, spleen, and kidneyswere found of a pale colour, and very greatly enlarged, but thequantity 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 ofmild ale, and was now become dropsical. He was a lusty man, of a palecomplexion: his belly large, and his legs and thighs swollen to anenormous size. I directed the Infusion of Digitalis, which in ten dayscompletely emptied him. He was then put upon the use of steel andbitters, and directed to live temperately, which I believe he did, forI saw him two years afterwards in perfect health. 

 CASE LXXXII. 

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

 1782. 

 CASE LXXXIII. 

_January_ 23d. Mr. Q----, Æt. 74. A stone in his bladder for manyyears; dropsical for the last three months. Had taken at differenttimes soap with squill and gum ammoniac; soap lees; chrystals oftartar, oil of juniper, seneka, jallap, &c. But the dropsical symptomsstill increased, and the dysuria from the stone became very urgent. Inow directed a dram of the Fol. Digit. Siccat. In a half pintinfusion, half an ounce to be given every six hours. This presentlyrelieved the dysuria, and soon removed the dropsy, without anydisturbance to his system. 

 CASE LXXXIV. 

_January_ 27th. Mr. D----, Æt. 86. The debility of age and dropsicallegs had long oppressed him. A few weeks before his death hisbreathing became very short, he could not lie down in bed, and hisurine was small in quantity. A wine glass of a weak Infusion ofDigitalis, 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 oneounce was given night and morning, proved diuretic and removed hisdropsy. He then took medicines calculated to relieve his othercomplaints. The dropsy did not return during my attendance upon him, which was three or four weeks. A quack then undertook to cure him withblue vitriol vomits, but as I am informed, he presently sunk underthat rough treatment. 

 CASE LXXXVI. 

_January_ 29th. Mrs. O----, of D----, Æt. 53. A constant anddistressing palpitation of her heart, with great debility. From adegree of anasarca in her legs I was led to suspect effusion in thePericardium, and therefore directed Digitalis, but it produced nobenefit. She then took various other medicines with the same want ofsuccess, and about ten months afterwards died suddenly. 

 CASE LXXXVII. 

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

 CASE LXXXVIII. 

_January_ 31st. Mrs. J----, of S----, Æt. 67. A lusty woman, of aflorid complexion, large belly, and very thick legs. She had been keptalive for some years by the discharge from ulcers in her legs; but thesores now put on a very disagreeable livid appearance, her belly grewstill larger, her breath short, her pulse feeble, and she could nottake nourishment. Several medicines having been given in vain, theDigitalis was tried, but with no better effect; and in about a monthshe died. 

 CASE LXXXIX. 

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

 CASE XC. 

_February_ 24th. Master M----, of W----, Æt. 10. An epilepsy of someyears continuance, which had never been interrupted by any of thevarious methods tried for his relief. The Digitalis was given for afew days, but as he lived at a distance, so that I could not attend toits effects, he only took one half pint infusion, which made noalteration in his complaint. 

 CASE XCI. 

_March_ 6th. Mr. H----, Æt. 62. A very hard drinker, and had twice hadattacks of apoplexy. He had now an ascites, was anasarcous, and hadevery appearance of a diseased liver. Small doses of calomel, Dover'spowder, infusum amarum, and sal sodæ palliated his symptoms for awhile; these failing; blisters, squills, and cordials were givenwithout effect. A weak Infusion of Digitalis, well aromatised, wasthen directed to be given in small doses. It rather seemed to checkthan to increase the secretion of urine, and soon produced sickness. Failing in its usual effect, the medicine was no longer continued; butevery thing that was tried proved equally inefficacious, and he didnot long survive. 

 CASE XCII. 

_May_ 10th. Mrs. P----, Æt. 40. Spasmodic asthma of many yearscontinuance, 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 thanrelieve her symptoms. 

 CASE XCIII. 

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

 CASE XCIV. 

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

 CASE XCV. 

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

 CASE XCVI. 

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

 CASE XCVII. 

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

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

 CASE XCVIII. 

_September_ 25th. Mr. R----, Æt. 60. Complained to me of a sicknessafter eating, and for some weeks past he had thrown up all his food, soon after he had swallowed it. He had taken various medicines, butfound benefit from none, and had tried various kinds of diet. He wasnow very thin and weak; but had a good appetite. As several veryprobable methods had been prescribed, and as the usual symptoms oforganic disease were absent, I determined to give him a spoonful ofthe Infusion of Digitalis twice a day; made by digesting two drams ofthe dried leaves in half a pint of cinnamon water. From the time hebegan 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 removesickness, though prescribed for very different complaints. 

 CASE XCIX. 

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

 CASE C. 

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

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

 CASE CI. 

_October_ 2d. Mrs. R----, Æt. 60. Diseased viscera; ascites andanasarca. Had taken various deobstruent and diuretic medicines tolittle purpose. The Digitalis brought on a nausea and languor, but hadno effect on the kidneys. 

 CASE CII. 

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

 CASE CIII. 

_October_ 12th. Mr. B----, Æt. 39. Kept a public house, drank veryfreely, and became dropsical; he complained also of rheumatic pains. Idirected Infusion of Digitalis, half an ounce twice a day. In eightdays the swellings in his legs and the fulness about his stomachdisappeared. 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, producedno effect; probably the medicine was wasted in giving. An infusion ofthe dried leaf was then tried, a dram to four ounces, two teaspoonfuls for a dose; this soon increased the flow of urine to a verygreat degree, and he got perfectly well. 

 CASE CV. 

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

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

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

 CASE CVI. 

_November_ 2d. Mr. S----, of B----h----, Æt. 61. Hydrothorax andswelled legs. Squills were given for a week in very full doses, andother modes of relief attempted; but his breathing became so bad, hiscountenance so livid, his pulse so feeble, and his extremities socold, that I was apprehensive upon my second visit that he had nottwenty-four hours to live. In this situation I gave him the InfusumDigitalis stronger than usual, viz. Two drams to eight ounces. Findinghimself relieved by this, he continued to take it, contrary to thedirections given, after the diuretic effects had appeared. 

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

 CASE CVII. 

_November_ 19th. Master S----, Æt. 8. Ascites and anasarca. A dram ofFol. 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_ tothe first of _May_, not a single case occurs, and that the amount ofcases is likewise less than in the preceding or ensuing years; toprevent erroneous conjectures or conclusions, it may be expedient tomention, that the ill state of my own health obliged me to retire frombusiness for some time in the spring of the year, and that I did notperfectly recover until the following summer. 

 CASE CVIII. 

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

 CASE CIX. 

_May_ 1st. Mrs. D----, Æt. 72. A thin woman, with very largeanasarcous legs and thighs; no appetite and general debility. After amonth's trial of cordials and diuretics of different kinds, thesurgeon who had scarified her legs apprehended they would mortify; shehad very great pain in them, they were very red and black by places, and extremely tense. It was evident that unless the tension could beremoved, gangrene must soon ensue. I therefore gave her InfusumDigitalis, which increased the secretion of urine by the followingevening, so that the great tension began to abate, and together withit the pain and inflammation. She was so feeble that I dared not tourge the medicine further, but she occasionally took it at intervalsuntil 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 atHagley. Her disease appeared to me to be an ovarium dropsy. In otherrespects she was in perfect health. I directed the Digitalis to begiven, and gradually pushed so as to affect her very considerably. Itwas done; but the patient still carries her big belly, and isotherwise very well. 

 CASE CXI. 

_May_ 25th. Mr. G----, Æt. 28. In the last stage of a pulmonaryconsumption 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 phthisispulmonalis became dropsical. He took half a pint of the InfusumDigitalis 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 thecough at night, and 2 tea spoonfuls of Infus. Digit. Were orderedevery six hours. The dropsy was presently removed; but the coughcontinued, his flesh wasted, his strength failed, and some weeksafterwards he died tabid. 

 CASE CXIV. 

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

 CASE CXV. 

_June_ 20th. Mrs. H----, Æt. 46. A very fat, short woman; had sufferedseverely through the last winter and spring from what had been calledasthma; but for some time past an universal anasarca prevailed, andshe had not lain down for several weeks. After trying vitriolic acid, tincture of cantharides, squills, &c. Without advantage, she took halfa pint of Infus. Digitalis in three days. In a week afterwards thedropsical symptoms disappeared, her breath became easy, her appetitereturned, and she recovered perfect health. The infusion neitheroccasioned sickness nor purging. 

 CASE CXVI. 

_June_ 24th. Mrs. B----, Æt. 40. A puerperal fever, and swelled legsand thighs. The fever not yielding to the usual practice, I directedan Infusion of Fol. Digitalis. It proved diuretic; the swellingssubsided, but the fever continued, and a few days afterwards adiarrhœa 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 ofdiseased viscera, great dyspnœa, a very troublesome cough, andtotal loss of appetite. He took mild mercurials, pills of soap, rhubarb, and tartar of vitriol, with soluble tartar and dulcifiedspirits of nitre in barley water. After a reasonable trial of thisplan, he took squill every six hours, and a solution of assafetida andgum ammoniac, to ease his breathing: finding no relief, I gave himchrystals of tartar with ginger; but his remaining health and strengthdaily declined, and he was not at all benefited by the medicines. Iwas averse to the use of Digitalis in this case, judging from what Ihad seen in similar instances of tense fibre, that it would not act asa diuretic. I therefore once more directed squill, with decoction ofseneka and sal sodæ; but it was inefficacious. His strength being muchbroken down, I then ordered gum ammoniac, with small doses of opium, and infusum amarum, continuing the squill at intervals. At length Iwas urged to give the Digitalis, and considering the case asdesperate, I agreed to do it. The event was as I expected; no increasein the urine took place; and the medicine being still continued, hispulse became slow, and he apparently sunk under its sedative effects. He was neither purged nor vomited; and had the Digitalis either beenomitted altogether, or suspended upon its first effects upon thepulse 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 onlyrelief I could give in a case so circumstanced, would be by carryingoff the effused fluids. I tried squill and fixed alkaly; and thesefailing, 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, diseasedviscera, paucity of urine, and total loss of appetite. Thesecomplaints had heretofore existed repeatedly, and had been removed bydeobstruent and diuretic medicines; but in this attack the symptomswere suffered to exist a longer time and in a greater degree, beforeassistance was sought for. The remedies that used to relieve her werenow exhibited to no purpose. Mild mercurials, soap, rhubarb, andsquill were tried; but she grew rapidly worse. Saline draughts withacetum scilliticum seemed for a few days to check the progress of hercomplaint, but they soon lost their effect, and diarrhœa ensuedupon every attempt to increase the frequency of the dose. Draughtswith Infus. Digital. Were then directed to be taken twice a day. Theeffect was a powerful action on the kidneys, and a reduction of theswellings, but without sickness. A degree of appetite returned, butstill the tendency to diarrhœa existed, and kept her weak. Tonicmedicines were then tried, but without advantage, and in a month itwas necessary to have recourse to the Digitalis again. It was directedin a half pint mixture; an ounce to be taken thrice in twenty-fourhours. On the 2d day, finding her symptoms very much relieved, shetook in the absence of her nurse, nearly a double dose of themedicine. The consequence was great sickness, languor continuing forseveral days, and almost a total stop to the secretion of urine, fromthe time the sickness commenced. 

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

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

 CASE CXX. 

_August_ 22d. Mrs. S----, Æt. 36. Extreme faintiness; anasarcous legsand thighs; great difficulty of breathing, troublesome cough, frequentchilly fits succeeded by hot ones; night sweats, and a tendency todiarrhœa. Apprehensive that the more urgent symptoms were causedby water in the lungs, I directed an Infusion of Digitalis, with anounce of diacodium to the half pint to prevent it purging, a wineglass full to be taken every night at bed-time, and a mixture withconfect. Cardiac. And pulv. Ipecac. To be given in small doses afterevery loose stool. 

On the fourth day she was better in all respects; had made a largequantity of water and did not purge. In a few days more she lost allher complaints, except the cough, which gradually left her, withoutany further assistance. 

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

 CASE CXXI. 

