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.[v]

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

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

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

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

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

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

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

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

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

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

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

Birmingham, 1st July,
1785.

INTRODUCTION.[xi]

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

Our plant is the Digitalis purpurea[2] of Linnæus.
It belongs to the 2d order of the 14th class, or the
Didynamia Angiospermia. The essential characters
of the genus are, Cup with 5 divisions. Blossom
bell-shaped, bulging. Capsule egg-shaped, 2-celled.—Linn.

DIGITA’LIS purpu’rea. Little leaves of the
empalement egg-shaped, sharp. Blossoms blunt;
the upper lip entire. Linn.

[xii]

References to Figures. These are disposed in
the order of comparative excellence.

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

Blossom. The bellying part on the inside sprinkled
with spots like little eyes. Leaves wrinkled. Linn.

Blossom. Rather tubular than bell-shaped, bulging
on the under side, purple; the narrow tubular
part at the base, white. Upper lip sometimes
slightly cloven.

Chives. Threads crooked, white. Tips yellow.

Pointal. Seed-bud greenish. Honey-cup at its base
more yellow. Summit cloven.

S. Vess. Capsule not quite so long as the cup.

Root. Knotty and fibrous.[xiii]

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

Leaves. Slightly but irregularly serrated, wrinkled;
dark green above, paler underneath. Lower
leaves egg-shaped; upper leaves spear-shaped.
Leaf-stalks fleshy; bordered.

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

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

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

This plant ranks amongst the LURIDÆ, one of
the Linnæan orders in a natural system. It has for
congenera, Nicotiana, Atropa, Hyoscyamus, Datura,
Solanum, &c. so that from the knowledge we
possess of the virtues of those plants, and reasoning
from botanical analogy, we might be led to guess at
something of its properties.[xiv]

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

Historical View of the Properties of
Digitalis.

Fuchsius in his hist. stirp. 1542, is the first author
who notices it. From him it receives its name of
Digitalis, in allusion to the German name of Fingerhut,
which signifies a finger-stall, from the blossoms
resembling the finger of a glove.

Sensible Qualities. Leaves bitterish, very nauseous.
Lewis Mat. med. i. 342.

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

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

Boerhaave judges it to be of a poisonous nature,
hist. plant. but Dr. Alston ranks it among those indigenous
vegetables, “which, though now disregarded,[xv]
are medicines of great virtue, and scarcely
inferior to any that the Indies afford.” Lewis
Mat. med. i. p. 343.

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

The following is an abridged Account of
its Effects upon Turkeys.

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

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

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

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

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

Parkinson, p. 654.[xvii]

Scrophula.—”The herb bruised, or the juice
made up into an ointment, and applied to the
place, hath been found by late experience to be
availeable for the King’s Evill.” Park. p. 654.

Several hereditary instances of this disease said
to have been cured by it. Aereal Influences, p.
49, 50, quoted by Haller, hist. n. 330.

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

The leaves remaining after the pressing out of the
juice, were applied every day to the ulcers. Pract.
ess. p. 40. quoted by Murray apparat. medicam. i. p.
491.

A young woman with a scrophulous tumour of the
eye, a remarkable swelling of the upper lip, and painful
tumours of the joints of the fingers, much relieved;
but the medicine was left off, on account of its violent
effects on the constitution. Ib. p. 42 quoted as
above.

A man with scrophulous tumour of the right elbow,
attended for three years with excruciating pains, was
nearly cured by four doses of the juice taken once
a month. Ib. p. 43. as above.

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

Wounds. In considerable estimation for the
healing all kinds of wounds, Lobel. adv. 245.

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

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

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

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

Parkinson, p. 654.

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

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

[xx]

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

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

OF THE PLATE.

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

EXPLANATION.

AN[1]
ACCOUNT
OF THE
INTRODUCTION of FOXGLOVE
INTO
MODERN PRACTICE.

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

The first method has not yet been much attended
to; and the second can only be perfected in proportion
as we approach towards the discovery of a truly
natural system; but the last, as far as it extends, lies[2]
within the reach of every one who is open to information,
regardless of the source from whence it
springs.

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

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

My worthy predecessor in this place, the very humane
and ingenious Dr. Small, had made it a practice
to give his advice to the poor during one hour
in a day. This practice, which I continued until
we had an Hospital opened for the reception of the
sick poor, gave me an opportunity of putting my
ideas into execution in a variety of cases; for the
number of poor who thus applied for advice,
amounted to between two and three thousand annually.
I soon found the Foxglove to be a very
powerful diuretic; but then, and for a considerable
time afterwards, I gave it in doses very much too[3]
large, and urged its continuance too long; for misled
by reasoning from the effects of the squill, which
generally acts best upon the kidneys when it excites
nausea, I wished to produce the same effect by the
Foxglove. In this mode of prescribing, when I had
so many patients to attend to in the space of one,
or at most of two hours, it will not be expected that
I could be very particular, much less could I take
notes of all the cases which occurred. Two or three
of them only, in which the medicine succeeded, I
find mentioned amongst my papers. It was from
this kind of experience that I ventured to assert, in
the Botanical Arrangement published in the course of
the following spring, that the Digitalis purpurea
“merited more attention than modern practice bestowed
upon it.”

I had not, however, yet introduced it into the more
regular mode of prescription; but a circumstance
happened which accelerated that event. My truly
valuable and respectable friend, Dr. Ash, informed
me that Dr. Cawley, then principal of Brazen Nose
College, Oxford, had been cured of a Hydrops Pectoris,
by an empirical exhibition of the root of the
Foxglove, after some of the first physicians of the age
had declared they could do no more for him. I was
now determined to pursue my former ideas more
vigorously than before, but was too well aware of
the uncertainty which must attend on the exhibition
of the root of a biennial plant, and therefore continued
to use the leaves. These I had found to vary
much as to dose, at different seasons of the year;[4]
but I expected, if gathered always in one condition
of the plant, viz. when it was in its flowering state,
and carefully dried, that the dose might be ascertained
as exactly as that of any other medicine; nor
have I been disappointed in this expectation. The
more I saw of the great powers of this plant, the
more it seemed necessary to bring the doses of it to
the greatest possible accuracy. I suspected that this
degree of accuracy was not reconcileable with the
use of a decoction, as it depended not only upon the
care of those who had the preparation of it, but it
was easy to conceive from the analogy of another
plant of the same natural order, the tobacco, that
its active properties might be impaired by long boiling.
The decoction was therefore discarded, and
the infusion substituted in its place. After this I began
to use the leaves in powder, but I still very often
prescribe the infusion.

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

If the medicine purges, it is almost certain to fail
in its desired effect; but this having been the case,
I have seen it afterwards succeed when joined with[5]
small doses of opium, so as to restrain its action on
the bowels.

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

In the month of November 1777, in consequence
of an application from that very celebrated surgeon,
Mr. Russel, of Worcester, I sent him the following
account, which I choose to introduce here, as shewing
the ideas I then entertained of the medicine,
and how much I was mistaken as to its real dose.—”I
generally order it in decoction. Three drams of
the dried leaves, collected at the time of the blossoms
expanding, boiled in twelve to eight ounces of
water. Two spoonfuls of this medicine, given every
two hours, will sooner or later excite a nausea.
I have sometimes used the green leaves gathered in
winter, but then I order three times the weight;
and in one instance I used three ounces to a pint
decoction, before the desired effect took place. I
consider the Foxglove thus given, as the most certain
diuretic I know, nor do its diuretic effects
depend merely upon the nausea it produces, for
in cases where squill and ipecac. have been so
given as to keep up a nausea several days together,
and the flow of urine not taken place, I have found
the Foxglove to succeed; and I have, in more than
one instance, given the Foxglove in smaller and[6]
more distant doses, so that the flow of urine has
taken place without any sensible affection of the
stomach; but in general I give it in the manner
first mentioned, and order one dose to be taken
after the sickness commences. I then omit all medicines,
except those of the cordial kind are wanted,
during the space of three, four, or five days. By
this time the nausea abates, and the appetite becomes
better than it was before. Sometimes the
brain is considerably affected by the medicine, and
indistinct vision ensues; but I have never yet
found any permanent bad effects from it.”—

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

“I have often been obliged to evacuate the water
repeatedly in the same patient, by repeating the
decoction; but then this has been at such distances
of time as to allow of the interference of other
medicines and a proper regimen, so that the patient
obtains in the end a perfect cure. In these cases
the decoction becomes at length so very disagreeable,
that a much smaller quantity will produce the
effect, and I often find it necessary to alter its
taste by the addition of Aq. Cinnam. sp. or Aq.
Juniper. composita.”[7]

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

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

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

In February 1779, my friend, Dr. Stokes, communicated
to the Medical Society at Edinburgh the result
of my experience of the Foxglove; and, in a letter
addressed to me in November following, he says,
“Dr. Hope, in consequence of my mentioning its
use to my friend, Dr. Broughton, has tried the
Foxglove in the Infirmary with success.” Dr.[8]
Stokes also tells me that Dr. Hamilton cured Dropsies
with it in the year 1781.

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

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

In the following cases the reader will find other
diseases besides dropsies; particularly several cases
of consumption. I was induced to try it in these,
from being told, that it was much used in the West
of England, in the Phthisis Pulmonalis, by the
common people. In this disease, however, in my
hands, it has done but little service, and yet I am
disposed to wish it a further trial, for in a copy of
Parkinson’s Herbal, which I saw about two years ago,[9]
I found the following manuscript note at the article
Digitalis, written, I believe, by a Mr. Saunders, who
practised for many years with great reputation as a
surgeon and apothecary at Stourbridge, in Worcestershire.

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

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

I have lately been told, that a person in the neighbourhood
of Warwick, possesses a famous family receipt
for the dropsy, in which the Foxglove is the
active medicine; and a lady from the western part
of Yorkshire assures me, that the people in her country
often cure themselves of dropsical complaints by
drinking Foxglove tea. In confirmation of this, I
recollect about two years ago being desired to visit a[10]
travelling Yorkshire tradesman. I found him incessantly
vomiting, his vision indistinct, his pulse forty
in a minute. Upon enquiry it came out, that his
wife had stewed a large handful of green Foxglove
leaves in half a pint of water, and given him the
liquor, which he drank at one draught, in order to
cure him of an asthmatic affection. This good woman
knew the medicine of her country, but not
the dose of it, for her husband narrowly escaped
with his life.

It is probable that this rude mode of exhibiting
the Foxglove has been more general than I am at
present aware of; but it is wonderful that no author
seems to have been acquainted with its effects as a
diuretic.[11]

CASES,

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

1775.

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

CASE I.

December 8th. A man about fifty years of age,
who had formerly been a builder, but was now much
reduced in his circumstances, complained to me of
an asthma which first attacked him about the latter
end of autumn. His breath was very short, his
countenance was sunken, his belly large; and, upon
examination, a fluctuation in it was very perceptible.
His urine for some time past had been small
in quantity. I directed a decoction of Fol. Digital.
recent. which made him very sick, the sickness recurring
at intervals for several days, during which
time he made a large quantity of water. His breath
gradually drew easier, his belly subsided, and in[12]
about ten days he began to eat with a keen appetite.
He afterwards took steel and bitters.

1776.

CASE II.

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

CASE III.

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

CASE IV.

July 25th. Mrs. H——, of A——, near
N——, between forty and fifty years of age, a
few weeks ago, after some previous indisposition,
was attacked by a severe cold shivering fit, succeeded
by fever; great pain in her left side, shortness
of breath, perpetual cough, and, after some days,[13]
copious expectoration. On the 4th of June, Dr.
Darwin,[4] was called to her. I have not heard what
was then done for her, but, between the 15th of June,
and 25th of July, the Doctor, at his different visits,
gave her various medicines of the deobstruent, tonic,
antispasmodic, diuretic, and evacuant kinds.

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

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

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

26th. Our patient being thus snatched from impending
destruction, Dr. Darwin proposed to give
her a decoction of pareira brava and guiacum shavings,[15]
with pills of myrrh and white vitriol; and,
if costive, a pill with calomel and aloes. To these
propositions I gave a ready assent.

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

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

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

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

19th. The increase of the dropsical symptoms
now made it necessary to repeat the Digitalis. The
dried leaves were used in infusion, and the water
was presently evacuated, as before.[16]

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

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

CASE V.

December 10th. Mr. L——, Æt. 35. Ascites
and anasarca, the consequence of very intemperate
living. After trying squill and other medicines to
no purpose, I directed a decoction of the Fol. Digital.
recent. six drams to a pint; an eighth part to
be taken every fourth hour. This made him sick,
and produced a copious flow of urine, but not enough
to remove all the dropsical symptoms. After a fortnight
a stronger decoction was ordered, and, upon
a third trial, as the winter advanced, it became
necessary to use four ounces to the pint decoction;
and thus he got free from all his complaints.[17]

In October 1777, in consequence of having pursued
his intemperate mode of living, his dropsy returned,
accompanied by evident marks of diseased
viscera. A decoction of two drams of Fol. Digital.
siccat. to a pint, once more removed the dropsy. He
took a wine glass full thrice a day.

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

1777.
CASE VI.

February—. Mrs. M——, Æt. 45. Ascites
and anasarca, but not much otherwise diseased, and
well enough to walk about the house, and see after
her family affairs. I thought this a fair case for a
trial of the Digitalis, and therefore directed a decoction
of the fresh leaves, the stock of dried ones
being exhausted. About a week afterwards, calling
to see my patient, I was informed that she was dead;
that the third day after my first visit she suddenly
fell down, and expired. Upon enquiry I found
she had not taken any of the medicine; for the
snow had lain so deep upon the ground, that the
apothecary had not been able to procure it. Had[18]
the medicine been given in a case seemingly so favourable
as this, and had the patient died under its
use, is it not probable that the death would have
been attributed to it?

CASE VII.

