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+The Project Gutenberg EBook of An Account of the Foxglove and some of its
+Medical Uses, by William Withering
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: An Account of the Foxglove and some of its Medical Uses
+       With Practical Remarks on Dropsy and Other Diseases
+
+Author: William Withering
+
+Release Date: March 21, 2008 [EBook #24886]
+
+Language: English
+
+Character set encoding: UTF-8
+
+*** START OF THIS PROJECT GUTENBERG EBOOK AN ACCOUNT OF THE FOXGLOVE ***
+
+
+
+
+Produced by David Starner, Irma Spehar and the Online
+Distributed Proofreading Team at http://www.pgdp.net
+
+
+
+
+
+                                  AN
+                                ACCOUNT
+                                OF THE
+                               FOXGLOVE,
+                                  AND
+                       Some of its Medical Uses:
+                                 WITH
+           PRACTICAL REMARKS ON DROPSY, AND OTHER DISEASES.
+
+                                  BY
+
+                       WILLIAM WITHERING, M. D.
+
+           Physician to the General Hospital at Birmingham.
+
+
+                  _---- nonumque prematur in annum._
+
+                                                HORACE.
+
+
+                  BIRMINGHAM: PRINTED BY M. SWINNEY;
+                                  FOR
+          G. G. J. AND J. ROBINSON, PATERNOSTER-ROW, LONDON.
+                             M,DCC,LXXXV.
+
+
+
+
+                               PREFACE.
+
+
+After being frequently urged to write upon this subject, and as often
+declining to do it, from apprehension of my own inability, I am at
+length compelled to take up the pen, however unqualified I may still
+feel myself for the task.
+
+The use of the Foxglove is getting abroad, and it is better the world
+should derive some instruction, however imperfect, from my experience,
+than that the lives of men should be hazarded by its unguarded
+exhibition, or that a medicine of so much efficacy should be condemned
+and rejected as dangerous and unmanageable.
+
+It is now about ten years since I first began to use this medicine.
+Experience and cautious attention gradually taught me how to use it.
+For the last two years I have not had occasion to alter the modes of
+management; but I am still far from thinking them perfect.
+
+It would have been an easy task to have given select cases, whose
+successful treatment would have spoken strongly in favour of the
+medicine, and perhaps been flattering to my own reputation. But Truth
+and Science would condemn the procedure. I have therefore mentioned
+every case in which I have prescribed the Foxglove, proper or
+improper, successful or otherwise. Such a conduct will lay me open to
+the censure of those who are disposed to censure, but it will meet the
+approbation of others, who are the best qualified to be judges.
+
+To the Surgeons and Apothecaries, with whom I am connected in
+practice, both in this town and at a distance, I beg leave to make
+this public acknowledgment, for the assistance they so readily
+afforded me, in perfecting some of the cases, and in communicating the
+events of others.
+
+The ages of the patients are not always exact, nor would the labour of
+making them so have been repaid by any useful consequences. In a few
+instances accuracy in that respect was necessary, and there it has
+been attempted; but in general, an approximation towards the truth,
+was supposed to be sufficient.
+
+The cases related from my own experience, are generally written in the
+shortest form I could contrive, in order to save time and labour. Some
+of them are given more in detail, when particular circumstances made
+such detail necessary; but the cases communicated by other
+practitioners, are given in their own words.
+
+I must caution the reader, who is not a practitioner in physic, that
+no general deductions, decisive upon the failure or success of the
+medicine, can be drawn from the cases I now present to him. These
+cases must be considered as the most hopeless and deplorable that
+exist; for physicians are seldom consulted in chronic diseases, till
+the usual remedies have failed: and, indeed, for some years, whilst I
+was less expert in the management of the Digitalis, I seldom
+prescribed it, but when the failure of every other method compelled me
+to do it; so that upon the whole, the instances I am going to adduce,
+may truly be considered as cases lost to the common run of practice,
+and only snatched from destruction, by the efficacy of the Digitalis;
+and this in so remarkable a manner, that, if the properties of that
+plant had not been discovered, by far the greatest part of these
+patients must have died.
+
+There are men who will hardly admit of any thing which an author
+advances in support of a favorite medicine, and I allow they may have
+some cause for their hesitation; nor do I expect they will wave their
+usual modes of judging upon the present occasion. I could wish
+therefore that such readers would pass over what I have said, and
+attend only to the communications from correspondents, because they
+cannot be supposed to possess any unjust predilection in favour of the
+medicine: but I cannot advise them to this step, for I am certain they
+would then close the book, with much higher notions of the efficacy of
+the plant than what they would have learnt from me. Not that I want
+faith in the discernment or in the veracity of my correspondents, for
+they are men of established reputation; but the cases they have sent
+me are, with some exceptions, too much selected. They are not upon
+this account less valuable in themselves, but they are not the proper
+premises from which to draw permanent conclusions.
+
+I wish the reader to keep in view, that it is not my intention merely
+to introduce a new diuretic to his acquaintance, but one which, though
+not infallible, I believe to be much more certain than any other in
+present use.
+
+After all, in spite of opinion, prejudice, or error, TIME will fix the
+real value upon this discovery, and determine whether I have imposed
+upon myself and others, or contributed to the benefit of science and
+mankind.
+
+     _Birmingham, 1st July,_ 1785.
+
+
+
+
+                             INTRODUCTION.
+
+
+The Foxglove is a plant sufficiently common in this island, and as we
+have but one species, and that so generally known, I should have
+thought it superfluous either to figure or describe it; had I not more
+than once seen the leaves of Mullein[1] gathered for those of
+Foxglove. On the continent of Europe too, other species are found, and
+I have been informed that our species is very rare in some parts of
+Germany, existing only by means of cultivation, in gardens.
+
+    [Footnote 1: Verbascum of Linnæus.]
+
+Our plant is the _Digitalis purpurea_[2] of Linnæus. It belongs to the
+2d order of the 14th class, or the DIDYNAMIA ANGIOSPERMIA. The
+_essential characters_ of the genus are, _Cup with 5 divisions.
+Blossom bell-shaped, bulging. Capsule egg-shaped, 2-celled._--LINN.
+
+    [Footnote 2: The trivial name _purpurea_ is not a very happy
+    one, for the blossoms though generally purple, are sometimes
+    of a pure white.]
+
+DIGITA'LIS _purpu'rea_. Little leaves of the empalement egg-shaped,
+sharp. Blossoms blunt; the upper lip entire. LINN.
+
+REFERENCES TO FIGURES. These are disposed in the order of comparative
+excellence.
+
+    _Rivini monopet. 104.
+    Flora danica, 74, parts of fructification.
+    Tournefort Institutiones. 73, A, E, L, M.
+    Fuchsii Hist. Plant. 893, copied in
+    Tragi stirp. histor. 889.
+    J. Bauhini histor. Vol. ii. 812. 3, and
+    Lonicera 74, 1.
+    Blackwell. auct. 16.
+    Dodonœi pempt. stirp. hist. 169, reprinted in
+    Gerard emacul. 790, 1, and copied in
+    Parkinson Theatr. botanic. 653, 1.
+    Gerard, first edition, 646, 1.
+    Histor. Oxon. Morison. V. 8, row 1. 1.
+    Flor. danic. 74, the reduced figure._
+
+_Blossom._ The bellying part on the inside sprinkled with spots like
+little eyes. _Leaves_ wrinkled. LINN.
+
+BLOSSOM. Rather tubular than bell-shaped, bulging on the under side,
+purple; the narrow tubular part at the base, white. _Upper lip_
+sometimes slightly cloven.
+
+CHIVES. _Threads_ crooked, white. _Tips_ yellow.
+
+POINTAL. _Seed-bud_ greenish. _Honey-cup_ at its base more yellow.
+_Summit_ cloven.
+
+S. VESS. _Capsule_ not quite so long as the cup.
+
+ROOT. Knotty and fibrous.
+
+STEM. About 4 feet high; obscurely angular; leafy.
+
+LEAVES. Slightly but irregularly serrated, wrinkled; dark green above,
+paler underneath. _Lower leaves_ egg-shaped; upper leaves
+spear-shaped. _Leaf-stalks_ fleshy; bordered.
+
+FLOWERS. Numerous, mostly growing from one side of the stem and
+hanging down one over another. _Floral-leaves_ sitting, taper-pointed.
+The numerous purple blossoms hanging down, mottled within; as wide and
+nearly half as long as the finger of a common-sized glove, are
+sufficient marks whereby the most ignorant may distinguish this from
+every other British plant; and the leaves ought not to be gathered for
+use but when the plant is in blossom.
+
+PLACE. Dry, gravelly or sandy soils; particularly on sloping ground.
+It is a biennial, and flowers from the middle of _June_ to the end of
+_July_.
+
+I have not observed that any of our cattle eat it. The root, the stem,
+the leaves, and the flowers have a bitter herbaceous taste, but I
+don't perceive that nauseous bitter which has been attributed to it.
+
+       *       *       *       *       *
+
+This plant ranks amongst the LURIDÆ, one of the Linnæan orders in a
+natural system. It has for congenera, NICOTIANA, ATROPA, HYOSCYAMUS,
+DATURA, SOLANUM, &c. so that from the knowledge we possess of the
+virtues of those plants, and reasoning from botanical analogy, we
+might be led to guess at something of its properties.
+
+I intended in this place to have traced the history of its effects in
+diseases from the time of Fuchsius, who first describes it, but I have
+been anticipated in this intention by my very valuable friend, Dr.
+Stokes of Stourbridge, who has lately sent me the following
+
+
+            HISTORICAL VIEW of the Properties of Digitalis.
+
+FUCHSIUS in his _hist. stirp._ 1542, is the first author who notices
+it. From him it receives its name of DIGITALIS, in allusion to the
+German name of _Fingerhut_, which signifies a finger-stall, from the
+blossoms resembling the finger of a glove.
+
+SENSIBLE QUALITIES. Leaves bitterish, very nauseous. LEWIS _Mat. med._
+i. 342.
+
+SENSIBLE EFFECTS. Some persons, soon after eating of a kind of
+omalade, into which the leaves of this, with those of several other
+plants, had entered as an ingredient, found themselves much
+indisposed, and were presently after attacked with vomitings. DODONÆUS
+_pempt._ 170.
+
+It is a medicine which is proper only for strong constitutions, as it
+purges very violently, and excites excessive vomitings. RAY. _hist._
+767.
+
+BOERHAAVE judges it to be of a poisonous nature, _hist. plant._ but
+DR. ALSTON ranks it among those indigenous vegetables, “which, though
+now disregarded, are medicines of great virtue, and scarcely inferior
+to any that the Indies afford.” LEWIS _Mat. med._ i. _p._ 343.
+
+Six or seven spoonfuls of the decoction produce nausea and vomiting,
+and purge; not without some marks of a deleterious quality. HALLER
+_hist. n._ 330 from _Aerial Infl. p._ 49, 50.
+
+
+                 The following is an abridged ACCOUNT
+                     of its EFFECTS upon TURKEYS.
+
+M. SALERNE, a physician at Orleans, having heard that several turkey
+pouts had been killed by being fed with Foxglove leaves, instead of
+mullein, he gave some of the same leaves to a large vigorous turkey.
+The bird was so much affected that he could not stand upon his legs,
+he appeared drunk, and his excrements became reddish. Good nourishment
+restored him to health in eight days.
+
+Being then determined to push the experiment further, he chopped some
+more leaves, mixed them with bran, and gave them to a vigorous turkey
+cock which weighed seven pounds. This bird soon appeared drooping and
+melancholy; his feathers stared, his neck became pale and retracted.
+The leaves were given him for four days, during which time he took
+about half a handful. These leaves had been gathered about eight days,
+and the winter was far advanced. The excrements, which are naturally
+green and well formed, became, from the first, liquid and reddish,
+like those of a dysenteric patient.
+
+The animal refusing to eat any more of this mixture which had done him
+so much mischief, I was obliged to feed him with bran and water only;
+but notwithstanding this, he continued drooping, and without appetite.
+At times he was seized with convulsions, so strong as to throw him
+down; in the intervals he walked as if drunk; he did not attempt to
+perch, he uttered plaintive cries. At length he refused all
+nourishment. On the fifth or sixth day the excrements became as white
+as chalk; afterwards yellow, greenish, and black. On the eighteenth
+day he died, greatly reduced in flesh, for he now weighed only three
+pounds.
+
+On opening him we found the heart, the lungs, the liver, and
+gall-bladder shrunk and dried up; the stomach was quite empty, but not
+deprived of its villous coat. _Hist. de l'Academ._ 1748. _p._ 84.
+
+EPILEPSY.--“It hath beene of later experience found also to be
+effectual against the falling sicknesse, that divers have been cured
+thereby; for after the taking of the _Decoct. manipulor. ii. c.
+polypod. quercin. contus. ℥iv. in cerevisia_, they that
+have been troubled with it twenty-six years, and have fallen once in a
+weeke, or two or three times in a moneth, have not fallen once in
+fourteen or fifteen moneths, that is until the writing hereof.”
+
+                                        _Parkinson_, _p._ 654.
+
+SCROPHULA.--“The herb bruised, or the juice made up into an ointment,
+and applied to the place, hath been found by late experience to be
+availeable for the King's Evill.” PARK. p. 654.
+
+Several hereditary instances of this disease said to have been cured
+by it. AEREAL INFLUENCES, _p._ 49, 50, quoted by HALLER, _hist. n._
+330.
+
+A man with _scrophulous ulcers_ in various parts of the body, and
+which in the right leg were so virulent that its amputation was
+proposed, cured by _succ. express. cochl. i. bis intra xiv. dies, in
+½ pintæ cerevisiæ calidæ_.
+
+The leaves remaining after the pressing out of the juice, were applied
+every day to the ulcers. _Pract. ess. p._ 40. quoted by MURRAY
+_apparat. medicam. i. p._ 491.
+
+A young woman with a _scrophulous tumour of the eye_, a remarkable
+_swelling of the upper lip, and painful tumours of the joints of the
+fingers_, much relieved; but the medicine was left off, on account of
+its violent effects on the constitution. _Ib. p._ 42 quoted as above.
+
+A man with _scrophulous tumour of the right elbow_, attended for three
+years _with excruciating pains_, was nearly cured by four doses of the
+juice taken once a month. _Ib. p._ 43. as above.
+
+The physicians and surgeons of the Worcester Infirmary have employed
+it in ointments and poultices with remarkable efficacy. _Ib. p._ 44.
+It was recommended to them by Dr. Baylies of Evesham, now of Berlin,
+as a remedy for this disease. Dr. Wall gave it a tryal, as well
+externally as internally, but their experiments did not lead them to
+observe any other properties in it, than those of a highly nauseating
+medicine and drastic purgative.
+
+WOUNDS. In considerable estimation for the healing all kinds of
+wounds, _Lobel. adv._ 245.
+
+Principally of use in ulcers, which discharge considerably, being of
+little advantage in such as are dry. HULSE, in R. hist. 768.
+
+DOCTOR BAYLIES, physician to his Prussian Majesty, informed me, when
+at Berlin, that he employed it with great success in caries, and
+obstinate sore legs.
+
+DYSPNŒA _Pituitosa_ Sauvages i. 657.--“Boiled in water, or wine,
+and drunken doth cut and consume the thicke toughnesse of grosse, and
+slimie flegme, and naughtie humours. The same, or boiled with honied
+water or sugar, doth scoure and clense the brest, ripeneth and
+bringeth foorth tough and clammie flegme. It openeth also the stoppage
+of the liver spleene and milt, and of the inwarde parts.” GERARDE
+hist. ed. I p. 647.
+
+“Whensoever there is need of a rarefying or extenuating of tough
+flegme or viscous humours troubling the chest,--the decoction or juice
+hereof made up with sugar or honey is availeable, as also to clense
+and purge the body both upwards and downwards sometimes, of tough
+flegme, and clammy humours, notwithstanding that these qualities are
+found to bee in it, there are but few physitions in our times that put
+it to these uses, but it is in a manner wholly neglected.”
+
+                                                 PARKINSON, p. 654.
+
+Previous to the year 1777, you informed me of the great success you
+had met with in curing dropsies by means of the fol. Digitalis, which
+you then considered as a more certain diuretic than any you had ever
+tried. Some time afterwards, Mr. Russel, surgeon, of Worcester, having
+heard of the success which had attended some cases in which you had
+given it, requested me to obtain for him any information you might be
+inclined to communicate respecting its use. In consequence of this
+application, you wrote to me in the following terms.[3]
+
+    [Footnote 3: See the extract from this letter at page 5.]
+
+In a letter which I received from you in London, dated _September_ 29,
+1778, you write as follows:--“I wish it was as easy to write upon the
+Digitalis--I despair of pleasing myself or instructing others, in a
+subject so difficult. It is much easier to write upon a disease than
+upon a remedy. The former is in the hands of nature, and a faithful
+observer, with an eye of tolerable judgment, cannot fail to delineate
+a likeness. The latter will ever be subject to the whims, the
+inaccuracies, and the blunders of mankind.”--
+
+In my notes I find the following memorandum--“_February_ 20th, 1779,
+gave an account of Doctor Withering's practice, with the precautions
+necessary to its success, to the Medical Society at Edinburgh.”--In
+the course of that year, the Digitalis was prescribed in the Edinburgh
+Infirmary, by Dr. Hope, and in the following year, whilst I was Clerk
+to Dr. Home, as Clinical Professor, I had a favourable opportunity of
+observing its sensible effects.
+
+In one case in which it was given properly at first, the urine began
+to flow freely on the second day. On the third, the swellings began to
+subside. The dose was then increased more than _quadruple_ in the
+twenty-four hours. On the fifth day sickness came on, and much
+purging, but the urine still increased though the pulse sunk to 50. On
+the 7th day, a _quadruple_ dose of the infusion was ordered to be
+taken every third hour, so as to bring on nausea again. The pulse fell
+to forty-four, and at length to thirty-five in a minute. The patient
+gradually sunk and died on the sixteenth day; but previous to her
+death, for two or three days, her pulse rose to near one hundred.--It
+is needless to observe to you, how widely the treatment of this case
+differed from the method which you have found so successful.
+
+
+
+
+                             OF THE PLATE.
+
+
+The figure of the Foxglove, facing the Title Page, is copied by the
+permission and under the inspection of Mr. Curtis, from his admirable
+work, entitled FLORA LONDINENSIS. The accuracy of the drawings, the
+beauty of the colouring, the full descriptions, the accurate specific
+distinctions, and the uses of the different plants, cannot fail to
+recommend that work to the patronage of all who are interested in the
+encouragement of genius, or the promotion of useful knowledge.
+
+       *       *       *       *       *
+
+                             EXPLANATION.
+
+     Fig. 1. The Empalement.
+
+     Fig. 2, 3, 4. Four CHIVES two long and two short. TIPS at
+     first large, turgid, oval, touching at bottom, of a
+     yellowish colour, and often spotted; lastly changing both
+     their form and situation in a singular manner.
+
+     Fig. 5, 6, 7. SEED-BUD rather conical, of a yellow green
+     colour. _Shaft_ simple. _Summit_ cloven.
+
+     Fig. 8. _Honey-cup_ a gland, surrounding the bottom of the
+     Seed-bud.
+
+     Fig. 9. SEED-VESSEL, a pointed oval _Capsule_, of two cells
+     and two valves, the lowermost valve splitting in two.
+
+     Fig. 10. SEEDS numerous, blackish, small, lopped at each
+     end.
+
+
+
+
+   AN ACCOUNT OF THE INTRODUCTION of FOXGLOVE INTO MODERN PRACTICE.
+
+
+As the more obvious and sensible properties of plants, such as colour,
+taste, and smell, have but little connexion with the diseases they are
+adapted to cure; so their peculiar qualities have no certain
+dependence upon their external configuration. Their chemical
+examination by fire, after an immense waste of time and labour, having
+been found useless, is now abandoned by general consent. Possibly
+other modes of analysis will be found out, which may turn to better
+account; but we have hitherto made only a very small progress in the
+chemistry of animal and vegetable substances. Their virtues must
+therefore be learnt, either from observing their effects upon insects
+and quadrupeds; from analogy, deduced from the already known powers of
+some of their congenera, or from the empirical usages and experience
+of the populace.
+
+The first method has not yet been much attended to; and the second can
+only be perfected in proportion as we approach towards the discovery
+of a truly natural system; but the last, as far as it extends, lies
+within the reach of every one who is open to information, regardless
+of the source from whence it springs.
+
+It was a circumstance of this kind which first fixed my attention on
+the Foxglove.
+
+In the year 1775, my opinion was asked concerning a family receipt for
+the cure of the dropsy. I was told that it had long been kept a secret
+by an old woman in Shropshire, who had sometimes made cures after the
+more regular practitioners had failed. I was informed also, that the
+effects produced were violent vomiting and purging; for the diuretic
+effects seemed to have been overlooked. This medicine was composed of
+twenty or more different herbs; but it was not very difficult for one
+conversant in these subjects, to perceive, that the active herb could
+be no other than the Foxglove.
+
+My worthy predecessor in this place, the very humane and ingenious Dr.
+Small, had made it a practice to give his advice to the poor during
+one hour in a day. This practice, which I continued until we had an
+Hospital opened for the reception of the sick poor, gave me an
+opportunity of putting my ideas into execution in a variety of cases;
+for the number of poor who thus applied for advice, amounted to
+between two and three thousand annually. I soon found the Foxglove to
+be a very powerful diuretic; but then, and for a considerable time
+afterwards, I gave it in doses very much too large, and urged its
+continuance too long; for misled by reasoning from the effects of the
+squill, which generally acts best upon the kidneys when it excites
+nausea, I wished to produce the same effect by the Foxglove. In this
+mode of prescribing, when I had so many patients to attend to in the
+space of one, or at most of two hours, it will not be expected that I
+could be very particular, much less could I take notes of all the
+cases which occurred. Two or three of them only, in which the medicine
+succeeded, I find mentioned amongst my papers. It was from this kind
+of experience that I ventured to assert, in the Botanical Arrangement
+published in the course of the following spring, that the Digitalis
+purpurea “merited more attention than modern practice bestowed upon
+it.”
+
+I had not, however, yet introduced it into the more regular mode of
+prescription; but a circumstance happened which accelerated that
+event. My truly valuable and respectable friend, Dr. Ash, informed me
+that Dr. Cawley, then principal of Brazen Nose College, Oxford, had
+been cured of a Hydrops Pectoris, by an empirical exhibition of the
+root of the Foxglove, after some of the first physicians of the age
+had declared they could do no more for him. I was now determined to
+pursue my former ideas more vigorously than before, but was too well
+aware of the uncertainty which must attend on the exhibition of the
+_root_ of a _biennial_ plant, and therefore continued to use the
+_leaves_. These I had found to vary much as to dose, at different
+seasons of the year; but I expected, if gathered always in one
+condition of the plant, viz. when it was in its flowering state, and
+carefully dried, that the dose might be ascertained as exactly as that
+of any other medicine; nor have I been disappointed in this
+expectation. The more I saw of the great powers of this plant, the
+more it seemed necessary to bring the doses of it to the greatest
+possible accuracy. I suspected that this degree of accuracy was not
+reconcileable with the use of a _decoction_, as it depended not only
+upon the care of those who had the preparation of it, but it was easy
+to conceive from the analogy of another plant of the same natural
+order, the tobacco, that its active properties might be impaired by
+long boiling. The decoction was therefore discarded, and the
+_infusion_ substituted in its place. After this I began to use the
+leaves in _powder_, but I still very often prescribe the infusion.
+
+Further experience convinced me, that the _diuretic_ effects of this
+medicine do not at all depend upon its exciting a nausea or vomiting;
+but, on the contrary, that though the increased secretion of urine
+will frequently succeed to, or exist along with these circumstances,
+yet they are so far from being friendly or necessary, that I have
+often known the discharge of urine checked, when the doses have been
+imprudently urged so as to occasion sickness.
+
+If the medicine purges, it is almost certain to fail in its desired
+effect; but this having been the case, I have seen it afterwards
+succeed when joined with small doses of opium, so as to restrain its
+action on the bowels.
+
+In the summer of the year 1776, I ordered a quantity of the leaves to
+be dried, and as it then became possible to ascertain its doses, it
+was gradually adopted by the medical practitioners in the circle of my
+acquaintance.
+
+In the month of _November_ 1777, in consequence of an application from
+that very celebrated surgeon, Mr. Russel, of Worcester, I sent him the
+following account, which I choose to introduce here, as shewing the
+ideas I then entertained of the medicine, and how much I was mistaken
+as to its real dose.--“I generally order it in decoction. Three drams
+of the dried leaves, collected at the time of the blossoms expanding,
+boiled in twelve to eight ounces of water. Two spoonfuls of this
+medicine, given every two hours, will sooner or later excite a nausea.
+I have sometimes used the green leaves gathered in winter, but then I
+order three times the weight; and in one instance I used three ounces
+to a pint decoction, before the desired effect took place. I consider
+the Foxglove thus given, as the most certain diuretic I know, nor do
+its diuretic effects depend merely upon the nausea it produces, for in
+cases where squill and ipecac. have been so given as to keep up a
+nausea several days together, and the flow of urine not taken place, I
+have found the Foxglove to succeed; and I have, in more than one
+instance, given the Foxglove in smaller and more distant doses, so
+that the flow of urine has taken place without any sensible affection
+of the stomach; but in general I give it in the manner first
+mentioned, and order one dose to be taken after the sickness
+commences. I then omit all medicines, except those of the cordial kind
+are wanted, during the space of three, four, or five days. By this
+time the nausea abates, and the appetite becomes better than it was
+before. Sometimes the brain is considerably affected by the medicine,
+and indistinct vision ensues; but I have never yet found any permanent
+bad effects from it.”--
+
+“I use it in the Ascites, Anasarca, and Hydrops Pectoris; and so far
+as the removal of the water will contribute to cure the patient, so
+far may be expected from this medicine: but I wish it not to be tried
+in ascites of female patients, believing that many of these cases are
+dropsies of the ovaria; and no sensible man will ever expect to see
+these encysted fluids removed by any medicine.”
+
+“I have often been obliged to evacuate the water repeatedly in the
+same patient, by repeating the decoction; but then this has been at
+such distances of time as to allow of the interference of other
+medicines and a proper regimen, so that the patient obtains in the end
+a perfect cure. In these cases the decoction becomes at length so very
+disagreeable, that a much smaller quantity will produce the effect,
+and I often find it necessary to alter its taste by the addition of
+Aq. Cinnam. sp. or Aq. Juniper. composita.”
+
+“I allow, and indeed enjoin my patients to drink very plentifully of
+small liquors through the whole course of the cure; and sometimes,
+where the evacuations have been very sudden, I have found a bandage as
+necessary as in the use of the trochar.”--
+
+Early in the year 1779, a number of dropsical cases offered themselves
+to my attention, the consequences of the scarlet fever and sore throat
+which had raged so very generally amongst us in the preceding year.
+Some of these had been cured by squills or other diuretics, and
+relapsed; in others, the dropsy did not appear for several weeks after
+the original disease had ceased: but I am not able to mention many
+particulars, having omitted to make notes. This, however, is the less
+to be regretted, as the symptoms in all were very much alike, and they
+were all without an exception cured by the Foxglove.
+
+This last circumstance encouraged me to use the medicine more
+frequently than I had done heretofore, and the increase of practice
+had taught me to improve the management of it.
+
+In _February_ 1779, my friend, Dr. Stokes, communicated to the Medical
+Society at Edinburgh the result of my experience of the Foxglove; and,
+in a letter addressed to me in _November_ following, he says, “Dr.
+Hope, in consequence of my mentioning its use to my friend, Dr.
+Broughton, has tried the Foxglove in the Infirmary with success.” Dr.
+Stokes also tells me that Dr. Hamilton cured Dropsies with it in the
+year 1781.
+
+I am informed by my very worthy friend Dr. Duncan, that Dr. Hamilton,
+who learnt its use from Dr. Hope, has employed it very frequently in
+the Hospital at Edinburgh. Dr. Duncan also tells me, that the late
+very ingenious and accomplished Mr. Charles Darwin, informed him of
+its being used by his father and myself, in cases of Hydrothorax, and
+that he has ever since mentioned it in his lectures, and sometimes
+employed it in his practice.
+
+At length, in the year 1783, it appeared in the new edition of the
+Edinburgh Pharmacopœia, into which, I am told, it was received in
+consequence of the recommendation of Dr. Hope. But from which, I am
+satisfied, it will be again very soon rejected, if it should continue
+to be exhibited in the unrestrained manner in which it has heretofore
+been used at Edinburgh, and in the enormous doses in which it is now
+directed in London.
+
+In the following cases the reader will find other diseases besides
+dropsies; particularly several cases of consumption. I was induced to
+try it in these, from being told, that it was much used in the West of
+England, in the Phthisis Pulmonalis, by the common people. In this
+disease, however, in my hands, it has done but little service, and yet
+I am disposed to wish it a further trial, for in a copy of Parkinson's
+Herbal, which I saw about two years ago, I found the following
+manuscript note at the article Digitalis, written, I believe, by a Mr.
+Saunders, who practised for many years with great reputation as a
+surgeon and apothecary at Stourbridge, in Worcestershire.
+
+“Consumptions are cured infallibly by weak decoction of Foxglove
+leaves in water, or wine and water, and drank for constant drink. Or
+take of the juice of the herb and flowers, clarify it, and make a fine
+syrup with honey, of which take three spoonfuls thrice in a day, at
+physical hours. The use of these two things of late has done, in
+consumptive cases, great wonders. But be cautious of its use, for it
+is of a vomiting nature. In these things begin sparingly, and increase
+the dose as the patient's strength will bear, least, instead of a
+sovereign medicine, you do real damage by this infusion or syrup.”
+
+The precautions annexed to his encomiums of this medicine, lead one to
+think that he has spoken from his own proper experience.
+
+I have lately been told, that a person in the neighbourhood of
+Warwick, possesses a famous family receipt for the dropsy, in which
+the Foxglove is the active medicine; and a lady from the western part
+of Yorkshire assures me, that the people in her country often cure
+themselves of dropsical complaints by drinking Foxglove tea. In
+confirmation of this, I recollect about two years ago being desired to
+visit a travelling Yorkshire tradesman. I found him incessantly
+vomiting, his vision indistinct, his pulse forty in a minute. Upon
+enquiry it came out, that his wife had stewed a large handful of green
+Foxglove leaves in half a pint of water, and given him the liquor,
+which he drank at one draught, in order to cure him of an asthmatic
+affection. This good woman knew the medicine of her country, but not
+the dose of it, for her husband narrowly escaped with his life.
+
+It is probable that this rude mode of exhibiting the Foxglove has been
+more general than I am at present aware of; but it is wonderful that
+no author seems to have been acquainted with its effects as a
+diuretic.
+
+
+
+
+                                CASES,
+
+                In which the Digitalis was given by the
+                       Direction of the Author.
+
+
+                                 1775.
+
+It was in the course of this year that I began to use the Digitalis in
+dropsical cases. The patients were such as applied at my house for
+advice gratis. I cannot pretend to charge my memory with particular
+cases, or particular effects, and I had not leisure to make notes.
+Upon the whole, however, it may be concluded, that the medicine was
+found useful, or I should not have continued to employ it.
+
+
+                                CASE I.
+
+_December_ 8th. A man about fifty years of age, who had formerly been
+a builder, but was now much reduced in his circumstances, complained
+to me of an asthma which first attacked him about the latter end of
+autumn. His breath was very short, his countenance was sunken, his
+belly large; and, upon examination, a fluctuation in it was very
+perceptible. His urine for some time past had been small in quantity.
+I directed a decoction of Fol. Digital. recent. which made him very
+sick, the sickness recurring at intervals for several days, during
+which time he made a large quantity of water. His breath gradually
+drew easier, his belly subsided, and in about ten days he began to
+eat with a keen appetite. He afterwards took steel and bitters.
+
+
+                                 1776.
+
+                               CASE II.
+
+_January_ 14th. A poor man labouring under an ascites and anasarca,
+was directed to take a decoction of Digitalis every four hours. It
+purged him smartly, but did not relieve him. An opiate was now ordered
+with each dose of the medicine, which then acted upon the kidneys very
+freely, and he soon lost all his complaints.
+
+
+                               CASE III.
+
+_March_ 15th. A poor boy, about nine years of age, was brought for my
+advice. His countenance was pale, his pulse quick and feeble, his body
+greatly emaciated, except his belly, which was very large, and, upon
+examination, contained a fluid. The case had been considered as
+arising from worms. He was directed to take the decoction of Digitalis
+night and morning. It operated as a diuretic, never made him sick, and
+he got well without any other medicine.
+
+
+                               CASE IV.
+
+_July_ 25th. Mrs. H----, of A----, near N----, between forty and fifty
+years of age, a few weeks ago, after some previous indisposition, was
+attacked by a severe cold shivering fit, succeeded by fever; great
+pain in her left side, shortness of breath, perpetual cough, and,
+after some days, copious expectoration. On the 4th of _June_, Dr.
+Darwin,[4] was called to her. I have not heard what was then done for
+her, but, between the 15th of _June_, and 25th of _July_, the Doctor,
+at his different visits, gave her various medicines of the
+deobstruent, tonic, antispasmodic, diuretic, and evacuant kinds.
+
+    [Footnote 4: Then resident at Lichfield, now at Derby.]
+
+On the 25th of _July_ I was desired to meet Dr. Darwin at the lady's
+house. I found her nearly in a state of suffocation; her pulse
+extremely weak and irregular, her breath very short and laborious, her
+countenance sunk, her arms of a leaden colour, clammy and cold. She
+could not lye down in bed, and had neither strength nor appetite, but
+was extremely thirsty. Her stomach, legs, and thighs were greatly
+swollen; her urine very small in quantity, not more than a spoonful at
+a time, and that very seldom. It had been proposed to scarify her
+legs, but the proposition was not acceded to.
+
+She had experienced no relief from any means that had been used,
+except from ipecacoanha vomits; the dose of which had been gradually
+increased from 15 to 40 grains, but such was the insensible state of
+her stomach for the last few days, that even those very large doses
+failed to make her sick, and consequently purged her. In this
+situation of things I knew of nothing likely to avail us, except the
+Digitalis: but this I hesitated to propose, from an apprehension that
+little could be expected from any thing; that an unfavourable
+termination would tend to discredit a medicine which promised to be
+of great benefit to mankind, and I might be censured for a
+prescription which could not be countenanced by the experience of any
+other regular practitioner. But these considerations soon gave way to
+the desire of preserving the life of this valuable woman, and
+accordingly I proposed the Digitalis to be tried; adding, that I
+sometimes had found it to succeed when other, even the most judicious
+methods, had failed. Dr. Darwin very politely, acceded immediately to
+my proposition, and, as he had never seen it given, left the
+preparation and the dose to my direction. We therefore prescribed as
+follows:
+
+    R. Fol. Digital. purp. recent. ℥iv. coque ex Aq. fontan. puræ
+    ℔iss ad ℔i. et cola.
+    R. Decoct. Digital. ℥iss.
+    Aq. Nuc. Moschat. ʒii. M. fiat. haust. 2dis horis sumend.
+
+The patient took five of these draughts, which made her very sick, and
+acted very powerfully upon the kidneys, for within the first
+twenty-four hours she made upwards of eight quarts of water. The sense
+of fulness and oppression across her stomach was greatly diminished,
+her breath was eased, her pulse became more full and more regular, and
+the swellings of her legs subsided.
+
+26th. Our patient being thus snatched from impending destruction, Dr.
+Darwin proposed to give her a decoction of pareira brava and guiacum
+shavings, with pills of myrrh and white vitriol; and, if costive, a
+pill with calomel and aloes. To these propositions I gave a ready
+assent.
+
+30th. This day Dr. Darwin saw her, and directed a continuation of the
+medicines last prescribed.
+
+_August_ 1st. I found the patient perfectly free from every appearance
+of dropsy, her breath quite easy, her appetite much improved, but
+still very weak. Having some suspicion of a diseased liver, I directed
+pills of soap, rhubarb, tartar of vitriol, and calomel to be taken
+twice a day, with a neutral saline draught.
+
+9th. We visited our patient together, and repeated the draughts
+directed on the 26th of _June_, with the addition of tincture of bark,
+and also ordered pills of aloes, guiacum, and sal martis to be taken
+if costive.
+
+_September_ 10th. From this time the management of the case fell
+entirely under my direction, and perceiving symptoms of effusion going
+forwards, I desired that a solution of merc. subl. corr. might be
+given twice a day.
+
+19th. The increase of the dropsical symptoms now made it necessary to
+repeat the Digitalis. The dried leaves were used in infusion, and the
+water was presently evacuated, as before.
+
+It is now almost nine years since the Digitalis was first prescribed
+for this lady, and notwithstanding I have tried every preventive
+method I could devise, the dropsy still continues to recur at times;
+but is never allowed to increase so as to cause much distress, for she
+occasionally takes the infusion and relieves herself whenever she
+chooses. Since the first exhibition of that medicine, very small doses
+have been always found sufficient to promote the flow of urine.
+
+I have been more particular in the narrative of this case, partly
+because Dr. Darwin has related it rather imperfectly in the notes to
+his son's posthumous publication, trusting, I imagine, to memory, and
+partly because it was a case which gave rise to a very general use of
+the medicine in that part of Shropshire.
+
+
+                                CASE V.
+
+_December_ 10th. Mr. L----, Æt. 35. Ascites and anasarca, the
+consequence of very intemperate living. After trying squill and other
+medicines to no purpose, I directed a decoction of the Fol. Digital.
+recent. six drams to a pint; an eighth part to be taken every fourth
+hour. This made him sick, and produced a copious flow of urine, but
+not enough to remove all the dropsical symptoms. After a fortnight a
+stronger decoction was ordered, and, upon a third trial, as the winter
+advanced, it became necessary to use four ounces to the pint
+decoction; and thus he got free from all his complaints.
+
+In _October_ 1777, in consequence of having pursued his intemperate
+mode of living, his dropsy returned, accompanied by evident marks of
+diseased viscera. A decoction of two drams of Fol. Digital. siccat. to
+a pint, once more removed the dropsy. He took a wine glass full thrice
+a day.
+
+In _January_ 1778, I was desired to visit him again. I found he had
+gone on in his usual intemperate life, his countenance jaundiced, and
+the dropsy coming on apace. After giving some deobstruent medicines, I
+again directed the Digitalis, which again emptied the water; but he
+did not survive many weeks.
+
+
+                                 1777.
+
+                               CASE VI.
+
+_February_--. Mrs. M----, Æt. 45. Ascites and anasarca, but not much
+otherwise diseased, and well enough to walk about the house, and see
+after her family affairs. I thought this a fair case for a trial of
+the Digitalis, and therefore directed a decoction of the fresh leaves,
+the stock of dried ones being exhausted. About a week afterwards,
+calling to see my patient, I was informed that she was dead; that the
+third day after my first visit she suddenly fell down, and expired.
+Upon enquiry I found she had not taken any of the medicine; for the
+snow had lain so deep upon the ground, that the apothecary had not
+been able to procure it. Had the medicine been given in a case
+seemingly so favourable as this, and had the patient died under its
+use, is it not probable that the death would have been attributed to
+it?
+
+
+                               CASE VII.
+
+_February_ 11th. Mr. E----, of W----, Æt. 61. Hydrothorax, ascites and
+anasarca, consequences of hard drinking. He had been attended for some
+time by a physician in his neighbourhood, who had treated his case
+with the usual remedies, but without affording him any relief; nor
+could I expect to succeed better by any other medicine than the
+Digitalis. The dried leaves were not to be had; and the green ones at
+this season being very uncertain in their strength, I ordered four
+ounces of the roots in a pint decoction, and directed three spoonfuls
+to be given every fourth hour, until it either excited nausea, or a
+free discharge of urine; both these effects took place nearly at the
+same time: he made a large quantity of water, the swellings subsided
+very considerably, and his breath became easy. Eight days afterwards
+he began upon a course of bitters and deobstruents. The dropsical
+symptoms soon increased again, but he had suffered so much from the
+severity of the sickness before, that he was neither willing to take,
+nor I to give the same medicine again.
+
+Perhaps this patient might have been saved, if I had been well
+acquainted with the management and real doses of the medicine, which
+was certainly in this instance made very much too strong; and
+notwithstanding the caution to stop the further exhibition when
+certain effects should take place, it seems the quantity previously
+swallowed was sufficient to distress him exceedingly.
+
+
+                              CASE VIII.
+
+_March_ 11th. Mrs. H----, Æt. 32. A few days after a tedious labour,
+had her legs and thighs swelled to a very great degree; pale and
+semi-transparent,[5] with pain in both groins. After a purge of
+calomel and rhubarb, ung. merc. was ordered to be rubbed upon the
+groins, and the following decoction was directed:
+
+    R. Fol. Digital. purp. recent. ℥ii.
+    Aq. puræ. ℔i. coque ad ℔iss et colatur. adde.
+    Aq. cinn. sp. ℥iv. M. capiat. cyath. vinos. parv. bis
+    quotidie.
+
+The decoction presently increased the secretion of urine, and abated
+the distension of the legs: in a fortnight the swelling was gone; but
+some days after leaving her bed, her legs swelled again about the
+ancles, which was removed by another bottle of the decoction on the
+21st of _April_.
+
+    [Footnote 5: This disease has lately been well described by
+    Mr. White, of Manchester.]
+
+
+                               CASE IX.
+
+_March_ 29th. Mr. G----, Æt. 47. Very much deformed; asthma of several
+years continuance, but now dropsical to a great degree. Took several
+medicines without relief, and then tried the Digitalis, but with no
+better success.
+
+
+                                CASE X.
+
+_April_ 10th. G--G----, Æt. 70. Asthma and anasarca. Took a decoction
+of the fresh leaves of the Digitalis, which produced violent sickness,
+but no immediate evacuation of water. After the sickness had ceased
+altogether, the urine began to flow copiously, and he was cured.
+
+
+                               CASE XI.
+
+_July_ 10th. Mr. M---- of T----, Æt. 54. A very hard drinker; had been
+affected since _November_ last with ascites and anasarca, for which he
+had taken several medicines without benefit. A decoction of the recent
+leaves of the Digitalis was then directed, an ounce and half to a
+pint, one eighth of which I ordered to be given every fourth hour. A
+few doses brought on great nausea, indistinct vision, and a great flow
+of urine, so as presently to empty him of all the dropsical water.
+Indeed the evacuation was so rapid and so complete, that it became
+necessary to apply a bandage round the belly, and to support him with
+cordials.
+
+In something more than a year and a half, his dropsy returned, but the
+Digitalis did not then succeed to our wishes. In _August_, 1779, he
+was tapped, and lived afterwards only about five weeks.
+
+For more particulars, see the extract of a letter from Mr. Lyon.
+
+
+                               CASE XII.
+
+_September_ 12th. Miss C---- of T----, Æt 48. An ovarium dropsy, and
+anasarcous legs and thighs. For three months in the beginning of this
+year she had been under the care of Dr. Darwin, who at different times
+had given her blue vitriol, elaterium, and calomel; decoction of
+pareira brava, and guiacum wood, with tincture of cantharides; oxymel
+of squills, decoction of parsley roots, &c. Finding no relief, she
+discontinued the use of medicines, until the urgency of her symptoms
+induced her to ask my advice about the end of _August_. She was
+greatly emaciated, and had almost a total loss of appetite. I first
+tried small doses of Merc. sublim. corr. in solution, with decoction
+of burdock roots, and blisters to the thighs. No advantage attending
+the use of this plan, I directed a decoction of Fol. Digit. a dram and
+half to a pint; one ounce to be taken twice a day. It presently
+reduced the anasarcous swellings, but made no alteration in the
+distension of the abdomen.
+
+
+                              CASE XIII.
+
+_October_ 9th. Mrs. B----, Æt. 40. An ovarium dropsy. Took a decoction
+of Digitalis without effect. Her life was preserved for some years by
+repeated tapping.
+
+
+                                 1778.
+
+                               CASE XIV.
+
+_February_ 8th. Mr. R---- of K----. Had formerly suffered much from
+gout, and lived very intemperately. Jaundiced countenance; ascites;
+legs and thighs greatly swollen; appetite none; extremely weak;
+confined to his bed. Had taken many medicines from his apothecary
+without advantage. I ordered him decoction of Digitalis, and a
+cordial; but he survived only a few days.
+
+
+                               CASE XV.
+
+_March_ 13th. Mr. M----, Æt. 54. A thorax greatly deformed; asthma
+through the winter, succeeded by dropsy in belly and legs. Pulse very
+small; face leaden coloured; cough almost continual. Decoction of
+seneka was directed, and small doses of Dover's powder at night.
+
+17th. Gum-ammoniac and squill, with elixir paregor. at night.--26th,
+Squill and decoction of seneka.--30th, His complaints still
+increasing, decoction of Digitalis was then directed, which relieved
+him in a few days; but his complaints returned again, and he died in
+the month of _June_.
+
+
+                               CASE XVI.
+
+_August_ 18th. Mr. B----, Æt. 33. Pulmonary consumption and dropsy.
+The Digitalis, and that failing, other diuretics were used, in hopes
+of gaining some relief from the distress occasioned by the dropsical
+symptoms; but none of them were effectual. He was then attended by
+another physician, and died in about two months.
+
+
+                              CASE XVII.
+
+_September_ 21st. Mrs. M---- W---- G----, Æt. 50. An ovarium dropsy.
+She took half a pint of Infus. Digitalis, which made her sick, but did
+not increase the quantity of urine. She was afterwards relieved by
+tapping.
+
+
+                              CASE XVIII.
+
+_October_ 28th. R---- W----, Æt. 33. Ascites and universal anasarca;
+countenance quite pale and bloated; appetite none, and the little food
+he forces down is generally rejected.
+
+    R. Fol. Digit. purp. siccat. ʒiii.
+    Aq. bull. ℔i. digere per horas duas, et colat. adde aq.
+    junip. comp. ℥iii.
+
+He was directed to take one ounce of this infusion every two hours
+until it should make him sick. This was on Wednesday. The fifth dose
+made him vomit. On Thursday afternoon he vomited again very freely,
+without having taken any more of the medicine. On Friday and Saturday
+he made more water than he had done for a week before, and the
+swellings of his face and body were considerably abated. He was
+directed to omit all medicine so long as the urine continued to flow
+freely, and also to keep an account of the quantity he made in
+twenty-four hours.
+
+These were his reports:
+
+    _October_ 31st. Saturday,   5 half pints.
+    _November_ 1st. Sunday,     6
+               2d. Monday,      8
+               3d. Tuesday,     8
+               4th. Wednesday,  7
+               5th. Thursday,   8
+
+On Wednesday he began to purge, and the purging still continues, but
+his appetite is better than he has known it for a long time. No
+swelling remains but about his ancles, extending at night half way up
+his legs.
+
+Omit all medicines at present.
+
+               7th. Saturday,   7½ half pints.
+               8th. Sunday,     8
+               9th. Monday,     6¾
+              10th. Tuesday,    6½
+              11th. Wednesday,  6
+              12th. Thursday,   6¼
+
+On Tuesday the 17th, some swelling still remained about his ancles,
+but he was in every other respect perfectly well.
+
+He took a few more doses of the infusion, and no other medicine.
+
+
+                               CASE XIX.
+
+_December_ 8th. W---- B----, Æt. 60. A hard drinker. Diseased viscera;
+ascites and anasarca. An infusion of Digitalis was directed, but it
+had no other effect than to make him sick.
+
+
+                                 1779.
+
+In the beginning of this year we had many dropsies in children, who
+had suffered from the Scarlatina Anginosa; they all yielded very
+readily to the Digitalis, but in some the medicine purged, and then it
+did not prove diuretic, nor did it remove the dropsy until opium was
+joined with it, so as to prevent it purging.--I did not keep notes of
+these cases, but I do not recollect a single instance in which the
+Digitalis failed to effect a cure.
+
+
+                               CASE XX.
+
+_January_ 1st. Mr. H----. Hydrops Pectoris; legs and thighs
+prodigiously anasarcous; a very distressing sense of fulness and
+tightness across his stomach; urine in small quantity; pulse
+intermitting; breath very short.
+
+He had taken various medicines, and been blistered, but without
+relief. His complaints continuing to increase, I directed an infusion
+of Digitalis, which made him very sick; acted powerfully as a
+diuretic, and removed all his symptoms.
+
+About three months afterwards he was out upon a journey, and, after
+taking cold, was suddenly seized with difficulty of breathing, and
+violent palpitation of his heart: he sent for me, and I ordered the
+infusion as before, which very soon removed his complaints. He is now
+active and well; but, whenever he takes cold, finds some return of
+difficult breathing, which he soon removes by a dose or two of the
+infusion.
+
+
+                               CASE XXI.
+
+_January_ 5th. Mrs. M----, Æt. 69. Hydrothorax, (called asthma)
+ascites and anasarca. I directed an infusion of Fol. Digital. siccat.
+three drams to a pint; a small wine glass to be taken every third or
+fourth hour. It made her violently sick, acted powerfully as a
+diuretic, set her breath perfectly at liberty, and carried off the
+swelling of her legs; when she was nearly emptied, she became so
+languid, that I thought it necessary to order cordials, and a large
+blister to her back. Mr. Ward, who attended as her apothecary, tells
+me she had some return of her asthma in _June_ and _October_
+following, which was each time removed by the same medicine.
+
+
+                              CASE XXII.
+
+_January_ 11th. Mr. H----, Æt. 59. Ascites and general anasarca. A
+large corpulent man, and a hard drinker: he had repeatedly suffered
+under complaints of this kind, but had been always relieved by the
+judicious assistance of Dr. Ash. In the present instance, however, not
+finding relief as usual from the prescriptions of my worthy friend, he
+sent for me; after examining into his situation, and informing myself
+what had been done to relieve him, I was satisfied that the Digitalis
+was the only medicine from which I had any thing to hope. It was
+therefore directed; but another patient requiring my assistance at a
+distance from town, I desired he would not begin the medicine before I
+returned, which would be early on the third day; for I was well aware
+of the difficulties before me, and that he would inevitably sink under
+too rapid an evacuation of the water. On my return I was informed,
+that the preceding evening, as he sat on his chair, his head sunk upon
+his breast, and he died.
+
+This case, as well as case VI. is mentioned with a view to demonstrate
+to younger practitioners, how sudden and unexpected the deaths of
+dropsical patients sometimes happen, and how cautious we should be in
+assigning causes for effects.
+
+
+                              CASE XXIII.
+
+_August_ 31st. Mr. C----, Æt. 57. Diseased viscera, jaundice, ascites
+and anasarca. After trying calomel, saline draughts, jallap purges,
+chrystals of tartar, pills of gum ammoniac, squills, and soap, sal
+succini, eleterium, &c. infusion of Digitalis was directed, which
+removed all his urgent symptoms, and he recovered a pretty good state
+of health.
+
+
+                              CASE XXIV.
+
+_September_ 11th. I was desired to visit Mr. L----, Æt. 63; a middle
+sized man; rather thin; not habitually intemperate; found him in bed,
+where he had been for three days. He was in a state of furious
+insanity, and had been gradually losing his reason for ten days
+before, but was not outrageous the first week; his apothecary had
+given him ten grains of emetic tartar, a dram of ipecacoanha, and an
+ounce of tincture of jallap, in the space of a few hours, which
+scarcely made him sick, and only occasioned a stool or two; upon
+enquiring into the usual state of his health, I was told that he had
+been troubled with some difficulty of breathing for thirty years past,
+but for the nine last years this complaint had increased, so that he
+was often obliged to sit up the greater part of the night; and, for
+the last year, the sense of suffocation was so great, when he lay
+down, that he often sat up for a week together. His father died of an
+asthma before he was fifty. A few years ago, at an election, where he
+drank more than usual, his head was affected as now, but in a slighter
+degree, and his asthmatic symptoms vanished; and now, notwithstanding
+he has been several days in bed, he feels not the least difficulty in
+breathing.
+
+Apprehending that the insanity might be owing to the same cause which
+had heretofore occasioned the asthma, and that this cause was water; I
+ordered a decoction of the Fol. siccat Digital, three drams to half a
+pint; three spoonfuls to be taken every third hour: the fourth dose
+made him sick; the medicine was then stopped; the sickness continued
+at intervals, more or less, for four days, during which time he made a
+great quantity of water, and gradually became more rational. On the
+fifth day his appetite began to return, and the sickness ceased, but
+the flow of urine still continued.
+
+A week afterwards I saw him again, and examined him particularly; his
+head was then perfectly rational, appetite very good, breath quite
+easy, permitting him to lie down in bed without inconvenience, makes
+plenty of water, coughs a little, and expectorates freely. He took no
+other medicine, except a little rhubarb when costive.
+
+
+                               CASE XXV.
+
+_September_ 15th. Mr. J. R----, Æt. 50. Subject to an asthmatical
+complaint for more than twenty years, but was this year much worse
+than usual, and symptoms of dropsy appeared. In _July_ he took G.
+ammon. squill and seneka, with infus. amarum and fossil alkaly. In
+_August_, infusum amar. with vin. chalyb. and at bed-time pil. styr.
+and squill. His complaints increasing, the squill was pushed as far as
+could be borne, but without any good effect. _September_ 15th, an
+infusion of Digitalis was directed, but he died the next morning.
+
+
+                              CASE XXVI.
+
+_September_ 18th. Mrs. R----, Æt. 30. After a severe child-bearing,
+found both her legs and thighs swelled to the utmost stretch of the
+skin. They looked pale, and almost transparent. The case being similar
+to that related at No. VIII. I determined upon a similar method of
+treatment; but as this patient had an inflammatory sore throat also, I
+wished to get that removed first, and in three or four days it was
+done. I then directed an infusion of Digitalis, which soon increased
+the urinary secretion, and reduced the swellings, without any
+disturbance of her stomach.
+
+A few days after quitting her bed and coming down stairs, some degree
+of swelling in her legs returned, which was removed by calomel, an
+opening electuary, and the application of rollers.
+
+
+                              CASE XXVII.
+
+_October_ 7th. Mr. F----, a little man, with a spine and thorax
+greatly deformed; for more than a year past had complained of
+difficult respiration, and a sense of fulness about his stomach; these
+complaints increasing, his abdomen gradually enlarged, and a
+fluctuation in it became perceptible. He had no anasarca, no
+appearance of diseased viscera, and no great paucity of urine. Purges
+and diuretics of different kinds affording him no relief, my
+assistance was desired. After trying squill medicines without effect,
+he was ordered to take Pulv. fol. Digital. in small doses. These
+producing no sensible effect, the doses were gradually increased until
+nausea was excited; but there was no alteration in the quantity of
+urine, and consequently no relief to his complaints. I then advised
+tapping, but he would not hear of it; however, the distress occasioned
+by the increasing fulness of his belly at length compelled him to
+submit to the operation on the 20th of _November_. It was necessary to
+draw off the water again upon the following days:
+
+          _December_ the 8th.
+             -- --      27th.
+    1780. _February_ the 4th.
+             -- --       23d.
+          _March_ the    9th.
+
+During the intervals, no method I could think of was omitted to
+prevent the return of the disease, but nothing seemed to avail. In the
+operation of _February_ 23d, his strength was so much reduced, that
+the water was not entirely removed; and on the 9th of March, before
+his belly was half emptied, notwithstanding the most judicious
+application of bandage, his debility was so great, that it was judged
+prudent to stop. After being placed in bed, the faintness and sickness
+continued; severe rigors ensued, and violent vomiting; these
+vomitings continued through the night, and in the intervals he lay in
+a state nearly approaching to syncope. The next day I found him with
+nearly the same symptoms, but remarked that the quantity of fluid he
+had thrown up was very much more than what he had taken, and that his
+abdomen was considerably fallen; in the course of two or three days
+more, he discharged the whole of the effused fluid; his strength and
+appetite gradually returned, and he was in all respects much better
+than he had been before the last operation.
+
+Some time afterwards, his belly began to fill again, and he again
+applied to me; upon an accurate examination, I judged the quantity of
+fluid might then be about four or five quarts. Nature had pointed out
+the true method of cure in this case; I therefore ordered him to bed,
+and directed ipecacoanha vomits to be given night and morning: in two
+or three days the whole of the water was removed by vomiting, for he
+never purged, nor was the quantity of his urine increased; his
+appetite and strength gradually returned; he never had any further
+relapse, and is now an active healthy man. I must leave the reader to
+make his own reflections on this singular case.
+
+
+                                 1780.
+
+                             CASE XXVIII.
+
+_January_ 11th. Captain V----, Æt. 42. Had suffered much from residing
+in hot climates, and drinking very freely, particularly rum in large
+quantity. He had tried many physicians before I saw him, but nothing
+relieved him. I found him greatly emaciated, his countenance of a
+brownish yellow; no appetite, extremely low, distressing fulness
+across his stomach; legs and thighs greatly swollen; pulse quick, and
+very feeble; urine in small quantity. As he had evidently only a few
+days to live, I ordered him nothing but a solution of sal diureticus
+in cinnamon water, slightly acidulated with syrup of lemons. This
+medicine effecting no change, and his symptoms becoming daily more
+distressing, I directed an infusion of Digitalis. A few doses
+occasioned a copious flow of urine, without sickness or any other
+disturbance. The medicine was discontinued; and the next day the urine
+continuing to be secreted very plentifully, he lost his most
+distressing complaints, was in great spirits, and ate a pretty good
+dinner. In the evening, as he was conversing chearfully with some
+friends, he stooped forwards, fell from his chair, and died instantly.
+Had he been in bed, I think there is reason to believe this fatal
+syncope, if such it was, would not have happened.
+
+
+                              CASE XXIX.
+
+_February_ 6th. Mr. H----, Æt. 63. A corpulent man; had suffered much
+from gout, which for the last year or two had formed very imperfectly.
+He had now symptoms of water in his chest, his belly and his legs. An
+infusion of Digitalis removed these complaints, and after being
+confined for the greater part of the winter, he was well enough to get
+abroad again. In the course of a month the dropsical symptoms
+returned, and were again removed by the same medicine. Bitters and
+tonics were now occasionally prescribed, but his debility gradually
+increased, and he died some time afterwards; but the dropsy never
+returned.
+
+
+                               CASE XXX.
+
+_February_ 17th. Mr. D----, Æt. 50. Ascites and anasarca, with
+symptoms of phthisis. He had been a very hard drinker. The infusum
+Digitalis removed his dropsical symptoms, and he was sufficiently
+recovered to take a journey; but as the spring advanced, the
+consumptive symptoms increased, and he died soon afterwards, perfectly
+emaciated.
+
+
+                              CASE XXXI.
+
+_March_ 5th. I was desired to visit Mrs. H----, a very delicate woman,
+who after a severe lying-in, had her legs and thighs swollen to a very
+great degree; pale and semi-transparent. I found her extremely faint,
+her pulse very small and slow; vomiting violently, and frequently
+purging. She was attended by a gentleman who had seen me give the
+Digitalis in a similar case of swelled legs after a lying-in (see Case
+XXVI.) about six months before. He had not considered that this
+patient was delicate, the other robust; nor had he attended to stop
+the exhibition of the medicine when its effects began to take place.
+The great distress of her situation was evidently owing to the
+imprudent and unlimited use of the Digitalis. I was very apprehensive
+for her safety; ordered her cordials and volatiles; a free supply of
+wine, chamomile tea with brandy for common drink, and blisters. The
+next day the situation of things was much the same, but with all this
+disturbance no increased secretion of urine. The same methods were
+continued; an opiate ordered at night, and liniment. volatile upon
+flannel applied to the groins, as she now complained of great pain in
+those parts. The third day the nausea was less urgent, the vomitings
+less frequent, the pulse not so slow. Camphorated spirit, with caustic
+volatile alkaly, was applied to the stomach, emulsion given for common
+drink, and the same medicines repeated. From this time, the intervals
+became gradually longer between the fits of vomiting, the flow of
+urine increased, the swellings subsided, the appetite returned, and
+she recovered perfectly.
+
+
+                              CASE XXXII.
+
+_March_ 16th. Mr. D----, Æt. 70. A paralytic stroke had for some weeks
+past impaired the use of his left side, and he complained much of his
+breath, and of a straitness across his stomach; at length, an anasarca
+and ascites appearing, I had no doubt as to the cause of the former
+symptoms; but, upon account of his advanced age, and the paralytic
+affection, I hesitated to give the Digitalis, and therefore tried the
+other usual modes of practice, until at length his breath would not
+permit him to lie down in bed, and his other symptoms increased so
+rapidly as to threaten a speedy dissolution. In this dilemma I
+ventured to prescribe an infusion of the Fol. siccat. Digital. which
+presently excited a copious flow of urine, and made him very sick; a
+strong infusion of chamomile flowers, with brandy, relieved the
+sickness, but the diuretic effects of the Digitalis continuing, his
+dropsy was removed, and his breathing became easy. The palsy remained
+nearly in the same state. He lived until _August_ 1782, and without
+any return of the dropsy.
+
+
+                             CASE XXXIII.
+
+_March_ 18th. Miss S----, Æt. 5. Hydrocephalus internus. As the case
+did not yield to calomel, when matters were nearly advanced to
+extremities, it occurred to me to try the Infusum Digitalis; a few
+doses of which were given, but had no sensible effect.
+
+
+                              CASE XXXIV.
+
+_March_ 19th. A young lady, soon after the birth of an illegitimate
+child, became insane. After being near a month under my care,
+swellings of her legs, which at first had been attributed to weakness,
+extended to her thighs and belly; her urine became foul, and small in
+quantity, and the insanity remained nearly the same. As it had been
+very difficult to procure evacuations by any means, I ordered half an
+ounce of Fol. Digital. siccat. in a pint infusion, and directed two
+spoonfuls to be given every two hours: this had the desired effect;
+the dropsy and the insanity disappeared together, and she had
+afterwards no other medicine but some aperient pills to take
+occasionally.
+
+
+                              CASE XXXV.
+
+_April_ 12th. Mr. R----, Æt. 32. For the last three or four years had
+had more or less of what was considered as asthma;--it appeared to me
+Hydrothorax. I directed an infusion of Digitalis, which presently
+removed his complaints. In _June_ following he had a relapse, and took
+two grains of the Pulv. fol. Digit. three times a day, which cured him
+after taking forty grains, and he has never had a return.
+
+
+                              CASE XXXVI.
+
+_May_ 15th. Mrs. H----, Æt. 40. A spasmodic asthma, attended with
+symptoms of effusion. An infusion of Digitalis relieved her very
+considerably, and she lived four years afterwards without any relapse.
+
+
+                             CASE XXXVII.
+
+_May_ 26th. R---- B----, Æt. 12. Scrophulous, consumptive, and at
+length anasarcous. Took Infus. Digital. without advantage. Died the
+_July_ following.
+
+
+                             CASE XXXVIII.