_August_ 25th. T---- W----, Esq; Æt, 50. A free liver, diseasedviscera, belly very tense, and much swollen; fluctuation perceptible, but the swelling circumscribed; pulse 132. This gentleman was underthe care of my very worthy friend Dr. Ash, who, having tried variousmodes of cure to no purpose, asked me if I thought the Digitalis wouldanswer in this case. I replied that it would not, for I had never seenit effectual where the swelling appeared very tense and circumscribed. It was tried however, but did not lessen the swelling. I mention thiscase, to introduce the above remark, and also to point out the greateffect the Digitalis has upon the action of the heart; for the pulsecame down to 96. He was afterwards tapped, and continued, for sometime 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 ofill formed gout, attended for some time past with jaundice and othersymptoms of diseased viscera, the consequences of intemperate living, was sent to Buxton; from whence he returned in three weeks withascites and anasarca. Under this complicated load of disease, Iprescribed repeatedly without advantage, and at length gave him theDigitalis, which carried off the more obvious symptoms of dropsy; butthe jaundice, loss of appetite, diseased viscera, &c. Rendered hisrecovery impossible. 

 1784. 

 CASE CXXIII. 

_February_ 12th. Mrs. C----, Æt. 54. A strong short woman of a floridcomplexion; complained of great fullness across the region of thestomach; short breath, a troublesome cough, loss of appetite, paucityof 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 doorabout the beginning of winter. From the beginning of January to thistime, she had been repeatedly let blood, had taken calomel purgeswith jallap; pills of soap, rhubarb and calomel; saline julep withacet. Scillit. Nitrous decoction, garlic, mercury rubbed down, infus. Amarum purg. &c. After the failure of medicines so powerful, andseemingly so well adapted, and during the use of which all thesymptoms continued to increase, it was evident that a favourable eventcould not be expected. However, I tried the infusum Digitalis, but itdid nothing. I then gave her pills of quicksilver, soap and squill, with decoction of dandelion, and after some time, chrystals of tartarwith ginger. Nothing succeeded to our wishes, and the increase oforthopnœa compelled me occasionally to relieve her by drasticpurges, but these diminished her strength, more in proportion thanthey relieved her symptoms. Tincture of cantharides, sal diureticusand various other means were occasionally tried, but with very littleeffect, and she died towards the end of March. 

 CASE CXXIV. 

_March_ 31st. Miss W----, Æt. 60. Had been subject to peripneumonicaffections in the winter. She had now total loss of appetite, verygreat debility, difficult breathing; much cough, a considerable degreeof expectoration, and a paucity of urine. She had been blooded, takensoap, assaf. And squill, afterwards assaf. And ammon. With acet. Scillit. : but all her complaints increasing, a blister was applied toher back, and the Digitalis infusion directed to be taken every night. The effect was an increased secretion of urine, a considerable reliefto her breath, and some return of appetite; but soon afterwards shebecame hectic, spat purulent matter, and died in a few weeks. 

 CASE CXXV. 

_April_ 12th. Mrs. H----, of L----, Æt. 61. In _December_ last thisLady, then upon a visit in London, was attacked with severe symptomsof peripneumony. She was treated as an asthmatic patient, but findingno relief, she made an effort to return to her home to die. In her waythrough this place, the latter end of December, I was desired to seeher. By repeated bleedings, blisters, and other usual methods, she wasso far relieved, that she wished to remain under my care. After awhile she began to spit matter and became hectic. With greatdifficulty she was kept alive during the discharge of the abscess, andabout the end of March she had swelled legs, and unequivocal symptomsof dropsy in the chest. Other diuretics failing, on the 12th of AprilI was induced to give her the Digitalis in small doses. The relief wasgreat and effectual. After an interval of fifteen days, some swellingsstill remaining in the legs, I repeated the medicine, and with suchgood effect, that she lost all her complaints, got a keen appetite, recovered her strength, and about the end of May undertook a journeyof fifty miles to her own home, where she still remains in perfecthealth. 

 CASE CXXVI. 

_April_ 17th. Mr. F----, Æt. 59. A very fat man, and a free liver; hadlong been subject to what was called asthma, particularly in thewinter. For some weeks past his legs swelled, he had great sense offullness across his stomach; a severe cough; total loss of appetite, thirst great, urine sparing, his breath so difficult that he had notlain down in bed for several nights. Calomel, gum ammoniac, tinctureof cantharides, &c. Having been given in vain, I ordered two grains ofpulv. 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 morehe was free from all complaints, and has since had no relapse. 

 CASE CXXVII. 

_May_ 7th. Miss K----, Æt. 8. After a long continued ague, becamehectic and dropsical. Her belly was very large, and she had a totalloss of appetite. Half a grain of fol. Digital, pulv. With 2 gr. Ofmerc. Alcalis. Were ordered night and morning, and an infusion of barkand rhubarb with steel wine to be given in the day time. Her bellybegan 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, haddied, from the parents being persuaded that an ague in the spring washealthful and should not be stopped. --I know not how far the recoveryin this case may be attributed to the Digitalis, but the child was sonear 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, noappetite; urine thick and foul; complection brownish yellow. Mercurialmedicines, diuretics of different kinds, and bitters, had been tryingfor the last three months, but with little advantage. I directed twograins of the fol. Digital. In powder to be taken every night, andinfus. Amar. With tinct. Sacr. Twice a day. In three days the quantityof his urine increased, in ten or twelve days all his symptomsdisappeared, and he has had no relapse. 

 CASE CXXIX. 

_June_ 17th. Mr. N----, of W----, Æt. 54. A large man, of a palecomplexion; had been subject to severe fits of asthma for some years, but now worse than usual. The intermitting pulse, the greatdisturbance from change of posture, and the swelled legs induced me toconclude that the exacerbation of his old complaint was occasioned byserous 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 apart of the composition. He was also directed to take mustardseedevery morning and a solution of assafetida twice in the day. Theeffect of this plan was perfectly to our wishes, and in a short timehe recovered his usual health. About half a year afterwards he diedapoplectic. 

 CASE CXXX. 

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

 CASE CXXXI. 

_July_ 12th. Mrs. A----, of C----, Æt. 56. After a series ofindispositions for several years, became dropsical; and had long beenconfined to her chamber, unable to lie down or to walk. She was sofeeble, her legs so much swelled, her breath so short, and thesymptoms of diseased viscera so strong, that I dared not to entertainhopes of a cure; but wishing to relieve her more urgent symptoms, directed quicksilver rubbed down and fol. Digital. Pulv. To be madeinto pills: the dose, containing two grains of the latter, to be givennight and morning. She was also ordered to take a draught with a dramof æther twice a day, and to have scapulary issues. Her breath was somuch 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 12months continuation, suffered great indisposition for 10 months more. He chiefly complained of great straitness and pain in thehypochondriac region, very short breath, swelled legs, want ofappetite. He had been under the care of some very sensiblepractitioners, but his complaints increased, and he determined to cometo Birmingham. I found him supported upright in his chair, by pillows, every attempt to lean back or stoop forward giving him the sensationof instantaneous suffocation. He said he had not been in bed for manyweeks. His countenance was sunk and pale; his lips livid; his belly, thighs and legs very greatly swollen; hands and feet cold, the nailsalmost black, pulse 160 tremulous beats in a minute, but the pulsationin the carolid arteries was such as to be visible to the eye, and toshake his head so that he could not hold it still. His thirst was verygreat, his urine small in quantity, and he was disposed to purge. Iimmediately ordered a spoonful of the infusum Digitalis every sixhours, with a small quantity of laudanum, to prevent its running offby stool, and decoction of leontodon taraxacum to allay his thirst. The next day he began to make water freely, and could allow of beingput into bed, but was raised high with pillows. Omit the infusion. That night he parted with six quarts of water, and the next nightcould lie down and slept comfortably. _July_ 21st. He took a mildmercurial bolus. On the 25th. The diuretic effects of the Digitalishaving nearly ceased, he was ordered to take three grains of the pulv. Digital. Night and morning, for five days, and a draught with half anounce of vin. Chalyb. Twice a day. _August_ 15th. He took a purge ofcalomel and jallap, and some swelling still remaining in his legs, theDigitalis infusion was repeated. The water having been thus entirelyevacuated, he was ordered saline draughts with acetum scilliticum andpills of salt of steel and extract of gentian. About a month afterthis, he returned home perfectly well. 

 CASE CXXXIII. 

_July_ 28th. Mr. A---- of W----, Æt. 29, became dropsical towards theclose of a pulmonary consumption. He was ordered 12 grains of pulv. Fol. Cicutæ and 1 of Digitalis twice a day. No remarkable effect tookplace. 

 CASE CXXXIV. 

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

 CASE CXXXV. 

_August_ 6th. Mr. C---- of B----, Æt. 42. Asthma and anasarca, theconsequence of free living. He had been for some time under the careof an eminent physician of this place, but his complaints provingunusually obstinate, he consulted me. I directed an infusion ofDigitalis to be taken every night, and a mixture with squill andtincture of cantharides twice every day. In about a week he becamebetter, and continued daily mending. He has since enjoyed perfecthealth, having quitted a line of business which exposed him to drinktoo 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 twograins 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 ofNovember following he relapsed, and again asked my advice. TheDigitalis alone was now prescribed, which proved as efficacious as inthe first trial. He then took bitters twice a day, and vitriolic acidnight 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 themanner recommended by Cotunnius; and two grains of fol. Digital. Withfifteen of fol. Cicutæ were directed to be taken night and morning. The medicine acted only as a diuretic; the pain and swelling of thelimb gradually abated; and I have not heard of any return. 

I must here bear witness to the efficacy of Cotunnius's method ofblistering 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 Summerbegan to complain of short breath, great debility, and loss ofappetite. At this time there were evident marks of effusion in thethorax, and some swelling in the legs. The advanced age, the weakness, and other circumstances of this patient, precluded every idea of herrecovery; but something was to be attempted. Squills and otherremedies had been tried; I therefore directed pills with two or threegrains of the pulv. Digitalis to be taken every night for six nights, and a saline draught with forty drops of acetum scillit. Twice in theday. She took but few of the draughts, seldom more than half one at atime, for they purged her, and she disliked them. The pills she tookregularly, and with the happiest effect, for she could lie down, herbreath was very much relieved, and a degree of appetite returned. _Sept. _ 4th, some return of her symptoms demanded the further use ofdiuretics. I was afraid to push the Digitalis in so hazardous asubject, and therefore directed tinct. Amara with tinct. Canthar. Andpills of squill, seneka, salt of tartar and gum ammoniac. Thesemedicines did not at all check the progress of the disease, and on the26th it became necessary to give the Digitalis again. The pills weretherefore repeated as before, and infus. Amarum with fixed alkalyordered to be taken twice a day. The event was as favorable as before;and from this time she had no considerable return of dropsy, butlanguished under various nameless symptoms, until the middle or end ofNovember. 

 CASE CXXXIX. 

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

 CASE CXL. 

_Sept. _ 20th. B---- B----, Esq. A true spasmodic asthma of many yearscontinuance. After every method of relief had failed; both under mymanagement, and also under the direction of several of the ablestphysicians of this kingdom; I was induced to give him an infusion ofthe Digitalis. It was continued until nausea came on, but procured norelief. 

 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 ofhis complaints, with evident marks of diseased viscera. His belly notvery large, but uncommonly tense. From this circumstance I did notexpect the Digitalis to succeed, and therefore tried for some time torelieve 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 tothe Digitalis. As he was very weak and much emaciated, I only gave twograins night and morning for five days. As no increase of urine tookplace, I used alkaline salt with tinct. Cantharides:--This provingequally unsuccessful, on the 18th, I directed two ounces of theinfusum Digitalis night and morning. This was continued until nauseatook place, but the kidney secretion was not increased. Squill withopium, deobstruents of different kinds, sublimate solution, fixedalkaly, tobacco infusion, were now successively tried, but with thesame want of success. The fullness of his belly made it necessary totap him, and by repeating this operation he continued alive to the endof the year. 

 CASE CXLII. 