February 11th. Mr. E——, of W——, Æt. 61.
Hydrothorax, ascites and anasarca, consequences of
hard drinking. He had been attended for some
time by a physician in his neighbourhood, who had
treated his case with the usual remedies, but without
affording him any relief; nor could I expect to
succeed better by any other medicine than the Digitalis.
The dried leaves were not to be had; and
the green ones at this season being very uncertain in
their strength, I ordered four ounces of the roots
in a pint decoction, and directed three spoonfuls to
be given every fourth hour, until it either excited
nausea, or a free discharge of urine; both these
effects took place nearly at the same time: he made
a large quantity of water, the swellings subsided
very considerably, and his breath became easy. Eight
days afterwards he began upon a course of bitters
and deobstruents. The dropsical symptoms soon
increased again, but he had suffered so much from
the severity of the sickness before, that he was neither
willing to take, nor I to give the same medicine
again.

Perhaps this patient might have been saved, if I
had been well acquainted with the management and[19]
real doses of the medicine, which was certainly in
this instance made very much too strong; and notwithstanding
the caution to stop the further exhibition
when certain effects should take place, it seems the
quantity previously swallowed was sufficient to distress
him exceedingly.

CASE VIII.

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

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

[20]

CASE IX.

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

CASE X.

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

CASE XI.

July 10th. Mr. M—— of T——, Æt. 54. A
very hard drinker; had been affected since November
last with ascites and anasarca, for which he had
taken several medicines without benefit. A decoction
of the recent leaves of the Digitalis was then
directed, an ounce and half to a pint, one eighth
of which I ordered to be given every fourth hour.
A few doses brought on great nausea, indistinct vision,
and a great flow of urine, so as presently to
empty him of all the dropsical water. Indeed the
evacuation was so rapid and so complete, that it became
necessary to apply a bandage round the belly,
and to support him with cordials.[21]

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

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

CASE XII.

September 12th. Miss C—— of T——, Æt 48.
An ovarium dropsy, and anasarcous legs and thighs.
For three months in the beginning of this year she
had been under the care of Dr. Darwin, who at
different times had given her blue vitriol, elaterium,
and calomel; decoction of pareira brava, and guiacum
wood, with tincture of cantharides; oxymel of
squills, decoction of parsley roots, &c. Finding no
relief, she discontinued the use of medicines, until
the urgency of her symptoms induced her to ask
my advice about the end of August. She was greatly
emaciated, and had almost a total loss of appetite.
I first tried small doses of Merc. sublim. corr. in
solution, with decoction of burdock roots, and blisters
to the thighs. No advantage attending the
use of this plan, I directed a decoction of Fol.
Digit. a dram and half to a pint; one ounce to be
taken twice a day. It presently reduced the anasarcous
swellings, but made no alteration in the distension
of the abdomen.[22]

CASE XIII.

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

1778.

CASE XIV.

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

CASE XV.

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

17th. Gum-ammoniac and squill, with elixir
paregor. at night.—26th, Squill and decoction of
seneka.—30th, His complaints still increasing, decoction[23]
of Digitalis was then directed, which relieved
him in a few days; but his complaints returned
again, and he died in the month of June.

CASE XVI.

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

CASE XVII.

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

CASE XVIII.

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

He was directed to take one ounce of this infusion[24]
every two hours until it should make him sick.
This was on Wednesday. The fifth dose made
him vomit. On Thursday afternoon he vomited
again very freely, without having taken any more
of the medicine. On Friday and Saturday he made
more water than he had done for a week before,
and the swellings of his face and body were considerably
abated. He was directed to omit all medicine
so long as the urine continued to flow freely,
and also to keep an account of the quantity he made
in twenty-four hours.

These were his reports:

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

Omit all medicines at present.

On Tuesday the 17th, some swelling still remained[25]
about his ancles, but he was in every other respect
perfectly well.

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

CASE XIX.

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

1779.

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

CASE XX.

January 1st. Mr. H——. Hydrops Pectoris;
legs and thighs prodigiously anasarcous; a very distressing
sense of fulness and tightness across his stomach;
urine in small quantity; pulse intermitting;
breath very short.[26]

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

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

CASE XXI.

January 5th. Mrs. M——, Æt. 69. Hydrothorax,
(called asthma) ascites and anasarca. I directed
an infusion of Fol. Digital. siccat. three drams
to a pint; a small wine glass to be taken every third
or fourth hour. It made her violently sick, acted
powerfully as a diuretic, set her breath perfectly at
liberty, and carried off the swelling of her legs;
when she was nearly emptied, she became so languid,
that I thought it necessary to order cordials,
and a large blister to her back. Mr. Ward, who
attended as her apothecary, tells me she had some
return of her asthma in June and October following,
which was each time removed by the same medicine.[27]

CASE XXII.

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

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

CASE XXIII.

August 31st. Mr. C——, Æt. 57. Diseased
viscera, jaundice, ascites and anasarca. After trying[28]
calomel, saline draughts, jallap purges, chrystals
of tartar, pills of gum ammoniac, squills, and
soap, sal succini, eleterium, &c. infusion of Digitalis
was directed, which removed all his urgent
symptoms, and he recovered a pretty good state of
health.

CASE XXIV.

September 11th. I was desired to visit Mr. L——,
Æt. 63; a middle sized man; rather thin; not habitually
intemperate; found him in bed, where he
had been for three days. He was in a state of furious
insanity, and had been gradually losing his reason
for ten days before, but was not outrageous the
first week; his apothecary had given him ten grains
of emetic tartar, a dram of ipecacoanha, and an
ounce of tincture of jallap, in the space of a few
hours, which scarcely made him sick, and only occasioned
a stool or two; upon enquiring into the
usual state of his health, I was told that he had been
troubled with some difficulty of breathing for thirty
years past, but for the nine last years this complaint
had increased, so that he was often obliged to sit up
the greater part of the night; and, for the last year,
the sense of suffocation was so great, when he lay
down, that he often sat up for a week together. His
father died of an asthma before he was fifty. A few
years ago, at an election, where he drank more
than usual, his head was affected as now, but in a
slighter degree, and his asthmatic symptoms vanished;
and now, notwithstanding he has been several[29]
days in bed, he feels not the least difficulty in
breathing.

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

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

CASE XXV.

September 15th. Mr. J. R——, Æt. 50. Subject
to an asthmatical complaint for more than twenty
years, but was this year much worse than usual,
and symptoms of dropsy appeared. In July he
took G. ammon. squill and seneka, with infus.
amarum and fossil alkaly. In August, infusum amar.[30]
with vin. chalyb. and at bed-time pil. styr. and
squill. His complaints increasing, the squill was
pushed as far as could be borne, but without any
good effect. September 15th, an infusion of Digitalis
was directed, but he died the next morning.

CASE XXVI.

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

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

CASE XXVII.

October 7th. Mr. F——, a little man, with a
spine and thorax greatly deformed; for more than
a year past had complained of difficult respiration,
and a sense of fulness about his stomach; these complaints
increasing, his abdomen gradually enlarged,[31]
and a fluctuation in it became perceptible. He had
no anasarca, no appearance of diseased viscera, and
no great paucity of urine. Purges and diuretics of
different kinds affording him no relief, my assistance
was desired. After trying squill medicines without
effect, he was ordered to take Pulv. fol. Digital. in
small doses. These producing no sensible effect,
the doses were gradually increased until nausea was
excited; but there was no alteration in the quantity
of urine, and consequently no relief to his complaints.
I then advised tapping, but he would not
hear of it; however, the distress occasioned by the
increasing fulness of his belly at length compelled
him to submit to the operation on the 20th of November.
It was necessary to draw off the water again
upon the following days:

During the intervals, no method I could think of
was omitted to prevent the return of the disease,
but nothing seemed to avail. In the operation of
February 23d, his strength was so much reduced,
that the water was not entirely removed; and on
the 9th of March, before his belly was half emptied,
notwithstanding the most judicious application
of bandage, his debility was so great, that it was
judged prudent to stop. After being placed in bed,
the faintness and sickness continued; severe rigors[32]
ensued, and violent vomiting; these vomitings continued
through the night, and in the intervals he
lay in a state nearly approaching to syncope. The
next day I found him with nearly the same symptoms,
but remarked that the quantity of fluid he
had thrown up was very much more than what he
had taken, and that his abdomen was considerably
fallen; in the course of two or three days more, he
discharged the whole of the effused fluid; his strength
and appetite gradually returned, and he was in all
respects much better than he had been before the
last operation.

Some time afterwards, his belly began to fill
again, and he again applied to me; upon an accurate
examination, I judged the quantity of fluid
might then be about four or five quarts. Nature
had pointed out the true method of cure in this
case; I therefore ordered him to bed, and directed
ipecacoanha vomits to be given night and morning:
in two or three days the whole of the water was
removed by vomiting, for he never purged, nor
was the quantity of his urine increased; his appetite
and strength gradually returned; he never had
any further relapse, and is now an active healthy
man. I must leave the reader to make his own reflections
on this singular case.[33]

1780.

CASE XXVIII.

January 11th. Captain V——, Æt. 42. Had
suffered much from residing in hot climates, and
drinking very freely, particularly rum in large quantity.
He had tried many physicians before I saw
him, but nothing relieved him. I found him
greatly emaciated, his countenance of a brownish
yellow; no appetite, extremely low, distressing
fulness across his stomach; legs and thighs greatly
swollen; pulse quick, and very feeble; urine in
small quantity. As he had evidently only a few
days to live, I ordered him nothing but a solution
of sal diureticus in cinnamon water, slightly acidulated
with syrup of lemons. This medicine effecting
no change, and his symptoms becoming daily
more distressing, I directed an infusion of Digitalis.
A few doses occasioned a copious flow of urine,
without sickness or any other disturbance. The medicine
was discontinued; and the next day the urine
continuing to be secreted very plentifully, he lost
his most distressing complaints, was in great spirits,
and ate a pretty good dinner. In the evening, as
he was conversing chearfully with some friends, he
stooped forwards, fell from his chair, and died instantly.
Had he been in bed, I think there is reason
to believe this fatal syncope, if such it was,
would not have happened.[34]

CASE XXIX.

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

CASE XXX.

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

CASE XXXI.

March 5th. I was desired to visit Mrs. H——,
a very delicate woman, who after a severe lying-in,
had her legs and thighs swollen to a very great degree;[35]
pale and semi-transparent. I found her extremely
faint, her pulse very small and slow; vomiting
violently, and frequently purging. She was attended
by a gentleman who had seen me give the
Digitalis in a similar case of swelled legs after a lying-in
(see Case XXVI.) about six months before. He
had not considered that this patient was delicate,
the other robust; nor had he attended to stop the
exhibition of the medicine when its effects began to
take place. The great distress of her situation was
evidently owing to the imprudent and unlimited
use of the Digitalis. I was very apprehensive for
her safety; ordered her cordials and volatiles; a free
supply of wine, chamomile tea with brandy for
common drink, and blisters. The next day the situation
of things was much the same, but with all this
disturbance no increased secretion of urine. The same
methods were continued; an opiate ordered at night,
and liniment. volatile upon flannel applied to the
groins, as she now complained of great pain in those
parts. The third day the nausea was less urgent,
the vomitings less frequent, the pulse not so slow.
Camphorated spirit, with caustic volatile alkaly, was
applied to the stomach, emulsion given for common
drink, and the same medicines repeated. From
this time, the intervals became gradually longer between
the fits of vomiting, the flow of urine increased,
the swellings subsided, the appetite returned,
and she recovered perfectly.[36]

CASE XXXII.

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

CASE XXXIII.

March 18th. Miss S——, Æt. 5. Hydrocephalus
internus. As the case did not yield to calomel,
when matters were nearly advanced to extremities,
it occurred to me to try the Infusum Digitalis; a
few doses of which were given, but had no sensible
effect.[37]

CASE XXXIV.

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

CASE XXXV.

April 12th. Mr. R——, Æt. 32. For the last
three or four years had had more or less of what
was considered as asthma;—it appeared to me Hydrothorax.
I directed an infusion of Digitalis,
which presently removed his complaints. In June
following he had a relapse, and took two grains of
the Pulv. fol. Digit. three times a day, which cured
him after taking forty grains, and he has never had
a return.[38]

CASE XXXVI.

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

CASE XXXVII.

May 26th. R—— B——, Æt. 12. Scrophulous,
consumptive, and at length anasarcous. Took
Infus. Digital. without advantage. Died the July
following.

CASE XXXVIII.

June 4th. Mrs. S——, of W——, Æt 49.
Ascites and anasarca. Had taken many medicines;
first from her apothecary, afterwards by the direction
of a very judicious and very celebrated physician,
but nothing retarded the increase of the
dropsy. I first saw her along with the physician
mentioned above, on the 14th of May; we directed
an electuary of chrystals of tartar, and Seltzer
water for common drink; this plan failing, as others
had done before, we ordered the Infus. Digital. which
in a few days nearly removed the dropsy. I then
left her to the care of her physician; but her constitution
was too much impaired to admit of restoration
to health, and I understand she died a few
weeks afterwards.[39]

CASE XXXIX.

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

CASE XL.

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

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

CASE XLI.

July 6th. Mr. E——, Æt. 57. Hydrothorax
and anasarca; his breath so short that he could not[40]
lie down. After a trial of squill, fixed alkaly, and
dulcified spirit of nitre, I directed Pulv. Digital.
gr. 2, thrice a day. In four days he was able to
come down stairs; in three days more no appearance
of disease remained; and under the use of aromatics
and small doses of opium, he soon recovered his
strength.

CASE XLII.

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

CASE XLIII.

