An Account of the Foxglove and some of its Medical Uses With Practical Remarks on Dropsy and Other Diseases

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

By

William Withering, M. D.

Physician to the General Hospital at Birmingham.

_---- nonumque prematur in annum._

Horace.

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

Preface.

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

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

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

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

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

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

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

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

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

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

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

_Birmingham, 1st July,_ 1785.

Introduction.

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

[Footnote 1: Verbascum of Linnaeus.]

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

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

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

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

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

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

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

CHIVES. _Threads_ crooked, white. _Tips_ yellow.

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

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

ROOT. Knotty and fibrous.

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

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

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

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

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

* * * * *

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

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

HISTORICAL VIEW of the Properties of Digitalis.

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

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

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

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

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

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

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

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

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

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

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

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

_Parkinson_, _p._ 654.

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

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

A man with _scrophulous ulcers_ in various parts of the body, and which in the right leg were so virulent that its amputation was proposed, cured by _succ. express. cochl. i. bis intra xiv. dies, in 1/2 pintae cerevisiae calidae_.

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

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

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

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

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

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

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

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

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

PARKINSON, p. 654.

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

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

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

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

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

Of The Plate.

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

* * * * *

Explanation.

Fig. 1. The Empalement.

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

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

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

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

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

AN ACCOUNT OF THE INTRODUCTION of FOXGLOVE INTO MODERN PRACTICE.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cases,

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

1775.

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

Case I.

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

1776.

Case II.

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

Case III.

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

Case IV.

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

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

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

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

R. Fol. Digital. purp. recent. [Symbol: ounce]iv. coque ex Aq. fontan. purae [Symbol: pound]iss ad [Symbol: pound]i. et cola. R. Decoct. Digital. [Symbol: ounce]iss. Aq. Nuc. Moschat. [Symbol: dram]ii. M. fiat. haust. 2dis horis sumend.

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

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

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

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

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

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

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

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

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

Case V.

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

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

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

1777.

Case VI.

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

Case VII.

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

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

Case VIII.

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

R. Fol. Digital. purp. recent. [Symbol: ounce]ii. Aq. purae. [Symbol: pound]i. coque ad [Symbol: pound]iss et colatur. adde. Aq. cinn. sp. [Symbol: ounce]iv. M. capiat. cyath. vinos. parv. bis quotidie.

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

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

Case IX.

_March_ 29th. Mr. G----, AEt. 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----, AEt. 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----, AEt. 54. A very hard drinker; had been affected since _November_ last with ascites and anasarca, for which he had taken several medicines without benefit. A decoction of the recent leaves of the Digitalis was then directed, an ounce and half to a pint, one eighth of which I ordered to be given every fourth hour. A few doses brought on great nausea, indistinct vision, and a great flow of urine, so as presently to empty him of all the dropsical water. Indeed the evacuation was so rapid and so complete, that it became necessary to apply a bandage round the belly, and to support him with cordials.

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

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

Case XII.

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

Case XIII.

_October_ 9th. Mrs. B----, AEt. 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----, AEt. 54. A thorax greatly deformed; asthma through the winter, succeeded by dropsy in belly and legs. Pulse very small; face leaden coloured; cough almost continual. Decoction of seneka was directed, and small doses of Dover's powder at night.

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

Case XVI.

_August_ 18th. Mr. B----, AEt. 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----, AEt. 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----, AEt. 33. Ascites and universal anasarca; countenance quite pale and bloated; appetite none, and the little food he forces down is generally rejected.

R. Fol. Digit. purp. siccat. [Symbol: dram]iii. Aq. bull. [Symbol: pound]i. digere per horas duas, et colat. adde aq. junip. comp. [Symbol: ounce]iii.

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

These were his reports:

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

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

Omit all medicines at present.

7th. Saturday, 71/2 half pints. 8th. Sunday, 8 9th. Monday, 63/4 10th. Tuesday, 61/2 11th. Wednesday, 6 12th. Thursday, 61/4

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

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

Case XIX.

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

1779.

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

Case XX.

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

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

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

Case XXI.

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

Case XXII.