_October_ 19th. Mrs. R----, of B----, Æt. 47. Supposed Asthma, ofeighteen months duration. She had kept her room for four months, andcould not lie down without great disturbance; was very thin, and hadtotally lost all inclination for food. She was directed to take twogr. Of pulv. Fol. Digital. Night and morning for five days, andinfusum amarum, at the hours of eleven and five. In the course of aweek she was much relieved, and could remain in bed all night. After afew days interval she took the Digitalis for five days more, and wassoon after that well enough to come down stairs and conduct her familyaffairs. 

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

 CASE CXLIII. 

_October_ 28th. Mr. A----, subject to nephritis calculosa: After anattack of that kind, had still a troublesome sense of weight about hisloins, now and then rising to pain, and a degree of dysuria, togetherwith a want of appetite. These symptoms not readily yielding to theusual methods of treatment, I directed an infusion of Digitalis. Thefourth 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 moreof his complaints. 

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

 CASE CXLIV. 

_October_ 31st. Mrs. C----, of W----, Æt. 67. Asthma, and very thickhard legs of long continuance. The last month or two her breath worsethan usual, her belly swollen, her thighs anasarcous, and her urine insmall quantity. After trying garlic, squill, and purgatives withoutadvantage, I directed the Digital. Infus. After taking about fiveounces, her urine from thick and turbid, changed to clear and ambercoloured, its quantity considerably increased, and her breathing easy. Contrary to my orders, but impelled by the relief she had found, shefinished the remaining three ounces of the infusion, which made hervery sick, and the free flow of urine immediately ceased. No medicinewas administered for a fortnight, during which time her complaintsincreased. I then directed an infusion of tobacco, which affected herhead, but did not increase her urine. She had recourse again to theDigitalis infusion, which once more removed the fulness of the belly, reduced the swellings of her thighs, and relieved her breath, but hadno effect upon her legs. 

 CASE CXLV. 

_Nov. _ 2d. Miss B---- of C----, Æt. 22. A very evident fluctuation inthe abdomen, which was considerably distended, whilst the rest of herframe was greatly emaciated. The presence of cough, hectic fever, andother circumstances, made it probable that this apparent ascites wascaused by a purulent, and not a watery effusion. However it waspossible I might be mistaken; the Digitalis was therefore given, butwithout any advantage. 

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

 CASE CXLVI. 

_Nov. _ 4th. Mr. P---- of M----, Æt. 40. Subject to troublesomenephritic complaints, and after the last attack did not recover, orvoid the gravelly concretions as usual, a sense of weight across hisloins continuing very troublesome. The usual medicines failing torelieve him, I ordered four grains of pulv. Digital. To be taken everyother night for a week, and fifteen grains of mild fixed vegetablealkaly to be swallowed twice a day in barley water. He soon lost allhis complaints; but we must not in this case too hastily attribute thecure to the Digitalis, as the alkaly has also been found a very usefulmedicine 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, hebecame 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 itthen produced no effect, and he was so debilitated that it was noturged further. 

 CASE CXLVIII. 

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

 CASE CXLIX. 

_Nov. _ 13th. Mrs. A---- of W----h----, Æt. 68. One of those rare casesin which no urine is secreted. It proved as refractory as usual toremedies, and not having ever succeeded in the cure of this disease, Idetermined to try the Digitalis. It was given in infusion, and, aftera few doses, the secretion of a small quantity of urine seemed tojustify the attempt. The next day, however, the secretion ceased, norcould it be excited again, tho' at last the medicine was pushed so asto occasion sickness, which continued at intervals for three days. 

 CASE CL. 

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

 CASE CLI. 

_Nov. _ 23d. Master W----, Æt. 7. Supposed hydrocephalus internus. Agrain of pulv. Fol. Digitalis was directed night and morning. Afterthree days, no sensible effects taking place, it was omitted, and themercurial plan of treatment adopted. The child lived near five monthsafterwards. Upon dissection near four ounces of water were found inthe ventricles of the brain. 

 CASE CLII. 

_Nov. _ 26th. Mrs. W----, Æt. 65. I had attended this lady last winterin a very severe peripneumony, from which she narrowly escaped withher life. When the cold season advanced this winter, she perceived adifficulty in breathing, which gradually became more and moretroublesome. I found her much harassed by a cough, which occasionedher to expectorate a little: the least motion increased herdyspnœa; she could not lie down in bed; her legs were considerablyswelled, 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. Herurine in five days became clear and copious, and in a fortnight moreshe lost all her complaints, except a cough, for which she took thelac ammoniacum. 

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

 CASE CLIII. 

_December_ 7th. Mr. H----, Æt. 42. A large sat man, very subject togravelly complaints. After an attack in the usual manner, continued tofeel numbness in his lower limbs, and a sense of weight across hisloins. I directed infusum Digitalis to be given every six hours. Sixounces made him sick, and he took no more. The next day his urineincreased, a good deal of sand passed with it, and he lost hisdisagreeable feels, but the sickness did not entirely cease before thefourth 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 thingswere tried, but the squill alone gave relief. At length this failed. About the third month of the disease, a grain of pulv. Digital. Wasordered to be taken night and morning. This produced the happiesteffects. In _March_ following he had some slight symptoms of relapse, which were soon removed by the same medicine, and he now enjoys goodhealth. 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 oflong continuance. She took three grains of pulv. Digital. Every nightat bed time, for a fortnight, but without any effect. 

 CASE CLVI. 

A poor man in this town, after his kidneys had ceased to secrete urinefor several days, was seized with hickup, fits of vomiting, andtransient delirium. After examination I was satisfied the disease wasthe same as that mentioned at CXLIX. A very experienced apothecaryhaving tried various methods to relieve him, I despaired of anysuccess, but determined to try the Digitalis. It was accordinglygiven in infusion. At first it checked the vomitings, but did notoccasion any secretion of urine. 

 1785. 

The cases which have occurred to me in the course of this year, arenumerous; but as the events of some of them are not yet sufficientlyascertained, 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 theHospital cases for which the Digitalis was prescribed by me, whilst hecontinued in that office. 

 CASE CLVII. 

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

 CASE CLVIII. 

_November_ 18th, 1780. Henry Warren, Æt. 60. This man had a generalanasarca and ascites, and was moreover so asthmatic, that, neitherbeing able to sit in a chair nor lie in bed, he was obliged constantlyto walk about, or to lean forward against a window or table. Youprescribed 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 25thyou ordered the infusion of Digitalis, two spoonfuls every four hours. After taking this for thirty six hours, his urine was discharged invery great quantity; his breath became easy, and the swellingsdisappeared in a few days, though he took no more of the medicine. Onthe 2d of _December_ he was ordered myrrh and lac ammoniacum, which hecontinued until the 23d, when he was discharged cured, and is now ingood health. 

 CASE CLIX. 

_November_ 3d, 1781. Mary Crockett, Æt. 40. Ascites and universalanasarca. For one week she took sal. Diureticus and tincture ofcantharides, but without advantage. On the 10th you directed theinfusion of Digitalis, a dram and half to half a pint, an ounce to betaken every fourth hour. Before this quantity was quite finished, theurine began to be discharged very copiously. The medicine was thenstopped as you had directed. On the 15th, being costive, she took ajallap purge, and on the 24th she was discharged cured. 

 CASE CLX. 

_March_ 16th, 1782. Mary Bird, Æt. 61. Great fullness about thestomach; diseased liver, and anasarcous legs and thighs. For thefirst week squill was tried in more forms than one, but withoutadvantage. On the 22d she began with the Digitalis, which presentlyremoved all the swelling. 

She was then put upon the use of aperient medicines and tonics, and onthe 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 frequentopportunities of seeing the great effects of the Digitalis in dropsy. As the exhibition of it was in the following instances immediatelyunder your own direction, I have drawn them up for your inspection, previous to your publishing upon that excellent diuretic. Of itsefficacy in dropsy I have considerable evidence in my possession, butconsider myself not at liberty to send you any other cases exceptthose you had yourself the conduct of. The Digitalis is a veryvaluable acquisition to medicine; and, I trust, it will cease to bedreaded 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 BirminghamGeneral Hospital _February_ 12th, 1784, labouring under all theeffects of hydrothorax; her dread of suffocation during sleep was sogreat, that she always reposed in an elbow chair. She was directed totake two grains of Digitalis in powder every night and morning, andfor a few days found great relief; but, on the eighth day, as she hadcomplained of sickness, and had been considerably purged, she wasordered to desist taking any more of her powders. On the 14th day shewas 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, butsometimes excited nausea, though not sufficient to prevent her fromcontinuing its use. She grew gradually better, and on the 6th of _May_was discharged perfectly cured. The diuretic effects of the Digitaliswere in this instance immediate. 

 CASE CLXII. 

Edward James, Æt. 21. Admitted _March_ 20th, 1784. Complained of greatdifficulty of breathing, pain in his head, and tightness about thestomach, with a trifling swelling of his legs. Ordered pil. Scillit. ℈i. Ter de die. On the third day his legs much more swelled, hisbreathing more difficult, and in every respect worse; his pulse verysmall and quick, complained when he turned in bed, of something likewater rolling from one side of the thorax to the other. A remarkableblueness about the mouth and eyes, and purged considerably from thepil. Scill. Ordered to omit the pills and to take ℥i. Of infus. Digitalis every eight hours; the proportion ʒiss. To eight ounces ofwater and ℥i. Of aq. N. M. Sp. --7th Day, The infusion had neitherpurged, nor vomited him: he only complained once or twice ofgiddiness. His belly was now very hard, rather black on the right sidethe navel, and his legs amazingly swelled. Ordered a bolus withrhubarb and calomel, to be taken in the morning, and ℥ii. Julep salin. Cum tinct. Canthar. Gutt. Forty ter die. --12th Day, nearly in the samestate, except his breathing which was somewhat more difficult, beingnow obliged to have his head considerably raised. Persistat--From thisday to the 32d day he became hourly worse. His belly which at firstwas only hard, now evidently contained a large quantity of water, hislegs were more swelled, and a large sphacelated sore appeared uponeach outer ancle. Respiration was so much obstructed, that he wasobliged to sit quite upright to prevent suffocation. He made verylittle water, not more than eight ounces in a day and a night, and wasmuch emaciated. Ordered his purging bolus again, and ℥ii. Of a mixturewith sal diuretic, ℥ss. To ℥xii. Three times in a day, and a poulticewith ale grounds to his legs. 

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

69th day. His belly nearly reduced to its natural size, still made aprodigious quantity of water, his appetite very good, habit of bodyrather lax, and his complexion ruddy. On the 2d of _June_, being stillrather weak, he was ordered decoct. Cort. ℥ii. Ter de die; and on the12th 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 anout-patient of the Birmingham General Hospital: she complained ofconsiderable pain in her chest, and great difficulty of breathing, herface was much swelled and her thighs and legs were anasarcous. She hadextreme difficulty in making water, and with many painful efforts shedid not void more than six ounces in twenty-four hours. She had beenin this situation about six weeks, during which time she had takenammoniacum, olibanum, and large quantities of squills, without anyother effect than frequent sickness. Upon her commencing an Hospitalpatient, 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 fewdays, without any sensible effect. On the eighth day her breathing wasmuch relieved, her legs and thighs were not so much swelled, and in aday and a night she made five pints of water. By the 12th day herlegs and thighs were nearly reduced to their natural size. Shecontinued to make water in large quantities, and had lost her pain inthe thorax. To the 20th of _March_, she made rapid advances towardshealth, 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 happyif I can give you any intelligence relating to the Foxglove, that cananswer 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 theFoxglove root; but why it had not a more lasting effect, it isnecessary I should tell you that he had all the signs of a distemperedviscera, long before any watery swellings appeared; it was manifestthat his dropsy was merely symptomatic, and he could therefore onlyfrom time to time have any relief from medicine. In the year 1776, hereturned from London to Oxon. Having consulted several physicians atthe former place, and Dr. Vivian at the latter, but without anysuccess; and he was then told of a carpenter at Oxon. That had beencured of a Hydrops pectoris by the Foxglove root, and as he was ayounger, 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 thereforeI cannot speak precisely to the operation of it; but I remember, byhis letters, that he was dreadfully sick and ill for several daysbefore the secretion of urine came on, but which it did do to a greatdegree; relieved his breath, and greatly lessened the swelling in hislegs and thighs; but the two instances I have lately seen in this partof the world, are much stronger proofs of the efficacy of it than mybrother's case. 