July 9th. Mrs. F——, Æt. 70. A chearful,
strong, healthy woman; but for a few years
back had experienced a degree of difficult breathing
when in exercise. In the course of the last year her
legs swelled, and she felt great fulness about her
stomach. These symptoms continued increasing
very fast, notwithstanding several attempts made by
a very judicious apothecary to relieve her. The
more regular practitioner failing, she had recourse
to a quack, who I believe plied her very powerfully
with Daphne laureola, or some drastic purge of that
kind. I found her greatly reduced in strength, her
belly and lower extremities swollen to an amazing
size, her urine small in quantity, and her appetite
greatly impaired. For the first fortnight of my attendance
blisters were applied, solution of fixed
alkaly, decoction of seneka with vitriolic æther,[41]
chrystals of tartar, squill and cordial medicines were
successively exhibited, but with no advantage. I
then directed Pulv. Fol. Digital. two grains every
four hours. After taking eighteen grains, the urine
began to increase. The medicine was then stopped.
The discharge of urine continued to increase, and
in five or six days the whole of the dropsical water
passed off, without any disturbance to the stomach
or bowels. As the distension of the belly had been
very great, a swathe was applied, and drawn gradually
tighter as the water was evacuated. As no pains
were spared to prevent the return of the dropsy,
and as the best means I could devise proved unequal
to my wishes, both in this and in some other cases,
I shall take the liberty to point out the methods
I tried at different times in as concise a manner as
possible, for the knowledge of what will not do, may
sometimes assist us to discover what will.

INTERVALS.

• From July 9th, 1780, to December 21st, 171 days.
• From December 21st to February 3d, 1781, 34 days.
• From February 3d to March 18th, 44 days.
• From March 18th to May 24th, 66 days.
• From May 24th to August 11th, 79 days.
• From August 11th to November 16th, 98 days.
• From November 16th to January 28th, 1782, 74 days.
• From January 28th to March 26th, 57 days.

None of the accumulations of water were at all
equal to that which existed when I first saw her, for
finding so easy a mode of relief, she became impatient
under a small degree of pressure, and often
insisted upon taking her medicine sooner than I
thought it necessary. After the 26th of March the
degree of effusion was inconsiderable, and at the
time of her death very trifling, being probably carried
off by the diarrhœa.[44]

CASE XLIV.

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

CASE XLV.

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

CASE XLVI.

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

CASE XLVII.

August 16th. Mr. G——, of W——, Æt. 86.
Asthma of many years duration, and lately an incipient
anasarca, with a paucity of urine. He had
never lived intemperately, was of a chearful disposition,
and very sensible: for some years back had[45]
lost all relish for animal food, and his only support
had been an ounce or two of bread and cheese, or
a small slice of seed-cake, with three or four pints
of mild ale, in the twenty-four hours. After trying
chrystals of tartar, fixed alkaly, squills, &c. I
directed three grains of Pulv. fol. Digital. made
into pills, with G. ammoniac, to be given every six
hours; this presently occasioned copious discharges
of urine, removed his swellings, and restored him
to his usual standard of health.

CASE XLVIII.

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

CASE XLIX.

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

CASE L.

August 24th. Mrs. W——, Æt. 39. Anasarcous
legs and symptoms of hydrothorax, consequent[46]
to a tertian ague. Three grains of Pulv. Digitalis,
given every fourth hour, occasioned a very copious
flow of urine, and she got well without any other
medicine.

CASE LI.

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

CASE LII.

September 27th. Mr. S——, Æt. 45. Had been
long in an ill state of health, from what had been
supposed an irregular gout, was greatly emaciated,
had a sallow complexion, no appetite, costive bowels,
quick and feeble pulse. The cause of his complaints
was involved in obscurity; but I suspected
the poison of lead, and was strengthened in this
suspicion, upon finding his wife had likewise ill
health, and, at times, severe attacks of colic; but
the answers to my enquiries seemed to prove my
suspicions fruitless, and, amongst other things, I
was told the pump was of wood. He had lately suffered
extremely from difficult breathing, which I
thought owing to anasarcous lungs; there was also
a slight degree of pale swelling in his legs. Pulv.[47]
fol. Digital. made into pills, with gum ammoniac
and aromatic species, soon relieved his breathing.
Attempts were then made to assist him in other respects,
but with little good effect, and some months
afterwards he died, with every appearance of a
worn out constitution.

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

The deleterious effects of lead seem to be considerably
modified by the constitution of the patient;
for in some families only one or two individuals
shall suffer from it, whilst the rest receive it with
impunity. In the spring of the year 1776, I was
desired to visit Mrs. H——, of S—— Park, who
had repeatedly been attacked with painful colics,
and had suffered much from insuperable costiveness;
I suspected lead to be the cause of her complaints,
but was unable to trace by what means it was taken.
She was relieved by the usual methods; but, a few
months afterwards, I was desired to see her again:
her sufferings were the same as before, and notwithstanding
every precaution to guard against costiveness,
she was never in perfect health, and seldom[48]
escaped severe attacks twice or thrice in a year; she
had also frequent pains in her joints. I could not
find any traces of similar complaints either in Mr.
H——, the children, or the servants. Mrs. H——
was a water drinker, and seldom tasted any fermented
liquor. The pump was of wood, as I had
been informed upon my first visit. Her health continued
nearly in the same state for two or three years
more, but she always found herself better if she left
her own house for any length of time. At length it
occurred to me, that though the pump was a wooden
one, the piston might work in lead. I therefore
ordered the pump rods to be drawn up, and upon
examination with a magnifying glass, found the
leather of the piston covered with an infinite number
of very minute shining particles of lead. Perhaps
in this instance the metal was so minutely
divided by abrasion, as to be mechanically suspended
in the water. The lady was directed to drink
the water of a spring, and never to swallow that
from the pump. The event confirmed my suspicions,
for she gradually recovered a good state of
health, lost the obstinate costiveness, and has never
to this day had any attack of the colic.

CASE LIII.

September 28th. Mrs. J——, Æt. 70. Ascites
and very thick anasarcous legs and thighs, total loss
of strength and appetite. Infusion of Digitalis was
given, but, as had been prognosticated, with no
good effect.[49]

CASE LIV.

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

CASE LV.

November 2d. Mr. P—— of T——, Æt. 42. A
very strong man, drank a great quantity of strong
ale, and was much exposed to alterations of heat
and cold. About the end of summer found himself
short winded, and lost his appetite. The dyspnœa
gradually increased, he got a most distressing sense
of tightness across his stomach, his urine was little,
and high coloured, and his legs began to swell; his
pulse slender and feeble. From the 20th of September
I frequently saw him, and observed a gradual
and regular increase of all his complaints, notwithstanding
the use of the most powerful medicines I
could prescribe. He took chrystals of tartar, seneka,
gum ammoniac, saline draughts, emetics, tinct. of
cantharides, spirits of nitre dulcified, squills in all
forms, volatile alkaly, calomel, Dover’s powder,
&c. Blisters and drastic purgatives were tried, interposing
salt of steel and gentian. I had all along
felt a reluctance to prescribe the Digitalis in this
case, from a persuasion that it would not succeed.[50]
At length I was compelled to it, and directed one
grain to be given every two hours until it should
excite nausea. This it did; but, as I expected, it
did no more. The reason of this belief will be
mentioned hereafter. Five days after this last trial
I gave him assafetida in large quantity, flattered by a
hope that his extreme sufferings from the state of his
respiration, might perhaps arise in part from spasm,
but my hopes were in vain. I now thought of using
an infusion of tobacco, and prescribed the following:

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

CASE LVI.

November 6th. Mr. H——, Æt. 47. In the
last stage of a phthisis pulmonalis, suffered much
from dyspnœa, and anasarca. Squill medicines
gave no relief. Digitalis in pills, with gum ammon.
purged him, but opium being added, that effect
ceased, and he continued to be relieved by them as
long as he lived.[51]

CASE LVII.

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

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

1781.

CASE LVIII.

January 1st. Mrs. G——, of H——, Æt. 62.
Ascites and very large hard legs. After trying various
medicines, under the direction of a very able
physician, I ordered her to take one grain of Pulv.[52]
Digital. every six hours, but it produced no effect.
Other Medicines were then tried to as little purpose.
About the end of February, I directed an
infusion of the Fol. Digital. but with no better success.
Other methods were thought of, but none
proved efficacious, and she died a few weeks afterwards.

CASE LIX.

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

CASE LX.

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

CASE LXI.

February 2d. I was desired by the late learned
and ingenious Dr. Groome, to visit Miss S——, a[53]
young lady in the last state of emaciation from a
dropsy. Every probable means to relieve her had
been attempted by Dr. Groome, but to no purpose;
and she had undergone the operation of the
paracentesis repeatedly. The Doctor knew, he said,
that I had cured many cases of dropsy, by the Digitalis,
after other more usual methods had been
attempted without success, and he wished this lady
to try that medicine under my direction; after examining
the patient, and enquiring into the history
of the disease, I was satisfied that the dropsy was
encysted, and that no medicine could avail. The
Digitalis, however, was directed, and she took it,
but without advantage. She had determined not to
be tapped again, and neither persuasion, nor distress
from the distension, could prevail upon her: I at length
proposed to make an opening into the sac, by means of
a caustic, which was done under the judicious management
of Mr. Wainwright, surgeon, at Dudley.
The water was evacuated without any accident, and
the patient afterwards let it out herself from time to
time as the pressure of it became troublesome, until
she died at length perfectly exhausted.

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

CASE LXII.

February 27th. Mrs. O——, of T——, Æt. 52,
with a constitution worn out by various complicated[54]
disorders, at length became dropsical. The Digitalis
was given in small doses, in hopes of temporary
benefit, and it did not fail to fulfil our expectations.

CASE LXIII.

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

CASE LXIV.

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

CASE LXV.

April 6th. Mr. B——, Æt. 63. For some
years back had complained of being asthmatical,
and was not without suspicion of diseased viscera.
The last winter he had been mostly confined
to his house; became dropsical, lost his appetite,
and his skin and eyes turned yellow. By the use
of medicines of the deobstruent class he became less
discoloured, and the hardness about his stomach
seemed to yield; but the ascites and anasarcous
symptoms increased so as to oppress his breathing[55]
exceedingly. Alkaline salts, and other diuretics
failing of their effects, I ordered him to take an infus.
of Digitalis. It operated so powerfully that it became
necessary to support him with cordials and
blisters, but it freed him from the dropsy, and his
breath became quite easy. He then took soap, rhubarb,
tartar of vitriol, and steel, and gradually attained
a good state of health, which he still continues
to enjoy.

CASE LXVI.

April 8th. Mr. B——, Æt. 60. A corpulent
man, with a stone in his bladder, from which at times
his sufferings are extreme. He had been affected
with what was supposed to be an asthma, for several
years by fits, but through the last winter his breath had
been much worse than usual; universal anasarca
came on, and soon afterwards an ascites. Now his urine
was small in quantity and much saturated, the dysuria
was more dreadful than ever; his breath would
not allow him to lie in bed, nor would the dysuria
permit him to sleep; in this distressful situation, after
having used other medicines to little purpose, I directed
an infusion of Digitalis to be given. When
the quantity of urine became more plentiful, the
pain from his stone grew easier; in a few days the
dropsy and asthma disappeared, and he soon regained
his usual strength and health. Every year
since, there has been a tendency to a return of these
complaints, but he has recourse to the infusion, and
immediately removes them.[56]

CASE LXVII.

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

CASE LXVIII.

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

CASE LXIX.

May 1st. Master W——, of St——, Æt. 6.
I found him with every symptom of hydrocephalus
internus. As it was yet early in the disease, in consequence
of ideas which will be mentioned hereafter,
I directed six ounces of blood to be immediately
taken from the arm; the temporal artery to
be opened the succeeding day; the head to be shaven,
and six pints of cold water to be poured upon
it every fourth hour, and two scruples of strong mercurial[57]
ointment to be rubbed into the legs every
day. Five days afterwards, finding the febrile symptoms
very much abated, and judging the remaining
disease to be the effect of effusion, I directed a scruple
of Fol. Digital. siccat. to be infused in three
ounces of water, and a table spoonful of the infusion
to be given every third or fourth hour, until
its action should be someway sensible. The effect
was, an increased secretion of urine; and the patient
soon recovered.

CASE LXX.

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

CASE LXXI.

May 3d. Mr. S——, Æt. 48. A strong man,
who had lived intemperately. For some time past his
breath had been very short, his legs swollen towards
evening, and his urine small in quantity. Eight
ounces of the Infus. Digitalis caused a considerable
flow of urine; his complaints gradually vanished,
and did not return.[58]

CASE LXXII.

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

CASE LXXIII.

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

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

CASE LXXIV.

June 29th. Mr. A——, Æt. 58. Kept a public
house and drank very hard. He had symptoms of
diseased viscera, jaundice, ascites, and anasarca. After
taking various deobstruents and diuretics, to no
purpose, he was ordered the Infusion of Digitalis:[59]
a few doses occasioned a plentiful flow of urine, relieved
his breath, and reduced his swellings; but,
on account of his great weakness, it was judged imprudent
to urge the medicine to the entire evacuation
of the water. He was so much relieved as to
be able to come down stairs and to walk about, but
his want of appetite and jaundice continuing, and
his debility increasing, he died in about two
months.

CASE LXXV.

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

The usual modes of practice failing, the Digitalis
was tried, but with no better success, and in about a
month she died; not without suspicion of her death
having been accelerated a few days, by her taking
half a grain of opium. This may be a caution to
young practitioners to be careful how they venture
upon even small doses of opium in such constitutions,
however much they may be urged by the patient
to prescribe something that may procure a little
rest and ease.[60]

CASE LXXVI.

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

CASE LXXVII.

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

CASE LXXVIII.

September 25th. Mr. O——, of M——, Æt. 63.
Very painful and general swellings in all his limbs,
which had confined him mostly to his bed since the
preceding winter; the swellings were uniform, tense,
and resisting, but the skin not discoloured. After
trying guiacum and Dover’s powder without advantage.
I directed Infusion of Digitalis. It acted on
the kidneys, but did net relieve him. It is not[61]
easy to say what the disease was, and the patient
living at a distance, I never learnt the future progress
or termination of it.