+
+_June_ 4th. Mrs. S----, of W----, Æt 49. Ascites and anasarca. Had
+taken many medicines; first from her apothecary, afterwards by the
+direction of a very judicious and very celebrated physician, but
+nothing retarded the increase of the dropsy. I first saw her along
+with the physician mentioned above, on the 14th of _May_; we directed
+an electuary of chrystals of tartar, and Seltzer water for common
+drink; this plan failing, as others had done before, we ordered the
+Infus. Digital. which in a few days nearly removed the dropsy. I then
+left her to the care of her physician; but her constitution was too
+much impaired to admit of restoration to health, and I understand she
+died a few weeks afterwards.
+
+
+                              CASE XXXIX.
+
+_June_ 13th. Mr. P----, Æt. 35. A very hard drinker, was attacked with
+a severe hæmoptoe, which was followed by ascites and anasarca. He had
+every appearance of diseased viscera, and his urine was small in
+quantity. The powder and the infusion of Digitalis were given at
+different times, but without the desired effect. Other medicines were
+tried, but in vain. Tapping prolonged his existence a few weeks, and
+he died early in the following autumn.
+
+
+                               CASE XL.
+
+_June_ 27th. Mr. W----, Æt. 37. An apparently asthmatic affection,
+gradually increasing for three or four years, which not yielding to
+the usual remedies, he took the infusion of Digitalis. Two or three
+doses made him very sick; but he thought his breathing relieved. After
+one week he took it again, and was so much better as to want no other
+medicine.
+
+In the course of the following winter he became hectic, and died
+consumptive about a year afterwards.
+
+
+                               CASE XLI.
+
+_July_ 6th. Mr. E----, Æt. 57. Hydrothorax and anasarca; his breath so
+short that he could not lie down. After a trial of squill, fixed
+alkaly, and dulcified spirit of nitre, I directed Pulv. Digital. gr.
+2, thrice a day. In four days he was able to come down stairs; in
+three days more no appearance of disease remained; and under the use
+of aromatics and small doses of opium, he soon recovered his strength.
+
+
+                              CASE XLII.
+
+_July_ 7th. Miss H---- of T----, Æt. 39. In the last stage of a
+phthisis pulmonalis became dropsical. She took the Digitalis without
+being relieved.
+
+
+                              CASE XLIII.
+
+_July_ 9th. Mrs. F----, Æt. 70. A chearful, strong, healthy woman; but
+for a few years back had experienced a degree of difficult breathing
+when in exercise. In the course of the last year her legs swelled, and
+she felt great fulness about her stomach. These symptoms continued
+increasing very fast, notwithstanding several attempts made by a very
+judicious apothecary to relieve her. The more regular practitioner
+failing, she had recourse to a quack, who I believe plied her very
+powerfully with Daphne laureola, or some drastic purge of that kind. I
+found her greatly reduced in strength, her belly and lower extremities
+swollen to an amazing size, her urine small in quantity, and her
+appetite greatly impaired. For the first fortnight of my attendance
+blisters were applied, solution of fixed alkaly, decoction of seneka
+with vitriolic æther, chrystals of tartar, squill and cordial
+medicines were successively exhibited, but with no advantage. I then
+directed Pulv. Fol. Digital. two grains every four hours. After taking
+eighteen grains, the urine began to increase. The medicine was then
+stopped. The discharge of urine continued to increase, and in five or
+six days the whole of the dropsical water passed off, without any
+disturbance to the stomach or bowels. As the distension of the belly
+had been very great, a swathe was applied, and drawn gradually tighter
+as the water was evacuated. As no pains were spared to prevent the
+return of the dropsy, and as the best means I could devise proved
+unequal to my wishes, both in this and in some other cases, I shall
+take the liberty to point out the methods I tried at different times
+in as concise a manner as possible, for the knowledge of what will not
+do, may sometimes assist us to discover what will.
+
+     1780.
+
+     _July_ 18th. Infusum amarum, steel, Seltzer water.
+
+     _September_ 22d. Neutral saline draughts, with tinct.
+     canthar.
+
+     26th. Pills of soap, garlic and millepedes.
+
+     30th. The same pills, with infusum amarum.
+
+     _October_ 11th. Pills of aloes, assafetida, and sal martis,
+     in the day-time, and mercury rubbed down, at night.
+
+     _December_ 21st. The accumulation of water now required a
+     repetition of the Digitalis. It was directed in infusion, a
+     dram and half to eight ounces, and an ounce and half given
+     every fourth hour, until its effects began to appear. The
+     water was soon carried off.
+
+     30th. Sal diuretic. twice a day. To eat preserved garlic
+     frequently.
+
+
+     1781.
+
+     _February_ 1st. Pills of calomel, squill and gum ammoniac.
+
+     3d. Infusion of Digitalis repeated, and after the water was
+     carried off, Dover's powder was tried as a sudorific.
+
+     _March_ 18th. Infus. Digital. repeated.
+
+     26th. Pills of sal martis and aromatic species, with infusum
+     amarum.
+
+     _May_ 5th. Being feverish; James's powder and saline
+     draughts.
+
+     10th. Laudanum every night, and an opening tincture to
+     obviate costiveness.
+
+     24th. Infus. Digitalis, one ounce only every fourth hour,
+     which soon procured a perfect evacuation of the water.
+
+     _August_ 11th. Infus. Digitalis.
+
+     _October_ 19th. An emetic, and fol. Cicut. pulv. ten grains
+     every six hours.
+
+     _November_ 8th. A mercurial bolus at bed-time.
+
+     16th. Infus. Digitalis.
+
+     _December_ 23d. An emetic--Pills of seneka and gum
+     ammoniac--Vitriolic acid in every thing she drinks.
+
+     25th. Squill united to small doses of opium.
+
+
+     1782.
+
+     _January_ 2d. A troublesome cough--Syrup of garlic and
+     oxymel of squills. A blister to the back.
+
+     4th. Tincture of cantharides and paregoric elixir.
+
+     28th. Infus. Digitalis, half an ounce every morning, and one
+     ounce every night, was now sufficient to empty her.
+
+     _March_ 26th. Infus. Digitalis; and when emptied, vitriol of
+     copper twice a day.
+
+     _April_ 1st. A cordial mixture for occasional use.
+
+     Two months afterwards a purging came on, which every now and
+     then returned, inducing great weakness--her appetite failed,
+     and she died in _July_.
+
+
+                              INTERVALS.
+
+     From _July_ 9th, 1780, to _December_ 21st, 171 days.
+     From _December_ 21st to _February_ 3d, 1781, 34 days.
+     From _February_ 3d to _March_ 18th, 44 days.
+     From _March_ 18th to _May_ 24th, 66 days.
+     From _May_ 24th to _August_ 11th, 79 days.
+     From _August_ 11th to _November_ 16th, 98 days.
+     From _November_ 16th to _January_ 28th, 1782, 74 days.
+     From _January_ 28th to _March_ 26th, 57 days.
+
+None of the accumulations of water were at all equal to that which
+existed when I first saw her, for finding so easy a mode of relief,
+she became impatient under a small degree of pressure, and often
+insisted upon taking her medicine sooner than I thought it necessary.
+After the 26th of _March_ the degree of effusion was inconsiderable,
+and at the time of her death very trifling, being probably carried off
+by the diarrhœa.
+
+
+                              CASE XLIV.
+
+_July_ 12th. Mr. H----, of A----, Æt. 60. In the last stage of a life
+hurried to a termination by free living, dropsical symptoms became the
+most distressing. He wished to take the Digitalis. It was given, but
+afforded no relief.
+
+
+                               CASE XLV.
+
+_July_ 13th. Mr. S----, Æt. 49. Asthma, or rather hydrothorax,
+anasarca, and symptoms of a diseased liver. He was directed to take
+two grains of Pulv. fol. Digital. every two hours, until it produced
+some effect. It soon removed the dropsical and asthmatic affections,
+and steel, with Seltzer water, restored him to health.
+
+
+                              CASE XLVI.
+
+_August_ 6th. Mr. L----, Æt. 35. Ascites and anasarca. Pulv. Digital.
+grains three, repeated every fourth hour, until he had taken two
+scruples, removed every appearance of dropsy in a few days. He was
+then directed to take solution of merc. sublimat. and soon recovered
+his health and strength.
+
+
+                              CASE XLVII.
+
+_August_ 16th. Mr. G----, of W----, Æt. 86. Asthma of many years
+duration, and lately an incipient anasarca, with a paucity of urine.
+He had never lived intemperately, was of a chearful disposition, and
+very sensible: for some years back had lost all relish for animal
+food, and his only support had been an ounce or two of bread and
+cheese, or a small slice of seed-cake, with three or four pints of
+mild ale, in the twenty-four hours. After trying chrystals of tartar,
+fixed alkaly, squills, &c. I directed three grains of Pulv. fol.
+Digital. made into pills, with G. ammoniac, to be given every six
+hours; this presently occasioned copious discharges of urine, removed
+his swellings, and restored him to his usual standard of health.
+
+
+                             CASE XLVIII.
+
+_August_ 17th. T---- B----, Esq. of K----, Æt. 46. Jaundice, dropsy,
+and great hardness in the region of the liver. Infusion of Digitalis
+carried off all the effusion, and afterwards a course of deobstruent
+and tonic medicines removed his other complaints.
+
+
+                              CASE XLIX.
+
+_August_ 23d. Mr. C----, Æt. 58. (The person mentioned at Case XXIII.)
+He had continued free from dropsy until within the last six weeks; his
+appetite was now totally gone, his strength extremely reduced, and the
+yellow of his jaundice changed to a blackish hue. The Digitalis was
+now tried in vain, and he died shortly afterwards.
+
+
+                                CASE L.
+
+_August_ 24th. Mrs. W----, Æt. 39. Anasarcous legs and symptoms of
+hydrothorax, consequent to a tertian ague. Three grains of Pulv.
+Digitalis, given every fourth hour, occasioned a very copious flow of
+urine, and she got well without any other medicine.
+
+
+                               CASE LI.
+
+_August_ 28th. Mr. J---- H----, Æt. 27. In consequence of very free
+living, had an ascites and swelled legs. I ordered him to take two
+grains of Fol. Digital. pulv. every two hours, until it produced some
+effect; a few doses caused a plentiful secretion of urine, but no
+sickness, or purging: in six days the swellings disappeared, and he
+has since remained in good health.
+
+
+                               CASE LII.
+
+_September_ 27th. Mr. S----, Æt. 45. Had been long in an ill state of
+health, from what had been supposed an irregular gout, was greatly
+emaciated, had a sallow complexion, no appetite, costive bowels, quick
+and feeble pulse. The cause of his complaints was involved in
+obscurity; but I suspected the poison of lead, and was strengthened in
+this suspicion, upon finding his wife had likewise ill health, and, at
+times, severe attacks of colic; but the answers to my enquiries seemed
+to prove my suspicions fruitless, and, amongst other things, I was
+told the pump was of wood. He had lately suffered extremely from
+difficult breathing, which I thought owing to anasarcous lungs; there
+was also a slight degree of pale swelling in his legs. Pulv. fol.
+Digital. made into pills, with gum ammoniac and aromatic species, soon
+relieved his breathing. Attempts were then made to assist him in other
+respects, but with little good effect, and some months afterwards he
+died, with every appearance of a worn out constitution.
+
+About two years after this gentleman's death, I was talking to a
+pump-maker, who, in the course of conversation, mentioned the
+corrosion of leaden pumps, by some of the water in this town, and
+instanced that at the house of Mr. S----, which he had replaced with a
+wooden one about three years before. The lead, he said, was eaten
+away, so as to be very thin in some places, and full of holes in
+others;--this accidental information explained the mystery.
+
+The deleterious effects of lead seem to be considerably modified by
+the constitution of the patient; for in some families only one or two
+individuals shall suffer from it, whilst the rest receive it with
+impunity. In the spring of the year 1776, I was desired to visit Mrs.
+H----, of S---- Park, who had repeatedly been attacked with painful
+colics, and had suffered much from insuperable costiveness; I
+suspected lead to be the cause of her complaints, but was unable to
+trace by what means it was taken. She was relieved by the usual
+methods; but, a few months afterwards, I was desired to see her again:
+her sufferings were the same as before, and notwithstanding every
+precaution to guard against costiveness, she was never in perfect
+health, and seldom escaped severe attacks twice or thrice in a year;
+she had also frequent pains in her joints. I could not find any traces
+of similar complaints either in Mr. H----, the children, or the
+servants. Mrs. H----was a water drinker, and seldom tasted any
+fermented liquor. The pump was of wood, as I had been informed upon my
+first visit. Her health continued nearly in the same state for two or
+three years more, but she always found herself better if she left her
+own house for any length of time. At length it occurred to me, that
+though the pump was a wooden one, the piston might work in lead. I
+therefore ordered the pump rods to be drawn up, and upon examination
+with a magnifying glass, found the leather of the piston covered with
+an infinite number of very minute shining particles of lead. Perhaps
+in this instance the metal was so minutely divided by abrasion, as to
+be mechanically suspended in the water. The lady was directed to drink
+the water of a spring, and never to swallow that from the pump. The
+event confirmed my suspicions, for she gradually recovered a good
+state of health, lost the obstinate costiveness, and has never to this
+day had any attack of the colic.
+
+
+                              CASE LIII.
+
+_September_ 28th. Mrs. J----, Æt. 70. Ascites and very thick
+anasarcous legs and thighs, total loss of strength and appetite.
+Infusion of Digitalis was given, but, as had been prognosticated, with
+no good effect.
+
+
+                               CASE LIV.
+
+_September_ 30th. Mr. A----, Æt. 57. A strong man; hydrothorax and
+swelled legs; in other respects not unhealthful. He was directed to
+take two grains of the Pulv. fol. Digit. made into a pill with gum
+ammoniac. Forty grains thus taken at intervals, effected a cure by
+increasing the quantity of urine, and he has had no relapse.
+
+
+                               CASE LV.
+
+_November_ 2d. Mr. P---- of T----, Æt. 42. A very strong man, drank a
+great quantity of strong ale, and was much exposed to alterations of
+heat and cold. About the end of summer found himself short winded, and
+lost his appetite. The dyspnœa gradually increased, he got a most
+distressing sense of tightness across his stomach, his urine was
+little, and high coloured, and his legs began to swell; his pulse
+slender and feeble. From the 20th of _September_ I frequently saw him,
+and observed a gradual and regular increase of all his complaints,
+notwithstanding the use of the most powerful medicines I could
+prescribe. He took chrystals of tartar, seneka, gum ammoniac, saline
+draughts, emetics, tinct. of cantharides, spirits of nitre dulcified,
+squills in all forms, volatile alkaly, calomel, Dover's powder, &c.
+Blisters and drastic purgatives were tried, interposing salt of steel
+and gentian. I had all along felt a reluctance to prescribe the
+Digitalis in this case, from a persuasion that it would not succeed.
+At length I was compelled to it, and directed one grain to be given
+every two hours until it should excite nausea. This it did; but, as I
+expected, it did no more. The reason of this belief will be mentioned
+hereafter. Five days after this last trial I gave him assafetida in
+large quantity, flattered by a hope that his extreme sufferings from
+the state of his respiration, might perhaps arise in part from spasm,
+but my hopes were in vain. I now thought of using an infusion of
+tobacco, and prescribed the following:
+
+    R. Fol. Nicotian. incis. ʒii.
+    Aq. bull. ℔ss.
+    Sp. Vini rectif. ℥i digere per horam.
+
+I directed a spoonful of this to be given every two hours until it
+should vomit. This medicine had no better effect than the former ones,
+and he died some days afterwards.
+
+
+                               CASE LVI.
+
+_November_ 6th. Mr. H----, Æt. 47. In the last stage of a phthisis
+pulmonalis, suffered much from dyspnœa, and anasarca. Squill
+medicines gave no relief. Digitalis in pills, with gum ammon. purged
+him, but opium being added, that effect ceased, and he continued to be
+relieved by them as long as he lived.
+
+
+                              CASE LVII.
+
+_November_ 16th. Mrs. F----, Æt. 53. In _August_ last was suddenly
+seized with epileptic fits, which continued to recur at uncertain
+intervals. Her belly had long been larger than natural, but without
+any perceptible fluctuation. Her legs and thighs swelled very
+considerably the beginning of this month, and now there was evidently
+water in the abdomen. The medicines hitherto in vain directed against
+the epileptic attacks, were now suspended, and two grains of the Pulv.
+fol. Digital. directed to be taken every six hours. The effects were
+most favourable, and the dropsical symptoms were soon removed by
+copious urinary discharges.
+
+The attacks of epilepsy ceased soon afterwards. In _February_, 1781,
+there was some return of the swellings, which were soon removed, and
+she now enjoys very good health. Does not the narrative of this case
+throw light upon the nature of the epilepsy which sometimes attacks
+women, soon after the cessation of the menstrual flux?
+
+
+                                 1781.
+
+                              CASE LVIII.
+
+_January_ 1st. Mrs. G----, of H----, Æt. 62. Ascites and very large
+hard legs. After trying various medicines, under the direction of a
+very able physician, I ordered her to take one grain of Pulv.
+Digital. every six hours, but it produced no effect. Other Medicines
+were then tried to as little purpose. About the end of _February_, I
+directed an infusion of the Fol. Digital. but with no better success.
+Other methods were thought of, but none proved efficacious, and she
+died a few weeks afterwards.
+
+
+                               CASE LIX.
+
+_January_ 3d. Mrs. B----, Æt. 53. Ascites, anasarca, and jaundice.
+After a purge of calomel and jallap, was ordered the Infusion of
+Digitalis: it acted kindly as a diuretic, and greatly reduced her
+swellings. Other medicines were then administered, with a view to her
+other complaints, but to no purpose, and she died about a month
+afterwards.
+
+
+                               CASE LX.
+
+_January_ 14th. Mr. B----, of D----. Jaundice and ascites, the
+consequences of great intemperance. Extremely emaciated; his tongue
+and fauces covered with apthous crusts, and his appetite gone. He
+first took tincture of cantharides with infusum amarum, then vitriolic
+salts, and various other medicines without relief; Infusum Digitalis
+was given afterwards, but was equally unsuccessful.
+
+
+                               CASE LXI.
+
+_February_ 2d. I was desired by the late learned and ingenious Dr.
+Groome, to visit Miss S----, a young lady in the last state of
+emaciation from a dropsy. Every probable means to relieve her had been
+attempted by Dr. Groome, but to no purpose; and she had undergone the
+operation of the paracentesis repeatedly. The Doctor knew, he said,
+that I had cured many cases of dropsy, by the Digitalis, after other
+more usual methods had been attempted without success, and he wished
+this lady to try that medicine under my direction; after examining the
+patient, and enquiring into the history of the disease, I was
+satisfied that the dropsy was encysted, and that no medicine could
+avail. The Digitalis, however, was directed, and she took it, but
+without advantage. She had determined not to be tapped again, and
+neither persuasion, nor distress from the distension, could prevail
+upon her: I at length proposed to make an opening into the sac, by
+means of a caustic, which was done under the judicious management of
+Mr. Wainwright, surgeon, at Dudley. The water was evacuated without
+any accident, and the patient afterwards let it out herself from time
+to time as the pressure of it became troublesome, until she died at
+length perfectly exhausted.
+
+_Query._ Is there not a probability that this method, assisted by
+bandage, might be used so as to effect a cure, in the earlier stages
+of ovarium dropsy?
+
+
+                              CASE LXII.
+
+_February_ 27th. Mrs. O----, of T----, Æt. 52, with a constitution
+worn out by various complicated disorders, at length became
+dropsical. The Digitalis was given in small doses, in hopes of
+temporary benefit, and it did not fail to fulfil our expectations.
+
+
+                              CASE LXIII.
+
+_March_ 16th. Mrs. P----, Æt. 47. Great debility, pale countenance,
+loss of appetite, legs swelled, urine in small quantity. A dram of
+Fol. siccat. Digital. in a half pint infusion was ordered, and an
+ounce of this infusion directed to be taken every morning. Myrrh and
+steel were given at intervals. Her urine soon increased, and the
+symptoms of dropsy disappeared.
+
+
+                              CASE LXIV.
+
+_March_ 18th. Mr. W----, in the last stage of a pulmonary consumption
+became dropsical. The Digitalis was given, but without any good
+effect.
+
+
+                               CASE LXV.
+
+_April_ 6th. Mr. B----, Æt. 63. For some years back had complained of
+being asthmatical, and was not without suspicion of diseased viscera.
+The last winter he had been mostly confined to his house; became
+dropsical, lost his appetite, and his skin and eyes turned yellow. By
+the use of medicines of the deobstruent class he became less
+discoloured, and the hardness about his stomach seemed to yield; but
+the ascites and anasarcous symptoms increased so as to oppress his
+breathing exceedingly. Alkaline salts, and other diuretics failing of
+their effects, I ordered him to take an infus. of Digitalis. It
+operated so powerfully that it became necessary to support him with
+cordials and blisters, but it freed him from the dropsy, and his
+breath became quite easy. He then took soap, rhubarb, tartar of
+vitriol, and steel, and gradually attained a good state of health,
+which he still continues to enjoy.
+
+
+                              CASE LXVI.
+
+_April_ 8th. Mr. B----, Æt. 60. A corpulent man, with a stone in his
+bladder, from which at times his sufferings are extreme. He had been
+affected with what was supposed to be an asthma, for several years by
+fits, but through the last winter his breath had been much worse than
+usual; universal anasarca came on, and soon afterwards an ascites. Now
+his urine was small in quantity and much saturated, the dysuria was
+more dreadful than ever; his breath would not allow him to lie in bed,
+nor would the dysuria permit him to sleep; in this distressful
+situation, after having used other medicines to little purpose, I
+directed an infusion of Digitalis to be given. When the quantity of
+urine became more plentiful, the pain from his stone grew easier; in a
+few days the dropsy and asthma disappeared, and he soon regained his
+usual strength and health. Every year since, there has been a tendency
+to a return of these complaints, but he has recourse to the infusion,
+and immediately removes them.
+
+
+                              CASE LXVII.
+
+_April_ 24th. Mr. M----, of C----, Æt. 57. Asthma, anasarca, jaundice,
+and great hardness and straitness across the region of the stomach.
+After a free exhibition of neutral draughts, alkaline salt, &c. the
+dropsy and difficult breathing remaining the same, he took Infusum
+Digitalis, which removed those complaints. He never lost the hardness
+about his stomach, but enjoyed very tolerable health for three years
+afterwards, without any return of the dropsy.
+
+
+                             CASE LXVIII.
+
+_April_ 25th. Mrs. J----, Æt. 42. Phthisis pulmonalis and anasarcous
+legs and thighs. She took the Infusum Digitalis without effect. Myrrh
+and steel, with fixed alkaly, were then ordered, but to no purpose.
+
+
+                              CASE LXIX.
+
+_May_ 1st. Master W----, of St----, Æt. 6. I found him with every
+symptom of hydrocephalus internus. As it was yet early in the disease,
+in consequence of ideas which will be mentioned hereafter, I directed
+six ounces of blood to be immediately taken from the arm; the temporal
+artery to be opened the succeeding day; the head to be shaven, and six
+pints of cold water to be poured upon it every fourth hour, and two
+scruples of strong mercurial ointment to be rubbed into the legs
+every day. Five days afterwards, finding the febrile symptoms very
+much abated, and judging the remaining disease to be the effect of
+effusion, I directed a scruple of Fol. Digital. siccat. to be infused
+in three ounces of water, and a table spoonful of the infusion to be
+given every third or fourth hour, until its action should be someway
+sensible. The effect was, an increased secretion of urine; and the
+patient soon recovered.
+
+
+                               CASE LXX.
+
+_May_ 3d. Mrs. B----, Æt. 59. Ascites and anasarca, with strong
+symptoms of diseased viscera. Infusum Digitalis was at first
+prescribed, and presently removed the dropsy. She was then put upon
+saline draughts and calomel. After some time she became feverish: the
+fever proved intermittent, and was cured by the bark.
+
+
+                              CASE LXXI.
+
+_May_ 3d. Mr. S----, Æt. 48. A strong man, who had lived
+intemperately. For some time past his breath had been very short, his
+legs swollen towards evening, and his urine small in quantity. Eight
+ounces of the Infus. Digitalis caused a considerable flow of urine;
+his complaints gradually vanished, and did not return.
+
+
+                              CASE LXXII.
+
+_May_ 24th. Joseph B----, Æt. 50. Ascites, anasarca, and jaundice,
+from intemperate living. Infusion of Digitalis produced nausea, and
+lowered the frequency of the pulse; but had no other sensible effects.
+His disorder continued to increase, and killed him about two months
+afterwards.
+
+
+                             CASE LXXIII.
+
+_June_ 29th. Mr. B----, Æt. 60. A hard drinker; afflicted with asthma,
+jaundice, and dropsy. His appetite gone; his water foul and in small
+quantity. Neutral saline mixture, chrystals of tartar, vinum
+chalybeat. and other medicines had been prescribed to little
+advantage. Infusion of Fol. Digitalis acted powerfully as a diuretic,
+and removed the most urgent of his complaints, viz. the dropsical and
+asthmatical symptoms.
+
+The following winter his breathing grew bad again, his appetite
+totally failed, and he died, but without any return of the ascites.
+
+
+                              CASE LXXIV.
+
+_June_ 29th. Mr. A----, Æt. 58. Kept a public house and drank very
+hard. He had symptoms of diseased viscera, jaundice, ascites, and
+anasarca. After taking various deobstruents and diuretics, to no
+purpose, he was ordered the Infusion of Digitalis: a few doses
+occasioned a plentiful flow of urine, relieved his breath, and reduced
+his swellings; but, on account of his great weakness, it was judged
+imprudent to urge the medicine to the entire evacuation of the water.
+He was so much relieved as to be able to come down stairs and to walk
+about, but his want of appetite and jaundice continuing, and his
+debility increasing, he died in about two months.
+
+
+                              CASE LXXV.
+
+_July_ 18th. Mrs. B----, Æt. 46. A little woman, and very much
+deformed. Asthmatical for many years. For several months past had been
+worse than usual; appetite totally gone, legs swollen, sense of great
+fulness about her stomach, countenance fallen, lips livid, could not
+lie down.
+
+The usual modes of practice failing, the Digitalis was tried, but with
+no better success, and in about a month she died; not without
+suspicion of her death having been accelerated a few days, by her
+taking half a grain of opium. This may be a caution to young
+practitioners to be careful how they venture upon even small doses of
+opium in such constitutions, however much they may be urged by the
+patient to prescribe something that may procure a little rest and
+ease.
+
+
+                              CASE LXXVI.
+
+_August_ 12th. Mr. L----, Æt. 65, the person whose Case is recorded at
+No. XXIV, had a return of his insanity, after near two years perfect
+health. He was extremely reduced when I saw him, and the medicine
+which cured him before was now administered without effect, for his
+weakness was such that I did not dare to urge it.
+
+
+                             CASE LXXVII.
+
+_September_ 10th. Mr. V----, of S----, Æt. 47. A man of strong fibre,
+and the remains of a florid complexion. His disease an ascites and
+swelled legs, the consequence of a very free course of life; he had
+been once tapped, and taken much medicine before I saw him. The
+Digitalis was now directed: it lowered his pulse, but did not prove
+diuretic. He returned home, and soon after was tapped again, but
+survived the operation only a few hours.
+
+
+                             CASE LXXVIII.
+
+_September_ 25th. Mr. O----, of M----, Æt. 63. Very painful and
+general swellings in all his limbs, which had confined him mostly to
+his bed since the preceding winter; the swellings were uniform, tense,
+and resisting, but the skin not discoloured. After trying guiacum and
+Dover's powder without advantage. I directed Infusion of Digitalis. It
+acted on the kidneys, but did net relieve him. It is not easy to say
+what the disease was, and the patient living at a distance, I never
+learnt the future progress or termination of it.
+
+
+                              CASE LXXIX.
+
+_September_ 26th. Mr. D----, Æt. 42, a very sensible and judicious
+surgeon at B----, in Staffordshire, laboured under ascites and very
+large anasarcous legs, together with indubitable symptoms of diseased
+viscera. Having tried the usual diuretics to no purpose, I directed a
+scruple of Fol. Digital siccat. in a four ounce infusion, a table
+spoonful to be taken twice a day. The second bottle wholly removed his
+dropsy, which never returned.
+
+
+                              CASE LXXX.
+
+_September_ 27th. Mrs. E----, Æt. 42. A fat sedentary woman; after a
+long illness, very indistinctly marked; had symptoms of enlarged liver
+and dropsy. In this case I was happy in the assistance of Dr. Ash.
+Digitalis was once exhibited in small doses, but to no better purpose
+than many other medicines. She suffered great pain in the abdomen for
+several weeks, and after her death, the liver, spleen, and kidneys
+were found of a pale colour, and very greatly enlarged, but the
+quantity of effused fluid in the cavity was not more than a pint.
+
+
+                              CASE LXXXI.
+
+_October_ 28th. Mr. B----, Æt. 33. Had drank an immense quantity of
+mild ale, and was now become dropsical. He was a lusty man, of a pale
+complexion: his belly large, and his legs and thighs swollen to an
+enormous size. I directed the Infusion of Digitalis, which in ten days
+completely emptied him. He was then put upon the use of steel and
+bitters, and directed to live temperately, which I believe he did, for
+I saw him two years afterwards in perfect health.
+
+
+                             CASE LXXXII.
+
+_November_ 14th. Mr. W----, of T----, Æt. 49. A lusty man, with an
+asthma and anasarca. He had taken several medicines by the direction
+of a very judicious apothecary, but not getting relief as he had been
+accustomed to do in former years, he came under my direction. For the
+space of a month I tried to relieve him by fixed alkaly, seneka,
+Dover's powder, gum ammoniac, squill, &c. but without effect. I then
+directed Infusion of Digitalis, which soon increased the flow of urine
+without exciting nausea, and in a few days removed all his
+complaints.
+
+
+                                 1782.
+
+                             CASE LXXXIII.
+
+_January_ 23d. Mr. Q----, Æt. 74. A stone in his bladder for many
+years; dropsical for the last three months. Had taken at different
+times soap with squill and gum ammoniac; soap lees; chrystals of
+tartar, oil of juniper, seneka, jallap, &c. but the dropsical symptoms
+still increased, and the dysuria from the stone became very urgent. I
+now directed a dram of the Fol. Digit. siccat. in a half pint
+infusion, half an ounce to be given every six hours. This presently
+relieved the dysuria, and soon removed the dropsy, without any
+disturbance to his system.
+
+
+                             CASE LXXXIV.
+
+_January_ 27th. Mr. D----, Æt. 86. The debility of age and dropsical
+legs had long oppressed him. A few weeks before his death his
+breathing became very short, he could not lie down in bed, and his
+urine was small in quantity. A wine glass of a weak Infusion of
+Digitalis, warmed with aromatics, was ordered to be taken twice a day.
+It afforded a temporary relief, but he did not long survive.
+
+
+                              CASE LXXXV.
+
+_January_ 28th. Mr. D----, Æt. 35. A publican and a hard drinker.
+Ascites, anasarca, diseased viscera, and slight attacks of hæmoptoe.
+A dram of Fol. Digital. sicc. in a half pint infusion, of which one
+ounce was given night and morning, proved diuretic and removed his
+dropsy. He then took medicines calculated to relieve his other
+complaints. The dropsy did not return during my attendance upon him,
+which was three or four weeks. A quack then undertook to cure him with
+blue vitriol vomits, but as I am informed, he presently sunk under
+that rough treatment.
+
+
+                             CASE LXXXVI.
+
+_January_ 29th. Mrs. O----, of D----, Æt. 53. A constant and
+distressing palpitation of her heart, with great debility. From a
+degree of anasarca in her legs I was led to suspect effusion in the
+Pericardium, and therefore directed Digitalis, but it produced no
+benefit. She then took various other medicines with the same want of
+success, and about ten months afterwards died suddenly.
+
+
+                             CASE LXXXVII.
+
+_January_ 31st. Mr. T----, of A----, Æt. 81. Great difficulty of
+breathing, so that he had not lain in bed for the last six weeks, and
+some swelling in his legs. These complaints were subsequent to a very
+severe cold, and he had still a troublesome cough. He told me that at
+his age he did not look for a cure, but should be glad of relief, if
+it could be obtained without taking much medicine. I directed an
+Infusion of Digitalis, a dram to eight ounces, one spoonful to be
+taken every morning, and two at night. He only took this quantity; for
+in four days he could lie down, and soon afterwards quitted his
+chamber. In a month he had a return of his complaints, and was
+relieved as before.
+
+
+                            CASE LXXXVIII.
+
+_January_ 31st. Mrs. J----, of S----, Æt. 67. A lusty woman, of a
+florid complexion, large belly, and very thick legs. She had been kept
+alive for some years by the discharge from ulcers in her legs; but the
+sores now put on a very disagreeable livid appearance, her belly grew
+still larger, her breath short, her pulse feeble, and she could not
+take nourishment. Several medicines having been given in vain, the
+Digitalis was tried, but with no better effect; and in about a month
+she died.
+
+
+                             CASE LXXXIX.
+
+_February_ 2d. Mr. B----, Æt. 73. An universal dropsy. He took various
+medicines, and Digitalis in small doses, but without any good effect.
+
+
+                               CASE XC.
+
+_February_ 24th. Master M----, of W----, Æt. 10. An epilepsy of some
+years continuance, which had never been interrupted by any of the
+various methods tried for his relief. The Digitalis was given for a
+few days, but as he lived at a distance, so that I could not attend to
+its effects, he only took one half pint infusion, which made no
+alteration in his complaint.
+
+
+                               CASE XCI.
+
+_March_ 6th. Mr. H----, Æt. 62. A very hard drinker, and had twice had
+attacks of apoplexy. He had now an ascites, was anasarcous, and had
+every appearance of a diseased liver. Small doses of calomel, Dover's
+powder, infusum amarum, and sal sodæ palliated his symptoms for a
+while; these failing; blisters, squills, and cordials were given
+without effect. A weak Infusion of Digitalis, well aromatised, was
+then directed to be given in small doses. It rather seemed to check
+than to increase the secretion of urine, and soon produced sickness.
+Failing in its usual effect, the medicine was no longer continued; but
+every thing that was tried proved equally inefficacious, and he did
+not long survive.
+
+
+                              CASE XCII.
+
+_May_ 10th. Mrs. P----, Æt. 40. Spasmodic asthma of many years
+continuance, which had frequently been relieved by ammoniacum,
+squills, &c. but these now failing in their wonted effects, an Infus.
+of Fol. Digitalis was tried, but it seemed rather to increase than
+relieve her symptoms.
+
+
+                              CASE XCIII.
+
+_May_ 22d. Mr. O----, of B----, Æt. 61. A very large man, and a free
+liver; after an attack of hemiplegia early in the spring, from which
+he only partially recovered, became dropsical. The dropsy occupied
+both legs and thighs, and the arm of the affected side. I directed an
+Infusion of Digitalis in small doses, so as not to affect his stomach.
+The swellings gradually subsided, and in the course of the summer he
+recovered perfectly from the palsy.
+
+
+                              CASE XCIV.
+
+_July_ 5th. Mr. C----, of W----, Æt. 28. Had drank very freely both of
+ale and spirits; and in consequence had an ascites, very large legs,
+and great fulness about the stomach. He was ordered to take the
+Infusion of Digitalis night and morning for a few days, and then to
+keep his bowels open with chrystals of tartar. The first half pint of
+infusion relieved him greatly; after an interval of a fortnight it was
+repeated, and he got well without any other medicine, only continuing
+the chrystals of tartar occasionally. I forgot to mention that this
+gentleman, before I saw him, had been for two months under the care of
+a very celebrated physician, by whose direction he had taken
+mercurials, bitters, squills, alkaline salts, and other things, but
+without much advantage.
+
+
+                               CASE XCV.
+
+_March_ 6th. Mrs. W----, Æt. 36. In the last stage of a pulmonary
+consumption, took the Infus. Digitalis, but without any advantage.
+
+
+                              CASE XCVI.
+
+_August_ 20th. Mr. P----, Æt. 43. In the year 1781 he had a severe
+peripneumony, from which he recovered with difficulty. At the date of
+this, when he first consulted me, the symptoms of hydrothorax were
+pretty obvious. I directed a purge, and then the Infusum Digitalis,
+three drams to half a pint, one ounce to be taken every four hours. It
+made him sick, and occasioned a copious discharge of urine. His
+complaints immediately vanished, and he remains in perfect health.
+
+
+                              CASE XCVII.
+
+_September_ 24th. Mrs. R----, of B----, Æt. 35, the mother of many
+children. After her last lying in, three months ago, had that kind of
+swelling in one of her legs which is mentioned at No. VIII. XXVI, and
+XXXI. A considerable degree of swelling still remained; the limb was
+heavy to her feeling, and not devoid of pain. I directed a bolus of
+five grains of Pulv. Digitalis, and twenty-five of crude quicksilver
+rubbed down, with conserve of cynosbat. to be taken at bed-time, and
+afterwards an Infusion of red bark and Fol. Digitalis to be taken
+twice a day. There was half an ounce of bark and half a dram of the
+leaves in a pint infusion: the dose two ounces.
+
+The leg soon began to mend, and two pints of the infusion finished the
+cure.
+
+
+                             CASE XCVIII.
+
+_September_ 25th. Mr. R----, Æt. 60. Complained to me of a sickness
+after eating, and for some weeks past he had thrown up all his food,
+soon after he had swallowed it. He had taken various medicines, but
+found benefit from none, and had tried various kinds of diet. He was
+now very thin and weak; but had a good appetite. As several very
+probable methods had been prescribed, and as the usual symptoms of
+organic disease were absent, I determined to give him a spoonful of
+the Infusion of Digitalis twice a day; made by digesting two drams of
+the dried leaves in half a pint of cinnamon water. From the time he
+began to take this medicine he suffered no return of his complaint,
+and soon recovered his flesh and his strength.
+
+It should be observed, that I had frequently seen the Digitalis remove
+sickness, though prescribed for very different complaints.
+
+
+                              CASE XCIX.
+
+_September_ 30th. Mrs. A----, Æt. 38. Hydrothorax and anasarca. Her
+chest was very considerably deformed. One half pint of the Digitalis
+Infusion entirely cured her.
+
+
+                                CASE C.
+
+_September_ 30th. Mr. R----, of W----, Æt. 47. Hydrothorax and
+anasarca. An Infusion of Digitalis was directed, and after the
+expected effects from that should take place, sixty drops of tincture
+of cantharides twice a day. As he was costive, pills of aloes and
+steel were ordered to be taken occasionally.
+
+This plan succeeded perfectly. About a month afterwards he had some
+rheumatic affections, which were removed by guiacum.
+
+
+                               CASE CI.
+
+_October_ 2d. Mrs. R----, Æt. 60. Diseased viscera; ascites and
+anasarca. Had taken various deobstruent and diuretic medicines to
+little purpose. The Digitalis brought on a nausea and languor, but had
+no effect on the kidneys.
+
+
+                               CASE CII.
+
+_October_ 12th. Mr. R----, Æt. 41. A publican, and a hard drinker. His
+legs and belly greatly swollen; appetite gone, countenance yellow,
+breath very short, and cough troublesome. After a vomit I gave him
+calomel, saline draughts, steel and bitters, &c. He had taken the more
+usual diuretics before I saw him. As the dropsical symptoms increased,
+I changed his medicines for pills made of soap, containing two grains
+of Pulv. fol. Digital, in each dose, and, as he was costive, two
+grains of jallap. He took them twice a day, and in a week was free
+from every appearance of dropsy. The jaundice soon afterwards
+vanished, and tonics restored him to perfect health.
+
+
+                              CASE CIII.
+
+_October_ 12th. Mr. B----, Æt. 39. Kept a public house, drank very
+freely, and became dropsical; he complained also of rheumatic pains. I
+directed Infusion of Digitalis, half an ounce twice a day. In eight
+days the swellings in his legs and the fulness about his stomach
+disappeared. His rheumatic affections were cured by the usual methods.
+
+
+                               CASE CIV.
+
+_October_ 22d. Master B----, Æt. 3. Ascites and universal anasarca.
+Half a grain of Fol. Digital. siccat. given every six hours, produced
+no effect; probably the medicine was wasted in giving. An infusion of
+the dried leaf was then tried, a dram to four ounces, two tea
+spoonfuls for a dose; this soon increased the flow of urine to a very
+great degree, and he got perfectly well.
+
+
+                               CASE CV.
+
+_October_ 30th. Mr. G----, of W----, Æt. 88. The gentleman mentioned
+in No. XLVII. His complaints and manner of living the same as there
+mentioned. I ordered an Infusion of the Digitalis, a dram and half to
+half a pint; one ounce to be taken twice a day; which cured him in a
+short time.
+
+On _March_ the 23d, 1784, he sent for me again. His complaints were
+the same, but he was much more feeble. On this account I directed a
+dram of the Fol. Digitalis to be infused for a night in four ounces of
+spirituous cinnamon water, a spoonful to be taken every night. This
+had not a sufficient effect; therefore, on the 22d of _April_, I
+ordered the infusion prescribed two years before, which soon removed
+his complaints.
+
+He died soon afterwards, fairly worn out, in his ninetieth year.
+
+
+                               CASE CVI.
+
+_November_ 2d. Mr. S----, of B----h----, Æt. 61. Hydrothorax and
+swelled legs. Squills were given for a week in very full doses, and
+other modes of relief attempted; but his breathing became so bad, his
+countenance so livid, his pulse so feeble, and his extremities so
+cold, that I was apprehensive upon my second visit that he had not
+twenty-four hours to live. In this situation I gave him the Infusum
+Digitalis stronger than usual, viz. two drams to eight ounces. Finding
+himself relieved by this, he continued to take it, contrary to the
+directions given, after the diuretic effects had appeared.
+
+The sickness which followed was truly alarming; it continued at
+intervals for many days, his pulse sunk down to forty in a minute,
+every object appeared green to his eyes, and between the exertions of
+reaching he lay in a state approaching to syncope. The strongest
+cordials, volatiles, and repeated blisters barely supported him. At
+length, however, he did begin to emerge out of the extreme danger into
+which his folly had plunged him; and by generous living and tonics, in
+about two months he came to enjoy a perfect state of health.
+
+
+                              CASE CVII.
+
+_November_ 19th. Master S----, Æt. 8. Ascites and anasarca. A dram of
+Fol. Digitalis in a six ounce infusion, given in doses of a spoonful,
+effected a perfect cure, without producing nausea.
+
+
+                                 1783.
+
+The reader will perhaps remark, that from the middle of _January_ to
+the first of _May_, not a single case occurs, and that the amount of
+cases is likewise less than in the preceding or ensuing years; to
+prevent erroneous conjectures or conclusions, it may be expedient to
+mention, that the ill state of my own health obliged me to retire from
+business for some time in the spring of the year, and that I did not
+perfectly recover until the following summer.
+
+
+                              CASE CVIII.
+
+_January_ 15th. Mrs. G----, Æt. 57. A very fat woman; has been
+dropsical since _November_ last; with symptoms of diseased viscera.
+Various remedies having been taken without effect, an Infusion of
+Digitalis was directed twice a day, with a view to palliate the more
+urgent symptoms. She took it four days without relief, and as her
+recovery seemed impossible it was urged no farther.
+
+
+                               CASE CIX.
+
+_May_ 1st. Mrs. D----, Æt. 72. A thin woman, with very large
+anasarcous legs and thighs; no appetite and general debility. After a
+month's trial of cordials and diuretics of different kinds, the
+surgeon who had scarified her legs apprehended they would mortify; she
+had very great pain in them, they were very red and black by places,
+and extremely tense. It was evident that unless the tension could be
+removed, gangrene must soon ensue. I therefore gave her Infusum
+Digitalis, which increased the secretion of urine by the following
+evening, so that the great tension began to abate, and together with
+it the pain and inflammation. She was so feeble that I dared not to
+urge the medicine further, but she occasionally took it at intervals
+until the time of her death, which happened a few weeks afterwards.
+
+
+                               CASE CX.
+
+_May_ 18th. I was desired to prescribe for Mary Bowen, a poor girl at
+Hagley. Her disease appeared to me to be an ovarium dropsy. In other
+respects she was in perfect health. I directed the Digitalis to be
+given, and gradually pushed so as to affect her very considerably. It
+was done; but the patient still carries her big belly, and is
+otherwise very well.
+
+
+                               CASE CXI.
+
+_May_ 25th. Mr. G----, Æt. 28. In the last stage of a pulmonary
+consumption of the scrophulous kind, took an Infusion of Digitalis,
+but without any advantage.
+
+
+                              CASE CXII.
+
+_May_ 31st. Mr. H----, Æt 27. In the last stage of a phthisis
+pulmonalis became dropsical. He took half a pint of the Infusum
+Digitalis in six days, but without any sensible effect.
+
+
+                              CASE CXIII.
+
+_June_ 3d. Master B----, of D----, Æt. 6. With an universal anasarca,
+had an extremely troublesome cough. An opiate was given to quiet the
+cough at night, and 2 tea spoonfuls of Infus. Digit. were ordered
+every six hours. The dropsy was presently removed; but the cough
+continued, his flesh wasted, his strength failed, and some weeks
+afterwards he died tabid.
+
+
+                              CASE CXIV.
+
+_June_ 19th. Mrs. L----, Æt. 28. A dropsy in the last stage of a
+phthisis. Infusum Digitalis was tried to no purpose.
+
+
+                               CASE CXV.
+
+_June_ 20th. Mrs. H----, Æt. 46. A very fat, short woman; had suffered
+severely through the last winter and spring from what had been called
+asthma; but for some time past an universal anasarca prevailed, and
+she had not lain down for several weeks. After trying vitriolic acid,
+tincture of cantharides, squills, &c. without advantage, she took half
+a pint of Infus. Digitalis in three days. In a week afterwards the
+dropsical symptoms disappeared, her breath became easy, her appetite
+returned, and she recovered perfect health. The infusion neither
+occasioned sickness nor purging.
+
+
+                              CASE CXVI.
+
+_June_ 24th. Mrs. B----, Æt. 40. A puerperal fever, and swelled legs
+and thighs. The fever not yielding to the usual practice, I directed
+an Infusion of Fol. Digitalis. It proved diuretic; the swellings
+subsided, but the fever continued, and a few days afterwards a
+diarrhœa coming on, she died.
+
+
+                              CASE CXVII.
+
+_July_ 22d. Mr. F----, Æt. 48. A strong man, of a florid complexion,
+in consequence of intemperance became dropsical, with symptoms of
+diseased viscera, great dyspnœa, a very troublesome cough, and
+total loss of appetite. He took mild mercurials, pills of soap,
+rhubarb, and tartar of vitriol, with soluble tartar and dulcified
+spirits of nitre in barley water. After a reasonable trial of this
+plan, he took squill every six hours, and a solution of assafetida and
+gum ammoniac, to ease his breathing: finding no relief, I gave him
+chrystals of tartar with ginger; but his remaining health and strength
+daily declined, and he was not at all benefited by the medicines. I
+was averse to the use of Digitalis in this case, judging from what I
+had seen in similar instances of tense fibre, that it would not act as
+a diuretic. I therefore once more directed squill, with decoction of
+seneka and sal sodæ; but it was inefficacious. His strength being much
+broken down, I then ordered gum ammoniac, with small doses of opium,
+and infusum amarum, continuing the squill at intervals. At length I
+was urged to give the Digitalis, and considering the case as
+desperate, I agreed to do it. The event was as I expected; no increase
+in the urine took place; and the medicine being still continued, his
+pulse became slow, and he apparently sunk under its sedative effects.
+He was neither purged nor vomited; and had the Digitalis either been
+omitted altogether, or suspended upon its first effects upon the
+pulse being observed, he might perhaps have existed a week longer.
+
+
+                             CASE CXVIII.
+
+_July_ 26th. Mr. W----, of W----, Æt. 47. Phthisis pulmonalis,
+jaundice, ascites, and swelled legs. As it was probable that the only
+relief I could give in a case so circumstanced, would be by carrying
+off the effused fluids. I tried squill and fixed alkaly; and these
+failing, I ordered the Infusum Digitalis. This had the desired effect,
+and, I believe, prolonged his life a few weeks.
+
+
+                              CASE CXIX.
+
+_August_ 15th. Mrs. C----, Æt. 60. Ascites, anasarca, diseased
+viscera, paucity of urine, and total loss of appetite. These
+complaints had heretofore existed repeatedly, and had been removed by
+deobstruent and diuretic medicines; but in this attack the symptoms
+were suffered to exist a longer time and in a greater degree, before
+assistance was sought for. The remedies that used to relieve her were
+now exhibited to no purpose. Mild mercurials, soap, rhubarb, and
+squill were tried; but she grew rapidly worse. Saline draughts with
+acetum scilliticum seemed for a few days to check the progress of her
+complaint, but they soon lost their effect, and diarrhœa ensued
+upon every attempt to increase the frequency of the dose. Draughts
+with Infus. Digital. were then directed to be taken twice a day. The
+effect was a powerful action on the kidneys, and a reduction of the
+swellings, but without sickness. A degree of appetite returned, but
+still the tendency to diarrhœa existed, and kept her weak. Tonic
+medicines were then tried, but without advantage, and in a month it
+was necessary to have recourse to the Digitalis again. It was directed
+in a half pint mixture; an ounce to be taken thrice in twenty-four
+hours. On the 2d day, finding her symptoms very much relieved, she
+took in the absence of her nurse, nearly a double dose of the
+medicine. The consequence was great sickness, languor continuing for
+several days, and almost a total stop to the secretion of urine, from
+the time the sickness commenced.
+
+The case now became totally unmanageable in my hands, and, after a
+fortnight, I was dismissed, and another physician called in; but she
+did not long survive.
+
+This was not the first, nor the last instance, in which I have seen
+too large a dose of the medicine, defeat the very purpose for which it
+was directed.
+
+
+                               CASE CXX.
+
+_August_ 22d. Mrs. S----, Æt. 36. Extreme faintiness; anasarcous legs
+and thighs; great difficulty of breathing, troublesome cough, frequent
+chilly fits succeeded by hot ones; night sweats, and a tendency to
+diarrhœa. Apprehensive that the more urgent symptoms were caused
+by water in the lungs, I directed an Infusion of Digitalis, with an
+ounce of diacodium to the half pint to prevent it purging, a wine
+glass full to be taken every night at bed-time, and a mixture with
+confect. cardiac. and pulv. ipecac. to be given in small doses after
+every loose stool.
+
+On the fourth day she was better in all respects; had made a large
+quantity of water and did not purge. In a few days more she lost all
+her complaints, except the cough, which gradually left her, without
+any further assistance.
+
+I was agreeably deceived in the event of this case, for I expected
+after the water was removed, to have had a phthisis to contend with.
+
+
+                              CASE CXXI.
+
+_August_ 25th. T---- W----, Esq; Æt, 50. A free liver, diseased
+viscera, belly very tense, and much swollen; fluctuation perceptible,
+but the swelling circumscribed; pulse 132. This gentleman was under
+the care of my very worthy friend Dr. Ash, who, having tried various
+modes of cure to no purpose, asked me if I thought the Digitalis would
+answer in this case. I replied that it would not, for I had never seen
+it effectual where the swelling appeared very tense and circumscribed.
+It was tried however, but did not lessen the swelling. I mention this
+case, to introduce the above remark, and also to point out the great
+effect the Digitalis has upon the action of the heart; for the pulse
+came down to 96. He was afterwards tapped, and continued, for some
+time under our joint attendance, but the pulse never became quicker,
+nor did the swelling return.
+
+
+                              CASE CXXII.
+
+_September_ 7th. Mr. L----, Æt. 43. After several severe attacks of
+ill formed gout, attended for some time past with jaundice and other
+symptoms of diseased viscera, the consequences of intemperate living,
+was sent to Buxton; from whence he returned in three weeks with
+ascites and anasarca. Under this complicated load of disease, I
+prescribed repeatedly without advantage, and at length gave him the
+Digitalis, which carried off the more obvious symptoms of dropsy; but
+the jaundice, loss of appetite, diseased viscera, &c. rendered his
+recovery impossible.
+
+
+                                 1784.
+
+                             CASE CXXIII.
+
+_February_ 12th. Mrs. C----, Æt. 54. A strong short woman of a florid
+complexion; complained of great fullness across the region of the
+stomach; short breath, a troublesome cough, loss of appetite, paucity
+of urine; and had a brownish yellow tinge on her skin and in her eyes.
+She dated these complaints from a fall she had through a trap door
+about the beginning of winter. From the beginning of January to this
+time, she had been repeatedly let blood, had taken calomel purges
+with jallap; pills of soap, rhubarb and calomel; saline julep with
+acet. scillit. nitrous decoction, garlic, mercury rubbed down, infus.
+amarum purg. &c. After the failure of medicines so powerful, and
+seemingly so well adapted, and during the use of which all the
+symptoms continued to increase, it was evident that a favourable event
+could not be expected. However, I tried the infusum Digitalis, but it
+did nothing. I then gave her pills of quicksilver, soap and squill,
+with decoction of dandelion, and after some time, chrystals of tartar
+with ginger. Nothing succeeded to our wishes, and the increase of
+orthopnœa compelled me occasionally to relieve her by drastic
+purges, but these diminished her strength, more in proportion than
+they relieved her symptoms. Tincture of cantharides, sal diureticus
+and various other means were occasionally tried, but with very little
+effect, and she died towards the end of March.
+
+
+                              CASE CXXIV.
+
+_March_ 31st. Miss W----, Æt. 60. Had been subject to peripneumonic
+affections in the winter. She had now total loss of appetite, very
+great debility, difficult breathing; much cough, a considerable degree
+of expectoration, and a paucity of urine. She had been blooded, taken
+soap, assaf. and squill, afterwards assaf. and ammon. with acet.
+scillit.: but all her complaints increasing, a blister was applied to
+her back, and the Digitalis infusion directed to be taken every night.
+The effect was an increased secretion of urine, a considerable relief
+to her breath, and some return of appetite; but soon afterwards she
+became hectic, spat purulent matter, and died in a few weeks.
+
+
+                              CASE CXXV.
+
+_April_ 12th. Mrs. H----, of L----, Æt. 61. In _December_ last this
+Lady, then upon a visit in London, was attacked with severe symptoms
+of peripneumony. She was treated as an asthmatic patient, but finding
+no relief, she made an effort to return to her home to die. In her way
+through this place, the latter end of December, I was desired to see
+her. By repeated bleedings, blisters, and other usual methods, she was
+so far relieved, that she wished to remain under my care. After a
+while she began to spit matter and became hectic. With great
+difficulty she was kept alive during the discharge of the abscess, and
+about the end of March she had swelled legs, and unequivocal symptoms
+of dropsy in the chest. Other diuretics failing, on the 12th of April
+I was induced to give her the Digitalis in small doses. The relief was
+great and effectual. After an interval of fifteen days, some swellings
+still remaining in the legs, I repeated the medicine, and with such
+good effect, that she lost all her complaints, got a keen appetite,
+recovered her strength, and about the end of May undertook a journey
+of fifty miles to her own home, where she still remains in perfect
+health.
+
+
+                              CASE CXXVI.
+
+_April_ 17th. Mr. F----, Æt. 59. A very fat man, and a free liver; had
+long been subject to what was called asthma, particularly in the
+winter. For some weeks past his legs swelled, he had great sense of
+fullness across his stomach; a severe cough; total loss of appetite,
+thirst great, urine sparing, his breath so difficult that he had not
+lain down in bed for several nights. Calomel, gum ammoniac, tincture
+of cantharides, &c. having been given in vain, I ordered two grains of
+pulv. fol. Digitalis made into pills, with aromatic species and syrup,
+to be given every night. On the third day his urine was less turbid;
+on the fourth considerably increased in quantity, and in ten days more
+he was free from all complaints, and has since had no relapse.
+
+
+                             CASE CXXVII.
+
+_May_ 7th. Miss K----, Æt. 8. After a long continued ague, became
+hectic and dropsical. Her belly was very large, and she had a total
+loss of appetite. Half a grain of fol. Digital, pulv. with 2 gr. of
+merc. alcalis. were ordered night and morning, and an infusion of bark
+and rhubarb with steel wine to be given in the day time. Her belly
+began to subside in a few days, and she was soon restored to health.
+Two other children in the family, affected nearly in the same way, had
+died, from the parents being persuaded that an ague in the spring was
+healthful and should not be stopped.--I know not how far the recovery
+in this case may be attributed to the Digitalis, but the child was so
+near dying that I dared not trust to any less efficacious diuretic.
+
+
+                             CASE CXXVIII.
+
+_June_ 13th. Mr. C----, Æt. 45. A fat man, had formerly drank hard,
+but not latterly: last March began to complain of difficult breathing,
+swelled legs, full belly, but without fluctuation, great thirst, no
+appetite; urine thick and foul; complection brownish yellow. Mercurial
+medicines, diuretics of different kinds, and bitters, had been trying
+for the last three months, but with little advantage. I directed two
+grains of the fol. Digital. in powder to be taken every night, and
+infus. amar. with tinct. sacr. twice a day. In three days the quantity
+of his urine increased, in ten or twelve days all his symptoms
+disappeared, and he has had no relapse.
+
+
+                              CASE CXXIX.
+
+_June_ 17th. Mr. N----, of W----, Æt. 54. A large man, of a pale
+complexion; had been subject to severe fits of asthma for some years,
+but now worse than usual. The intermitting pulse, the great
+disturbance from change of posture, and the swelled legs induced me to
+conclude that the exacerbation of his old complaint was occasioned by
+serous effusion. I directed pills with a grain and half of the pulv.
+Digital. to be taken every night, and as he was costive, jallap made a
+part of the composition. He was also directed to take mustardseed
+every morning and a solution of assafetida twice in the day. The
+effect of this plan was perfectly to our wishes, and in a short time
+he recovered his usual health. About half a year afterwards he died
+apoplectic.
+
+
+                              CASE CXXX.
+
+_Mary_ B----. A young unmarried woman. Her disease appeared to me a
+dropsy of the right ovarium. She took an infusion of Digitalis, but,
+as I expected with no good effect. She is still, I am informed nearly
+in the same state.
+
+
+                              CASE CXXXI.
+
+_July_ 12th. Mrs. A----, of C----, Æt. 56. After a series of
+indispositions for several years, became dropsical; and had long been
+confined to her chamber, unable to lie down or to walk. She was so
+feeble, her legs so much swelled, her breath so short, and the
+symptoms of diseased viscera so strong, that I dared not to entertain
+hopes of a cure; but wishing to relieve her more urgent symptoms,
+directed quicksilver rubbed down and fol. Digital. pulv. to be made
+into pills: the dose, containing two grains of the latter, to be given
+night and morning. She was also ordered to take a draught with a dram
+of æther twice a day, and to have scapulary issues. Her breath was so
+much relieved, that she was able soon afterwards to come down stairs;
+but her constitution was too much broken to admit of a recovery.
+
+
+                             CASE CXXXII.
+
+_July_ 16th. Mr. B----, of W----, Æt. 31. After a tertian ague of 12
+months continuation, suffered great indisposition for 10 months more.
+He chiefly complained of great straitness and pain in the
+hypochondriac region, very short breath, swelled legs, want of
+appetite. He had been under the care of some very sensible
+practitioners, but his complaints increased, and he determined to come
+to Birmingham. I found him supported upright in his chair, by pillows,
+every attempt to lean back or stoop forward giving him the sensation
+of instantaneous suffocation. He said he had not been in bed for many
+weeks. His countenance was sunk and pale; his lips livid; his belly,
+thighs and legs very greatly swollen; hands and feet cold, the nails
+almost black, pulse 160 tremulous beats in a minute, but the pulsation
+in the carolid arteries was such as to be visible to the eye, and to
+shake his head so that he could not hold it still. His thirst was very
+great, his urine small in quantity, and he was disposed to purge. I
+immediately ordered a spoonful of the infusum Digitalis every six
+hours, with a small quantity of laudanum, to prevent its running off
+by stool, and decoction of leontodon taraxacum to allay his thirst.
+The next day he began to make water freely, and could allow of being
+put into bed, but was raised high with pillows. Omit the infusion.
+That night he parted with six quarts of water, and the next night
+could lie down and slept comfortably. _July_ 21st. he took a mild
+mercurial bolus. On the 25th. the diuretic effects of the Digitalis
+having nearly ceased, he was ordered to take three grains of the pulv.
+Digital. night and morning, for five days, and a draught with half an
+ounce of vin. chalyb. twice a day. _August_ 15th. He took a purge of
+calomel and jallap, and some swelling still remaining in his legs, the
+Digitalis infusion was repeated. The water having been thus entirely
+evacuated, he was ordered saline draughts with acetum scilliticum and
+pills of salt of steel and extract of gentian. About a month after
+this, he returned home perfectly well.
+
+
+                             CASE CXXXIII.
+
+_July_ 28th. Mr. A---- of W----, Æt. 29, became dropsical towards the
+close of a pulmonary consumption. He was ordered 12 grains of pulv.
+fol. cicutæ and 1 of Digitalis twice a day. No remarkable effect took
+place.
+
+
+                             CASE CXXXIV.
+
+_July_ 31. Mr. M----, Æt 37. Hydrothorax. A single grain of fol.
+Digital. pulv. taken every night for three weeks cured him. The
+medicine never made him sick, but increased his urine, which became
+clear; whereas before it had been high coloured and turbid.
+
+
+                              CASE CXXXV.
+
+_August_ 6th. Mr. C---- of B----, Æt. 42. Asthma and anasarca, the
+consequence of free living. He had been for some time under the care
+of an eminent physician of this place, but his complaints proving
+unusually obstinate, he consulted me. I directed an infusion of
+Digitalis to be taken every night, and a mixture with squill and
+tincture of cantharides twice every day. In about a week he became
+better, and continued daily mending. He has since enjoyed perfect
+health, having quitted a line of business which exposed him to drink
+too much.
+
+
+                             CASE CXXXVI.
+
+_August_ 6th. Mr. M---- of C----, Æt. 44. Ascites and anasarca,
+preceded by symptoms of the epileptic kind. He was ordered to take two
+grains of pulv. Digitalis every morning, and three every night;
+likewise a saline draught with syrup of squills, every day at noon.
+His complaints soon yielded to this treatment, but in the month of
+November following he relapsed, and again asked my advice. The
+Digitalis alone was now prescribed, which proved as efficacious as in
+the first trial. He then took bitters twice a day, and vitriolic acid
+night and morning, and now enjoys good health.
+
+Before the Digitalis was prescribed, he had taken jallap purges,
+soluble tartar, salt of steel, vitriol of copper, &c.
+
+
+                             CASE CXXXVII.
+
+_August_ 10th. Mrs. W----, Æt. 55. An anasarcous leg, and sciatica;
+full habit. After bleeding and a purge, a blister was applied in the
+manner recommended by Cotunnius; and two grains of fol. Digital. with
+fifteen of fol. cicutæ were directed to be taken night and morning.
+The medicine acted only as a diuretic; the pain and swelling of the
+limb gradually abated; and I have not heard of any return.
+
+I must here bear witness to the efficacy of Cotunnius's method of
+blistering in the sciatica, having used it in a great number of cases,
+and generally with success.