 I am, &c. ROBERT CAWLEY. 

N. B. Whenever I have another opportunity of giving the Foxglove, itshall 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, Ishould 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 properlygiven, and the diuretic effects produced, that an accidental over-dosebringing on sickness, has stopped the secretion of urine. In thepresent instance it likewise appears, that violent sickness may beexcited, and continue for several days without being accompanied by aflow of urine; and it is probable that the latter circumstance did nottake place, until the severity of the former abated. If Dr. Cawley hadnot had a constitution very retentive of life, I think he must havedied from the enormous doses he took; and he probably would have diedprevious to the augmentation of the urinary discharge. For if the rootfrom which his medicine was prepared, was gathered in its activestate, he did not take at each dose less than _twelve_ times thequantity a strong man ought to have taken. Shall we wonder then thatpatients refuse to repeat such a medicine, and that practitionerstremble to prescribe it? Were any of the active and powerful medicinesin daily use to be given in doses _twelve_ times greater than theyare, and these doses to be repeated without attention to the effects, would not the patients die, and the medicines be condemned asdangerous 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. WhichI gave to Thomas Cooke and Thomas Roberts. 

Thomas Cooke, Æt. 49, had been ill about two or three weeks. When Isaw him he had no appetite, and a constant thirst: a fullness and loadin the stomach: the thighs, legs and hands, much swell'd, and the faceand throat in a morning; was costive, and made but little water, whichwas 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. Hewas likewise purged by a bolus of argent. Viv. Jallap, Digit. Elaterium and calomel, which was repeated on the fourth day, to thethird time. From _June_ 17th to the 29th, the symptoms were mostlyremoved, making water freely, and having plenty of stools; in a weekafter he was perfectly well, and remains so ever since. The cure wasfinished by steel and bitters. 

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

 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 about60; had been a strong healthy, robust, corpulent man; worked hardearly in life at edge-tool making, and drank freely of strong maltliquor; for many years had been subject to gout in the extremities;for a few years past had been very asthmatic, and the gout in theextremities 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, anirregular pulse, and unable to lie down. His easiest posture wasstanding with his body leaning over a chair, in which situation hewould continue many hours together, labouring for breath, with thesweat trickling down his face very profusely; the urine in very smallquantity. Diuretics of every kind I could think of were used with verylittle or no advantage. Blisters applied to the legs relieved veryconsiderably for a time, but by no means could I increase the urinarydischarge. Warm stomachic medicines were given, and at the same timesinapisms applied to the feet, in hopes of enticing gout to theextremities, but without any good effect. --_November_ 22d. Theswelling considerably increasing, an emetic of acet. Scillitic. Wasgiven, which acted very violently, and increased the urinary dischargeconsiderably. He continued better and worse, using different kinds ofdiuretic and expectorating medicines until _September_ 1781, when thedisease 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 increasingthe urinary discharge. --On the 17th of _September_ I infused ʒiii. Ofthe fol. Digitalis in ℥vi. Of boiling water, for four hours; thenstrained it, and added ℥i. Of tinct. Aromatica. --On the 18th he beganby taking one spoonful, which he was to repeat every half hour, tillit made him very sick, unless giddiness, loss of sight, or any otherdisagreeable effect took place. I had never given the medicine before, and had prepared him to expect the operation to be very severe. I sawhim again on the 21st; he had taken the medicine regularly, till thewhole quantity was consumed, without perceiving the least effect ofany kind from it, and continued well till the evening of the followingday, when a little sickness took place, which increased, but never soas to occasion either vomiting or purging, but a surprising dischargeof urine. The saliva increased so as to run out of his mouth, and awatery discharge from his eyes; these discharges continued, with acontinual sickness, till the swelling was totally gone, which happenedin three or four days. He afterwards took steel and bitters; andcontinued very comfortably, without any return of his dropsy, untilthe 7th of _April_ 1782, when he was seized with an epidemic cough, which was very frequent with us at that time. His swellings nowreturned very rapidly, with the greatest difficulty in breathing, andhe died in a few days. Blisters and expectorating medicines were usedon this last return. 

 Extract of a Letter from Mr. CAUSER. 

Mrs. S----, the subject of the following Case, was as ill as it ispossible for woman to be and recover; from the inefficacy of themedicines used, I am convinced no medicine would have saved her butthe Digitalis. I never saw so bad a case recovered; and it shews, thatin the most reduced state of body, the medicine in small doses, willprove 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 greatdifficulty in breathing, which is much increased on moving; a veryirregular, intermittent pulse, urine in very small quantity, and inthe seventh month of her pregnancy: a woman of very delicateconstitution, with tender lungs from her infancy and very subject tolong 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 urineabout ℥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 tookplace. The first was sickness, succeeded by a considerable dischargeof 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, andshe got perfectly free from her dropsical complaints. 

_March_ 15th she was delivered: had a good labour, was treated as isusual, except in not having her breasts drawn, not intending seeshould suckle her child, being in so reduced a state. Continued goingon well till the 18th, when she was seized with very violent painsacross her loins, at times so violent as to make her cry out as muchas 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 pulsescarcely to be felt, fainty, and a universal cold sweat: no appetitenor 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 toswell. --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 muchthe same. 

30th. Breathing very bad, with cough and pain across the sternum, unable to lie down, legs, thighs, and body very much swelled, urinenot more than four or five ounces in the twenty-four hours; hot andfeverish, 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 andfainting. She desired to have some of the pills which relieved her somuch when with child. I was almost afraid to give them, but theinefficacy of the other medicines gave me no hopes of a cure fromcontinuing 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 intwenty-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 cupof cold chamomile tea every morning. 

25th. Swelling much diminished, makes plenty of water, appetite muchmended, cough and breathing better. She omitted the medicine for threedays; the urine began to diminish, the swelling and shortness ofbreathing worse. On repeating it for two days, the discharge was againaugmented, and a diminution of the swelling succeeded. She hascontinued the pills ever since till the 14th of _May_; the dropsicalsymptoms and cough are entirely gone, the water is in sufficientquantity, her strength is recovered, and she has a good appetite. Allshe now complains of is a weight across her stomach, which is worse attimes, and she thinks, unless it can be removed, she shall have areturn 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 amglad to hear, for I have long wished to see your ideas in print aboutit, and I know of no one (from the great attention you have paid tothe subject) qualified to treat on it but yourself. There aregentlemen of the faculty who give verbal directions to poor patients, for the preparing and taking of an infusion or decoction of the greenplant. Would one suppose that such gentlemen had ever attended to thenature and operation of a sedative power on the functions, _particularly_ the _vital_? Is not such a vague and unscientific modeof proceeding putting a two edged sword into the the hands of theignorant, and the most likely method to damn the reputation of anyvery active and powerful medicine? And is it not more than probablethat 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 causesof the once rising reputation of that noted plant being damned abovea century ago? In short, the Digitalis is beginning to be used indropsies, (although some patients are said to go off suddenly underits administration) somewhat in the style of broom ashes; and, in myhumble opinion, the public, at this very instant, stand in great needof your _precepts_, _guards_, and _cautions_ towards the safe andsuccessful use of such a powerful sedative diuretic; and I have nodoubt of your minute attention to those particulars, from a regard tothe good and welfare of mankind, as well as to your own reputationwith respect to that medicine. 

I remember an officer in the Staffordshire militia, who died here of adropsy five years ago. The Digitalis relieved him a number of times ina wonderful manner, so that in all probability he might have obtaineda radical cure, if he would have refrained from hard drinking. Iunderstood it was first ordered for him by a medical gentleman, andits sedative effects proved so mild, and diuretic operation sopowerful, that he used to prepare it afterwards for himself, and wouldtake it with as little ceremony as he would his tea. It is said, thathe was so certain of its successful operation, that he would boast tohis bacchanalian companions, when much swelled, you shall see me intwo 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 forseveral years; after a severe fit of it her legs began to swell, andthe quantity of urine to diminish. In six weeks she was much troubledwith the swellings in her thighs and abdomen, which decreased verylittle when she lay down: she made not quite a pint of water in thetwenty-four hours. I ordered her to take two spoonfuls of the infusionof Foxglove every three hours. By the time she had taken eight dosesher urine had increased to the quantity of two quarts in the day andnight, but as she complained of nausea, and had once vomited, Iordered the use of the medicine to be suspended for two days. Thenausea being then removed, she again had recourse to it, but atintervals of six hours. The urine continued to discharge freely, andin three weeks she was perfectly cured of her swellings. 

 CASE II. 

_December_, 1782. A poor woman, who had been afflicted with an agueduring the whole of her pregnancy, and for two months with dropsicalswellings of the feet, legs, thighs, abdomen, and labia pudenda; wasat the expiration of the seventh month taken in labour. On the dayafter her delivery the ague returned, with so much violence as toendanger her life. As soon as the fit left her, I began to give herthe red bark in substance, which had the desired effect of preventinganother paroxysm. She continued to recover her health for a fortnight, but did not find any diminution in the swellings; her legs were now solarge as to oblige her to keep constantly on the bed, and she madevery little water. I ordered her the infusion of Foxglove three timesa day, which, on the third day, produced a very copious discharge ofurine, without any sickness; she continued the use of it for ten days, and was then able to walk. Having lost all her swellings, and nocomplaint remaining but weakness, the bark and steel compleated thecure. 

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

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

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

 CASE I. 

Ann Willott, 50 years of age, became a patient of the Dispensary onthe 11th of April 1783. She then complained of an enlargement of theabdomen, difficulty of breathing, particularly when lying, andcostiveness. She passed small quantities of high-coloured urine; andhad 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 threedrams of the dry leaves, in eight ounces, three times a day. Her urinesoon increased, and in a few days she passed it freely, whichcontinued, and her breath returned. 

 CASE II. 

Mr. ----, 45 years of age, had been long subject to dropsicalswellings of the legs, and made little water. Two spoonfuls of thesame 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, shehad a great diminution of urine, and considerable difficulty ofbreathing, particularly on motion, or when lying. Her body was muchbound. There was, however, no apparent swelling. She took threespoonfuls of an aperient decoction of forty-five grains in six ouncesand a half, every other morning. The urine was plentiful those days, and her breathing much relieved. In two or three weeks after the useof it she was perfectly restored. The purgative medicine neitherincreased the urine, nor relieved the breathing, till the Foxglove wasadded. 

This spring she long laboured with the gout in her stomach, whichterminated in a fit in her hand. During the whole of this tediousillness, of nearly three months, she passed little urine, and herbreathing 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 aslittle. The dulcified spirits of vitriol, however, quickly promotedthe urinary secretion. 

 CASE IV. 

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

 CASE V. 

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

 CASE VI. 

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

 CASE VII. 

Mrs. P----, in her 70th year, took three grains of the powder twice aday, 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 eightounce decoction. 

 CASE IX. 

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

 CASE X. 

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

 CASE XI. 

Mrs. Smith, about 50 years of age, after a tedious illness of manyweeks, had a jaundice, and became dropsical in the legs. Two spoonfulsof 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 thesame way for dropsy of the legs, with little effect. 

 CASE XIII. 

---- Genders, about thirty-four years of age, was delivered of threechildren, and became dropsical of the abdomen. She passed little or nourine, had constant thirst, and no appetite. She took two spoonfuls ofan eight ounce decoction, with three drams twice a day. By the timeshe had finished the bottle, (which must have been on the fourth day, )she had evacuated all her water, and could go about. Her appetiteincreased 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 œdematousswelling of one leg and thigh, of many weeks standing. She passedlittle or no urine, and had all her other complaints. She took 2spoonfuls of an eight oz. Decoction of two drams, twice a day. Herurine immediately increased; and, on the third day, the swelling hadentirely subsided. 