_January_ 11th. Mr. H----, AEt. 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----, AEt. 57. Diseased viscera, jaundice, ascites and anasarca. After trying calomel, saline draughts, jallap purges, chrystals of tartar, pills of gum ammoniac, squills, and soap, sal succini, eleterium, &c. infusion of Digitalis was directed, which removed all his urgent symptoms, and he recovered a pretty good state of health.

Case XXIV.

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

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

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

Case XXV.

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

Case XXVI.

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

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

Case XXVII.

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

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

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

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

1780.

Case XXVIII.

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

Case XXIX.

_February_ 6th. Mr. H----, AEt. 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----, AEt. 50. Ascites and anasarca, with symptoms of phthisis. He had been a very hard drinker. The infusum Digitalis removed his dropsical symptoms, and he was sufficiently recovered to take a journey; but as the spring advanced, the consumptive symptoms increased, and he died soon afterwards, perfectly emaciated.

Case XXXI.

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

Case XXXII.

_March_ 16th. Mr. D----, AEt. 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----, AEt. 5. Hydrocephalus internus. As the case did not yield to calomel, when matters were nearly advanced to extremities, it occurred to me to try the Infusum Digitalis; a few doses of which were given, but had no sensible effect.

Case XXXIV.

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

Case XXXV.

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

Case XXXVI.

_May_ 15th. Mrs. H----, AEt. 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----, AEt. 12. Scrophulous, consumptive, and at length anasarcous. Took Infus. Digital. without advantage. Died the _July_ following.

Case XXXVIII.

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

Case XXXIX.

_June_ 13th. Mr. P----, AEt. 35. A very hard drinker, was attacked with a severe haemoptoe, 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----, AEt. 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----, AEt. 57. Hydrothorax and anasarca; his breath so short that he could not lie down. After a trial of squill, fixed alkaly, and dulcified spirit of nitre, I directed Pulv. Digital. gr. 2, thrice a day. In four days he was able to come down stairs; in three days more no appearance of disease remained; and under the use of aromatics and small doses of opium, he soon recovered his strength.

Case XLII.

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

Case XLIII.

_July_ 9th. Mrs. F----, AEt. 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 aether, chrystals of tartar, squill and cordial medicines were successively exhibited, but with no advantage. I then directed Pulv. Fol. Digital. two grains every four hours. After taking eighteen grains, the urine began to increase. The medicine was then stopped. The discharge of urine continued to increase, and in five or six days the whole of the dropsical water passed off, without any disturbance to the stomach or bowels. As the distension of the belly had been very great, a swathe was applied, and drawn gradually tighter as the water was evacuated. As no pains were spared to prevent the return of the dropsy, and as the best means I could devise proved unequal to my wishes, both in this and in some other cases, I shall take the liberty to point out the methods I tried at different times in as concise a manner as possible, for the knowledge of what will not do, may sometimes assist us to discover what will.

1780.

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

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

26th. Pills of soap, garlic and millepedes.

30th. The same pills, with infusum amarum.

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

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

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

1781.

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

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

_March_ 18th. Infus. Digital. repeated.

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

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

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

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

_August_ 11th. Infus. Digitalis.

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

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

16th. Infus. Digitalis.

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

25th. Squill united to small doses of opium.

1782.

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

4th. Tincture of cantharides and paregoric elixir.

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

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

_April_ 1st. A cordial mixture for occasional use.

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

Intervals.

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

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

Case XLIV.

_July_ 12th. Mr. H----, of A----, AEt. 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----, AEt. 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----, AEt. 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----, AEt. 86. Asthma of many years duration, and lately an incipient anasarca, with a paucity of urine. He had never lived intemperately, was of a chearful disposition, and very sensible: for some years back had lost all relish for animal food, and his only support had been an ounce or two of bread and cheese, or a small slice of seed-cake, with three or four pints of mild ale, in the twenty-four hours. After trying chrystals of tartar, fixed alkaly, squills, &c. I directed three grains of Pulv. fol. Digital. made into pills, with G. ammoniac, to be given every six hours; this presently occasioned copious discharges of urine, removed his swellings, and restored him to his usual standard of health.

Case XLVIII.