+
+
+                            CASE CXXXVIII.
+
+_August_ 16th. Mrs. A---- of S----, Æt. 78. About the middle of Summer
+began to complain of short breath, great debility, and loss of
+appetite. At this time there were evident marks of effusion in the
+thorax, and some swelling in the legs. The advanced age, the weakness,
+and other circumstances of this patient, precluded every idea of her
+recovery; but something was to be attempted. Squills and other
+remedies had been tried; I therefore directed pills with two or three
+grains of the pulv. Digitalis to be taken every night for six nights,
+and a saline draught with forty drops of acetum scillit. twice in the
+day. She took but few of the draughts, seldom more than half one at a
+time, for they purged her, and she disliked them. The pills she took
+regularly, and with the happiest effect, for she could lie down, her
+breath was very much relieved, and a degree of appetite returned.
+_Sept._ 4th, some return of her symptoms demanded the further use of
+diuretics. I was afraid to push the Digitalis in so hazardous a
+subject, and therefore directed tinct. amara with tinct. canthar. and
+pills of squill, seneka, salt of tartar and gum ammoniac. These
+medicines did not at all check the progress of the disease, and on the
+26th it became necessary to give the Digitalis again. The pills were
+therefore repeated as before, and infus. amarum with fixed alkaly
+ordered to be taken twice a day. The event was as favorable as before;
+and from this time she had no considerable return of dropsy, but
+languished under various nameless symptoms, until the middle or end of
+November.
+
+
+                             CASE CXXXIX.
+
+_Aug._ 16th. Mrs. P---- of S----, Æt. 50. For a particular account of
+this patient, see Mr. Yonge's second Case.
+
+
+                               CASE CXL.
+
+_Sept._ 20th. B---- B----, Esq. A true spasmodic asthma of many years
+continuance. After every method of relief had failed; both under my
+management, and also under the direction of several of the ablest
+physicians of this kingdom; I was induced to give him an infusion of
+the Digitalis. It was continued until nausea came on, but procured no
+relief.
+
+
+                              CASE CXLI.
+
+_October_ 5th. Mr. R----, Æt. 43. _(The patient mentioned at No.
+102.)_ He had pursued his former mode of life, and had now a return of
+his complaints, with evident marks of diseased viscera. His belly not
+very large, but uncommonly tense. From this circumstance I did not
+expect the Digitalis to succeed, and therefore tried for some time to
+relieve him by the saline julep, with acet. scillitic. jallap,
+mercury, syrup of squill, with aq. cinnam. decoction of Dandelion,
+&c.; but these being administered without advantage, I was driven to
+the Digitalis. As he was very weak and much emaciated, I only gave two
+grains night and morning for five days. As no increase of urine took
+place, I used alkaline salt with tinct. cantharides:--This proving
+equally unsuccessful, on the 18th, I directed two ounces of the
+infusum Digitalis night and morning. This was continued until nausea
+took place, but the kidney secretion was not increased. Squill with
+opium, deobstruents of different kinds, sublimate solution, fixed
+alkaly, tobacco infusion, were now successively tried, but with the
+same want of success. The fullness of his belly made it necessary to
+tap him, and by repeating this operation he continued alive to the end
+of the year.
+
+
+                              CASE CXLII.
+
+_October_ 19th. Mrs. R----, of B----, Æt. 47. Supposed Asthma, of
+eighteen months duration. She had kept her room for four months, and
+could not lie down without great disturbance; was very thin, and had
+totally lost all inclination for food. She was directed to take two
+gr. of pulv. fol. Digital. night and morning for five days, and
+infusum amarum, at the hours of eleven and five. In the course of a
+week she was much relieved, and could remain in bed all night. After a
+few days interval she took the Digitalis for five days more, and was
+soon after that well enough to come down stairs and conduct her family
+affairs.
+
+In _April_ 1785, she had a slight return, but not such as to confine
+her to her chamber. She experienced the same relief from the same
+medicine, but continuing it for seven days without interruption, it
+excited nausea.
+
+
+                             CASE CXLIII.
+
+_October_ 28th. Mr. A----, subject to nephritis calculosa: After an
+attack of that kind, had still a troublesome sense of weight about his
+loins, now and then rising to pain, and a degree of dysuria, together
+with a want of appetite. These symptoms not readily yielding to the
+usual methods of treatment, I directed an infusion of Digitalis. The
+fourth dose caused a copious flow of urine; the sixth made him sick,
+and he was more or less sick at times for three days; but felt no more
+of his complaints.
+
+I don't believe it is at all necessary to bring on sickness in these
+cases, but an unexpected absence from town prevented me from seeing
+him time enough to stop the exhibition of the medicine.
+
+
+                              CASE CXLIV.
+
+_October_ 31st. Mrs. C----, of W----, Æt. 67. Asthma, and very thick
+hard legs of long continuance. The last month or two her breath worse
+than usual, her belly swollen, her thighs anasarcous, and her urine in
+small quantity. After trying garlic, squill, and purgatives without
+advantage, I directed the Digital. Infus. After taking about five
+ounces, her urine from thick and turbid, changed to clear and amber
+coloured, its quantity considerably increased, and her breathing easy.
+Contrary to my orders, but impelled by the relief she had found, she
+finished the remaining three ounces of the infusion, which made her
+very sick, and the free flow of urine immediately ceased. No medicine
+was administered for a fortnight, during which time her complaints
+increased. I then directed an infusion of tobacco, which affected her
+head, but did not increase her urine. She had recourse again to the
+Digitalis infusion, which once more removed the fulness of the belly,
+reduced the swellings of her thighs, and relieved her breath, but had
+no effect upon her legs.
+
+
+                              CASE CXLV.
+
+_Nov._ 2d. Miss B---- of C----, Æt. 22. A very evident fluctuation in
+the abdomen, which was considerably distended, whilst the rest of her
+frame was greatly emaciated. The presence of cough, hectic fever, and
+other circumstances, made it probable that this apparent ascites was
+caused by a purulent, and not a watery effusion. However it was
+possible I might be mistaken; the Digitalis was therefore given, but
+without any advantage.
+
+The further progress of the disease confirmed my first opinion, and
+she died consumptive.
+
+
+                              CASE CXLVI.
+
+_Nov._ 4th. Mr. P---- of M----, Æt. 40. Subject to troublesome
+nephritic complaints, and after the last attack did not recover, or
+void the gravelly concretions as usual, a sense of weight across his
+loins continuing very troublesome. The usual medicines failing to
+relieve him, I ordered four grains of pulv. Digital. to be taken every
+other night for a week, and fifteen grains of mild fixed vegetable
+alkaly to be swallowed twice a day in barley water. He soon lost all
+his complaints; but we must not in this case too hastily attribute the
+cure to the Digitalis, as the alkaly has also been found a very useful
+medicine in similar disorders.
+
+
+                             CASE CXLVII.
+
+_Nov._ 4th. Mr. B---- of N----, Æt. 60. Had been much subject to gout,
+but his constitution being at length unable to form regular fits, he
+became dropsical. Pulv. fol. Digital. in doses of two or three grains,
+at bed-time, gave him some relief, but did not perfectly empty him.
+About three months afterwards he had occasion to take it again; but it
+then produced no effect, and he was so debilitated that it was not
+urged further.
+
+
+                             CASE CXLVIII.
+
+_Nov._ 8th. Mr. G----, Æt. 35. In the last stage of a phthisis
+pulmonalis, was attacked with a most urgent and painful difficulty of
+breathing. Suspecting this distress might arise from watery effusion
+in the chest, I gave him Digitalis, which relieved him considerably;
+and during the remainder of his life his breath never became so bad
+again.
+
+
+                              CASE CXLIX.
+
+_Nov._ 13th. Mrs. A---- of W----h----, Æt. 68. One of those rare cases
+in which no urine is secreted. It proved as refractory as usual to
+remedies, and not having ever succeeded in the cure of this disease, I
+determined to try the Digitalis. It was given in infusion, and, after
+a few doses, the secretion of a small quantity of urine seemed to
+justify the attempt. The next day, however, the secretion ceased, nor
+could it be excited again, tho' at last the medicine was pushed so as
+to occasion sickness, which continued at intervals for three days.
+
+
+                               CASE CL.
+
+_Nov._ 20th. Mrs. B----, Æt. 28. In the last stage of a pulmonary
+consumption became dropsical. I directed three grains of the pulv.
+Digital. to be taken daily, one in the morning, and two at night. She
+took twenty grains without any sensible effect.
+
+
+                               CASE CLI.
+
+_Nov._ 23d. Master W----, Æt. 7. Supposed hydrocephalus internus. A
+grain of pulv. fol. Digitalis was directed night and morning. After
+three days, no sensible effects taking place, it was omitted, and the
+mercurial plan of treatment adopted. The child lived near five months
+afterwards. Upon dissection near four ounces of water were found in
+the ventricles of the brain.
+
+
+                              CASE CLII.
+
+_Nov._ 26th. Mrs. W----, Æt. 65. I had attended this lady last winter
+in a very severe peripneumony, from which she narrowly escaped with
+her life. When the cold season advanced this winter, she perceived a
+difficulty in breathing, which gradually became more and more
+troublesome. I found her much harassed by a cough, which occasioned
+her to expectorate a little: the least motion increased her
+dyspnœa; she could not lie down in bed; her legs were considerably
+swelled, her urine small in quantity. I directed two grains of pulv.
+Digitalis made into a pill with gum ammoniac, to be taken every night,
+and to promote expectoration, a squill mixture twice in the day. Her
+urine in five days became clear and copious, and in a fortnight more
+she lost all her complaints, except a cough, for which she took the
+lac ammoniacum.
+
+It is not improbable that the squill might have some share in this
+cure.
+
+
+                              CASE CLIII.
+
+_December_ 7th. Mr. H----, Æt. 42. A large sat man, very subject to
+gravelly complaints. After an attack in the usual manner, continued to
+feel numbness in his lower limbs, and a sense of weight across his
+loins. I directed infusum Digitalis to be given every six hours. Six
+ounces made him sick, and he took no more. The next day his urine
+increased, a good deal of sand passed with it, and he lost his
+disagreeable feels, but the sickness did not entirely cease before the
+fourth day from its commencement.
+
+
+                              CASE CLIV.
+
+_December_ 27th. Mr. B----, of H----, Æt. 55. Symptoms of hydrothorax,
+at first obscurely, afterwards more distinctly marked. Many things
+were tried, but the squill alone gave relief. At length this failed.
+About the third month of the disease, a grain of pulv. Digital. was
+ordered to be taken night and morning. This produced the happiest
+effects. In _March_ following he had some slight symptoms of relapse,
+which were soon removed by the same medicine, and he now enjoys good
+health. For a more particular narrative see case the first,
+communicated by Mr. Yonge.
+
+
+                               CASE CLV.
+
+_December_ 31st. Mrs. B----, of E----, Æt. 50. An ovarium dropsy of
+long continuance. She took three grains of pulv. Digital. every night
+at bed time, for a fortnight, but without any effect.
+
+
+                              CASE CLVI.
+
+A poor man in this town, after his kidneys had ceased to secrete urine
+for several days, was seized with hickup, fits of vomiting, and
+transient delirium. After examination I was satisfied the disease was
+the same as that mentioned at CXLIX. A very experienced apothecary
+having tried various methods to relieve him, I despaired of any
+success, but determined to try the Digitalis. It was accordingly
+given in infusion. At first it checked the vomitings, but did not
+occasion any secretion of urine.
+
+
+                                 1785.
+
+The cases which have occurred to me in the course of this year, are
+numerous; but as the events of some of them are not yet sufficiently
+ascertained, I think it better to with-hold them at present.
+
+
+
+
+                            HOSPITAL CASES,
+                  Under the Direction of the Author.
+
+
+The four following cases were drawn out at my request by Mr. Cha.
+Hinchley, late apothecary to the Birmingham Hospital. They are all the
+Hospital cases for which the Digitalis was prescribed by me, whilst he
+continued in that office.
+
+
+                              CASE CLVII.
+
+_March_ 15th, 1780. John Butler, Æt. 30. Asthma and swelled legs. He
+was directed to take myrrh and steel every day, and three spoonfuls of
+infusum Digitalis every night. On the 8th of April he was discharged,
+cured of the swellings and something relieved of his asthmatic
+affections.
+
+
+                             CASE CLVIII.
+
+_November_ 18th, 1780. Henry Warren, Æt. 60. This man had a general
+anasarca and ascites, and was moreover so asthmatic, that, neither
+being able to sit in a chair nor lie in bed, he was obliged constantly
+to walk about, or to lean forward against a window or table. You
+prescribed for him thus.
+
+    R. Aq. cinn. spt. ℥iv.
+    Oxymel. scillit.
+    Syr. scillit. aa. ℥i. m. cap. cochlear. larg. sexta quaque
+    horâ.
+
+This medicine producing no increased discharge of urine, on the 25th
+you ordered the infusion of Digitalis, two spoonfuls every four hours.
+After taking this for thirty six hours, his urine was discharged in
+very great quantity; his breath became easy, and the swellings
+disappeared in a few days, though he took no more of the medicine. On
+the 2d of _December_ he was ordered myrrh and lac ammoniacum, which he
+continued until the 23d, when he was discharged cured, and is now in
+good health.
+
+
+                              CASE CLIX.
+
+_November_ 3d, 1781. Mary Crockett, Æt. 40. Ascites and universal
+anasarca. For one week she took sal. diureticus and tincture of
+cantharides, but without advantage. On the 10th you directed the
+infusion of Digitalis, a dram and half to half a pint, an ounce to be
+taken every fourth hour. Before this quantity was quite finished, the
+urine began to be discharged very copiously. The medicine was then
+stopped as you had directed. On the 15th, being costive, she took a
+jallap purge, and on the 24th she was discharged cured.
+
+
+                               CASE CLX.
+
+_March_ 16th, 1782. Mary Bird, Æt. 61. Great fullness about the
+stomach; diseased liver, and anasarcous legs and thighs. For the
+first week squill was tried in more forms than one, but without
+advantage. On the 22d she began with the Digitalis, which presently
+removed all the swelling.
+
+She was then put upon the use of aperient medicines and tonics, and on
+the first of _August_ was discharged perfectly cured.
+
+       *       *       *       *       *
+
+    The three following Cases were drawn up and communicated to
+    me by Mr. Bayley, who succeeded Mr. Hinchley as apothecary to
+    the Hospital at Birmingham:
+
+
+                                    Shiffnall, April 26th, 1785.
+    DEAR SIR,
+
+During my residence in the Birmingham General Hospital, I had frequent
+opportunities of seeing the great effects of the Digitalis in dropsy.
+As the exhibition of it was in the following instances immediately
+under your own direction, I have drawn them up for your inspection,
+previous to your publishing upon that excellent diuretic. Of its
+efficacy in dropsy I have considerable evidence in my possession, but
+consider myself not at liberty to send you any other cases except
+those you had yourself the conduct of. The Digitalis is a very
+valuable acquisition to medicine; and, I trust, it will cease to be
+dreaded when it is well understood.
+
+                                     I am, Sir, your obedient,
+                                        And very humble servant,
+                                                      W. BAYLEY.
+
+
+                              CASE CLXI.
+
+Mary Hollis, aged 62, was admitted an out patient of the Birmingham
+General Hospital _February_ 12th, 1784, labouring under all the
+effects of hydrothorax; her dread of suffocation during sleep was so
+great, that she always reposed in an elbow chair. She was directed to
+take two grains of Digitalis in powder every night and morning, and
+for a few days found great relief; but, on the eighth day, as she had
+complained of sickness, and had been considerably purged, she was
+ordered to desist taking any more of her powders. On the 14th day she
+was ordered an ounce of the following infusion twice in a day: R. Fol.
+Digital. purp. sicc. ʒiss. aq. bullient. ℔ss. digere per semi-horam,
+colaturæ adde tinct. aromatic ℥i. This infusion did not purge, but
+sometimes excited nausea, though not sufficient to prevent her from
+continuing its use. She grew gradually better, and on the 6th of _May_
+was discharged perfectly cured. The diuretic effects of the Digitalis
+were in this instance immediate.
+
+
+                              CASE CLXII.
+
+Edward James, Æt. 21. Admitted _March_ 20th, 1784. Complained of great
+difficulty of breathing, pain in his head, and tightness about the
+stomach, with a trifling swelling of his legs. Ordered pil. scillit.
+℈i. ter de die. On the third day his legs much more swelled, his
+breathing more difficult, and in every respect worse; his pulse very
+small and quick, complained when he turned in bed, of something like
+water rolling from one side of the thorax to the other. A remarkable
+blueness about the mouth and eyes, and purged considerably from the
+pil. scill. Ordered to omit the pills and to take ℥i. of infus.
+Digitalis every eight hours; the proportion ʒiss. to eight ounces of
+water and ℥i. of aq. n. m. sp.--7th Day, The infusion had neither
+purged, nor vomited him: he only complained once or twice of
+giddiness. His belly was now very hard, rather black on the right side
+the navel, and his legs amazingly swelled. Ordered a bolus with
+rhubarb and calomel, to be taken in the morning, and ℥ii. julep salin.
+cum tinct. canthar. gutt. forty ter die.--12th Day, nearly in the same
+state, except his breathing which was somewhat more difficult, being
+now obliged to have his head considerably raised. Persistat--From this
+day to the 32d day he became hourly worse. His belly which at first
+was only hard, now evidently contained a large quantity of water, his
+legs were more swelled, and a large sphacelated sore appeared upon
+each outer ancle. Respiration was so much obstructed, that he was
+obliged to sit quite upright to prevent suffocation. He made very
+little water, not more than eight ounces in a day and a night, and was
+much emaciated. Ordered his purging bolus again, and ℥ii. of a mixture
+with sal diuretic, ℥ss. to ℥xii. three times in a day, and a poultice
+with ale grounds to his legs.
+
+54th day. To this period there was not the least probability of his
+existing; his legs and thighs were one continued blubber, his thorax
+quite flat, and his belly so large that it measured within one inch as
+much as a woman's in this Hospital the day she was tapped, and from
+whom twenty seven pounds of coagulable lymph were taken. He made about
+three ounces of water in twenty-four hours: his penis and scrotum were
+astonishingly swelled, and no discharge from the sores upon his legs.
+Ordered to take a pill with two grains of powdered Foxglove night and
+morning. For a few days no sensible effect, but about the 60th day he
+complained of being continually giddy, and had some little pain in his
+stomach. He now made much more water, and dared to sleep. His appetite
+which through the whole of his illness had been very bad, was also
+better. 66th day. Breathing very much relieved, the quantity of water
+he made was three chamber pots full in a day and a night, each pot
+containing two quarts and four ounces, moderately full. Ordered to
+continue his pills, and his legs which were very flabby, to be rolled.
+
+69th day. His belly nearly reduced to its natural size, still made a
+prodigious quantity of water, his appetite very good, habit of body
+rather lax, and his complexion ruddy. On the 2d of _June_, being still
+rather weak, he was ordered decoct. cort. ℥ii. ter de die; and on the
+12th was discharged from this Hospital perfectly cured.
+
+                                                      W. BAYLEY.
+
+
+     Mr. Bayley's respectful compliments to Doctor Withering: he
+     sends the case of Edward James, which he believes is pretty
+     correct. He laments not having it in his power to send the
+     measure of his belly, having unfortunately, mislaid the
+     tape: he heard from James yesterday, and he is perfectly
+     well.
+
+     _General Hospital, August 5, 1784._
+
+
+                             CASE CLXIII.
+
+On the 26th _February_, 1785, Sarah Ford, aged 42, was admitted an
+out-patient of the Birmingham General Hospital: she complained of
+considerable pain in her chest, and great difficulty of breathing, her
+face was much swelled and her thighs and legs were anasarcous. She had
+extreme difficulty in making water, and with many painful efforts she
+did not void more than six ounces in twenty-four hours. She had been
+in this situation about six weeks, during which time she had taken
+ammoniacum, olibanum, and large quantities of squills, without any
+other effect than frequent sickness. Upon her commencing an Hospital
+patient, the following medicine was exhibited. R. gum ammoniac ʒii.
+pulv. fol. Digital. purp. ℈ii. sp. lavand. comp. ut fiat pil. 40. cap.
+ii. nocte maneque. She continued the use of these pills for a few
+days, without any sensible effect. On the eighth day her breathing was
+much relieved, her legs and thighs were not so much swelled, and in a
+day and a night she made five pints of water. By the 12th day her
+legs and thighs were nearly reduced to their natural size. She
+continued to make water in large quantities, and had lost her pain in
+the thorax. To the 20th of _March_, she made rapid advances towards
+health, when not a symptom of disease remaining, she was discharged.
+
+
+
+
+                  COMMUNICATIONS FROM CORRESPONDENTS.
+
+
+                                       London, Norfolk-street,
+                                                 May 31st, 1785.
+
+SIR,
+
+I had the favour of your letter last week; and I shall be very happy
+if I can give you any intelligence relating to the Foxglove, that can
+answer the purpose in which you are so laudably engaged.
+
+It is true that my brother, the late Dr. Cawley, was greatly relieved,
+and his life, perhaps, prolonged for a year, by a decoction of the
+Foxglove root; but why it had not a more lasting effect, it is
+necessary I should tell you that he had all the signs of a distempered
+viscera, long before any watery swellings appeared; it was manifest
+that his dropsy was merely symptomatic, and he could therefore only
+from time to time have any relief from medicine. In the year 1776, he
+returned from London to Oxon. having consulted several physicians at
+the former place, and Dr. Vivian at the latter, but without any
+success; and he was then told of a carpenter at Oxon. that had been
+cured of a Hydrops pectoris by the Foxglove root, and as he was a
+younger, and in other respects an healthy man, his cure, I believe,
+remains a perfect one.
+
+I did not attend my brother whilst he took the medicine, and therefore
+I cannot speak precisely to the operation of it; but I remember, by
+his letters, that he was dreadfully sick and ill for several days
+before the secretion of urine came on, but which it did do to a great
+degree; relieved his breath, and greatly lessened the swelling in his
+legs and thighs; but the two instances I have lately seen in this part
+of the world, are much stronger proofs of the efficacy of it than my
+brother's case.
+
+                                               I am, &c.
+                                                  ROBERT CAWLEY.
+
+N. B. Whenever I have another opportunity of giving the Foxglove, it
+shall be in small doses:--In which I should hope it might succeed,
+although it might be more slowly. If you should try it with success, I
+should be glad to know what mode you made use of.
+
+
+                      Dr. Cawley's prescription.
+
+    R. Rad. Digital. purpur. siccat. et contus. ℥ii.
+
+    Coque ex aq. font. ℔ii. ad ℔i. colat. liquor. adde aq. junip.
+    comp. ℥ii.
+
+    Mell. anglic ℥i. m. sumat cochl. iv. omni nocte h. s. et
+    mane.
+
+--I have elsewhere remarked, that when the Digitalis has been properly
+given, and the diuretic effects produced, that an accidental over-dose
+bringing on sickness, has stopped the secretion of urine. In the
+present instance it likewise appears, that violent sickness may be
+excited, and continue for several days without being accompanied by a
+flow of urine; and it is probable that the latter circumstance did not
+take place, until the severity of the former abated. If Dr. Cawley had
+not had a constitution very retentive of life, I think he must have
+died from the enormous doses he took; and he probably would have died
+previous to the augmentation of the urinary discharge. For if the root
+from which his medicine was prepared, was gathered in its active
+state, he did not take at each dose less than _twelve_ times the
+quantity a strong man ought to have taken. Shall we wonder then that
+patients refuse to repeat such a medicine, and that practitioners
+tremble to prescribe it? Were any of the active and powerful medicines
+in daily use to be given in doses _twelve_ times greater than they
+are, and these doses to be repeated without attention to the effects,
+would not the patients die, and the medicines be condemned as
+dangerous and deleterious?--Yet such has been the fate of Foxglove!
+
+
+     A Letter to the Author, from Mr. BODEN, Surgeon, at Broseley,
+                            in Shropshire.
+
+                                       Broseley, 25th May, 1785.
+     Dear SIR,
+
+Have inclosed the prescriptions that contained the fol. Digital. which
+I gave to Thomas Cooke and Thomas Roberts.
+
+Thomas Cooke, Æt. 49, had been ill about two or three weeks. When I
+saw him he had no appetite, and a constant thirst: a fullness and load
+in the stomach: the thighs, legs and hands, much swell'd, and the face
+and throat in a morning; was costive, and made but little water, which
+was high coloured; the pulse very weak, and his breath exceeding bad.
+_June_ 17th. R. Argent, viv ʒi. cons. cynosbat. ℈ii. fol. Digital.
+pulv. gr. xv. f. pil. xxiv. capt. ii. omni nocte horâ decubitus. He
+was likewise purged by a bolus of argent. viv. jallap, Digit.
+elaterium and calomel, which was repeated on the fourth day, to the
+third time. From _June_ 17th to the 29th, the symptoms were mostly
+removed, making water freely, and having plenty of stools; in a week
+after he was perfectly well, and remains so ever since. The cure was
+finished by steel and bitters.
+
+Thomas Roberts, Æt. 40, had a deformed chest, was obliged to be almost
+in an erect posture when in bed; the other symptoms were nearly the
+same as Cooke's. _August_ 3d. The pills prescribed _June_ 17th for
+Cooke.--17th. A purging bolus of jalap and Digitalis, once a week. He
+continued the medicines till the latter end of _August_, when he got
+very well; but the complaint returned in _Jan._ worse than before. He
+is now much better, but I have great reason to believe the liver to be
+diseased.
+
+                            I am, with the greatest respect,
+
+                             Your very obliged humble servant,
+
+                                                   DANIEL BODEN.
+
+P. S. The second patient, on his relapse, took Digitalis again,
+combined with other things.
+
+
+
+       CASE communicated by Mr. CAUSER, Surgeon, at Stourbridge,
+                            Worcestershire.
+
+
+Mr. P---- of H---- M----, in the parish of Kingswinford, aged about
+60; had been a strong healthy, robust, corpulent man; worked hard
+early in life at edge-tool making, and drank freely of strong malt
+liquor; for many years had been subject to gout in the extremities;
+for a few years past had been very asthmatic, and the gout in the
+extremities gradually decreased. When I first saw him, which was
+_Sept._ 12, 1779, his legs were anasarcous, his belly much swelled,
+and an evident fluctuation of water. His breathing very bad, an
+irregular pulse, and unable to lie down. His easiest posture was
+standing with his body leaning over a chair, in which situation he
+would continue many hours together, labouring for breath, with the
+sweat trickling down his face very profusely; the urine in very small
+quantity. Diuretics of every kind I could think of were used with very
+little or no advantage. Blisters applied to the legs relieved very
+considerably for a time, but by no means could I increase the urinary
+discharge. Warm stomachic medicines were given, and at the same time
+sinapisms applied to the feet, in hopes of enticing gout to the
+extremities, but without any good effect.--_November_ 22d. The
+swelling considerably increasing, an emetic of acet. scillitic. was
+given, which acted very violently, and increased the urinary discharge
+considerably. He continued better and worse, using different kinds of
+diuretic and expectorating medicines until _September_ 1781, when the
+disease was so much worse, I did not expect he could live many days.
+The acet. scillitic. was repeated, a table spoonful every half hour,
+till it acted briskly upwards and downwards; but without increasing
+the urinary discharge.--On the 17th of _September_ I infused ʒiii. of
+the fol. Digitalis in ℥vi. of boiling water, for four hours; then
+strained it, and added ℥i. of tinct. aromatica.--On the 18th he began
+by taking one spoonful, which he was to repeat every half hour, till
+it made him very sick, unless giddiness, loss of sight, or any other
+disagreeable effect took place. I had never given the medicine before,
+and had prepared him to expect the operation to be very severe. I saw
+him again on the 21st; he had taken the medicine regularly, till the
+whole quantity was consumed, without perceiving the least effect of
+any kind from it, and continued well till the evening of the following
+day, when a little sickness took place, which increased, but never so
+as to occasion either vomiting or purging, but a surprising discharge
+of urine. The saliva increased so as to run out of his mouth, and a
+watery discharge from his eyes; these discharges continued, with a
+continual sickness, till the swelling was totally gone, which happened
+in three or four days. He afterwards took steel and bitters; and
+continued very comfortably, without any return of his dropsy, until
+the 7th of _April_ 1782, when he was seized with an epidemic cough,
+which was very frequent with us at that time. His swellings now
+returned very rapidly, with the greatest difficulty in breathing, and
+he died in a few days. Blisters and expectorating medicines were used
+on this last return.
+
+
+                 Extract of a Letter from Mr. CAUSER.
+
+Mrs. S----, the subject of the following Case, was as ill as it is
+possible for woman to be and recover; from the inefficacy of the
+medicines used, I am convinced no medicine would have saved her but
+the Digitalis. I never saw so bad a case recovered; and it shews, that
+in the most reduced state of body, the medicine in small doses, will
+prove safe and efficacious.
+
+N. B. The Digitalis, in pills, never occasioned the least sickness.
+She took two boxes of them.
+
+
+                                 CASE.
+
+_January_ 2d, 1785. Mrs. S----, of W----, near Kidderminster, aged 38,
+has been affected with dropsical swellings of her legs and thighs,
+about six weeks, which have gradually grown worse; has now great
+difficulty in breathing, which is much increased on moving; a very
+irregular, intermittent pulse, urine in very small quantity, and in
+the seventh month of her pregnancy: a woman of very delicate
+constitution, with tender lungs from her infancy and very subject to
+long continued coughs.
+
+    R. Pulv. scillæ gr. iii.
+    Jalap gr. x. syr. rosar. solut. tinct. senn. aa
+    ʒii. aq. menth. v. simpl. ℥iss. m. mane sumend.
+
+    R. pulv. scillæ ℈i. G. ammoniac, sapon. venet. aa ʒiss. syr.
+    q. s. f. pilul. 42 cap. iii. nocte maneque.
+
+On the 7th found her worse, and the swelling increased; the urine
+about ℥x in the twenty-four hours.
+
+    R. Fol. siccat. Digital. ʒiii. coque in. aq. fontan. ℥xii. ad
+    ℥vi. cola et adde. aq. juniper. comp. ℥ii. sacchar. alb. ℥ss.
+    m. cap. cochlear. i. larg. 4tis horis.
+
+She took about three parts of the medicine before any effect took
+place. The first was sickness, succeeded by a considerable discharge
+of urine. She continued the medicine till the whole was consumed,
+which caused a good deal of sickness for three or four days.
+
+I saw her again on the 12th. The quantity of urine was much increased,
+and the swelling diminished. Pulse and breathing better.
+
+    R. Fol. sicc. Digital. G. assafetid. aa ʒi. calomel. pp. gr.
+    x. sp. lavand. comp. q. s. fiat pilul. xxxii. cap. ii. omni
+    nocte horâ somni.
+
+A plentiful discharge of urine attended the use of these pills, and
+she got perfectly free from her dropsical complaints.
+
+_March_ 15th she was delivered: had a good labour, was treated as is
+usual, except in not having her breasts drawn, not intending see
+should suckle her child, being in so reduced a state. Continued going
+on well till the 18th, when she was seized with very violent pains
+across her loins, at times so violent as to make her cry out as much
+as labour pains. Enema cathartic. Fot. papav. applied to the part.
+
+    R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s. fiat
+    pilul. vi. capt. i. 2da quaque horâ durante dolore.
+
+    R. Julep, e camphor, sp. minder. aa ℥ii. capt. cochlear, i.
+    larg. post singul. pilul.
+
+19th. Breathing short, unable to lie down, very irregular low pulse
+scarcely to be felt, fainty, and a universal cold sweat: no appetite
+nor thirst, spasmodic pains at times across the loins very violent,
+but not so frequent as on the preceding day.
+
+    R. Gum ammoniac, assafetid. aa ʒi. camphor. gr. xii. fiat
+    pilul. 24. capt. ii. 3tia quaque horâ in cochlear. ii.
+    mixtur. seq.
+
+    R. Balsam. peruv. ʒiii. mucilag. G. arab. q. s. flor. zinci
+    g. vi. aq. menth. simp. ℔ss. m.
+
+    Applic. Emp. vesicat. femorib. internis.
+
+    R. Sp. vol. fœtid. elixir. paregor. balsam. Traumatic. aa
+    ʒiii. capt. cochlear. parv. urgente languore.
+
+20th. Much the same; makes very little water, and the legs begin to
+swell.--Applic. Emp. e pice burgund. lumbis.
+
+23d. The swelling very much increased.--Capt. gutt. xv. acet.
+scillitic. ter die in two spoonfuls of the following mixture.
+
+    R. Infus. baccar. juniper, ℥vi. tinct. amar. tinct.
+    stomachic. aa ℥i. m.
+
+25th. Much the same.
+
+28th. The swelling considerably increased, in other respects very much
+the same.
+
+30th. Breathing very bad, with cough and pain across the sternum,
+unable to lie down, legs, thighs, and body very much swelled, urine
+not more than four or five ounces in the twenty-four hours; hot and
+feverish, with thirst.
+
+    Applic. Emp. vesicat. stomacho et sterno.
+
+    R. G. assafetid. ℈ii. pulv. jacob. ℈i. rad. scill. recent.
+    gr. xii. extract. thebaic. gr. iv. f. pilul. xvi. cap. iv.
+    omni nocte.
+
+    R. Sal. nitr. sal. diuretic. aa ʒii. pulv. e contrayerv.
+    comp. ʒi. sacchar. ℥i. emuls. commun. ℔i. aq. cinnam. simpl.
+    ℥i. m. capt. cochlear. iv. ter die.
+
+_April_ 2d. Much the same, no increase of urine.
+
+3d. Breathing much relieved by the blister, which runs profusely.
+Repeated the medicines, and continued them till the
+
+12th. The cough very bad, pulse irregular, swelling much increased,
+urine in very small quantity, not at all increased; great lowness and
+fainting. She desired to have some of the pills which relieved her so
+much when with child. I was almost afraid to give them, but the
+inefficacy of the other medicines gave me no hopes of a cure from
+continuing them, which made me venture to comply with her request.
+
+    R. Fol. siccat. Digital. G. assafetid. aa ʒi. sp. lavand.
+    comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node
+    cap. pilul. e styrace gr. vi.
+
+17th. Considerable increase of urine.
+
+21st. Swelling a good deal diminished; urine near four pints in
+twenty-four hours, which is more than double the quantity she drinks.
+
+    Applic. Emp. vesicat. femoribus internis.
+
+The Digitalis pills and opiate at bed-time continued. Takes a tea cup
+of cold chamomile tea every morning.
+
+25th. Swelling much diminished, makes plenty of water, appetite much
+mended, cough and breathing better. She omitted the medicine for three
+days; the urine began to diminish, the swelling and shortness of
+breathing worse. On repeating it for two days, the discharge was again
+augmented, and a diminution of the swelling succeeded. She has
+continued the pills ever since till the 14th of _May_; the dropsical
+symptoms and cough are entirely gone, the water is in sufficient
+quantity, her strength is recovered, and she has a good appetite. All
+she now complains of is a weight across her stomach, which is worse at
+times, and she thinks, unless it can be removed, she shall have a
+return of her dropsy.
+
+
+                Extract of a Letter from Doctor FOWLER,
+                        Physician, at Stafford.
+
+I understand you are going to publish on the Digitalis, which I am
+glad to hear, for I have long wished to see your ideas in print about
+it, and I know of no one (from the great attention you have paid to
+the subject) qualified to treat on it but yourself. There are
+gentlemen of the faculty who give verbal directions to poor patients,
+for the preparing and taking of an infusion or decoction of the green
+plant. Would one suppose that such gentlemen had ever attended to the
+nature and operation of a sedative power on the functions,
+_particularly_ the _vital_? Is not such a vague and unscientific mode
+of proceeding putting a two edged sword into the the hands of the
+ignorant, and the most likely method to damn the reputation of any
+very active and powerful medicine? And is it not more than probable
+that the _neglect_ of adhereing to a _certain_ and _regular_
+preparation of the nicotiana, and the _want_ (of what you
+_emphatically_ call) a _practicable_ dose, have been the chief causes
+of the once rising reputation of that noted plant being damned above
+a century ago? In short, the Digitalis is beginning to be used in
+dropsies, (although some patients are said to go off suddenly under
+its administration) somewhat in the style of broom ashes; and, in my
+humble opinion, the public, at this very instant, stand in great need
+of your _precepts_, _guards_, and _cautions_ towards the safe and
+successful use of such a powerful sedative diuretic; and I have no
+doubt of your minute attention to those particulars, from a regard to
+the good and welfare of mankind, as well as to your own reputation
+with respect to that medicine.
+
+I remember an officer in the Staffordshire militia, who died here of a
+dropsy five years ago. The Digitalis relieved him a number of times in
+a wonderful manner, so that in all probability he might have obtained
+a radical cure, if he would have refrained from hard drinking. I
+understood it was first ordered for him by a medical gentleman, and
+its sedative effects proved so mild, and diuretic operation so
+powerful, that he used to prepare it afterwards for himself, and would
+take it with as little ceremony as he would his tea. It is said, that
+he was so certain of its successful operation, that he would boast to
+his bacchanalian companions, when much swelled, you shall see me in
+two days time quite another man.
+
+
+                  CASES communicated by Mr. J. FREER,
+                     jun. Surgeon, in Birmingham.
+
+
+                                CASE I.
+
+_Nov._ 1780. Mary Terry, aged 60. Had been subject to asthma for
+several years; after a severe fit of it her legs began to swell, and
+the quantity of urine to diminish. In six weeks she was much troubled
+with the swellings in her thighs and abdomen, which decreased very
+little when she lay down: she made not quite a pint of water in the
+twenty-four hours. I ordered her to take two spoonfuls of the infusion
+of Foxglove every three hours. By the time she had taken eight doses
+her urine had increased to the quantity of two quarts in the day and
+night, but as she complained of nausea, and had once vomited, I
+ordered the use of the medicine to be suspended for two days. The
+nausea being then removed, she again had recourse to it, but at
+intervals of six hours. The urine continued to discharge freely, and
+in three weeks she was perfectly cured of her swellings.
+
+
+                               CASE II.
+
+_December_, 1782. A poor woman, who had been afflicted with an ague
+during the whole of her pregnancy, and for two months with dropsical
+swellings of the feet, legs, thighs, abdomen, and labia pudenda; was
+at the expiration of the seventh month taken in labour. On the day
+after her delivery the ague returned, with so much violence as to
+endanger her life. As soon as the fit left her, I began to give her
+the red bark in substance, which had the desired effect of preventing
+another paroxysm. She continued to recover her health for a fortnight,
+but did not find any diminution in the swellings; her legs were now so
+large as to oblige her to keep constantly on the bed, and she made
+very little water. I ordered her the infusion of Foxglove three times
+a day, which, on the third day, produced a very copious discharge of
+urine, without any sickness; she continued the use of it for ten days,
+and was then able to walk. Having lost all her swellings, and no
+complaint remaining but weakness, the bark and steel compleated the
+cure.
+
+
+                Extract of a Letter from Doctor JONES,
+                       Physician, in Lichfield.
+
+Anxious to procure authentic accounts from the patients, to whom I
+gave the Foxglove, I have unavoidably been delayed in answering your
+last favour. However, I hope the delay will be made up by the efficacy
+of the plant being confirmed by the enquiry. Long cases are tedious,
+and seldom read, and as seldom is it necessary to describe every
+symptom; for every case would be a history of dropsy. I shall
+therefore content myself with specifying the nature of the disease,
+and when the dropsy is attended with any other affection shall notice
+it.
+
+Two years have scarcely elapsed since I first employed the Digitalis;
+and the success I have had has induced me to use it largely and
+frequently.
+
+
+                                CASE I.
+
+Ann Willott, 50 years of age, became a patient of the Dispensary on
+the 11th of April 1783. She then complained of an enlargement of the
+abdomen, difficulty of breathing, particularly when lying, and
+costiveness. She passed small quantities of high-coloured urine; and
+had an evident fluctuation in the belly. Her legs were œdematous.
+Chrystals of tartar, squills, &c. had no effect. The 13th of _June_
+she took two spoonfuls of a decoction of Foxglove, containing three
+drams of the dry leaves, in eight ounces, three times a day. Her urine
+soon increased, and in a few days she passed it freely, which
+continued, and her breath returned.
+
+
+                               CASE II.
+
+Mr. ----, 45 years of age, had been long subject to dropsical
+swellings of the legs, and made little water. Two spoonfuls of the
+same decoction twice a day, soon relieved him.
+
+
+                               CASE III.
+
+Mrs. ----, aged 70 years. A lady frequently afflicted with the gout,
+and an asthmatical cough. After a long continuance of the latter, she
+had a great diminution of urine, and considerable difficulty of
+breathing, particularly on motion, or when lying. Her body was much
+bound. There was, however, no apparent swelling. She took three
+spoonfuls of an aperient decoction of forty-five grains in six ounces
+and a half, every other morning. The urine was plentiful those days,
+and her breathing much relieved. In two or three weeks after the use
+of it she was perfectly restored. The purgative medicine neither
+increased the urine, nor relieved the breathing, till the Foxglove was
+added.
+
+This spring she long laboured with the gout in her stomach, which
+terminated in a fit in her hand. During the whole of this tedious
+illness, of nearly three months, she passed little urine, and her
+breathing was again short.
+
+She took the same preparation of Foxglove without any diuretic effect,
+and afterwards two and three grains of the powder twice a day with as
+little. The dulcified spirits of vitriol, however, quickly promoted
+the urinary secretion.
+
+
+                               CASE IV.
+
+Mr. C----, 46 years of age, had dropsical swellings of the legs, and
+passed little urine. He took the decoction with three drams, and was
+soon relieved.
+
+
+                                CASE V.
+
+Lady----, took three grains of the dried leaves twice a day, for
+swelled legs, and scantiness of urine, without effect.
+
+
+                               CASE VI.
+
+Mrs. Slater, aged 36 years. For dropsy of the belly and legs, and
+scantiness of urine, of several weeks standing, took three grains of
+the powder twice a day, and was quite restored in ten days. She took
+many medicines without effect.
+
+
+                               CASE VII.
+
+Mrs. P----, in her 70th year, took three grains of the powder twice a
+day, for scantiness of urine, and swelled legs, without effect.
+
+
+                              CASE VIII.
+
+Ann Winterleg, in her 26th year, had dropsical swellings of the legs,
+and passed little urine: she was relieved by two drams, in an eight
+ounce decoction.
+
+
+                               CASE IX.
+
+William Brown, aged 76. In the last stage of dropsy of the belly and
+legs, found a considerable increase of his urine by a decoction of
+Foxglove, but it was not permanent.
+
+
+                                CASE X.
+
+Mr. ----, -- years of age, and of very gross habit of body, became
+highly dropsical, and took various medicines, without effect. One
+ounce of the decoction, with three drams of the dry leaves in eight
+ounces, twice or three times a day, increased his urine prodigiously.
+He was evidently better, but a little attendant nausea overcame his
+resolution, and in the course of some weeks afterwards he fell a
+victim to his obstinacy.
+
+
+                               CASE XI.
+
+Mrs. Smith, about 50 years of age, after a tedious illness of many
+weeks, had a jaundice, and became dropsical in the legs. Two spoonfuls
+of the decoction, with three drams twice a day, increased her urine,
+and abated the swelling.
+
+
+                               CASE XII.
+
+Widow Chatterton, about 60 years of age. Took the decoction in the
+same way for dropsy of the legs, with little effect.
+
+
+                              CASE XIII.
+
+---- Genders, about thirty-four years of age, was delivered of three
+children, and became dropsical of the abdomen. She passed little or no
+urine, had constant thirst, and no appetite. She took two spoonfuls of
+an eight ounce decoction, with three drams twice a day. By the time
+she had finished the bottle, (which must have been on the fourth day,)
+she had evacuated all her water, and could go about. Her appetite
+increased with every dose, and she recovered without farther help.
+
+
+                               CASE XIV.
+
+Miss M---- M----, in her 20th year. Had been infirm from her cradle,
+and, after various sufferings, had an astonishing œdematous
+swelling of one leg and thigh, of many weeks standing. She passed
+little or no urine, and had all her other complaints. She took 2
+spoonfuls of an eight oz. decoction of two drams, twice a day. Her
+urine immediately increased; and, on the third day, the swelling had
+entirely subsided.
+
+
+                               CASE XV.
+
+Mr. P----, 65 years of age, and of a full habit of body. Had lived
+freely in his youth, and for many years led rather an inactive life.
+His health was much impaired several months, and he had a considerable
+distention, and evident fluctuation in the abdomen, and a very great
+œdema of the legs and thighs. His breathing was very short, and
+rather laborious, appetite bad, and thirst considerable. His belly was
+bound, and he passed very small quantities of high-coloured urine,
+that deposited a reddish matter. He had taken medicines some time,
+and, I believe, the Digitalis; and had been better.
+
+A blister was applied to the upper and inside of each thigh; he took
+two spoonfuls of the decoction, with three drams of the dry leaves,
+two or three times a day; and some opening physic occasionally.
+
+He lived at a considerable distance, and I did not visit him a second
+time; but I was well informed, about ten days or a fortnight
+afterwards, that his urine increased amazingly upon taking the
+decoction, and that the water was entirely evacuated.
+
+
+                               CASE XVI.
+
+Mrs. G----, aged 50 years. After being long ailing, had a large
+collection of water in the abdomen and lower extremities. Her urine
+was high-coloured, in small quantities, and had a reddish sediment.
+She took the decoction of Digitalis, squills, &c. without any effect.
+The chrystals of tartar, however, cured her speedily.
+
+
+                              CASE XVII.
+
+Mr. ----, about 50 years of age, complained of great tension and pain
+across the abdomen, and of loss of appetite; his urine, he thought,
+was less than usual, but the difference was so trifling he could speak
+with no certainty: his belly seemed to fluctuate. Among other things
+he tried the Foxglove leaves dried, twice a day; and, although it
+appeared to afford him relief, yet the effect was not permanent.
+
+
+                              CASE XVIII.
+
+Mr. W----, aged between 60 and 70 years; and rather corpulent: was
+considerably dropsical, both of the belly and legs, and his urine in
+small quantities. Three grains of the dry leaves, twice a day,
+evacuated the water in less than a fortnight.
+
+
+                               CASE XIX.
+
+Sarah Taylor, 40 years of age, was admitted into the Dispensary for
+dropsy of the abdomen and legs; and was relieved by the Decoctum
+digitalianum.
+
+
+                               CASE XX.
+
+Lydia Smith, aged 60. Dispensary. Laboured many years under an asthma,
+and became dropsical. She took the decoction without effect.
+
+
+                               CASE XXI.
+
+John Leadbeater, aged 15 years. Had a quotidian intermittent, which
+was removed by the humane assistance of an amiable young lady. His
+intermittent was soon attended by a very considerable ascites; for
+which he became a patient of the Dispensary. He took a decoction of
+Foxglove night and morning. His urine increased immediately, and he
+lost all his complaints in four days.
+
+
+                              CASE XXII.
+
+William Millar, aged 50 years. Admitted into the Dispensary for a
+tertian ague, and general dropsy. The dropsy continuing after the ague
+was removed, and his urine being still passed in small quantities; he
+took the powdered leaves, and recovered his health in five days.
+
+
+                              CASE XXIII.
+
+Ann Wakelin, 10 years of age. Had for several weeks a dropsy of the
+belly after an ague. She took a decoction of Foxglove, which removed
+all complaint by the fourth day.
+
+
+                              CASE XXIV.
+
+Ann Meachime; a Dispensary patient. Had an ascites and scantiness of
+urine. She took the powder of Foxglove, and evacuated all her water
+in three days.
+
+It may not be improper to observe, 1st. That various diuretics had
+long been given in many of these cases before I was consulted. And,
+2dly. That the exhibition of the Foxglove was but seldom attended with
+sickness.
+
+
+                               REMARKS.
+
+These Cases, thus liberally communicated by my friend, Dr. Jones, are
+more acceptable, as they seem to contain a faithful abstract from his
+notes, both of the unsuccessful as well as the successful Cases.
+
+     The following Tabular View of them will give us some Idea of
+     the efficacy of the Medicine.
+
+    Anasarca                            7 Cases   Cured     3
+                                                  Relieved  1
+                                                  Failed    3
+    Ascites                             5 Cases   Cured     4
+                                                  Relieved  1
+    Œdematous leg                       1 Case    Cured     1
+    Ascites and anasarca                7 Cases   Cured     4
+                                                  Relieved  2
+                                                  Failed    1
+    Asthma and dropsy                   1 Case    Failed    1
+    Hydrothorax and gout                1 Case    Cured     1
+    ----, ascites and anasarca--        2 Cases   Cured     2
+
+
+                A CASE of Anasarca communicated by Mr.
+                    JONES, Surgeon, in Birmingham.
+
+     Dear SIR,
+
+Having lately experienced the diuretic powers of the Foxglove, in a
+case of anasarca; I do myself the pleasure of communicating a short
+history of the treatment to you.
+
+                                                I am, &c.
+                                                       W. JONES.
+
+         Birmingham,
+     May 17th, 1785.
+
+My patient, Mrs. C----, who is in her 51st year, had the following
+symptoms, viz. alternate swelling of the legs and abdomen, a little
+cough, shortness of breath in a morning, thirst, weak pulse, and her
+urine, which was so small in quantity as seldom to amount to half a
+pint in twenty-four hours, deposited a clay-coloured sediment.
+
+_April_ 16th, 1785, I directed the following form:
+
+    R. Fol. Digitalis siccat. ʒii.
+    Aq. fontanæ bullient. ℥viii. f. infus. et cola.
+    Sumat cochl. larga iii. o. n. et mane.
+
+On the 17th she had taken twice of the infusion, and though by mistake
+only two tea spoonfuls for a dose, yet the quantity of urine was
+increased to about a pint in the twenty-four hours. She was then
+directed to take two table spoonfuls night and morning. And.
+
+On the 18th, a degree of nausea was produced. A pint and half of urine
+was made in the last twenty-four hours. During the time above
+specified she had two or three stools every day. The infusion was now
+omitted.
+
+On the 19th the swelling of the legs was removed. A degree of nausea
+took place in the morning, and increased so much during the day, that
+she vomited up all her food and medicine. As she was very low, and
+complained of want of appetite, a cordial julep was directed to be
+taken occasionally, as well as red port and water, mint tea, &c. She
+informed me that whatever she took generally staid about an hour
+before it came up again, and that the mint tea staid longest on the
+stomach. The vomiting decreased gradually, and ceased on the 22d. The
+discharge of urine remained considerable during the three following
+days, but its quantity was not measured.
+
+22d. A dose of neutral saline julep was directed to be taken every
+fourth hour.
+
+On the 23d she complained of thirst, and thought the discharge of
+urine not so copious as on the preceding days, therefore the saline
+julep was continued every fourth hour, with the addition of thirty
+drops of the following medicine:
+
+    R. Aceti scillitic. ʒvi.
+    Tinct. aromat. ʒii.
+    Tinct. thebaic. gutt. xx. m.
+
+The bowels have been kept open from the 19th, by the occasional use of
+emollient injections.
+
+On the 24th the legs were much swelled again; she complained of
+languor and a degree of nausea. The discharge of urine increased a
+little since the 23d. Her pulse was low and her tongue white. The
+urine, which had been rendered clear by the infusion of Foxglove, now
+deposited a whitish sediment.
+
+On the 25th her appetite began to return, the swelling of the legs
+diminished, and she thought herself much relieved. The urine was
+considerable in quantity, and clear.
+
+On the 26th she was thirsty and languid. The swelling was removed; the
+quantity of urine discharged in the last twenty-four hours was about a
+pint. She continued to mend from this time, and is now in good health.
+
+A giddiness of the head, more or less remarkable at times, was
+observed to follow the use of the Foxglove, and it lasted nine or ten
+days.
+
+This is the second time that I have relieved this patient by the
+infusion of Foxglove. I used the same proportion of the fresh leaves
+the first time as I did of the dried ones the last. The violent
+vomiting which followed the use of the infusion made with the dried
+leaves, did not take place with the fresh though she took near a pint
+made with the same proportion of the herb fresh gathered.
+
+
+                               REMARKS.
+
+The above is a very instructive case, as it teaches us how small a
+quantity of the infusion was necessary to effect every desirable
+purpose. At first sight it may appear from the concluding paragraph,
+that the green leaves ought to be preferred to the dried ones, as
+being so much milder in their operation; but let it be noticed, that
+the same quantity of infusion was prepared from the same weight of the
+green as of the dried leaves, and consequently, as will appear
+hereafter, the infusion with the dried leaves was five times the
+strength of that before prepared from the green ones. We need not
+wonder, therefore, that the effects of the former were so
+disagreeable, when the dose was five times greater than it ought to
+have been. But what makes this matter still more obvious, is the
+mistake mentioned at first, of two tea spoonfuls only being given for
+a dose. Now a tea spoonful, containing about a fourth or a fifth part
+of the contents of a table spoon, the dose then given, was very nearly
+the same as that which had before been taken of the infusion of the
+green leaves, and it produced precisely the same effects for it
+increased the urinary discharge, without exciting the violent
+vomiting.
+
+
+                     Letter from Doctor JOHNSTONE,
+                       Physician, in Birmingham.
+
+     Dear SIR,
+
+The following cases are selected from many others in which I have
+given the Digitalis purpurea; and from repeated experience of its
+efficacy after other diuretics have failed. I can recommend it as an
+effectual, and when properly managed, a safe medicine.
+
+                                            I am, &c.
+                                                   E. JOHNSTONE.
+
+     Birmingham, May 26,
+     1785.
+
+_March_ 8th, 1783, I was called to attend Mr. G----, a gentleman of a
+robust habit, who had led a regular and temperate life, Æt. 68. He was
+affected with great difficulty of respiration, and cough particularly
+troublesome on attempting to lie down, œdematous swellings of the
+legs and thighs, abdomen tense and sore on being pressed, pain
+striking from the pit of the stomach to the back and shoulders; almost
+constant nausea, especially after taking food, which he frequently
+threw up; water thick and high-coloured, passed with difficulty and
+in small quantity; body costive; pulse natural; face much emaciated,
+eyes yellow and depressed. He had been subject to cough and difficulty
+of breathing in the winter for several years; and about four years
+before this time, after being exposed to cold, was suddenly deprived
+of his speech and the use of the right side, which he recovered as the
+warm weather came on; but since that time had been remarkably costive,
+and was in every respect much debilitated. He first perceived his legs
+swell about a year ago; by the use of medicines and exercise, the
+swellings subsided during the summer, but returned on the approach of
+winter, and gradually increased to the state in which I found them,
+notwithstanding he had used different preparations of squills and a
+great variety of other diuretic medicines. I ordered the following
+mixture.
+
+    R. Foliorum Digitalis purpur. recent. ʒiii. decoque ex aq.
+    fontan. ℥xii ad ℥vi colaturæ adde Tinctur. aromatic.
+    Syr. zinzib. aa ℥i. m. capt. cochl. duo larga secunda quaque
+    hora ad quartam vicem nisi prius nausea supervenerit.
+
+_March_ 9th. He took four doses of the mixture without being in the
+least sick, and made, during the night upwards of two quarts of
+natural coloured water.
+
+10th. Took the remainder of the mixture yesterday afternoon and
+evening, and was sick for a short time, but made nearly the same
+quantity of water as before, the swellings are considerably
+diminished, his appetite increased, but he is still costive.
+
+    R. Argent, viv. balsam peruv. aa ʒss tere ad extinctionem
+    merc. et adde gum. ammon. ℈iii aloes socotorin. ʒss rad.
+    scil. recent. ℈ss syr. simpl. q. s. f. mass. in pil. xxxii
+    divid. cap. iii. bis in die.
+
+14th. Continues to make water freely. The swellings of his legs have
+gradually decreased; soreness and tension of the abdomen considerably
+less.
+
+    Omittant. pil. cap. mistur. c. decoct. Digitalis. &c. 3tia
+    quaque hora ad 3tiam vicem.
+
+15th. Made a pint and a half of water last night, without being in the
+least sick, and is in every respect considerably better. Repet.
+Pillul. ut antea.
+
+21st. Makes water as usual when in health, and the swellings are
+entirely gone.
+
+    R. Infus. amar. ℥v. tinctur. Rhei spirit. ℥ii. spirit
+    vitriol. dulc. ʒii. syr. zinzib. ʒvi. m. cap. cochl. iii.
+    larg. ter in die.
+
+He soon gained sufficient strength to enable him to go a journey, and
+returned home in much better health than he had been from the time he
+was affected with the paralytic stroke, and excepting some return of
+his asthmatic complaint in the winter, hath continued so ever since.
+
+
+                               CASE II.
+
+R---- Howgate, a man much addicted to intemperance, particularly in
+the use of spirituous liquors, Æt. 60, was admitted into the Hospital
+near Birmingham, _May_ 17, 1783. He complained of difficulty of
+breathing, attended with cough, particularly troublesome on lying
+down; drowsiness and frequent dozing, from which he was roused by
+startings, accompanied with great anxiety and oppression about the
+breast; œdematous swellings of the legs; constant desire to make
+water, which he passed with difficulty, and only by drops; pulse weak
+and irregular; body rather costive; face much emaciated; no appetite
+for food.--Cap. pil. scil. iii. ter in die.[6]
+
+    [Footnote 6: R. Rad. scil. recent. sapon. castiliens. pulv.
+    Rhei opt. aa. ℈i. ol. junip. gutt. xvi. syr. bals. q. s. f.
+    mass. in pil. xxiv. divid.]
+
+_May_ 20th. The pills have had no effect.--Cap. mistur. c.[7] Decoct.
+Digital. &c. cochl. ii. larg. 3tia quaque hora, ad 3tiam vicem.
+
+    [Footnote 7: Prepared in the same manner as in the former
+    case.]
+
+_May_ 21st. Made near two quarts of water in the night, without being
+in the least sick. He continued the use of the mixture three times in
+the day till the 30th, and made about three pints of water daily, by
+which means the swellings were entirely taken away; and his other
+complaints so much relieved, that on the 6th of June he was dismissed
+free from complaint, except a slight cough. But returning to his old
+course of life, he hath had frequent attacks of his disorder, which
+have been always removed by using the Digitalis.
+
+
+                  Extract of a letter from Mr. LYON,
+                         Surgeon, at Tamworth.
+
+--Mr. Moggs was about 54 years of age, his disease a dropsy of the
+abdomen, attended with anasarcous swellings of the limbs, &c. brought
+on by excessive drinking. I believe the first symptoms of the disease
+appeared the beginning of November, 1776; the medicines he took before
+you saw him, were squills in different forms, sal diureticus and
+calomel, but without any good effect; he begun the Digitalis on the
+10th of July 1777; a few doses of it caused a giddiness in the head,
+and almost deprived him of sight, with very great nausea, but very
+little vomiting, after which a considerable flow of urine ensued, and
+in a very short time, a very little water remained either in the
+cavity of the abdomen, or the membrana adiposa, but he remained
+excessive weak, with a fluttering pulse at the rate of 150 or
+frequently 160 in a minute; he kept pretty free from water for upwards
+of twelve months; it then collected, and neither the Digitalis nor
+any other medicine would carry it off. I tapped him the 2d of August
+1779 in the usual place, and took some gallons of water from him, but
+he very soon filled again, and as he had a very large rupture, a
+considerable quantity of the water lodged in the scrotum, and could
+not be got away by tapping in the usual place. I therefore (on the
+28th of the same month) made an incision into the lower part of the
+scrotum, and drained off all the water that way, but he was so very
+much reduced, that he died the 8th or 9th of _September_ following,
+which was about two years and two months after he first begun the
+Digitalis.
+
+I have had several dropsical patients relieved, and some perfectly
+recovered by the Digitalis, since you attended Mr. Moggs, but as I did
+not take any notes or make any memorandums of them, cannot give you
+any of them.
+
+
+                    Communications from Dr. STOKES,
+                      Physician, in Stourbridge.
+
+     Dear SIR,
+
+I accept with pleasure your invitation to communicate what I know
+respecting the properties of _Digitalis_; and if an account of what
+others had discovered before you,[8] with a detail of my own
+experience, shall be allowed the merit of at least a well meant
+acknowledgment, for the early communication you were so kind to make
+me, of the valuable properties you had found in it; I shall consider
+my time as well employed. A knowledge of what has been already done is
+the best ground work of future experiment; on which account I have
+been the more full on this subject, in hopes that given with the
+cautions which you mean to lay down in the cure of dropsies, it may
+prove alike useful in that of other diseases, one of which stands
+foremost among the _opprobria_ of medicine.
+
+    [Footnote 8: See this account in the Introduction.]
+
+
+                                CASE I.
+
+Mrs. M----. Orthopnea, pain, and excessive oppression at the bottom of
+the sternum. Pulse irregular, with frequent intermissions. Appetite
+very much impaired. Legs anasarcous.
+
+    _Empl. vesicator. pectori dolent._
+    _Infus. Digital. e ʒiii. ad. aq. &c. ℥viii. cochl. j. o. h.
+    donec nausea excitetur vel diuresis satis copiosa proveniat._
+
+I ordered it of the above strength, and to be repeated often, on
+account of the great emergency of the case, but the nausea excited by
+the first dose prevented its being given at such short intervals. A 3d
+dose I found had been given, which was followed by vomitings. All her
+complaints gradually abated, but in about a fortnight recurred,
+notwithstanding the use of infus. amar. &c.
+
+    _Dec. 2. Infus. Digit. e. ʒiss ad aq. &c. ℥viii. cochl. ii.
+    horis &c. u. a._
+
+Complaints gradually abated, swellings of the legs nearly gone down.
+
+About a month afterwards you was desired to visit this patient.[9]
+
+    [Footnote 9: For reasons assigned at p. 100, I did not intend
+    to introduce any case, occurring under my own inspection, in
+    the course of the present year; but it may be satisfactory to
+    continue the history of this disease, as Dr. Stokes's
+    narrative would otherwise be incomplete.
+
+
+                                 1785.
+
+                                 CASE.
+
+    _Jan._ 5th. Mrs. M----, Æt. 48. Hydrothorax and anasarcous
+    legs, of eight months duration. She had taken jallap, squill,
+    salt of tartar, and various other medicines. I found her in a
+    very reduced state, and therefore directed only a grain and
+    half of the Pulv. Digital. to be given night and morning.
+    This in a few days encreased the secretion of urine, removed
+    her difficulty of breathing, and reduced the swelling of her
+    legs, without any disturbance to her system.
+
+    Three months afterwards, a severe attack of gout in her legs
+    and arms, removing to her head, she died.
+
+    Dr. Stokes had an opportunity of examining the dead body, and
+    I had the satisfaction to learn from him, that there did not
+    appear to have been any return of the dropsy.]
+
+On the examination of the body I noticed, among others, the following
+appearances.
+
+About ¾ oz. of bloody water flowed out, on elevating the upper half
+of the scull, and a small quantity also was found at the base.
+
+BRAIN. Blood-vessels turgid with blood, and many of those of
+considerable size distended with air.