 CASE XV. 

Mr. P----, 65 years of age, and of a full habit of body. Had livedfreely in his youth, and for many years led rather an inactive life. His health was much impaired several months, and he had a considerabledistention, and evident fluctuation in the abdomen, and a very greatœdema of the legs and thighs. His breathing was very short, andrather laborious, appetite bad, and thirst considerable. His belly wasbound, 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 tooktwo 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 secondtime; but I was well informed, about ten days or a fortnightafterwards, that his urine increased amazingly upon taking thedecoction, and that the water was entirely evacuated. 

 CASE XVI. 

Mrs. G----, aged 50 years. After being long ailing, had a largecollection of water in the abdomen and lower extremities. Her urinewas 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 painacross the abdomen, and of loss of appetite; his urine, he thought, was less than usual, but the difference was so trifling he could speakwith no certainty: his belly seemed to fluctuate. Among other thingshe tried the Foxglove leaves dried, twice a day; and, although itappeared to afford him relief, yet the effect was not permanent. 

 CASE XVIII. 

Mr. W----, aged between 60 and 70 years; and rather corpulent: wasconsiderably dropsical, both of the belly and legs, and his urine insmall 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 fordropsy of the abdomen and legs; and was relieved by the Decoctumdigitalianum. 

 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, whichwas removed by the humane assistance of an amiable young lady. Hisintermittent was soon attended by a very considerable ascites; forwhich he became a patient of the Dispensary. He took a decoction ofFoxglove night and morning. His urine increased immediately, and helost all his complaints in four days. 

 CASE XXII. 

William Millar, aged 50 years. Admitted into the Dispensary for atertian ague, and general dropsy. The dropsy continuing after the aguewas removed, and his urine being still passed in small quantities; hetook 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 thebelly after an ague. She took a decoction of Foxglove, which removedall complaint by the fourth day. 

 CASE XXIV. 

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

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

 REMARKS. 

These Cases, thus liberally communicated by my friend, Dr. Jones, aremore acceptable, as they seem to contain a faithful abstract from hisnotes, 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 acase of anasarca; I do myself the pleasure of communicating a shorthistory 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 followingsymptoms, viz. Alternate swelling of the legs and abdomen, a littlecough, shortness of breath in a morning, thirst, weak pulse, and herurine, which was so small in quantity as seldom to amount to half apint 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 mistakeonly two tea spoonfuls for a dose, yet the quantity of urine wasincreased to about a pint in the twenty-four hours. She was thendirected to take two table spoonfuls night and morning. And. 

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

On the 19th the swelling of the legs was removed. A degree of nauseatook place in the morning, and increased so much during the day, thatshe vomited up all her food and medicine. As she was very low, andcomplained of want of appetite, a cordial julep was directed to betaken occasionally, as well as red port and water, mint tea, &c. Sheinformed me that whatever she took generally staid about an hourbefore it came up again, and that the mint tea staid longest on thestomach. The vomiting decreased gradually, and ceased on the 22d. Thedischarge of urine remained considerable during the three followingdays, but its quantity was not measured. 

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

On the 23d she complained of thirst, and thought the discharge ofurine not so copious as on the preceding days, therefore the salinejulep was continued every fourth hour, with the addition of thirtydrops 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 ofemollient injections. 

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

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

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

A giddiness of the head, more or less remarkable at times, wasobserved to follow the use of the Foxglove, and it lasted nine or tendays. 

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

 REMARKS. 

The above is a very instructive case, as it teaches us how small aquantity of the infusion was necessary to effect every desirablepurpose. At first sight it may appear from the concluding paragraph, that the green leaves ought to be preferred to the dried ones, asbeing so much milder in their operation; but let it be noticed, thatthe same quantity of infusion was prepared from the same weight of thegreen as of the dried leaves, and consequently, as will appearhereafter, the infusion with the dried leaves was five times thestrength of that before prepared from the green ones. We need notwonder, therefore, that the effects of the former were sodisagreeable, when the dose was five times greater than it ought tohave been. But what makes this matter still more obvious, is themistake mentioned at first, of two tea spoonfuls only being given fora dose. Now a tea spoonful, containing about a fourth or a fifth partof the contents of a table spoon, the dose then given, was very nearlythe same as that which had before been taken of the infusion of thegreen leaves, and it produced precisely the same effects for itincreased the urinary discharge, without exciting the violentvomiting. 

 Letter from Doctor JOHNSTONE, Physician, in Birmingham. 

 Dear SIR, The following cases are selected from many others in which I havegiven the Digitalis purpurea; and from repeated experience of itsefficacy after other diuretics have failed. I can recommend it as aneffectual, 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 arobust habit, who had led a regular and temperate life, Æt. 68. He wasaffected with great difficulty of respiration, and cough particularlytroublesome on attempting to lie down, œdematous swellings of thelegs and thighs, abdomen tense and sore on being pressed, painstriking from the pit of the stomach to the back and shoulders; almostconstant nausea, especially after taking food, which he frequentlythrew up; water thick and high-coloured, passed with difficulty andin small quantity; body costive; pulse natural; face much emaciated, eyes yellow and depressed. He had been subject to cough and difficultyof breathing in the winter for several years; and about four yearsbefore this time, after being exposed to cold, was suddenly deprivedof his speech and the use of the right side, which he recovered as thewarm weather came on; but since that time had been remarkably costive, and was in every respect much debilitated. He first perceived his legsswell about a year ago; by the use of medicines and exercise, theswellings subsided during the summer, but returned on the approach ofwinter, and gradually increased to the state in which I found them, notwithstanding he had used different preparations of squills and agreat variety of other diuretic medicines. I ordered the followingmixture. 

 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 theleast sick, and made, during the night upwards of two quarts ofnatural coloured water. 

10th. Took the remainder of the mixture yesterday afternoon andevening, and was sick for a short time, but made nearly the samequantity of water as before, the swellings are considerablydiminished, 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 havegradually decreased; soreness and tension of the abdomen considerablyless. 

 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 theleast sick, and is in every respect considerably better. Repet. Pillul. Ut antea. 

21st. Makes water as usual when in health, and the swellings areentirely 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, andreturned home in much better health than he had been from the time hewas affected with the paralytic stroke, and excepting some return ofhis asthmatic complaint in the winter, hath continued so ever since. 

 CASE II. 

R---- Howgate, a man much addicted to intemperance, particularly inthe use of spirituous liquors, Æt. 60, was admitted into the Hospitalnear Birmingham, _May_ 17, 1783. He complained of difficulty ofbreathing, attended with cough, particularly troublesome on lyingdown; drowsiness and frequent dozing, from which he was roused bystartings, accompanied with great anxiety and oppression about thebreast; œdematous swellings of the legs; constant desire to makewater, which he passed with difficulty, and only by drops; pulse weakand irregular; body rather costive; face much emaciated; no appetitefor 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 beingin the least sick. He continued the use of the mixture three times inthe day till the 30th, and made about three pints of water daily, bywhich means the swellings were entirely taken away; and his othercomplaints so much relieved, that on the 6th of June he was dismissedfree from complaint, except a slight cough. But returning to his oldcourse of life, he hath had frequent attacks of his disorder, whichhave 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 theabdomen, attended with anasarcous swellings of the limbs, &c. Broughton by excessive drinking. I believe the first symptoms of the diseaseappeared the beginning of November, 1776; the medicines he took beforeyou saw him, were squills in different forms, sal diureticus andcalomel, but without any good effect; he begun the Digitalis on the10th 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 verylittle vomiting, after which a considerable flow of urine ensued, andin a very short time, a very little water remained either in thecavity of the abdomen, or the membrana adiposa, but he remainedexcessive weak, with a fluttering pulse at the rate of 150 orfrequently 160 in a minute; he kept pretty free from water for upwardsof twelve months; it then collected, and neither the Digitalis norany other medicine would carry it off. I tapped him the 2d of August1779 in the usual place, and took some gallons of water from him, buthe very soon filled again, and as he had a very large rupture, aconsiderable quantity of the water lodged in the scrotum, and couldnot be got away by tapping in the usual place. I therefore (on the28th of the same month) made an incision into the lower part of thescrotum, and drained off all the water that way, but he was so verymuch reduced, that he died the 8th or 9th of _September_ following, which was about two years and two months after he first begun theDigitalis. 

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

 Communications from Dr. STOKES, Physician, in Stourbridge. 

 Dear SIR, I accept with pleasure your invitation to communicate what I knowrespecting the properties of _Digitalis_; and if an account of whatothers had discovered before you, [8] with a detail of my ownexperience, shall be allowed the merit of at least a well meantacknowledgment, for the early communication you were so kind to makeme, of the valuable properties you had found in it; I shall considermy time as well employed. A knowledge of what has been already done isthe best ground work of future experiment; on which account I havebeen the more full on this subject, in hopes that given with thecautions which you mean to lay down in the cure of dropsies, it mayprove alike useful in that of other diseases, one of which standsforemost 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 ofthe sternum. Pulse irregular, with frequent intermissions. Appetitevery 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, onaccount of the great emergency of the case, but the nausea excited bythe first dose prevented its being given at such short intervals. A 3ddose I found had been given, which was followed by vomitings. All hercomplaints 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 followingappearances. 

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

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

A very slight watery effusion between the _Pia Mater_ and _Tunicaarachnoidea_. About ¾ oz. Of watery fluid in the _lateralventricles_. 

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

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

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

 CASE II. 

Mrs. C---- of K----, Æt. 80. Orthopnœa, with sense of oppressionabout the prœcordia. Unable to lie down in bed for some nightspast. Anasarca of the lower extremities. Urine very scanty. Complaintsof 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. 4tishoris. _ Ordered to drink largely of _infus. Baccar. Junip. _ The thirddose produced great nausea which continued ten hours, during whichtime the urine made was about a quart. The next day her apothecarydirected her to begin again with it. The second dose producedvomiting. 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 continuedthe _inf. Bacc. Junip. _ until about _March_ 2d, when all the swellingswere gone down, her respiration perfectly free, and she herself quiterestored to her former state of health. On the 29th she had an attackof jaundice which was some time after removed; since which she hasenjoyed a good state of health, excepting that for some little timepast her ancles have been slightly œdematous, which will I trustsoon yield to strengthening medicines. 

 CASE III. 

Mrs. M---- G----, Æt. 64. Has had sore legs for these thirty-fouryears 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 thecourse of the night. The flow of urine continued, and complaintsrelieved. Sal. Mart. C. Extr. Gent. And afterwards with the additionof 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 similartrain of symptoms, excepting that the pulse was but just perceptiblyirregular. 

 _Infus. Digital. U. A. Præscript. _

The directions on the phial not being attended to, _two doses of itwere given after a nausea had been excited_, which, with occasionalvomitings, became exceedingly oppressive. A saline draught, given inDr. 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 agreat propensity to sleep coming on, I directed _sal. C. C. Conf. Card, aa gr. Viii. 4tis horis_, which removed the unpleasant symptomsand _myrrh. C. Sal. Mart. _ completed the cure. During the use of theabove medicines, the urine was augmented, and the pulmonary complaintsremoved, even before the nausea left her; and the sores of her legswhich were much inflamed before she began with the infus. Digital. Ina day's time assumed a much healthier appearance, and on her othercomplaints going off, they shewed a greater tendency to heal than shehad ever observed in them for twenty years before. This instance is avery pleasing confirmation of the experience of Hulse and Dr. Baylies, and of the advantage to be derived from a medicine, which, while ithelps to heal the ulcers, removes that from the constitution whichoften renders the healing of them improper. 

In one case in which I ordered it, the infusion, instead of digestingthree hours as I had directed, was suffered to stand upon the leavesall night. The consequence was that the first dose producedconsiderable nausea. 