CASE LXXIX.

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

CASE LXXX.

September 27th. Mrs. E——, Æt. 42. A fat
sedentary woman; after a long illness, very indistinctly
marked; had symptoms of enlarged liver and
dropsy. In this case I was happy in the assistance
of Dr. Ash. Digitalis was once exhibited in small
doses, but to no better purpose than many other
medicines. She suffered great pain in the abdomen
for several weeks, and after her death, the liver,
spleen, and kidneys were found of a pale colour,
and very greatly enlarged, but the quantity of effused
fluid in the cavity was not more than a pint.[62]

CASE LXXXI.

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

CASE LXXXII.

November 14th. Mr. W——, of T——, Æt. 49.
A lusty man, with an asthma and anasarca. He had
taken several medicines by the direction of a very
judicious apothecary, but not getting relief as he had
been accustomed to do in former years, he came
under my direction. For the space of a month I
tried to relieve him by fixed alkaly, seneka, Dover’s
powder, gum ammoniac, squill, &c. but without
effect. I then directed Infusion of Digitalis, which
soon increased the flow of urine without exciting
nausea, and in a few days removed all his complaints.[63]

1782.

CASE LXXXIII.

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

CASE LXXXIV.

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

CASE LXXXV.

January 28th. Mr. D——, Æt. 35. A publican
and a hard drinker. Ascites, anasarca, diseased[64]
viscera, and slight attacks of hæmoptoe. A dram
of Fol. Digital. sicc. in a half pint infusion, of which
one ounce was given night and morning, proved
diuretic and removed his dropsy. He then took
medicines calculated to relieve his other complaints.
The dropsy did not return during my attendance
upon him, which was three or four weeks. A quack
then undertook to cure him with blue vitriol vomits,
but as I am informed, he presently sunk under that
rough treatment.

CASE LXXXVI.

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

CASE LXXXVII.

January 31st. Mr. T——, of A——, Æt. 81.
Great difficulty of breathing, so that he had not
lain in bed for the last six weeks, and some swelling
in his legs. These complaints were subsequent to a
very severe cold, and he had still a troublesome
cough. He told me that at his age he did not look for
a cure, but should be glad of relief, if it could be
obtained without taking much medicine. I directed
an Infusion of Digitalis, a dram to eight ounces,[65]
one spoonful to be taken every morning, and two
at night. He only took this quantity; for in four
days he could lie down, and soon afterwards quitted
his chamber. In a month he had a return of his
complaints, and was relieved as before.

CASE LXXXVIII.

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

CASE LXXXIX.

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

CASE XC.

February 24th. Master M——, of W——, Æt.
10. An epilepsy of some years continuance, which
had never been interrupted by any of the various
methods tried for his relief. The Digitalis was given
for a few days, but as he lived at a distance, so that
I could not attend to its effects, he only took one[66]
half pint infusion, which made no alteration in his
complaint.

CASE XCI.

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

CASE XCII.

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

CASE XCIII.

May 22d. Mr. O——, of B——, Æt. 61. A
very large man, and a free liver; after an attack of[67]
hemiplegia early in the spring, from which he only
partially recovered, became dropsical. The dropsy
occupied both legs and thighs, and the arm of the
affected side. I directed an Infusion of Digitalis in
small doses, so as not to affect his stomach. The
swellings gradually subsided, and in the course of
the summer he recovered perfectly from the palsy.

CASE XCIV.

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

CASE XCV.

March 6th. Mrs. W——, Æt. 36. In the last
stage of a pulmonary consumption, took the Infus.
Digitalis, but without any advantage.[68]

CASE XCVI.

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

CASE XCVII.

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

The leg soon began to mend, and two pints of the
infusion finished the cure.[69]

CASE XCVIII.

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

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

CASE XCIX.

September 30th. Mrs. A——, Æt. 38. Hydrothorax
and anasarca. Her chest was very considerably
deformed. One half pint of the Digitalis Infusion
entirely cured her.[70]

CASE C.

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

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

CASE CI.

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

CASE CII.

October 12th. Mr. R——, Æt. 41. A publican,
and a hard drinker. His legs and belly greatly
swollen; appetite gone, countenance yellow, breath
very short, and cough troublesome. After a vomit
I gave him calomel, saline draughts, steel and bitters,
&c. He had taken the more usual diuretics
before I saw him. As the dropsical symptoms increased,
I changed his medicines for pills made of[71]
soap, containing two grains of Pulv. fol. Digital, in
each dose, and, as he was costive, two grains of
jallap. He took them twice a day, and in a week
was free from every appearance of dropsy. The
jaundice soon afterwards vanished, and tonics restored
him to perfect health.

CASE CIII.

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

CASE CIV.

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

CASE CV.

October 30th. Mr. G——, of W——, Æt. 88.
The gentleman mentioned in No. XLVII. His
complaints and manner of living the same as there[72]
mentioned. I ordered an Infusion of the Digitalis,
a dram and half to half a pint; one ounce to be
taken twice a day; which cured him in a short time.

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

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

CASE CVI.

November 2d. Mr. S——, of B——h——,
Æt. 61. Hydrothorax and swelled legs. Squills
were given for a week in very full doses, and other
modes of relief attempted; but his breathing became
so bad, his countenance so livid, his pulse so
feeble, and his extremities so cold, that I was apprehensive
upon my second visit that he had not
twenty-four hours to live. In this situation I gave
him the Infusum Digitalis stronger than usual, viz.
two drams to eight ounces. Finding himself relieved
by this, he continued to take it, contrary to the directions
given, after the diuretic effects had appeared.[73]

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

CASE CVII.

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

1783.

The reader will perhaps remark, that from the
middle of January to the first of May, not a single
case occurs, and that the amount of cases is likewise
less than in the preceding or ensuing years; to prevent
erroneous conjectures or conclusions, it may
be expedient to mention, that the ill state of my
own health obliged me to retire from business for
some time in the spring of the year, and that I did
not perfectly recover until the following summer.[74]

CASE CVIII.

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

CASE CIX.

May 1st. Mrs. D——, Æt. 72. A thin woman,
with very large anasarcous legs and thighs;
no appetite and general debility. After a month’s
trial of cordials and diuretics of different kinds, the
surgeon who had scarified her legs apprehended they
would mortify; she had very great pain in them,
they were very red and black by places, and extremely
tense. It was evident that unless the tension
could be removed, gangrene must soon ensue.
I therefore gave her Infusum Digitalis, which increased
the secretion of urine by the following evening,
so that the great tension began to abate, and
together with it the pain and inflammation. She
was so feeble that I dared not to urge the medicine
further, but she occasionally took it at intervals until
the time of her death, which happened a few
weeks afterwards.[75]

CASE CX.

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

CASE CXI.

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

CASE CXII.

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

CASE CXIII.

June 3d. Master B——, of D——, Æt. 6.
With an universal anasarca, had an extremely troublesome
cough. An opiate was given to quiet the
cough at night, and 2 tea spoonfuls of Infus. Digit.
were ordered every six hours. The dropsy was
presently removed; but the cough continued, his[76]
flesh wasted, his strength failed, and some weeks afterwards
he died tabid.

CASE CXIV.

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

CASE CXV.

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

CASE CXVI.

June 24th. Mrs. B——, Æt. 40. A puerperal
fever, and swelled legs and thighs. The fever not
yielding to the usual practice, I directed an Infusion
of Fol. Digitalis. It proved diuretic; the swellings
subsided, but the fever continued, and a few days
afterwards a diarrhœa coming on, she died.[77]

CASE CXVII.

July 22d. Mr. F——, Æt. 48. A strong man,
of a florid complexion, in consequence of intemperance
became dropsical, with symptoms of diseased
viscera, great dyspnœa, a very troublesome
cough, and total loss of appetite. He took mild
mercurials, pills of soap, rhubarb, and tartar of
vitriol, with soluble tartar and dulcified spirits of
nitre in barley water. After a reasonable trial of
this plan, he took squill every six hours, and a solution
of assafetida and gum ammoniac, to ease his
breathing: finding no relief, I gave him chrystals
of tartar with ginger; but his remaining health and
strength daily declined, and he was not at all benefited
by the medicines. I was averse to the use of
Digitalis in this case, judging from what I had seen
in similar instances of tense fibre, that it would not
act as a diuretic. I therefore once more directed
squill, with decoction of seneka and sal sodæ; but
it was inefficacious. His strength being much broken
down, I then ordered gum ammoniac, with
small doses of opium, and infusum amarum, continuing
the squill at intervals. At length I was
urged to give the Digitalis, and considering the
case as desperate, I agreed to do it. The event
was as I expected; no increase in the urine took
place; and the medicine being still continued, his
pulse became slow, and he apparently sunk under
its sedative effects. He was neither purged nor vomited;
and had the Digitalis either been omitted[78]
altogether, or suspended upon its first effects upon
the pulse being observed, he might perhaps have
existed a week longer.

CASE CXVIII.

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

CASE CXIX.

August 15th. Mrs. C——, Æt. 60. Ascites,
anasarca, diseased viscera, paucity of urine, and
total loss of appetite. These complaints had heretofore
existed repeatedly, and had been removed
by deobstruent and diuretic medicines; but in this
attack the symptoms were suffered to exist a longer
time and in a greater degree, before assistance was
sought for. The remedies that used to relieve her
were now exhibited to no purpose. Mild mercurials,
soap, rhubarb, and squill were tried; but she
grew rapidly worse. Saline draughts with acetum
scilliticum seemed for a few days to check the progress
of her complaint, but they soon lost their effect,
and diarrhœa ensued upon every attempt to
increase the frequency of the dose. Draughts with
Infus. Digital. were then directed to be taken twice[79]
a day. The effect was a powerful action on the kidneys,
and a reduction of the swellings, but without
sickness. A degree of appetite returned, but still
the tendency to diarrhœa existed, and kept her
weak. Tonic medicines were then tried, but without
advantage, and in a month it was necessary to
have recourse to the Digitalis again. It was directed
in a half pint mixture; an ounce to be taken
thrice in twenty-four hours. On the 2d day, finding
her symptoms very much relieved, she took in
the absence of her nurse, nearly a double dose of
the medicine. The consequence was great sickness,
languor continuing for several days, and almost a
total stop to the secretion of urine, from the time the
sickness commenced.

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

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

CASE CXX.

August 22d. Mrs. S——, Æt. 36. Extreme
faintiness; anasarcous legs and thighs; great difficulty
of breathing, troublesome cough, frequent
chilly fits succeeded by hot ones; night sweats, and
a tendency to diarrhœa. Apprehensive that the[80]
more urgent symptoms were caused by water in the
lungs, I directed an Infusion of Digitalis, with an
ounce of diacodium to the half pint to prevent it
purging, a wine glass full to be taken every night at
bed-time, and a mixture with confect. cardiac. and
pulv. ipecac. to be given in small doses after every
loose stool.

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

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

CASE CXXI.

August 25th. T—— W——, Esq; Æt, 50. A free
liver, diseased viscera, belly very tense, and much
swollen; fluctuation perceptible, but the swelling
circumscribed; pulse 132. This gentleman was under
the care of my very worthy friend Dr. Ash,
who, having tried various modes of cure to no purpose,
asked me if I thought the Digitalis would
answer in this case. I replied that it would not,
for I had never seen it effectual where the swelling
appeared very tense and circumscribed. It was tried
however, but did not lessen the swelling. I mention
this case, to introduce the above remark, and also[81]
to point out the great effect the Digitalis has upon
the action of the heart; for the pulse came down to
96. He was afterwards tapped, and continued, for some
time under our joint attendance, but the pulse
never became quicker, nor did the swelling return.

CASE CXXII.

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

1784.

CASE CXXIII.

February 12th. Mrs. C——, Æt. 54. A strong
short woman of a florid complexion; complained of
great fullness across the region of the stomach; short
breath, a troublesome cough, loss of appetite, paucity
of urine; and had a brownish yellow tinge on
her skin and in her eyes. She dated these complaints
from a fall she had through a trap door about
the beginning of winter. From the beginning of
January to this time, she had been repeatedly let[82]
blood, had taken calomel purges with jallap; pills
of soap, rhubarb and calomel; saline julep with
acet. scillit. nitrous decoction, garlic, mercury rubbed
down, infus. amarum purg. &c. After the failure
of medicines so powerful, and seemingly so well
adapted, and during the use of which all the symptoms
continued to increase, it was evident that a
favourable event could not be expected. However,
I tried the infusum Digitalis, but it did nothing. I
then gave her pills of quicksilver, soap and squill,
with decoction of dandelion, and after some time,
chrystals of tartar with ginger. Nothing succeeded
to our wishes, and the increase of orthopnœa compelled
me occasionally to relieve her by drastic
purges, but these diminished her strength, more in
proportion than they relieved her symptoms. Tincture
of cantharides, sal diureticus and various other
means were occasionally tried, but with very little
effect, and she died towards the end of March.

CASE CXXIV.

March 31st. Miss W——, Æt. 60. Had been
subject to peripneumonic affections in the winter.
She had now total loss of appetite, very great debility,
difficult breathing; much cough, a considerable
degree of expectoration, and a paucity of urine. She
had been blooded, taken soap, assaf. and squill,
afterwards assaf. and ammon. with acet. scillit.:
but all her complaints increasing, a blister was applied
to her back, and the Digitalis infusion directed
to be taken every night. The effect was an increased[83]
secretion of urine, a considerable relief to her breath,
and some return of appetite; but soon afterwards
she became hectic, spat purulent matter, and died
in a few weeks.

CASE CXXV.