+
+A very slight watery effusion between the _Pia Mater_ and _Tunica
+arachnoidea_. About ¾ oz. of watery fluid in the _lateral
+ventricles_.
+
+THORAX. In the left cavity about 4 oz. of bloody serum; in the right
+but little. Lungs, the hinder parts loaded with blood. Adhesions of
+each lobe to the pleura. _Pericardium_ containing but a very small
+quantity of fluid. _Heart_ containing no coagula of blood. _Valves of
+the Aorta_ of a cartilaginous texture, as if beginning to ossify.
+
+_Abdominal Viscera_ natural, and a profusion of _Fat_ under the
+integuments of the abdomen and thorax, in the former to the thickness
+of an inch and upwards, and in very considerable quantity on the
+mesentery, omentum, kidneys, &c.
+
+OBS. The intermitting pulse should seem to have been owing to
+effusions of water in some of the cavities of the breast, as it
+disappeared on the removal of the waters.
+
+
+                               CASE II.
+
+Mrs. C---- of K----, Æt. 80. Orthopnœa, with sense of oppression
+about the prœcordia. Unable to lie down in bed for some nights
+past. Anasarca of the lower extremities. Urine very scanty. Complaints
+of six weeks standing. Had taken _sal. diuret. c. ol. junip.--Calom.
+c. jalap, et gambog.--Et ol. junip. c. ol. Terebinth._ without effect.
+
+_Feb._ 7. _Infus. Digital. e. ʒiii. ad aq. &c. ℥viii. cochl. ii. 4tis
+horis._ Ordered to drink largely of _infus. baccar. junip._ The third
+dose produced great nausea which continued ten hours, during which
+time the urine made was about a quart. The next day her apothecary
+directed her to begin again with it. The second dose produced
+vomiting. During the next twenty hours she made two quarts of water,
+about four times as much as she drank.
+
+From this time she took no more of the _infus. Digital._ but continued
+the _inf. bacc. junip._ until about _March_ 2d, when all the swellings
+were gone down, her respiration perfectly free, and she herself quite
+restored to her former state of health. On the 29th she had an attack
+of jaundice which was some time after removed; since which she has
+enjoyed a good state of health, excepting that for some little time
+past her ancles have been slightly œdematous, which will I trust
+soon yield to strengthening medicines.
+
+
+                               CASE III.
+
+Mrs. M---- G----, Æt. 64. Has had sore legs for these thirty-four
+years past. Orthopnœa. Sense of oppression at the prœcordia.
+Pulse intermitting. Legs anasarcous. Urine scanty, high-coloured.
+
+    _Infus. Digital. c. ʒiss ad aq. bull. ℥viii. cochl. ii. 4tis
+    horis._
+
+Took six doses, when nausea was excited. Urine a quart during the
+course of the night. The flow of urine continued, and complaints
+relieved. Sal. Mart. c. extr. gent. and afterwards with the addition
+of extr. cort. for which last ingredient she had a predilection,
+confirmed the cure.
+
+On the same day the next year I was called in to her for a similar
+train of symptoms, excepting that the pulse was but just perceptibly
+irregular.
+
+    _Infus. Digital. u. a. præscript._
+
+The directions on the phial not being attended to, _two doses of it
+were given after a nausea had been excited_, which, with occasional
+vomitings, became exceedingly oppressive. A saline draught, given in
+Dr. Hulme's method, a draught _sal. c. c. gr. xii. c. conf. card. gr.
+x._ produced no immediate effect, but the nausea gradually abating,
+inf. bacc. junip. was ordered; but this appeared to augment it, and a
+great propensity to sleep coming on, I directed _sal. c. c. conf.
+card, aa gr. viii. 4tis horis_, which removed the unpleasant symptoms
+and _myrrh. c. sal. mart._ completed the cure. During the use of the
+above medicines, the urine was augmented, and the pulmonary complaints
+removed, even before the nausea left her; and the sores of her legs
+which were much inflamed before she began with the infus. Digital. in
+a day's time assumed a much healthier appearance, and on her other
+complaints going off, they shewed a greater tendency to heal than she
+had ever observed in them for twenty years before. This instance is a
+very pleasing confirmation of the experience of Hulse and Dr. Baylies,
+and of the advantage to be derived from a medicine, which, while it
+helps to heal the ulcers, removes that from the constitution which
+often renders the healing of them improper.
+
+In one case in which I ordered it, the infusion, instead of digesting
+three hours as I had directed, was suffered to stand upon the leaves
+all night. The consequence was that the first dose produced
+considerable nausea.
+
+The two following cases, with which I have been favoured by a
+physician very justly eminent, convince me of the necessity there is
+that every one who discovers a new medicine, or new virtues in an old
+one, should, in announcing such discoveries, publish to the world the
+exact manner in which he exhibits such medicines, with all the
+precautions necessary to obtain the promised success.
+
+    In these (says my correspondent) “the infusion was given in
+    small doses, repeated every hour or two, till a nausea was
+    raised, when it was omitted for a day or perhaps two, and
+    then repeated in the same manner.
+
+    “An ASCITES emptied by it, but filled again very speedily,
+    though _its use was never discontinued_, and who afterwards
+    found no salutary effects from it. Ended fatally.
+
+    “In an ANASARCA it sometimes increased the quantity of urine,
+    and abated the swelling, but which as often returned in as
+    great a degree as before, though _the medicine was still
+    given_, and always increased in quantity so as to excite
+    nausea. Ended fatally.
+
+    “I have tried it in many other cases, but found very little
+    difference in the success attending it.”
+
+May we not be allowed to conjecture that the inefficacy of _its
+continued use_ is owing to its narcotic property gradually diminishing
+the irritability of the muscular fibres of the absorbents, or possibly
+of the whole vascular system, and thus adding to that weakened action
+which seems to be the cause of the generality of dropsies, which leads
+us to caution the medical experimenter against trying it, at least
+_against its continued use, even in small doses_, in other diseases of
+diminished energy, as continued fever, palsy, &c.
+
+             I remain with the greatest truth,
+
+                       Your obliged and affectionate friend,
+
+                                                JONATHAN STOKES.
+
+     Stourbridge,
+     May 17, 1785.
+
+
+    The three following Hospital Cases, which Dr. STOKES had an
+    opportunity of observing, are related as instances of bad
+    practice, and tend to demonstrate how necessary it is when
+    one physician adopts the medicine of another, that he should
+    also at first rigidly adopt his method.
+
+
+                                CASE I.
+
+Esther K----, Æt. 33. General anasarca, ascites, and dyspnœa, of
+seven months duration.
+
+_Decoct. c Digit. ʒiv. c. aq. ℔i. coquend. ad ℔ss. cap. ℥i. 2dis.
+horis._ 1st DAY. 4th dose made her sick. 2d DAY. The first dose she
+took to-day produced vomiting.
+
+3d DAY. _Minuatur dosis ad ℥ss._ This stayed upon her
+stomach, but produced an almost constant sickness. Stools more
+frequent, water scarce sensibly increased; and her swellings not at
+all reduced.
+
+4th DAY. _Cap. Calomel. gambog. scill. &c._
+
+OBS. Sufficient time was not allowed to observe its effects, neither
+was the patient enjoined the free use of diluents. The disease
+terminated fatally.
+
+
+                               CASE II.
+
+William T----, Æt. 42. Ascites, with cough and dyspnœa. Abdomen
+very much distended. The rest of his body highly emaciated. Urine
+thick, high coloured, and in very small quantity.
+
+    _Decoct. Digit. (u. in Esther K----,) 4tis horis._
+
+1st DAY of taking it. The 4th dose produced sickness.
+
+2d. Vomiting after the second dose.
+
+10th. Urine increased to ℔vi.
+
+11th. Flow of urine continues. Abdomen quite flaccid.
+
+12th. Abdomen not diminished.
+
+15th: A smart purging came on, and the flow of urine diminished.
+
+23d. Belly much bound. Took a cathart. powder, which was followed by a
+diminution of the abdomen.
+
+29th. To take a cathart. powder every 4th morning, continuing the
+decoct. Digit.
+
+32d. Urine exceedingly scanty.
+
+35th. _Vin. scill. ℥ss. o. m. &c._ This produced
+diuretic effects.
+
+44th. Tapped. Terminated fatally.
+
+OBS. Here the medicine was _continued till it ceased to produce
+diuretic effects_; and these effects were not aided by any
+strengthening remedies.
+
+
+                               CASE III.
+
+George R----, Æt. 52. Ascites, general anasarca, and dyspnœa. His
+legs so greatly distended that it was with great difficulty he could
+draw the one after the other.
+
+    _Infus. Digital. ʒiiiss. ad. aq. ℔ss. cap. ℥i. altern. horis
+    donec nauseam excitaverit._ _Rep. 3tiis diebus. tempore
+    intermedio cap. sol. guaic. ℥i. ter in die ex inf. sinap._
+
+1st DAY of taking it. Became sickish towards night.
+
+2d DAY. Made a great quantity of water during the night, and spat up a
+great deal of watery phlegm. The first dose he took in the morning has
+produced a sickness which has continued all day, but he has never
+vomited.
+
+3d. DAY. The change in his appearance so great as to make it difficult
+to conceive him to be the same person. Instead of a large corpulent
+man, he appeared tall, thin, and rather aged. Breathes freely, and can
+walk up and down stairs without inconvenience.
+
+4th DAY. _Decoct. bacc. junip. and cyder for common drink._
+
+6th DAY. A second course of his medicine produced a flow of urine
+almost as plentiful as the former, though he drank little or nothing
+at the time. In a day or two after he walked to some distance.
+
+12th DAY. _Pot. purgans illico._
+
+14th DAY. _Pot. purg. c. jalap. ʒss. 4tis diebus._
+          _Infus. Dig. 3tiis diebus._
+
+17th DAY. _R. Gamb. gr. iii. calom. gr. ii. camph.
+          gr. i. syr. simpl. fiat pil. o. n. sum._
+          _Infus. Digit. 3tiis diebus._
+
+21st DAY. Made an out-patient. The super-abundant flow of urine
+continued for the first three days after his last course; but since,
+the flow of saliva has been nearly equal to that of urine.
+
+The smalls of his legs not quite reduced, and are fuller at night. He
+has shrunk round the middle from four feet two inches to three feet
+six inches; and in the calves of his legs, from seventeen inches to
+thirteen and a half.[10]
+
+
+    [Footnote 10: In the three last recited cases, the medicine
+    was directed in doses quite too strong, and repeated too
+    frequently. If Esther K---- could have survived the extreme
+    sickness, the diuretic effects would probably have taken
+    place, and, from her time of life, I should have expected a
+    recovery. Wm. T---- seems to have been a bad case, and I
+    think would not have been cured under any management. G.
+    R---- certainly possessed a good constitution, or he must
+    have shared the fate of the other two.]
+
+OBS. The waters were here very successfully evacuated, but as you
+remarked to me, on communicating the case to you at the time, tonic
+medicines should have been given, to second the ground that had been
+gained, instead of weakening the patient by drastic purgatives.
+
+
+                   A CASE from Mr. SHAW, Surgeon, at
+             Stourbridge.--Communicated by Doctor STOKES.
+
+Matth. D----, Æt. 71. Tall and thin. Disease a general anasarca, with
+great difficulty of breathing. The lac ammoniac. somewhat relieved his
+breath; but the swellings increased, and his urine was not augmented.
+I considered it as a lost case, but having seen the good effects of
+the Digitalis, as ordered by Dr. Stokes in the case of Mrs. G----, I
+gave him one spoonful of an infusion of ʒii to half a pint, twice a
+day. His breath became much easier, his urine increased considerably,
+and the swellings gradually disappeared; since which his health has
+been pretty good, except that about three weeks ago, he had a slight
+dyspnœa, with pain in his stomach, which were soon removed by a
+repetition of the same medicine.
+
+Mr. Shaw likewise informs me, that he has removed pains in the stomach
+and bowels, by giving a spoonful of the infusion, ʒiss. to ℥viii.
+morning and night.
+
+
+            A Letter from Mr. VAUX, Surgeon, in Birmingham.
+
+     Dear SIR,
+
+I send you the two following cases, wherein the Digitalis had very
+powerful and sensible effects, in the cure of the different patients.
+
+
+                                CASE I.
+
+Mrs. O---- of L---- street, in this town, aged 28, naturally of a
+thin, spare habit, and her family inclinable to phthisis, sent for me
+on the 11th of June, 1779, at which time she complained of great pain
+in her side, a constant cough, expectorated much, which sunk in water;
+had colliquative sweats and frequent purging stools; the lower
+extremities and belly full of water, and from the great difficulty she
+had in breathing, I concluded there was water in the chest also. The
+quantity of water made at a time for three weeks before I saw her,
+never amounted to more than a tea-cup full, frequently not so much.
+Finding her in so alarming a situation, I gave it as my opinion she
+could receive no benefit from medicine, and requested her not to take
+any; but she being very desirous of my ordering her something, I
+complied, and sent her a box of gum pills with squills, and a mixture
+with salt of tartar: these medicines she took until the sixteenth,
+without any good effects: the water in her legs now began to exsude
+through the skin, and a small blister on one of her legs broke.
+Believing she could not exist much longer, unless an evacuation of the
+water could be procured; after fully informing her of her situation,
+and the uncertainty of her surviving the use of the medicine, I
+ventured to propose her taking the Digitalis, which she chearfully
+agreed to. I accordingly sent her a pint mixture, made as under, of
+the fresh leaves of the Digitalis. Three drams infused in one pint of
+boiling water, when cold strained off, without pressing the leaves,
+and two ounces of the strong juniper water added to it: of this
+mixture she was ordered four table spoonfuls every third hour, till it
+either made her sick, purged her, or had a sensible effect on the
+kidneys. This mixture was sent on the seventeenth, and she began
+taking it at noon on the eighteenth. At one o'clock the following
+morning I was called up, and informed she was dying. I immediately
+attended her, and was agreeably surprised to find their fright arose
+from her having fainted, in consequence of the sudden loss of twelve
+quarts of water she had made in about two hours. I immediately applied
+a roller round her belly, and, as soon as they could be made, 2
+others, which were carried from the toes quite up the thighs. The
+relief afforded by these was immediate; but the medicine now began to
+affect her stomach so much, that she kept nothing on it many minutes
+together. I ordered her to drink freely of beef tea, which she did,
+but kept it on her stomach but a very short time. A neutral draught in
+a state of effervescence was taken to no good purpose: She therefore
+continued the beef tea, and took no other medicine for five days,
+when her sickness went off: her cough abated, but the pain in her side
+still continuing, I applied a blister which had the desired effect:
+her urine after the first day flowed naturally. Her cure was
+compleated by the gum pills with steel and the bitter infusion. It
+must be observed she never had any collection of water afterwards.
+
+It affords me great pleasure to inform you that she is now living, and
+has since had four children; all of whom, I think I may justly say,
+are indebted to the Digitalis for their existence.
+
+There appears in this case a striking proof of the utility of emetics
+in some kinds of consumptions, as it appears to me the dropsy was
+brought on by the cough, &c. and I believe these were cured by the
+continual vomitings, occasioned by the medicine.
+
+
+                                CASE II.
+
+Mr. H----, a publican, aged about 48 years, sent for me in _March_,
+1778. He complained of a cough, shortness of breathing, which
+prevented him from laying down in bed; his belly, thighs and legs very
+much distended with water; the quantity of urine made at a time seldom
+exceeded a spoonful. I requested him to get some of the Digitalis, and
+as they had no proper weights in the house, I told them to put as much
+of the fresh leaves as would weigh down a guinea, into half a pint of
+boiling water; to let it stand till cold, then to pour off the clear
+liquor, and add a glass of gin to it, and to take three table
+spoonfuls every third hour, until it had some sensible effect upon
+him.
+
+Before he had taken all the infusion, the quantity of urine made
+increased, (he therefore left off taking it), and it continued to do
+so until all the water was evacuated. His breathing became much
+better, his cough abated, though it never quite left him; he being for
+some time before asthmatic. By taking some tonic pills he continued
+quite well until the next spring, when he had a return of his
+complaint, which was carried off by the same means. Two years after,
+he had a third attack, and this also gave way to the medicine. Last
+year he died of a pleurisy.
+
+                                                  I am, &c.
+                                                       JER. VAUX
+
+     Moor-Street, 8th May,
+     1785.
+
+P. S. You must well recollect the case of Mrs. F----.--It was “a
+general dropsy--every time she took the medicine its effects were
+similar, viz. The discharge of urine came on gradually at first,
+increased afterwards, and the whole of the water both in the belly,
+legs, &c. was perfectly evacuated. Although the effects were only
+temporary, they were exceedingly agreeable to the patient, making her
+time much more comfortable.”--(_See Case_ XLIII.)
+
+
+                     A Letter from Mr. WAINWRIGHT,
+                          Surgeon, in Dudley.
+
+     Dear SIR,
+
+It gives me great pleasure to find you intend to publish your
+observations on the Digitalis purpurea.
+
+Several years are now elapsed since you communicated to me the high
+opinion you entertained of the diuretic qualities of this noble plant.
+To ensure success, due attention was recommended to its _preparation_,
+its _dose_, and its _effects_ upon the system.
+
+I always gave the infusion of the dried leaves; the dose the same as
+in the prescriptions returned. If the medicine operated on the stomach
+or bowels, it was thought prudent to forbear. When the kidneys began
+to perform their proper functions, and the urine to be discharged, a
+continuance of its farther use was unnecessary.
+
+These remarks you made in the case of the first patient for whom you
+prescribed the Digitalis in our neighbourhood, and I have found them
+all necessary at this present period. From the _decided_ good effects
+that followed from its use, in those cases where the most powerful
+remedies had failed, I was soon convinced it was a most valuable
+addition to the materia medica.
+
+The want of a certain diuretic, has long been one of the desiderata of
+medicine. The Digitalis is undoubtedly at the head of that class, and
+will seldom, if properly administered, disappoint the expectation. I
+can speak with the more confidence, having, in an extensive practice,
+been a happy witness to its good qualities.
+
+For several years, I have given the infusion in a variety of cases,
+where there was a deficiency in the secretion of the urine, with the
+greatest success. In recent obstructions, I do not recollect many
+failures. In anasarcous diseases, and in the anasarca, when combined
+with the ascites; in swellings of the limbs, and in diseases of the
+chest, when there was the greatest reason to believe an accumulation
+of serum, the most beneficial consequences have followed from its use.
+
+Had I been earlier acquainted with your intention to publish an
+account of the Digitalis, I could have transmitted some cases, which
+might have served to corroborate these assertions: but I am convinced
+the Digitalis needs not my assistance to procure a favorable
+reception. Its own merit will ensure success, more than a hundred
+recited cases.
+
+I could wish those gentlemen who intend to make use of this plant, to
+collect it in a hot dry day, when the petals fall, and the
+seed-vessels begin to swell.
+
+The leaves kept to the second year are weaker, and their diuretic
+qualities much diminished. It will therefore be necessary to gather
+the plant fresh every season.
+
+These cautions are unnecessary to the accurate botanist, who well
+knows, that a plant in the spring, though more succulent and full of
+juices, is destitute of those qualities which may be expected when
+that plant has attained its full vigour, and the seed-vessels begin to
+be manifest. But for want of attention to these particulars, its
+virtues may be thought exaggerated, or doubtful, if beneficial
+consequences do not always flow from its use. There are diseases it
+cannot cure; and in several of those patients in this town, who first
+took the Digitalis by your orders, there was the most positive proof
+of the viscera being unsound. In these desperate cases it often
+procured a plentiful flow of urine, and palliated a disease which
+medicine could not remove.
+
+At a remote distance, physicians are seldom applied to for advice in
+trifling disorders. Many remedies have been tried without relief, and
+the disease is generally obstinate or confirmed.--It would not be fair
+to try the merits of the Digitalis in this scale. It might often fail
+of promoting the end desired. I flatter myself the reputation of this
+plant will be equal to its merit, and that it will meet with a candid
+reception.
+
+As there is no pleasure equal to relieving the miseries and distresses
+of our fellow-creatures, I hope you will long enjoy that peculiar
+felicity.
+
+Permit me to return my thankful acknowledgments, for your free
+communication of a medicine, by which means, through the blessing of
+providence, I have been enabled to restore health and happiness to
+many miserable objects.
+
+                                           I am, &c.
+                                                 Yours,
+                                                  J. WAINWRIGHT.
+
+     Dudley, April 26th,
+     1785.
+
+
+                     CASE of Mr. WARD, Surgeon, in
+                   Birmingham.--Related by himself.
+
+In _September_, 1782, I was seized with a difficulty of breathing, and
+oppression in my chest, in consequence of taking cold from being
+called out in the night. My tongue was foul; my urine small in
+quantity; my breath laborious and distressing on the slightest
+exercise. I tried the medicines most generally recommended, such as
+emetics, blisters, lac ammoniacum, oxymel of squills, &c. but finding
+little or no relief, I consulted Dr. Withering, who advised me to try
+the following prescription.
+
+    R. Fol. Digital. purp. siccat. ʒiss.
+    Aq. bullientis ℥iv.
+    Aq. cinn. sp. ℥ss. digere per horas quatuor, et colaturæ
+    capiat cochlear. i. nocte maneque.
+
+He also desired me to take fifty drops of tincture of cantharides
+three or four times a day.
+
+After taking eight ounces of the infusion, and about twelve drams of
+the drops, I was perfectly cured, and have had no return since. The
+medicine did not occasion sickness or vertigo, nor had they any other
+sensible effect than in changing the appearance, and increasing the
+quantity of the urine, and rendering the tongue clean. After the last
+dose or two indeed, I had a little nausea, which was immediately
+removed by a small glass of brandy.
+
+     Birmingham, 1st July, 1785.
+
+
+                    Communications from Mr. YONGE,
+                  Surgeon, in Shiffnall, Shropshire.
+
+     Dear SIR,
+
+I have great satisfaction in complying with your just claim, by
+transcribing outlines of the subsequent cases, for insertion in your
+long requested tract on the Digitalis purpurea. The two first of these
+you will easily recollect, the cures having been conducted immediately
+under your own management, and the whole may add to that weight of
+evidence which long experience enables you to adduce of the efficacy
+of that valuable medicine. I have recited the only instances of its
+failure which occur to me, but many other, though successful cases,
+wherein its utility might seem dubious, and also the accounts received
+from people whose accuracy might be suspected, I shall not for obvious
+reasons trouble you with.
+
+                                      I am, dear Sir,
+                                        Your obliged friend,
+                                                  WILLIAM YONGE.
+
+     Shiffnall,
+     _May_ 1, 1785.
+
+
+                                CASE I.
+
+A Gentleman aged 49, on the night of the 21st of August, 1784, awaked
+with a sense of suffocation, which obliged him to rise up suddenly in
+bed. I found him complaining of difficult respiration, particularly on
+lying down; the countenance pale, and the pulse smaller and quicker
+than usual. Some brandy and water having been given, the symptoms
+gradually abated, so that he slept in a half recumbent posture. The
+following day he expressed a sense of anxiety and weight in the chest,
+attended by quicker breathing upon motion of the body. That evening an
+emetic of ipecacoanha was given, and afterwards a draught, with
+vitriolic æther and confect. card. aa ʒi to be repeated as the
+symptoms should require it. He continued to be affected with slighter
+returns of the dyspnœa at irregular intervals, until _September_ 15th,
+when upon a more severe attack, the emetic was repeated. He now
+recollected some slight pain in his arms which had affected him
+previous to this last seizure, and was disposed to consider his
+complaint as rheumatic. Pills with gum ammoniac. gum guaiac. and
+antimonial powder were directed, with infus. amar. simpl. twice a day.
+The bowels were regulated by aperient pills of pulv. jalap. aloes and
+sal. tartar. and ʒiss balsam peruv. was given occasionally to
+alleviate the paroxysms of dyspnœa.
+
+From this period until the beginning of November, little amendment or
+variation happened, except that respiration became more permanently
+difficult, and particularly oppressed upon motion, nor was it relieved
+by the expectoration of a mucous discharge, which now increased
+considerably. Squills, musk, ol. succini, æther, with other medicines
+of the same kind, were now used, but without success. The effects of
+opium and venæfection were tried. The appetite diminished, and his
+sleep became short and disturbed. He sometimes slept lying upon his
+back, but generally upon his left side. The urine which had hitherto
+been of good colour, and sufficient quantity, now became diminished,
+and lateritious; and the ancles œdematous.
+
+On the 15th of _November_ a blister was laid over the sternum, and
+ʒiss of oxymel scillitic. was given every eight hours.
+
+On the 18th, a more copious discharge of urine took place; the
+swelling of the feet soon disappeared, and the respiration became
+gradually relieved.
+
+On the 30th ʒi tinct. cantharidum twice a day in pyrmont water, with
+pills of ammoniac, sal tartar. et extract. gentian. were substituted,
+but
+
+On the 7th of _December_, from some symptoms of relapse, the oxymel
+was used as before, and continued to be taken until the 27th, in doses
+as large as could be dispensed with on account of the great nausea
+which attended its exhibition: The urine was made in the quantity of
+four or five pints each day, during the whole time; the quantity then
+drank being seldom more than three pints. But now the sickness being
+exceedingly depressing, the strength failing, and the diuretic effects
+beginning to cease, the following prescription was directed.
+
+    R. Fol. Digitalis purpur. pulv. ℈ss.
+    Spec. Aromatic. ℈i. sp. lav. c. f. pilul. no. x. capiat i.
+    nocte maneque, et alternis diebus sensim augeatur dosin.
+
+In three days the effect of this medicine became visible, and when the
+dose of the Digitalis had been increased to six grains per day, the
+flow of urine generally amounted to seven pints every twenty-four
+hours. Not the least sickness, nor any other disagreeable symptom
+supervened, though he persevered in this plan until the end of
+_January_ at which time the dyspnœa was removed, and he has
+continued gradually to regain his flesh, strength, and appetite,
+without any relapse.
+
+
+                               CASE II.
+
+About the middle of the year 1784 a lady aged 48, returned from
+London, to her native air in Shropshire, under symptoms of complicated
+disease. It was your opinion that the plethoric state, consequent to
+that period, when menstruation first begins to cease, had under
+various appearances, laid the foundation of that deplorable state
+which now presented itself. The skin was universally of a pale, leaden
+colour; her person much emaciated, and her strength so reduced, as to
+disable her from walking without support. The appetite fluctuating,
+the digestion impaired so much, that solids passed the intestines with
+little appearance of solution: She had generally eight or ten alvine
+evacuations every day, and without this number, febrile symptoms,
+attended with severe vertiginous affection, and vomiting regularly
+ensued. The stools were of a pale ash colour. The urine generally
+pale, and at first in due quantity. The region of the stomach had a
+tense feel, without soreness: the feet and ancles œdematous, her
+sleep was uncertain: the pulse varying between 94 and 100, and feeble,
+except upon the approach of the menstrual periods, which were now only
+marked by its increased strength, and exacerbation of other febrile
+symptoms. Emetics, saline medicines, and gentle aperients were
+necessary to alleviate these. Six grains of ipecac, operated with
+sufficient power, and half a grain of calomel would have purged with
+great violence.
+
+From the time of her arrival till the middle of _August_, mercury had
+been continued in various forms, and in doses such as the irritable
+state of her stomach and bowels would admit of. Spirit. nitri dulc.;
+sal. tartar, squill, and cantharides were alternately employed as
+diuretics, but without success, to retard the progress of an universal
+anasarca which was then advanced to such degree and accompanied by so
+great debility, and other dreadful concomitants, as to threaten a
+speedy and fatal catastrophe.
+
+On the 16th of _August_ you first saw her, and directed thus.
+
+    R. Mercur. cinerei gr. ii.
+    Fol. Digital, purpur. pulv. ℈i. f. mass. in pill. no. xvi.
+    dividend.--sumat unam hora meridiana, iterumque hora quinta
+    pomeridiana quotidie.
+    Capiat lixivii saponac. gutt. L. in haust. juscul. sine sale
+    parati omni nocte.
+
+On the 20th the flow of urine began to increase, and she continued the
+medicine in the same dose until the 20th of _September_, discharging
+from six to eight pints of water each day for the first week, and
+which quantity gradually diminished as she became empty. During this
+period she complained not of any sickness, except from the lixivium,
+which was after the first dose reduced to 20 drops; and her appetite
+and strength increased daily, though it was evident that no bile had
+yet flowed into the bowels, nor was the digestion at all improved. The
+anasarcous appearances being then removed, the Digitalis was omitted,
+and pills, composed of mercur. cinereus, aloes, and sal tartari
+directed twice a day, with ʒi. of vin. chalybeat. in infus. amar.
+simpl.
+
+Her amendment in other respects proceeded slowly, but regularly, from
+that time until the 9th of October; when the state of plethora again
+recurring, with its usual attendant symptoms, ℥iv. of blood were taken
+from the arm; and this was upon the same occasion, repeated in the
+following month, with manifest good consequences; though in both
+instances the colour of the blood, as flowing from the vein could
+hardly be called red, and the coagulum was as weak in its cohesion as
+possible. The state of the stomach and bowels was by this time greatly
+improved, in common with other parts of the system; but no
+intromission of bile had yet happened: the hardness about the
+hypogastric region, though less, continued in a considerable degree,
+and you ordered pills of mercury rubbed down, and rust of iron, to be
+taken twice a day, with a decoction of dandelion and sal sodæ.
+
+A cataplasm of linseed was applied every night over the stomach and
+right side; and, with little deviation from this plan, she continued
+to the end of the year, improving in her general health, but the
+hepatic affection yet remaining. It was then determined to try the
+effects of electricity, and gentle shocks were passed through the body
+daily, and as nearly as could be through the liver, in various
+directions.
+
+On the fifth day there was reason to think that some gall had been
+secreted and poured out, and this became every day more evident; but
+it flowed only in small quantity, and irregularly into the bowels, as
+appeared from the fæces being partially tinged by it.
+
+In _February_ the lady left this neighbourhood, and though
+convalescent, yet so nearly well as to promise us the satisfaction of
+seeing her perfectly restored.
+
+_June_ 29. The bile is now secreted in pretty good quantity, her
+appetite is perfectly good, her strength equal to almost any degree of
+exercise, and her health in general better than it has been for some
+years.
+
+
+                               CASE III.
+
+Mr. W----, aged--. In _June_, 1782, was affected with slight
+difficulty in respiration, upon taking exercise or lying down in bed.
+These symptoms increased gradually until the end of _July_, when he
+complained of sense of weight and uneasiness about the prœcordia;
+loss of appetite; and costiveness. The urine was small in quantity,
+and high coloured; his pulse feeble, and intermitting; he breathed
+with difficulty when in bed, and slept little. After the exhibition of
+an emetic, and an opening medicine of rhubarb, sena, and sal tartari,
+he was directed to take half a dram of squill pill, pharm. Edinburg.
+night and morning, with ʒss sal. sodæ in ℥iss. infus. amar. simpl.
+twice a day; and these medicines were continued during ten days,
+without any sensible effect. A blister was then applied to the
+sternum, and six grains of calomel given in the evening. The symptoms
+were now increased very considerably, in every particular; and the
+following infusion was substituted for the former medicines.
+
+    R. Fol. Digital. purpur. ʒiii.
+    Cort. limon. ʒii. infund.
+    Aq. bullient. ℔i. per hor. 2 et cola. sumat cochl. i. primo
+    mane et repet. omni hora.
+
+Sometime in the night considerable nausea occurred, and the following
+day he began to make water in great quantity, which he continued to do
+for three or four days. The pulse in a few hours became regular,
+slower, and stronger, and, in the course of a week, all the symptoms
+entirely vanished, and an electuary of cort. peruvian, sal martis, and
+spec. aromatic. confirmed his cure.
+
+In _February_, 1784, this gentleman had a relapse of his disease, from
+which he again soon recovered by the same means, and is now perfectly
+well.
+
+
+                               CASE IV.
+
+G---- A----, a husbandman, aged 57. Was in the year 1782 affected with
+a slight, but constant pain in his breast, with difficult respiration.
+His countenance was yellow; the abdomen swelled, and hard; his urine
+high coloured, and in small quantity; appetite and sleep little.
+Complained of frequent nausea, and of sudden profuse sweatings, which
+seemed for a short time to relieve the dyspnœa.
+
+After the exhibition of an emetic, six grains of calomel were given,
+with a purge of jalap in the morning, and repeated in a few days, with
+some appearance of advantage. He was then directed to take some pills
+of squill, soap, and rhubarb, with a draught twice a day, consisting
+of infus. amar. simp. and sal tartari. The skin soon became clearer
+and the pain in his breast considerably diminished. But every other
+circumstance remaining the same, and a fluctuation in the belly being
+now more evident, the infusion of Digitalis as prescribed in case
+third, was given in the dose of one ounce twice a day.
+
+On the 5th day the effects were apparent, and he continued his
+medicine for a fortnight without nausea, making four or five pints of
+water every night, but little in the day, and gradually losing the
+symptoms of his disease.
+
+In 1784, this person had a relapse, and was again cured by similar
+treatment.
+
+
+                                CASE V.
+
+R---- H----, Aged 43. Towards the end of the year 1783, became
+affected with slight cough and expectoration of purulent matter. In
+December his skin became universally of a pale yellow colour. The
+abdomen was swelled and hard; his appetite little, and he complained
+of a violent and constant palpitation of the heart, which prevented
+him from sleeping. The urine pale, and in small quantity. The pulse
+exceedingly strong, and rebounding; beating 114 to 120 strokes every
+minute. He suffered violent pain of his head, and was very feeble and
+emaciated. After bleeding, and the use of gentle aperient medicines,
+he continued to take the infusion of Digitalis for some days, without
+any sensible effect. Other diuretics were tried to as little purpose.
+Repeated bleeding had no effect in diminishing the violent action of
+the heart. He died in January following, under complicated symptoms of
+phthisis and ascites.
+
+
+                               CASE VI.
+
+A man aged 57, who had lived freely in the summer of 1784, became
+affected with œdematous swelling of his legs, for which he was
+advised to drink Fox Glove Tea. He took a four ounce bason of the
+infusion made strong with the green leaves, every morning for four
+successive days.
+
+On the 5th he was suddenly seized with faintness and cold sweatings. I
+found him with a pale countenance, complaining of weakness, and of
+pain, with a sense of great heat in his stomach and bowels. The
+swelling of the legs was entirely gone, he having evacuated urine in
+very large quantities for the two preceding days. He was affected with
+frequent diarrhœa. The pulse was very quick and small, and his
+extremities cold.
+
+A small quantity of broth was directed to be given him every half
+hour, and blisters were applied to the ancles, by which his symptoms
+became gradually alleviated, and he recovered perfectly in the space
+of three weeks; except a relapse of the anasarca, for which the
+Digitalis was afterwards successfully employed, in small doses,
+without any disagreeable consequence.
+
+
+                               CASE VII.
+
+S---- D----, a middle aged single woman, was affected in the year
+eighty-one, with a painful rigidity and slight inflammation of the
+integuments on the left side, extending from the ear to the shoulder.
+In every other particular she was healthy. The use of warm
+fomentations, and opium, with two or three doses of mercurial physic,
+afforded her ease and the inflammation disappeared, but was succeeded
+by an œdematous swelling of the part, which very gradually extended
+along the arm, and downward to the breast, back, and belly. Friction,
+electricity and mercurial ointment were amongst the number of
+applications unsuccessfully employed to relieve her for the space of
+three months, during which time she continued in good general health.
+
+In _November_ she became ascitic, passing small quantities of urine,
+and soon afterwards a sudden dyspnœa gave occasion to suppose an
+effusion of water in the thorax. The Digitalis, squills, and
+cantharides were given in very considerable doses without effect. She
+died the latter end of December following.
+
+
+                              CASE VIII.
+
+W---- C----, a collier aged 58, was attacked in the spring of 1783
+with a tertian ague, which he attributed to cold, by sleeping in a
+coal pit, and from which he recovered in a few days, except a
+swelling of the lower extremities, which had appeared about that time,
+and gradually increased for two or three months. The legs and thighs
+were greatly enlarged and œdematous. His belly was swelled, but no
+fluctuation perceptible. He made small quantities of high coloured
+water. The appetite bad, and pulse feeble. He had taken many medicines
+without relief, and was now so reduced in strength, as to sit up with
+difficulty. An infusion of the Digitalis was directed for him, in the
+proportion of one ounce of the fresh leaves to a pint of water, two
+ounces to be taken three times a day, until the stomach or bowels
+became affected. Upon the exhibition of the sixth dose, nausea
+supervened, and continued to oppress him at intervals for two or three
+days, during which he passed large quantities of pale urine. The
+swelling, assisted by moderate bandage rapidly diminished, and without
+any repetition of his medicine, at the expiration of sixteen days, he
+returned to his labour perfectly recovered.
+
+
+
+
+            OF THE PREPARATIONS and DOSES, OF THE FOXGLOVE.
+
+
+Every part of the plant has more or less of the same bitter taste,
+varying, however, as to strength, and changing with the age of the
+plant and the season of the year.
+
+ROOT.--This varies greatly with the age of the plant. When the stem
+has shot up for flowering, which it does the second year of its
+growth, the root becomes dry, nearly tasteless, and inert.
+
+Some practitioners, who have used the root, and been so happy as to
+cure their patients without exciting sickness, have been pleased to
+communicate the circumstance to me as an improvement in the use of the
+plant. I have no doubt of the truth of their remarks, and I thank
+them. But the case of Dr. Cawley puts this matter beyond dispute. The
+fact is, they have fortunately happened to use the root in its
+approach to its inert state, and consequently have not over dosed
+their patients. I could, if necessary, bring other proof to shew that
+the root is just as capable as the leaves, of exciting nausea.
+
+STEM.--The stem has more taste than the root has, in the season the
+stem shoots out, and less taste than the leaves. I do not know that it
+has been particularly selected for use.
+
+LEAVES.--These vary greatly in their efficacy at different seasons of
+the year, and, perhaps, at different stages of their growth; but I am
+not certain that this variation keeps pace with the greater or lesser
+intensity of their bitter taste.
+
+Some who have been habituated to the use of the recent leaves, tell
+me, that they answer their purpose at every season of the year; and I
+believe them, notwithstanding I myself have found very great
+variations in this respect. The solution of this difficulty is
+obvious. They have used the leaves in such large proportion, that the
+doses have been sufficient, or more than sufficient, even in their
+most inefficacious state. _The Leaf-stalks_ seem, in their sensible
+properties, to partake of an intermediate state between the leaves and
+the stem.
+
+FLOWERS.--The petals, the chives, and the pointal have nearly the
+taste of the leaves, and it has been suggested to me, by a very
+sensible and judicious friend, that it might be well to fix on the
+flower for internal use. I see no objection to the proposition; but I
+have not tried it.
+
+SEEDS.--These I believe are equally untried.
+
+From this view of the different parts of the plant, it is sufficiently
+obvious why I still continue to prefer the leaves.
+
+These should be gathered after the flowering stem has shot up, and
+about the time that the blossoms are coming forth.
+
+The leaf-stalk and mid-rib of the leaves should be rejected, and the
+remaining part should be dried, either in the sun-shine, or on a tin
+pan or pewter dish before a fire.
+
+If well dried, they readily rub down to a beautiful green powder,
+which weighs something less than one-fifth of the original weight of
+the leaves. Care must be taken that the leaves be not scorched in
+drying, and they should not be dried more than what is requisite to
+allow of their being readily reduced to powder.
+
+I give to adults, from one to three grains of this powder twice a day.
+In the reduced state in which physicians generally find dropsical
+patients, four grains a day are sufficient. I sometimes give the
+powder alone; sometimes unite it with aromatics, and sometimes form it
+into pills with a sufficient quantity of soap or gum ammoniac.
+
+If a liquid medicine be preferred, I order a dram of these dried
+leaves to be infused for four hours in half a pint of boiling water,
+adding to the strained liquor an ounce of any spirituous water. One
+ounce of this infusion given twice a day, is a medium dose for an
+adult patient. If the patient be stronger than usual, or the symptoms
+very urgent, this dose may be given once in eight hours; and on the
+contrary in many instances half an ounce at a time will be quite
+sufficient. About thirty grains of the powder or eight ounces of the
+infusion, may generally be taken before the nausea commences.
+
+The ingenuity of man has ever been fond of exerting itself to vary the
+forms and combinations of medicines. Hence we have spirituous, vinous,
+and acetous tinctures; extracts hard and soft, syrups with sugar or
+honey, &c. but the more we multiply the forms of any medicine, the
+longer we shall be in ascertaining its real dose. I have no lasting
+objection however to any of these formulæ except the extract, which,
+from the nature of its preparation must ever be uncertain in its
+effects; and a medicine whose fullest dose in substance does not
+exceed three grains, cannot be supposed to stand in need of
+condensation.
+
+It appears from several of the cases, that when the Digitalis is
+disposed to purge, opium may be joined with it advantageously; and
+when the bowels are too tardy, jalap may be given at the same time,
+without interfering with its diuretic effects; but I have not found
+benefit from any other adjunct.
+
+From this view of the doses in which the Digitalis really ought to be
+exhibited, and from the evidence of many of the cases, in which it
+appears to have been given in quantities six, eight, ten or even
+twelve times more than necessary, we must admit as an inference either
+that this medicine is perfectly safe when given as I advise, or that
+the medicines in daily use are highly dangerous.
+
+
+
+
+                     EFFECTS, RULES, and CAUTIONS.
+
+
+The Foxglove when given in very large and quickly-repeated doses,
+occasions sickness, vomiting, purging, giddiness, confused vision,
+objects appearing green or yellow; increased secretion of urine, with
+frequent motions to part with it, and sometimes inability to retain
+it; slow pulse, even as slow as 35 in a minute, cold sweats,
+convulsions, syncope, death.[11]
+
+    [Footnote 11: I am doubtful whether it does not sometimes
+    excite a copious flow of saliva.--See cases at pages 115,
+    154, and 155.]
+
+When given in a less violent manner, it produces most of these effects
+in a lower degree; and it is curious to observe, that the sickness,
+with a certain dose of the medicine, does not take place for many
+hours after its exhibition has been discontinued; that the flow of
+urine will often precede, sometimes accompany, frequently follow the
+sickness at the distance of some days, and not unfrequently be checked
+by it. The sickness thus excited, is extremely different from that
+occasioned by any other medicine; it is peculiarly distressing to the
+patient; it ceases, it recurs again as violent as before; and thus it
+will continue to recur for three or four days, at distant and more
+distant intervals.
+
+These sufferings of the patient are generally rewarded by a return of
+appetite, much greater than what existed before the taking of the
+medicine.
+
+But these sufferings are not at all necessary; they are the effects of
+our inexperience, and would in similar circumstances, more or less
+attend the exhibition of almost every active and powerful medicine we
+use.
+
+Perhaps the reader will better understand how it ought to be given,
+from the following detail of my own improvement, than from precepts
+peremptorily delivered, and their source veiled in obscurity.
+
+At first I thought it necessary _to bring on and continue the
+sickness, in order to ensure the diuretic effects_.
+
+I soon learnt that the nausea being once excited, it was unnecessary
+to repeat the medicine, as it was certain to recur frequently, at
+intervals more or less distant.
+
+Therefore my patients were ordered _to persist until the nausea came
+on, and then to stop_. But it soon appeared that the diuretic effects
+would often take place first, and sometimes be checked when the
+sickness or a purging supervened.
+
+The direction was therefore enlarged thus--_Continue the medicine
+until the urine flows, or sickness or purging take place_.
+
+I found myself safe under this regulation for two or three years; but
+at length cases occurred in which the pulse would be retarded to an
+alarming degree, without any other preceding effect.
+
+The directions therefore required an additional attention to the state
+of the pulse, and it was moreover of consequence not to repeat the
+doses too quickly, but to allow sufficient time for the effects of
+each to take place, as it was found very possible to pour in an
+injurious quantity of the medicine, before any of the signals for
+forbearance appeared.
+
+_Let the medicine therefore be given in the doses, and at the
+intervals mentioned above:--let it be continued until it either acts
+on the kidneys, the stomach, the pulse, or the bowels; let it be
+stopped upon the first appearance of any one of these effects_, and I
+will maintain that the patient will not suffer from its exhibition,
+nor the practitioner be disappointed in any reasonable expectation.
+
+If it purges, it seldom succeeds well.
+
+The patients should be enjoined to drink very freely during its
+operation. I mean, they should drink whatever they prefer, and in as
+great quantity as their appetite for drink demands. This direction is
+the more necessary, as they are very generally prepossessed with an
+idea of drying up a dropsy, by abstinence from liquids, and fear to
+add to the disease, by indulging their inclination to drink.
+
+In cases of ascites and anasarca; when the patients are weak, and the
+evacuation of the water rapid; the use of proper bandage is
+indispensably necessary to their safety.
+
+If the water should not be wholly evacuated, it is best to allow an
+interval of several days before the medicine be repeated, that food
+and tonics maybe administered; but truth compels me to say, that the
+usual tonic medicines have in these cases very often deceived my
+expectations.
+
+From some cases which have occurred in the course of the present year,
+I am disposed to believe that the Digitalis may be given in small
+doses, viz. two or three grains a day, so as gradually to remove a
+dropsy, without any other than mild diuretic effects, and without any
+interruption to its use until the cure be compleated.
+
+If inadvertently the doses of the Foxglove should be prescribed too
+largely, exhibited too rapidly, or urged to too great a length; the
+knowledge of a remedy to counteract its effects would be a desirable
+thing. Such a remedy may perhaps in time be discovered. The usual
+cordials and volatiles are generally rejected from the stomach;
+aromatics and strong bitters are longer retained; brandy will
+sometimes remove the sickness when only slight; I have sometimes
+thought small doses of opium useful, but I am more confident of the
+advantage from blisters. Mr. Jones (_Page_ 135) in one case, found
+mint tea to be retained longer than other things.
+
+
+
+
+                       CONSTITUTION of PATIENTS.
+
+
+Independent of the degree of disease, or of the strength or age of the
+patient, I have had occasion to remark, that there are certain
+constitutions favourable, and others unfavourable to the success of
+the Digitalis.
+
+From large experience, and attentive observation, I am pretty well
+enabled to decide _a priori_ upon this matter, and I wish to enable
+others to do the same: but I feel myself hardly equal to the
+undertaking. The following hints, however, aiding a degree of
+experience in others, may lead them to accomplish what I yet can
+describe but imperfectly.
+
+It seldom succeeds in men of great natural strength, of tense fibre,
+of warm skin, of florid complexion, or in those with a tight and cordy
+pulse.
+
+If the belly in ascites be tense, hard, and circumscribed, or the
+limbs in anasarca solid and resisting, we have but little to hope.
+
+On the contrary, if the pulse be feeble or intermitting, the
+countenance pale, the lips livid, the skin cold, the swollen belly
+soft and fluctuating, or the anasarcous limbs readily pitting under
+the pressure of the finger, we may expect the diuretic effects to
+follow in a kindly manner.
+
+In cases which foil every attempt at relief, I have been aiming, for
+some time past, to make such a change in the constitution of the
+patient, as might give a chance of success to the Digitalis.
+
+By blood-letting, by neutral salts, by chrystals of tartar, squills,
+and occasional purging, I have succeeded, though imperfectly. Next to
+the use of the lancet, I think nothing lowers the tone of the system
+more effectually than the squill, and consequently it will always be
+proper, in such cases, to use the squill; for if that fail in its
+desired effect, it is one of the best preparatives to the adoption of
+the Digitalis.
+
+A tendency to paralytic affections, or a stroke of the palsy having
+actually taken place, is no objection to the use of the Digitalis;
+neither does a stone existing in the bladder forbid its use.
+Theoretical ideas of sedative effects in the former, and apprehensions
+of its excitement of the urinary organs in the latter case, might
+operate so as to make us with-hold relief from the patient; but
+experience tells me, that such apprehensions are groundless.
+
+
+
+
+                              INFERENCES.
+
+
+To prevent any improper influence, which the above recitals of the
+efficacy of the medicine, aided by the novelty of the subject, may
+have upon the minds of the younger part of my readers, in raising
+their expectations to too high a pitch, I beg leave to deduce a few
+inferences, which I apprehend the facts will fairly support.
+
+I. That the Digitalis will not universally act as a diuretic.
+
+II. That it does do so more generally than any other medicine.
+
+III. That it will often produce this effect after every other probable
+method has been fruitlessly tried.
+
+IV. That if this fails, there is but little chance of any other
+medicine succeeding.
+
+V. That in proper doses, and under the management now pointed out, it
+is mild in its operation, and gives less disturbance to the system,
+than squill, or almost any other active medicine.
+
+VI. That when dropsy is attended by palsy, unsound viscera, great
+debility, or other complication of disease, neither the Digitalis, nor
+any other diuretic can do more than obtain a truce to the urgency of
+the symptoms; unless by gaining time, it may afford opportunity for
+other medicines to combat and subdue the original disease.
+
+VII. That the Digitalis may be used with advantage in every species of
+dropsy, except the encysted.
+
+VIII. That it may be made subservient to the cure of diseases,
+unconnected with dropsy.
+
+IX. That it has a power over the motion of the heart, to a degree yet
+unobserved in any other medicine, and that this power may be converted
+to salutary ends.
+
+
+
+
+         PRACTICAL REMARKS ON DROPSY, AND SOME OTHER DISEASES.
+
+
+The following remarks consist partly of matter of fact, and partly of
+opinion. The former will be permanent; the latter must vary with the
+detection of error, or the improvement of knowledge. I hazard them
+with diffidence, and hope they will be examined with candour; not by a
+contrast with other opinions, but by an attentive comparison with the
+phœnomena of disease.
+
+
+                               ANASARCA.
+
+§ 1. The anasarca is generally curable when seated in the
+sub-cutaneous cellular membrane, or in the substance of the lungs.
+
+§ 2. When the abdominal viscera in general are greatly enlarged, which
+they sometimes are, without effused fluid in the cavity of the
+abdomen; the disease is incurable. After death, the more solid viscera
+are found very large and pale. If the cavity contains water, that
+water may be removed by diuretics.
+
+§ 3. In swollen legs and thighs, where the resistance to pressure is
+considerable, the tendency to transparency in the skin not obvious,
+and where the alteration of posture occasions but little alteration in
+the state of distension, the cure cannot be effected by diuretics.
+
+Is this difficulty of cure occasioned by spissitude in the effused
+fluids, by want of proper communication from cell to cell, or is the
+disease rather caused by a morbid growth of the solids, than by an
+accumulation of fluid?
+
+Is not this disease in the limbs similar to that of the viscera (§ 2)?
+
+§ 4. Anasarcous swellings often take place in palsied limbs, in arms
+as well as legs; so that the swelling does not depend merely upon
+position.
+
+§ 5. Is there not cause to suspect that many dropsies originate from
+paralytic affections of the lymphatic absorbents? And if so, is it not
+probable that the Digitalis, which is so effectual in removing dropsy,
+may also be used advantageously in some kinds of palsy?
+
+
+                               ASCITES.
+
+§ 6. If existing alone, (_i. e._) without accompanying anasarca, is in
+children curable; in adults generally incurable by medicines. Tapping
+may be used here with better chance for success than in more
+complicated dropsies. Sometimes cured by vomiting.
+
+
+                         ASCITES and ANASARCA.
+
+§ 7. Incurable if dependant upon irremediably diseased viscera, or on
+a gouty constitution, so debilitated, that the gouty paroxysms no
+longer continue to be formed.
+
+In every other situation the disease yields to diuretics and tonics.
+
+
+                  ASCITES, ANASARCA, and HYDROTHORAX.
+
+§ 8. Under this complication, though the symptoms admit of relief, the
+restoration of the constitution can hardly be hoped for.
+
+
+                                ASTHMA.
+
+§ 9. The true spasmodic asthma, a rare disease--is not relieved by
+Digitalis.
+
+§ 10. In the greater part of what are called asthmatical cases, the
+real disease is anasarca of the lungs, and is generally to be cured by
+diuretics. (See § 1.) This is almost always combined with some
+swelling of the legs.
+
+§ 11. There is another kind of asthma, in which change of posture does
+not much affect the patient. I believe it to be caused by an
+infarction of the lungs. It is incurable by diuretics; but it is often
+accompanied with a degree of anasarca, and so far it admits of relief.
+
+Is not this disease similar to that in the limbs at (§3,) and also to
+that of the abdominal viscera at (§2.)?
+
+
+                         ASTHMA and ANASARCA.
+
+§ 12. If the asthma be of the kind mentioned at (§§ 9 and 11,)
+diuretics can only remove the accompanying anasarca. But if the
+affection of the breath depends also upon cellular effusion, as it
+mostly does, the patient may be taught to expect a recovery.
+
+
+                          ASTHMA and ASCITES.
+
+§ 13. A rare combination, but not incurable if the abdominal viscera
+are sound. The asthma is here most probably of the anasarcous kind (§
+10;) and this being seldom confined to the lungs only, the disease
+generally appears in the following form.
+
+
+                    ASTHMA, ASCITES, and ANASARCA.
+
+§ 14. The curability of this combination will depend upon the
+circumstances mentioned in the preceding section, taking also into the
+account the strength or weakness of the patient.
+
+
+                               EPILEPSY.
+
+§ 15. In epilepsy dependant upon effusion, the Digitalis will effect a
+cure; and in the cases alluded to, the dropsical symptoms were
+unequivocal. It has not had a sufficient trial in my hands, to
+determine what it can do in other kinds of epilepsy.
+
+
+                            HYDATID DROPSY.
+
+§ 16. This may be distinguished from common ascites, by the want of
+evident fluctuation. It is common to both sexes. It does not admit of
+a cure either by tapping or by medicine.
+
+
+                            HYDROCEPHALUS.
+
+§ 17. This disease, which has of late so much attracted the attention
+of the medical world, I believe, originates in inflammation; and that
+the water found in the ventricles of the brain after death, is the
+consequence, and not the cause of the illness.
+
+It has seldom happened to me to be called upon in the earlier stages
+of this complaint, and the symptoms are at first so similar to those
+usually attendant upon dentition and worms, that it is very difficult
+to pronounce decidedly upon the real nature of the disease; and it is
+rather from the failure of the usual modes of relief, than from any
+other more decided observation, that we at length dare to give it a
+name.
+
+At first, the febrile symptoms are sometimes so unsteady, that I have
+known them mistaken for the symptoms of an intermittent, and the cure
+attempted by the bark.
+
+In the more advanced stages, the diagnostics obtrude themselves upon
+our notice, and put the situation of the patient beyond a doubt. But
+this does not always happen. The variations of the pulse, so
+accurately described by the late Dr. Whytt, do not always ensue. The
+dilatation of the pupils, the squinting, and the aversion to light, do
+not universally exist. The screaming upon raising the head from the
+pillow or the lap, and the flushing of the cheeks, I once considered
+as affording indubitable marks of the disease; but in a child which I
+sometime since attended with Dr. Ash, the pulse was uniformly about
+85, (except during the first week, before we had the care of the
+patient.) The child never shewed any aversion to the light; never had
+dilated pupils, never squinted, never screamed when raised from the
+lap or taken out of the bed, nor did we observe any remarkable
+flushing of the cheeks; and the sleep was quiet, but sometimes
+moaning.
+
+Frequent vomiting existed from the first, but ceased for several days
+towards the conclusion. One or two worms came away during the illness,
+and it was all along difficult to purge the child. Three days before
+death, the right side became slightly paralytic, and the pupil of that
+eye somewhat dilated.
+
+After death, about two ounces and a half of water were found in the
+ventricles of the brain, and the vessels of the dura mater were turgid
+with blood.
+
+If I am right as to the nature of hydrocephalus, that it is at first
+dependant upon inflammation, or congestion; and that the water in the
+ventricles is a consequence, and not a cause of the disease; the
+curative intentions ought to be extremely different in the first and
+the last stages.
+
+It happens very rarely that I am called to patients at the beginning,
+but in two instances wherein I was called at first, the patients were
+cured by repeated topical bleedings, vomits, and purges.
+
+Some years ago I mentioned these opinions, and the success of the
+practice resulting from them, to Dr. Quin, now physician at Dublin.
+That gentleman had lately taken his degree, and had chosen
+hydrocephalus for the subject of his thesis in the year 1779. In this
+very ingenious essay, which he gave me the same morning, I was much
+pleased to find that the author had not only held the same ideas
+relative to the nature of the disease, but had also confirmed them by
+dissections.
+
+In the year 1781, another case in the first stage demanded my
+attention. The reader is referred back to Case LXIX for the
+particulars.
+
+I have not yet been able to determine whether the Digitalis can or
+cannot be used with advantage in the second stage of the
+hydrocephalus. In Case XXXIII. the symptoms of death were at hand; in
+Case LXIX. the practice, though successful, was too complicated, and
+in Case CLI. the medicine was certainly stopped too soon.
+
+When we consider what enormous quantities of mercury may be used in
+this complaint, without affecting the salivary glands, it seems
+probable that other parts may be equally insensible to the action of
+their peculiar stimuli, and therefore that the Digitalis ought to be
+given in much larger doses in this, than in other diseases.
+
+
+                             HYDROTHORAX.
+
+§ 18. Under this name I also include the dropsy of the pericardium.
+
+The intermitting pulse, and pain in the arms, sufficiently distinguish
+this disease from asthma, and from anasarcous lungs.
+
+It is very universally cured by the Digitalis.
+
+§ 19. I lately met with two cases which had been considered and
+treated as angina pectoris. They both appeared to me to be cases of
+hydrothorax. One subject was a clergyman, whose strength had been so
+compleatly exhausted by the continuance of the disease, and the
+attempts to relieve it, that he did not survive many days. The other
+was a lady, whose time of life made me suspect effusion. I directed
+her to take small doses of the pulv. Digitalis, which in eight days
+removed all her complaints. This happened six months ago, and she
+remains perfectly well.
+
+
+                       HYDROTHORAX and ANASARCA.
+
+§ 20. This combination is very frequent, and, I believe, may always be
+cured by the Digitalis.
+
+§ 21. Dropsies in the chest either with or without anasarcous limbs,
+are much more curable than those of the belly. Probably because the
+abdominal viscera are more frequently diseased in the latter than in
+the former cases.
+
+
+                               INSANITY.
+
+§ 22. I apprehend this disease to be more frequently connected with
+serous effusion than has been commonly imagined.
+
+§ 23. Where appearances of anasarca point out the true cause of the
+complaint, as in cases XXIV. and XXXIV. the happiest effects may be
+expected from the Digitalis; and men of more experience than myself in
+cases of insanity, will probably employ it successfully in other less
+obvious circumstances.
+
+
+                         NEPHRITIS CALCULOSA.
+
+§ 24. We have had sufficient evidence of the efficacy of the Foxglove
+in removing the Dysuria and other symptoms of this disease; but
+probably it is not in these cases preferable to the tobacco.[12]
+
+    [Footnote 12: See an original and valuable treatise by Dr.
+    Fowler, entitled, _Medical Reports of the Effects of
+    Tobacco_.]
+
+
+                            OVARIUM DROPSY.
+
+§ 25. This species of encysted dropsy is not without difficulty
+distinguishable from an ascites; and yet it is necessary to
+distinguish them, because the two diseases require different treatment
+and because the probality of a cure is much greater in one than in the
+other.
+
+§ 26. The ovarium dropsy is generally slow in its progress; for a
+considerable time the patient though somewhat emaciated, does not lose
+the appearance of health, and the urine flows in the usual quantity.
+It is seldom that the practitioner is called in early enough to
+distinguish by the feel on which side the cyst originated, and the
+patients do not attend to that circumstance themselves. They generally
+menstruate regularly in the incipient state of the disease, and it is
+not until the pressure from the sac becomes very great, that the
+urinary secretion diminishes. In this species of dropsy, the patients,
+upon being questioned, acknowledge even from a pretty early date,
+pains in the upper and inner parts of the thighs, similar to those
+which women experience in a state of pregnancy. These pains are for a
+length of time greater in one thigh than in the other, and I believe
+it will be found that the disease originated on that side.
+
+§ 27. The ovarium dropsy defies the power of medicine. It admits of
+relief, and sometimes of a cure, by tapping. I submit to the
+consideration of practitioners, how far we may hope to cure this
+disease by a seton or a caustic.--In the LXIst case the patient was
+too much reduced, and the disease too far advanced to allow of a cure
+by any method; but it teaches us that a caustic may be used with
+safety.
+
+§ 28. When tapping becomes necessary, I always advise the adoption of
+the waistcoat bandage or belt, invented by the late very justly
+celebrated Dr. Monro, and described in the first volume of the Medical
+Essays. I also enjoin my patients to wear this bandage afterwards,
+from a persuasion that it retards the return of the disease. The
+proper use of bandage, when the disorder first discovers itself,
+certainly contributes much to prevent its increase.
+
+
+                     OVARIUM DROPSY with ANASARCA.
+
+§ 29. The anasarca does not appear until the encysted dropsy is very
+far advanced. It is then probably caused by weakness and pressure. The
+Digitalis removes it for a time.
+
+
+                         PHTHISIS PULMONALIS.
+
+§ 30. This is a very increasing malady in the present day. It is no
+longer limited to the middle part of life: children at five years of
+age die of it, and old people at sixty or seventy. It is not confined
+to the flat-chested, the fair-skinned, the blue eyed, the
+light-haired, or the scrophulous: it often attacks people with full
+chests, brown skins, dark hair and eyes, and those in whose family no
+scrophulous taint can be traced. It is certainly infectious. The very
+strict laws still existing in Italy to prevent the infection from
+consumptive patients, were probably not enacted originally without a
+sufficient cause. We seem to be approaching to that state which first
+made such restrictions necessary, and in the further course of time,
+the disease will probably fall off again, both in virulency and
+frequency.
+
+§ 31. The younger part of the female sex are liable to a disease very
+much resembling a true consumption, and from which it is difficult to
+distinguish it; but this disease is curable by steel and bitters. A
+criterion of true phthisis has been sought for in the state of the
+teeth; but the exceptions to that rule are numerous. An unusual
+dilatation of the pupil of the eye, is the most certain
+characteristic.[13]
+
+    [Footnote 13: Many years ago I communicated to my friend, Dr.
+    Percival, an account of some trials of breathing fixed air in
+    consumptive cases. The results were published by him in the
+    second Vol. of his very useful Essays Medical and
+    Experimental, and have since been copied into other
+    publications. I take this opportunity of acknowledging that I
+    suspect myself to have been mistaken in the nature of the
+    disease there mentioned to have been cured. I believe it was
+    a case of _Vomica_, and not a true _Phthisis_ that was cured.
+    The Vomica is almost always curable. The fixed air corrects
+    the smell of the matter, and very shortly removes the hectic
+    fever. My patients not only inspire it, but I keep large jars
+    of the effervescing mixture constantly at work in their
+    chambers.]
+
+§ 32. Sydenham asserts, that the bark did not more certainly cure an
+intermittent, than riding did a consumption. We must not deny the
+truth of an assertion, from such authority, but we must conclude that
+the disease was more easily curable a century ago than it is at
+present.