_August_ 17th. T---- B----, Esq. of K----, AEt. 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----, AEt. 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----, AEt. 39. Anasarcous legs and symptoms of hydrothorax, consequent to a tertian ague. Three grains of Pulv. Digitalis, given every fourth hour, occasioned a very copious flow of urine, and she got well without any other medicine.

Case LI.

_August_ 28th. Mr. J---- H----, AEt. 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----, AEt. 45. Had been long in an ill state of health, from what had been supposed an irregular gout, was greatly emaciated, had a sallow complexion, no appetite, costive bowels, quick and feeble pulse. The cause of his complaints was involved in obscurity; but I suspected the poison of lead, and was strengthened in this suspicion, upon finding his wife had likewise ill health, and, at times, severe attacks of colic; but the answers to my enquiries seemed to prove my suspicions fruitless, and, amongst other things, I was told the pump was of wood. He had lately suffered extremely from difficult breathing, which I thought owing to anasarcous lungs; there was also a slight degree of pale swelling in his legs. Pulv. fol. Digital. made into pills, with gum ammoniac and aromatic species, soon relieved his breathing. Attempts were then made to assist him in other respects, but with little good effect, and some months afterwards he died, with every appearance of a worn out constitution.

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

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

Case LIII.

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

Case LIV.

_September_ 30th. Mr. A----, AEt. 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----, AEt. 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 dyspnoea gradually increased, he got a most distressing sense of tightness across his stomach, his urine was little, and high coloured, and his legs began to swell; his pulse slender and feeble. From the 20th of _September_ I frequently saw him, and observed a gradual and regular increase of all his complaints, notwithstanding the use of the most powerful medicines I could prescribe. He took chrystals of tartar, seneka, gum ammoniac, saline draughts, emetics, tinct. of cantharides, spirits of nitre dulcified, squills in all forms, volatile alkaly, calomel, Dover's powder, &c. Blisters and drastic purgatives were tried, interposing salt of steel and gentian. I had all along felt a reluctance to prescribe the Digitalis in this case, from a persuasion that it would not succeed. At length I was compelled to it, and directed one grain to be given every two hours until it should excite nausea. This it did; but, as I expected, it did no more. The reason of this belief will be mentioned hereafter. Five days after this last trial I gave him assafetida in large quantity, flattered by a hope that his extreme sufferings from the state of his respiration, might perhaps arise in part from spasm, but my hopes were in vain. I now thought of using an infusion of tobacco, and prescribed the following:

R. Fol. Nicotian. incis. [Symbol: dram]ii. Aq. bull. [Symbol: pound]ss. Sp. Vini rectif. [Symbol: ounce]i digere per horam.

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

Case LVI.

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

Case LVII.

_November_ 16th. Mrs. F----, AEt. 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----, AEt. 62. Ascites and very large hard legs. After trying various medicines, under the direction of a very able physician, I ordered her to take one grain of Pulv. Digital. every six hours, but it produced no effect. Other Medicines were then tried to as little purpose. About the end of _February_, I directed an infusion of the Fol. Digital. but with no better success. Other methods were thought of, but none proved efficacious, and she died a few weeks afterwards.

Case LIX.

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

Case LX.

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

Case LXI.

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

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

Case LXII.

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

Case LXIII.

_March_ 16th. Mrs. P----, AEt. 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----, AEt. 63. For some years back had complained of being asthmatical, and was not without suspicion of diseased viscera. The last winter he had been mostly confined to his house; became dropsical, lost his appetite, and his skin and eyes turned yellow. By the use of medicines of the deobstruent class he became less discoloured, and the hardness about his stomach seemed to yield; but the ascites and anasarcous symptoms increased so as to oppress his breathing exceedingly. Alkaline salts, and other diuretics failing of their effects, I ordered him to take an infus. of Digitalis. It operated so powerfully that it became necessary to support him with cordials and blisters, but it freed him from the dropsy, and his breath became quite easy. He then took soap, rhubarb, tartar of vitriol, and steel, and gradually attained a good state of health, which he still continues to enjoy.

Case LXVI.

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

Case LXVII.