April 12th. Mrs. H——, of L——, Æt. 61.
In December last this Lady, then upon a visit in London,
was attacked with severe symptoms of peripneumony.
She was treated as an asthmatic
patient, but finding no relief, she made an effort
to return to her home to die. In her way through
this place, the latter end of December, I was desired
to see her. By repeated bleedings, blisters, and
other usual methods, she was so far relieved, that
she wished to remain under my care. After a
while she began to spit matter and became hectic.
With great difficulty she was kept alive during the
discharge of the abscess, and about the end of March
she had swelled legs, and unequivocal symptoms of
dropsy in the chest. Other diuretics failing, on the
12th of April I was induced to give her the Digitalis
in small doses. The relief was great and effectual.
After an interval of fifteen days, some swellings
still remaining in the legs, I repeated the
medicine, and with such good effect, that she lost
all her complaints, got a keen appetite, recovered
her strength, and about the end of May undertook
a journey of fifty miles to her own home, where she
still remains in perfect health.[84]

CASE CXXVI.

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

CASE CXXVII.

May 7th. Miss K——, Æt. 8. After a long
continued ague, became hectic and dropsical. Her
belly was very large, and she had a total loss of appetite.
Half a grain of fol. Digital, pulv. with 2
gr. of merc. alcalis. were ordered night and morning,
and an infusion of bark and rhubarb with steel
wine to be given in the day time. Her belly began
to subside in a few days, and she was soon restored
to health. Two other children in the family,
affected nearly in the same way, had died, from the
parents being persuaded that an ague in the spring[85]
was healthful and should not be stopped.—I know
not how far the recovery in this case may be attributed
to the Digitalis, but the child was so near
dying that I dared not trust to any less efficacious
diuretic.

CASE CXXVIII.

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

CASE CXXIX.

June 17th. Mr. N——, of W——, Æt. 54.
A large man, of a pale complexion; had been subject
to severe fits of asthma for some years, but now
worse than usual. The intermitting pulse, the
great disturbance from change of posture, and the
swelled legs induced me to conclude that the exacerbation
of his old complaint was occasioned by serous
effusion. I directed pills with a grain and half of the[86]
pulv. Digital. to be taken every night, and as he was
costive, jallap made a part of the composition. He
was also directed to take mustardseed every morning
and a solution of assafetida twice in the day. The
effect of this plan was perfectly to our wishes, and
in a short time he recovered his usual health. About
half a year afterwards he died apoplectic.

CASE CXXX.

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

CASE CXXXI.

July 12th. Mrs. A——, of C——, Æt. 56.
After a series of indispositions for several years,
became dropsical; and had long been confined to
her chamber, unable to lie down or to walk. She
was so feeble, her legs so much swelled, her breath
so short, and the symptoms of diseased viscera so
strong, that I dared not to entertain hopes of a cure;
but wishing to relieve her more urgent symptoms,
directed quicksilver rubbed down and fol. Digital.
pulv. to be made into pills: the dose, containing
two grains of the latter, to be given night and
morning. She was also ordered to take a draught
with a dram of æther twice a day, and to have scapulary
issues. Her breath was so much relieved,[87]
that she was able soon afterwards to come down
stairs; but her constitution was too much broken to
admit of a recovery.

CASE CXXXII.

July 16th. Mr. B——, of W——, Æt. 31.
After a tertian ague of 12 months continuation, suffered
great indisposition for 10 months more. He
chiefly complained of great straitness and pain in
the hypochondriac region, very short breath,
swelled legs, want of appetite. He had been under
the care of some very sensible practitioners, but his
complaints increased, and he determined to come to
Birmingham. I found him supported upright in
his chair, by pillows, every attempt to lean back
or stoop forward giving him the sensation of instantaneous
suffocation. He said he had not been in bed
for many weeks. His countenance was sunk and
pale; his lips livid; his belly, thighs and legs
very greatly swollen; hands and feet cold, the
nails almost black, pulse 160 tremulous beats in a
minute, but the pulsation in the carolid arteries
was such as to be visible to the eye, and to
shake his head so that he could not hold it still.
His thirst was very great, his urine small in quantity,
and he was disposed to purge. I immediately
ordered a spoonful of the infusum Digitalis every
six hours, with a small quantity of laudanum, to
prevent its running off by stool, and decoction of
leontodon taraxacum to allay his thirst. The next
day he began to make water freely, and could[88]
allow of being put into bed, but was raised high
with pillows. Omit the infusion. That night he
parted with six quarts of water, and the next night
could lie down and slept comfortably. July 21st.
he took a mild mercurial bolus. On the 25th. the
diuretic effects of the Digitalis having nearly ceased,
he was ordered to take three grains of the pulv.
Digital. night and morning, for five days, and a
draught with half an ounce of vin. chalyb. twice a
day. August 15th. He took a purge of calomel and
jallap, and some swelling still remaining in his legs,
the Digitalis infusion was repeated. The water
having been thus entirely evacuated, he was ordered
saline draughts with acetum scilliticum and
pills of salt of steel and extract of gentian. About
a month after this, he returned home perfectly well.

CASE CXXXIII.

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

CASE CXXXIV.

July 31. Mr. M——, Æt 37. Hydrothorax.
A single grain of fol. Digital. pulv. taken every
night for three weeks cured him. The medicine
never made him sick, but increased his urine, which
became clear; whereas before it had been high coloured
and turbid.[89]

CASE CXXXV.

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

CASE CXXXVI.

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

Before the Digitalis was prescribed, he had taken
jallap purges, soluble tartar, salt of steel, vitriol of
copper, [90]&c.

CASE CXXXVII.

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

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

CASE CXXXVIII.

August 16th. Mrs. A—— of S——, Æt. 78.
About the middle of Summer began to complain of
short breath, great debility, and loss of appetite. At
this time there were evident marks of effusion in the
thorax, and some swelling in the legs. The advanced
age, the weakness, and other circumstances
of this patient, precluded every idea of her recovery;
but something was to be attempted. Squills and
other remedies had been tried; I therefore directed
pills with two or three grains of the pulv. Digitalis
to be taken every night for six nights, and a saline
draught with forty drops of acetum scillit. twice in
the day. She took but few of the draughts, seldom[91]
more than half one at a time, for they purged her,
and she disliked them. The pills she took regularly,
and with the happiest effect, for she could lie down,
her breath was very much relieved, and a degree of
appetite returned. Sept. 4th, some return of her
symptoms demanded the further use of diuretics.
I was afraid to push the Digitalis in so hazardous a
subject, and therefore directed tinct. amara with tinct.
canthar. and pills of squill, seneka, salt of tartar and
gum ammoniac. These medicines did not at all
check the progress of the disease, and on the 26th
it became necessary to give the Digitalis again. The
pills were therefore repeated as before, and infus.
amarum with fixed alkaly ordered to be taken twice
a day. The event was as favorable as before; and
from this time she had no considerable return of
dropsy, but languished under various nameless
symptoms, until the middle or end of November.

CASE CXXXIX.

Aug. 16th. Mrs. P—— of S——, Æt. 50. For
a particular account of this patient, see Mr. Yonge’s
second Case.

CASE CXL.

Sept. 20th. B—— B——, Esq. A true spasmodic
asthma of many years continuance. After every
method of relief had failed; both under my management,
and also under the direction of several of the
ablest physicians of this kingdom; I was induced to[92]
give him an infusion of the Digitalis. It was continued
until nausea came on, but procured no relief.

CASE CXLI.

October 5th. Mr. R——, Æt. 43. (The patient
mentioned at No. 102.) He had pursued his former
mode of life, and had now a return of his complaints,
with evident marks of diseased viscera. His
belly not very large, but uncommonly tense. From
this circumstance I did not expect the Digitalis to
succeed, and therefore tried for some time to relieve
him by the saline julep, with acet. scillitic.
jallap, mercury, syrup of squill, with aq. cinnam. decoction
of Dandelion, &c.; but these being administered
without advantage, I was driven to the
Digitalis. As he was very weak and much emaciated,
I only gave two grains night and morning for
five days. As no increase of urine took place, I
used alkaline salt with tinct. cantharides:—This
proving equally unsuccessful, on the 18th, I directed
two ounces of the infusum Digitalis night and morning.
This was continued until nausea took place,
but the kidney secretion was not increased. Squill
with opium, deobstruents of different kinds, sublimate
solution, fixed alkaly, tobacco infusion, were
now successively tried, but with the same want of
success. The fullness of his belly made it necessary
to tap him, and by repeating this operation he
continued alive to the end of the year.[93]

CASE CXLII.

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

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

CASE CXLIII.

October 28th. Mr. A——, subject to nephritis
calculosa: After an attack of that kind, had still a
troublesome sense of weight about his loins, now and
then rising to pain, and a degree of dysuria, together
with a want of appetite. These symptoms not
readily yielding to the usual methods of treatment,
I directed an infusion of Digitalis. The fourth dose[94]
caused a copious flow of urine; the sixth made him
sick, and he was more or less sick at times for three
days; but felt no more of his complaints.

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

CASE CXLIV.

October 31st. Mrs. C——, of W——, Æt. 67.
Asthma, and very thick hard legs of long continuance.
The last month or two her breath worse than
usual, her belly swollen, her thighs anasarcous, and
her urine in small quantity. After trying garlic,
squill, and purgatives without advantage, I directed
the Digital. Infus. After taking about five ounces,
her urine from thick and turbid, changed to clear
and amber coloured, its quantity considerably increased,
and her breathing easy. Contrary to my
orders, but impelled by the relief she had found,
she finished the remaining three ounces of the infusion,
which made her very sick, and the free flow
of urine immediately ceased. No medicine was
administered for a fortnight, during which time her
complaints increased. I then directed an infusion
of tobacco, which affected her head, but did not
increase her urine. She had recourse again to the
Digitalis infusion, which once more removed the
fulness of the belly, reduced the swellings of her
thighs, and relieved her breath, but had no effect
upon her legs.[95]

CASE CXLV.

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

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

CASE CXLVI.

Nov. 4th. Mr. P—— of M——, Æt. 40. Subject
to troublesome nephritic complaints, and after the last
attack did not recover, or void the gravelly concretions
as usual, a sense of weight across his loins continuing
very troublesome. The usual medicines failing to
relieve him, I ordered four grains of pulv. Digital.
to be taken every other night for a week, and fifteen
grains of mild fixed vegetable alkaly to be swallowed
twice a day in barley water. He soon lost all
his complaints; but we must not in this case too
hastily attribute the cure to the Digitalis, as the alkaly
has also been found a very useful medicine in
similar disorders.[96]

CASE CXLVII.

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

CASE CXLVIII.

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

CASE CXLIX.

Nov. 13th. Mrs. A—— of W——h——, Æt.
68. One of those rare cases in which no urine is
secreted. It proved as refractory as usual to remedies,
and not having ever succeeded in the cure of
this disease, I determined to try the Digitalis. It
was given in infusion, and, after a few doses, the
secretion of a small quantity of urine seemed to justify
the attempt. The next day, however, the secretion[97]
ceased, nor could it be excited again, tho’
at last the medicine was pushed so as to occasion
sickness, which continued at intervals for three
days.

CASE CL.

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

CASE CLI.

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

CASE CLII.

Nov. 26th. Mrs. W——, Æt. 65. I had attended
this lady last winter in a very severe peripneumony,
from which she narrowly escaped with
her life. When the cold season advanced this winter,
she perceived a difficulty in breathing, which gradually
became more and more troublesome. I found[98]
her much harassed by a cough, which occasioned her
to expectorate a little: the least motion increased her
dyspnœa; she could not lie down in bed; her legs
were considerably swelled, her urine small in quantity.
I directed two grains of pulv. Digitalis made
into a pill with gum ammoniac, to be taken every
night, and to promote expectoration, a squill mixture
twice in the day. Her urine in five days became
clear and copious, and in a fortnight more she
lost all her complaints, except a cough, for which
she took the lac ammoniacum.

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

CASE CLIII.

December 7th. Mr. H——, Æt. 42. A large
sat man, very subject to gravelly complaints. After
an attack in the usual manner, continued to feel
numbness in his lower limbs, and a sense of weight
across his loins. I directed infusum Digitalis to be
given every six hours. Six ounces made him sick,
and he took no more. The next day his urine increased,
a good deal of sand passed with it, and he
lost his disagreeable feels, but the sickness did not
entirely cease before the fourth day from its commencement.[99]

CASE CLIV.

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

CASE CLV.

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

CASE CLVI.

A poor man in this town, after his kidneys had
ceased to secrete urine for several days, was seized
with hickup, fits of vomiting, and transient delirium.
After examination I was satisfied the disease was
the same as that mentioned at CXLIX. A very experienced
apothecary having tried various methods to
relieve him, I despaired of any success, but determined
to try the Digitalis. It was accordingly given[100]
in infusion. At first it checked the vomitings, but
did not occasion any secretion of urine.

1785.

The cases which have occurred to me in the course
of this year, are numerous; but as the events of
some of them are not yet sufficiently ascertained, I
think it better to with-hold them at present.[101]

HOSPITAL CASES,

Under the Direction of the Author.

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

CASE CLVII.

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

CASE CLVIII.

November 18th, 1780. Henry Warren, Æt. 60.
This man had a general anasarca and ascites, and
was moreover so asthmatic, that, neither being able
to sit in a chair nor lie in bed, he was obliged constantly
to walk about, or to lean forward against a
window or table. You prescribed for him thus.[102]

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

CASE CLIX.

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

CASE CLX.

March 16th, 1782. Mary Bird, Æt. 61. Great
fullness about the stomach; diseased liver, and anasarcous[103]
legs and thighs. For the first week squill
was tried in more forms than one, but without advantage.
On the 22d she began with the Digitalis,
which presently removed all the swelling.

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

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

CASE CLXI.[104]

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

CASE CLXII.