+
+§ 33. If the Digitalis is no longer useful in consumptive cases, it
+must be that I know not how to manage it, or that the disease is more
+fatal than formerly; for it would be hard to deny the testimony cited
+at page 9. I wish others would undertake the enquiry.
+
+§ 34. When phthisis is accompanied with anasarca, or when there is
+reason to suspect hydrothorax, the Digitalis will often relieve the
+sufferings, and prolong the life of the patient.
+
+§ 35. Many years ago, during an attendance upon Mr. B----, of a
+consumptive family, and himself in the last stage of a phthisis; after
+he was so ill as to be confined to his chamber, his breathing became
+so extremely difficult and distressing, that he wished rather to die
+than to live, and urged me warmly to devise some mode to relieve him.
+Suspecting serous effusion to be the cause of this symptom, and he
+being a man of sense and resolution, I fully explained my ideas to
+him, and told him what kind of operation might afford him a chance of
+relief; for I was then but little acquainted with the Digitalis. He
+was earnest for the operation to be tried, and with the assistance of
+Mr. Parrott, a very respectable surgeon of this place, I got an
+opening made between the ribs upon the lower and hinder part of the
+thorax. About a pint of fluid was immediately discharged, and his
+breath became easy. This fluid coagulated by heat.
+
+After some days a copious purulent discharge issued from the opening,
+his cough became less troublesome, his expectoration less copious, his
+appetite and strength returned, he got abroad, and the wound, which
+became very troublesome, was allowed to heal.
+
+He then undertook a journey to London; whilst there he became worse:
+returned home, and died consumptive some weeks afterwards.
+
+
+                          PUERPERAL ANASARCA.
+
+§ 36. This disease admits of an easy and certain cure by the
+Digitalis.
+
+§ 37. This species of dropsy may originate from other causes than
+child birth. In the beginning of last _March_, a gentleman at
+Wolverhampton desired my advice for very large and painful swelled
+legs and thighs. He was a temperate man, not of a dropsical habit, had
+great pain in his groins, and attributed his complaints to a fall from
+his horse. He had taken diuretics, and the strongest drastic
+purgatives with very little benefit. Considering the anasarca as
+caused by the diseased inguinal glands, I ordered common poultice and
+mercurial ointment to the groins, three grains of pulv. fol. Digitalis
+night and morning, and a cooling diuretic decoction in the day-time.
+He soon lost his pain, and the swellings gradually subsided.
+
+
+                               THE END.
+
+
+
+
+                                BOOKS,
+
+                 Printed for G. G. J. and J. ROBINSON,
+                 Booksellers, Paternoster-Row, London.
+
+                           AN ACCOUNT OF THE
+                    Scarlet Fever and Sore Throat,
+                       Or, SCARLATINA ANGINOSA;
+
+               Particularly as it appeared at BIRMINGHAM
+                           in the Year 1778.
+
+                      By WILLIAM WITHERING, M. D.
+
+                             Price 1s. 6d.
+
+
+                          Also, Price 2s. 6d.
+
+                        Outlines of MINERALOGY,
+                    Translated from the original of
+                   Sir TORBERN BERGMAN; with NOTES,
+
+                      By WILLIAM WITHERING, M. D.
+
+           Member of the Royal Medical Society at Edinburgh.
+
+
+          In the Spring of the Year 1786, will be published,
+               by the same Author, a New Edition of the
+
+                        BOTANICAL ARRANGEMENT.
+
+        With very great Additions; in Three Vols. large Octavo.
+
+
+
+
+                          TRANSCRIBER'S NOTES
+
+Obvious printer's errors have been fixed. For the detailed list,
+please see below. The frontispiece has been moved from the beginning
+of the book to the section explaining it.
+
+
+                             Errors fixed
+
+page xvi--typo fixed: changed 'afterterwards' to 'afterwards'
+page 029--typo fixed: changed 'apetite' to 'appetite'
+page 043--typo fixed: removed an extra 'in' after 'and she died'
+page 062--typo fixed: changed 'Dovers' to 'Dover's'
+page 095--typo fixed: changed 'ef' to 'of' after 'whilst the rest'
+page 098--typo fixed: changed 'harrassed' to 'harassed'
+page 103--typo fixed: changed 'Shiffnal' to 'Shiffnall'
+page 106--typo fixed: changed 'Fox-glove' to 'Foxglove'
+page 110--typo fixed: changed 'suceed' to 'succeed'
+page 111--typo fixed: changed 'atttention' to 'attention'
+page 114--typo fixed: changed 'disgreeable' to 'disagreeable'
+page 115--typo fixed: removed an extra 'the' in front of '7th of April'
+page 123--typo fixed: changed 'susspended' to 'suspended'
+page 135--typo fixed: changed 'vomitted' to 'vomited'
+page 141--typo fixed: changed 'contiued' to 'continued'
+page 148--typo fixed: changed 'præcordia' to 'prœcordia'
+page 158--typo fixed: changed 'spoonfulls' to 'spoonfuls'
+page 163--typo fixed: changed 'mecine' to 'medicine'
+page 164--typo fixed: changed 'slighest' to 'slightest'
+page 166--typo fixed: changed 'ipecacohana' to 'ipecacoanha'
+page 170--typo fixed: changed 'meridiaana' to 'meridiana'
+page 196--typo fixed: removed an extra 'the' in front of 'viscera'
+page 200--typo fixed: removed an extra 'and' after 'from asthma'
+
+
+
+
+
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+The Project Gutenberg EBook of An Account of the Foxglove and some of its
+Medical Uses, by William Withering
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: An Account of the Foxglove and some of its Medical Uses
+       With Practical Remarks on Dropsy and Other Diseases
+
+Author: William Withering
+
+Release Date: March 21, 2008 [EBook #24886]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK AN ACCOUNT OF THE FOXGLOVE ***
+
+
+
+
+Produced by David Starner, Irma Spehar and the Online
+Distributed Proofreading Team at http://www.pgdp.net
+
+
+
+
+
+                                  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 Linn�us.]
+
+Our plant is the _Digitalis purpurea_[2] of Linn�us. 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 LURID�, one of the Linn�an 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. DODON�US
+_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
+� pint� cerevisi� calid�_.
+
+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. pur� [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----, �t. 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----, �t. 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----, �t. 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----, �t. 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. pur�. [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----, �t. 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----, �t. 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----, �t. 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----, �t 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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,   7� half pints.
+               8th. Sunday,     8
+               9th. Monday,     6�
+              10th. Tuesday,    6�
+              11th. Wednesday,  6
+              12th. Thursday,   6�
+
+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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 12. Scrophulous, consumptive, and at
+length anasarcous. Took Infus. Digital. without advantage. Died the
+_July_ following.
+
+
+                             CASE XXXVIII.
+
+_June_ 4th. Mrs. S----, of W----, �t 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----, �t. 35. A very hard drinker, was attacked with
+a severe h�moptoe, 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----, �t. 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----, �t. 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----, �t. 39. In the last stage of a
+phthisis pulmonalis became dropsical. She took the Digitalis without
+being relieved.
+
+
+                              CASE XLIII.
+
+_July_ 9th. Mrs. F----, �t. 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 �ther, 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 35. A publican and a hard drinker.
+Ascites, anasarca, diseased viscera, and slight attacks of h�moptoe.
+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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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 sod� 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----, �t. 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----, �t. 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----, �t. 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----, �t. 36. In the last stage of a pulmonary
+consumption, took the Infus. Digitalis, but without any advantage.
+
+
+                              CASE XCVI.
+
+_August_ 20th. Mr. P----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t 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----, �t. 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----, �t. 28. A dropsy in the last stage of a
+phthisis. Infusum Digitalis was tried to no purpose.
+
+
+                               CASE CXV.
+
+_June_ 20th. Mrs. H----, �t. 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----, �t. 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----, �t. 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 sod�; 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----, �t. 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----, �t. 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----, �t. 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; �t, 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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 �ther 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----, �t. 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----, �t. 29, became dropsical towards the
+close of a pulmonary consumption. He was ordered 12 grains of pulv.
+fol. cicut� and 1 of Digitalis twice a day. No remarkable effect took
+place.
+
+
+                             CASE CXXXIV.
+
+_July_ 31. Mr. M----, �t 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----, �t. 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----, �t. 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----, �t. 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. cicut� 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 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----, �t. 50. An ovarium dropsy of
+long continuance. She took three grains of pulv. Digital. every night
+at bed time, for a fortnight, but without any effect.
+
+
+                              CASE CLVI.
+
+A poor man in this town, after his kidneys had ceased to secrete urine
+for several days, was seized with hickup, fits of vomiting, and
+transient delirium. After examination I was satisfied the disease was
+the same as that mentioned at CXLIX. A very experienced apothecary
+having tried various methods to relieve him, I despaired of any
+success, but determined to try the Digitalis. It was accordingly
+given in infusion. At first it checked the vomitings, but did not
+occasion any secretion of urine.
+
+
+                                 1785.
+
+The cases which have occurred to me in the course of this year, are
+numerous; but as the events of some of them are not yet sufficiently
+ascertained, I think it better to with-hold them at present.
+
+
+
+
+                            HOSPITAL CASES,
+                  Under the Direction of the Author.
+
+
+The four following cases were drawn out at my request by Mr. Cha.
+Hinchley, late apothecary to the Birmingham Hospital. They are all the
+Hospital cases for which the Digitalis was prescribed by me, whilst he
+continued in that office.
+
+
+                              CASE CLVII.
+
+_March_ 15th, 1780. John Butler, �t. 30. Asthma and swelled legs. He
+was directed to take myrrh and steel every day, and three spoonfuls of
+infusum Digitalis every night. On the 8th of April he was discharged,
+cured of the swellings and something relieved of his asthmatic
+affections.
+
+
+                             CASE CLVIII.
+
+_November_ 18th, 1780. Henry Warren, �t. 60. This man had a general
+anasarca and ascites, and was moreover so asthmatic, that, neither
+being able to sit in a chair nor lie in bed, he was obliged constantly
+to walk about, or to lean forward against a window or table. You
+prescribed for him thus.
+
+    R. Aq. cinn. spt. [Symbol: ounce]iv.
+    Oxymel. scillit.
+    Syr. scillit. aa. [Symbol: ounce]i. m. cap. cochlear. larg.
+    sexta quaque hor�.
+
+This medicine producing no increased discharge of urine, on the 25th
+you ordered the infusion of Digitalis, two spoonfuls every four hours.
+After taking this for thirty six hours, his urine was discharged in
+very great quantity; his breath became easy, and the swellings
+disappeared in a few days, though he took no more of the medicine. On
+the 2d of _December_ he was ordered myrrh and lac ammoniacum, which he
+continued until the 23d, when he was discharged cured, and is now in
+good health.
+
+
+                              CASE CLIX.
+
+_November_ 3d, 1781. Mary Crockett, �t. 40. Ascites and universal
+anasarca. For one week she took sal. diureticus and tincture of
+cantharides, but without advantage. On the 10th you directed the
+infusion of Digitalis, a dram and half to half a pint, an ounce to be
+taken every fourth hour. Before this quantity was quite finished, the
+urine began to be discharged very copiously. The medicine was then
+stopped as you had directed. On the 15th, being costive, she took a
+jallap purge, and on the 24th she was discharged cured.
+
+
+                               CASE CLX.
+
+_March_ 16th, 1782. Mary Bird, �t. 61. Great fullness about the
+stomach; diseased liver, and anasarcous legs and thighs. For the
+first week squill was tried in more forms than one, but without
+advantage. On the 22d she began with the Digitalis, which presently
+removed all the swelling.
+
+She was then put upon the use of aperient medicines and tonics, and on
+the first of _August_ was discharged perfectly cured.
+
+       *       *       *       *       *
+
+    The three following Cases were drawn up and communicated to
+    me by Mr. Bayley, who succeeded Mr. Hinchley as apothecary to
+    the Hospital at Birmingham:
+
+
+                                    Shiffnall, April 26th, 1785.
+    DEAR SIR,
+
+During my residence in the Birmingham General Hospital, I had frequent
+opportunities of seeing the great effects of the Digitalis in dropsy.
+As the exhibition of it was in the following instances immediately
+under your own direction, I have drawn them up for your inspection,
+previous to your publishing upon that excellent diuretic. Of its
+efficacy in dropsy I have considerable evidence in my possession, but
+consider myself not at liberty to send you any other cases except
+those you had yourself the conduct of. The Digitalis is a very
+valuable acquisition to medicine; and, I trust, it will cease to be
+dreaded when it is well understood.
+
+                                     I am, Sir, your obedient,
+                                        And very humble servant,
+                                                      W. BAYLEY.
+
+
+                              CASE CLXI.
+
+Mary Hollis, aged 62, was admitted an out patient of the Birmingham
+General Hospital _February_ 12th, 1784, labouring under all the
+effects of hydrothorax; her dread of suffocation during sleep was so
+great, that she always reposed in an elbow chair. She was directed to
+take two grains of Digitalis in powder every night and morning, and
+for a few days found great relief; but, on the eighth day, as she had
+complained of sickness, and had been considerably purged, she was
+ordered to desist taking any more of her powders. On the 14th day she
+was ordered an ounce of the following infusion twice in a day: R. Fol.
+Digital. purp. sicc. [Symbol: dram]iss. aq. bullient. [Symbol: pound]ss.
+digere per semi-horam, colatur� adde tinct. aromatic [Symbol: ounce]i.
+This infusion did not purge, but sometimes excited nausea, though not
+sufficient to prevent her from continuing its use. She grew gradually
+better, and on the 6th of _May_ was discharged perfectly cured. The
+diuretic effects of the Digitalis were in this instance immediate.
+
+
+                              CASE CLXII.
+
+Edward James, �t. 21. Admitted _March_ 20th, 1784. Complained of great
+difficulty of breathing, pain in his head, and tightness about the
+stomach, with a trifling swelling of his legs. Ordered pil. scillit.
+[Symbol: scruple]i. ter de die. On the third day his legs much more
+swelled, his breathing more difficult, and in every respect worse; his
+pulse very small and quick, complained when he turned in bed, of
+something like water rolling from one side of the thorax to the other.
+A remarkable blueness about the mouth and eyes, and purged considerably
+from the pil. scill. Ordered to omit the pills and to take
+[Symbol: ounce]i. of infus. Digitalis every eight hours; the proportion
+[Symbol: dram]iss. to eight ounces of water and [Symbol: ounce]i. of
+aq. n. m. sp.--7th Day, The infusion had neither purged, nor vomited
+him: he only complained once or twice of giddiness. His belly was now
+very hard, rather black on the right side the navel, and his legs
+amazingly swelled. Ordered a bolus with rhubarb and calomel, to be
+taken in the morning, and [Symbol: ounce]ii. julep salin. cum tinct.
+canthar. gutt. forty ter die.--12th Day, nearly in the same state,
+except his breathing which was somewhat more difficult, being now
+obliged to have his head considerably raised. Persistat--From this day
+to the 32d day he became hourly worse. His belly which at first was
+only hard, now evidently contained a large quantity of water, his legs
+were more swelled, and a large sphacelated sore appeared upon each
+outer ancle. Respiration was so much obstructed, that he was obliged
+to sit quite upright to prevent suffocation. He made very little
+water, not more than eight ounces in a day and a night, and was much
+emaciated. Ordered his purging bolus again, and [Symbol: ounce]ii. of
+a mixture with sal diuretic, [Symbol: ounce]ss. to [Symbol: ounce]xii.
+three times in a day, and a poultice with ale grounds to his legs.
+
+54th day. To this period there was not the least probability of his
+existing; his legs and thighs were one continued blubber, his thorax
+quite flat, and his belly so large that it measured within one inch as
+much as a woman's in this Hospital the day she was tapped, and from
+whom twenty seven pounds of coagulable lymph were taken. He made about
+three ounces of water in twenty-four hours: his penis and scrotum were
+astonishingly swelled, and no discharge from the sores upon his legs.
+Ordered to take a pill with two grains of powdered Foxglove night and
+morning. For a few days no sensible effect, but about the 60th day he
+complained of being continually giddy, and had some little pain in his
+stomach. He now made much more water, and dared to sleep. His appetite
+which through the whole of his illness had been very bad, was also
+better. 66th day. Breathing very much relieved, the quantity of water
+he made was three chamber pots full in a day and a night, each pot
+containing two quarts and four ounces, moderately full. Ordered to
+continue his pills, and his legs which were very flabby, to be rolled.
+
+69th day. His belly nearly reduced to its natural size, still made a
+prodigious quantity of water, his appetite very good, habit of body
+rather lax, and his complexion ruddy. On the 2d of _June_, being still
+rather weak, he was ordered decoct. cort. [Symbol: ounce]ii. ter de
+die; and on the 12th was discharged from this Hospital perfectly
+cured.
+
+                                                      W. BAYLEY.
+
+
+     Mr. Bayley's respectful compliments to Doctor Withering: he
+     sends the case of Edward James, which he believes is pretty
+     correct. He laments not having it in his power to send the
+     measure of his belly, having unfortunately, mislaid the
+     tape: he heard from James yesterday, and he is perfectly
+     well.
+
+     _General Hospital, August 5, 1784._
+
+
+                             CASE CLXIII.
+
+On the 26th _February_, 1785, Sarah Ford, aged 42, was admitted an
+out-patient of the Birmingham General Hospital: she complained of
+considerable pain in her chest, and great difficulty of breathing, her
+face was much swelled and her thighs and legs were anasarcous. She had
+extreme difficulty in making water, and with many painful efforts she
+did not void more than six ounces in twenty-four hours. She had been
+in this situation about six weeks, during which time she had taken
+ammoniacum, olibanum, and large quantities of squills, without any
+other effect than frequent sickness. Upon her commencing an Hospital
+patient, the following medicine was exhibited. R. gum ammoniac
+[Symbol: dram]ii. pulv. fol. Digital. purp. [Symbol: scruple]ii. sp.
+lavand. comp. ut fiat pil. 40. cap. ii. nocte maneque. She continued
+the use of these pills for a few days, without any sensible effect. On
+the eighth day her breathing was much relieved, her legs and thighs
+were not so much swelled, and in a day and a night she made five
+pints of water. By the 12th day her legs and thighs were nearly
+reduced to their natural size. She continued to make water in large
+quantities, and had lost her pain in the thorax. To the 20th of
+_March_, she made rapid advances towards health, when not a symptom of
+disease remaining, she was discharged.
+
+
+
+
+                  COMMUNICATIONS FROM CORRESPONDENTS.
+
+
+                                       London, Norfolk-street,
+                                                 May 31st, 1785.
+
+SIR,
+
+I had the favour of your letter last week; and I shall be very happy
+if I can give you any intelligence relating to the Foxglove, that can
+answer the purpose in which you are so laudably engaged.
+
+It is true that my brother, the late Dr. Cawley, was greatly relieved,
+and his life, perhaps, prolonged for a year, by a decoction of the
+Foxglove root; but why it had not a more lasting effect, it is
+necessary I should tell you that he had all the signs of a distempered
+viscera, long before any watery swellings appeared; it was manifest
+that his dropsy was merely symptomatic, and he could therefore only
+from time to time have any relief from medicine. In the year 1776, he
+returned from London to Oxon. having consulted several physicians at
+the former place, and Dr. Vivian at the latter, but without any
+success; and he was then told of a carpenter at Oxon. that had been
+cured of a Hydrops pectoris by the Foxglove root, and as he was a
+younger, and in other respects an healthy man, his cure, I believe,
+remains a perfect one.
+
+I did not attend my brother whilst he took the medicine, and therefore
+I cannot speak precisely to the operation of it; but I remember, by
+his letters, that he was dreadfully sick and ill for several days
+before the secretion of urine came on, but which it did do to a great
+degree; relieved his breath, and greatly lessened the swelling in his
+legs and thighs; but the two instances I have lately seen in this part
+of the world, are much stronger proofs of the efficacy of it than my
+brother's case.
+
+                                               I am, &c.
+                                                  ROBERT CAWLEY.
+
+N. B. Whenever I have another opportunity of giving the Foxglove, it
+shall be in small doses:--In which I should hope it might succeed,
+although it might be more slowly. If you should try it with success, I
+should be glad to know what mode you made use of.
+
+
+                      Dr. Cawley's prescription.
+
+    R. Rad. Digital. purpur. siccat. et contus. [Symbol: ounce]ii.
+
+    Coque ex aq. font. [Symbol: pound]ii. ad [Symbol: pound]i.
+    colat. liquor. adde aq. junip. comp. [Symbol: ounce]ii.
+
+    Mell. anglic [Symbol: ounce]i. m. sumat cochl. iv. omni nocte h. s. et
+    mane.
+
+--I have elsewhere remarked, that when the Digitalis has been properly
+given, and the diuretic effects produced, that an accidental over-dose
+bringing on sickness, has stopped the secretion of urine. In the
+present instance it likewise appears, that violent sickness may be
+excited, and continue for several days without being accompanied by a
+flow of urine; and it is probable that the latter circumstance did not
+take place, until the severity of the former abated. If Dr. Cawley had
+not had a constitution very retentive of life, I think he must have
+died from the enormous doses he took; and he probably would have died
+previous to the augmentation of the urinary discharge. For if the root
+from which his medicine was prepared, was gathered in its active
+state, he did not take at each dose less than _twelve_ times the
+quantity a strong man ought to have taken. Shall we wonder then that
+patients refuse to repeat such a medicine, and that practitioners
+tremble to prescribe it? Were any of the active and powerful medicines
+in daily use to be given in doses _twelve_ times greater than they
+are, and these doses to be repeated without attention to the effects,
+would not the patients die, and the medicines be condemned as
+dangerous and deleterious?--Yet such has been the fate of Foxglove!
+
+
+     A Letter to the Author, from Mr. BODEN, Surgeon, at Broseley,
+                            in Shropshire.
+
+                                       Broseley, 25th May, 1785.
+     Dear SIR,
+
+Have inclosed the prescriptions that contained the fol. Digital. which
+I gave to Thomas Cooke and Thomas Roberts.
+
+Thomas Cooke, �t. 49, had been ill about two or three weeks. When I saw
+him he had no appetite, and a constant thirst: a fullness and load in
+the stomach: the thighs, legs and hands, much swell'd, and the face and
+throat in a morning; was costive, and made but little water, which was
+high coloured; the pulse very weak, and his breath exceeding bad. _June_
+17th. R. Argent, viv [Symbol: dram]i. cons. cynosbat. [Symbol: scruple]ii.
+fol. Digital. pulv. gr. xv. f. pil. xxiv. capt. ii. omni nocte hor�
+decubitus. He was likewise purged by a bolus of argent. viv. jallap,
+Digit. elaterium and calomel, which was repeated on the fourth day, to
+the third time. From _June_ 17th to the 29th, the symptoms were mostly
+removed, making water freely, and having plenty of stools; in a week
+after he was perfectly well, and remains so ever since. The cure was
+finished by steel and bitters.
+
+Thomas Roberts, �t. 40, had a deformed chest, was obliged to be almost
+in an erect posture when in bed; the other symptoms were nearly the
+same as Cooke's. _August_ 3d. The pills prescribed _June_ 17th for
+Cooke.--17th. A purging bolus of jalap and Digitalis, once a week. He
+continued the medicines till the latter end of _August_, when he got
+very well; but the complaint returned in _Jan._ worse than before. He
+is now much better, but I have great reason to believe the liver to be
+diseased.
+
+                            I am, with the greatest respect,
+
+                             Your very obliged humble servant,
+
+                                                   DANIEL BODEN.
+
+P. S. The second patient, on his relapse, took Digitalis again,
+combined with other things.
+
+
+
+       CASE communicated by Mr. CAUSER, Surgeon, at Stourbridge,
+                            Worcestershire.
+
+
+Mr. P---- of H---- M----, in the parish of Kingswinford, aged about
+60; had been a strong healthy, robust, corpulent man; worked hard
+early in life at edge-tool making, and drank freely of strong malt
+liquor; for many years had been subject to gout in the extremities;
+for a few years past had been very asthmatic, and the gout in the
+extremities gradually decreased. When I first saw him, which was
+_Sept._ 12, 1779, his legs were anasarcous, his belly much swelled,
+and an evident fluctuation of water. His breathing very bad, an
+irregular pulse, and unable to lie down. His easiest posture was
+standing with his body leaning over a chair, in which situation he
+would continue many hours together, labouring for breath, with the
+sweat trickling down his face very profusely; the urine in very small
+quantity. Diuretics of every kind I could think of were used with very
+little or no advantage. Blisters applied to the legs relieved very
+considerably for a time, but by no means could I increase the urinary
+discharge. Warm stomachic medicines were given, and at the same time
+sinapisms applied to the feet, in hopes of enticing gout to the
+extremities, but without any good effect.--_November_ 22d. The
+swelling considerably increasing, an emetic of acet. scillitic. was
+given, which acted very violently, and increased the urinary discharge
+considerably. He continued better and worse, using different kinds of
+diuretic and expectorating medicines until _September_ 1781, when the
+disease was so much worse, I did not expect he could live many days.
+The acet. scillitic. was repeated, a table spoonful every half hour,
+till it acted briskly upwards and downwards; but without increasing the
+urinary discharge.--On the 17th of _September_ I infused [Symbol: dram]iii.
+of the fol. Digitalis in [Symbol: ounce]vi. of boiling water, for four
+hours; then strained it, and added [Symbol: ounce]i. of tinct.
+aromatica.--On the 18th he began by taking one spoonful, which he was
+to repeat every half hour, till it made him very sick, unless
+giddiness, loss of sight, or any other disagreeable effect took place.
+I had never given the medicine before, and had prepared him to expect
+the operation to be very severe. I saw him again on the 21st; he had
+taken the medicine regularly, till the whole quantity was consumed,
+without perceiving the least effect of any kind from it, and continued
+well till the evening of the following day, when a little sickness
+took place, which increased, but never so as to occasion either
+vomiting or purging, but a surprising discharge of urine. The saliva
+increased so as to run out of his mouth, and a watery discharge from
+his eyes; these discharges continued, with a continual sickness, till
+the swelling was totally gone, which happened in three or four days.
+He afterwards took steel and bitters; and continued very comfortably,
+without any return of his dropsy, until the 7th of _April_ 1782, when
+he was seized with an epidemic cough, which was very frequent with us
+at that time. His swellings now returned very rapidly, with the
+greatest difficulty in breathing, and he died in a few days. Blisters
+and expectorating medicines were used on this last return.
+
+
+                 Extract of a Letter from Mr. CAUSER.
+
+Mrs. S----, the subject of the following Case, was as ill as it is
+possible for woman to be and recover; from the inefficacy of the
+medicines used, I am convinced no medicine would have saved her but
+the Digitalis. I never saw so bad a case recovered; and it shews, that
+in the most reduced state of body, the medicine in small doses, will
+prove safe and efficacious.
+
+N. B. The Digitalis, in pills, never occasioned the least sickness.
+She took two boxes of them.
+
+
+                                 CASE.
+
+_January_ 2d, 1785. Mrs. S----, of W----, near Kidderminster, aged 38,
+has been affected with dropsical swellings of her legs and thighs,
+about six weeks, which have gradually grown worse; has now great
+difficulty in breathing, which is much increased on moving; a very
+irregular, intermittent pulse, urine in very small quantity, and in
+the seventh month of her pregnancy: a woman of very delicate
+constitution, with tender lungs from her infancy and very subject to
+long continued coughs.
+
+    R. Pulv. scill� gr. iii.
+    Jalap gr. x. syr. rosar. solut. tinct. senn. aa [Symbol:
+    dram]ii. aq. menth. v. simpl. [Symbol: ounce]iss. m. mane
+    sumend.
+
+    R. pulv. scill� [Symbol: scruple]i. G. ammoniac, sapon.
+    venet. aa [Symbol: dram]iss. syr. q. s. f. pilul. 42 cap.
+    iii. nocte maneque.
+
+On the 7th found her worse, and the swelling increased; the urine
+about [Symbol: ounce]x in the twenty-four hours.
+
+    R. Fol. siccat. Digital. [Symbol: dram]iii. coque in. aq.
+    fontan. [Symbol: ounce]xii. ad [Symbol: ounce]vi. cola et
+    adde. aq. juniper. comp. [Symbol: ounce]ii. sacchar. alb.
+    [Symbol: ounce]ss. m. cap. cochlear. i. larg. 4tis horis.
+
+She took about three parts of the medicine before any effect took
+place. The first was sickness, succeeded by a considerable discharge
+of urine. She continued the medicine till the whole was consumed,
+which caused a good deal of sickness for three or four days.
+
+I saw her again on the 12th. The quantity of urine was much increased,
+and the swelling diminished. Pulse and breathing better.
+
+    R. Fol. sicc. Digital. G. assafetid. aa [Symbol: dram]i.
+    calomel. pp. gr. x. sp. lavand. comp. q. s. fiat pilul.
+    xxxii. cap. ii. omni nocte hor� somni.
+
+A plentiful discharge of urine attended the use of these pills, and
+she got perfectly free from her dropsical complaints.
+
+_March_ 15th she was delivered: had a good labour, was treated as is
+usual, except in not having her breasts drawn, not intending see
+should suckle her child, being in so reduced a state. Continued going
+on well till the 18th, when she was seized with very violent pains
+across her loins, at times so violent as to make her cry out as much
+as labour pains. Enema cathartic. Fot. papav. applied to the part.
+
+    R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s. fiat
+    pilul. vi. capt. i. 2da quaque hor� durante dolore.
+
+    R. Julep, e camphor, sp. minder. aa [Symbol: ounce]ii. capt.
+    cochlear, i. larg. post singul. pilul.
+
+19th. Breathing short, unable to lie down, very irregular low pulse
+scarcely to be felt, fainty, and a universal cold sweat: no appetite
+nor thirst, spasmodic pains at times across the loins very violent,
+but not so frequent as on the preceding day.
+
+    R. Gum ammoniac, assafetid. aa [Symbol: dram]i. camphor. gr. xii. fiat
+    pilul. 24. capt. ii. 3tia quaque hor� in cochlear. ii.
+    mixtur. seq.
+
+    R. Balsam. peruv. [Symbol: dram]iii. mucilag. G. arab. q. s.
+    flor. zinci g. vi. aq. menth. simp. [Symbol: pound]ss. m.
+
+    Applic. Emp. vesicat. femorib. internis.
+
+    R. Sp. vol. foetid. elixir. paregor. balsam. Traumatic. aa
+    [Symbol: dram]iii. capt. cochlear. parv. urgente languore.
+
+20th. Much the same; makes very little water, and the legs begin to
+swell.--Applic. Emp. e pice burgund. lumbis.
+
+23d. The swelling very much increased.--Capt. gutt. xv. acet.
+scillitic. ter die in two spoonfuls of the following mixture.
+
+    R. Infus. baccar. juniper, [Symbol: ounce]vi. tinct. amar. tinct.
+    stomachic. aa [Symbol: ounce]i. m.
+
+25th. Much the same.
+
+28th. The swelling considerably increased, in other respects very much
+the same.
+
+30th. Breathing very bad, with cough and pain across the sternum,
+unable to lie down, legs, thighs, and body very much swelled, urine
+not more than four or five ounces in the twenty-four hours; hot and
+feverish, with thirst.
+
+    Applic. Emp. vesicat. stomacho et sterno.
+
+    R. G. assafetid. [Symbol: scruple]ii. pulv. jacob. [Symbol:
+    scruple]i. rad. scill. recent. gr. xii. extract. thebaic. gr.
+    iv. f. pilul. xvi. cap. iv. omni nocte.
+
+    R. Sal. nitr. sal. diuretic. aa [Symbol: dram]ii. pulv. e
+    contrayerv. comp. [Symbol: dram]i. sacchar. [Symbol: ounce]i.
+    emuls. commun. [Symbol: pound]i. aq. cinnam. simpl. [Symbol: ounce]i.
+    m. capt. cochlear. iv. ter die.
+
+_April_ 2d. Much the same, no increase of urine.
+
+3d. Breathing much relieved by the blister, which runs profusely.
+Repeated the medicines, and continued them till the
+
+12th. The cough very bad, pulse irregular, swelling much increased,
+urine in very small quantity, not at all increased; great lowness and
+fainting. She desired to have some of the pills which relieved her so
+much when with child. I was almost afraid to give them, but the
+inefficacy of the other medicines gave me no hopes of a cure from
+continuing them, which made me venture to comply with her request.
+
+    R. Fol. siccat. Digital. G. assafetid. aa [Symbol: dram]i. sp. lavand.
+    comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node
+    cap. pilul. e styrace gr. vi.
+
+17th. Considerable increase of urine.
+
+21st. Swelling a good deal diminished; urine near four pints in
+twenty-four hours, which is more than double the quantity she drinks.
+
+    Applic. Emp. vesicat. femoribus internis.
+
+The Digitalis pills and opiate at bed-time continued. Takes a tea cup
+of cold chamomile tea every morning.
+
+25th. Swelling much diminished, makes plenty of water, appetite much
+mended, cough and breathing better. She omitted the medicine for three
+days; the urine began to diminish, the swelling and shortness of
+breathing worse. On repeating it for two days, the discharge was again
+augmented, and a diminution of the swelling succeeded. She has
+continued the pills ever since till the 14th of _May_; the dropsical
+symptoms and cough are entirely gone, the water is in sufficient
+quantity, her strength is recovered, and she has a good appetite. All
+she now complains of is a weight across her stomach, which is worse at
+times, and she thinks, unless it can be removed, she shall have a
+return of her dropsy.
+
+
+                Extract of a Letter from Doctor FOWLER,
+                        Physician, at Stafford.
+
+I understand you are going to publish on the Digitalis, which I am
+glad to hear, for I have long wished to see your ideas in print about
+it, and I know of no one (from the great attention you have paid to
+the subject) qualified to treat on it but yourself. There are
+gentlemen of the faculty who give verbal directions to poor patients,
+for the preparing and taking of an infusion or decoction of the green
+plant. Would one suppose that such gentlemen had ever attended to the
+nature and operation of a sedative power on the functions,
+_particularly_ the _vital_? Is not such a vague and unscientific mode
+of proceeding putting a two edged sword into the the hands of the
+ignorant, and the most likely method to damn the reputation of any
+very active and powerful medicine? And is it not more than probable
+that the _neglect_ of adhereing to a _certain_ and _regular_
+preparation of the nicotiana, and the _want_ (of what you
+_emphatically_ call) a _practicable_ dose, have been the chief causes
+of the once rising reputation of that noted plant being damned above
+a century ago? In short, the Digitalis is beginning to be used in
+dropsies, (although some patients are said to go off suddenly under
+its administration) somewhat in the style of broom ashes; and, in my
+humble opinion, the public, at this very instant, stand in great need
+of your _precepts_, _guards_, and _cautions_ towards the safe and
+successful use of such a powerful sedative diuretic; and I have no
+doubt of your minute attention to those particulars, from a regard to
+the good and welfare of mankind, as well as to your own reputation
+with respect to that medicine.
+
+I remember an officer in the Staffordshire militia, who died here of a
+dropsy five years ago. The Digitalis relieved him a number of times in
+a wonderful manner, so that in all probability he might have obtained
+a radical cure, if he would have refrained from hard drinking. I
+understood it was first ordered for him by a medical gentleman, and
+its sedative effects proved so mild, and diuretic operation so
+powerful, that he used to prepare it afterwards for himself, and would
+take it with as little ceremony as he would his tea. It is said, that
+he was so certain of its successful operation, that he would boast to
+his bacchanalian companions, when much swelled, you shall see me in
+two days time quite another man.
+
+
+                  CASES communicated by Mr. J. FREER,
+                     jun. Surgeon, in Birmingham.
+
+
+                                CASE I.
+
+_Nov._ 1780. Mary Terry, aged 60. Had been subject to asthma for
+several years; after a severe fit of it her legs began to swell, and
+the quantity of urine to diminish. In six weeks she was much troubled
+with the swellings in her thighs and abdomen, which decreased very
+little when she lay down: she made not quite a pint of water in the
+twenty-four hours. I ordered her to take two spoonfuls of the infusion
+of Foxglove every three hours. By the time she had taken eight doses
+her urine had increased to the quantity of two quarts in the day and
+night, but as she complained of nausea, and had once vomited, I
+ordered the use of the medicine to be suspended for two days. The
+nausea being then removed, she again had recourse to it, but at
+intervals of six hours. The urine continued to discharge freely, and
+in three weeks she was perfectly cured of her swellings.
+
+
+                               CASE II.
+
+_December_, 1782. A poor woman, who had been afflicted with an ague
+during the whole of her pregnancy, and for two months with dropsical
+swellings of the feet, legs, thighs, abdomen, and labia pudenda; was
+at the expiration of the seventh month taken in labour. On the day
+after her delivery the ague returned, with so much violence as to
+endanger her life. As soon as the fit left her, I began to give her
+the red bark in substance, which had the desired effect of preventing
+another paroxysm. She continued to recover her health for a fortnight,
+but did not find any diminution in the swellings; her legs were now so
+large as to oblige her to keep constantly on the bed, and she made
+very little water. I ordered her the infusion of Foxglove three times
+a day, which, on the third day, produced a very copious discharge of
+urine, without any sickness; she continued the use of it for ten days,
+and was then able to walk. Having lost all her swellings, and no
+complaint remaining but weakness, the bark and steel compleated the
+cure.
+
+
+                Extract of a Letter from Doctor JONES,
+                       Physician, in Lichfield.
+
+Anxious to procure authentic accounts from the patients, to whom I
+gave the Foxglove, I have unavoidably been delayed in answering your
+last favour. However, I hope the delay will be made up by the efficacy
+of the plant being confirmed by the enquiry. Long cases are tedious,
+and seldom read, and as seldom is it necessary to describe every
+symptom; for every case would be a history of dropsy. I shall
+therefore content myself with specifying the nature of the disease,
+and when the dropsy is attended with any other affection shall notice
+it.
+
+Two years have scarcely elapsed since I first employed the Digitalis;
+and the success I have had has induced me to use it largely and
+frequently.
+
+
+                                CASE I.
+
+Ann Willott, 50 years of age, became a patient of the Dispensary on
+the 11th of April 1783. She then complained of an enlargement of the
+abdomen, difficulty of breathing, particularly when lying, and
+costiveness. She passed small quantities of high-coloured urine; and
+had an evident fluctuation in the belly. Her legs were oedematous.
+Chrystals of tartar, squills, &c. had no effect. The 13th of _June_
+she took two spoonfuls of a decoction of Foxglove, containing three
+drams of the dry leaves, in eight ounces, three times a day. Her urine
+soon increased, and in a few days she passed it freely, which
+continued, and her breath returned.
+
+
+                               CASE II.
+
+Mr. ----, 45 years of age, had been long subject to dropsical
+swellings of the legs, and made little water. Two spoonfuls of the
+same decoction twice a day, soon relieved him.
+
+
+                               CASE III.
+
+Mrs. ----, aged 70 years. A lady frequently afflicted with the gout,
+and an asthmatical cough. After a long continuance of the latter, she
+had a great diminution of urine, and considerable difficulty of
+breathing, particularly on motion, or when lying. Her body was much
+bound. There was, however, no apparent swelling. She took three
+spoonfuls of an aperient decoction of forty-five grains in six ounces
+and a half, every other morning. The urine was plentiful those days,
+and her breathing much relieved. In two or three weeks after the use
+of it she was perfectly restored. The purgative medicine neither
+increased the urine, nor relieved the breathing, till the Foxglove was
+added.
+
+This spring she long laboured with the gout in her stomach, which
+terminated in a fit in her hand. During the whole of this tedious
+illness, of nearly three months, she passed little urine, and her
+breathing was again short.
+
+She took the same preparation of Foxglove without any diuretic effect,
+and afterwards two and three grains of the powder twice a day with as
+little. The dulcified spirits of vitriol, however, quickly promoted
+the urinary secretion.
+
+
+                               CASE IV.
+
+Mr. C----, 46 years of age, had dropsical swellings of the legs, and
+passed little urine. He took the decoction with three drams, and was
+soon relieved.
+
+
+                                CASE V.
+
+Lady----, took three grains of the dried leaves twice a day, for
+swelled legs, and scantiness of urine, without effect.
+
+
+                               CASE VI.
+
+Mrs. Slater, aged 36 years. For dropsy of the belly and legs, and
+scantiness of urine, of several weeks standing, took three grains of
+the powder twice a day, and was quite restored in ten days. She took
+many medicines without effect.
+
+
+                               CASE VII.
+
+Mrs. P----, in her 70th year, took three grains of the powder twice a
+day, for scantiness of urine, and swelled legs, without effect.
+
+
+                              CASE VIII.
+
+Ann Winterleg, in her 26th year, had dropsical swellings of the legs,
+and passed little urine: she was relieved by two drams, in an eight
+ounce decoction.
+
+
+                               CASE IX.
+
+William Brown, aged 76. In the last stage of dropsy of the belly and
+legs, found a considerable increase of his urine by a decoction of
+Foxglove, but it was not permanent.
+
+
+                                CASE X.
+
+Mr. ----, -- years of age, and of very gross habit of body, became
+highly dropsical, and took various medicines, without effect. One
+ounce of the decoction, with three drams of the dry leaves in eight
+ounces, twice or three times a day, increased his urine prodigiously.
+He was evidently better, but a little attendant nausea overcame his
+resolution, and in the course of some weeks afterwards he fell a
+victim to his obstinacy.
+
+
+                               CASE XI.
+
+Mrs. Smith, about 50 years of age, after a tedious illness of many
+weeks, had a jaundice, and became dropsical in the legs. Two spoonfuls
+of the decoction, with three drams twice a day, increased her urine,
+and abated the swelling.
+
+
+                               CASE XII.
+
+Widow Chatterton, about 60 years of age. Took the decoction in the
+same way for dropsy of the legs, with little effect.
+
+
+                              CASE XIII.
+
+---- Genders, about thirty-four years of age, was delivered of three
+children, and became dropsical of the abdomen. She passed little or no
+urine, had constant thirst, and no appetite. She took two spoonfuls of
+an eight ounce decoction, with three drams twice a day. By the time
+she had finished the bottle, (which must have been on the fourth day,)
+she had evacuated all her water, and could go about. Her appetite
+increased with every dose, and she recovered without farther help.
+
+
+                               CASE XIV.
+
+Miss M---- M----, in her 20th year. Had been infirm from her cradle,
+and, after various sufferings, had an astonishing oedematous
+swelling of one leg and thigh, of many weeks standing. She passed
+little or no urine, and had all her other complaints. She took 2
+spoonfuls of an eight oz. decoction of two drams, twice a day. Her
+urine immediately increased; and, on the third day, the swelling had
+entirely subsided.
+
+
+                               CASE XV.
+
+Mr. P----, 65 years of age, and of a full habit of body. Had lived
+freely in his youth, and for many years led rather an inactive life.
+His health was much impaired several months, and he had a considerable
+distention, and evident fluctuation in the abdomen, and a very great
+oedema of the legs and thighs. His breathing was very short, and
+rather laborious, appetite bad, and thirst considerable. His belly was
+bound, and he passed very small quantities of high-coloured urine,
+that deposited a reddish matter. He had taken medicines some time,
+and, I believe, the Digitalis; and had been better.
+
+A blister was applied to the upper and inside of each thigh; he took
+two spoonfuls of the decoction, with three drams of the dry leaves,
+two or three times a day; and some opening physic occasionally.
+
+He lived at a considerable distance, and I did not visit him a second
+time; but I was well informed, about ten days or a fortnight
+afterwards, that his urine increased amazingly upon taking the
+decoction, and that the water was entirely evacuated.
+
+
+                               CASE XVI.
+
+Mrs. G----, aged 50 years. After being long ailing, had a large
+collection of water in the abdomen and lower extremities. Her urine
+was high-coloured, in small quantities, and had a reddish sediment.
+She took the decoction of Digitalis, squills, &c. without any effect.
+The chrystals of tartar, however, cured her speedily.
+
+
+                              CASE XVII.
+
+Mr. ----, about 50 years of age, complained of great tension and pain
+across the abdomen, and of loss of appetite; his urine, he thought,
+was less than usual, but the difference was so trifling he could speak
+with no certainty: his belly seemed to fluctuate. Among other things
+he tried the Foxglove leaves dried, twice a day; and, although it
+appeared to afford him relief, yet the effect was not permanent.
+
+
+                              CASE XVIII.
+
+Mr. W----, aged between 60 and 70 years; and rather corpulent: was
+considerably dropsical, both of the belly and legs, and his urine in
+small quantities. Three grains of the dry leaves, twice a day,
+evacuated the water in less than a fortnight.
+
+
+                               CASE XIX.
+
+Sarah Taylor, 40 years of age, was admitted into the Dispensary for
+dropsy of the abdomen and legs; and was relieved by the Decoctum
+digitalianum.
+
+
+                               CASE XX.
+
+Lydia Smith, aged 60. Dispensary. Laboured many years under an asthma,
+and became dropsical. She took the decoction without effect.
+
+
+                               CASE XXI.
+
+John Leadbeater, aged 15 years. Had a quotidian intermittent, which
+was removed by the humane assistance of an amiable young lady. His
+intermittent was soon attended by a very considerable ascites; for
+which he became a patient of the Dispensary. He took a decoction of
+Foxglove night and morning. His urine increased immediately, and he
+lost all his complaints in four days.
+
+
+                              CASE XXII.
+
+William Millar, aged 50 years. Admitted into the Dispensary for a
+tertian ague, and general dropsy. The dropsy continuing after the ague
+was removed, and his urine being still passed in small quantities; he
+took the powdered leaves, and recovered his health in five days.
+
+
+                              CASE XXIII.
+
+Ann Wakelin, 10 years of age. Had for several weeks a dropsy of the
+belly after an ague. She took a decoction of Foxglove, which removed
+all complaint by the fourth day.
+
+
+                              CASE XXIV.
+
+Ann Meachime; a Dispensary patient. Had an ascites and scantiness of
+urine. She took the powder of Foxglove, and evacuated all her water
+in three days.
+
+It may not be improper to observe, 1st. That various diuretics had
+long been given in many of these cases before I was consulted. And,
+2dly. That the exhibition of the Foxglove was but seldom attended with
+sickness.
+
+
+                               REMARKS.
+
+These Cases, thus liberally communicated by my friend, Dr. Jones, are
+more acceptable, as they seem to contain a faithful abstract from his
+notes, both of the unsuccessful as well as the successful Cases.
+
+     The following Tabular View of them will give us some Idea of
+     the efficacy of the Medicine.
+
+    Anasarca                            7 Cases   Cured     3
+                                                  Relieved  1
+                                                  Failed    3
+    Ascites                             5 Cases   Cured     4
+                                                  Relieved  1
+    OEdematous leg                       1 Case    Cured     1
+    Ascites and anasarca                7 Cases   Cured     4
+                                                  Relieved  2
+                                                  Failed    1
+    Asthma and dropsy                   1 Case    Failed    1
+    Hydrothorax and gout                1 Case    Cured     1
+    ----, ascites and anasarca--        2 Cases   Cured     2
+
+
+                A CASE of Anasarca communicated by Mr.
+                    JONES, Surgeon, in Birmingham.
+
+     Dear SIR,
+
+Having lately experienced the diuretic powers of the Foxglove, in a
+case of anasarca; I do myself the pleasure of communicating a short
+history of the treatment to you.
+
+                                                I am, &c.
+                                                       W. JONES.
+
+         Birmingham,
+     May 17th, 1785.
+
+My patient, Mrs. C----, who is in her 51st year, had the following
+symptoms, viz. alternate swelling of the legs and abdomen, a little
+cough, shortness of breath in a morning, thirst, weak pulse, and her
+urine, which was so small in quantity as seldom to amount to half a
+pint in twenty-four hours, deposited a clay-coloured sediment.
+
+_April_ 16th, 1785, I directed the following form:
+
+    R. Fol. Digitalis siccat. [Symbol: dram]ii.
+    Aq. fontan� bullient. [Symbol: ounce]viii. f. infus. et cola.
+    Sumat cochl. larga iii. o. n. et mane.
+
+On the 17th she had taken twice of the infusion, and though by mistake
+only two tea spoonfuls for a dose, yet the quantity of urine was
+increased to about a pint in the twenty-four hours. She was then
+directed to take two table spoonfuls night and morning. And.
+
+On the 18th, a degree of nausea was produced. A pint and half of urine
+was made in the last twenty-four hours. During the time above
+specified she had two or three stools every day. The infusion was now
+omitted.
+
+On the 19th the swelling of the legs was removed. A degree of nausea
+took place in the morning, and increased so much during the day, that
+she vomited up all her food and medicine. As she was very low, and
+complained of want of appetite, a cordial julep was directed to be
+taken occasionally, as well as red port and water, mint tea, &c. She
+informed me that whatever she took generally staid about an hour
+before it came up again, and that the mint tea staid longest on the
+stomach. The vomiting decreased gradually, and ceased on the 22d. The
+discharge of urine remained considerable during the three following
+days, but its quantity was not measured.
+
+22d. A dose of neutral saline julep was directed to be taken every
+fourth hour.
+
+On the 23d she complained of thirst, and thought the discharge of
+urine not so copious as on the preceding days, therefore the saline
+julep was continued every fourth hour, with the addition of thirty
+drops of the following medicine:
+
+    R. Aceti scillitic. [Symbol: dram]vi.
+    Tinct. aromat. [Symbol: dram]ii.
+    Tinct. thebaic. gutt. xx. m.
+
+The bowels have been kept open from the 19th, by the occasional use of
+emollient injections.
+
+On the 24th the legs were much swelled again; she complained of
+languor and a degree of nausea. The discharge of urine increased a
+little since the 23d. Her pulse was low and her tongue white. The
+urine, which had been rendered clear by the infusion of Foxglove, now
+deposited a whitish sediment.
+
+On the 25th her appetite began to return, the swelling of the legs
+diminished, and she thought herself much relieved. The urine was
+considerable in quantity, and clear.
+
+On the 26th she was thirsty and languid. The swelling was removed; the
+quantity of urine discharged in the last twenty-four hours was about a
+pint. She continued to mend from this time, and is now in good health.
+
+A giddiness of the head, more or less remarkable at times, was
+observed to follow the use of the Foxglove, and it lasted nine or ten
+days.
+
+This is the second time that I have relieved this patient by the
+infusion of Foxglove. I used the same proportion of the fresh leaves
+the first time as I did of the dried ones the last. The violent
+vomiting which followed the use of the infusion made with the dried
+leaves, did not take place with the fresh though she took near a pint
+made with the same proportion of the herb fresh gathered.
+
+
+                               REMARKS.
+
+The above is a very instructive case, as it teaches us how small a
+quantity of the infusion was necessary to effect every desirable
+purpose. At first sight it may appear from the concluding paragraph,
+that the green leaves ought to be preferred to the dried ones, as
+being so much milder in their operation; but let it be noticed, that
+the same quantity of infusion was prepared from the same weight of the
+green as of the dried leaves, and consequently, as will appear
+hereafter, the infusion with the dried leaves was five times the
+strength of that before prepared from the green ones. We need not
+wonder, therefore, that the effects of the former were so
+disagreeable, when the dose was five times greater than it ought to
+have been. But what makes this matter still more obvious, is the
+mistake mentioned at first, of two tea spoonfuls only being given for
+a dose. Now a tea spoonful, containing about a fourth or a fifth part
+of the contents of a table spoon, the dose then given, was very nearly
+the same as that which had before been taken of the infusion of the
+green leaves, and it produced precisely the same effects for it
+increased the urinary discharge, without exciting the violent
+vomiting.
+
+
+                     Letter from Doctor JOHNSTONE,
+                       Physician, in Birmingham.
+
+     Dear SIR,
+
+The following cases are selected from many others in which I have
+given the Digitalis purpurea; and from repeated experience of its
+efficacy after other diuretics have failed. I can recommend it as an
+effectual, and when properly managed, a safe medicine.
+
+                                            I am, &c.
+                                                   E. JOHNSTONE.
+
+     Birmingham, May 26,
+     1785.
+
+_March_ 8th, 1783, I was called to attend Mr. G----, a gentleman of a
+robust habit, who had led a regular and temperate life, �t. 68. He was
+affected with great difficulty of respiration, and cough particularly
+troublesome on attempting to lie down, oedematous swellings of the
+legs and thighs, abdomen tense and sore on being pressed, pain
+striking from the pit of the stomach to the back and shoulders; almost
+constant nausea, especially after taking food, which he frequently
+threw up; water thick and high-coloured, passed with difficulty and
+in small quantity; body costive; pulse natural; face much emaciated,
+eyes yellow and depressed. He had been subject to cough and difficulty
+of breathing in the winter for several years; and about four years
+before this time, after being exposed to cold, was suddenly deprived
+of his speech and the use of the right side, which he recovered as the
+warm weather came on; but since that time had been remarkably costive,
+and was in every respect much debilitated. He first perceived his legs
+swell about a year ago; by the use of medicines and exercise, the
+swellings subsided during the summer, but returned on the approach of
+winter, and gradually increased to the state in which I found them,
+notwithstanding he had used different preparations of squills and a
+great variety of other diuretic medicines. I ordered the following
+mixture.
+
+    R. Foliorum Digitalis purpur. recent. [Symbol: dram]iii.
+    decoque ex aq. fontan. [Symbol: ounce]xii ad [Symbol:
+    ounce]vi colatur� adde Tinctur. aromatic.
+
+    Syr. zinzib. aa [Symbol: ounce]i. m. capt. cochl. duo larga
+    secunda quaque hora ad quartam vicem nisi prius nausea
+    supervenerit.
+
+_March_ 9th. He took four doses of the mixture without being in the
+least sick, and made, during the night upwards of two quarts of
+natural coloured water.
+
+10th. Took the remainder of the mixture yesterday afternoon and
+evening, and was sick for a short time, but made nearly the same
+quantity of water as before, the swellings are considerably
+diminished, his appetite increased, but he is still costive.
+
+    R. Argent, viv. balsam peruv. aa [Symbol: dram]ss tere ad
+    extinctionem merc. et adde gum. ammon. [Symbol: scruple]iii aloes
+    socotorin. [Symbol: dram]ss rad. scil. recent. [Symbol: scruple]ss
+    syr. simpl. q. s. f. mass. in pil. xxxii divid. cap. iii. bis in die.
+
+14th. Continues to make water freely. The swellings of his legs have
+gradually decreased; soreness and tension of the abdomen considerably
+less.
+
+    Omittant. pil. cap. mistur. c. decoct. Digitalis. &c. 3tia
+    quaque hora ad 3tiam vicem.
+
+15th. Made a pint and a half of water last night, without being in the
+least sick, and is in every respect considerably better. Repet.
+Pillul. ut antea.
+
+21st. Makes water as usual when in health, and the swellings are
+entirely gone.
+
+    R. Infus. amar. [Symbol: ounce]v. tinctur. Rhei spirit.
+    [Symbol: ounce]ii. spirit vitriol. dulc. [Symbol: dram]ii.
+    syr. zinzib. [Symbol: dram]vi. m. cap. cochl. iii. larg. ter
+    in die.
+
+He soon gained sufficient strength to enable him to go a journey, and
+returned home in much better health than he had been from the time he
+was affected with the paralytic stroke, and excepting some return of
+his asthmatic complaint in the winter, hath continued so ever since.
+
+
+                               CASE II.
+
+R---- Howgate, a man much addicted to intemperance, particularly in
+the use of spirituous liquors, �t. 60, was admitted into the Hospital
+near Birmingham, _May_ 17, 1783. He complained of difficulty of
+breathing, attended with cough, particularly troublesome on lying
+down; drowsiness and frequent dozing, from which he was roused by
+startings, accompanied with great anxiety and oppression about the
+breast; oedematous swellings of the legs; constant desire to make
+water, which he passed with difficulty, and only by drops; pulse weak
+and irregular; body rather costive; face much emaciated; no appetite
+for food.--Cap. pil. scil. iii. ter in die.[6]
+
+    [Footnote 6: R. Rad. scil. recent. sapon. castiliens. pulv.
+    Rhei opt. aa. [Symbol: scruple]i. ol. junip. gutt. xvi. syr.
+    bals. q. s. f. mass. in pil. xxiv. divid.]
+
+_May_ 20th. The pills have had no effect.--Cap. mistur. c.[7] Decoct.
+Digital. &c. cochl. ii. larg. 3tia quaque hora, ad 3tiam vicem.
+
+    [Footnote 7: Prepared in the same manner as in the former
+    case.]
+
+_May_ 21st. Made near two quarts of water in the night, without being
+in the least sick. He continued the use of the mixture three times in
+the day till the 30th, and made about three pints of water daily, by
+which means the swellings were entirely taken away; and his other
+complaints so much relieved, that on the 6th of June he was dismissed
+free from complaint, except a slight cough. But returning to his old
+course of life, he hath had frequent attacks of his disorder, which
+have been always removed by using the Digitalis.
+
+
+                  Extract of a letter from Mr. LYON,
+                         Surgeon, at Tamworth.
+
+--Mr. Moggs was about 54 years of age, his disease a dropsy of the
+abdomen, attended with anasarcous swellings of the limbs, &c. brought
+on by excessive drinking. I believe the first symptoms of the disease
+appeared the beginning of November, 1776; the medicines he took before
+you saw him, were squills in different forms, sal diureticus and
+calomel, but without any good effect; he begun the Digitalis on the
+10th of July 1777; a few doses of it caused a giddiness in the head,
+and almost deprived him of sight, with very great nausea, but very
+little vomiting, after which a considerable flow of urine ensued, and
+in a very short time, a very little water remained either in the
+cavity of the abdomen, or the membrana adiposa, but he remained
+excessive weak, with a fluttering pulse at the rate of 150 or
+frequently 160 in a minute; he kept pretty free from water for upwards
+of twelve months; it then collected, and neither the Digitalis nor
+any other medicine would carry it off. I tapped him the 2d of August
+1779 in the usual place, and took some gallons of water from him, but
+he very soon filled again, and as he had a very large rupture, a
+considerable quantity of the water lodged in the scrotum, and could
+not be got away by tapping in the usual place. I therefore (on the
+28th of the same month) made an incision into the lower part of the
+scrotum, and drained off all the water that way, but he was so very
+much reduced, that he died the 8th or 9th of _September_ following,
+which was about two years and two months after he first begun the
+Digitalis.
+
+I have had several dropsical patients relieved, and some perfectly
+recovered by the Digitalis, since you attended Mr. Moggs, but as I did
+not take any notes or make any memorandums of them, cannot give you
+any of them.
+
+
+                    Communications from Dr. STOKES,
+                      Physician, in Stourbridge.
+
+     Dear SIR,
+
+I accept with pleasure your invitation to communicate what I know
+respecting the properties of _Digitalis_; and if an account of what
+others had discovered before you,[8] with a detail of my own
+experience, shall be allowed the merit of at least a well meant
+acknowledgment, for the early communication you were so kind to make
+me, of the valuable properties you had found in it; I shall consider
+my time as well employed. A knowledge of what has been already done is
+the best ground work of future experiment; on which account I have
+been the more full on this subject, in hopes that given with the
+cautions which you mean to lay down in the cure of dropsies, it may
+prove alike useful in that of other diseases, one of which stands
+foremost among the _opprobria_ of medicine.
+
+    [Footnote 8: See this account in the Introduction.]
+
+
+                                CASE I.
+
+Mrs. M----. Orthopnea, pain, and excessive oppression at the bottom of
+the sternum. Pulse irregular, with frequent intermissions. Appetite
+very much impaired. Legs anasarcous.
+
+    _Empl. vesicator. pectori dolent._
+    _Infus. Digital. e [Symbol: dram]iii. ad. aq. &c. [Symbol: ounce]viii.
+    cochl. j. o. h. donec nausea excitetur vel diuresis satis copiosa
+    proveniat._
+
+I ordered it of the above strength, and to be repeated often, on
+account of the great emergency of the case, but the nausea excited by
+the first dose prevented its being given at such short intervals. A 3d
+dose I found had been given, which was followed by vomitings. All her
+complaints gradually abated, but in about a fortnight recurred,
+notwithstanding the use of infus. amar. &c.
+
+    _Dec. 2. Infus. Digit. e. [Symbol: dram]iss ad aq. &c.
+    [Symbol: ounce]viii. cochl. ii. horis &c. u. a._
+
+Complaints gradually abated, swellings of the legs nearly gone down.
+
+About a month afterwards you was desired to visit this patient.[9]
+
+    [Footnote 9: For reasons assigned at p. 100, I did not intend
+    to introduce any case, occurring under my own inspection, in
+    the course of the present year; but it may be satisfactory to
+    continue the history of this disease, as Dr. Stokes's
+    narrative would otherwise be incomplete.
+
+
+                                 1785.
+
+                                 CASE.
+
+    _Jan._ 5th. Mrs. M----, �t. 48. Hydrothorax and anasarcous
+    legs, of eight months duration. She had taken jallap, squill,
+    salt of tartar, and various other medicines. I found her in a
+    very reduced state, and therefore directed only a grain and
+    half of the Pulv. Digital. to be given night and morning.
+    This in a few days encreased the secretion of urine, removed
+    her difficulty of breathing, and reduced the swelling of her
+    legs, without any disturbance to her system.
+
+    Three months afterwards, a severe attack of gout in her legs
+    and arms, removing to her head, she died.
+
+    Dr. Stokes had an opportunity of examining the dead body, and
+    I had the satisfaction to learn from him, that there did not
+    appear to have been any return of the dropsy.]
+
+On the examination of the body I noticed, among others, the following
+appearances.
+
+About � oz. of bloody water flowed out, on elevating the upper half
+of the scull, and a small quantity also was found at the base.
+
+BRAIN. Blood-vessels turgid with blood, and many of those of
+considerable size distended with air.
+
+A very slight watery effusion between the _Pia Mater_ and _Tunica
+arachnoidea_. About � oz. of watery fluid in the _lateral
+ventricles_.
+
+THORAX. In the left cavity about 4 oz. of bloody serum; in the right
+but little. Lungs, the hinder parts loaded with blood. Adhesions of
+each lobe to the pleura. _Pericardium_ containing but a very small
+quantity of fluid. _Heart_ containing no coagula of blood. _Valves of
+the Aorta_ of a cartilaginous texture, as if beginning to ossify.
+
+_Abdominal Viscera_ natural, and a profusion of _Fat_ under the
+integuments of the abdomen and thorax, in the former to the thickness
+of an inch and upwards, and in very considerable quantity on the
+mesentery, omentum, kidneys, &c.
+
+OBS. The intermitting pulse should seem to have been owing to
+effusions of water in some of the cavities of the breast, as it
+disappeared on the removal of the waters.
+
+
+                               CASE II.
+
+Mrs. C---- of K----, �t. 80. Orthopnoea, with sense of oppression
+about the proecordia. Unable to lie down in bed for some nights
+past. Anasarca of the lower extremities. Urine very scanty. Complaints
+of six weeks standing. Had taken _sal. diuret. c. ol. junip.--Calom.
+c. jalap, et gambog.--Et ol. junip. c. ol. Terebinth._ without effect.