The two following cases, with which I have been favoured by aphysician very justly eminent, convince me of the necessity there isthat every one who discovers a new medicine, or new virtues in an oldone, should, in announcing such discoveries, publish to the world theexact manner in which he exhibits such medicines, with all theprecautions 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 _itscontinued use_ is owing to its narcotic property gradually diminishingthe irritability of the muscular fibres of the absorbents, or possiblyof the whole vascular system, and thus adding to that weakened actionwhich seems to be the cause of the generality of dropsies, which leadsus to caution the medical experimenter against trying it, at least_against its continued use, even in small doses_, in other diseases ofdiminished 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, ofseven 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 shetook to-day produced vomiting. 

3d DAY. _Minuatur dosis ad ℥ss. _ This stayed upon herstomach, but produced an almost constant sickness. Stools morefrequent, water scarce sensibly increased; and her swellings not atall reduced. 

4th DAY. _Cap. Calomel. Gambog. Scill. &c. _

OBS. Sufficient time was not allowed to observe its effects, neitherwas the patient enjoined the free use of diluents. The diseaseterminated fatally. 

 CASE II. 

William T----, Æt. 42. Ascites, with cough and dyspnœa. Abdomenvery much distended. The rest of his body highly emaciated. Urinethick, 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 adiminution of the abdomen. 

29th. To take a cathart. Powder every 4th morning, continuing thedecoct. Digit. 

32d. Urine exceedingly scanty. 

35th. _Vin. Scill. ℥ss. O. M. &c. _ This produceddiuretic effects. 

44th. Tapped. Terminated fatally. 

OBS. Here the medicine was _continued till it ceased to producediuretic effects_; and these effects were not aided by anystrengthening remedies. 

 CASE III. 

George R----, Æt. 52. Ascites, general anasarca, and dyspnœa. Hislegs so greatly distended that it was with great difficulty he coulddraw 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 agreat deal of watery phlegm. The first dose he took in the morning hasproduced a sickness which has continued all day, but he has nevervomited. 

3d. DAY. The change in his appearance so great as to make it difficultto conceive him to be the same person. Instead of a large corpulentman, he appeared tall, thin, and rather aged. Breathes freely, and canwalk 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 urinealmost as plentiful as the former, though he drank little or nothingat 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 urinecontinued 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. Hehas shrunk round the middle from four feet two inches to three feetsix inches; and in the calves of his legs, from seventeen inches tothirteen 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 youremarked to me, on communicating the case to you at the time, tonicmedicines should have been given, to second the ground that had beengained, 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, withgreat difficulty of breathing. The lac ammoniac. Somewhat relieved hisbreath; but the swellings increased, and his urine was not augmented. I considered it as a lost case, but having seen the good effects ofthe Digitalis, as ordered by Dr. Stokes in the case of Mrs. G----, Igave him one spoonful of an infusion of ʒii to half a pint, twice aday. His breath became much easier, his urine increased considerably, and the swellings gradually disappeared; since which his health hasbeen pretty good, except that about three weeks ago, he had a slightdyspnœa, with pain in his stomach, which were soon removed by arepetition of the same medicine. 

Mr. Shaw likewise informs me, that he has removed pains in the stomachand 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 verypowerful and sensible effects, in the cure of the different patients. 

 CASE I. 

Mrs. O---- of L---- street, in this town, aged 28, naturally of athin, spare habit, and her family inclinable to phthisis, sent for meon the 11th of June, 1779, at which time she complained of great painin her side, a constant cough, expectorated much, which sunk in water;had colliquative sweats and frequent purging stools; the lowerextremities and belly full of water, and from the great difficulty shehad in breathing, I concluded there was water in the chest also. Thequantity 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 shecould receive no benefit from medicine, and requested her not to takeany; but she being very desirous of my ordering her something, Icomplied, and sent her a box of gum pills with squills, and a mixturewith salt of tartar: these medicines she took until the sixteenth, without any good effects: the water in her legs now began to exsudethrough the skin, and a small blister on one of her legs broke. Believing she could not exist much longer, unless an evacuation of thewater could be procured; after fully informing her of her situation, and the uncertainty of her surviving the use of the medicine, Iventured to propose her taking the Digitalis, which she chearfullyagreed to. I accordingly sent her a pint mixture, made as under, ofthe fresh leaves of the Digitalis. Three drams infused in one pint ofboiling water, when cold strained off, without pressing the leaves, and two ounces of the strong juniper water added to it: of thismixture she was ordered four table spoonfuls every third hour, till iteither made her sick, purged her, or had a sensible effect on thekidneys. This mixture was sent on the seventeenth, and she begantaking it at noon on the eighteenth. At one o'clock the followingmorning I was called up, and informed she was dying. I immediatelyattended her, and was agreeably surprised to find their fright arosefrom her having fainted, in consequence of the sudden loss of twelvequarts of water she had made in about two hours. I immediately applieda roller round her belly, and, as soon as they could be made, 2others, which were carried from the toes quite up the thighs. Therelief afforded by these was immediate; but the medicine now began toaffect her stomach so much, that she kept nothing on it many minutestogether. 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 ina state of effervescence was taken to no good purpose: She thereforecontinued the beef tea, and took no other medicine for five days, when her sickness went off: her cough abated, but the pain in her sidestill continuing, I applied a blister which had the desired effect:her urine after the first day flowed naturally. Her cure wascompleated by the gum pills with steel and the bitter infusion. Itmust be observed she never had any collection of water afterwards. 

It affords me great pleasure to inform you that she is now living, andhas 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 emeticsin some kinds of consumptions, as it appears to me the dropsy wasbrought on by the cough, &c. And I believe these were cured by thecontinual 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, whichprevented him from laying down in bed; his belly, thighs and legs verymuch distended with water; the quantity of urine made at a time seldomexceeded a spoonful. I requested him to get some of the Digitalis, andas they had no proper weights in the house, I told them to put as muchof the fresh leaves as would weigh down a guinea, into half a pint ofboiling water; to let it stand till cold, then to pour off the clearliquor, and add a glass of gin to it, and to take three tablespoonfuls every third hour, until it had some sensible effect uponhim. 

Before he had taken all the infusion, the quantity of urine madeincreased, (he therefore left off taking it), and it continued to doso until all the water was evacuated. His breathing became muchbetter, his cough abated, though it never quite left him; he being forsome time before asthmatic. By taking some tonic pills he continuedquite well until the next spring, when he had a return of hiscomplaint, which was carried off by the same means. Two years after, he had a third attack, and this also gave way to the medicine. Lastyear 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 “ageneral dropsy--every time she took the medicine its effects weresimilar, 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 onlytemporary, they were exceedingly agreeable to the patient, making hertime 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 yourobservations on the Digitalis purpurea. 

Several years are now elapsed since you communicated to me the highopinion 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 asin the prescriptions returned. If the medicine operated on the stomachor bowels, it was thought prudent to forbear. When the kidneys beganto perform their proper functions, and the urine to be discharged, acontinuance of its farther use was unnecessary. 

These remarks you made in the case of the first patient for whom youprescribed the Digitalis in our neighbourhood, and I have found themall necessary at this present period. From the _decided_ good effectsthat followed from its use, in those cases where the most powerfulremedies had failed, I was soon convinced it was a most valuableaddition to the materia medica. 

The want of a certain diuretic, has long been one of the desiderata ofmedicine. The Digitalis is undoubtedly at the head of that class, andwill seldom, if properly administered, disappoint the expectation. Ican 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 thegreatest success. In recent obstructions, I do not recollect manyfailures. In anasarcous diseases, and in the anasarca, when combinedwith the ascites; in swellings of the limbs, and in diseases of thechest, when there was the greatest reason to believe an accumulationof serum, the most beneficial consequences have followed from its use. 

Had I been earlier acquainted with your intention to publish anaccount of the Digitalis, I could have transmitted some cases, whichmight have served to corroborate these assertions: but I am convincedthe Digitalis needs not my assistance to procure a favorablereception. Its own merit will ensure success, more than a hundredrecited cases. 

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

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

These cautions are unnecessary to the accurate botanist, who wellknows, that a plant in the spring, though more succulent and full ofjuices, is destitute of those qualities which may be expected whenthat plant has attained its full vigour, and the seed-vessels begin tobe manifest. But for want of attention to these particulars, itsvirtues may be thought exaggerated, or doubtful, if beneficialconsequences do not always flow from its use. There are diseases itcannot cure; and in several of those patients in this town, who firsttook the Digitalis by your orders, there was the most positive proofof the viscera being unsound. In these desperate cases it oftenprocured a plentiful flow of urine, and palliated a disease whichmedicine could not remove. 

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

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

Permit me to return my thankful acknowledgments, for your freecommunication of a medicine, by which means, through the blessing ofprovidence, I have been enabled to restore health and happiness tomany 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, andoppression in my chest, in consequence of taking cold from beingcalled out in the night. My tongue was foul; my urine small inquantity; my breath laborious and distressing on the slightestexercise. I tried the medicines most generally recommended, such asemetics, blisters, lac ammoniacum, oxymel of squills, &c. But findinglittle or no relief, I consulted Dr. Withering, who advised me to trythe 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 cantharidesthree or four times a day. 

After taking eight ounces of the infusion, and about twelve drams ofthe drops, I was perfectly cured, and have had no return since. Themedicine did not occasion sickness or vertigo, nor had they any othersensible effect than in changing the appearance, and increasing thequantity of the urine, and rendering the tongue clean. After the lastdose or two indeed, I had a little nausea, which was immediatelyremoved 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, bytranscribing outlines of the subsequent cases, for insertion in yourlong requested tract on the Digitalis purpurea. The two first of theseyou will easily recollect, the cures having been conducted immediatelyunder your own management, and the whole may add to that weight ofevidence which long experience enables you to adduce of the efficacyof that valuable medicine. I have recited the only instances of itsfailure which occur to me, but many other, though successful cases, wherein its utility might seem dubious, and also the accounts receivedfrom people whose accuracy might be suspected, I shall not for obviousreasons 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, awakedwith a sense of suffocation, which obliged him to rise up suddenly inbed. I found him complaining of difficult respiration, particularly onlying down; the countenance pale, and the pulse smaller and quickerthan usual. Some brandy and water having been given, the symptomsgradually abated, so that he slept in a half recumbent posture. Thefollowing day he expressed a sense of anxiety and weight in the chest, attended by quicker breathing upon motion of the body. That evening anemetic of ipecacoanha was given, and afterwards a draught, withvitriolic æther and confect. Card. Aa ʒi to be repeated as thesymptoms should require it. He continued to be affected with slighterreturns of the dyspnœa at irregular intervals, until _September_ 15th, when upon a more severe attack, the emetic was repeated. He nowrecollected some slight pain in his arms which had affected himprevious to this last seizure, and was disposed to consider hiscomplaint as rheumatic. Pills with gum ammoniac. Gum guaiac. Andantimonial powder were directed, with infus. Amar. Simpl. Twice a day. The bowels were regulated by aperient pills of pulv. Jalap. Aloes andsal. Tartar. And ʒiss balsam peruv. Was given occasionally toalleviate the paroxysms of dyspnœa. 

From this period until the beginning of November, little amendment orvariation happened, except that respiration became more permanentlydifficult, and particularly oppressed upon motion, nor was it relievedby the expectoration of a mucous discharge, which now increasedconsiderably. Squills, musk, ol. Succini, æther, with other medicinesof the same kind, were now used, but without success. The effects ofopium and venæfection were tried. The appetite diminished, and hissleep became short and disturbed. He sometimes slept lying upon hisback, but generally upon his left side. The urine which had hithertobeen 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, andʒiss of oxymel scillitic. Was given every eight hours. 

On the 18th, a more copious discharge of urine took place; theswelling of the feet soon disappeared, and the respiration becamegradually relieved. 