Edward James, Æt. 21. Admitted March 20th,
1784. Complained of great difficulty of breathing,
pain in his head, and tightness about the stomach,
with a trifling swelling of his legs. Ordered
pil. scillit. ℈i. ter de die. On the third day his legs
much more swelled, his breathing more difficult,
and in every respect worse; his pulse very small[105]
and quick, complained when he turned in bed, of
something like water rolling from one side of the
thorax to the other. A remarkable blueness about
the mouth and eyes, and purged considerably from
the pil. scill. Ordered to omit the pills and to
take ℥i. of infus. Digitalis every eight hours; the
proportion ʒiss. to eight ounces of water and ℥i. of
aq. n. m. sp.—7th Day, The infusion had neither
purged, nor vomited him: he only complained once
or twice of giddiness. His belly was now very hard,
rather black on the right side the navel, and his legs
amazingly swelled. Ordered a bolus with rhubarb
and calomel, to be taken in the morning, and ℥ii.
julep salin. cum tinct. canthar. gutt. forty ter die.—12th Day,
nearly in the same state, except his
breathing which was somewhat more difficult, being
now obliged to have his head considerably raised.
Persistat—From this day to the 32d day he became
hourly worse. His belly which at first was only
hard, now evidently contained a large quantity of
water, his legs were more swelled, and a large sphacelated
sore appeared upon each outer ancle. Respiration
was so much obstructed, that he was obliged
to sit quite upright to prevent suffocation. He made
very little water, not more than eight ounces in a
day and a night, and was much emaciated. Ordered
his purging bolus again, and ℥ii. of a mixture with
sal diuretic, ℥ss. to ℥xii. three times in a day, and
a poultice with ale grounds to his legs.

54th day. To this period there was not the least
probability of his existing; his legs and thighs were[106]
one continued blubber, his thorax quite flat, and
his belly so large that it measured within one inch
as much as a woman’s in this Hospital the day she
was tapped, and from whom twenty seven pounds
of coagulable lymph were taken. He made about
three ounces of water in twenty-four hours: his
penis and scrotum were astonishingly swelled, and
no discharge from the sores upon his legs. Ordered
to take a pill with two grains of powdered Foxglove
night and morning. For a few days no sensible
effect, but about the 60th day he complained of
being continually giddy, and had some little pain
in his stomach. He now made much more water,
and dared to sleep. His appetite which through the
whole of his illness had been very bad, was also better.
66th day. Breathing very much relieved, the
quantity of water he made was three chamber pots
full in a day and a night, each pot containing two
quarts and four ounces, moderately full. Ordered
to continue his pills, and his legs which were very
flabby, to be rolled.

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

W. BAYLEY.
[107]

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

General Hospital, August 5, 1784.

CASE CLXIII.

On the 26th February, 1785, Sarah Ford, aged
42, was admitted an out-patient of the Birmingham
General Hospital: she complained of considerable
pain in her chest, and great difficulty of
breathing, her face was much swelled and her
thighs and legs were anasarcous. She had extreme
difficulty in making water, and with many painful
efforts she did not void more than six ounces in
twenty-four hours. She had been in this situation
about six weeks, during which time she had taken
ammoniacum, olibanum, and large quantities of
squills, without any other effect than frequent sickness.
Upon her commencing an Hospital patient,
the following medicine was exhibited. R. gum ammoniac
ʒii. pulv. fol. Digital. purp. ℈ii. sp. lavand.
comp. ut fiat pil. 40. cap. ii. nocte maneque. She
continued the use of these pills for a few days, without
any sensible effect. On the eighth day her
breathing was much relieved, her legs and
thighs were not so much swelled, and in a day and[108]
a night she made five pints of water. By the 12th
day her legs and thighs were nearly reduced to their
natural size. She continued to make water in large
quantities, and had lost her pain in the thorax. To
the 20th of March, she made rapid advances towards
health, when not a symptom of disease remaining,
she was discharged.[109]

COMMUNICATIONS

FROM CORRESPONDENTS.

Dr. Cawley’s prescription.

—I have elsewhere remarked, that when the Digitalis
has been properly given, and the diuretic effects
produced, that an accidental over-dose bringing
on sickness, has stopped the secretion of urine.
In the present instance it likewise appears, that violent
sickness may be excited, and continue for several
days without being accompanied by a flow of
urine; and it is probable that the latter circumstance
did not take place, until the severity of the
former abated. If Dr. Cawley had not had a constitution
very retentive of life, I think he must
have died from the enormous doses he took; and
he probably would have died previous to the augmentation
of the urinary discharge. For if the
root from which his medicine was prepared, was
gathered in its active state, he did not take at each
dose less than twelve times the quantity a strong man
ought to have taken. Shall we wonder then that
patients refuse to repeat such a medicine, and that
practitioners tremble to prescribe it? Were any of
the active and powerful medicines in daily use to
be given in doses twelve times greater than they are,
and these doses to be repeated without attention to
the effects, would not the patients die, and the
medicines be condemned as dangerous and deleterious?—Yet
such has been the fate of Foxglove![112]

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

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

Mr. P—— of H—— M——, in the parish of
Kingswinford, aged about 60; had been a strong
healthy, robust, corpulent man; worked hard early
in life at edge-tool making, and drank freely of
strong malt liquor; for many years had been subject
to gout in the extremities; for a few years past
had been very asthmatic, and the gout in the extremities
gradually decreased. When I first saw
him, which was Sept. 12, 1779, his legs were anasarcous,
his belly much swelled, and an evident fluctuation
of water. His breathing very bad, an irregular
pulse, and unable to lie down. His easiest[114]
posture was standing with his body leaning over a
chair, in which situation he would continue many
hours together, labouring for breath, with the sweat
trickling down his face very profusely; the urine
in very small quantity. Diuretics of every kind I
could think of were used with very little or no advantage.
Blisters applied to the legs relieved very
considerably for a time, but by no means could I
increase the urinary discharge. Warm stomachic
medicines were given, and at the same time sinapisms
applied to the feet, in hopes of enticing gout
to the extremities, but without any good effect.—November
22d. The swelling considerably increasing,
an emetic of acet. scillitic. was given, which acted
very violently, and increased the urinary discharge
considerably. He continued better and worse, using
different kinds of diuretic and expectorating medicines
until September 1781, when the disease was so
much worse, I did not expect he could live many
days. The acet. scillitic. was repeated, a table
spoonful every half hour, till it acted briskly upwards
and downwards; but without increasing the
urinary discharge.—On the 17th of September I infused
ʒiii. of the fol. Digitalis in ℥vi. of boiling
water, for four hours; then strained it, and added
℥i. of tinct. aromatica.—On the 18th he began by
taking one spoonful, which he was to repeat every
half hour, till it made him very sick, unless giddiness,
loss of sight, or any other disagreeable effect
took place. I had never given the medicine before,
and had prepared him to expect the operation to
be very severe. I saw him again on the 21st; he[115]
had taken the medicine regularly, till the whole
quantity was consumed, without perceiving the least
effect of any kind from it, and continued well till
the evening of the following day, when a
little sickness took place, which increased, but
never so as to occasion either vomiting or purging,
but a surprising discharge of urine. The saliva increased
so as to run out of his mouth, and a watery
discharge from his eyes; these discharges continued,
with a continual sickness, till the swelling was totally
gone, which happened in three or four days.
He afterwards took steel and bitters; and continued
very comfortably, without any return of his
dropsy, until the 7th of April 1782, when he
was seized with an epidemic cough, which was very
frequent with us at that time. His swellings now
returned very rapidly, with the greatest difficulty
in breathing, and he died in a few days. Blisters
and expectorating medicines were used on this last
return.

Extract of a Letter from Mr. Causer.

Mrs. S——, the subject of the following Case,
was as ill as it is possible for woman to be and recover;
from the inefficacy of the medicines used, I
am convinced no medicine would have saved her
but the Digitalis. I never saw so bad a case recovered;
and it shews, that in the most reduced state
of body, the medicine in small doses, will prove
safe and efficacious.[116]

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

CASE.

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

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

She took about three parts of the medicine before[117]
any effect took place. The first was sickness,
succeeded by a considerable discharge of urine.
She continued the medicine till the whole was consumed,
which caused a good deal of sickness for
three or four days.

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

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

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

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

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

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

25th. Much the same.[119]

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

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

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

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

12th. The cough very bad, pulse irregular, swelling
much increased, urine in very small quantity,
not at all increased; great lowness and fainting.
She desired to have some of the pills which relieved[120]
her so much when with child. I was almost afraid
to give them, but the inefficacy of the other medicines
gave me no hopes of a cure from continuing
them, which made me venture to comply with
her request.

17th. Considerable increase of urine.

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

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

25th. Swelling much diminished, makes plenty
of water, appetite much mended, cough and breathing
better. She omitted the medicine for three
days; the urine began to diminish, the swelling
and shortness of breathing worse. On repeating it
for two days, the discharge was again augmented,
and a diminution of the swelling succeeded. She
has continued the pills ever since till the 14th of[121]
May; the dropsical symptoms and cough are entirely
gone, the water is in sufficient quantity, her
strength is recovered, and she has a good appetite.
All she now complains of is a weight across her stomach,
which is worse at times, and she thinks, unless
it can be removed, she shall have a return of
her dropsy.

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

I understand you are going to publish
on the Digitalis, which I am glad to hear, for I have
long wished to see your ideas in print about it, and
I know of no one (from the great attention you
have paid to the subject) qualified to treat on it but
yourself. There are gentlemen of the faculty who
give verbal directions to poor patients, for the preparing
and taking of an infusion or decoction of the
green plant. Would one suppose that such gentlemen
had ever attended to the nature and operation
of a sedative power on the functions, particularly
the vital? Is not such a vague and unscientific mode
of proceeding putting a two edged sword into the
the hands of the ignorant, and the most likely method
to damn the reputation of any very active and
powerful medicine? And is it not more than probable
that the neglect of adhereing to a certain and regular
preparation of the nicotiana, and the want (of what
you emphatically call) a practicable dose, have been
the chief causes of the once rising reputation of[122]
that noted plant being damned above a century
ago? In short, the Digitalis is beginning to be used
in dropsies, (although some patients are said to go
off suddenly under its administration) somewhat
in the style of broom ashes; and, in my humble
opinion, the public, at this very instant, stand in
great need of your precepts, guards, and cautions towards
the safe and successful use of such a powerful
sedative diuretic; and I have no doubt of your
minute attention to those particulars, from a regard
to the good and welfare of mankind, as well as to
your own reputation with respect to that medicine.

I remember an officer in the Staffordshire militia,
who died here of a dropsy five years ago. The Digitalis
relieved him a number of times in a wonderful
manner, so that in all probability he might have
obtained a radical cure, if he would have refrained
from hard drinking. I understood it was first ordered
for him by a medical gentleman, and its sedative
effects proved so mild, and diuretic operation
so powerful, that he used to prepare it afterwards
for himself, and would take it with as little
ceremony as he would his tea. It is said, that he
was so certain of its successful operation, that he
would boast to his bacchanalian companions, when
much swelled, you shall see me in two days time
quite another man.[123]

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

CASE I.

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

CASE II.

December, 1782. A poor woman, who had been
afflicted with an ague during the whole of her pregnancy,
and for two months with dropsical swellings
of the feet, legs, thighs, abdomen, and labia pudenda;
was at the expiration of the seventh month[124]
taken in labour. On the day after her delivery
the ague returned, with so much violence as to endanger
her life. As soon as the fit left her, I began
to give her the red bark in substance, which
had the desired effect of preventing another paroxysm.
She continued to recover her health for a
fortnight, but did not find any diminution in the
swellings; her legs were now so large as to oblige
her to keep constantly on the bed, and she made
very little water. I ordered her the infusion of
Foxglove three times a day, which, on the third
day, produced a very copious discharge of urine,
without any sickness; she continued the use of it
for ten days, and was then able to walk. Having
lost all her swellings, and no complaint remaining
but weakness, the bark and steel compleated the
cure.

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

Anxious to procure authentic accounts from
the patients, to whom I gave the Foxglove, I have
unavoidably been delayed in answering your last
favour. However, I hope the delay will be made
up by the efficacy of the plant being confirmed by
the enquiry. Long cases are tedious, and seldom
read, and as seldom is it necessary to describe every
symptom; for every case would be a history of
dropsy. I shall therefore content myself with specifying[125]
the nature of the disease, and when the dropsy
is attended with any other affection shall notice
it.

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

CASE I.

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

CASE II.

Mr. ——, 45 years of age, had been long
subject to dropsical swellings of the legs, and made
little water. Two spoonfuls of the same decoction
twice a day, soon relieved him.[126]

CASE III.

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

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

She took the same preparation of Foxglove without
any diuretic effect, and afterwards two and three
grains of the powder twice a day with as little. The
dulcified spirits of vitriol, however, quickly promoted
the urinary secretion.[127]

CASE IV.

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

CASE V.

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

CASE VI.

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

CASE VII.

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

CASE VIII.

Ann Winterleg, in her 26th year, had dropsical
swellings of the legs, and passed little urine: she
was relieved by two drams, in an eight ounce decoction.[128]

CASE IX.

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

CASE X.

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

CASE XI.

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

CASE XII.

Widow Chatterton, about 60 years of age. Took
the decoction in the same way for dropsy of the legs,
with little effect.[129]

CASE XIII.

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

CASE XIV.

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

CASE XV.

Mr. P——, 65 years of age, and of a full habit
of body. Had lived freely in his youth, and for
many years led rather an inactive life. His health
was much impaired several months, and he had a
considerable distention, and evident fluctuation in[130]
the abdomen, and a very great œdema of the legs
and thighs. His breathing was very short, and rather
laborious, appetite bad, and thirst considerable.
His belly was bound, and he passed very small
quantities of high-coloured urine, that deposited a
reddish matter. He had taken medicines some
time, and, I believe, the Digitalis; and had been
better.

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

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

CASE XVI.

Mrs. G——, aged 50 years. After being long
ailing, had a large collection of water in the abdomen
and lower extremities. Her urine was high-coloured,
in small quantities, and had a reddish
sediment. She took the decoction of Digitalis,
squills, &c. without any effect. The chrystals of
tartar, however, cured her speedily.[131]

CASE XVII.