_April_ 24th. Mr. M----, of C----, AEt. 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----, AEt. 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----, AEt. 6. I found him with every symptom of hydrocephalus internus. As it was yet early in the disease, in consequence of ideas which will be mentioned hereafter, I directed six ounces of blood to be immediately taken from the arm; the temporal artery to be opened the succeeding day; the head to be shaven, and six pints of cold water to be poured upon it every fourth hour, and two scruples of strong mercurial ointment to be rubbed into the legs every day. Five days afterwards, finding the febrile symptoms very much abated, and judging the remaining disease to be the effect of effusion, I directed a scruple of Fol. Digital. siccat. to be infused in three ounces of water, and a table spoonful of the infusion to be given every third or fourth hour, until its action should be someway sensible. The effect was, an increased secretion of urine; and the patient soon recovered.

Case LXX.

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

Case LXXII.

_May_ 24th. Joseph B----, AEt. 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----, AEt. 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----, AEt. 58. Kept a public house and drank very hard. He had symptoms of diseased viscera, jaundice, ascites, and anasarca. After taking various deobstruents and diuretics, to no purpose, he was ordered the Infusion of Digitalis: a few doses occasioned a plentiful flow of urine, relieved his breath, and reduced his swellings; but, on account of his great weakness, it was judged imprudent to urge the medicine to the entire evacuation of the water. He was so much relieved as to be able to come down stairs and to walk about, but his want of appetite and jaundice continuing, and his debility increasing, he died in about two months.

Case LXXV.

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

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

Case LXXVI.

_August_ 12th. Mr. L----, AEt. 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----, AEt. 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----, AEt. 63. Very painful and general swellings in all his limbs, which had confined him mostly to his bed since the preceding winter; the swellings were uniform, tense, and resisting, but the skin not discoloured. After trying guiacum and Dover's powder without advantage. I directed Infusion of Digitalis. It acted on the kidneys, but did net relieve him. It is not easy to say what the disease was, and the patient living at a distance, I never learnt the future progress or termination of it.

Case LXXIX.

_September_ 26th. Mr. D----, AEt. 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----, AEt. 42. A fat sedentary woman; after a long illness, very indistinctly marked; had symptoms of enlarged liver and dropsy. In this case I was happy in the assistance of Dr. Ash. Digitalis was once exhibited in small doses, but to no better purpose than many other medicines. She suffered great pain in the abdomen for several weeks, and after her death, the liver, spleen, and kidneys were found of a pale colour, and very greatly enlarged, but the quantity of effused fluid in the cavity was not more than a pint.

Case LXXXI.

_October_ 28th. Mr. B----, AEt. 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----, AEt. 49. A lusty man, with an asthma and anasarca. He had taken several medicines by the direction of a very judicious apothecary, but not getting relief as he had been accustomed to do in former years, he came under my direction. For the space of a month I tried to relieve him by fixed alkaly, seneka, Dover's powder, gum ammoniac, squill, &c. but without effect. I then directed Infusion of Digitalis, which soon increased the flow of urine without exciting nausea, and in a few days removed all his complaints.

1782.

Case LXXXIII.

_January_ 23d. Mr. Q----, AEt. 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----, AEt. 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----, AEt. 35. A publican and a hard drinker. Ascites, anasarca, diseased viscera, and slight attacks of haemoptoe. 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----, AEt. 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----, AEt. 81. Great difficulty of breathing, so that he had not lain in bed for the last six weeks, and some swelling in his legs. These complaints were subsequent to a very severe cold, and he had still a troublesome cough. He told me that at his age he did not look for a cure, but should be glad of relief, if it could be obtained without taking much medicine. I directed an Infusion of Digitalis, a dram to eight ounces, one spoonful to be taken every morning, and two at night. He only took this quantity; for in four days he could lie down, and soon afterwards quitted his chamber. In a month he had a return of his complaints, and was relieved as before.

Case LXXXVIII.

_January_ 31st. Mrs. J----, of S----, AEt. 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----, AEt. 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----, AEt. 10. An epilepsy of some years continuance, which had never been interrupted by any of the various methods tried for his relief. The Digitalis was given for a few days, but as he lived at a distance, so that I could not attend to its effects, he only took one half pint infusion, which made no alteration in his complaint.