On the 30th ʒi tinct. Cantharidum twice a day in pyrmont water, withpills of ammoniac, sal tartar. Et extract. Gentian. Were substituted, but

On the 7th of _December_, from some symptoms of relapse, the oxymelwas used as before, and continued to be taken until the 27th, in dosesas large as could be dispensed with on account of the great nauseawhich attended its exhibition: The urine was made in the quantity offour or five pints each day, during the whole time; the quantity thendrank being seldom more than three pints. But now the sickness beingexceedingly depressing, the strength failing, and the diuretic effectsbeginning 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 thedose of the Digitalis had been increased to six grains per day, theflow of urine generally amounted to seven pints every twenty-fourhours. Not the least sickness, nor any other disagreeable symptomsupervened, though he persevered in this plan until the end of_January_ at which time the dyspnœa was removed, and he hascontinued 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 fromLondon, to her native air in Shropshire, under symptoms of complicateddisease. It was your opinion that the plethoric state, consequent tothat period, when menstruation first begins to cease, had undervarious appearances, laid the foundation of that deplorable statewhich now presented itself. The skin was universally of a pale, leadencolour; her person much emaciated, and her strength so reduced, as todisable her from walking without support. The appetite fluctuating, the digestion impaired so much, that solids passed the intestines withlittle appearance of solution: She had generally eight or ten alvineevacuations every day, and without this number, febrile symptoms, attended with severe vertiginous affection, and vomiting regularlyensued. The stools were of a pale ash colour. The urine generallypale, and at first in due quantity. The region of the stomach had atense feel, without soreness: the feet and ancles œdematous, hersleep was uncertain: the pulse varying between 94 and 100, and feeble, except upon the approach of the menstrual periods, which were now onlymarked by its increased strength, and exacerbation of other febrilesymptoms. Emetics, saline medicines, and gentle aperients werenecessary to alleviate these. Six grains of ipecac, operated withsufficient power, and half a grain of calomel would have purged withgreat violence. 

From the time of her arrival till the middle of _August_, mercury hadbeen continued in various forms, and in doses such as the irritablestate of her stomach and bowels would admit of. Spirit. Nitri dulc. ;sal. Tartar, squill, and cantharides were alternately employed asdiuretics, but without success, to retard the progress of an universalanasarca which was then advanced to such degree and accompanied by sogreat debility, and other dreadful concomitants, as to threaten aspeedy 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 themedicine in the same dose until the 20th of _September_, dischargingfrom six to eight pints of water each day for the first week, andwhich quantity gradually diminished as she became empty. During thisperiod she complained not of any sickness, except from the lixivium, which was after the first dose reduced to 20 drops; and her appetiteand strength increased daily, though it was evident that no bile hadyet flowed into the bowels, nor was the digestion at all improved. Theanasarcous appearances being then removed, the Digitalis was omitted, and pills, composed of mercur. Cinereus, aloes, and sal tartaridirected twice a day, with ʒi. Of vin. Chalybeat. In infus. Amar. Simpl. 

Her amendment in other respects proceeded slowly, but regularly, fromthat time until the 9th of October; when the state of plethora againrecurring, with its usual attendant symptoms, ℥iv. Of blood were takenfrom the arm; and this was upon the same occasion, repeated in thefollowing month, with manifest good consequences; though in bothinstances the colour of the blood, as flowing from the vein couldhardly be called red, and the coagulum was as weak in its cohesion aspossible. The state of the stomach and bowels was by this time greatlyimproved, in common with other parts of the system; but nointromission of bile had yet happened: the hardness about thehypogastric region, though less, continued in a considerable degree, and you ordered pills of mercury rubbed down, and rust of iron, to betaken twice a day, with a decoction of dandelion and sal sodæ. 

A cataplasm of linseed was applied every night over the stomach andright side; and, with little deviation from this plan, she continuedto the end of the year, improving in her general health, but thehepatic affection yet remaining. It was then determined to try theeffects of electricity, and gentle shocks were passed through the bodydaily, and as nearly as could be through the liver, in variousdirections. 

On the fifth day there was reason to think that some gall had beensecreted and poured out, and this became every day more evident; butit flowed only in small quantity, and irregularly into the bowels, asappeared from the fæces being partially tinged by it. 

In _February_ the lady left this neighbourhood, and thoughconvalescent, yet so nearly well as to promise us the satisfaction ofseeing her perfectly restored. 

_June_ 29. The bile is now secreted in pretty good quantity, herappetite is perfectly good, her strength equal to almost any degree ofexercise, and her health in general better than it has been for someyears. 

 CASE III. 

Mr. W----, aged--. In _June_, 1782, was affected with slightdifficulty in respiration, upon taking exercise or lying down in bed. These symptoms increased gradually until the end of _July_, when hecomplained 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 breathedwith difficulty when in bed, and slept little. After the exhibition ofan 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 thesternum, and six grains of calomel given in the evening. The symptomswere now increased very considerably, in every particular; and thefollowing 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 followingday he began to make water in great quantity, which he continued to dofor three or four days. The pulse in a few hours became regular, slower, and stronger, and, in the course of a week, all the symptomsentirely vanished, and an electuary of cort. Peruvian, sal martis, andspec. Aromatic. Confirmed his cure. 

In _February_, 1784, this gentleman had a relapse of his disease, fromwhich he again soon recovered by the same means, and is now perfectlywell. 

 CASE IV. 

G---- A----, a husbandman, aged 57. Was in the year 1782 affected witha slight, but constant pain in his breast, with difficult respiration. His countenance was yellow; the abdomen swelled, and hard; his urinehigh coloured, and in small quantity; appetite and sleep little. Complained of frequent nausea, and of sudden profuse sweatings, whichseemed 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, withsome appearance of advantage. He was then directed to take some pillsof squill, soap, and rhubarb, with a draught twice a day, consistingof infus. Amar. Simp. And sal tartari. The skin soon became clearerand the pain in his breast considerably diminished. But every othercircumstance remaining the same, and a fluctuation in the belly beingnow more evident, the infusion of Digitalis as prescribed in casethird, was given in the dose of one ounce twice a day. 

On the 5th day the effects were apparent, and he continued hismedicine for a fortnight without nausea, making four or five pints ofwater every night, but little in the day, and gradually losing thesymptoms of his disease. 

In 1784, this person had a relapse, and was again cured by similartreatment. 

 CASE V. 

R---- H----, Aged 43. Towards the end of the year 1783, becameaffected with slight cough and expectoration of purulent matter. InDecember his skin became universally of a pale yellow colour. Theabdomen was swelled and hard; his appetite little, and he complainedof a violent and constant palpitation of the heart, which preventedhim from sleeping. The urine pale, and in small quantity. The pulseexceedingly strong, and rebounding; beating 114 to 120 strokes everyminute. He suffered violent pain of his head, and was very feeble andemaciated. After bleeding, and the use of gentle aperient medicines, he continued to take the infusion of Digitalis for some days, withoutany sensible effect. Other diuretics were tried to as little purpose. Repeated bleeding had no effect in diminishing the violent action ofthe heart. He died in January following, under complicated symptoms ofphthisis and ascites. 

 CASE VI. 

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

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

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

 CASE VII. 

S---- D----, a middle aged single woman, was affected in the yeareighty-one, with a painful rigidity and slight inflammation of theinteguments on the left side, extending from the ear to the shoulder. In every other particular she was healthy. The use of warmfomentations, and opium, with two or three doses of mercurial physic, afforded her ease and the inflammation disappeared, but was succeededby an œdematous swelling of the part, which very gradually extendedalong the arm, and downward to the breast, back, and belly. Friction, electricity and mercurial ointment were amongst the number ofapplications unsuccessfully employed to relieve her for the space ofthree 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 aneffusion of water in the thorax. The Digitalis, squills, andcantharides were given in very considerable doses without effect. Shedied the latter end of December following. 

 CASE VIII. 

W---- C----, a collier aged 58, was attacked in the spring of 1783with a tertian ague, which he attributed to cold, by sleeping in acoal pit, and from which he recovered in a few days, except aswelling of the lower extremities, which had appeared about that time, and gradually increased for two or three months. The legs and thighswere greatly enlarged and œdematous. His belly was swelled, but nofluctuation perceptible. He made small quantities of high colouredwater. The appetite bad, and pulse feeble. He had taken many medicineswithout relief, and was now so reduced in strength, as to sit up withdifficulty. An infusion of the Digitalis was directed for him, in theproportion of one ounce of the fresh leaves to a pint of water, twoounces to be taken three times a day, until the stomach or bowelsbecame affected. Upon the exhibition of the sixth dose, nauseasupervened, and continued to oppress him at intervals for two or threedays, during which he passed large quantities of pale urine. Theswelling, assisted by moderate bandage rapidly diminished, and withoutany repetition of his medicine, at the expiration of sixteen days, hereturned 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 theplant and the season of the year. 

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

Some practitioners, who have used the root, and been so happy as tocure their patients without exciting sickness, have been pleased tocommunicate the circumstance to me as an improvement in the use of theplant. I have no doubt of the truth of their remarks, and I thankthem. But the case of Dr. Cawley puts this matter beyond dispute. Thefact is, they have fortunately happened to use the root in itsapproach to its inert state, and consequently have not over dosedtheir patients. I could, if necessary, bring other proof to shew thatthe root is just as capable as the leaves, of exciting nausea. 

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

LEAVES. --These vary greatly in their efficacy at different seasons ofthe year, and, perhaps, at different stages of their growth; but I amnot certain that this variation keeps pace with the greater or lesserintensity of their bitter taste. 

Some who have been habituated to the use of the recent leaves, tellme, that they answer their purpose at every season of the year; and Ibelieve them, notwithstanding I myself have found very greatvariations in this respect. The solution of this difficulty isobvious. They have used the leaves in such large proportion, that thedoses have been sufficient, or more than sufficient, even in theirmost inefficacious state. _The Leaf-stalks_ seem, in their sensibleproperties, to partake of an intermediate state between the leaves andthe stem. 

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

SEEDS. --These I believe are equally untried. 

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

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

The leaf-stalk and mid-rib of the leaves should be rejected, and theremaining part should be dried, either in the sun-shine, or on a tinpan 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 ofthe leaves. Care must be taken that the leaves be not scorched indrying, and they should not be dried more than what is requisite toallow 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 dropsicalpatients, four grains a day are sufficient. I sometimes give thepowder alone; sometimes unite it with aromatics, and sometimes form itinto pills with a sufficient quantity of soap or gum ammoniac. 

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

The ingenuity of man has ever been fond of exerting itself to vary theforms and combinations of medicines. Hence we have spirituous, vinous, and acetous tinctures; extracts hard and soft, syrups with sugar orhoney, &c. But the more we multiply the forms of any medicine, thelonger we shall be in ascertaining its real dose. I have no lastingobjection however to any of these formulæ except the extract, which, from the nature of its preparation must ever be uncertain in itseffects; and a medicine whose fullest dose in substance does notexceed three grains, cannot be supposed to stand in need ofcondensation. 

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

From this view of the doses in which the Digitalis really ought to beexhibited, and from the evidence of many of the cases, in which itappears to have been given in quantities six, eight, ten or eventwelve times more than necessary, we must admit as an inference eitherthat this medicine is perfectly safe when given as I advise, or thatthe 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, withfrequent motions to part with it, and sometimes inability to retainit; 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 effectsin a lower degree; and it is curious to observe, that the sickness, with a certain dose of the medicine, does not take place for manyhours after its exhibition has been discontinued; that the flow ofurine will often precede, sometimes accompany, frequently follow thesickness at the distance of some days, and not unfrequently be checkedby it. The sickness thus excited, is extremely different from thatoccasioned by any other medicine; it is peculiarly distressing to thepatient; it ceases, it recurs again as violent as before; and thus itwill continue to recur for three or four days, at distant and moredistant intervals. 

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

But these sufferings are not at all necessary; they are the effects ofour inexperience, and would in similar circumstances, more or lessattend the exhibition of almost every active and powerful medicine weuse. 

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

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

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

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

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

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

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

_Let the medicine therefore be given in the doses, and at theintervals mentioned above:--let it be continued until it either actson the kidneys, the stomach, the pulse, or the bowels; let it bestopped upon the first appearance of any one of these effects_, and Iwill 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 itsoperation. I mean, they should drink whatever they prefer, and in asgreat quantity as their appetite for drink demands. This direction isthe more necessary, as they are very generally prepossessed with anidea of drying up a dropsy, by abstinence from liquids, and fear toadd to the disease, by indulging their inclination to drink. 