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

CASE XVIII.

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

CASE XIX.

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

CASE XX.

Lydia Smith, aged 60. Dispensary. Laboured
many years under an asthma, and became dropsical.
She took the decoction without effect.[132]

CASE XXI.

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

CASE XXII.

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

CASE XXIII.

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

CASE XXIV.

Ann Meachime; a Dispensary patient. Had an
ascites and scantiness of urine. She took the powder[133]
of Foxglove, and evacuated all her water in
three days.

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

REMARKS.

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

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

A CASE of Anasarca communicated by Mr.
[134]
Jones, Surgeon, in Birmingham.

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

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

On the 17th she had taken twice of the infusion,
and though by mistake only two tea spoonfuls for a[135]
dose, yet the quantity of urine was increased to
about a pint in the twenty-four hours. She was
then directed to take two table spoonfuls night and
morning. And.

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

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

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

On the 23d she complained of thirst, and thought
the discharge of urine not so copious as on the preceding
days, therefore the saline julep was continued[136]
every fourth hour, with the addition of thirty
drops of the following medicine:

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

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

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

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

A giddiness of the head, more or less remarkable
at times, was observed to follow the use of the Foxglove,
and it lasted nine or ten days.[137]

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

REMARKS.

The above is a very instructive case, as it
teaches us how small a quantity of the infusion was
necessary to effect every desirable purpose. At first
sight it may appear from the concluding paragraph,
that the green leaves ought to be preferred to the
dried ones, as being so much milder in their operation;
but let it be noticed, that the same quantity
of infusion was prepared from the same weight of
the green as of the dried leaves, and consequently,
as will appear hereafter, the infusion with the dried
leaves was five times the strength of that before
prepared from the green ones. We need not wonder,
therefore, that the effects of the former were
so disagreeable, when the dose was five times greater
than it ought to have been. But what makes this
matter still more obvious, is the mistake mentioned
at first, of two tea spoonfuls only being given for a
dose. Now a tea spoonful, containing about a
fourth or a fifth part of the contents of a table
spoon, the dose then given, was very nearly the
same as that which had before been taken of the[138]
infusion of the green leaves, and it produced precisely
the same effects for it increased the urinary
discharge, without exciting the violent vomiting.

Letter from Doctor Johnstone, Physician, in
Birmingham.

March 8th, 1783, I was called to attend Mr.
G——, a gentleman of a robust habit, who had led
a regular and temperate life, Æt. 68. He was
affected with great difficulty of respiration, and cough
particularly troublesome on attempting to lie down,
œdematous swellings of the legs and thighs, abdomen
tense and sore on being pressed, pain striking
from the pit of the stomach to the back and shoulders;
almost constant nausea, especially after taking
food, which he frequently threw up; water thick
and high-coloured, passed with difficulty and in[139]
small quantity; body costive; pulse natural; face
much emaciated, eyes yellow and depressed. He
had been subject to cough and difficulty of breathing
in the winter for several years; and about four
years before this time, after being exposed to cold,
was suddenly deprived of his speech and the use of
the right side, which he recovered as the warm weather
came on; but since that time had been remarkably
costive, and was in every respect much debilitated.
He first perceived his legs swell about a year
ago; by the use of medicines and exercise, the
swellings subsided during the summer, but returned
on the approach of winter, and gradually increased
to the state in which I found them, notwithstanding
he had used different preparations of squills and
a great variety of other diuretic medicines. I
ordered the following mixture.

March 9th. He took four doses of the mixture
without being in the least sick, and made, during
the night upwards of two quarts of natural coloured
water.[140]

10th. Took the remainder of the mixture yesterday
afternoon and evening, and was sick for a short
time, but made nearly the same quantity of water
as before, the swellings are considerably diminished,
his appetite increased, but he is still costive.

14th. Continues to make water freely. The
swellings of his legs have gradually decreased; soreness
and tension of the abdomen considerably less.

15th. Made a pint and a half of water last night,
without being in the least sick, and is in every
respect considerably better. Repet. Pillul. ut
antea.

21st. Makes water as usual when in health, and
the swellings are entirely gone.

He soon gained sufficient strength to enable him
to go a journey, and returned home in much better[141]
health than he had been from the time he was
affected with the paralytic stroke, and excepting
some return of his asthmatic complaint in the winter,
hath continued so ever since.

CASE II.

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

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

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

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

—Mr. Moggs was about 54 years of age, his disease
a dropsy of the abdomen, attended with
anasarcous swellings of the limbs, &c. brought on by
excessive drinking. I believe the first symptoms of
the disease appeared the beginning of November,
1776; the medicines he took before you saw him,
were squills in different forms, sal diureticus and
calomel, but without any good effect; he begun the
Digitalis on the 10th of July 1777; a few doses of
it caused a giddiness in the head, and almost deprived
him of sight, with very great nausea, but
very little vomiting, after which a considerable flow of
urine ensued, and in a very short time, a very little
water remained either in the cavity of the abdomen,
or the membrana adiposa, but he remained excessive
weak, with a fluttering pulse at the rate of 150 or
frequently 160 in a minute; he kept pretty free
from water for upwards of twelve months; it then[143]
collected, and neither the Digitalis nor any other
medicine would carry it off. I tapped him the 2d
of August 1779 in the usual place, and took some
gallons of water from him, but he very soon filled
again, and as he had a very large rupture, a considerable
quantity of the water lodged in the scrotum,
and could not be got away by tapping in the usual
place. I therefore (on the 28th of the same month)
made an incision into the lower part of the scrotum,
and drained off all the water that way, but he was
so very much reduced, that he died the 8th or 9th
of September following, which was about two years
and two months after he first begun the Digitalis.

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

Communications from Dr. Stokes, Physician,
in Stourbridge.

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

CASE I.

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

Decoct. c Digit. ʒiv. c. aq. ℔i. coquend. ad ℔ss. cap.
℥i. 2dis. horis. 1st Day. 4th dose made her sick.
2d Day. The first dose she took to-day produced
vomiting.[152]

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

4th Day. Cap. Calomel. gambog. scill. &c.

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

CASE II.

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

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.[153]

12th. Abdomen not diminished.

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

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

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

32d. Urine exceedingly scanty.

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

44th. Tapped. Terminated fatally.

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

CASE III.

George R——, Æt. 52. Ascites, general anasarca,
and dyspnœa. His legs so greatly distended
that it was with great difficulty he could draw the
one after the other.[154]

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

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

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

4th Day. Decoct. bacc. junip. and cyder for common
drink.

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

12th Day. Pot. purgans illico.

14th Day. Pot. purg. c. jalap. ʒss. 4tis diebus.
Infus. Dig. 3tiis diebus.
[155]

17th Day. R. Gamb. gr. iii. calom. gr. ii. camph.
gr. i. syr. simpl. fiat pil. o. n. sum.
Infus. Digit. 3tiis diebus.

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

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

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

[156]

A CASE from Mr. Shaw, Surgeon, at
Stourbridge.—Communicated by Doctor
Stokes.

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

Mr. Shaw likewise informs me, that he has removed
pains in the stomach and bowels, by giving
a spoonful of the infusion, ʒiss. to ℥viii. morning
and night.[157]

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

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

CASE of Mr. Ward, Surgeon, in
Birmingham.—Related by himself.

In September, 1782, I was seized with a difficulty
of breathing, and oppression in my chest, in
consequence of taking cold from being called out in
the night. My tongue was foul; my urine small
in quantity; my breath laborious and distressing on
the slightest exercise. I tried the medicines most generally
recommended, such as emetics, blisters, lac
ammoniacum, oxymel of squills, &c. but finding
little or no relief, I consulted Dr. Withering, who
advised me to try the following prescription.[165]

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

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

Birmingham, 1st July, 1785.

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

CASE I.

A Gentleman aged 49, on the night of the
21st of August, 1784, awaked with a sense of suffocation,
which obliged him to rise up suddenly in
bed. I found him complaining of difficult respiration,
particularly on lying down; the countenance
pale, and the pulse smaller and quicker than
usual. Some brandy and water having been given,
the symptoms gradually abated, so that he slept in a
half recumbent posture. The following day he
expressed a sense of anxiety and weight in the chest,
attended by quicker breathing upon motion of the
body. That evening an emetic of ipecacoanha was
given, and afterwards a draught, with vitriolic æther[167]
and confect. card. aa ʒi to be repeated as the symptoms
should require it. He continued to be affected
with slighter returns of the dyspnœa at irregular
intervals, until September 15th, when upon a more
severe attack, the emetic was repeated. He now
recollected some slight pain in his arms which had
affected him previous to this last seizure, and was
disposed to consider his complaint as rheumatic.
Pills with gum ammoniac. gum guaiac. and antimonial
powder were directed, with infus. amar. simpl.
twice a day. The bowels were regulated by aperient
pills of pulv. jalap. aloes and sal. tartar. and
ʒiss balsam peruv. was given occasionally to alleviate
the paroxysms of dyspnœa.

From this period until the beginning of November,
little amendment or variation happened,
except that respiration became more permanently
difficult, and particularly oppressed upon motion,
nor was it relieved by the expectoration of a mucous
discharge, which now increased considerably.
Squills, musk, ol. succini, æther, with other medicines
of the same kind, were now used, but without
success. The effects of opium and venæfection
were tried. The appetite diminished, and his
sleep became short and disturbed. He sometimes
slept lying upon his back, but generally upon his
left side. The urine which had hitherto been of
good colour, and sufficient quantity, now became
diminished, and lateritious; and the ancles œdematous.[168]

On the 15th of November a blister was laid over
the sternum, and ʒiss of oxymel scillitic. was given
every eight hours.

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

On the 30th ʒi tinct. cantharidum twice a day in
pyrmont water, with pills of ammoniac, sal tartar.
et extract. gentian. were substituted, but

On the 7th of December, from some symptoms
of relapse, the oxymel was used as before, and continued
to be taken until the 27th, in doses as large
as could be dispensed with on account of the great
nausea which attended its exhibition: The urine
was made in the quantity of four or five pints each
day, during the whole time; the quantity then
drank being seldom more than three pints. But
now the sickness being exceedingly depressing, the
strength failing, and the diuretic effects beginning
to cease, the following prescription was directed.

In three days the effect of this medicine became
visible, and when the dose of the Digitalis had been[169]
increased to six grains per day, the flow of urine
generally amounted to seven pints every twenty-four
hours. Not the least sickness, nor any other
disagreeable symptom supervened, though he persevered
in this plan until the end of January at
which time the dyspnœa was removed, and he has
continued gradually to regain his flesh, strength,
and appetite, without any relapse.

CASE II.

About the middle of the year 1784 a lady aged 48,
returned from London, to her native air in Shropshire,
under symptoms of complicated disease. It
was your opinion that the plethoric state, consequent
to that period, when menstruation first begins
to cease, had under various appearances, laid the
foundation of that deplorable state which now presented
itself. The skin was universally of a pale,
leaden colour; her person much emaciated, and her
strength so reduced, as to disable her from walking
without support. The appetite fluctuating, the digestion
impaired so much, that solids passed the
intestines with little appearance of solution: She
had generally eight or ten alvine evacuations every
day, and without this number, febrile symptoms,
attended with severe vertiginous affection, and
vomiting regularly ensued. The stools were of a
pale ash colour. The urine generally pale, and at
first in due quantity. The region of the stomach[170]
had a tense feel, without soreness: the feet and
ancles œdematous, her sleep was uncertain: the
pulse varying between 94 and 100, and feeble,
except upon the approach of the menstrual periods,
which were now only marked by its increased
strength, and exacerbation of other febrile symptoms.
Emetics, saline medicines, and gentle aperients
were necessary to alleviate these. Six grains
of ipecac, operated with sufficient power, and half
a grain of calomel would have purged with great
violence.

From the time of her arrival till the middle of
August, mercury had been continued in various
forms, and in doses such as the irritable state of her
stomach and bowels would admit of. Spirit. nitri
dulc.; sal. tartar, squill, and cantharides were
alternately employed as diuretics, but without success,
to retard the progress of an universal anasarca
which was then advanced to such degree and accompanied
by so great debility, and other dreadful concomitants,
as to threaten a speedy and fatal catastrophe.

On the 16th of August you first saw her, and
directed thus.

On the 20th the flow of urine began to increase,
and she continued the medicine in the same dose
until the 20th of September, discharging from six to
eight pints of water each day for the first week, and
which quantity gradually diminished as she became
empty. During this period she complained not of
any sickness, except from the lixivium, which was
after the first dose reduced to 20 drops; and her appetite
and strength increased daily, though it was
evident that no bile had yet flowed into the bowels,
nor was the digestion at all improved. The anasarcous
appearances being then removed, the Digitalis
was omitted, and pills, composed of mercur.
cinereus, aloes, and sal tartari directed twice a day,
with ʒi. of vin. chalybeat. in infus. amar. simpl.

Her amendment in other respects proceeded
slowly, but regularly, from that time until the 9th
of October; when the state of plethora again recurring,
with its usual attendant symptoms, ℥iv. of
blood were taken from the arm; and this was upon
the same occasion, repeated in the following month,
with manifest good consequences; though in both
instances the colour of the blood, as flowing from
the vein could hardly be called red, and the coagulum
was as weak in its cohesion as possible. The
state of the stomach and bowels was by this time
greatly improved, in common with other parts of[172]
the system; but no intromission of bile had yet
happened: the hardness about the hypogastric region,
though less, continued in a considerable degree,
and you ordered pills of mercury rubbed
down, and rust of iron, to be taken twice a day,
with a decoction of dandelion and sal sodæ.

A cataplasm of linseed was applied every night
over the stomach and right side; and, with little
deviation from this plan, she continued to the end
of the year, improving in her general health, but
the hepatic affection yet remaining. It was then
determined to try the effects of electricity, and
gentle shocks were passed through the body daily,
and as nearly as could be through the liver, in various
directions.