Case XCI.

_March_ 6th. Mr. H----, AEt. 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 sodae 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----, AEt. 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----, AEt. 61. A very large man, and a free liver; after an attack of hemiplegia early in the spring, from which he only partially recovered, became dropsical. The dropsy occupied both legs and thighs, and the arm of the affected side. I directed an Infusion of Digitalis in small doses, so as not to affect his stomach. The swellings gradually subsided, and in the course of the summer he recovered perfectly from the palsy.

Case XCIV.

_July_ 5th. Mr. C----, of W----, AEt. 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----, AEt. 36. In the last stage of a pulmonary consumption, took the Infus. Digitalis, but without any advantage.

Case XCVI.

_August_ 20th. Mr. P----, AEt. 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----, AEt. 35, the mother of many children. After her last lying in, three months ago, had that kind of swelling in one of her legs which is mentioned at No. VIII. XXVI, and XXXI. A considerable degree of swelling still remained; the limb was heavy to her feeling, and not devoid of pain. I directed a bolus of five grains of Pulv. Digitalis, and twenty-five of crude quicksilver rubbed down, with conserve of cynosbat. to be taken at bed-time, and afterwards an Infusion of red bark and Fol. Digitalis to be taken twice a day. There was half an ounce of bark and half a dram of the leaves in a pint infusion: the dose two ounces.

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

Case XCVIII.

_September_ 25th. Mr. R----, AEt. 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----, AEt. 38. Hydrothorax and anasarca. Her chest was very considerably deformed. One half pint of the Digitalis Infusion entirely cured her.

Case C.

_September_ 30th. Mr. R----, of W----, AEt. 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----, AEt. 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----, AEt. 41. A publican, and a hard drinker. His legs and belly greatly swollen; appetite gone, countenance yellow, breath very short, and cough troublesome. After a vomit I gave him calomel, saline draughts, steel and bitters, &c. He had taken the more usual diuretics before I saw him. As the dropsical symptoms increased, I changed his medicines for pills made of soap, containing two grains of Pulv. fol. Digital, in each dose, and, as he was costive, two grains of jallap. He took them twice a day, and in a week was free from every appearance of dropsy. The jaundice soon afterwards vanished, and tonics restored him to perfect health.

Case CIII.

_October_ 12th. Mr. B----, AEt. 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----, AEt. 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----, AEt. 88. The gentleman mentioned in No. XLVII. His complaints and manner of living the same as there mentioned. I ordered an Infusion of the Digitalis, a dram and half to half a pint; one ounce to be taken twice a day; which cured him in a short time.

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

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

Case CVI.

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

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

Case CVII.

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

1783.

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

Case CVIII.

_January_ 15th. Mrs. G----, AEt. 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----, AEt. 72. A thin woman, with very large anasarcous legs and thighs; no appetite and general debility. After a month's trial of cordials and diuretics of different kinds, the surgeon who had scarified her legs apprehended they would mortify; she had very great pain in them, they were very red and black by places, and extremely tense. It was evident that unless the tension could be removed, gangrene must soon ensue. I therefore gave her Infusum Digitalis, which increased the secretion of urine by the following evening, so that the great tension began to abate, and together with it the pain and inflammation. She was so feeble that I dared not to urge the medicine further, but she occasionally took it at intervals until the time of her death, which happened a few weeks afterwards.

Case CX.

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

Case CXI.

_May_ 25th. Mr. G----, AEt. 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----, AEt 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----, AEt. 6. With an universal anasarca, had an extremely troublesome cough. An opiate was given to quiet the cough at night, and 2 tea spoonfuls of Infus. Digit. were ordered every six hours. The dropsy was presently removed; but the cough continued, his flesh wasted, his strength failed, and some weeks afterwards he died tabid.

Case CXIV.

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

Case CXV.

_June_ 20th. Mrs. H----, AEt. 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----, AEt. 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 diarrhoea coming on, she died.

Case CXVII.