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

If the water should not be wholly evacuated, it is best to allow aninterval of several days before the medicine be repeated, that foodand tonics maybe administered; but truth compels me to say, that theusual tonic medicines have in these cases very often deceived myexpectations. 

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 smalldoses, viz. Two or three grains a day, so as gradually to remove adropsy, without any other than mild diuretic effects, and without anyinterruption to its use until the cure be compleated. 

If inadvertently the doses of the Foxglove should be prescribed toolargely, exhibited too rapidly, or urged to too great a length; theknowledge of a remedy to counteract its effects would be a desirablething. Such a remedy may perhaps in time be discovered. The usualcordials and volatiles are generally rejected from the stomach;aromatics and strong bitters are longer retained; brandy willsometimes remove the sickness when only slight; I have sometimesthought small doses of opium useful, but I am more confident of theadvantage from blisters. Mr. Jones (_Page_ 135) in one case, foundmint tea to be retained longer than other things. 

 CONSTITUTION of PATIENTS. 

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

From large experience, and attentive observation, I am pretty wellenabled to decide _a priori_ upon this matter, and I wish to enableothers to do the same: but I feel myself hardly equal to theundertaking. The following hints, however, aiding a degree ofexperience in others, may lead them to accomplish what I yet candescribe 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 cordypulse. 

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

On the contrary, if the pulse be feeble or intermitting, thecountenance pale, the lips livid, the skin cold, the swollen bellysoft and fluctuating, or the anasarcous limbs readily pitting underthe pressure of the finger, we may expect the diuretic effects tofollow in a kindly manner. 

In cases which foil every attempt at relief, I have been aiming, forsome time past, to make such a change in the constitution of thepatient, 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 tothe use of the lancet, I think nothing lowers the tone of the systemmore effectually than the squill, and consequently it will always beproper, in such cases, to use the squill; for if that fail in itsdesired effect, it is one of the best preparatives to the adoption ofthe Digitalis. 

A tendency to paralytic affections, or a stroke of the palsy havingactually 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 apprehensionsof its excitement of the urinary organs in the latter case, mightoperate so as to make us with-hold relief from the patient; butexperience tells me, that such apprehensions are groundless. 

 INFERENCES. 

To prevent any improper influence, which the above recitals of theefficacy of the medicine, aided by the novelty of the subject, mayhave upon the minds of the younger part of my readers, in raisingtheir expectations to too high a pitch, I beg leave to deduce a fewinferences, 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 probablemethod has been fruitlessly tried. 

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

V. That in proper doses, and under the management now pointed out, itis 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, greatdebility, or other complication of disease, neither the Digitalis, norany other diuretic can do more than obtain a truce to the urgency ofthe symptoms; unless by gaining time, it may afford opportunity forother medicines to combat and subdue the original disease. 

VII. That the Digitalis may be used with advantage in every species ofdropsy, 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 yetunobserved in any other medicine, and that this power may be convertedto salutary ends. 

 PRACTICAL REMARKS ON DROPSY, AND SOME OTHER DISEASES. 

The following remarks consist partly of matter of fact, and partly ofopinion. The former will be permanent; the latter must vary with thedetection of error, or the improvement of knowledge. I hazard themwith diffidence, and hope they will be examined with candour; not by acontrast with other opinions, but by an attentive comparison with thephœnomena of disease. 

 ANASARCA. 

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

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

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

Is this difficulty of cure occasioned by spissitude in the effusedfluids, by want of proper communication from cell to cell, or is thedisease rather caused by a morbid growth of the solids, than by anaccumulation 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 armsas well as legs; so that the swelling does not depend merely uponposition. 

§ 5. Is there not cause to suspect that many dropsies originate fromparalytic affections of the lymphatic absorbents? And if so, is it notprobable 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 inchildren curable; in adults generally incurable by medicines. Tappingmay be used here with better chance for success than in morecomplicated dropsies. Sometimes cured by vomiting. 

 ASCITES and ANASARCA. 

§ 7. Incurable if dependant upon irremediably diseased viscera, or ona gouty constitution, so debilitated, that the gouty paroxysms nolonger 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, therestoration of the constitution can hardly be hoped for. 

 ASTHMA. 

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

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

§ 11. There is another kind of asthma, in which change of posture doesnot much affect the patient. I believe it to be caused by aninfarction of the lungs. It is incurable by diuretics; but it is oftenaccompanied 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 tothat 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 theaffection of the breath depends also upon cellular effusion, as itmostly does, the patient may be taught to expect a recovery. 

 ASTHMA and ASCITES. 

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

 ASTHMA, ASCITES, and ANASARCA. 

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

 EPILEPSY. 

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

 HYDATID DROPSY. 

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

 HYDROCEPHALUS. 

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

It has seldom happened to me to be called upon in the earlier stagesof this complaint, and the symptoms are at first so similar to thoseusually attendant upon dentition and worms, that it is very difficultto pronounce decidedly upon the real nature of the disease; and it israther from the failure of the usual modes of relief, than from anyother more decided observation, that we at length dare to give it aname. 

At first, the febrile symptoms are sometimes so unsteady, that I haveknown them mistaken for the symptoms of an intermittent, and the cureattempted by the bark. 

In the more advanced stages, the diagnostics obtrude themselves uponour notice, and put the situation of the patient beyond a doubt. Butthis does not always happen. The variations of the pulse, soaccurately described by the late Dr. Whytt, do not always ensue. Thedilatation of the pupils, the squinting, and the aversion to light, donot universally exist. The screaming upon raising the head from thepillow or the lap, and the flushing of the cheeks, I once consideredas affording indubitable marks of the disease; but in a child which Isometime since attended with Dr. Ash, the pulse was uniformly about85, (except during the first week, before we had the care of thepatient. ) The child never shewed any aversion to the light; never haddilated pupils, never squinted, never screamed when raised from thelap or taken out of the bed, nor did we observe any remarkableflushing of the cheeks; and the sleep was quiet, but sometimesmoaning. 

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

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

If I am right as to the nature of hydrocephalus, that it is at firstdependant upon inflammation, or congestion; and that the water in theventricles is a consequence, and not a cause of the disease; thecurative intentions ought to be extremely different in the first andthe 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 werecured by repeated topical bleedings, vomits, and purges. 

Some years ago I mentioned these opinions, and the success of thepractice resulting from them, to Dr. Quin, now physician at Dublin. That gentleman had lately taken his degree, and had chosenhydrocephalus for the subject of his thesis in the year 1779. In thisvery ingenious essay, which he gave me the same morning, I was muchpleased to find that the author had not only held the same ideasrelative to the nature of the disease, but had also confirmed them bydissections. 

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

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

When we consider what enormous quantities of mercury may be used inthis complaint, without affecting the salivary glands, it seemsprobable that other parts may be equally insensible to the action oftheir peculiar stimuli, and therefore that the Digitalis ought to begiven 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 distinguishthis 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 andtreated as angina pectoris. They both appeared to me to be cases ofhydrothorax. One subject was a clergyman, whose strength had been socompleatly exhausted by the continuance of the disease, and theattempts to relieve it, that he did not survive many days. The otherwas a lady, whose time of life made me suspect effusion. I directedher to take small doses of the pulv. Digitalis, which in eight daysremoved all her complaints. This happened six months ago, and sheremains perfectly well. 

 HYDROTHORAX and ANASARCA. 

§ 20. This combination is very frequent, and, I believe, may always becured 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 theabdominal viscera are more frequently diseased in the latter than inthe former cases. 

 INSANITY. 

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

§ 23. Where appearances of anasarca point out the true cause of thecomplaint, as in cases XXIV. And XXXIV. The happiest effects may beexpected from the Digitalis; and men of more experience than myself incases of insanity, will probably employ it successfully in other lessobvious circumstances. 

 NEPHRITIS CALCULOSA. 

§ 24. We have had sufficient evidence of the efficacy of the Foxglovein removing the Dysuria and other symptoms of this disease; butprobably 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 difficultydistinguishable from an ascites; and yet it is necessary todistinguish them, because the two diseases require different treatmentand because the probality of a cure is much greater in one than in theother. 

§ 26. The ovarium dropsy is generally slow in its progress; for aconsiderable time the patient though somewhat emaciated, does not losethe appearance of health, and the urine flows in the usual quantity. It is seldom that the practitioner is called in early enough todistinguish by the feel on which side the cyst originated, and thepatients do not attend to that circumstance themselves. They generallymenstruate regularly in the incipient state of the disease, and it isnot until the pressure from the sac becomes very great, that theurinary 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 thosewhich women experience in a state of pregnancy. These pains are for alength of time greater in one thigh than in the other, and I believeit will be found that the disease originated on that side. 

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

§ 28. When tapping becomes necessary, I always advise the adoption ofthe waistcoat bandage or belt, invented by the late very justlycelebrated Dr. Monro, and described in the first volume of the MedicalEssays. I also enjoin my patients to wear this bandage afterwards, from a persuasion that it retards the return of the disease. Theproper 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 veryfar advanced. It is then probably caused by weakness and pressure. TheDigitalis removes it for a time. 

 PHTHISIS PULMONALIS. 

§ 30. This is a very increasing malady in the present day. It is nolonger limited to the middle part of life: children at five years ofage die of it, and old people at sixty or seventy. It is not confinedto the flat-chested, the fair-skinned, the blue eyed, thelight-haired, or the scrophulous: it often attacks people with fullchests, brown skins, dark hair and eyes, and those in whose family noscrophulous taint can be traced. It is certainly infectious. The verystrict laws still existing in Italy to prevent the infection fromconsumptive patients, were probably not enacted originally without asufficient cause. We seem to be approaching to that state which firstmade such restrictions necessary, and in the further course of time, the disease will probably fall off again, both in virulency andfrequency. 

§ 31. The younger part of the female sex are liable to a disease verymuch resembling a true consumption, and from which it is difficult todistinguish it; but this disease is curable by steel and bitters. Acriterion of true phthisis has been sought for in the state of theteeth; but the exceptions to that rule are numerous. An unusualdilatation of the pupil of the eye, is the most certaincharacteristic. [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 anintermittent, than riding did a consumption. We must not deny thetruth of an assertion, from such authority, but we must conclude thatthe disease was more easily curable a century ago than it is atpresent. 

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

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

§ 35. Many years ago, during an attendance upon Mr. B----, of aconsumptive family, and himself in the last stage of a phthisis; afterhe was so ill as to be confined to his chamber, his breathing becameso extremely difficult and distressing, that he wished rather to diethan to live, and urged me warmly to devise some mode to relieve him. Suspecting serous effusion to be the cause of this symptom, and hebeing a man of sense and resolution, I fully explained my ideas tohim, and told him what kind of operation might afford him a chance ofrelief; for I was then but little acquainted with the Digitalis. Hewas earnest for the operation to be tried, and with the assistance ofMr. Parrott, a very respectable surgeon of this place, I got anopening made between the ribs upon the lower and hinder part of thethorax. About a pint of fluid was immediately discharged, and hisbreath 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, hisappetite and strength returned, he got abroad, and the wound, whichbecame 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 theDigitalis. 

§ 37. This species of dropsy may originate from other causes thanchild birth. In the beginning of last _March_, a gentleman atWolverhampton desired my advice for very large and painful swelledlegs and thighs. He was a temperate man, not of a dropsical habit, hadgreat pain in his groins, and attributed his complaints to a fall fromhis horse. He had taken diuretics, and the strongest drasticpurgatives with very little benefit. Considering the anasarca ascaused by the diseased inguinal glands, I ordered common poultice andmercurial ointment to the groins, three grains of pulv. Fol. Digitalisnight 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;

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 By WILLIAM WITHERING, M. D. 

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 Outlines of MINERALOGY, Translated from the original of Sir TORBERN BERGMAN; with NOTES, By WILLIAM WITHERING, M. D. 

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 TRANSCRIBER'S NOTES

Obvious printer's errors have been fixed. For the detailed list, please see below. The frontispiece has been moved from the beginningof 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'