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

In February the lady left this neighbourhood, and
though convalescent, yet so nearly well as to promise
us the satisfaction of seeing her perfectly restored.

June 29. The bile is now secreted in pretty good
quantity, her appetite is perfectly good, her strength
equal to almost any degree of exercise, and her[173]
health in general better than it has been for some
years.

CASE III.

Mr. W——, aged—. In June, 1782, was
affected with slight difficulty in respiration, upon taking
exercise or lying down in bed. These symptoms
increased gradually until the end of July,
when he complained of sense of weight and uneasiness
about the prœcordia; loss of appetite; and
costiveness. The urine was small in quantity, and
high coloured; his pulse feeble, and intermitting;
he breathed with difficulty when in bed, and slept
little. After the exhibition of an emetic, and an
opening medicine of rhubarb, sena, and sal tartari,
he was directed to take half a dram of squill pill,
pharm. Edinburg. night and morning, with ʒss sal.
sodæ in ℥iss. infus. amar. simpl. twice a day; and
these medicines were continued during ten days,
without any sensible effect. A blister was then applied
to the sternum, and six grains of calomel given
in the evening. The symptoms were now increased
very considerably, in every particular; and
the following infusion was substituted for the former
medicines.

Sometime in the night considerable nausea occurred,[174]
and the following day he began to make water
in great quantity, which he continued to do for
three or four days. The pulse in a few hours became
regular, slower, and stronger, and, in the
course of a week, all the symptoms entirely vanished,
and an electuary of cort. peruvian, sal martis,
and spec. aromatic. confirmed his cure.

In February, 1784, this gentleman had a relapse
of his disease, from which he again soon recovered
by the same means, and is now perfectly well.

CASE IV.

G—— A——, a husbandman, aged 57. Was
in the year 1782 affected with a slight, but constant
pain in his breast, with difficult respiration. His
countenance was yellow; the abdomen swelled, and
hard; his urine high coloured, and in small quantity;
appetite and sleep little. Complained of frequent
nausea, and of sudden profuse sweatings,
which seemed for a short time to relieve the dyspnœa.

After the exhibition of an emetic, six grains of
calomel were given, with a purge of jalap in the
morning, and repeated in a few days, with some appearance
of advantage. He was then directed to
take some pills of squill, soap, and rhubarb, with a
draught twice a day, consisting of infus. amar. simp.
and sal tartari. The skin soon became clearer and[175]
the pain in his breast considerably diminished. But
every other circumstance remaining the same, and
a fluctuation in the belly being now more evident,
the infusion of Digitalis as prescribed in case third,
was given in the dose of one ounce twice a day.

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

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

CASE V.

R—— H——, Aged 43. Towards the end of the
year 1783, became affected with slight cough and expectoration
of purulent matter. In December his
skin became universally of a pale yellow colour.
The abdomen was swelled and hard; his appetite
little, and he complained of a violent and constant
palpitation of the heart, which prevented him from
sleeping. The urine pale, and in small quantity.
The pulse exceedingly strong, and rebounding;
beating 114 to 120 strokes every minute. He suffered
violent pain of his head, and was very feeble and
emaciated. After bleeding, and the use of gentle
aperient medicines, he continued to take the infusion
of Digitalis for some days, without any sensible
effect. Other diuretics were tried to as little purpose.[176]
Repeated bleeding had no effect in diminishing
the violent action of the heart. He died in
January following, under complicated symptoms of
phthisis and ascites.

CASE VI.

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

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

A small quantity of broth was directed to be given
him every half hour, and blisters were applied
to the ancles, by which his symptoms became gradually
alleviated, and he recovered perfectly in the
space of three weeks; except a relapse of the anasarca,
for which the Digitalis was afterwards successfully
employed, in small doses, without any disagreeable
consequence.[177]

CASE VII.

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

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

CASE VIII.

W—— C——, a collier aged 58, was attacked
in the spring of 1783 with a tertian ague,
which he attributed to cold, by sleeping in a coal[178]
pit, and from which he recovered in a few days,
except a swelling of the lower extremities, which
had appeared about that time, and gradually increased
for two or three months. The legs and
thighs were greatly enlarged and œdematous. His
belly was swelled, but no fluctuation perceptible. He
made small quantities of high coloured water. The
appetite bad, and pulse feeble. He had taken many
medicines without relief, and was now so reduced
in strength, as to sit up with difficulty. An infusion
of the Digitalis was directed for him, in the
proportion of one ounce of the fresh leaves to a pint
of water, two ounces to be taken three times a day,
until the stomach or bowels became affected. Upon
the exhibition of the sixth dose, nausea supervened,
and continued to oppress him at intervals for two or
three days, during which he passed large quantities of
pale urine. The swelling, assisted by moderate
bandage rapidly diminished, and without any repetition
of his medicine, at the expiration of sixteen
days, he returned to his labour perfectly recovered.[179]

OF THE
PREPARATIONS and DOSES,
OF THE
FOXGLOVE.

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

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

Some practitioners, who have used the root, and
been so happy as to cure their patients without exciting
sickness, have been pleased to communicate
the circumstance to me as an improvement in the
use of the plant. I have no doubt of the truth of
their remarks, and I thank them. But the case of
Dr. Cawley puts this matter beyond dispute. The
fact is, they have fortunately happened to use the
root in its approach to its inert state, and consequently
have not over dosed their patients. I could,[180]
if necessary, bring other proof to shew that the root
is just as capable as the leaves, of exciting nausea.

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

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

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

FLOWERS.—The petals, the chives, and the
pointal have nearly the taste of the leaves, and it
has been suggested to me, by a very sensible and
judicious friend, that it might be well to fix on the
flower for internal use. I see no objection to the
proposition; but I have not tried it.[181]

SEEDS.—These I believe are equally untried.

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

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

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

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

I give to adults, from one to three grains of this
powder twice a day. In the reduced state in which
physicians generally find dropsical patients, four
grains a day are sufficient. I sometimes give the
powder alone; sometimes unite it with aromatics,
and sometimes form it into pills with a sufficient
quantity of soap or gum ammoniac.[182]

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

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

It appears from several of the cases, that when the
Digitalis is disposed to purge, opium may be joined
with it advantageously; and when the bowels are
too tardy, jalap may be given at the same time,[183]
without interfering with its diuretic effects; but I
have not found benefit from any other adjunct.

From this view of the doses in which the Digitalis
really ought to be exhibited, and from the evidence
of many of the cases, in which it appears to
have been given in quantities six, eight, ten or even
twelve times more than necessary, we must admit
as an inference either that this medicine is perfectly
safe when given as I advise, or that the medicines
in daily use are highly dangerous.[184]

EFFECTS, RULES, and CAUTIONS.

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

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

[185]

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

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

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

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

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

Therefore my patients were ordered to persist
until the nausea came on, and then to stop. But it
soon appeared that the diuretic effects would often
take place first, and sometimes be checked when the
sickness or a purging supervened.[186]

The direction was therefore enlarged thus—Continue
the medicine until the urine flows, or sickness or
purging take place.

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

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

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

If it purges, it seldom succeeds well.

The patients should be enjoined to drink very
freely during its operation. I mean, they should
drink whatever they prefer, and in as great quantity[187]
as their appetite for drink demands. This direction
is the more necessary, as they are very generally
prepossessed with an idea of drying up a
dropsy, by abstinence from liquids, and fear to add
to the disease, by indulging their inclination to
drink.

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

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

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

If inadvertently the doses of the Foxglove should
be prescribed too largely, exhibited too rapidly, or
urged to too great a length; the knowledge of a
remedy to counteract its effects would be a desirable[188]
thing. Such a remedy may perhaps in time be
discovered. The usual cordials and volatiles are
generally rejected from the stomach; aromatics and
strong bitters are longer retained; brandy will sometimes
remove the sickness when only slight; I have
sometimes thought small doses of opium useful, but I
am more confident of the advantage from blisters.
Mr. Jones (Page 135) in one case, found mint tea to
be retained longer than other things.

CONSTITUTION of PATIENTS.[189]

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

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

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

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

On the contrary, if the pulse be feeble or intermitting,
the countenance pale, the lips livid, the
skin cold, the swollen belly soft and fluctuating, or[190]
the anasarcous limbs readily pitting under the pressure
of the finger, we may expect the diuretic effects
to follow in a kindly manner.

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

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

A tendency to paralytic affections, or a stroke of
the palsy having actually taken place, is no objection
to the use of the Digitalis; neither does a
stone existing in the bladder forbid its use. Theoretical
ideas of sedative effects in the former, and
apprehensions of its excitement of the urinary organs
in the latter case, might operate so as to
make us with-hold relief from the patient; but experience
tells me, that such apprehensions are
groundless.[191]

INFERENCES.

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

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

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

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

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

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

VI. That when dropsy is attended by palsy, unsound
viscera, great debility, or other complication
of disease, neither the Digitalis, nor any other diuretic[192]
can do more than obtain a truce to the urgency
of the symptoms; unless by gaining time, it may
afford opportunity for other medicines to combat
and subdue the original disease.

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

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

IX. That it has a power over the motion of the
heart, to a degree yet unobserved in any other medicine,
and that this power may be converted to salutary
ends.[193]

PRACTICAL
REMARKS ON DROPSY,
AND SOME OTHER DISEASES.

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

ANASARCA.

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

§ 2. When the abdominal viscera in general are
greatly enlarged, which they sometimes are, without
effused fluid in the cavity of the abdomen; the
disease is incurable. After death, the more solid
viscera are found very large and pale. If the cavity
contains water, that water may be removed by
diuretics.[194]

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

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

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

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

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

ASCITES.

§ 6. If existing alone, (i. e.) without accompanying
anasarca, is in children curable; in adults
generally incurable by medicines. Tapping may be[195]
used here with better chance for success than in
more complicated dropsies. Sometimes cured by
vomiting.

ASCITES and ANASARCA.

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

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

ASCITES, ANASARCA, and
HYDROTHORAX.

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

ASTHMA.

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

§ 10. In the greater part of what are called
asthmatical cases, the real disease is anasarca of the
lungs, and is generally to be cured by diuretics. (See
§ 1.) This is almost always combined with some
swelling of the legs.[196]

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

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

ASTHMA and ANASARCA.

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

ASTHMA and ASCITES.

§ 13. A rare combination, but not incurable
if the abdominal viscera are sound. The
asthma is here most probably of the anasarcous
kind (§ 10😉 and this being seldom confined to the
lungs only, the disease generally appears in the following
form.[197]

ASTHMA, ASCITES, and ANASARCA.

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

EPILEPSY.

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

HYDATID DROPSY.

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

HYDROCEPHALUS.

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

It has seldom happened to me to be called upon
in the earlier stages of this complaint, and the symptoms[198]
are at first so similar to those usually attendant
upon dentition and worms, that it is very difficult
to pronounce decidedly upon the real nature of the
disease; and it is rather from the failure of the usual
modes of relief, than from any other more decided
observation, that we at length dare to give it a name.

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

In the more advanced stages, the diagnostics obtrude
themselves upon our notice, and put the situation
of the patient beyond a doubt. But this does
not always happen. The variations of the pulse,
so accurately described by the late Dr. Whytt, do
not always ensue. The dilatation of the pupils,
the squinting, and the aversion to light, do not
universally exist. The screaming upon raising the
head from the pillow or the lap, and the flushing of
the cheeks, I once considered as affording indubitable
marks of the disease; but in a child which I
sometime since attended with Dr. Ash, the pulse
was uniformly about 85, (except during the first
week, before we had the care of the patient.) The
child never shewed any aversion to the light; never
had dilated pupils, never squinted, never screamed
when raised from the lap or taken out of the bed,
nor did we observe any remarkable flushing of the
cheeks; and the sleep was quiet, but sometimes
moaning.[199]

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

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

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

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

Some years ago I mentioned these opinions, and
the success of the practice resulting from them, to
Dr. Quin, now physician at Dublin. That gentleman
had lately taken his degree, and had chosen
hydrocephalus for the subject of his thesis in the
year 1779. In this very ingenious essay, which he
gave me the same morning, I was much pleased to
find that the author had not only held the same[200]
ideas relative to the nature of the disease, but had
also confirmed them by dissections.

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

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

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

HYDROTHORAX.

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

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

It is very universally cured by the Digitalis.[201]

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

HYDROTHORAX and ANASARCA.

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

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

INSANITY.

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

§ 23. Where appearances of anasarca point out the
true cause of the complaint, as in cases XXIV. and[202]
XXXIV. the happiest effects may be expected from
the Digitalis; and men of more experience than myself
in cases of insanity, will probably employ it successfully
in other less obvious circumstances.

NEPHRITIS CALCULOSA.

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

OVARIUM DROPSY.

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

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

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

§ 28. When tapping becomes necessary, I always
advise the adoption of the waistcoat bandage
or belt, invented by the late very justly celebrated
Dr. Monro, and described in the first volume of
the Medical Essays. I also enjoin my patients to
wear this bandage afterwards, from a persuasion
that it retards the return of the disease. The proper
use of bandage, when the disorder first discovers
itself, certainly contributes much to prevent its
increase.[204]

OVARIUM DROPSY with ANASARCA.

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

PHTHISIS PULMONALIS.

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

§ 31. The younger part of the female sex are
liable to a disease very much resembling a true consumption,
and from which it is difficult to distinguish
it; but this disease is curable by steel and bitters.
A criterion of true phthisis has been sought for in the[205]
state of the teeth; but the exceptions to that rule
are numerous. An unusual dilatation of the pupil
of the eye, is the most certain characteristic.[13]

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

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

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

[206]

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

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

He then undertook a journey to London; whilst
there he became worse: returned home, and died
consumptive some weeks afterwards.[207]

PUERPERAL ANASARCA.

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

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

THE END.