+
+_Feb._ 7. _Infus. Digital. e. [Symbol: dram]iii. ad aq. &c.
+[Symbol: ounce]viii. cochl. ii. 4tis horis._ Ordered to drink largely
+of _infus. baccar. junip._ The third dose produced great nausea which
+continued ten hours, during which time the urine made was about a
+quart. The next day her apothecary directed her to begin again with
+it. The second dose produced vomiting. During the next twenty hours
+she made two quarts of water, about four times as much as she drank.
+
+From this time she took no more of the _infus. Digital._ but continued
+the _inf. bacc. junip._ until about _March_ 2d, when all the swellings
+were gone down, her respiration perfectly free, and she herself quite
+restored to her former state of health. On the 29th she had an attack
+of jaundice which was some time after removed; since which she has
+enjoyed a good state of health, excepting that for some little time
+past her ancles have been slightly oedematous, which will I trust
+soon yield to strengthening medicines.
+
+
+                               CASE III.
+
+Mrs. M---- G----, �t. 64. Has had sore legs for these thirty-four
+years past. Orthopnoea. Sense of oppression at the proecordia.
+Pulse intermitting. Legs anasarcous. Urine scanty, high-coloured.
+
+    _Infus. Digital. c. [Symbol: dram]iss ad aq. bull. [Symbol: ounce]viii.
+    cochl. ii. 4tis horis._
+
+Took six doses, when nausea was excited. Urine a quart during the
+course of the night. The flow of urine continued, and complaints
+relieved. Sal. Mart. c. extr. gent. and afterwards with the addition
+of extr. cort. for which last ingredient she had a predilection,
+confirmed the cure.
+
+On the same day the next year I was called in to her for a similar
+train of symptoms, excepting that the pulse was but just perceptibly
+irregular.
+
+    _Infus. Digital. u. a. pr�script._
+
+The directions on the phial not being attended to, _two doses of it
+were given after a nausea had been excited_, which, with occasional
+vomitings, became exceedingly oppressive. A saline draught, given in
+Dr. Hulme's method, a draught _sal. c. c. gr. xii. c. conf. card. gr.
+x._ produced no immediate effect, but the nausea gradually abating,
+inf. bacc. junip. was ordered; but this appeared to augment it, and a
+great propensity to sleep coming on, I directed _sal. c. c. conf.
+card, aa gr. viii. 4tis horis_, which removed the unpleasant symptoms
+and _myrrh. c. sal. mart._ completed the cure. During the use of the
+above medicines, the urine was augmented, and the pulmonary complaints
+removed, even before the nausea left her; and the sores of her legs
+which were much inflamed before she began with the infus. Digital. in
+a day's time assumed a much healthier appearance, and on her other
+complaints going off, they shewed a greater tendency to heal than she
+had ever observed in them for twenty years before. This instance is a
+very pleasing confirmation of the experience of Hulse and Dr. Baylies,
+and of the advantage to be derived from a medicine, which, while it
+helps to heal the ulcers, removes that from the constitution which
+often renders the healing of them improper.
+
+In one case in which I ordered it, the infusion, instead of digesting
+three hours as I had directed, was suffered to stand upon the leaves
+all night. The consequence was that the first dose produced
+considerable nausea.
+
+The two following cases, with which I have been favoured by a
+physician very justly eminent, convince me of the necessity there is
+that every one who discovers a new medicine, or new virtues in an old
+one, should, in announcing such discoveries, publish to the world the
+exact manner in which he exhibits such medicines, with all the
+precautions necessary to obtain the promised success.
+
+    In these (says my correspondent) "the infusion was given in
+    small doses, repeated every hour or two, till a nausea was
+    raised, when it was omitted for a day or perhaps two, and
+    then repeated in the same manner.
+
+    "An ASCITES emptied by it, but filled again very speedily,
+    though _its use was never discontinued_, and who afterwards
+    found no salutary effects from it. Ended fatally.
+
+    "In an ANASARCA it sometimes increased the quantity of urine,
+    and abated the swelling, but which as often returned in as
+    great a degree as before, though _the medicine was still
+    given_, and always increased in quantity so as to excite
+    nausea. Ended fatally.
+
+    "I have tried it in many other cases, but found very little
+    difference in the success attending it."
+
+May we not be allowed to conjecture that the inefficacy of _its
+continued use_ is owing to its narcotic property gradually diminishing
+the irritability of the muscular fibres of the absorbents, or possibly
+of the whole vascular system, and thus adding to that weakened action
+which seems to be the cause of the generality of dropsies, which leads
+us to caution the medical experimenter against trying it, at least
+_against its continued use, even in small doses_, in other diseases of
+diminished energy, as continued fever, palsy, &c.
+
+             I remain with the greatest truth,
+
+                       Your obliged and affectionate friend,
+
+                                                JONATHAN STOKES.
+
+     Stourbridge,
+     May 17, 1785.
+
+
+    The three following Hospital Cases, which Dr. STOKES had an
+    opportunity of observing, are related as instances of bad
+    practice, and tend to demonstrate how necessary it is when
+    one physician adopts the medicine of another, that he should
+    also at first rigidly adopt his method.
+
+
+                                CASE I.
+
+Esther K----, �t. 33. General anasarca, ascites, and dyspnoea, of
+seven months duration.
+
+_Decoct. c Digit. [Symbol: dram]iv. c. aq. [Symbol: pound]i. coquend.
+ad [Symbol: pound]ss. cap. [Symbol: ounce]i. 2dis. horis._ 1st DAY.
+4th dose made her sick. 2d DAY. The first dose she took to-day
+produced vomiting.
+
+3d DAY. _Minuatur dosis ad [Symbol: ounce]ss._ This stayed upon her
+stomach, but produced an almost constant sickness. Stools more
+frequent, water scarce sensibly increased; and her swellings not at
+all reduced.
+
+4th DAY. _Cap. Calomel. gambog. scill. &c._
+
+OBS. Sufficient time was not allowed to observe its effects, neither
+was the patient enjoined the free use of diluents. The disease
+terminated fatally.
+
+
+                               CASE II.
+
+William T----, �t. 42. Ascites, with cough and dyspnoea. Abdomen
+very much distended. The rest of his body highly emaciated. Urine
+thick, high coloured, and in very small quantity.
+
+    _Decoct. Digit. (u. in Esther K----,) 4tis horis._
+
+1st DAY of taking it. The 4th dose produced sickness.
+
+2d. Vomiting after the second dose.
+
+10th. Urine increased to [Symbol: pound]vi.
+
+11th. Flow of urine continues. Abdomen quite flaccid.
+
+12th. Abdomen not diminished.
+
+15th: A smart purging came on, and the flow of urine diminished.
+
+23d. Belly much bound. Took a cathart. powder, which was followed by a
+diminution of the abdomen.
+
+29th. To take a cathart. powder every 4th morning, continuing the
+decoct. Digit.
+
+32d. Urine exceedingly scanty.
+
+35th. _Vin. scill. [Symbol: ounce]ss. o. m. &c._ This produced
+diuretic effects.
+
+44th. Tapped. Terminated fatally.
+
+OBS. Here the medicine was _continued till it ceased to produce
+diuretic effects_; and these effects were not aided by any
+strengthening remedies.
+
+
+                               CASE III.
+
+George R----, �t. 52. Ascites, general anasarca, and dyspnoea. His
+legs so greatly distended that it was with great difficulty he could
+draw the one after the other.
+
+    _Infus. Digital. [Symbol: dram]iiiss. ad. aq. [Symbol: pound]ss.
+    cap. [Symbol: ounce]i. altern. horis donec nauseam
+    excitaverit._ _Rep. 3tiis diebus. tempore intermedio cap.
+    sol. guaic. [Symbol: ounce]i. ter in die ex inf. sinap._
+
+1st DAY of taking it. Became sickish towards night.
+
+2d DAY. Made a great quantity of water during the night, and spat up a
+great deal of watery phlegm. The first dose he took in the morning has
+produced a sickness which has continued all day, but he has never
+vomited.
+
+3d. DAY. The change in his appearance so great as to make it difficult
+to conceive him to be the same person. Instead of a large corpulent
+man, he appeared tall, thin, and rather aged. Breathes freely, and can
+walk up and down stairs without inconvenience.
+
+4th DAY. _Decoct. bacc. junip. and cyder for common drink._
+
+6th DAY. A second course of his medicine produced a flow of urine
+almost as plentiful as the former, though he drank little or nothing
+at the time. In a day or two after he walked to some distance.
+
+12th DAY. _Pot. purgans illico._
+
+14th DAY. _Pot. purg. c. jalap. [Symbol: dram]ss. 4tis diebus._
+          _Infus. Dig. 3tiis diebus._
+
+17th DAY. _R. Gamb. gr. iii. calom. gr. ii. camph.
+          gr. i. syr. simpl. fiat pil. o. n. sum._
+          _Infus. Digit. 3tiis diebus._
+
+21st DAY. Made an out-patient. The super-abundant flow of urine
+continued for the first three days after his last course; but since,
+the flow of saliva has been nearly equal to that of urine.
+
+The smalls of his legs not quite reduced, and are fuller at night. He
+has shrunk round the middle from four feet two inches to three feet
+six inches; and in the calves of his legs, from seventeen inches to
+thirteen and a half.[10]
+
+
+    [Footnote 10: In the three last recited cases, the medicine
+    was directed in doses quite too strong, and repeated too
+    frequently. If Esther K---- could have survived the extreme
+    sickness, the diuretic effects would probably have taken
+    place, and, from her time of life, I should have expected a
+    recovery. Wm. T---- seems to have been a bad case, and I
+    think would not have been cured under any management. G.
+    R---- certainly possessed a good constitution, or he must
+    have shared the fate of the other two.]
+
+OBS. The waters were here very successfully evacuated, but as you
+remarked to me, on communicating the case to you at the time, tonic
+medicines should have been given, to second the ground that had been
+gained, instead of weakening the patient by drastic purgatives.
+
+
+                   A CASE from Mr. SHAW, Surgeon, at
+             Stourbridge.--Communicated by Doctor STOKES.
+
+Matth. D----, �t. 71. Tall and thin. Disease a general anasarca, with
+great difficulty of breathing. The lac ammoniac. somewhat relieved his
+breath; but the swellings increased, and his urine was not augmented.
+I considered it as a lost case, but having seen the good effects of
+the Digitalis, as ordered by Dr. Stokes in the case of Mrs. G----, I
+gave him one spoonful of an infusion of [Symbol: dram]ii to half a
+pint, twice a day. His breath became much easier, his urine increased
+considerably, and the swellings gradually disappeared; since which his
+health has been pretty good, except that about three weeks ago, he had
+a slight dyspnoea, with pain in his stomach, which were soon removed
+by a repetition of the same medicine.
+
+Mr. Shaw likewise informs me, that he has removed pains in the stomach
+and bowels, by giving a spoonful of the infusion, [Symbol: dram]iss.
+to [Symbol: ounce]viii. morning and night.
+
+
+            A Letter from Mr. VAUX, Surgeon, in Birmingham.
+
+     Dear SIR,
+
+I send you the two following cases, wherein the Digitalis had very
+powerful and sensible effects, in the cure of the different patients.
+
+
+                                CASE I.
+
+Mrs. O---- of L---- street, in this town, aged 28, naturally of a
+thin, spare habit, and her family inclinable to phthisis, sent for me
+on the 11th of June, 1779, at which time she complained of great pain
+in her side, a constant cough, expectorated much, which sunk in water;
+had colliquative sweats and frequent purging stools; the lower
+extremities and belly full of water, and from the great difficulty she
+had in breathing, I concluded there was water in the chest also. The
+quantity of water made at a time for three weeks before I saw her,
+never amounted to more than a tea-cup full, frequently not so much.
+Finding her in so alarming a situation, I gave it as my opinion she
+could receive no benefit from medicine, and requested her not to take
+any; but she being very desirous of my ordering her something, I
+complied, and sent her a box of gum pills with squills, and a mixture
+with salt of tartar: these medicines she took until the sixteenth,
+without any good effects: the water in her legs now began to exsude
+through the skin, and a small blister on one of her legs broke.
+Believing she could not exist much longer, unless an evacuation of the
+water could be procured; after fully informing her of her situation,
+and the uncertainty of her surviving the use of the medicine, I
+ventured to propose her taking the Digitalis, which she chearfully
+agreed to. I accordingly sent her a pint mixture, made as under, of
+the fresh leaves of the Digitalis. Three drams infused in one pint of
+boiling water, when cold strained off, without pressing the leaves,
+and two ounces of the strong juniper water added to it: of this
+mixture she was ordered four table spoonfuls every third hour, till it
+either made her sick, purged her, or had a sensible effect on the
+kidneys. This mixture was sent on the seventeenth, and she began
+taking it at noon on the eighteenth. At one o'clock the following
+morning I was called up, and informed she was dying. I immediately
+attended her, and was agreeably surprised to find their fright arose
+from her having fainted, in consequence of the sudden loss of twelve
+quarts of water she had made in about two hours. I immediately applied
+a roller round her belly, and, as soon as they could be made, 2
+others, which were carried from the toes quite up the thighs. The
+relief afforded by these was immediate; but the medicine now began to
+affect her stomach so much, that she kept nothing on it many minutes
+together. I ordered her to drink freely of beef tea, which she did,
+but kept it on her stomach but a very short time. A neutral draught in
+a state of effervescence was taken to no good purpose: She therefore
+continued the beef tea, and took no other medicine for five days,
+when her sickness went off: her cough abated, but the pain in her side
+still continuing, I applied a blister which had the desired effect:
+her urine after the first day flowed naturally. Her cure was
+compleated by the gum pills with steel and the bitter infusion. It
+must be observed she never had any collection of water afterwards.
+
+It affords me great pleasure to inform you that she is now living, and
+has since had four children; all of whom, I think I may justly say,
+are indebted to the Digitalis for their existence.
+
+There appears in this case a striking proof of the utility of emetics
+in some kinds of consumptions, as it appears to me the dropsy was
+brought on by the cough, &c. and I believe these were cured by the
+continual vomitings, occasioned by the medicine.
+
+
+                                CASE II.
+
+Mr. H----, a publican, aged about 48 years, sent for me in _March_,
+1778. He complained of a cough, shortness of breathing, which
+prevented him from laying down in bed; his belly, thighs and legs very
+much distended with water; the quantity of urine made at a time seldom
+exceeded a spoonful. I requested him to get some of the Digitalis, and
+as they had no proper weights in the house, I told them to put as much
+of the fresh leaves as would weigh down a guinea, into half a pint of
+boiling water; to let it stand till cold, then to pour off the clear
+liquor, and add a glass of gin to it, and to take three table
+spoonfuls every third hour, until it had some sensible effect upon
+him.
+
+Before he had taken all the infusion, the quantity of urine made
+increased, (he therefore left off taking it), and it continued to do
+so until all the water was evacuated. His breathing became much
+better, his cough abated, though it never quite left him; he being for
+some time before asthmatic. By taking some tonic pills he continued
+quite well until the next spring, when he had a return of his
+complaint, which was carried off by the same means. Two years after,
+he had a third attack, and this also gave way to the medicine. Last
+year he died of a pleurisy.
+
+                                                  I am, &c.
+                                                       JER. VAUX
+
+     Moor-Street, 8th May,
+     1785.
+
+P. S. You must well recollect the case of Mrs. F----.--It was "a
+general dropsy--every time she took the medicine its effects were
+similar, viz. The discharge of urine came on gradually at first,
+increased afterwards, and the whole of the water both in the belly,
+legs, &c. was perfectly evacuated. Although the effects were only
+temporary, they were exceedingly agreeable to the patient, making her
+time much more comfortable."--(_See Case_ XLIII.)
+
+
+                     A Letter from Mr. WAINWRIGHT,
+                          Surgeon, in Dudley.
+
+     Dear SIR,
+
+It gives me great pleasure to find you intend to publish your
+observations on the Digitalis purpurea.
+
+Several years are now elapsed since you communicated to me the high
+opinion you entertained of the diuretic qualities of this noble plant.
+To ensure success, due attention was recommended to its _preparation_,
+its _dose_, and its _effects_ upon the system.
+
+I always gave the infusion of the dried leaves; the dose the same as
+in the prescriptions returned. If the medicine operated on the stomach
+or bowels, it was thought prudent to forbear. When the kidneys began
+to perform their proper functions, and the urine to be discharged, a
+continuance of its farther use was unnecessary.
+
+These remarks you made in the case of the first patient for whom you
+prescribed the Digitalis in our neighbourhood, and I have found them
+all necessary at this present period. From the _decided_ good effects
+that followed from its use, in those cases where the most powerful
+remedies had failed, I was soon convinced it was a most valuable
+addition to the materia medica.
+
+The want of a certain diuretic, has long been one of the desiderata of
+medicine. The Digitalis is undoubtedly at the head of that class, and
+will seldom, if properly administered, disappoint the expectation. I
+can speak with the more confidence, having, in an extensive practice,
+been a happy witness to its good qualities.
+
+For several years, I have given the infusion in a variety of cases,
+where there was a deficiency in the secretion of the urine, with the
+greatest success. In recent obstructions, I do not recollect many
+failures. In anasarcous diseases, and in the anasarca, when combined
+with the ascites; in swellings of the limbs, and in diseases of the
+chest, when there was the greatest reason to believe an accumulation
+of serum, the most beneficial consequences have followed from its use.
+
+Had I been earlier acquainted with your intention to publish an
+account of the Digitalis, I could have transmitted some cases, which
+might have served to corroborate these assertions: but I am convinced
+the Digitalis needs not my assistance to procure a favorable
+reception. Its own merit will ensure success, more than a hundred
+recited cases.
+
+I could wish those gentlemen who intend to make use of this plant, to
+collect it in a hot dry day, when the petals fall, and the
+seed-vessels begin to swell.
+
+The leaves kept to the second year are weaker, and their diuretic
+qualities much diminished. It will therefore be necessary to gather
+the plant fresh every season.
+
+These cautions are unnecessary to the accurate botanist, who well
+knows, that a plant in the spring, though more succulent and full of
+juices, is destitute of those qualities which may be expected when
+that plant has attained its full vigour, and the seed-vessels begin to
+be manifest. But for want of attention to these particulars, its
+virtues may be thought exaggerated, or doubtful, if beneficial
+consequences do not always flow from its use. There are diseases it
+cannot cure; and in several of those patients in this town, who first
+took the Digitalis by your orders, there was the most positive proof
+of the viscera being unsound. In these desperate cases it often
+procured a plentiful flow of urine, and palliated a disease which
+medicine could not remove.
+
+At a remote distance, physicians are seldom applied to for advice in
+trifling disorders. Many remedies have been tried without relief, and
+the disease is generally obstinate or confirmed.--It would not be fair
+to try the merits of the Digitalis in this scale. It might often fail
+of promoting the end desired. I flatter myself the reputation of this
+plant will be equal to its merit, and that it will meet with a candid
+reception.
+
+As there is no pleasure equal to relieving the miseries and distresses
+of our fellow-creatures, I hope you will long enjoy that peculiar
+felicity.
+
+Permit me to return my thankful acknowledgments, for your free
+communication of a medicine, by which means, through the blessing of
+providence, I have been enabled to restore health and happiness to
+many miserable objects.
+
+                                           I am, &c.
+                                                 Yours,
+                                                  J. WAINWRIGHT.
+
+     Dudley, April 26th,
+     1785.
+
+
+                     CASE of Mr. WARD, Surgeon, in
+                   Birmingham.--Related by himself.
+
+In _September_, 1782, I was seized with a difficulty of breathing, and
+oppression in my chest, in consequence of taking cold from being
+called out in the night. My tongue was foul; my urine small in
+quantity; my breath laborious and distressing on the slightest
+exercise. I tried the medicines most generally recommended, such as
+emetics, blisters, lac ammoniacum, oxymel of squills, &c. but finding
+little or no relief, I consulted Dr. Withering, who advised me to try
+the following prescription.
+
+    R. Fol. Digital. purp. siccat. [Symbol: dram]iss.
+    Aq. bullientis [Symbol: ounce]iv.
+    Aq. cinn. sp. [Symbol: ounce]ss. digere per horas quatuor, et colatur�
+    capiat cochlear. i. nocte maneque.
+
+He also desired me to take fifty drops of tincture of cantharides
+three or four times a day.
+
+After taking eight ounces of the infusion, and about twelve drams of
+the drops, I was perfectly cured, and have had no return since. The
+medicine did not occasion sickness or vertigo, nor had they any other
+sensible effect than in changing the appearance, and increasing the
+quantity of the urine, and rendering the tongue clean. After the last
+dose or two indeed, I had a little nausea, which was immediately
+removed by a small glass of brandy.
+
+     Birmingham, 1st July, 1785.
+
+
+                    Communications from Mr. YONGE,
+                  Surgeon, in Shiffnall, Shropshire.
+
+     Dear SIR,
+
+I have great satisfaction in complying with your just claim, by
+transcribing outlines of the subsequent cases, for insertion in your
+long requested tract on the Digitalis purpurea. The two first of these
+you will easily recollect, the cures having been conducted immediately
+under your own management, and the whole may add to that weight of
+evidence which long experience enables you to adduce of the efficacy
+of that valuable medicine. I have recited the only instances of its
+failure which occur to me, but many other, though successful cases,
+wherein its utility might seem dubious, and also the accounts received
+from people whose accuracy might be suspected, I shall not for obvious
+reasons trouble you with.
+
+                                      I am, dear Sir,
+                                        Your obliged friend,
+                                                  WILLIAM YONGE.
+
+     Shiffnall,
+     _May_ 1, 1785.
+
+
+                                CASE I.
+
+A Gentleman aged 49, on the night of the 21st of August, 1784, awaked
+with a sense of suffocation, which obliged him to rise up suddenly in
+bed. I found him complaining of difficult respiration, particularly on
+lying down; the countenance pale, and the pulse smaller and quicker
+than usual. Some brandy and water having been given, the symptoms
+gradually abated, so that he slept in a half recumbent posture. The
+following day he expressed a sense of anxiety and weight in the chest,
+attended by quicker breathing upon motion of the body. That evening an
+emetic of ipecacoanha was given, and afterwards a draught, with
+vitriolic �ther and confect. card. aa [Symbol: dram]i to be repeated as the
+symptoms should require it. He continued to be affected with slighter
+returns of the dyspnoea at irregular intervals, until _September_ 15th,
+when upon a more severe attack, the emetic was repeated. He now
+recollected some slight pain in his arms which had affected him
+previous to this last seizure, and was disposed to consider his
+complaint as rheumatic. Pills with gum ammoniac. gum guaiac. and
+antimonial powder were directed, with infus. amar. simpl. twice a day.
+The bowels were regulated by aperient pills of pulv. jalap. aloes and
+sal. tartar. and [Symbol: dram]iss balsam peruv. was given occasionally to
+alleviate the paroxysms of dyspnoea.
+
+From this period until the beginning of November, little amendment or
+variation happened, except that respiration became more permanently
+difficult, and particularly oppressed upon motion, nor was it relieved
+by the expectoration of a mucous discharge, which now increased
+considerably. Squills, musk, ol. succini, �ther, with other medicines
+of the same kind, were now used, but without success. The effects of
+opium and ven�fection were tried. The appetite diminished, and his
+sleep became short and disturbed. He sometimes slept lying upon his
+back, but generally upon his left side. The urine which had hitherto
+been of good colour, and sufficient quantity, now became diminished,
+and lateritious; and the ancles oedematous.
+
+On the 15th of _November_ a blister was laid over the sternum, and
+[Symbol: dram]iss of oxymel scillitic. was given every eight hours.
+
+On the 18th, a more copious discharge of urine took place; the
+swelling of the feet soon disappeared, and the respiration became
+gradually relieved.
+
+On the 30th [Symbol: dram]i tinct. cantharidum twice a day in pyrmont
+water, with pills of ammoniac, sal tartar. et extract. gentian. were
+substituted, but
+
+On the 7th of _December_, from some symptoms of relapse, the oxymel
+was used as before, and continued to be taken until the 27th, in doses
+as large as could be dispensed with on account of the great nausea
+which attended its exhibition: The urine was made in the quantity of
+four or five pints each day, during the whole time; the quantity then
+drank being seldom more than three pints. But now the sickness being
+exceedingly depressing, the strength failing, and the diuretic effects
+beginning to cease, the following prescription was directed.
+
+    R. Fol. Digitalis purpur. pulv. [Symbol: scruple]ss.
+    Spec. Aromatic. [Symbol: scruple]i. sp. lav. c. f. pilul. no.
+    x. capiat i. nocte maneque, et alternis diebus sensim
+    augeatur dosin.
+
+In three days the effect of this medicine became visible, and when the
+dose of the Digitalis had been increased to six grains per day, the
+flow of urine generally amounted to seven pints every twenty-four
+hours. Not the least sickness, nor any other disagreeable symptom
+supervened, though he persevered in this plan until the end of
+_January_ at which time the dyspnoea was removed, and he has
+continued gradually to regain his flesh, strength, and appetite,
+without any relapse.
+
+
+                               CASE II.
+
+About the middle of the year 1784 a lady aged 48, returned from
+London, to her native air in Shropshire, under symptoms of complicated
+disease. It was your opinion that the plethoric state, consequent to
+that period, when menstruation first begins to cease, had under
+various appearances, laid the foundation of that deplorable state
+which now presented itself. The skin was universally of a pale, leaden
+colour; her person much emaciated, and her strength so reduced, as to
+disable her from walking without support. The appetite fluctuating,
+the digestion impaired so much, that solids passed the intestines with
+little appearance of solution: She had generally eight or ten alvine
+evacuations every day, and without this number, febrile symptoms,
+attended with severe vertiginous affection, and vomiting regularly
+ensued. The stools were of a pale ash colour. The urine generally
+pale, and at first in due quantity. The region of the stomach had a
+tense feel, without soreness: the feet and ancles oedematous, her
+sleep was uncertain: the pulse varying between 94 and 100, and feeble,
+except upon the approach of the menstrual periods, which were now only
+marked by its increased strength, and exacerbation of other febrile
+symptoms. Emetics, saline medicines, and gentle aperients were
+necessary to alleviate these. Six grains of ipecac, operated with
+sufficient power, and half a grain of calomel would have purged with
+great violence.
+
+From the time of her arrival till the middle of _August_, mercury had
+been continued in various forms, and in doses such as the irritable
+state of her stomach and bowels would admit of. Spirit. nitri dulc.;
+sal. tartar, squill, and cantharides were alternately employed as
+diuretics, but without success, to retard the progress of an universal
+anasarca which was then advanced to such degree and accompanied by so
+great debility, and other dreadful concomitants, as to threaten a
+speedy and fatal catastrophe.
+
+On the 16th of _August_ you first saw her, and directed thus.
+
+    R. Mercur. cinerei gr. ii.
+    Fol. Digital, purpur. pulv. [Symbol: scruple]i. f. mass. in
+    pill. no. xvi. dividend.--sumat unam hora meridiana,
+    iterumque hora quinta pomeridiana quotidie.
+    Capiat lixivii saponac. gutt. L. in haust. juscul. sine sale
+    parati omni nocte.
+
+On the 20th the flow of urine began to increase, and she continued the
+medicine in the same dose until the 20th of _September_, discharging
+from six to eight pints of water each day for the first week, and
+which quantity gradually diminished as she became empty. During this
+period she complained not of any sickness, except from the lixivium,
+which was after the first dose reduced to 20 drops; and her appetite
+and strength increased daily, though it was evident that no bile had
+yet flowed into the bowels, nor was the digestion at all improved. The
+anasarcous appearances being then removed, the Digitalis was omitted,
+and pills, composed of mercur. cinereus, aloes, and sal tartari
+directed twice a day, with [Symbol: dram]i. of vin. chalybeat. in
+infus. amar. simpl.
+
+Her amendment in other respects proceeded slowly, but regularly, from
+that time until the 9th of October; when the state of plethora again
+recurring, with its usual attendant symptoms, [Symbol: ounce]iv. of
+blood were taken from the arm; and this was upon the same occasion,
+repeated in the following month, with manifest good consequences;
+though in both instances the colour of the blood, as flowing from the
+vein could hardly be called red, and the coagulum was as weak in its
+cohesion as possible. The state of the stomach and bowels was by this
+time greatly improved, in common with other parts of the system; but
+no intromission of bile had yet happened: the hardness about the
+hypogastric region, though less, continued in a considerable degree,
+and you ordered pills of mercury rubbed down, and rust of iron, to be
+taken twice a day, with a decoction of dandelion and sal sod�.
+
+A cataplasm of linseed was applied every night over the stomach and
+right side; and, with little deviation from this plan, she continued
+to the end of the year, improving in her general health, but the
+hepatic affection yet remaining. It was then determined to try the
+effects of electricity, and gentle shocks were passed through the body
+daily, and as nearly as could be through the liver, in various
+directions.
+
+On the fifth day there was reason to think that some gall had been
+secreted and poured out, and this became every day more evident; but
+it flowed only in small quantity, and irregularly into the bowels, as
+appeared from the f�ces being partially tinged by it.
+
+In _February_ the lady left this neighbourhood, and though
+convalescent, yet so nearly well as to promise us the satisfaction of
+seeing her perfectly restored.
+
+_June_ 29. The bile is now secreted in pretty good quantity, her
+appetite is perfectly good, her strength equal to almost any degree of
+exercise, and her health in general better than it has been for some
+years.
+
+
+                               CASE III.
+
+Mr. W----, aged--. In _June_, 1782, was affected with slight
+difficulty in respiration, upon taking exercise or lying down in bed.
+These symptoms increased gradually until the end of _July_, when he
+complained of sense of weight and uneasiness about the proecordia;
+loss of appetite; and costiveness. The urine was small in quantity,
+and high coloured; his pulse feeble, and intermitting; he breathed
+with difficulty when in bed, and slept little. After the exhibition of
+an emetic, and an opening medicine of rhubarb, sena, and sal tartari,
+he was directed to take half a dram of squill pill, pharm. Edinburg.
+night and morning, with [Symbol: dram]ss sal. sod� in [Symbol: ounce]iss.
+infus. amar. simpl. twice a day; and these medicines were continued
+during ten days, without any sensible effect. A blister was then
+applied to the sternum, and six grains of calomel given in the
+evening. The symptoms were now increased very considerably, in every
+particular; and the following infusion was substituted for the former
+medicines.
+
+    R. Fol. Digital. purpur. [Symbol: dram]iii.
+    Cort. limon. [Symbol: dram]ii. infund.
+    Aq. bullient. [Symbol: pound]i. per hor. 2 et cola. sumat
+    cochl. i. primo mane et repet. omni hora.
+
+Sometime in the night considerable nausea occurred, and the following
+day he began to make water in great quantity, which he continued to do
+for three or four days. The pulse in a few hours became regular,
+slower, and stronger, and, in the course of a week, all the symptoms
+entirely vanished, and an electuary of cort. peruvian, sal martis, and
+spec. aromatic. confirmed his cure.
+
+In _February_, 1784, this gentleman had a relapse of his disease, from
+which he again soon recovered by the same means, and is now perfectly
+well.
+
+
+                               CASE IV.
+
+G---- A----, a husbandman, aged 57. Was in the year 1782 affected with
+a slight, but constant pain in his breast, with difficult respiration.
+His countenance was yellow; the abdomen swelled, and hard; his urine
+high coloured, and in small quantity; appetite and sleep little.
+Complained of frequent nausea, and of sudden profuse sweatings, which
+seemed for a short time to relieve the dyspnoea.
+
+After the exhibition of an emetic, six grains of calomel were given,
+with a purge of jalap in the morning, and repeated in a few days, with
+some appearance of advantage. He was then directed to take some pills
+of squill, soap, and rhubarb, with a draught twice a day, consisting
+of infus. amar. simp. and sal tartari. The skin soon became clearer
+and the pain in his breast considerably diminished. But every other
+circumstance remaining the same, and a fluctuation in the belly being
+now more evident, the infusion of Digitalis as prescribed in case
+third, was given in the dose of one ounce twice a day.
+
+On the 5th day the effects were apparent, and he continued his
+medicine for a fortnight without nausea, making four or five pints of
+water every night, but little in the day, and gradually losing the
+symptoms of his disease.
+
+In 1784, this person had a relapse, and was again cured by similar
+treatment.
+
+
+                                CASE V.
+
+R---- H----, Aged 43. Towards the end of the year 1783, became
+affected with slight cough and expectoration of purulent matter. In
+December his skin became universally of a pale yellow colour. The
+abdomen was swelled and hard; his appetite little, and he complained
+of a violent and constant palpitation of the heart, which prevented
+him from sleeping. The urine pale, and in small quantity. The pulse
+exceedingly strong, and rebounding; beating 114 to 120 strokes every
+minute. He suffered violent pain of his head, and was very feeble and
+emaciated. After bleeding, and the use of gentle aperient medicines,
+he continued to take the infusion of Digitalis for some days, without
+any sensible effect. Other diuretics were tried to as little purpose.
+Repeated bleeding had no effect in diminishing the violent action of
+the heart. He died in January following, under complicated symptoms of
+phthisis and ascites.
+
+
+                               CASE VI.
+
+A man aged 57, who had lived freely in the summer of 1784, became
+affected with oedematous swelling of his legs, for which he was
+advised to drink Fox Glove Tea. He took a four ounce bason of the
+infusion made strong with the green leaves, every morning for four
+successive days.
+
+On the 5th he was suddenly seized with faintness and cold sweatings. I
+found him with a pale countenance, complaining of weakness, and of
+pain, with a sense of great heat in his stomach and bowels. The
+swelling of the legs was entirely gone, he having evacuated urine in
+very large quantities for the two preceding days. He was affected with
+frequent diarrhoea. The pulse was very quick and small, and his
+extremities cold.
+
+A small quantity of broth was directed to be given him every half
+hour, and blisters were applied to the ancles, by which his symptoms
+became gradually alleviated, and he recovered perfectly in the space
+of three weeks; except a relapse of the anasarca, for which the
+Digitalis was afterwards successfully employed, in small doses,
+without any disagreeable consequence.
+
+
+                               CASE VII.
+
+S---- D----, a middle aged single woman, was affected in the year
+eighty-one, with a painful rigidity and slight inflammation of the
+integuments on the left side, extending from the ear to the shoulder.
+In every other particular she was healthy. The use of warm
+fomentations, and opium, with two or three doses of mercurial physic,
+afforded her ease and the inflammation disappeared, but was succeeded
+by an oedematous swelling of the part, which very gradually extended
+along the arm, and downward to the breast, back, and belly. Friction,
+electricity and mercurial ointment were amongst the number of
+applications unsuccessfully employed to relieve her for the space of
+three months, during which time she continued in good general health.
+
+In _November_ she became ascitic, passing small quantities of urine,
+and soon afterwards a sudden dyspnoea gave occasion to suppose an
+effusion of water in the thorax. The Digitalis, squills, and
+cantharides were given in very considerable doses without effect. She
+died the latter end of December following.
+
+
+                              CASE VIII.
+
+W---- C----, a collier aged 58, was attacked in the spring of 1783
+with a tertian ague, which he attributed to cold, by sleeping in a
+coal pit, and from which he recovered in a few days, except a
+swelling of the lower extremities, which had appeared about that time,
+and gradually increased for two or three months. The legs and thighs
+were greatly enlarged and oedematous. His belly was swelled, but no
+fluctuation perceptible. He made small quantities of high coloured
+water. The appetite bad, and pulse feeble. He had taken many medicines
+without relief, and was now so reduced in strength, as to sit up with
+difficulty. An infusion of the Digitalis was directed for him, in the
+proportion of one ounce of the fresh leaves to a pint of water, two
+ounces to be taken three times a day, until the stomach or bowels
+became affected. Upon the exhibition of the sixth dose, nausea
+supervened, and continued to oppress him at intervals for two or three
+days, during which he passed large quantities of pale urine. The
+swelling, assisted by moderate bandage rapidly diminished, and without
+any repetition of his medicine, at the expiration of sixteen days, he
+returned to his labour perfectly recovered.
+
+
+
+
+            OF THE PREPARATIONS and DOSES, OF THE FOXGLOVE.
+
+
+Every part of the plant has more or less of the same bitter taste,
+varying, however, as to strength, and changing with the age of the
+plant and the season of the year.
+
+ROOT.--This varies greatly with the age of the plant. When the stem
+has shot up for flowering, which it does the second year of its
+growth, the root becomes dry, nearly tasteless, and inert.
+
+Some practitioners, who have used the root, and been so happy as to
+cure their patients without exciting sickness, have been pleased to
+communicate the circumstance to me as an improvement in the use of the
+plant. I have no doubt of the truth of their remarks, and I thank
+them. But the case of Dr. Cawley puts this matter beyond dispute. The
+fact is, they have fortunately happened to use the root in its
+approach to its inert state, and consequently have not over dosed
+their patients. I could, if necessary, bring other proof to shew that
+the root is just as capable as the leaves, of exciting nausea.
+
+STEM.--The stem has more taste than the root has, in the season the
+stem shoots out, and less taste than the leaves. I do not know that it
+has been particularly selected for use.
+
+LEAVES.--These vary greatly in their efficacy at different seasons of
+the year, and, perhaps, at different stages of their growth; but I am
+not certain that this variation keeps pace with the greater or lesser
+intensity of their bitter taste.
+
+Some who have been habituated to the use of the recent leaves, tell
+me, that they answer their purpose at every season of the year; and I
+believe them, notwithstanding I myself have found very great
+variations in this respect. The solution of this difficulty is
+obvious. They have used the leaves in such large proportion, that the
+doses have been sufficient, or more than sufficient, even in their
+most inefficacious state. _The Leaf-stalks_ seem, in their sensible
+properties, to partake of an intermediate state between the leaves and
+the stem.
+
+FLOWERS.--The petals, the chives, and the pointal have nearly the
+taste of the leaves, and it has been suggested to me, by a very
+sensible and judicious friend, that it might be well to fix on the
+flower for internal use. I see no objection to the proposition; but I
+have not tried it.
+
+SEEDS.--These I believe are equally untried.
+
+From this view of the different parts of the plant, it is sufficiently
+obvious why I still continue to prefer the leaves.
+
+These should be gathered after the flowering stem has shot up, and
+about the time that the blossoms are coming forth.
+
+The leaf-stalk and mid-rib of the leaves should be rejected, and the
+remaining part should be dried, either in the sun-shine, or on a tin
+pan or pewter dish before a fire.
+
+If well dried, they readily rub down to a beautiful green powder,
+which weighs something less than one-fifth of the original weight of
+the leaves. Care must be taken that the leaves be not scorched in
+drying, and they should not be dried more than what is requisite to
+allow of their being readily reduced to powder.
+
+I give to adults, from one to three grains of this powder twice a day.
+In the reduced state in which physicians generally find dropsical
+patients, four grains a day are sufficient. I sometimes give the
+powder alone; sometimes unite it with aromatics, and sometimes form it
+into pills with a sufficient quantity of soap or gum ammoniac.
+
+If a liquid medicine be preferred, I order a dram of these dried
+leaves to be infused for four hours in half a pint of boiling water,
+adding to the strained liquor an ounce of any spirituous water. One
+ounce of this infusion given twice a day, is a medium dose for an
+adult patient. If the patient be stronger than usual, or the symptoms
+very urgent, this dose may be given once in eight hours; and on the
+contrary in many instances half an ounce at a time will be quite
+sufficient. About thirty grains of the powder or eight ounces of the
+infusion, may generally be taken before the nausea commences.
+
+The ingenuity of man has ever been fond of exerting itself to vary the
+forms and combinations of medicines. Hence we have spirituous, vinous,
+and acetous tinctures; extracts hard and soft, syrups with sugar or
+honey, &c. but the more we multiply the forms of any medicine, the
+longer we shall be in ascertaining its real dose. I have no lasting
+objection however to any of these formul� except the extract, which,
+from the nature of its preparation must ever be uncertain in its
+effects; and a medicine whose fullest dose in substance does not
+exceed three grains, cannot be supposed to stand in need of
+condensation.
+
+It appears from several of the cases, that when the Digitalis is
+disposed to purge, opium may be joined with it advantageously; and
+when the bowels are too tardy, jalap may be given at the same time,
+without interfering with its diuretic effects; but I have not found
+benefit from any other adjunct.
+
+From this view of the doses in which the Digitalis really ought to be
+exhibited, and from the evidence of many of the cases, in which it
+appears to have been given in quantities six, eight, ten or even
+twelve times more than necessary, we must admit as an inference either
+that this medicine is perfectly safe when given as I advise, or that
+the medicines in daily use are highly dangerous.
+
+
+
+
+                     EFFECTS, RULES, and CAUTIONS.
+
+
+The Foxglove when given in very large and quickly-repeated doses,
+occasions sickness, vomiting, purging, giddiness, confused vision,
+objects appearing green or yellow; increased secretion of urine, with
+frequent motions to part with it, and sometimes inability to retain
+it; slow pulse, even as slow as 35 in a minute, cold sweats,
+convulsions, syncope, death.[11]
+
+    [Footnote 11: I am doubtful whether it does not sometimes
+    excite a copious flow of saliva.--See cases at pages 115,
+    154, and 155.]
+
+When given in a less violent manner, it produces most of these effects
+in a lower degree; and it is curious to observe, that the sickness,
+with a certain dose of the medicine, does not take place for many
+hours after its exhibition has been discontinued; that the flow of
+urine will often precede, sometimes accompany, frequently follow the
+sickness at the distance of some days, and not unfrequently be checked
+by it. The sickness thus excited, is extremely different from that
+occasioned by any other medicine; it is peculiarly distressing to the
+patient; it ceases, it recurs again as violent as before; and thus it
+will continue to recur for three or four days, at distant and more
+distant intervals.
+
+These sufferings of the patient are generally rewarded by a return of
+appetite, much greater than what existed before the taking of the
+medicine.
+
+But these sufferings are not at all necessary; they are the effects of
+our inexperience, and would in similar circumstances, more or less
+attend the exhibition of almost every active and powerful medicine we
+use.
+
+Perhaps the reader will better understand how it ought to be given,
+from the following detail of my own improvement, than from precepts
+peremptorily delivered, and their source veiled in obscurity.
+
+At first I thought it necessary _to bring on and continue the
+sickness, in order to ensure the diuretic effects_.
+
+I soon learnt that the nausea being once excited, it was unnecessary
+to repeat the medicine, as it was certain to recur frequently, at
+intervals more or less distant.
+
+Therefore my patients were ordered _to persist until the nausea came
+on, and then to stop_. But it soon appeared that the diuretic effects
+would often take place first, and sometimes be checked when the
+sickness or a purging supervened.
+
+The direction was therefore enlarged thus--_Continue the medicine
+until the urine flows, or sickness or purging take place_.
+
+I found myself safe under this regulation for two or three years; but
+at length cases occurred in which the pulse would be retarded to an
+alarming degree, without any other preceding effect.
+
+The directions therefore required an additional attention to the state
+of the pulse, and it was moreover of consequence not to repeat the
+doses too quickly, but to allow sufficient time for the effects of
+each to take place, as it was found very possible to pour in an
+injurious quantity of the medicine, before any of the signals for
+forbearance appeared.
+
+_Let the medicine therefore be given in the doses, and at the
+intervals mentioned above:--let it be continued until it either acts
+on the kidneys, the stomach, the pulse, or the bowels; let it be
+stopped upon the first appearance of any one of these effects_, and I
+will maintain that the patient will not suffer from its exhibition,
+nor the practitioner be disappointed in any reasonable expectation.
+
+If it purges, it seldom succeeds well.
+
+The patients should be enjoined to drink very freely during its
+operation. I mean, they should drink whatever they prefer, and in as
+great quantity as their appetite for drink demands. This direction is
+the more necessary, as they are very generally prepossessed with an
+idea of drying up a dropsy, by abstinence from liquids, and fear to
+add to the disease, by indulging their inclination to drink.
+
+In cases of ascites and anasarca; when the patients are weak, and the
+evacuation of the water rapid; the use of proper bandage is
+indispensably necessary to their safety.
+
+If the water should not be wholly evacuated, it is best to allow an
+interval of several days before the medicine be repeated, that food
+and tonics maybe administered; but truth compels me to say, that the
+usual tonic medicines have in these cases very often deceived my
+expectations.
+
+From some cases which have occurred in the course of the present year,
+I am disposed to believe that the Digitalis may be given in small
+doses, viz. two or three grains a day, so as gradually to remove a
+dropsy, without any other than mild diuretic effects, and without any
+interruption to its use until the cure be compleated.
+
+If inadvertently the doses of the Foxglove should be prescribed too
+largely, exhibited too rapidly, or urged to too great a length; the
+knowledge of a remedy to counteract its effects would be a desirable
+thing. Such a remedy may perhaps in time be discovered. The usual
+cordials and volatiles are generally rejected from the stomach;
+aromatics and strong bitters are longer retained; brandy will
+sometimes remove the sickness when only slight; I have sometimes
+thought small doses of opium useful, but I am more confident of the
+advantage from blisters. Mr. Jones (_Page_ 135) in one case, found
+mint tea to be retained longer than other things.
+
+
+
+
+                       CONSTITUTION of PATIENTS.
+
+
+Independent of the degree of disease, or of the strength or age of the
+patient, I have had occasion to remark, that there are certain
+constitutions favourable, and others unfavourable to the success of
+the Digitalis.
+
+From large experience, and attentive observation, I am pretty well
+enabled to decide _a priori_ upon this matter, and I wish to enable
+others to do the same: but I feel myself hardly equal to the
+undertaking. The following hints, however, aiding a degree of
+experience in others, may lead them to accomplish what I yet can
+describe but imperfectly.
+
+It seldom succeeds in men of great natural strength, of tense fibre,
+of warm skin, of florid complexion, or in those with a tight and cordy
+pulse.
+
+If the belly in ascites be tense, hard, and circumscribed, or the
+limbs in anasarca solid and resisting, we have but little to hope.
+
+On the contrary, if the pulse be feeble or intermitting, the
+countenance pale, the lips livid, the skin cold, the swollen belly
+soft and fluctuating, or the anasarcous limbs readily pitting under
+the pressure of the finger, we may expect the diuretic effects to
+follow in a kindly manner.
+
+In cases which foil every attempt at relief, I have been aiming, for
+some time past, to make such a change in the constitution of the
+patient, as might give a chance of success to the Digitalis.
+
+By blood-letting, by neutral salts, by chrystals of tartar, squills,
+and occasional purging, I have succeeded, though imperfectly. Next to
+the use of the lancet, I think nothing lowers the tone of the system
+more effectually than the squill, and consequently it will always be
+proper, in such cases, to use the squill; for if that fail in its
+desired effect, it is one of the best preparatives to the adoption of
+the Digitalis.
+
+A tendency to paralytic affections, or a stroke of the palsy having
+actually taken place, is no objection to the use of the Digitalis;
+neither does a stone existing in the bladder forbid its use.
+Theoretical ideas of sedative effects in the former, and apprehensions
+of its excitement of the urinary organs in the latter case, might
+operate so as to make us with-hold relief from the patient; but
+experience tells me, that such apprehensions are groundless.
+
+
+
+
+                              INFERENCES.
+
+
+To prevent any improper influence, which the above recitals of the
+efficacy of the medicine, aided by the novelty of the subject, may
+have upon the minds of the younger part of my readers, in raising
+their expectations to too high a pitch, I beg leave to deduce a few
+inferences, which I apprehend the facts will fairly support.
+
+I. That the Digitalis will not universally act as a diuretic.
+
+II. That it does do so more generally than any other medicine.
+
+III. That it will often produce this effect after every other probable
+method has been fruitlessly tried.
+
+IV. That if this fails, there is but little chance of any other
+medicine succeeding.
+
+V. That in proper doses, and under the management now pointed out, it
+is mild in its operation, and gives less disturbance to the system,
+than squill, or almost any other active medicine.
+
+VI. That when dropsy is attended by palsy, unsound viscera, great
+debility, or other complication of disease, neither the Digitalis, nor
+any other diuretic can do more than obtain a truce to the urgency of
+the symptoms; unless by gaining time, it may afford opportunity for
+other medicines to combat and subdue the original disease.
+
+VII. That the Digitalis may be used with advantage in every species of
+dropsy, except the encysted.
+
+VIII. That it may be made subservient to the cure of diseases,
+unconnected with dropsy.
+
+IX. That it has a power over the motion of the heart, to a degree yet
+unobserved in any other medicine, and that this power may be converted
+to salutary ends.
+
+
+
+
+         PRACTICAL REMARKS ON DROPSY, AND SOME OTHER DISEASES.
+
+
+The following remarks consist partly of matter of fact, and partly of
+opinion. The former will be permanent; the latter must vary with the
+detection of error, or the improvement of knowledge. I hazard them
+with diffidence, and hope they will be examined with candour; not by a
+contrast with other opinions, but by an attentive comparison with the
+phoenomena of disease.
+
+
+                               ANASARCA.
+
+� 1. The anasarca is generally curable when seated in the
+sub-cutaneous cellular membrane, or in the substance of the lungs.
+
+� 2. When the abdominal viscera in general are greatly enlarged, which
+they sometimes are, without effused fluid in the cavity of the
+abdomen; the disease is incurable. After death, the more solid viscera
+are found very large and pale. If the cavity contains water, that
+water may be removed by diuretics.
+
+� 3. In swollen legs and thighs, where the resistance to pressure is
+considerable, the tendency to transparency in the skin not obvious,
+and where the alteration of posture occasions but little alteration in
+the state of distension, the cure cannot be effected by diuretics.
+
+Is this difficulty of cure occasioned by spissitude in the effused
+fluids, by want of proper communication from cell to cell, or is the
+disease rather caused by a morbid growth of the solids, than by an
+accumulation of fluid?
+
+Is not this disease in the limbs similar to that of the viscera (� 2)?
+
+� 4. Anasarcous swellings often take place in palsied limbs, in arms
+as well as legs; so that the swelling does not depend merely upon
+position.
+
+� 5. Is there not cause to suspect that many dropsies originate from
+paralytic affections of the lymphatic absorbents? And if so, is it not
+probable that the Digitalis, which is so effectual in removing dropsy,
+may also be used advantageously in some kinds of palsy?
+
+
+                               ASCITES.
+
+� 6. If existing alone, (_i. e._) without accompanying anasarca, is in
+children curable; in adults generally incurable by medicines. Tapping
+may be used here with better chance for success than in more
+complicated dropsies. Sometimes cured by vomiting.
+
+
+                         ASCITES and ANASARCA.
+
+� 7. Incurable if dependant upon irremediably diseased viscera, or on
+a gouty constitution, so debilitated, that the gouty paroxysms no
+longer continue to be formed.
+
+In every other situation the disease yields to diuretics and tonics.
+
+
+                  ASCITES, ANASARCA, and HYDROTHORAX.
+
+� 8. Under this complication, though the symptoms admit of relief, the
+restoration of the constitution can hardly be hoped for.
+
+
+                                ASTHMA.
+
+� 9. The true spasmodic asthma, a rare disease--is not relieved by
+Digitalis.
+
+� 10. In the greater part of what are called asthmatical cases, the
+real disease is anasarca of the lungs, and is generally to be cured by
+diuretics. (See � 1.) This is almost always combined with some
+swelling of the legs.
+
+� 11. There is another kind of asthma, in which change of posture does
+not much affect the patient. I believe it to be caused by an
+infarction of the lungs. It is incurable by diuretics; but it is often
+accompanied with a degree of anasarca, and so far it admits of relief.
+
+Is not this disease similar to that in the limbs at (�3,) and also to
+that of the abdominal viscera at (�2.)?
+
+
+                         ASTHMA and ANASARCA.
+
+� 12. If the asthma be of the kind mentioned at (�� 9 and 11,)
+diuretics can only remove the accompanying anasarca. But if the
+affection of the breath depends also upon cellular effusion, as it
+mostly does, the patient may be taught to expect a recovery.
+
+
+                          ASTHMA and ASCITES.
+
+� 13. A rare combination, but not incurable if the abdominal viscera
+are sound. The asthma is here most probably of the anasarcous kind (�
+10;) and this being seldom confined to the lungs only, the disease
+generally appears in the following form.
+
+
+                    ASTHMA, ASCITES, and ANASARCA.
+
+� 14. The curability of this combination will depend upon the
+circumstances mentioned in the preceding section, taking also into the
+account the strength or weakness of the patient.
+
+
+                               EPILEPSY.
+
+� 15. In epilepsy dependant upon effusion, the Digitalis will effect a
+cure; and in the cases alluded to, the dropsical symptoms were
+unequivocal. It has not had a sufficient trial in my hands, to
+determine what it can do in other kinds of epilepsy.
+
+
+                            HYDATID DROPSY.
+
+� 16. This may be distinguished from common ascites, by the want of
+evident fluctuation. It is common to both sexes. It does not admit of
+a cure either by tapping or by medicine.
+
+
+                            HYDROCEPHALUS.
+
+� 17. This disease, which has of late so much attracted the attention
+of the medical world, I believe, originates in inflammation; and that
+the water found in the ventricles of the brain after death, is the
+consequence, and not the cause of the illness.
+
+It has seldom happened to me to be called upon in the earlier stages
+of this complaint, and the symptoms are at first so similar to those
+usually attendant upon dentition and worms, that it is very difficult
+to pronounce decidedly upon the real nature of the disease; and it is
+rather from the failure of the usual modes of relief, than from any
+other more decided observation, that we at length dare to give it a
+name.
+
+At first, the febrile symptoms are sometimes so unsteady, that I have
+known them mistaken for the symptoms of an intermittent, and the cure
+attempted by the bark.
+
+In the more advanced stages, the diagnostics obtrude themselves upon
+our notice, and put the situation of the patient beyond a doubt. But
+this does not always happen. The variations of the pulse, so
+accurately described by the late Dr. Whytt, do not always ensue. The
+dilatation of the pupils, the squinting, and the aversion to light, do
+not universally exist. The screaming upon raising the head from the
+pillow or the lap, and the flushing of the cheeks, I once considered
+as affording indubitable marks of the disease; but in a child which I
+sometime since attended with Dr. Ash, the pulse was uniformly about
+85, (except during the first week, before we had the care of the
+patient.) The child never shewed any aversion to the light; never had
+dilated pupils, never squinted, never screamed when raised from the
+lap or taken out of the bed, nor did we observe any remarkable
+flushing of the cheeks; and the sleep was quiet, but sometimes
+moaning.
+
+Frequent vomiting existed from the first, but ceased for several days
+towards the conclusion. One or two worms came away during the illness,
+and it was all along difficult to purge the child. Three days before
+death, the right side became slightly paralytic, and the pupil of that
+eye somewhat dilated.
+
+After death, about two ounces and a half of water were found in the
+ventricles of the brain, and the vessels of the dura mater were turgid
+with blood.
+
+If I am right as to the nature of hydrocephalus, that it is at first
+dependant upon inflammation, or congestion; and that the water in the
+ventricles is a consequence, and not a cause of the disease; the
+curative intentions ought to be extremely different in the first and
+the last stages.
+
+It happens very rarely that I am called to patients at the beginning,
+but in two instances wherein I was called at first, the patients were
+cured by repeated topical bleedings, vomits, and purges.
+
+Some years ago I mentioned these opinions, and the success of the
+practice resulting from them, to Dr. Quin, now physician at Dublin.
+That gentleman had lately taken his degree, and had chosen
+hydrocephalus for the subject of his thesis in the year 1779. In this
+very ingenious essay, which he gave me the same morning, I was much
+pleased to find that the author had not only held the same ideas
+relative to the nature of the disease, but had also confirmed them by
+dissections.
+
+In the year 1781, another case in the first stage demanded my
+attention. The reader is referred back to Case LXIX for the
+particulars.
+
+I have not yet been able to determine whether the Digitalis can or
+cannot be used with advantage in the second stage of the
+hydrocephalus. In Case XXXIII. the symptoms of death were at hand; in
+Case LXIX. the practice, though successful, was too complicated, and
+in Case CLI. the medicine was certainly stopped too soon.
+
+When we consider what enormous quantities of mercury may be used in
+this complaint, without affecting the salivary glands, it seems
+probable that other parts may be equally insensible to the action of
+their peculiar stimuli, and therefore that the Digitalis ought to be
+given in much larger doses in this, than in other diseases.
+
+
+                             HYDROTHORAX.
+
+� 18. Under this name I also include the dropsy of the pericardium.
+
+The intermitting pulse, and pain in the arms, sufficiently distinguish
+this disease from asthma, and from anasarcous lungs.
+
+It is very universally cured by the Digitalis.
+
+� 19. I lately met with two cases which had been considered and
+treated as angina pectoris. They both appeared to me to be cases of
+hydrothorax. One subject was a clergyman, whose strength had been so
+compleatly exhausted by the continuance of the disease, and the
+attempts to relieve it, that he did not survive many days. The other
+was a lady, whose time of life made me suspect effusion. I directed
+her to take small doses of the pulv. Digitalis, which in eight days
+removed all her complaints. This happened six months ago, and she
+remains perfectly well.
+
+
+                       HYDROTHORAX and ANASARCA.
+
+� 20. This combination is very frequent, and, I believe, may always be
+cured by the Digitalis.
+
+� 21. Dropsies in the chest either with or without anasarcous limbs,
+are much more curable than those of the belly. Probably because the
+abdominal viscera are more frequently diseased in the latter than in
+the former cases.
+
+
+                               INSANITY.
+
+� 22. I apprehend this disease to be more frequently connected with
+serous effusion than has been commonly imagined.
+
+� 23. Where appearances of anasarca point out the true cause of the
+complaint, as in cases XXIV. and XXXIV. the happiest effects may be
+expected from the Digitalis; and men of more experience than myself in
+cases of insanity, will probably employ it successfully in other less
+obvious circumstances.
+
+
+                         NEPHRITIS CALCULOSA.
+
+� 24. We have had sufficient evidence of the efficacy of the Foxglove
+in removing the Dysuria and other symptoms of this disease; but
+probably it is not in these cases preferable to the tobacco.[12]
+
+    [Footnote 12: See an original and valuable treatise by Dr.
+    Fowler, entitled, _Medical Reports of the Effects of
+    Tobacco_.]
+
+
+                            OVARIUM DROPSY.
+
+� 25. This species of encysted dropsy is not without difficulty
+distinguishable from an ascites; and yet it is necessary to
+distinguish them, because the two diseases require different treatment
+and because the probality of a cure is much greater in one than in the
+other.
+
+� 26. The ovarium dropsy is generally slow in its progress; for a
+considerable time the patient though somewhat emaciated, does not lose
+the appearance of health, and the urine flows in the usual quantity.
+It is seldom that the practitioner is called in early enough to
+distinguish by the feel on which side the cyst originated, and the
+patients do not attend to that circumstance themselves. They generally
+menstruate regularly in the incipient state of the disease, and it is
+not until the pressure from the sac becomes very great, that the
+urinary secretion diminishes. In this species of dropsy, the patients,
+upon being questioned, acknowledge even from a pretty early date,
+pains in the upper and inner parts of the thighs, similar to those
+which women experience in a state of pregnancy. These pains are for a
+length of time greater in one thigh than in the other, and I believe
+it will be found that the disease originated on that side.
+
+� 27. The ovarium dropsy defies the power of medicine. It admits of
+relief, and sometimes of a cure, by tapping. I submit to the
+consideration of practitioners, how far we may hope to cure this
+disease by a seton or a caustic.--In the LXIst case the patient was
+too much reduced, and the disease too far advanced to allow of a cure
+by any method; but it teaches us that a caustic may be used with
+safety.
+
+� 28. When tapping becomes necessary, I always advise the adoption of
+the waistcoat bandage or belt, invented by the late very justly
+celebrated Dr. Monro, and described in the first volume of the Medical
+Essays. I also enjoin my patients to wear this bandage afterwards,
+from a persuasion that it retards the return of the disease. The
+proper use of bandage, when the disorder first discovers itself,
+certainly contributes much to prevent its increase.
+
+
+                     OVARIUM DROPSY with ANASARCA.
+
+� 29. The anasarca does not appear until the encysted dropsy is very
+far advanced. It is then probably caused by weakness and pressure. The
+Digitalis removes it for a time.
+
+
+                         PHTHISIS PULMONALIS.
+
+� 30. This is a very increasing malady in the present day. It is no
+longer limited to the middle part of life: children at five years of
+age die of it, and old people at sixty or seventy. It is not confined
+to the flat-chested, the fair-skinned, the blue eyed, the
+light-haired, or the scrophulous: it often attacks people with full
+chests, brown skins, dark hair and eyes, and those in whose family no
+scrophulous taint can be traced. It is certainly infectious. The very
+strict laws still existing in Italy to prevent the infection from
+consumptive patients, were probably not enacted originally without a
+sufficient cause. We seem to be approaching to that state which first
+made such restrictions necessary, and in the further course of time,
+the disease will probably fall off again, both in virulency and
+frequency.
+
+� 31. The younger part of the female sex are liable to a disease very
+much resembling a true consumption, and from which it is difficult to
+distinguish it; but this disease is curable by steel and bitters. A
+criterion of true phthisis has been sought for in the state of the
+teeth; but the exceptions to that rule are numerous. An unusual
+dilatation of the pupil of the eye, is the most certain
+characteristic.[13]
+
+    [Footnote 13: Many years ago I communicated to my friend, Dr.
+    Percival, an account of some trials of breathing fixed air in
+    consumptive cases. The results were published by him in the
+    second Vol. of his very useful Essays Medical and
+    Experimental, and have since been copied into other
+    publications. I take this opportunity of acknowledging that I
+    suspect myself to have been mistaken in the nature of the
+    disease there mentioned to have been cured. I believe it was
+    a case of _Vomica_, and not a true _Phthisis_ that was cured.
+    The Vomica is almost always curable. The fixed air corrects
+    the smell of the matter, and very shortly removes the hectic
+    fever. My patients not only inspire it, but I keep large jars
+    of the effervescing mixture constantly at work in their
+    chambers.]
+
+� 32. Sydenham asserts, that the bark did not more certainly cure an
+intermittent, than riding did a consumption. We must not deny the
+truth of an assertion, from such authority, but we must conclude that
+the disease was more easily curable a century ago than it is at
+present.
+
+� 33. If the Digitalis is no longer useful in consumptive cases, it
+must be that I know not how to manage it, or that the disease is more
+fatal than formerly; for it would be hard to deny the testimony cited
+at page 9. I wish others would undertake the enquiry.
+
+� 34. When phthisis is accompanied with anasarca, or when there is
+reason to suspect hydrothorax, the Digitalis will often relieve the
+sufferings, and prolong the life of the patient.
+
+� 35. Many years ago, during an attendance upon Mr. B----, of a
+consumptive family, and himself in the last stage of a phthisis; after
+he was so ill as to be confined to his chamber, his breathing became
+so extremely difficult and distressing, that he wished rather to die
+than to live, and urged me warmly to devise some mode to relieve him.