_July_ 22d. Mr. F----, AEt. 48. A strong man, of a florid complexion, in consequence of intemperance became dropsical, with symptoms of diseased viscera, great dyspnoea, 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 sodae; but it was inefficacious. His strength being much broken down, I then ordered gum ammoniac, with small doses of opium, and infusum amarum, continuing the squill at intervals. At length I was urged to give the Digitalis, and considering the case as desperate, I agreed to do it. The event was as I expected; no increase in the urine took place; and the medicine being still continued, his pulse became slow, and he apparently sunk under its sedative effects. He was neither purged nor vomited; and had the Digitalis either been omitted altogether, or suspended upon its first effects upon the pulse being observed, he might perhaps have existed a week longer.

Case CXVIII.

_July_ 26th. Mr. W----, of W----, AEt. 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----, AEt. 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 diarrhoea ensued upon every attempt to increase the frequency of the dose. Draughts with Infus. Digital. were then directed to be taken twice a day. The effect was a powerful action on the kidneys, and a reduction of the swellings, but without sickness. A degree of appetite returned, but still the tendency to diarrhoea 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----, AEt. 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 diarrhoea. Apprehensive that the more urgent symptoms were caused by water in the lungs, I directed an Infusion of Digitalis, with an ounce of diacodium to the half pint to prevent it purging, a wine glass full to be taken every night at bed-time, and a mixture with confect. cardiac. and pulv. ipecac. to be given in small doses after every loose stool.

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

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

Case CXXI.

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

Case CXXII.

_September_ 7th. Mr. L----, AEt. 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----, AEt. 54. A strong short woman of a florid complexion; complained of great fullness across the region of the stomach; short breath, a troublesome cough, loss of appetite, paucity of urine; and had a brownish yellow tinge on her skin and in her eyes. She dated these complaints from a fall she had through a trap door about the beginning of winter. From the beginning of January to this time, she had been repeatedly let blood, had taken calomel purges with jallap; pills of soap, rhubarb and calomel; saline julep with acet. scillit. nitrous decoction, garlic, mercury rubbed down, infus. amarum purg. &c. After the failure of medicines so powerful, and seemingly so well adapted, and during the use of which all the symptoms continued to increase, it was evident that a favourable event could not be expected. However, I tried the infusum Digitalis, but it did nothing. I then gave her pills of quicksilver, soap and squill, with decoction of dandelion, and after some time, chrystals of tartar with ginger. Nothing succeeded to our wishes, and the increase of orthopnoea 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----, AEt. 60. Had been subject to peripneumonic affections in the winter. She had now total loss of appetite, very great debility, difficult breathing; much cough, a considerable degree of expectoration, and a paucity of urine. She had been blooded, taken soap, assaf. and squill, afterwards assaf. and ammon. with acet. scillit.: but all her complaints increasing, a blister was applied to her back, and the Digitalis infusion directed to be taken every night. The effect was an increased secretion of urine, a considerable relief to her breath, and some return of appetite; but soon afterwards she became hectic, spat purulent matter, and died in a few weeks.

Case CXXV.

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

Case CXXVI.

_April_ 17th. Mr. F----, AEt. 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----, AEt. 8. After a long continued ague, became hectic and dropsical. Her belly was very large, and she had a total loss of appetite. Half a grain of fol. Digital, pulv. with 2 gr. of merc. alcalis. were ordered night and morning, and an infusion of bark and rhubarb with steel wine to be given in the day time. Her belly began to subside in a few days, and she was soon restored to health. Two other children in the family, affected nearly in the same way, had died, from the parents being persuaded that an ague in the spring was healthful and should not be stopped.--I know not how far the recovery in this case may be attributed to the Digitalis, but the child was so near dying that I dared not trust to any less efficacious diuretic.

Case CXXVIII.

_June_ 13th. Mr. C----, AEt. 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----, AEt. 54. A large man, of a pale complexion; had been subject to severe fits of asthma for some years, but now worse than usual. The intermitting pulse, the great disturbance from change of posture, and the swelled legs induced me to conclude that the exacerbation of his old complaint was occasioned by serous effusion. I directed pills with a grain and half of the pulv. Digital. to be taken every night, and as he was costive, jallap made a part of the composition. He was also directed to take mustardseed every morning and a solution of assafetida twice in the day. The effect of this plan was perfectly to our wishes, and in a short time he recovered his usual health. About half a year afterwards he died apoplectic.

Case CXXX.

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

Case CXXXI.

_July_ 12th. Mrs. A----, of C----, AEt. 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 aether twice a day, and to have scapulary issues. Her breath was so much relieved, that she was able soon afterwards to come down stairs; but her constitution was too much broken to admit of a recovery.

Case CXXXII.

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

Case CXXXIII.

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

Case CXXXIV.

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

Case CXXXV.

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

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

Case CXXXVII.

_August_ 10th. Mrs. W----, AEt. 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. cicutae 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----, AEt. 78. About the middle of Summer began to complain of short breath, great debility, and loss of appetite. At this time there were evident marks of effusion in the thorax, and some swelling in the legs. The advanced age, the weakness, and other circumstances of this patient, precluded every idea of her recovery; but something was to be attempted. Squills and other remedies had been tried; I therefore directed pills with two or three grains of the pulv. Digitalis to be taken every night for six nights, and a saline draught with forty drops of acetum scillit. twice in the day. She took but few of the draughts, seldom more than half one at a time, for they purged her, and she disliked them. The pills she took regularly, and with the happiest effect, for she could lie down, her breath was very much relieved, and a degree of appetite returned. _Sept._ 4th, some return of her symptoms demanded the further use of diuretics. I was afraid to push the Digitalis in so hazardous a subject, and therefore directed tinct. amara with tinct. canthar. and pills of squill, seneka, salt of tartar and gum ammoniac. These medicines did not at all check the progress of the disease, and on the 26th it became necessary to give the Digitalis again. The pills were therefore repeated as before, and infus. amarum with fixed alkaly ordered to be taken twice a day. The event was as favorable as before; and from this time she had no considerable return of dropsy, but languished under various nameless symptoms, until the middle or end of November.

Case CXXXIX.

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

Case CXL.

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

Case CXLI.

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

Case CXLII.

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

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

Case CXLIII.

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

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

Case CXLIV.

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

Case CXLV.

_Nov._ 2d. Miss B---- of C----, AEt. 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----, AEt. 40. Subject to troublesome nephritic complaints, and after the last attack did not recover, or void the gravelly concretions as usual, a sense of weight across his loins continuing very troublesome. The usual medicines failing to relieve him, I ordered four grains of pulv. Digital. to be taken every other night for a week, and fifteen grains of mild fixed vegetable alkaly to be swallowed twice a day in barley water. He soon lost all his complaints; but we must not in this case too hastily attribute the cure to the Digitalis, as the alkaly has also been found a very useful medicine in similar disorders.

Case CXLVII.

_Nov._ 4th. Mr. B---- of N----, AEt. 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----, AEt. 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----, AEt. 68. One of those rare cases in which no urine is secreted. It proved as refractory as usual to remedies, and not having ever succeeded in the cure of this disease, I determined to try the Digitalis. It was given in infusion, and, after a few doses, the secretion of a small quantity of urine seemed to justify the attempt. The next day, however, the secretion ceased, nor could it be excited again, tho' at last the medicine was pushed so as to occasion sickness, which continued at intervals for three days.

Case CL.

_Nov._ 20th. Mrs. B----, AEt. 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----, AEt. 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----, AEt. 65. I had attended this lady last winter in a very severe peripneumony, from which she narrowly escaped with her life. When the cold season advanced this winter, she perceived a difficulty in breathing, which gradually became more and more troublesome. I found her much harassed by a cough, which occasioned her to expectorate a little: the least motion increased her dyspnoea; 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----, AEt. 42. A large sat man, very subject to gravelly complaints. After an attack in the usual manner, continued to feel numbness in his lower limbs, and a sense of weight across his loins. I directed infusum Digitalis to be given every six hours. Six ounces made him sick, and he took no more. The next day his urine increased, a good deal of sand passed with it, and he lost his disagreeable feels, but the sickness did not entirely cease before the fourth day from its commencement.

Case CLIV.

_December_ 27th. Mr. B----, of H----, AEt. 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----, AEt. 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. Aft