+Suspecting serous effusion to be the cause of this symptom, and he
+being a man of sense and resolution, I fully explained my ideas to
+him, and told him what kind of operation might afford him a chance of
+relief; for I was then but little acquainted with the Digitalis. He
+was earnest for the operation to be tried, and with the assistance of
+Mr. Parrott, a very respectable surgeon of this place, I got an
+opening made between the ribs upon the lower and hinder part of the
+thorax. About a pint of fluid was immediately discharged, and his
+breath became easy. This fluid coagulated by heat.
+
+After some days a copious purulent discharge issued from the opening,
+his cough became less troublesome, his expectoration less copious, his
+appetite and strength returned, he got abroad, and the wound, which
+became very troublesome, was allowed to heal.
+
+He then undertook a journey to London; whilst there he became worse:
+returned home, and died consumptive some weeks afterwards.
+
+
+                          PUERPERAL ANASARCA.
+
+� 36. This disease admits of an easy and certain cure by the
+Digitalis.
+
+� 37. This species of dropsy may originate from other causes than
+child birth. In the beginning of last _March_, a gentleman at
+Wolverhampton desired my advice for very large and painful swelled
+legs and thighs. He was a temperate man, not of a dropsical habit, had
+great pain in his groins, and attributed his complaints to a fall from
+his horse. He had taken diuretics, and the strongest drastic
+purgatives with very little benefit. Considering the anasarca as
+caused by the diseased inguinal glands, I ordered common poultice and
+mercurial ointment to the groins, three grains of pulv. fol. Digitalis
+night and morning, and a cooling diuretic decoction in the day-time.
+He soon lost his pain, and the swellings gradually subsided.
+
+
+                               THE END.
+
+
+
+
+                                BOOKS,
+
+                 Printed for G. G. J. and J. ROBINSON,
+                 Booksellers, Paternoster-Row, London.
+
+                           AN ACCOUNT OF THE
+                    Scarlet Fever and Sore Throat,
+                       Or, SCARLATINA ANGINOSA;
+
+               Particularly as it appeared at BIRMINGHAM
+                           in the Year 1778.
+
+                      By WILLIAM WITHERING, M. D.
+
+                             Price 1s. 6d.
+
+
+                          Also, Price 2s. 6d.
+
+                        Outlines of MINERALOGY,
+                    Translated from the original of
+                   Sir TORBERN BERGMAN; with NOTES,
+
+                      By WILLIAM WITHERING, M. D.
+
+           Member of the Royal Medical Society at Edinburgh.
+
+
+          In the Spring of the Year 1786, will be published,
+               by the same Author, a New Edition of the
+
+                        BOTANICAL ARRANGEMENT.
+
+        With very great Additions; in Three Vols. large Octavo.
+
+
+
+
+                          TRANSCRIBER'S NOTES
+
+Obvious printer's errors have been fixed. For the detailed list,
+please see below. The frontispiece has been moved from the beginning
+of the book to the section explaining it.
+
+
+                             Errors fixed
+
+page xvi--typo fixed: changed 'afterterwards' to 'afterwards'
+page 029--typo fixed: changed 'apetite' to 'appetite'
+page 043--typo fixed: removed an extra 'in' after 'and she died'
+page 062--typo fixed: changed 'Dovers' to 'Dover's'
+page 095--typo fixed: changed 'ef' to 'of' after 'whilst the rest'
+page 098--typo fixed: changed 'harrassed' to 'harassed'
+page 103--typo fixed: changed 'Shiffnal' to 'Shiffnall'
+page 106--typo fixed: changed 'Fox-glove' to 'Foxglove'
+page 110--typo fixed: changed 'suceed' to 'succeed'
+page 111--typo fixed: changed 'atttention' to 'attention'
+page 114--typo fixed: changed 'disgreeable' to 'disagreeable'
+page 115--typo fixed: removed an extra 'the' in front of '7th of April'
+page 123--typo fixed: changed 'susspended' to 'suspended'
+page 135--typo fixed: changed 'vomitted' to 'vomited'
+page 141--typo fixed: changed 'contiued' to 'continued'
+page 148--typo fixed: changed 'pr�cordia' to 'proecordia'
+page 158--typo fixed: changed 'spoonfulls' to 'spoonfuls'
+page 163--typo fixed: changed 'mecine' to 'medicine'
+page 164--typo fixed: changed 'slighest' to 'slightest'
+page 166--typo fixed: changed 'ipecacohana' to 'ipecacoanha'
+page 170--typo fixed: changed 'meridiaana' to 'meridiana'
+page 196--typo fixed: removed an extra 'the' in front of 'viscera'
+page 200--typo fixed: removed an extra 'and' after 'from asthma'
+
+
+
+
+
+End of the Project Gutenberg EBook of An Account of the Foxglove and some of
+its Medical Uses, by William Withering
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+
+The Project Gutenberg EBook of An Account of the Foxglove and some of its
+Medical Uses, by William Withering
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: An Account of the Foxglove and some of its Medical Uses
+       With Practical Remarks on Dropsy and Other Diseases
+
+Author: William Withering
+
+Release Date: March 21, 2008 [EBook #24886]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK AN ACCOUNT OF THE FOXGLOVE ***
+
+
+
+
+Produced by David Starner, Irma Spehar and the Online
+Distributed Proofreading Team at http://www.pgdp.net
+
+
+
+
+
+
+</pre>
+
+<h1><span style="font-size: 50%">AN</span><br />
+<span style="font-size: 90%">ACCOUNT</span><br />
+<span style="font-size: 50%">OF THE</span><br />
+FOXGLOVE,<br />
+
+<span style="font-size: 50%">AND</span><br />
+
+<span style="font-size: 70%; letter-spacing: 0ex">Some of its Medical Uses:</span><br />
+
+<span style="font-size: 50%">WITH</span><br />
+
+<span style="font-size: 70%; letter-spacing: 0ex; line-height: 100%">PRACTICAL REMARKS ON DROPSY,<br />
+AND OTHER DISEASES.</span></h1>
+
+<p class="center" style="padding-top: 2em; letter-spacing: 0.20ex; font-size: 110%">BY</p>
+
+<p class="center" style="letter-spacing: 0.20ex; font-size: 140%">WILLIAM WITHERING, M.&nbsp;D.<br />
+
+<span style="font-size: 60%; letter-spacing: 0ex">Physician to the General Hospital at Birmingham.</span></p>
+
+<p class="center" style="padding-top: 1em"><i>&mdash;&mdash; nonumque prematur in annum.</i></p>
+
+<p class="right" style="padding-right: 30%">
+<span class="smcap">Horace.</span></p>
+
+<p class="publisher">BIRMINGHAM: PRINTED BY M. SWINNEY;<br />
+
+<small>FOR</small><br />
+
+<span class="smcap">G.&nbsp;G.&nbsp;J. and J. Robinson, Paternoster-Row, London.</span></p>
+
+<hr class="title" />
+
+<p class="center" style="font-size: 80%">M,DCC,LXXXV.</p>
+
+
+
+<h2><a name="PREFACE" id="PREFACE"></a>PREFACE.<span class='pagenum'><a name="Page_v" id="Page_v">[v]</a></span></h2>
+
+<hr class="chapter" />
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">A</span>fter</span> 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.</p>
+
+<p>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.<span class='pagenum'><a name="Page_vi" id="Page_vi">[vi]</a></span></p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>To the Surgeons and Apothecaries, with
+whom I am connected in practice, both in
+this town and at a distance, I beg leave to<span class='pagenum'><a name="Page_vii" id="Page_vii">[vii]</a></span>
+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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>I must caution the reader, who is not a
+practitioner in physic, that no general deductions,
+decisive upon the failure or success<span class='pagenum'><a name="Page_viii" id="Page_viii">[viii]</a></span>
+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.</p>
+
+<p>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<span class='pagenum'><a name="Page_ix" id="Page_ix">[ix]</a></span>
+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.</p>
+
+<p>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.<span class='pagenum'><a name="Page_x" id="Page_x">[x]</a></span></p>
+
+<p>After all, in spite of opinion, prejudice,
+or error, <span class="smcap">Time</span> 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.</p>
+
+<p style="padding-top: 1em; padding-left: 1em">
+<i>Birmingham, 1st July,</i><br />
+<span style="margin-left: 4em; letter-spacing: 0.25ex">1785.</span></p>
+
+
+
+<h2><a name="INTRODUCTION" id="INTRODUCTION"></a>INTRODUCTION.<span class='pagenum'><a name="Page_xi" id="Page_xi">[xi]</a></span></h2>
+
+<hr class="chapter" />
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> 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<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a>
+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.</p>
+
+<p>Our plant is the <i>Digitalis purpurea</i><a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a> of Linn&aelig;us.
+It belongs to the 2d order of the 14th class, or the
+<span class="smcap">Didynamia Angiospermia</span>. The <i>essential characters</i>
+of the genus are, <i>Cup with 5 divisions. Blossom
+bell-shaped, bulging. Capsule egg-shaped, 2-celled.</i>&mdash;<span class="smcap">Linn.</span></p>
+
+<p><span style="letter-spacing: 0.25ex">DIGITA'LIS</span> <i>purpu'rea</i>. Little leaves of the
+empalement egg-shaped, sharp. Blossoms blunt;
+the upper lip entire. <span class="smcap">Linn.</span></p>
+
+<p><span class='pagenum'><a name="Page_xii" id="Page_xii">[xii]</a></span></p><p><span class="smcap">References to Figures.</span> These are disposed in
+the order of comparative excellence.</p>
+
+<ul class="reference">
+<li><i>Rivini monopet.</i> 104.</li>
+<li><i>Flora danica</i>, 74, <i>parts of fructification</i>.</li>
+<li><i>Tournefort Institutiones.</i> 73, <i>A, E, L, M</i>.</li>
+<li><i>Fuchsii Hist. Plant.</i> 893, <i>copied in</i></li>
+<li><i>Tragi stirp. histor.</i> 889.</li>
+<li><i>J. Bauhini histor. Vol. ii.</i> 812. 3, <i>and</i></li>
+<li><i>Lonicera</i> 74, 1.</li>
+<li><i>Blackwell. auct.</i> 16.</li>
+<li><i>Dodon&oelig;i pempt. stirp. hist.</i> 169, <i>reprinted in</i></li>
+<li><i>Gerard emacul.</i> 790, 1, <i>and copied in</i></li>
+<li><i>Parkinson Theatr. botanic.</i> 653, 1.</li>
+<li><i>Gerard, first edition</i>, 646, 1.</li>
+<li><i>Histor. Oxon. Morison. V.</i> 8, <i>row</i> 1. 1.</li>
+<li><i>Flor. danic.</i> 74, <i>the reduced figure</i>.</li>
+</ul>
+
+<p><i>Blossom.</i> The bellying part on the inside sprinkled
+with spots like little eyes. <i>Leaves</i> wrinkled. <span class="smcap">Linn.</span></p>
+
+<p class="negative"><span class="smcap">Blossom.</span> Rather tubular than bell-shaped, bulging
+on the under side, purple; the narrow tubular
+part at the base, white. <i>Upper lip</i> sometimes
+slightly cloven.</p>
+
+<p class="negative"><span class="smcap">Chives.</span> <i>Threads</i> crooked, white. <i>Tips</i> yellow.</p>
+
+<p class="negative"><span class="smcap">Pointal.</span> <i>Seed-bud</i> greenish. <i>Honey-cup</i> at its base
+more yellow. <i>Summit</i> cloven.</p>
+
+<p class="negative"><span class="smcap">S. Vess.</span> <i>Capsule</i> not quite so long as the cup.</p>
+
+<p class="negative"><span class="smcap">Root.</span> Knotty and fibrous.<span class='pagenum'><a name="Page_xiii" id="Page_xiii">[xiii]</a></span></p>
+
+<p><span class="smcap">Stem.</span> About 4 feet high; obscurely angular; leafy.</p>
+
+<p class="negative"><span class="smcap">Leaves.</span> Slightly but irregularly serrated, wrinkled;
+dark green above, paler underneath. <i>Lower
+leaves</i> egg-shaped; upper leaves spear-shaped.
+<i>Leaf-stalks</i> fleshy; bordered.</p>
+
+<p class="negative"><span class="smcap">Flowers.</span> Numerous, mostly growing from one side
+of the stem and hanging down one over another.
+<i>Floral-leaves</i> 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.</p>
+
+<p class="negative"><span class="smcap">Place.</span> Dry, gravelly or sandy soils; particularly on
+sloping ground. It is a biennial, and flowers
+from the middle of <i>June</i> to the end of <i>July</i>.</p>
+
+<p>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.</p>
+
+<p>This plant ranks amongst the LURID&AElig;, one of
+the Linn&aelig;an orders in a natural system. It has for
+congenera, <span class="smcap">Nicotiana</span>, <span class="smcap">Atropa</span>, <span class="smcap">Hyoscyamus</span>, <span class="smcap">Datura</span>,
+<span class="smcap">Solanum</span>, &amp;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.<span class='pagenum'><a name="Page_xiv" id="Page_xiv">[xiv]</a></span></p>
+
+<p>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</p>
+
+
+<h4><span class="smcap">Historical View</span> of the Properties of
+Digitalis.</h4>
+
+<p><span class="smcap">Fuchsius</span> in his <i>hist. stirp.</i> 1542, is the first author
+who notices it. From him it receives its name of
+<span class="smcap">Digitalis</span>, in allusion to the German name of <i>Fingerhut</i>,
+which signifies a finger-stall, from the blossoms
+resembling the finger of a glove.</p>
+
+<p><span class="smcap">Sensible Qualities.</span> Leaves bitterish, very nauseous.
+<span class="smcap">Lewis</span> <i>Mat. med.</i> i. 342.</p>
+
+<p><span class="smcap">Sensible Effects.</span> 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.
+<span class="smcap">Dodon&aelig;us</span> <i>pempt.</i> 170.</p>
+
+<p>It is a medicine which is proper only for strong
+constitutions, as it purges very violently, and excites
+excessive vomitings. <span class="smcap">Ray.</span> <i>hist.</i> 767.</p>
+
+<p><span class="smcap">Boerhaave</span> judges it to be of a poisonous nature,
+<i>hist. plant.</i> but <span class="smcap">Dr. Alston</span> ranks it among those indigenous
+vegetables, "which, though now disregarded,<span class='pagenum'><a name="Page_xv" id="Page_xv">[xv]</a></span>
+are medicines of great virtue, and scarcely
+inferior to any that the Indies afford." <span class="smcap">Lewis</span>
+<i>Mat. med.</i> i. <i>p.</i> 343.</p>
+
+<p>Six or seven spoonfuls of the decoction produce
+nausea and vomiting, and purge; not without
+some marks of a deleterious quality. <span class="smcap">Haller</span> <i>hist. n.</i>
+330 from <i>Aerial Infl. p.</i> 49, 50.</p>
+
+
+<h4>The following is an abridged <span class="smcap">Account</span> of
+its <span class="smcap">Effects</span> upon <span class="smcap">Turkeys</span>.</h4>
+
+<p><span class="smcap">M. Salerne</span>, 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.</p>
+
+<p>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<span class='pagenum'><a name="Page_xvi" id="Page_xvi">[xvi]</a></span>
+green and well formed, became, from the first,
+liquid and reddish, like those of a dysenteric patient.</p>
+
+<p>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.</p>
+
+<p>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. <i>Hist. de l'Academ.</i> 1748. <i>p.</i> 84.</p>
+
+<p style="margin-bottom: 0em"><span class="smcap">Epilepsy.</span>&mdash;"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 <i>Decoct. manipulor. ii. c. polypod.
+quercin. contus. &#8485;iv. in cerevisia</i>, 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."</p>
+
+<p class="signature"><i>Parkinson</i>, <i>p.</i> 654.<span class='pagenum'><a name="Page_xvii" id="Page_xvii">[xvii]</a></span></p>
+
+<p><span class="smcap">Scrophula.</span>&mdash;"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." <span class="smcap">Park.</span> p. 654.</p>
+
+<p>Several hereditary instances of this disease said
+to have been cured by it. <span class="smcap">Aereal Influences</span>, <i>p.</i>
+49, 50, quoted by <span class="smcap">Haller</span>, <i>hist. n.</i> 330.</p>
+
+<p>A man with <i>scrophulous ulcers</i> in various parts of
+the body, and which in the right leg were so virulent
+that its amputation was proposed, cured by
+<i>succ. express. cochl. i. bis intra xiv. dies, in &frac12; pint&aelig;
+cerevisi&aelig; calid&aelig;</i>.</p>
+
+<p>The leaves remaining after the pressing out of the
+juice, were applied every day to the ulcers. <i>Pract.
+ess. p.</i> 40. quoted by <span class="smcap">Murray</span> <i>apparat. medicam. i.&nbsp;p.</i>
+491.</p>
+
+<p>A young woman with a <i>scrophulous tumour of the
+eye</i>, a remarkable <i>swelling of the upper lip, and painful
+tumours of the joints of the fingers</i>, much relieved;
+but the medicine was left off, on account of its violent
+effects on the constitution. <i>Ib. p.</i> 42 quoted as
+above.</p>
+
+<p>A man with <i>scrophulous tumour of the right elbow</i>,
+attended for three years <i>with excruciating pains</i>, was
+nearly cured by four doses of the juice taken once
+a month. <i>Ib. p.</i> 43. as above.</p>
+
+<p>The physicians and surgeons of the Worcester Infirmary
+have employed it in ointments and poultices
+with remarkable efficacy. <i>Ib. p.</i> 44. It was recommended<span class='pagenum'><a name="Page_xviii" id="Page_xviii">[xviii]</a></span>
+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.</p>
+
+<p><span class="smcap">Wounds.</span> In considerable estimation for the
+healing all kinds of wounds, <i>Lobel. adv.</i> 245.</p>
+
+<p>Principally of use in ulcers, which discharge considerably,
+being of little advantage in such as are
+dry. <span class="smcap">Hulse</span>, in R. hist. 768.</p>
+
+<p><span class="smcap">Doctor Baylies</span>, physician to his Prussian Majesty,
+informed me, when at Berlin, that he employed it
+with great success in caries, and obstinate sore legs.</p>
+
+<p><span class="smcap">Dyspn&oelig;a</span> <i>Pituitosa</i> Sauvages i. 657.&mdash;"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." <span class="smcap">Gerarde</span> hist.
+ed. I p. 647.</p>
+
+<p style="margin-bottom: 0em">"Whensoever there is need of a rarefying or
+extenuating of tough flegme or viscous humours
+troubling the chest,&mdash;the decoction or juice hereof
+made up with sugar or honey is availeable, as
+also to clense and purge the body both upwards<span class='pagenum'><a name="Page_xix" id="Page_xix">[xix]</a></span>
+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."</p>
+
+<p class="signature"><span class="smcap">Parkinson</span>, p. 654.</p>
+
+<p>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.<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a></p>
+
+<p>In a letter which I received from you in London,
+dated <i>September</i> 29, 1778, you write as follows:&mdash;"I
+wish it was as easy to write upon the Digitalis&mdash;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."&mdash;</p>
+<p><span class='pagenum'><a name="Page_xx" id="Page_xx">[xx]</a></span></p>
+<p>In my notes I find the following memorandum&mdash;"<i>February</i>
+20th, 1779, gave an account of Doctor
+Withering's practice, with the precautions necessary
+to its success, to the Medical Society at
+Edinburgh."&mdash;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.</p>
+
+<p>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 <i>quadruple</i> 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
+<i>quadruple</i> 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.&mdash;It is needless to observe to you, how
+widely the treatment of this case differed from the
+method which you have found so successful.<span class='pagenum'><a name="Page_xxi" id="Page_xxi">[xxi]</a></span></p>
+
+
+
+<h2><a name="OF_THE_PLATE" id="OF_THE_PLATE"></a>OF THE PLATE.</h2>
+
+<hr class="chapter" />
+
+<p class="figcenter"><a href="images/frontispiece.jpg"><img src="images/frontispiece_th.jpg"
+alt="" title="" /></a></p>
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> 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 <span class="smcap">Flora Londinensis</span>. 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.</p>
+
+<hr />
+
+<h4>EXPLANATION.</h4>
+
+<div class="blockquot">
+<p class="negative">Fig. 1. The Empalement.</p>
+
+<p class="negative">Fig. 2, 3, 4. Four <span class="smcap">Chives</span> two long and two short.
+<span class="smcap">Tips</span> 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.</p>
+
+<p class="negative">Fig. 5, 6, 7. <span class="smcap">Seed-bud</span> rather conical, of a yellow
+green colour. <i>Shaft</i> simple. <i>Summit</i> cloven.</p>
+
+<p class="negative">Fig. 8. <i>Honey-cup</i> a gland, surrounding the bottom
+of the Seed-bud.</p>
+
+<p class="negative">Fig. 9. <span class="smcap">Seed-vessel</span>, a pointed oval <i>Capsule</i>, of two
+cells and two valves, the lowermost valve splitting
+in two.</p>
+
+<p class="negative">Fig. 10. <span class="smcap">Seeds</span> numerous, blackish, small, lopped
+at each end.</p></div>
+
+
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> Verbascum of Linn&aelig;us.</p></div>
+
+<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> The trivial name <i>purpurea</i> is not a very happy one, for the
+blossoms though generally purple, are sometimes of a pure white.</p></div>
+
+<div class="footnote"><p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> See the extract from this letter at <a href="#Page_5">page 5</a>.</p></div>
+</div>
+
+
+<h2 style="line-height: 150%"><a name="AN" id="AN"></a><span style="font-size: 70%">AN</span><span class='pagenum'><a name="Page_1" id="Page_1">[1]</a></span><br />
+ACCOUNT<br />
+<span style="font-size: 70%">OF THE</span><br />
+INTRODUCTION of FOXGLOVE<br />
+<span style="font-size: 70%">INTO</span><br />
+<small>MODERN PRACTICE.</small></h2>
+
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">A</span>s</span> 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.</p>
+
+<p>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<span class='pagenum'><a name="Page_2" id="Page_2">[2]</a></span>
+within the reach of every one who is open to information,
+regardless of the source from whence it
+springs.</p>
+
+<p>It was a circumstance of this kind which first fixed
+my attention on the Foxglove.</p>
+
+<p>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.</p>
+
+<p>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<span class='pagenum'><a name="Page_3" id="Page_3">[3]</a></span>
+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."</p>
+
+<p>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 <i>root</i> of a <i>biennial</i> plant, and therefore continued
+to use the <i>leaves</i>. These I had found to vary
+much as to dose, at different seasons of the year;<span class='pagenum'><a name="Page_4" id="Page_4">[4]</a></span>
+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 <i>decoction</i>, 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 <i>infusion</i> substituted in its place. After this I began
+to use the leaves in <i>powder</i>, but I still very often
+prescribe the infusion.</p>
+
+<p>Further experience convinced me, that the <i>diuretic</i>
+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.</p>
+
+<p>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<span class='pagenum'><a name="Page_5" id="Page_5">[5]</a></span>
+small doses of opium, so as to restrain its action on
+the bowels.</p>
+
+<p>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.</p>
+
+<p>In the month of <i>November</i> 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.&mdash;"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<span class='pagenum'><a name="Page_6" id="Page_6">[6]</a></span>
+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."&mdash;</p>
+
+<p>"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."</p>
+
+<p>"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."<span class='pagenum'><a name="Page_7" id="Page_7">[7]</a></span></p>
+
+<p>"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."&mdash;</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>In <i>February</i> 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 <i>November</i> 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.<span class='pagenum'><a name="Page_8" id="Page_8">[8]</a></span>
+Stokes also tells me that Dr. Hamilton cured Dropsies
+with it in the year 1781.</p>
+
+<p>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.</p>
+
+<p>At length, in the year 1783, it appeared in the
+new edition of the Edinburgh Pharmacop&oelig;ia, 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.</p>
+
+<p>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,<span class='pagenum'><a name="Page_9" id="Page_9">[9]</a></span>
+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.</p>
+
+<p>"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."</p>
+
+<p>The precautions annexed to his encomiums of this
+medicine, lead one to think that he has spoken from
+his own proper experience.</p>
+
+<p>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<span class='pagenum'><a name="Page_10" id="Page_10">[10]</a></span>
+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.</p>
+
+<p>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.<span class='pagenum'><a name="Page_11" id="Page_11">[11]</a></span></p>
+
+
+
+<h2><a name="CASES" id="CASES"></a>CASES,<br style="line-height: 2em" />
+
+<span style="letter-spacing: 0ex; font-size: 90%">In which the Digitalis was given by the</span><br />
+<span style="letter-spacing: 0ex; font-size: 90%">Direction of the Author.</span></h2>
+
+
+<h3>1775.</h3>
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">I</span>t</span> 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.</p>
+
+
+<h3>CASE I.</h3>
+
+<p><i>December</i> 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<span class='pagenum'><a name="Page_12" id="Page_12">[12]</a></span>
+about ten days he began to eat with a keen appetite.
+He afterwards took steel and bitters.</p>
+
+
+<h3>1776.<br />
+
+CASE <span style="letter-spacing: 0ex">II.</span></h3>
+
+<p><i>January</i> 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3>
+
+<p><i>March</i> 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">IV.</span></h3>
+
+<p><i>July</i> 25th. Mrs. H&mdash;&mdash;, of A&mdash;&mdash;, near
+N&mdash;&mdash;, 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,<span class='pagenum'><a name="Page_13" id="Page_13">[13]</a></span>
+copious expectoration. On the 4th of <i>June</i>, Dr.
+Darwin,<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a> was called to her. I have not heard what
+was then done for her, but, between the 15th of <i>June</i>,
+and 25th of <i>July</i>, the Doctor, at his different visits,
+gave her various medicines of the deobstruent, tonic,
+antispasmodic, diuretic, and evacuant kinds.</p>
+
+<p>On the 25th of <i>July</i> 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.</p>
+
+<p>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
+<span class='pagenum'><a name="Page_14" id="Page_14">[14]</a></span>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:</p>
+
+<div class="recipe">
+<p>R. Fol. Digital. purp. recent. &#8485;iv. coque ex</p>
+
+<p style="padding-left: 1em">Aq. fontan. pur&aelig; &#8468;iss ad &#8468;i. et cola.</p>
+
+<p>R. Decoct. Digital. &#8485;iss.</p>
+
+<p style="padding-left: 1em">Aq. Nuc. Moschat. &#658;ii. M. fiat. haust. 2dis
+horis sumend.</p>
+</div>
+
+<p>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.</p>
+
+<p>26th. Our patient being thus snatched from impending
+destruction, Dr. Darwin proposed to give
+her a decoction of pareira brava and guiacum shavings,<span class='pagenum'><a name="Page_15" id="Page_15">[15]</a></span>
+with pills of myrrh and white vitriol; and,
+if costive, a pill with calomel and aloes. To these
+propositions I gave a ready assent.</p>
+
+<p>30th. This day Dr. Darwin saw her, and directed
+a continuation of the medicines last prescribed.</p>
+
+<p><i>August</i> 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.</p>
+
+<p>9th. We visited our patient together, and repeated
+the draughts directed on the 26th of <i>June</i>,
+with the addition of tincture of bark, and also ordered
+pills of aloes, guiacum, and sal martis to be taken
+if costive.</p>
+
+<p><i>September</i> 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.</p>
+
+<p>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.<span class='pagenum'><a name="Page_16" id="Page_16">[16]</a></span></p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">V.</span></h3>
+
+<p><i>December</i> 10th. Mr. L&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_17" id="Page_17">[17]</a></span></p>
+
+<p>In <i>October</i> 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.</p>
+
+<p>In <i>January</i> 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.</p>
+
+
+<h3>1777.<br />
+
+<a name="CASEvi" id="CASEvi"></a>CASE <span style="letter-spacing: 0ex">VI.</span></h3>
+
+<p><i>February</i>&mdash;. Mrs. M&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_18" id="Page_18">[18]</a></span>
+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?</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">VII.</span></h3>
+
+<p><i>February</i> 11th. Mr. E&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>Perhaps this patient might have been saved, if I
+had been well acquainted with the management and<span class='pagenum'><a name="Page_19" id="Page_19">[19]</a></span>
+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.</p>
+
+
+<h3><a name="CASEviii" id="CASEviii"></a>CASE <span style="letter-spacing: 0ex">VIII.</span></h3>
+
+<p><i>March</i> 11th. Mrs. H&mdash;&mdash;, &AElig;t. 32. A few
+days after a tedious labour, had her legs and thighs
+swelled to a very great degree; pale and semi-transparent,<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a>
+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:</p>
+
+<div class="recipe">
+<p>R. Fol. Digital. purp. recent. &#8485;ii.</p>
+
+<p style="padding-left: 1em">Aq. pur&aelig;. &#8468;i. coque ad &#8468;iss et colatur. adde.</p>
+
+<p style="padding-left: 1em">Aq. cinn. sp. &#8485;iv. M. capiat. cyath. vinos. parv. bis quotidie.</p>
+</div>
+
+<p>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 <i>April</i>.</p>
+<p><span class='pagenum'><a name="Page_20" id="Page_20">[20]</a></span></p>
+
+<h3>CASE <span style="letter-spacing: 0ex">IX.</span></h3>
+
+<p><i>March</i> 29th. Mr. G&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">X.</span></h3>
+
+<p><i>April</i> 10th. G&mdash;G&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XI.</span></h3>
+
+<p><i>July</i> 10th. Mr. M&mdash;&mdash; of T&mdash;&mdash;, &AElig;t. 54. A
+very hard drinker; had been affected since <i>November</i>
+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.<span class='pagenum'><a name="Page_21" id="Page_21">[21]</a></span></p>
+
+<p>In something more than a year and a half, his
+dropsy returned, but the Digitalis did not then
+succeed to our wishes. In <i>August</i>, 1779, he was
+tapped, and lived afterwards only about five weeks.</p>
+
+<p>For more particulars, see the extract of a letter
+from Mr. Lyon.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XII.</span></h3>
+
+<p><i>September</i> 12th. Miss C&mdash;&mdash; of T&mdash;&mdash;, &AElig;t 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, &amp;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 <i>August</i>. 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.<span class='pagenum'><a name="Page_22" id="Page_22">[22]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XIII.</span></h3>
+
+<p><i>October</i> 9th. Mrs. B&mdash;&mdash;, &AElig;t. 40. An ovarium
+dropsy. Took a decoction of Digitalis without
+effect. Her life was preserved for some years by repeated
+tapping.</p>
+
+
+<h3>1778.<br />
+
+CASE <span style="letter-spacing: 0ex">XIV.</span></h3>
+
+<p><i>February</i> 8th. Mr. R&mdash;&mdash; of K&mdash;&mdash;. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XV.</span></h3>
+
+<p><i>March</i> 13th. Mr. M&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>17th. Gum-ammoniac and squill, with elixir
+paregor. at night.&mdash;26th, Squill and decoction of
+seneka.&mdash;30th, His complaints still increasing, decoction<span class='pagenum'><a name="Page_23" id="Page_23">[23]</a></span>
+of Digitalis was then directed, which relieved
+him in a few days; but his complaints returned
+again, and he died in the month of <i>June</i>.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XVI.</span></h3>
+
+<p><i>August</i> 18th. Mr. B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XVII.</span></h3>
+
+<p><i>September</i> 21st. Mrs. M&mdash;&mdash; W&mdash;&mdash; G&mdash;&mdash;,
+&AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XVIII.</span></h3>
+
+<p><i>October</i> 28th. R&mdash;&mdash; W&mdash;&mdash;, &AElig;t. 33. Ascites
+and universal anasarca; countenance quite pale
+and bloated; appetite none, and the little food he
+forces down is generally rejected.</p>
+
+<div class="recipe">
+<p>R. Fol. Digit. purp. siccat. &#658;iii.</p>
+
+<p style="padding-left: 1em">Aq. bull. &#8468;i. digere per horas duas, et colat.
+adde aq. junip. comp. &#8485;iii.</p>
+</div>
+
+<p>He was directed to take one ounce of this infusion<span class='pagenum'><a name="Page_24" id="Page_24">[24]</a></span>
+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.</p>
+
+<p>These were his reports:</p>
+
+<table summary="report">
+<tr><td><i>October</i></td><td class="rightalign">31st.</td><td>Saturday,</td><td>5 half pints.</td></tr>
+<tr><td><i>November</i></td><td class="rightalign">1st.</td><td>Sunday,</td><td>6</td></tr>
+<tr><td>&nbsp;</td><td class="rightalign">2d.</td><td>Monday,</td><td>8</td></tr>
+<tr><td>&nbsp;</td><td class="rightalign">3d.</td><td>Tuesday,</td><td>8</td></tr>
+<tr><td>&nbsp;</td><td class="rightalign">4th.</td><td>Wednesday,</td><td>7</td></tr>
+<tr><td>&nbsp;</td><td class="rightalign">5th.</td><td>Thursday,</td><td>8</td></tr>
+</table>
+
+<p>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.</p>
+
+<p>Omit all medicines at present.</p>
+
+<table summary="report">
+<tr><td style="padding-left: 3.5em">&nbsp;</td><td class="rightalign">7th.</td><td>Saturday,</td><td>7&frac12; half pints.</td></tr>
+<tr><td style="padding-left: 3.5em">&nbsp;</td><td class="rightalign">8th.</td><td>Sunday,</td><td>8</td></tr>
+<tr><td style="padding-left: 3.5em">&nbsp;</td><td class="rightalign">9th.</td><td>Monday,</td><td>6&frac34;</td></tr>
+<tr><td style="padding-left: 3.5em">&nbsp;</td><td class="rightalign">10th.</td><td>Tuesday,</td><td>6&frac12;</td></tr>
+<tr><td style="padding-left: 3.5em">&nbsp;</td><td class="rightalign">11th.</td><td>Wednesday,</td><td>6</td></tr>
+<tr><td style="padding-left: 3.5em">&nbsp;</td><td class="rightalign">12th.</td><td>Thursday,</td><td>6&frac14;</td></tr>
+</table>
+
+<p>On Tuesday the 17th, some swelling still remained<span class='pagenum'><a name="Page_25" id="Page_25">[25]</a></span>
+about his ancles, but he was in every other respect
+perfectly well.</p>
+
+<p>He took a few more doses of the infusion, and no
+other medicine.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XIX.</span></h3>
+
+<p><i>December</i> 8th. W&mdash;&mdash; B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>1779.</h3>
+
+<p>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.&mdash;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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XX.</span></h3>
+
+<p><i>January</i> 1st. Mr. H&mdash;&mdash;. 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.<span class='pagenum'><a name="Page_26" id="Page_26">[26]</a></span></p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXI.</span></h3>
+
+<p><i>January</i> 5th. Mrs. M&mdash;&mdash;, &AElig;t. 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 <i>June</i> and <i>October</i> following,
+which was each time removed by the same medicine.<span class='pagenum'><a name="Page_27" id="Page_27">[27]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXII.</span></h3>
+
+<p><i>January</i> 11th. Mr. H&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>This case, as well as <a href="#CASEvi">case VI.</a> 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.</p>
+
+
+<h3><a name="CASExxiii" id="CASExxiii"></a>CASE <span style="letter-spacing: 0ex">XXIII.</span></h3>
+
+<p><i>August</i> 31st. Mr. C&mdash;&mdash;, &AElig;t. 57. Diseased
+viscera, jaundice, ascites and anasarca. After trying<span class='pagenum'><a name="Page_28" id="Page_28">[28]</a></span>
+calomel, saline draughts, jallap purges, chrystals
+of tartar, pills of gum ammoniac, squills, and
+soap, sal succini, eleterium, &amp;c. infusion of Digitalis
+was directed, which removed all his urgent
+symptoms, and he recovered a pretty good state of
+health.</p>
+
+
+<h3><a name="CASExxiv" id="CASExxiv"></a>CASE <span style="letter-spacing: 0ex">XXIV.</span></h3>
+
+<p><i>September</i> 11th. I was desired to visit Mr. L&mdash;&mdash;,
+&AElig;t. 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<span class='pagenum'><a name="Page_29" id="Page_29">[29]</a></span>
+days in bed, he feels not the least difficulty in
+breathing.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXV.</span></h3>
+
+<p><i>September</i> 15th. Mr. J. R&mdash;&mdash;, &AElig;t. 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 <i>July</i> he
+took G. ammon. squill and seneka, with infus.
+amarum and fossil alkaly. In <i>August</i>, infusum amar.<span class='pagenum'><a name="Page_30" id="Page_30">[30]</a></span>
+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. <i>September</i> 15th, an infusion of Digitalis
+was directed, but he died the next morning.</p>
+
+
+<h3><a name="CASExxvi" id="CASExxvi"></a>CASE <span style="letter-spacing: 0ex">XXVI.</span></h3>
+
+<p><i>September</i> 18th. Mrs. R&mdash;&mdash;, &AElig;t. 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 <a href="#CASEviii">No. VIII.</a> 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.</p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXVII.</span></h3>
+
+<p><i>October</i> 7th. Mr. F&mdash;&mdash;, 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,<span class='pagenum'><a name="Page_31" id="Page_31">[31]</a></span>
+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 <i>November</i>.
+It was necessary to draw off the water again
+upon the following days:</p>
+
+<table summary="report">
+<tr><td rowspan="5">1780.</td><td><i>December</i> the</td><td class="rightalign">8th.</td></tr>
+<tr><td>&mdash;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&mdash;</td><td class="rightalign">27th.</td></tr>
+<tr><td><i>February</i> the</td><td class="rightalign">4th.</td></tr>
+<tr><td>&mdash;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&mdash;</td><td class="rightalign">23d.</td></tr>
+<tr><td><i>March</i> the</td><td class="rightalign">9th.</td></tr>
+</table>
+
+<p>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
+<i>February</i> 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<span class='pagenum'><a name="Page_32" id="Page_32">[32]</a></span>
+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.</p>
+
+<p>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.<span class='pagenum'><a name="Page_33" id="Page_33">[33]</a></span></p>
+
+
+<h3>1780.<br />
+
+CASE <span style="letter-spacing: 0ex">XXVIII.</span></h3>
+
+<p><i>January</i> 11th. Captain V&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_34" id="Page_34">[34]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXIX.</span></h3>
+
+<p><i>February</i> 6th. Mr. H&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXX.</span></h3>
+
+<p><i>February</i> 17th. Mr. D&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3><a name="CASExxxi" id="CASExxxi"></a>CASE <span style="letter-spacing: 0ex">XXXI.</span></h3>
+
+<p><i>March</i> 5th. I was desired to visit Mrs. H&mdash;&mdash;,
+a very delicate woman, who after a severe lying-in,
+had her legs and thighs swollen to a very great degree;<span class='pagenum'><a name="Page_35" id="Page_35">[35]</a></span>
+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 <a href="#CASExxvi">Case XXVI.</a>) 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.<span class='pagenum'><a name="Page_36" id="Page_36">[36]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXXII.</span></h3>
+
+<p><i>March</i> 16th. Mr. D&mdash;&mdash;, &AElig;t. 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 <i>August</i> 1782, and
+without any return of the dropsy.</p>
+
+
+<h3><a name="CASExxxiii" id="CASExxxiii"></a>CASE <span style="letter-spacing: 0ex">XXXIII.</span></h3>
+
+<p><i>March</i> 18th. Miss S&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_37" id="Page_37">[37]</a></span></p>
+
+
+<h3><a name="CASExxxiv" id="CASExxxiv"></a>CASE <span style="letter-spacing: 0ex">XXXIV.</span></h3>
+
+<p><i>March</i> 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXXV.</span></h3>
+
+<p><i>April</i> 12th. Mr. R&mdash;&mdash;, &AElig;t. 32. For the last
+three or four years had had more or less of what
+was considered as asthma;&mdash;it appeared to me Hydrothorax.
+I directed an infusion of Digitalis,
+which presently removed his complaints. In <i>June</i>
+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.<span class='pagenum'><a name="Page_38" id="Page_38">[38]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXXVI.</span></h3>
+
+<p><i>May</i> 15th. Mrs. H&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXXVII.</span></h3>
+
+<p><i>May</i> 26th. R&mdash;&mdash; B&mdash;&mdash;, &AElig;t. 12. Scrophulous,
+consumptive, and at length anasarcous. Took
+Infus. Digital. without advantage. Died the <i>July</i>
+following.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXXVIII.</span></h3>
+
+<p><i>June</i> 4th. Mrs. S&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t 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 <i>May</i>; 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.<span class='pagenum'><a name="Page_39" id="Page_39">[39]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXXIX.</span></h3>
+
+<p><i>June</i> 13th. Mr. P&mdash;&mdash;, &AElig;t. 35. A very
+hard drinker, was attacked with a severe h&aelig;moptoe,
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XL.</span></h3>
+
+<p><i>June</i> 27th. Mr. W&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>In the course of the following winter he became
+hectic, and died consumptive about a year afterwards.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XLI.</span></h3>
+
+<p><i>July</i> 6th. Mr. E&mdash;&mdash;, &AElig;t. 57. Hydrothorax
+and anasarca; his breath so short that he could not<span class='pagenum'><a name="Page_40" id="Page_40">[40]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XLII.</span></h3>
+
+<p><i>July</i> 7th. Miss H&mdash;&mdash; of T&mdash;&mdash;, &AElig;t. 39. In
+the last stage of a phthisis pulmonalis became dropsical.
+She took the Digitalis without being relieved.</p>
+
+
+<h3><a name="CASExliii" id="CASExliii"></a>CASE <span style="letter-spacing: 0ex">XLIII.</span></h3>
+
+<p><i>July</i> 9th. Mrs. F&mdash;&mdash;, &AElig;t. 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 &aelig;ther,<span class='pagenum'><a name="Page_41" id="Page_41">[41]</a></span>
+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.</p>
+
+<div class="timeline">
+<p style="padding-left: 2em">1780.</p>
+
+<p><i>July</i> 18th. Infusum amarum, steel, Seltzer water.</p>
+
+<p><i>September</i> 22d. Neutral saline draughts, with tinct.
+canthar.</p>
+
+<p>26th. Pills of soap, garlic and millepedes.</p>
+
+<p>30th. The same pills, with infusum amarum.</p>
+
+<p><i>October</i> 11th. Pills of aloes, assafetida, and sal martis,
+in the day-time, and mercury rubbed down,
+at night.</p>
+
+<p><i>December</i> 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,<span class='pagenum'><a name="Page_42" id="Page_42">[42]</a></span>
+until its effects began to appear. The water was
+soon carried off.</p>
+
+<p>30th. Sal diuretic. twice a day. To eat preserved
+garlic frequently.</p>
+
+<p style="padding-left: 2em; padding-top: 1em">1781.</p>
+
+<p><i>February</i> 1st. Pills of calomel, squill and gum ammoniac.</p>
+
+<p>3d. Infusion of Digitalis repeated, and after the
+water was carried off, Dover's powder was tried
+as a sudorific.</p>
+
+<p><i>March</i> 18th. Infus. Digital. repeated.</p>
+
+<p>26th. Pills of sal martis and aromatic species, with
+infusum amarum.</p>
+
+<p><i>May</i> 5th. Being feverish; James's powder and
+saline draughts.</p>
+
+<p>10th. Laudanum every night, and an opening
+tincture to obviate costiveness.</p>
+
+<p>24th. Infus. Digitalis, one ounce only every fourth
+hour, which soon procured a perfect evacuation
+of the water.</p>
+
+<p><i>August</i> 11th. Infus. Digitalis.</p>
+
+<p><i>October</i> 19th. An emetic, and fol. Cicut. pulv.
+ten grains every six hours.</p>
+
+<p><i>November</i> 8th. A mercurial bolus at bed-time.</p>
+
+<p>16th. Infus. Digitalis.</p>
+
+<p><i>December</i> 23d. An emetic&mdash;Pills of seneka and gum
+ammoniac&mdash;Vitriolic acid in every thing she
+drinks.</p>
+
+<p>25th. Squill united to small doses of opium.</p>
+
+<p style="padding-left: 2em; padding-top: 1em">1782.</p>
+
+<p><i>January</i> 2d. A troublesome cough&mdash;Syrup of garlic
+and oxymel of squills. A blister to the back.<span class='pagenum'><a name="Page_43" id="Page_43">[43]</a></span></p>
+
+<p>4th. Tincture of cantharides and paregoric elixir.</p>
+
+<p>28th. Infus. Digitalis, half an ounce every morning,
+and one ounce every night, was now sufficient
+to empty her.</p>
+
+<p><i>March</i> 26th. Infus. Digitalis; and when emptied,
+vitriol of copper twice a day.</p>
+
+<p><i>April</i> 1st. A cordial mixture for occasional use.</p>
+
+<p>Two months afterwards a purging came on, which
+every now and then returned, inducing great
+weakness&mdash;her appetite failed, and she died
+in <i>July</i>.</p></div>
+
+
+<h3>INTERVALS.</h3>
+
+<ul>
+<li>From <i>July</i> 9th, 1780, to <i>December</i> 21st, 171 days.</li>
+<li>From <i>December</i> 21st to <i>February</i> 3d, 1781, 34 days.</li>
+<li>From <i>February</i> 3d to <i>March</i> 18th, 44 days.</li>
+<li>From <i>March</i> 18th to <i>May</i> 24th, 66 days.</li>
+<li>From <i>May</i> 24th to <i>August</i> 11th, 79 days.</li>
+<li>From <i>August</i> 11th to <i>November</i> 16th, 98 days.</li>
+<li>From <i>November</i> 16th to <i>January</i> 28th, 1782, 74 days.</li>
+<li>From <i>January</i> 28th to <i>March</i> 26th, 57 days.</li>
+</ul>
+
+<p>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 <i>March</i> the
+degree of effusion was inconsiderable, and at the
+time of her death very trifling, being probably carried
+off by the diarrh&oelig;a.<span class='pagenum'><a name="Page_44" id="Page_44">[44]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XLIV.</span></h3>
+
+<p><i>July</i> 12th. Mr. H&mdash;&mdash;, of A&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XLV.</span></h3>
+
+<p><i>July</i> 13th. Mr. S&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XLVI.</span></h3>
+
+<p><i>August</i> 6th. Mr. L&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3><a name="CASExlvii" id="CASExlvii"></a>CASE <span style="letter-spacing: 0ex">XLVII.</span></h3>
+
+<p><i>August</i> 16th. Mr. G&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_45" id="Page_45">[45]</a></span>
+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, &amp;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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XLVIII.</span></h3>
+
+<p><i>August</i> 17th. T&mdash;&mdash; B&mdash;&mdash;, Esq. of K&mdash;&mdash;,
+&AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XLIX.</span></h3>
+
+<p><i>August</i> 23d. Mr. C&mdash;&mdash;, &AElig;t. 58. (The person
+mentioned at <a href="#CASExxiii">Case XXIII.</a>) 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">L.</span></h3>
+
+<p><i>August</i> 24th. Mrs. W&mdash;&mdash;, &AElig;t. 39. Anasarcous
+legs and symptoms of hydrothorax, consequent<span class='pagenum'><a name="Page_46" id="Page_46">[46]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LI.</span></h3>
+
+<p><i>August</i> 28th. Mr. J&mdash;&mdash; H&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LII.</span></h3>
+
+<p><i>September</i> 27th. Mr. S&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_47" id="Page_47">[47]</a></span>
+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.</p>
+
+<p>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&mdash;&mdash;, 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;&mdash;this
+accidental information explained the mystery.</p>
+
+<p>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&mdash;&mdash;, of S&mdash;&mdash; 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<span class='pagenum'><a name="Page_48" id="Page_48">[48]</a></span>
+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&mdash;&mdash;, the children, or the servants. Mrs. H&mdash;&mdash;
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LIII.</span></h3>
+
+<p><i>September</i> 28th. Mrs. J&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_49" id="Page_49">[49]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LIV.</span></h3>
+
+<p><i>September</i> 30th. Mr. A&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LV.</span></h3>
+
+<p><i>November</i> 2d. Mr. P&mdash;&mdash; of T&mdash;&mdash;, &AElig;t. 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 dyspn&oelig;a
+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 <i>September</i>
+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,
+&amp;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.<span class='pagenum'><a name="Page_50" id="Page_50">[50]</a></span>
+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:</p>
+
+<div class="recipe">
+<p>R. Fol. Nicotian. incis. &#658;ii.</p>
+<p style="padding-left: 1em">Aq. bull. &#8468;ss.</p>
+
+<p style="padding-left: 1em">Sp. Vini rectif. &#8485;i digere per horam.</p>
+</div>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LVI.</span></h3>
+
+<p><i>November</i> 6th. Mr. H&mdash;&mdash;, &AElig;t. 47. In the
+last stage of a phthisis pulmonalis, suffered much
+from dyspn&oelig;a, 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.<span class='pagenum'><a name="Page_51" id="Page_51">[51]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LVII.</span></h3>
+
+<p><i>November</i> 16th. Mrs. F&mdash;&mdash;, &AElig;t. 53. In
+<i>August</i> 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.</p>
+
+<p>The attacks of epilepsy ceased soon afterwards.
+In <i>February</i>, 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?</p>
+
+
+<h3>1781.<br />
+
+CASE <span style="letter-spacing: 0ex">LVIII.</span></h3>
+
+<p><i>January</i> 1st. Mrs. G&mdash;&mdash;, of H&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_52" id="Page_52">[52]</a></span>
+Digital. every six hours, but it produced no effect.
+Other Medicines were then tried to as little purpose.
+About the end of <i>February</i>, 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LIX.</span></h3>
+
+<p><i>January</i> 3d. Mrs. B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LX.</span></h3>
+
+<p><i>January</i> 14th. Mr. B&mdash;&mdash;, of D&mdash;&mdash;. 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.</p>
+
+
+<h3><a name="CASElxi" id="CASElxi"></a>CASE <span style="letter-spacing: 0ex">LXI.</span></h3>
+
+<p><i>February</i> 2d. I was desired by the late learned
+and ingenious Dr. Groome, to visit Miss S&mdash;&mdash;, a<span class='pagenum'><a name="Page_53" id="Page_53">[53]</a></span>
+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.</p>
+
+<p><i>Query.</i> 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?</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXII.</span></h3>
+
+<p><i>February</i> 27th. Mrs. O&mdash;&mdash;, of T&mdash;&mdash;, &AElig;t. 52,
+with a constitution worn out by various complicated<span class='pagenum'><a name="Page_54" id="Page_54">[54]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXIII.</span></h3>
+
+<p><i>March</i> 16th. Mrs. P&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXIV.</span></h3>
+
+<p><i>March</i> 18th. Mr. W&mdash;&mdash;, in the last stage
+of a pulmonary consumption became dropsical. The
+Digitalis was given, but without any good effect.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXV.</span></h3>
+
+<p><i>April</i> 6th. Mr. B&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_55" id="Page_55">[55]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXVI.</span></h3>
+
+<p><i>April</i> 8th. Mr. B&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_56" id="Page_56">[56]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXVII.</span></h3>
+
+<p><i>April</i> 24th. Mr. M&mdash;&mdash;, of C&mdash;&mdash;, &AElig;t. 57.
+Asthma, anasarca, jaundice, and great hardness and
+straitness across the region of the stomach. After a
+free exhibition of neutral draughts, alkaline salt,
+&amp;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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXVIII.</span></h3>
+
+<p><i>April</i> 25th. Mrs. J&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3><a name="CASElxix" id="CASElxix"></a>CASE <span style="letter-spacing: 0ex">LXIX.</span></h3>
+
+<p><i>May</i> 1st. Master W&mdash;&mdash;, of St&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_57" id="Page_57">[57]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXX.</span></h3>
+
+<p><i>May</i> 3d. Mrs. B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXI.</span></h3>
+
+<p><i>May</i> 3d. Mr. S&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_58" id="Page_58">[58]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXII.</span></h3>
+
+<p><i>May</i> 24th. Joseph B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXIII.</span></h3>
+
+<p><i>June</i> 29th. Mr. B&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>The following winter his breathing grew bad again,
+his appetite totally failed, and he died, but without
+any return of the ascites.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXIV.</span></h3>
+
+<p><i>June</i> 29th. Mr. A&mdash;&mdash;, &AElig;t. 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:<span class='pagenum'><a name="Page_59" id="Page_59">[59]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXV.</span></h3>
+
+<p><i>July</i> 18th. Mrs. B&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>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.<span class='pagenum'><a name="Page_60" id="Page_60">[60]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXVI.</span></h3>
+
+<p><i>August</i> 12th. Mr. L&mdash;&mdash;, &AElig;t. 65, the person
+whose Case is recorded at <a href="#CASExxiv">No. XXIV</a>, 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXVII.</span></h3>
+
+<p><i>September</i> 10th. Mr. V&mdash;&mdash;, of S&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXVIII.</span></h3>
+
+<p><i>September</i> 25th. Mr. O&mdash;&mdash;, of M&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_61" id="Page_61">[61]</a></span>
+easy to say what the disease was, and the patient
+living at a distance, I never learnt the future progress
+or termination of it.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXIX.</span></h3>
+
+<p><i>September</i> 26th. Mr. D&mdash;&mdash;, &AElig;t. 42, a very
+sensible and judicious surgeon at B&mdash;&mdash;, 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXX.</span></h3>
+
+<p><i>September</i> 27th. Mrs. E&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_62" id="Page_62">[62]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXXI.</span></h3>
+
+<p><i>October</i> 28th. Mr. B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXXII.</span></h3>
+
+<p><i>November</i> 14th. Mr. W&mdash;&mdash;, of T&mdash;&mdash;, &AElig;t. 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, &amp;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.<span class='pagenum'><a name="Page_63" id="Page_63">[63]</a></span></p>
+
+
+<h3>1782.<br />
+
+CASE <span style="letter-spacing: 0ex">LXXXIII.</span></h3>
+
+<p><i>January</i> 23d. Mr. Q&mdash;&mdash;, &AElig;t. 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, &amp;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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXXIV.</span></h3>
+
+<p><i>January</i> 27th. Mr. D&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXXV.</span></h3>
+
+<p><i>January</i> 28th. Mr. D&mdash;&mdash;, &AElig;t. 35. A publican
+and a hard drinker. Ascites, anasarca, diseased<span class='pagenum'><a name="Page_64" id="Page_64">[64]</a></span>
+viscera, and slight attacks of h&aelig;moptoe. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXXVI.</span></h3>
+
+<p><i>January</i> 29th. Mrs. O&mdash;&mdash;, of D&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXXVII.</span></h3>
+
+<p><i>January</i> 31st. Mr. T&mdash;&mdash;, of A&mdash;&mdash;, &AElig;t. 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,<span class='pagenum'><a name="Page_65" id="Page_65">[65]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXXVIII.</span></h3>
+
+<p><i>January</i> 31st. Mrs. J&mdash;&mdash;, of S&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">LXXXIX.</span></h3>
+
+<p><i>February</i> 2d. Mr. B&mdash;&mdash;, &AElig;t. 73. An universal
+dropsy. He took various medicines, and Digitalis
+in small doses, but without any good effect.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XC.</span></h3>
+
+<p><i>February</i> 24th. Master M&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t.
+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<span class='pagenum'><a name="Page_66" id="Page_66">[66]</a></span>
+half pint infusion, which made no alteration in his
+complaint.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCI.</span></h3>
+
+<p><i>March</i> 6th. Mr. H&mdash;&mdash;, &AElig;t. 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
+sod&aelig; 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCII.</span></h3>
+
+<p><i>May</i> 10th. Mrs. P&mdash;&mdash;, &AElig;t. 40. Spasmodic asthma
+of many years continuance, which had frequently
+been relieved by ammoniacum, squills, &amp;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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCIII.</span></h3>
+
+<p><i>May</i> 22d. Mr. O&mdash;&mdash;, of B&mdash;&mdash;, &AElig;t. 61. A
+very large man, and a free liver; after an attack of<span class='pagenum'><a name="Page_67" id="Page_67">[67]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCIV.</span></h3>
+
+<p><i>July</i> 5th. Mr. C&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCV.</span></h3>
+
+<p><i>March</i> 6th. Mrs. W&mdash;&mdash;, &AElig;t. 36. In the last
+stage of a pulmonary consumption, took the Infus.
+Digitalis, but without any advantage.<span class='pagenum'><a name="Page_68" id="Page_68">[68]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCVI.</span></h3>
+
+<p><i>August</i> 20th. Mr. P&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCVII.</span></h3>
+
+<p><i>September</i> 24th. Mrs. R&mdash;&mdash;, of B&mdash;&mdash;, &AElig;t. 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 <a href="#CASEviii">No. VIII</a>,
+<a href="#CASExxvi">XXVI</a>, and <a href="#CASExxxi">XXXI</a>. 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.</p>
+
+<p>The leg soon began to mend, and two pints of the
+infusion finished the cure.<span class='pagenum'><a name="Page_69" id="Page_69">[69]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCVIII.</span></h3>
+
+<p><i>September</i> 25th. Mr. R&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>It should be observed, that I had frequently seen
+the Digitalis remove sickness, though prescribed for
+very different complaints.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XCIX.</span></h3>
+
+<p><i>September</i> 30th. Mrs. A&mdash;&mdash;, &AElig;t. 38. Hydrothorax
+and anasarca. Her chest was very considerably
+deformed. One half pint of the Digitalis Infusion
+entirely cured her.<span class='pagenum'><a name="Page_70" id="Page_70">[70]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">C.</span></h3>
+
+<p><i>September</i> 30th. Mr. R&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>This plan succeeded perfectly. About a month
+afterwards he had some rheumatic affections, which
+were removed by guiacum.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CI.</span></h3>
+
+<p><i>October</i> 2d. Mrs. R&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3><a name="CASEcii" id="CASEcii"></a>CASE <span style="letter-spacing: 0ex">CII.</span></h3>
+
+<p><i>October</i> 12th. Mr. R&mdash;&mdash;, &AElig;t. 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,
+&amp;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<span class='pagenum'><a name="Page_71" id="Page_71">[71]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CIII.</span></h3>
+
+<p><i>October</i> 12th. Mr. B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CIV.</span></h3>
+
+<p><i>October</i> 22d. Master B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CV.</span></h3>
+
+<p><i>October</i> 30th. Mr. G&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 88.
+The gentleman mentioned in <a href="#CASExlvii">No. XLVII</a>. His
+complaints and manner of living the same as there<span class='pagenum'><a name="Page_72" id="Page_72">[72]</a></span>
+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.</p>
+
+<p>On <i>March</i> 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 <i>April</i>, I ordered the
+infusion prescribed two years before, which soon removed
+his complaints.</p>
+
+<p>He died soon afterwards, fairly worn out, in his
+ninetieth year.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CVI.</span></h3>
+
+<p><i>November</i> 2d. Mr. S&mdash;&mdash;, of B&mdash;&mdash;h&mdash;&mdash;,
+&AElig;t. 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.<span class='pagenum'><a name="Page_73" id="Page_73">[73]</a></span></p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CVII.</span></h3>
+
+<p><i>November</i> 19th. Master S&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>1783.</h3>
+
+<p>The reader will perhaps remark, that from the
+middle of <i>January</i> to the first of <i>May</i>, 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.<span class='pagenum'><a name="Page_74" id="Page_74">[74]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CVIII.</span></h3>
+
+<p><i>January</i> 15th. Mrs. G&mdash;&mdash;, &AElig;t. 57. A very
+fat woman; has been dropsical since <i>November</i> 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CIX.</span></h3>
+
+<p><i>May</i> 1st. Mrs. D&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_75" id="Page_75">[75]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CX.</span></h3>
+
+<p><i>May</i> 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXI.</span></h3>
+
+<p><i>May</i> 25th. Mr. G&mdash;&mdash;, &AElig;t. 28. In the last
+stage of a pulmonary consumption of the scrophulous
+kind, took an Infusion of Digitalis, but without
+any advantage.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXII.</span></h3>
+
+<p><i>May</i> 31st. Mr. H&mdash;&mdash;, &AElig;t 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXIII.</span></h3>
+
+<p><i>June</i> 3d. Master B&mdash;&mdash;, of D&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_76" id="Page_76">[76]</a></span>
+flesh wasted, his strength failed, and some weeks afterwards
+he died tabid.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXIV.</span></h3>
+
+<p><i>June</i> 19th. Mrs. L&mdash;&mdash;, &AElig;t. 28. A dropsy in
+the last stage of a phthisis. Infusum Digitalis was
+tried to no purpose.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXV.</span></h3>
+
+<p><i>June</i> 20th. Mrs. H&mdash;&mdash;, &AElig;t. 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, &amp;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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXVI.</span></h3>
+
+<p><i>June</i> 24th. Mrs. B&mdash;&mdash;, &AElig;t. 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 diarrh&oelig;a coming on, she died.<span class='pagenum'><a name="Page_77" id="Page_77">[77]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXVII.</span></h3>
+
+<p><i>July</i> 22d. Mr. F&mdash;&mdash;, &AElig;t. 48. A strong man,
+of a florid complexion, in consequence of intemperance
+became dropsical, with symptoms of diseased
+viscera, great dyspn&oelig;a, 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 sod&aelig;; 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<span class='pagenum'><a name="Page_78" id="Page_78">[78]</a></span>
+altogether, or suspended upon its first effects upon
+the pulse being observed, he might perhaps have
+existed a week longer.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXVIII.</span></h3>
+
+<p><i>July</i> 26th. Mr. W&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXIX.</span></h3>
+
+<p><i>August</i> 15th. Mrs. C&mdash;&mdash;, &AElig;t. 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 diarrh&oelig;a ensued upon every attempt to
+increase the frequency of the dose. Draughts with
+Infus. Digital. were then directed to be taken twice<span class='pagenum'><a name="Page_79" id="Page_79">[79]</a></span>
+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 diarrh&oelig;a 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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXX.</span></h3>
+
+<p><i>August</i> 22d. Mrs. S&mdash;&mdash;, &AElig;t. 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 diarrh&oelig;a. Apprehensive that the<span class='pagenum'><a name="Page_80" id="Page_80">[80]</a></span>
+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.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXI.</span></h3>
+
+<p><i>August</i> 25th. T&mdash;&mdash; W&mdash;&mdash;, Esq; &AElig;t, 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<span class='pagenum'><a name="Page_81" id="Page_81">[81]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXII.</span></h3>
+
+<p><i>September</i> 7th. Mr. L&mdash;&mdash;, &AElig;t. 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, &amp;c. rendered his recovery impossible.</p>
+
+
+<h3>1784.<br />
+
+CASE <span style="letter-spacing: 0ex">CXXIII.</span></h3>
+
+<p><i>February</i> 12th. Mrs. C&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_82" id="Page_82">[82]</a></span>
+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. &amp;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 orthopn&oelig;a 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXIV.</span></h3>
+
+<p><i>March</i> 31st. Miss W&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_83" id="Page_83">[83]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXV.</span></h3>
+
+<p><i>April</i> 12th. Mrs. H&mdash;&mdash;, of L&mdash;&mdash;, &AElig;t. 61.
+In <i>December</i> 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.<span class='pagenum'><a name="Page_84" id="Page_84">[84]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXVI.</span></h3>
+
+<p><i>April</i> 17th. Mr. F&mdash;&mdash;, &AElig;t. 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, &amp;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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXVII.</span></h3>
+
+<p><i>May</i> 7th. Miss K&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_85" id="Page_85">[85]</a></span>
+was healthful and should not be stopped.&mdash;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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXVIII.</span></h3>
+
+<p><i>June</i> 13th. Mr. C&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXIX.</span></h3>
+
+<p><i>June</i> 17th. Mr. N&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_86" id="Page_86">[86]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXX.</span></h3>
+
+<p><i>Mary</i> B&mdash;&mdash;. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXI.</span></h3>
+
+<p><i>July</i> 12th. Mrs. A&mdash;&mdash;, of C&mdash;&mdash;, &AElig;t. 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 &aelig;ther twice a day, and to have scapulary
+issues. Her breath was so much relieved,<span class='pagenum'><a name="Page_87" id="Page_87">[87]</a></span>
+that she was able soon afterwards to come down
+stairs; but her constitution was too much broken to
+admit of a recovery.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXII.</span></h3>
+
+<p><i>July</i> 16th. Mr. B&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_88" id="Page_88">[88]</a></span>
+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. <i>July</i> 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. <i>August</i> 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXIII.</span></h3>
+
+<p><i>July</i> 28th. Mr. A&mdash;&mdash; of W&mdash;&mdash;, &AElig;t. 29, became
+dropsical towards the close of a pulmonary
+consumption. He was ordered 12 grains of pulv.
+fol. cicut&aelig; and 1 of Digitalis twice a day. No remarkable
+effect took place.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXIV.</span></h3>
+
+<p><i>July</i> 31. Mr. M&mdash;&mdash;, &AElig;t 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.<span class='pagenum'><a name="Page_89" id="Page_89">[89]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXV.</span></h3>
+
+<p><i>August</i> 6th. Mr. C&mdash;&mdash; of B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXVI.</span></h3>
+
+<p><i>August</i> 6th. Mr. M&mdash;&mdash; of C&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>Before the Digitalis was prescribed, he had taken
+jallap purges, soluble tartar, salt of steel, vitriol of
+copper, <span class='pagenum'><a name="Page_90" id="Page_90">[90]</a></span>&amp;c.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXVII.</span></h3>
+
+<p><i>August</i> 10th. Mrs. W&mdash;&mdash;, &AElig;t. 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. cicut&aelig; 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.</p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXVIII.</span></h3>
+
+<p><i>August</i> 16th. Mrs. A&mdash;&mdash; of S&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_91" id="Page_91">[91]</a></span>
+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. <i>Sept.</i> 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXXXIX.</span></h3>
+
+<p><i>Aug.</i> 16th. Mrs. P&mdash;&mdash; of S&mdash;&mdash;, &AElig;t. 50. For
+a particular account of this patient, <a href="#CASEyii">see Mr. Yonge's
+second Case</a>.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXL.</span></h3>
+
+<p><i>Sept.</i> 20th. B&mdash;&mdash; B&mdash;&mdash;, 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<span class='pagenum'><a name="Page_92" id="Page_92">[92]</a></span>
+give him an infusion of the Digitalis. It was continued
+until nausea came on, but procured no relief.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXLI.</span></h3>
+
+<p><i>October</i> 5th. Mr. R&mdash;&mdash;, &AElig;t. 43. <i>(The patient
+mentioned at <a href="#CASEcii">No. 102</a>.)</i> 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, &amp;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:&mdash;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.<span class='pagenum'><a name="Page_93" id="Page_93">[93]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXLII.</span></h3>
+
+<p><i>October</i> 19th. Mrs. R&mdash;&mdash;, of B&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>In <i>April</i> 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXLIII.</span></h3>
+
+<p><i>October</i> 28th. Mr. A&mdash;&mdash;, 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<span class='pagenum'><a name="Page_94" id="Page_94">[94]</a></span>
+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.</p>
+
+<p>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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXLIV.</span></h3>
+
+<p><i>October</i> 31st. Mrs. C&mdash;&mdash;, of W&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_95" id="Page_95">[95]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXLV.</span></h3>
+
+<p><i>Nov.</i> 2d. Miss B&mdash;&mdash; of C&mdash;&mdash;, &AElig;t. 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.</p>
+
+<p>The further progress of the disease confirmed my
+first opinion, and she died consumptive.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXLVI.</span></h3>
+
+<p><i>Nov.</i> 4th. Mr. P&mdash;&mdash; of M&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_96" id="Page_96">[96]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXLVII.</span></h3>
+
+<p><i>Nov.</i> 4th. Mr. B&mdash;&mdash; of N&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CXLVIII.</span></h3>
+
+<p><i>Nov.</i> 8th. Mr. G&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3><a name="CASEcxlix" id="CASEcxlix"></a>CASE <span style="letter-spacing: 0ex">CXLIX.</span></h3>
+
+<p><i>Nov.</i> 13th. Mrs. A&mdash;&mdash; of W&mdash;&mdash;h&mdash;&mdash;, &AElig;t.
+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<span class='pagenum'><a name="Page_97" id="Page_97">[97]</a></span>
+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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CL.</span></h3>
+
+<p><i>Nov.</i> 20th. Mrs. B&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3><a name="CASEcli" id="CASEcli"></a>CASE <span style="letter-spacing: 0ex">CLI.</span></h3>
+
+<p><i>Nov.</i> 23d. Master W&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLII.</span></h3>
+
+<p><i>Nov.</i> 26th. Mrs. W&mdash;&mdash;, &AElig;t. 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<span class='pagenum'><a name="Page_98" id="Page_98">[98]</a></span>
+her much harassed by a cough, which occasioned her
+to expectorate a little: the least motion increased her
+dyspn&oelig;a; 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.</p>
+
+<p>It is not improbable that the squill might have
+some share in this cure.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLIII.</span></h3>
+
+<p><i>December</i> 7th. Mr. H&mdash;&mdash;, &AElig;t. 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.<span class='pagenum'><a name="Page_99" id="Page_99">[99]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLIV.</span></h3>
+
+<p><i>December</i> 27th. Mr. B&mdash;&mdash;, of H&mdash;&mdash;, &AElig;t. 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 <i>March</i> 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 <a href="#CASEyi">see case the first,
+communicated by Mr. Yonge</a>.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLV.</span></h3>
+
+<p><i>December</i> 31st. Mrs. B&mdash;&mdash;, of E&mdash;&mdash;, &AElig;t. 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.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLVI.</span></h3>
+
+<p>A poor man in this town, after his kidneys had
+ceased to secrete urine for several days, was seized
+with hickup, fits of vomiting, and transient delirium.
+After examination I was satisfied the disease was
+the same as that mentioned at <a href="#CASEcxlix">CXLIX</a>. A very experienced
+apothecary having tried various methods to
+relieve him, I despaired of any success, but determined
+to try the Digitalis. It was accordingly given<span class='pagenum'><a name="Page_100" id="Page_100">[100]</a></span>
+in infusion. At first it checked the vomitings, but
+did not occasion any secretion of urine.</p>
+
+
+<h3>1785.</h3>
+
+<p>The cases which have occurred to me in the course
+of this year, are numerous; but as the events of
+some of them are not yet sufficiently ascertained, I
+think it better to with-hold them at present.<span class='pagenum'><a name="Page_101" id="Page_101">[101]</a></span></p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Then resident at Lichfield, now at Derby.</p></div>
+
+<div class="footnote"><p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> This disease has lately been well described by Mr. White,
+of Manchester.</p></div>
+</div>
+
+
+<h2><a name="HOSPITAL_CASES" id="HOSPITAL_CASES"></a>HOSPITAL CASES,<br style="line-height: 2em" />
+
+<span style="letter-spacing: 0ex; font-size: 90%">Under the Direction of the Author.</span></h2>
+
+<hr class="chapter" />
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> four following cases were drawn out at my
+request by Mr. Cha. Hinchley, late apothecary
+to the Birmingham Hospital. They are all the
+Hospital cases for which the Digitalis was prescribed
+by me, whilst he continued in that office.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLVII.</span></h3>
+
+<p><i>March</i> 15th, 1780. John Butler, &AElig;t. 30.
+Asthma and swelled legs. He was directed to take
+myrrh and steel every day, and three spoonfuls of
+infusum Digitalis every night. On the 8th of April
+he was discharged, cured of the swellings and something
+relieved of his asthmatic affections.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLVIII.</span></h3>
+
+<p><i>November</i> 18th, 1780. Henry Warren, &AElig;t. 60.
+This man had a general anasarca and ascites, and
+was moreover so asthmatic, that, neither being able
+to sit in a chair nor lie in bed, he was obliged constantly
+to walk about, or to lean forward against a
+window or table. You prescribed for him thus.<span class='pagenum'><a name="Page_102" id="Page_102">[102]</a></span></p>
+
+<div class="recipe">
+<p>R. Aq. cinn. spt. &#8485;iv.</p>
+
+<p style="padding-left: 1em">Oxymel. scillit.</p>
+
+<p style="padding-left: 1em">Syr. scillit. aa. &#8485;i. m. cap. cochlear. larg. sexta quaque hor&acirc;.</p>
+</div>
+
+<p>This medicine producing no increased discharge
+of urine, on the 25th you ordered the infusion of
+Digitalis, two spoonfuls every four hours. After
+taking this for thirty six hours, his urine was discharged
+in very great quantity; his breath became
+easy, and the swellings disappeared in a few days,
+though he took no more of the medicine. On the
+2d of <i>December</i> he was ordered myrrh and lac ammoniacum,
+which he continued until the 23d, when
+he was discharged cured, and is now in good health.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLIX.</span></h3>
+
+<p><i>November</i> 3d, 1781. Mary Crockett, &AElig;t. 40.
+Ascites and universal anasarca. For one week she
+took sal. diureticus and tincture of cantharides, but
+without advantage. On the 10th you directed the
+infusion of Digitalis, a dram and half to half a pint,
+an ounce to be taken every fourth hour. Before
+this quantity was quite finished, the urine began to
+be discharged very copiously. The medicine was
+then stopped as you had directed. On the 15th,
+being costive, she took a jallap purge, and on the
+24th she was discharged cured.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLX.</span></h3>
+
+<p><i>March</i> 16th, 1782. Mary Bird, &AElig;t. 61. Great
+fullness about the stomach; diseased liver, and anasarcous<span class='pagenum'><a name="Page_103" id="Page_103">[103]</a></span>
+legs and thighs. For the first week squill
+was tried in more forms than one, but without advantage.
+On the 22d she began with the Digitalis,
+which presently removed all the swelling.</p>
+
+<p>She was then put upon the use of aperient medicines
+and tonics, and on the first of <i>August</i> was discharged
+perfectly cured.</p>
+
+<hr style="margin-bottom: 1em" />
+
+<p>The three following Cases were drawn up and communicated
+to me by Mr. Bayley, who succeeded
+Mr. Hinchley as apothecary to the Hospital at
+Birmingham:</p>
+
+<div class="blockquot">
+
+<p class="right">
+Shiffnall, April 26th, 1785.</p>
+
+<p><span class="smcap">Dear Sir</span>,</p>
+
+<p>During my residence in the
+Birmingham General Hospital, I had frequent opportunities
+of seeing the great effects of the Digitalis
+in dropsy. As the exhibition of it was in the following
+instances immediately under your own direction,
+I have drawn them up for your inspection,
+previous to your publishing upon that excellent
+diuretic. Of its efficacy in dropsy I have considerable
+evidence in my possession, but consider myself
+not at liberty to send you any other cases except
+those you had yourself the conduct of. The
+Digitalis is a very valuable acquisition to medicine;
+and, I trust, it will cease to be dreaded when it is
+well understood.</p>
+
+<p class="right">
+<span style="padding-right: 2em">I am, Sir, your obedient,</span><br />
+<span style="padding-right: 1em">And very humble servant,</span><br />
+<span style="letter-spacing: 0.25ex">W. BAYLEY</span>.</p>
+</div>
+
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLXI.</span><span class='pagenum'><a name="Page_104" id="Page_104">[104]</a></span></h3>
+
+<p>Mary Hollis, aged 62, was admitted an out patient
+of the Birmingham General Hospital <i>February</i>
+12th, 1784, labouring under all the effects of hydrothorax;
+her dread of suffocation during sleep
+was so great, that she always reposed in an elbow
+chair. She was directed to take two grains of Digitalis
+in powder every night and morning, and for
+a few days found great relief; but, on the eighth
+day, as she had complained of sickness, and had
+been considerably purged, she was ordered to desist
+taking any more of her powders. On the 14th day
+she was ordered an ounce of the following infusion
+twice in a day: R. Fol. Digital. purp. sicc. &#658;iss. aq.
+bullient. &#8468;ss. digere per semi-horam, colatur&aelig; adde
+tinct. aromatic &#8485;i. This infusion did not purge,
+but sometimes excited nausea, though not sufficient
+to prevent her from continuing its use. She grew
+gradually better, and on the 6th of <i>May</i> was discharged
+perfectly cured. The diuretic effects of the
+Digitalis were in this instance immediate.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLXII.</span></h3>
+
+<p>Edward James, &AElig;t. 21. Admitted <i>March</i> 20th,
+1784. Complained of great difficulty of breathing,
+pain in his head, and tightness about the stomach,
+with a trifling swelling of his legs. Ordered
+pil. scillit. &#8456;i. ter de die. On the third day his legs
+much more swelled, his breathing more difficult,
+and in every respect worse; his pulse very small<span class='pagenum'><a name="Page_105" id="Page_105">[105]</a></span>
+and quick, complained when he turned in bed, of
+something like water rolling from one side of the
+thorax to the other. A remarkable blueness about
+the mouth and eyes, and purged considerably from
+the pil. scill. Ordered to omit the pills and to
+take &#8485;i. of infus. Digitalis every eight hours; the
+proportion &#658;iss. to eight ounces of water and &#8485;i. of
+aq. n. m. sp.&mdash;7th Day, The infusion had neither
+purged, nor vomited him: he only complained once
+or twice of giddiness. His belly was now very hard,
+rather black on the right side the navel, and his legs
+amazingly swelled. Ordered a bolus with rhubarb
+and calomel, to be taken in the morning, and &#8485;ii.
+julep salin. cum tinct. canthar. gutt. forty ter die.&mdash;12th Day,
+nearly in the same state, except his
+breathing which was somewhat more difficult, being
+now obliged to have his head considerably raised.
+Persistat&mdash;From this day to the 32d day he became
+hourly worse. His belly which at first was only
+hard, now evidently contained a large quantity of
+water, his legs were more swelled, and a large sphacelated
+sore appeared upon each outer ancle. Respiration
+was so much obstructed, that he was obliged
+to sit quite upright to prevent suffocation. He made
+very little water, not more than eight ounces in a
+day and a night, and was much emaciated. Ordered
+his purging bolus again, and &#8485;ii. of a mixture with
+sal diuretic, &#8485;ss. to &#8485;xii. three times in a day, and
+a poultice with ale grounds to his legs.</p>
+
+<p>54th day. To this period there was not the least
+probability of his existing; his legs and thighs were<span class='pagenum'><a name="Page_106" id="Page_106">[106]</a></span>
+one continued blubber, his thorax quite flat, and
+his belly so large that it measured within one inch
+as much as a woman's in this Hospital the day she
+was tapped, and from whom twenty seven pounds
+of coagulable lymph were taken. He made about
+three ounces of water in twenty-four hours: his
+penis and scrotum were astonishingly swelled, and
+no discharge from the sores upon his legs. Ordered
+to take a pill with two grains of powdered Foxglove
+night and morning. For a few days no sensible
+effect, but about the 60th day he complained of
+being continually giddy, and had some little pain
+in his stomach. He now made much more water,
+and dared to sleep. His appetite which through the
+whole of his illness had been very bad, was also better.
+66th day. Breathing very much relieved, the
+quantity of water he made was three chamber pots
+full in a day and a night, each pot containing two
+quarts and four ounces, moderately full. Ordered
+to continue his pills, and his legs which were very
+flabby, to be rolled.</p>
+
+<p>69th day. His belly nearly reduced to its natural
+size, still made a prodigious quantity of water, his
+appetite very good, habit of body rather lax, and
+his complexion ruddy. On the 2d of <i>June</i>, being
+still rather weak, he was ordered decoct. cort. &#8485;ii.
+ter de die; and on the 12th was discharged from
+this Hospital perfectly cured.</p>
+
+<p class="right"><span style="letter-spacing: 0.25ex">W. BAYLEY</span>.
+<span class='pagenum'><a name="Page_107" id="Page_107">[107]</a></span></p>
+
+<p class="negative">Mr. Bayley's respectful compliments to Doctor
+Withering: he sends the case of Edward James,
+which he believes is pretty correct. He laments
+not having it in his power to send the
+measure of his belly, having unfortunately,
+mislaid the tape: he heard from James yesterday,
+and he is perfectly well.</p>
+
+<p style="text-indent: 0em">
+<i>General Hospital, August 5, 1784.</i></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">CLXIII.</span></h3>
+
+<p>On the 26th <i>February</i>, 1785, Sarah Ford, aged
+42, was admitted an out-patient of the Birmingham
+General Hospital: she complained of considerable
+pain in her chest, and great difficulty of
+breathing, her face was much swelled and her
+thighs and legs were anasarcous. She had extreme
+difficulty in making water, and with many painful
+efforts she did not void more than six ounces in
+twenty-four hours. She had been in this situation
+about six weeks, during which time she had taken
+ammoniacum, olibanum, and large quantities of
+squills, without any other effect than frequent sickness.
+Upon her commencing an Hospital patient,
+the following medicine was exhibited. R. gum ammoniac
+&#658;ii. pulv. fol. Digital. purp. &#8456;ii. sp. lavand.
+comp. ut fiat pil. 40. cap. ii. nocte maneque. She
+continued the use of these pills for a few days, without
+any sensible effect. On the eighth day her
+breathing was much relieved, her legs and
+thighs were not so much swelled, and in a day and<span class='pagenum'><a name="Page_108" id="Page_108">[108]</a></span>
+a night she made five pints of water. By the 12th
+day her legs and thighs were nearly reduced to their
+natural size. She continued to make water in large
+quantities, and had lost her pain in the thorax. To
+the 20th of <i>March</i>, she made rapid advances towards
+health, when not a symptom of disease remaining,
+she was discharged.<span class='pagenum'><a name="Page_109" id="Page_109">[109]</a></span></p>
+
+
+
+<h2><a name="COMMUNICATIONS" id="COMMUNICATIONS"></a>COMMUNICATIONS<br style="line-height: 2em" />
+<span style="letter-spacing: 0em; font-size: 90%">FROM CORRESPONDENTS.</span></h2>
+
+<hr class="chapter" />
+
+<div class="blockquot">
+<p class="right">
+<span style="padding-right: 1em">London, Norfolk-street,</span><br />
+May 31st, 1785.</p>
+
+<p><span class="smcap">Sir</span>,</p>
+
+<p>I had the favour of your letter last week;
+and I shall be very happy if I can give you any
+intelligence relating to the Foxglove, that can answer
+the purpose in which you are so laudably engaged.</p>
+
+<p>It is true that my brother, the late Dr. Cawley,
+was greatly relieved, and his life, perhaps, prolonged
+for a year, by a decoction of the Foxglove
+root; but why it had not a more lasting effect, it is
+necessary I should tell you that he had all the signs
+of a distempered viscera, long before any watery
+swellings appeared; it was manifest that his dropsy
+was merely symptomatic, and he could therefore only
+from time to time have any relief from medicine.
+In the year 1776, he returned from London
+to Oxon. having consulted several physicians
+at the former place, and Dr. Vivian at the latter,
+but without any success; and he was then told of
+a carpenter at Oxon. that had been cured of a
+Hydrops pectoris by the Foxglove root, and as he<span class='pagenum'><a name="Page_110" id="Page_110">[110]</a></span>
+was a younger, and in other respects an healthy
+man, his cure, I believe, remains a perfect one.</p>
+
+<p>I did not attend my brother whilst he took the
+medicine, and therefore I cannot speak precisely to
+the operation of it; but I remember, by his letters,
+that he was dreadfully sick and ill for several
+days before the secretion of urine came on, but
+which it did do to a great degree; relieved his
+breath, and greatly lessened the swelling in his legs
+and thighs; but the two instances I have lately seen
+in this part of the world, are much stronger proofs
+of the efficacy of it than my brother's case.</p>
+
+<p class="right">
+<span style="padding-right: 8em">I am, &amp;c.</span><br />
+<span style="letter-spacing: 0.25ex">ROBERT CAWLEY</span>.</p>
+
+
+<p>N.&nbsp;B. Whenever I have another opportunity of
+giving the Foxglove, it shall be in small doses:&mdash;In
+which I should hope it might succeed, although it
+might be more slowly. If you should try it with
+success, I should be glad to know what mode you
+made use of.</p>
+</div>
+
+<p class="center" style="padding-top: 1em">Dr. Cawley's prescription.</p>
+
+<div class="recipe">
+<p>R. Rad. Digital. purpur. siccat. et contus. &#8485;ii.</p>
+<p style="padding-left: 1em">Coque ex aq. font. &#8468;ii. ad &#8468;i. colat. liquor.
+adde aq. junip. comp. &#8485;ii.</p>
+<p style="padding-left: 1em">Mell. anglic &#658;i. m. sumat cochl. iv. omni nocte h. s. et mane.
+<span class='pagenum'><a name="Page_111" id="Page_111">[111]</a></span></p>
+</div>
+
+<p>&mdash;I have elsewhere remarked, that when the Digitalis
+has been properly given, and the diuretic effects
+produced, that an accidental over-dose bringing
+on sickness, has stopped the secretion of urine.
+In the present instance it likewise appears, that violent
+sickness may be excited, and continue for several
+days without being accompanied by a flow of
+urine; and it is probable that the latter circumstance
+did not take place, until the severity of the
+former abated. If Dr. Cawley had not had a constitution
+very retentive of life, I think he must
+have died from the enormous doses he took; and
+he probably would have died previous to the augmentation
+of the urinary discharge. For if the
+root from which his medicine was prepared, was
+gathered in its active state, he did not take at each
+dose less than <i>twelve</i> times the quantity a strong man
+ought to have taken. Shall we wonder then that
+patients refuse to repeat such a medicine, and that
+practitioners tremble to prescribe it? Were any of
+the active and powerful medicines in daily use to
+be given in doses <i>twelve</i> times greater than they are,
+and these doses to be repeated without attention to
+the effects, would not the patients die, and the
+medicines be condemned as dangerous and deleterious?&mdash;Yet
+such has been the fate of Foxglove!<span class='pagenum'><a name="Page_112" id="Page_112">[112]</a></span></p>
+
+<h4>A Letter to the Author, from Mr. <span class="smcap">Boden</span>,<br />
+Surgeon, at Broseley, in Shropshire.</h4>
+
+<div class="blockquot">
+
+<p class="right">
+Broseley, 25th May, 1785.</p>
+
+<p>Dear <span class="smcap">Sir</span>,</p>
+
+<p>Have inclosed the prescriptions that contained
+the fol. Digital. which I gave to Thomas Cooke and
+Thomas Roberts.</p>
+
+<p>Thomas Cooke, &AElig;t. 49, had been ill about two
+or three weeks. When I saw him he had no appetite,
+and a constant thirst: a fullness and load in
+the stomach: the thighs, legs and hands, much
+swell'd, and the face and throat in a morning; was
+costive, and made but little water, which was high
+coloured; the pulse very weak, and his breath exceeding
+bad. <i>June</i> 17th. R. Argent, viv &#658;i. cons.
+cynosbat. &#8456;ii. fol. Digital. pulv. gr. xv. f. pil. xxiv.
+capt. ii. omni nocte hor&acirc; decubitus. He was likewise
+purged by a bolus of argent. viv. jallap, Digit.
+elaterium and calomel, which was repeated on the
+fourth day, to the third time. From <i>June</i> 17th to
+the 29th, the symptoms were mostly removed,
+making water freely, and having plenty of stools;
+in a week after he was perfectly well, and remains
+so ever since. The cure was finished by steel and
+bitters.</p>
+
+<p>Thomas Roberts, &AElig;t. 40, had a deformed chest,
+was obliged to be almost in an erect posture when
+in bed; the other symptoms were nearly the same
+as Cooke's. <i>August</i> 3d. The pills prescribed <i>June</i><span class='pagenum'><a name="Page_113" id="Page_113">[113]</a></span>
+17th for Cooke.&mdash;17th. A purging bolus of jalap
+and Digitalis, once a week. He continued the medicines
+till the latter end of <i>August</i>, when he got
+very well; but the complaint returned in <i>Jan.</i> worse
+than before. He is now much better, but I have great
+reason to believe the liver to be diseased.</p>
+
+<p class="right">
+<span style="padding-right: 4em">I am, with the greatest respect,</span><br />
+
+<span style="padding-right: 2em">Your very obliged humble servant,</span><br />
+
+<span style="letter-spacing: 0.25ex">DANIEL BODEN</span>.</p>
+
+<p>P.&nbsp;S. The second patient, on his relapse, took
+Digitalis again, combined with other things.</p>
+</div>
+
+
+<h4>CASE communicated by Mr. <span class="smcap">Causer</span>,<br />
+Surgeon, at Stourbridge, Worcestershire.</h4>
+
+<p>Mr. P&mdash;&mdash; of H&mdash;&mdash; M&mdash;&mdash;, in the parish of
+Kingswinford, aged about 60; had been a strong
+healthy, robust, corpulent man; worked hard early
+in life at edge-tool making, and drank freely of
+strong malt liquor; for many years had been subject
+to gout in the extremities; for a few years past
+had been very asthmatic, and the gout in the extremities
+gradually decreased. When I first saw
+him, which was <i>Sept.</i> 12, 1779, his legs were anasarcous,
+his belly much swelled, and an evident fluctuation
+of water. His breathing very bad, an irregular
+pulse, and unable to lie down. His easiest<span class='pagenum'><a name="Page_114" id="Page_114">[114]</a></span>
+posture was standing with his body leaning over a
+chair, in which situation he would continue many
+hours together, labouring for breath, with the sweat
+trickling down his face very profusely; the urine
+in very small quantity. Diuretics of every kind I
+could think of were used with very little or no advantage.
+Blisters applied to the legs relieved very
+considerably for a time, but by no means could I
+increase the urinary discharge. Warm stomachic
+medicines were given, and at the same time sinapisms
+applied to the feet, in hopes of enticing gout
+to the extremities, but without any good effect.&mdash;<i>November</i>
+22d. The swelling considerably increasing,
+an emetic of acet. scillitic. was given, which acted
+very violently, and increased the urinary discharge
+considerably. He continued better and worse, using
+different kinds of diuretic and expectorating medicines
+until <i>September</i> 1781, when the disease was so
+much worse, I did not expect he could live many
+days. The acet. scillitic. was repeated, a table
+spoonful every half hour, till it acted briskly upwards
+and downwards; but without increasing the
+urinary discharge.&mdash;On the 17th of <i>September</i> I infused
+&#658;iii. of the fol. Digitalis in &#8485;vi. of boiling
+water, for four hours; then strained it, and added
+&#8485;i. of tinct. aromatica.&mdash;On the 18th he began by
+taking one spoonful, which he was to repeat every
+half hour, till it made him very sick, unless giddiness,
+loss of sight, or any other disagreeable effect
+took place. I had never given the medicine before,
+and had prepared him to expect the operation to
+be very severe. I saw him again on the 21st; he<span class='pagenum'><a name="Page_115" id="Page_115">[115]</a></span>
+had taken the medicine regularly, till the whole
+quantity was consumed, without perceiving the least
+effect of any kind from it, and continued well till
+the evening of the following day, when a
+little sickness took place, which increased, but
+never so as to occasion either vomiting or purging,
+but a surprising discharge of urine. The saliva increased
+so as to run out of his mouth, and a watery
+discharge from his eyes; these discharges continued,
+with a continual sickness, till the swelling was totally
+gone, which happened in three or four days.
+He afterwards took steel and bitters; and continued
+very comfortably, without any return of his
+dropsy, until the 7th of <i>April</i> 1782, when he
+was seized with an epidemic cough, which was very
+frequent with us at that time. His swellings now
+returned very rapidly, with the greatest difficulty
+in breathing, and he died in a few days. Blisters
+and expectorating medicines were used on this last
+return.</p>
+
+
+<h4>Extract of a Letter from Mr. <span class="smcap">Causer</span>.</h4>
+
+<p>Mrs. S&mdash;&mdash;, the subject of the following Case,
+was as ill as it is possible for woman to be and recover;
+from the inefficacy of the medicines used, I
+am convinced no medicine would have saved her
+but the Digitalis. I never saw so bad a case recovered;
+and it shews, that in the most reduced state
+of body, the medicine in small doses, will prove
+safe and efficacious.<span class='pagenum'><a name="Page_116" id="Page_116">[116]</a></span></p>
+
+<p>N.&nbsp;B. The Digitalis, in pills, never occasioned the
+least sickness. She took two boxes of them.</p>
+
+
+<h3>CASE.</h3>
+
+<p><i>January</i> 2d, 1785. Mrs. S&mdash;&mdash;, of W&mdash;&mdash;,
+near Kidderminster, aged 38, has been affected
+with dropsical swellings of her legs and thighs,
+about six weeks, which have gradually grown worse;
+has now great difficulty in breathing, which is much
+increased on moving; a very irregular, intermittent
+pulse, urine in very small quantity, and in the
+seventh month of her pregnancy: a woman of
+very delicate constitution, with tender lungs
+from her infancy and very subject to long continued
+coughs.</p>
+
+<div class="recipe">
+<p>R. Pulv. scill&aelig; gr. iii.</p>
+
+<p style="padding-left: 2em">Jalap gr. x. syr. rosar. solut. tinct. senn. aa
+&#658;ii. aq. menth. v. simpl. &#8485;iss. m. mane sumend.</p>
+</div>
+
+<div class="recipe">
+<p>R. pulv. scill&aelig; &#8456;i. G. ammoniac, sapon. venet.
+aa &#658;iss. syr. q. s. f. pilul. 42 cap. iii. nocte maneque.</p>
+</div>
+
+<p>On the 7th found her worse, and the swelling
+increased; the urine about &#8485;x in the twenty-four
+hours.</p>
+
+<div class="recipe">
+<p>R. Fol. siccat. Digital. &#658;iii. coque in. aq. fontan.
+&#8485;xii. ad &#8485;vi. cola et adde. aq. juniper. comp.
+&#8485;ii. sacchar. alb. &#8485;ss. m. cap. cochlear. i. larg.
+4tis horis.</p>
+</div>
+
+<p>She took about three parts of the medicine before<span class='pagenum'><a name="Page_117" id="Page_117">[117]</a></span>
+any effect took place. The first was sickness,
+succeeded by a considerable discharge of urine.
+She continued the medicine till the whole was consumed,
+which caused a good deal of sickness for
+three or four days.</p>
+
+<p>I saw her again on the 12th. The quantity of
+urine was much increased, and the swelling diminished.
+Pulse and breathing better.</p>
+
+<div class="recipe">
+<p>R. Fol. sicc. Digital. G. assafetid. aa &#658;i. calomel.
+pp. gr. x. sp. lavand. comp. q. s. fiat pilul.
+xxxii. cap. ii. omni nocte hor&acirc; somni.
+</p>
+</div>
+
+<p>A plentiful discharge of urine attended the use
+of these pills, and she got perfectly free from her
+dropsical complaints.</p>
+
+<p><i>March</i> 15th she was delivered: had a good labour,
+was treated as is usual, except in not having
+her breasts drawn, not intending see should
+suckle her child, being in so reduced a state. Continued
+going on well till the 18th, when she was seized
+with very violent pains across her loins, at times so
+violent as to make her cry out as much as labour
+pains. Enema cathartic. Fot. papav. applied to
+the part.</p>
+
+<div class="recipe"><p>
+R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s.
+fiat pilul. vi. capt. i. 2da quaque hor&acirc; durante
+dolore.
+<span class='pagenum'><a name="Page_118" id="Page_118">[118]</a></span></p>
+</div>
+
+<div class="recipe"><p>
+R. Julep, e camphor, sp. minder. aa &#8485;ii. capt.
+cochlear, i. larg. post singul. pilul.
+</p></div>
+
+<p>19th. Breathing short, unable to lie down, very
+irregular low pulse scarcely to be felt, fainty, and
+a universal cold sweat: no appetite nor thirst, spasmodic
+pains at times across the loins very violent,
+but not so frequent as on the preceding day.</p>
+
+<div class="recipe"><p>
+R. Gum ammoniac, assafetid. aa &#658;i. camphor.
+gr. xii. fiat pilul. 24. capt. ii. 3tia quaque
+hor&acirc; in cochlear. ii. mixtur. seq.
+</p></div>
+
+<div class="recipe"><p>R. Balsam. peruv. &#658;iii. mucilag. G. arab. q. s.
+flor. zinci g. vi. aq. menth. simp. &#8468;ss. m.</p></div>
+
+<div class="recipe"><p>Applic. Emp. vesicat. femorib. internis.</p></div>
+
+
+<div class="recipe">
+<p>R. Sp. vol. f&oelig;tid. elixir. paregor. balsam.<br />
+Traumatic. aa &#658;iii. capt. cochlear. parv. urgente
+languore.
+</p></div>
+
+<p>20th. Much the same; makes very little water,
+and the legs begin to swell.&mdash;Applic. Emp. e pice
+burgund. lumbis.</p>
+
+<p>23d. The swelling very much increased.&mdash;Capt.
+gutt. xv. acet. scillitic. ter die in two spoonfuls of
+the following mixture.</p>
+
+<div class="recipe"><p>
+R. Infus. baccar. juniper, &#8485;vi. tinct. amar. tinct.
+stomachic. aa &#8485;i. m.
+</p></div>
+
+<p>25th. Much the same.<span class='pagenum'><a name="Page_119" id="Page_119">[119]</a></span></p>
+
+<p>28th. The swelling considerably increased, in
+other respects very much the same.</p>
+
+<p>30th. Breathing very bad, with cough and pain
+across the sternum, unable to lie down, legs, thighs,
+and body very much swelled, urine not more than
+four or five ounces in the twenty-four hours; hot
+and feverish, with thirst.</p>
+
+<div class="recipe"><p>Applic. Emp. vesicat. stomacho et sterno.</p></div>
+
+
+<div class="recipe"><p>R. G. assafetid. &#8456;ii. pulv. jacob. &#8456;i. rad. scill. recent.
+gr. xii. extract. thebaic. gr. iv. f. pilul.
+xvi. cap. iv. omni nocte.</p></div>
+
+<div class="recipe"><p>R. Sal. nitr. sal. diuretic. aa &#658;ii. pulv. e contrayerv.
+comp. &#658;i. sacchar. &#8485;i. emuls. commun. &#8468;i.
+aq. cinnam. simpl. &#8485;i. m. capt. cochlear. iv.
+ter die.
+</p></div>
+
+<p><i>April</i> 2d. Much the same, no increase of urine.</p>
+
+<p>3d. Breathing much relieved by the blister, which
+runs profusely. Repeated the medicines, and continued
+them till the</p>
+
+<p>12th. The cough very bad, pulse irregular, swelling
+much increased, urine in very small quantity,
+not at all increased; great lowness and fainting.
+She desired to have some of the pills which relieved<span class='pagenum'><a name="Page_120" id="Page_120">[120]</a></span>
+her so much when with child. I was almost afraid
+to give them, but the inefficacy of the other medicines
+gave me no hopes of a cure from continuing
+them, which made me venture to comply with
+her request.</p>
+
+<div class="recipe"><p>R. Fol. siccat. Digital. G. assafetid. aa &#658;i. sp. lavand.
+comp. q. s. f. pilul. xxxii. cap. ii. omni
+mane; et omni node cap. pilul. e styrace
+gr. vi.</p></div>
+
+<p>17th. Considerable increase of urine.</p>
+
+<p>21st. Swelling a good deal diminished; urine
+near four pints in twenty-four hours, which is more
+than double the quantity she drinks.</p>
+
+<div class="recipe"><p>Applic. Emp. vesicat. femoribus internis.</p></div>
+
+<p>The Digitalis pills and opiate at bed-time continued.
+Takes a tea cup of cold chamomile tea every
+morning.</p>
+
+<p>25th. Swelling much diminished, makes plenty
+of water, appetite much mended, cough and breathing
+better. She omitted the medicine for three
+days; the urine began to diminish, the swelling
+and shortness of breathing worse. On repeating it
+for two days, the discharge was again augmented,
+and a diminution of the swelling succeeded. She
+has continued the pills ever since till the 14th of<span class='pagenum'><a name="Page_121" id="Page_121">[121]</a></span>
+<i>May</i>; the dropsical symptoms and cough are entirely
+gone, the water is in sufficient quantity, her
+strength is recovered, and she has a good appetite.
+All she now complains of is a weight across her stomach,
+which is worse at times, and she thinks, unless
+it can be removed, she shall have a return of
+her dropsy.</p>
+
+
+<h4>Extract of a Letter from Doctor <span class="smcap">Fowler</span>,<br />
+Physician, at Stafford.</h4>
+
+<p>I understand you are going to publish
+on the Digitalis, which I am glad to hear, for I have
+long wished to see your ideas in print about it, and
+I know of no one (from the great attention you
+have paid to the subject) qualified to treat on it but
+yourself. There are gentlemen of the faculty who
+give verbal directions to poor patients, for the preparing
+and taking of an infusion or decoction of the
+green plant. Would one suppose that such gentlemen
+had ever attended to the nature and operation
+of a sedative power on the functions, <i>particularly</i>
+the <i>vital</i>? Is not such a vague and unscientific mode
+of proceeding putting a two edged sword into the
+the hands of the ignorant, and the most likely method
+to damn the reputation of any very active and
+powerful medicine? And is it not more than probable
+that the <i>neglect</i> of adhereing to a <i>certain</i> and <i>regular</i>
+preparation of the nicotiana, and the <i>want</i> (of what
+you <i>emphatically</i> call) a <i>practicable</i> dose, have been
+the chief causes of the once rising reputation of<span class='pagenum'><a name="Page_122" id="Page_122">[122]</a></span>
+that noted plant being damned above a century
+ago? In short, the Digitalis is beginning to be used
+in dropsies, (although some patients are said to go
+off suddenly under its administration) somewhat
+in the style of broom ashes; and, in my humble
+opinion, the public, at this very instant, stand in
+great need of your <i>precepts</i>, <i>guards</i>, and <i>cautions</i> towards
+the safe and successful use of such a powerful
+sedative diuretic; and I have no doubt of your
+minute attention to those particulars, from a regard
+to the good and welfare of mankind, as well as to
+your own reputation with respect to that medicine.</p>
+
+<p>I remember an officer in the Staffordshire militia,
+who died here of a dropsy five years ago. The Digitalis
+relieved him a number of times in a wonderful
+manner, so that in all probability he might have
+obtained a radical cure, if he would have refrained
+from hard drinking. I understood it was first ordered
+for him by a medical gentleman, and its sedative
+effects proved so mild, and diuretic operation
+so powerful, that he used to prepare it afterwards
+for himself, and would take it with as little
+ceremony as he would his tea. It is said, that he
+was so certain of its successful operation, that he
+would boast to his bacchanalian companions, when
+much swelled, you shall see me in two days time
+quite another man.<span class='pagenum'><a name="Page_123" id="Page_123">[123]</a></span></p>
+
+
+<h4>CASES communicated by Mr. <span class="smcap">J. Freer</span>,<br />
+jun. Surgeon, in Birmingham.</h4>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3>
+
+<p><i>Nov.</i> 1780. Mary Terry, aged 60. Had been subject
+to asthma for several years; after a severe fit of it her
+legs began to swell, and the quantity of urine
+to diminish. In six weeks she was much troubled
+with the swellings in her thighs and abdomen, which
+decreased very little when she lay down: she made
+not quite a pint of water in the twenty-four hours.
+I ordered her to take two spoonfuls of the infusion
+of Foxglove every three hours. By the time she
+had taken eight doses her urine had increased to
+the quantity of two quarts in the day and night,
+but as she complained of nausea, and had once vomited,
+I ordered the use of the medicine to be suspended
+for two days. The nausea being then removed,
+she again had recourse to it, but at intervals
+of six hours. The urine continued to discharge
+freely, and in three weeks she was perfectly cured
+of her swellings.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3>
+
+<p><i>December</i>, 1782. A poor woman, who had been
+afflicted with an ague during the whole of her pregnancy,
+and for two months with dropsical swellings
+of the feet, legs, thighs, abdomen, and labia pudenda;
+was at the expiration of the seventh month<span class='pagenum'><a name="Page_124" id="Page_124">[124]</a></span>
+taken in labour. On the day after her delivery
+the ague returned, with so much violence as to endanger
+her life. As soon as the fit left her, I began
+to give her the red bark in substance, which
+had the desired effect of preventing another paroxysm.
+She continued to recover her health for a
+fortnight, but did not find any diminution in the
+swellings; her legs were now so large as to oblige
+her to keep constantly on the bed, and she made
+very little water. I ordered her the infusion of
+Foxglove three times a day, which, on the third
+day, produced a very copious discharge of urine,
+without any sickness; she continued the use of it
+for ten days, and was then able to walk. Having
+lost all her swellings, and no complaint remaining
+but weakness, the bark and steel compleated the
+cure.</p>
+
+
+<h4>Extract of a Letter from Doctor <span class="smcap">Jones</span>,<br />
+Physician, in Lichfield.</h4>
+
+<p>Anxious to procure authentic accounts from
+the patients, to whom I gave the Foxglove, I have
+unavoidably been delayed in answering your last
+favour. However, I hope the delay will be made
+up by the efficacy of the plant being confirmed by
+the enquiry. Long cases are tedious, and seldom
+read, and as seldom is it necessary to describe every
+symptom; for every case would be a history of
+dropsy. I shall therefore content myself with specifying<span class='pagenum'><a name="Page_125" id="Page_125">[125]</a></span>
+the nature of the disease, and when the dropsy
+is attended with any other affection shall notice
+it.</p>
+
+<p>Two years have scarcely elapsed since I first employed
+the Digitalis; and the success I have had
+has induced me to use it largely and frequently.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3>
+
+<p>Ann Willott, 50 years of age, became a patient
+of the Dispensary on the 11th of April 1783. She
+then complained of an enlargement of the abdomen,
+difficulty of breathing, particularly when lying,
+and costiveness. She passed small quantities
+of high-coloured urine; and had an evident fluctuation
+in the belly. Her legs were &oelig;dematous.
+Chrystals of tartar, squills, &amp;c. had no effect. The
+13th of <i>June</i> she took two spoonfuls of a decoction
+of Foxglove, containing three drams of the dry
+leaves, in eight ounces, three times a day. Her
+urine soon increased, and in a few days she passed
+it freely, which continued, and her breath returned.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3>
+
+<p>Mr. &mdash;&mdash;, 45 years of age, had been long
+subject to dropsical swellings of the legs, and made
+little water. Two spoonfuls of the same decoction
+twice a day, soon relieved him.<span class='pagenum'><a name="Page_126" id="Page_126">[126]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3>
+
+<p>Mrs. &mdash;&mdash;, aged 70 years. A lady frequently afflicted
+with the gout, and an asthmatical cough. After a
+long continuance of the latter, she had a great diminution
+of urine, and considerable difficulty of
+breathing, particularly on motion, or when lying.
+Her body was much bound. There was, however,
+no apparent swelling. She took three spoonfuls of
+an aperient decoction of forty-five grains in six
+ounces and a half, every other morning. The urine
+was plentiful those days, and her breathing much
+relieved. In two or three weeks after the use of it
+she was perfectly restored. The purgative medicine
+neither increased the urine, nor relieved the breathing,
+till the Foxglove was added.</p>
+
+<p>This spring she long laboured with the gout in
+her stomach, which terminated in a fit in her hand.
+During the whole of this tedious illness, of nearly
+three months, she passed little urine, and her breathing
+was again short.</p>
+
+<p>She took the same preparation of Foxglove without
+any diuretic effect, and afterwards two and three
+grains of the powder twice a day with as little. The
+dulcified spirits of vitriol, however, quickly promoted
+the urinary secretion.<span class='pagenum'><a name="Page_127" id="Page_127">[127]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">IV.</span></h3>
+
+<p>Mr. C&mdash;&mdash;, 46 years of age, had dropsical swellings
+of the legs, and passed little urine. He took
+the decoction with three drams, and was soon relieved.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">V.</span></h3>
+
+<p>Lady&mdash;&mdash;, took three grains of the dried
+leaves twice a day, for swelled legs, and scantiness
+of urine, without effect.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">VI.</span></h3>
+
+<p>Mrs. Slater, aged 36 years. For dropsy of the
+belly and legs, and scantiness of urine, of several
+weeks standing, took three grains of the powder
+twice a day, and was quite restored in ten days.
+She took many medicines without effect.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">VII.</span></h3>
+
+<p>Mrs. P&mdash;&mdash;, in her 70th year, took three
+grains of the powder twice a day, for scantiness of
+urine, and swelled legs, without effect.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">VIII.</span></h3>
+
+<p>Ann Winterleg, in her 26th year, had dropsical
+swellings of the legs, and passed little urine: she
+was relieved by two drams, in an eight ounce decoction.<span class='pagenum'><a name="Page_128" id="Page_128">[128]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">IX.</span></h3>
+
+<p>William Brown, aged 76. In the last stage of
+dropsy of the belly and legs, found a considerable
+increase of his urine by a decoction of Foxglove,
+but it was not permanent.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">X.</span></h3>
+
+<p>Mr. &mdash;&mdash;, &mdash; years of age, and of very gross
+habit of body, became highly dropsical, and took
+various medicines, without effect. One ounce of
+the decoction, with three drams of the dry leaves
+in eight ounces, twice or three times a day, increased
+his urine prodigiously. He was evidently better,
+but a little attendant nausea overcame his resolution,
+and in the course of some weeks afterwards he fell
+a victim to his obstinacy.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XI.</span></h3>
+
+<p>Mrs. Smith, about 50 years of age, after a tedious
+illness of many weeks, had a jaundice, and became
+dropsical in the legs. Two spoonfuls of the
+decoction, with three drams twice a day, increased
+her urine, and abated the swelling.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XII.</span></h3>
+
+<p>Widow Chatterton, about 60 years of age. Took
+the decoction in the same way for dropsy of the legs,
+with little effect.<span class='pagenum'><a name="Page_129" id="Page_129">[129]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XIII.</span></h3>
+
+<p>&mdash;&mdash; Genders, about thirty-four years of age,
+was delivered of three children, and became dropsical
+of the abdomen. She passed little or no urine,
+had constant thirst, and no appetite. She took two
+spoonfuls of an eight ounce decoction, with three
+drams twice a day. By the time she had finished
+the bottle, (which must have been on the fourth
+day,) she had evacuated all her water, and could
+go about. Her appetite increased with every dose,
+and she recovered without farther help.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XIV.</span></h3>
+
+<p>Miss M&mdash;&mdash; M&mdash;&mdash;, in her 20th year. Had
+been infirm from her cradle, and, after various sufferings,
+had an astonishing &oelig;dematous swelling of
+one leg and thigh, of many weeks standing. She
+passed little or no urine, and had all her other complaints.
+She took 2 spoonfuls of an eight oz. decoction
+of two drams, twice a day. Her urine immediately
+increased; and, on the third day, the swelling
+had entirely subsided.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XV.</span></h3>
+
+<p>Mr. P&mdash;&mdash;, 65 years of age, and of a full habit
+of body. Had lived freely in his youth, and for
+many years led rather an inactive life. His health
+was much impaired several months, and he had a
+considerable distention, and evident fluctuation in<span class='pagenum'><a name="Page_130" id="Page_130">[130]</a></span>
+the abdomen, and a very great &oelig;dema of the legs
+and thighs. His breathing was very short, and rather
+laborious, appetite bad, and thirst considerable.
+His belly was bound, and he passed very small
+quantities of high-coloured urine, that deposited a
+reddish matter. He had taken medicines some
+time, and, I believe, the Digitalis; and had been
+better.</p>
+
+<p>A blister was applied to the upper and inside of
+each thigh; he took two spoonfuls of the decoction,
+with three drams of the dry leaves, two or three
+times a day; and some opening physic occasionally.</p>
+
+<p>He lived at a considerable distance, and I did not
+visit him a second time; but I was well informed,
+about ten days or a fortnight afterwards, that his
+urine increased amazingly upon taking the decoction,
+and that the water was entirely evacuated.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XVI.</span></h3>
+
+<p>Mrs. G&mdash;&mdash;, aged 50 years. After being long
+ailing, had a large collection of water in the abdomen
+and lower extremities. Her urine was high-coloured,
+in small quantities, and had a reddish
+sediment. She took the decoction of Digitalis,
+squills, &amp;c. without any effect. The chrystals of
+tartar, however, cured her speedily.<span class='pagenum'><a name="Page_131" id="Page_131">[131]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XVII.</span></h3>
+
+<p>Mr. &mdash;&mdash;, about 50 years of age, complained
+of great tension and pain across the abdomen, and
+of loss of appetite; his urine, he thought, was less
+than usual, but the difference was so trifling he
+could speak with no certainty: his belly seemed to
+fluctuate. Among other things he tried the Foxglove
+leaves dried, twice a day; and, although it
+appeared to afford him relief, yet the effect was not
+permanent.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XVIII.</span></h3>
+
+<p>Mr. W&mdash;&mdash;, aged between 60 and 70 years;
+and rather corpulent: was considerably dropsical,
+both of the belly and legs, and his urine in small
+quantities. Three grains of the dry leaves, twice
+a day, evacuated the water in less than a fortnight.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XIX.</span></h3>
+
+<p>Sarah Taylor, 40 years of age, was admitted into
+the Dispensary for dropsy of the abdomen and
+legs; and was relieved by the Decoctum digitalianum.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XX.</span></h3>
+
+<p>Lydia Smith, aged 60. Dispensary. Laboured
+many years under an asthma, and became dropsical.
+She took the decoction without effect.<span class='pagenum'><a name="Page_132" id="Page_132">[132]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXI.</span></h3>
+
+<p>John Leadbeater, aged 15 years. Had a quotidian
+intermittent, which was removed by the humane
+assistance of an amiable young lady. His
+intermittent was soon attended by a very considerable
+ascites; for which he became a patient of the
+Dispensary. He took a decoction of Foxglove night
+and morning. His urine increased immediately,
+and he lost all his complaints in four days.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXII.</span></h3>
+
+<p>William Millar, aged 50 years. Admitted into
+the Dispensary for a tertian ague, and general dropsy.
+The dropsy continuing after the ague was removed,
+and his urine being still passed in small
+quantities; he took the powdered leaves, and recovered
+his health in five days.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXIII.</span></h3>
+
+<p>Ann Wakelin, 10 years of age. Had for several
+weeks a dropsy of the belly after an ague. She
+took a decoction of Foxglove, which removed all
+complaint by the fourth day.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">XXIV.</span></h3>
+
+<p>Ann Meachime; a Dispensary patient. Had an
+ascites and scantiness of urine. She took the powder<span class='pagenum'><a name="Page_133" id="Page_133">[133]</a></span>
+of Foxglove, and evacuated all her water in
+three days.</p>
+
+<p>It may not be improper to observe, 1st. That
+various diuretics had long been given in many of
+these cases before I was consulted. And, 2dly.
+That the exhibition of the Foxglove was but seldom
+attended with sickness.</p>
+
+
+<h3>REMARKS.</h3>
+
+<p>These Cases, thus liberally communicated by my
+friend, Dr. Jones, are more acceptable, as they
+seem to contain a faithful abstract from his notes,
+both of the unsuccessful as well as the successful
+Cases.</p>
+
+<p class="negative">The following Tabular View of them will give us
+some Idea of the efficacy of the Medicine.</p>
+
+<table summary="diseases" cellpadding="2">
+<tr><td>Anasarca</td><td style="padding-left: 1em">7 Cases</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">3</td></tr>
+<tr><td>&nbsp;</td><td>&nbsp;</td><td style="padding-left: 1em">Relieved</td><td style="padding-left: 1em">1</td></tr>
+<tr><td>&nbsp;</td><td>&nbsp;</td><td style="padding-left: 1em">Failed</td><td style="padding-left: 1em">3</td></tr>
+<tr><td>Ascites</td><td style="padding-left: 1em">5 Cases</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">4</td></tr>
+<tr><td>&nbsp;</td><td>&nbsp;</td><td style="padding-left: 1em">Relieved</td><td style="padding-left: 1em">1</td></tr>
+<tr><td>&OElig;dematous leg</td><td style="padding-left: 1em">1 Case</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">1</td></tr>
+<tr><td>Ascites and anasarca</td><td style="padding-left: 1em">7 Cases</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">4</td></tr>
+<tr><td>&nbsp;</td><td>&nbsp;</td><td style="padding-left: 1em">Relieved</td><td style="padding-left: 1em">2</td></tr>
+<tr><td>&nbsp;</td><td>&nbsp;</td><td style="padding-left: 1em">Failed</td><td style="padding-left: 1em">1</td></tr>
+<tr><td>Asthma and dropsy</td><td style="padding-left: 1em">1 Case</td><td style="padding-left: 1em">Failed</td><td style="padding-left: 1em">1</td></tr>
+<tr><td>Hydrothorax and gout</td><td style="padding-left: 1em">1 Case</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">1</td></tr>
+<tr><td>&nbsp;&nbsp;-&nbsp;&nbsp;-&nbsp;&nbsp;-&nbsp;&nbsp;-&nbsp;&nbsp;-, ascites and anasarca</td><td style="padding-left: 1em">2 Cases</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">2</td></tr>
+</table>
+
+
+<h4>A CASE of Anasarca communicated by Mr.<br /><span class='pagenum'><a name="Page_134" id="Page_134">[134]</a></span>
+<span class="smcap">Jones</span>, Surgeon, in Birmingham.</h4>
+
+<div class="blockquot">
+<p>Dear <span class="smcap">Sir</span>,</p>
+
+<p>Having lately experienced
+the diuretic powers of the Foxglove, in a case of
+anasarca; I do myself the pleasure of communicating
+a short history of the treatment to you.</p>
+
+<p class="right">
+<span style="padding-right: 4em">I am, &amp;c.</span><br />
+<span style="letter-spacing: 0.25ex">W. JONES</span>.</p>
+
+<p>Birmingham,<br />
+May 17th, 1785.</p>
+</div>
+
+<p>My patient, Mrs. C&mdash;&mdash;, who is in her 51st
+year, had the following symptoms, viz. alternate
+swelling of the legs and abdomen, a little cough,
+shortness of breath in a morning, thirst, weak pulse,
+and her urine, which was so small in quantity as
+seldom to amount to half a pint in twenty-four
+hours, deposited a clay-coloured sediment.</p>
+
+<p><i>April</i> 16th, 1785, I directed the following form:</p>
+
+<div class="recipe"><p>R. Fol. Digitalis siccat. &#658;ii.<br />
+Aq. fontan&aelig; bullient. &#8485;viii. f. infus. et cola.
+Sumat cochl. larga iii. o. n. et mane.</p></div>
+
+<p>On the 17th she had taken twice of the infusion,
+and though by mistake only two tea spoonfuls for a<span class='pagenum'><a name="Page_135" id="Page_135">[135]</a></span>
+dose, yet the quantity of urine was increased to
+about a pint in the twenty-four hours. She was
+then directed to take two table spoonfuls night and
+morning. And.</p>
+
+<p>On the 18th, a degree of nausea was produced.
+A pint and half of urine was made in the last twenty-four
+hours. During the time above specified she
+had two or three stools every day. The infusion
+was now omitted.</p>
+
+<p>On the 19th the swelling of the legs was removed.
+A degree of nausea took place in the morning,
+and increased so much during the day, that she vomited
+up all her food and medicine. As she was
+very low, and complained of want of appetite, a
+cordial julep was directed to be taken occasionally,
+as well as red port and water, mint tea, &amp;c. She
+informed me that whatever she took generally staid
+about an hour before it came up again, and that the
+mint tea staid longest on the stomach. The vomiting
+decreased gradually, and ceased on the 22d.
+The discharge of urine remained considerable during
+the three following days, but its quantity was
+not measured.</p>
+
+<p>22d. A dose of neutral saline julep was directed
+to be taken every fourth hour.</p>
+
+<p>On the 23d she complained of thirst, and thought
+the discharge of urine not so copious as on the preceding
+days, therefore the saline julep was continued<span class='pagenum'><a name="Page_136" id="Page_136">[136]</a></span>
+every fourth hour, with the addition of thirty
+drops of the following medicine:</p>
+
+<div class="recipe"><p>R. Aceti scillitic. &#658;vi.<br />
+Tinct. aromat. &#658;ii.<br />
+Tinct. thebaic. gutt. xx. m.</p></div>
+
+<p>The bowels have been kept open from the 19th,
+by the occasional use of emollient injections.</p>
+
+<p>On the 24th the legs were much swelled again;
+she complained of languor and a degree of nausea.
+The discharge of urine increased a little since the
+23d. Her pulse was low and her tongue white.
+The urine, which had been rendered clear by the
+infusion of Foxglove, now deposited a whitish sediment.</p>
+
+<p>On the 25th her appetite began to return, the
+swelling of the legs diminished, and she thought
+herself much relieved. The urine was considerable
+in quantity, and clear.</p>
+
+<p>On the 26th she was thirsty and languid. The
+swelling was removed; the quantity of urine discharged
+in the last twenty-four hours was about a
+pint. She continued to mend from this time, and
+is now in good health.</p>
+
+<p>A giddiness of the head, more or less remarkable
+at times, was observed to follow the use of the Foxglove,
+and it lasted nine or ten days.<span class='pagenum'><a name="Page_137" id="Page_137">[137]</a></span></p>
+
+<p>This is the second time that I have relieved this
+patient by the infusion of Foxglove. I used the
+same proportion of the fresh leaves the first time as
+I did of the dried ones the last. The violent vomiting
+which followed the use of the infusion made
+with the dried leaves, did not take place with the
+fresh though she took near a pint made with the
+same proportion of the herb fresh gathered.</p>
+
+
+<h3>REMARKS.</h3>
+
+<p>The above is a very instructive case, as it
+teaches us how small a quantity of the infusion was
+necessary to effect every desirable purpose. At first
+sight it may appear from the concluding paragraph,
+that the green leaves ought to be preferred to the
+dried ones, as being so much milder in their operation;
+but let it be noticed, that the same quantity
+of infusion was prepared from the same weight of
+the green as of the dried leaves, and consequently,
+as will appear hereafter, the infusion with the dried
+leaves was five times the strength of that before
+prepared from the green ones. We need not wonder,
+therefore, that the effects of the former were
+so disagreeable, when the dose was five times greater
+than it ought to have been. But what makes this
+matter still more obvious, is the mistake mentioned
+at first, of two tea spoonfuls only being given for a
+dose. Now a tea spoonful, containing about a
+fourth or a fifth part of the contents of a table
+spoon, the dose then given, was very nearly the
+same as that which had before been taken of the<span class='pagenum'><a name="Page_138" id="Page_138">[138]</a></span>
+infusion of the green leaves, and it produced precisely
+the same effects for it increased the urinary
+discharge, without exciting the violent vomiting.</p>
+
+
+<h4>Letter from Doctor <span class="smcap">Johnstone</span>, Physician, in
+Birmingham.</h4>
+
+<div class="blockquot">
+<p>
+Dear <span class="smcap">Sir</span>,<br />
+</p>
+
+<p>The following cases are selected
+from many others in which I have given the Digitalis
+purpurea; and from repeated experience of its
+efficacy after other diuretics have failed. I can recommend
+it as an effectual, and when properly
+managed, a safe medicine.</p>
+
+<p class="right">
+<span style="padding-right: 4em">I am, &amp;c.</span><br />
+<span style="letter-spacing: 0.25ex">E. JOHNSTONE</span>.</p>
+
+<p>Birmingham, May 26,
+1785.</p>
+</div>
+
+<p><i>March</i> 8th, 1783, I was called to attend Mr.
+G&mdash;&mdash;, a gentleman of a robust habit, who had led
+a regular and temperate life, &AElig;t. 68. He was
+affected with great difficulty of respiration, and cough
+particularly troublesome on attempting to lie down,
+&oelig;dematous swellings of the legs and thighs, abdomen
+tense and sore on being pressed, pain striking
+from the pit of the stomach to the back and shoulders;
+almost constant nausea, especially after taking
+food, which he frequently threw up; water thick
+and high-coloured, passed with difficulty and in<span class='pagenum'><a name="Page_139" id="Page_139">[139]</a></span>
+small quantity; body costive; pulse natural; face
+much emaciated, eyes yellow and depressed. He
+had been subject to cough and difficulty of breathing
+in the winter for several years; and about four
+years before this time, after being exposed to cold,
+was suddenly deprived of his speech and the use of
+the right side, which he recovered as the warm weather
+came on; but since that time had been remarkably
+costive, and was in every respect much debilitated.
+He first perceived his legs swell about a year
+ago; by the use of medicines and exercise, the
+swellings subsided during the summer, but returned
+on the approach of winter, and gradually increased
+to the state in which I found them, notwithstanding
+he had used different preparations of squills and
+a great variety of other diuretic medicines. I
+ordered the following mixture.</p>
+
+
+<div class="recipe"><p>
+R. Foliorum Digitalis purpur. recent. &#658;iii. decoque
+ex aq. fontan. &#8485;xii ad &#8485;vi colatur&aelig; adde
+Tinctur. aromatic.<br />
+Syr. zinzib. aa &#8485;i. m. capt. cochl. duo larga secunda
+quaque hora ad quartam vicem nisi
+prius nausea supervenerit.
+</p></div>
+
+<p><i>March</i> 9th. He took four doses of the mixture
+without being in the least sick, and made, during
+the night upwards of two quarts of natural coloured
+water.<span class='pagenum'><a name="Page_140" id="Page_140">[140]</a></span></p>
+
+<p>10th. Took the remainder of the mixture yesterday
+afternoon and evening, and was sick for a short
+time, but made nearly the same quantity of water
+as before, the swellings are considerably diminished,
+his appetite increased, but he is still costive.</p>
+
+<div class="recipe"><p>
+R. Argent, viv. balsam peruv. aa &#658;ss tere ad extinctionem
+merc. et adde gum. ammon.
+&#8456;iii aloes socotorin. &#658;ss rad. scil. recent. &#8456;ss
+syr. simpl. q. s. f. mass. in pil. xxxii divid.
+cap. iii. bis in die.
+</p></div>
+
+<p>14th. Continues to make water freely. The
+swellings of his legs have gradually decreased; soreness
+and tension of the abdomen considerably less.</p>
+
+<div class="recipe"><p>Omittant. pil. cap. mistur. c. decoct. Digitalis. &amp;c.
+3tia quaque hora ad 3tiam vicem.</p></div>
+
+<p>15th. Made a pint and a half of water last night,
+without being in the least sick, and is in every
+respect considerably better. Repet. Pillul. ut
+antea.</p>
+
+<p>21st. Makes water as usual when in health, and
+the swellings are entirely gone.</p>
+
+<div class="recipe"><p>
+R. Infus. amar. &#8485;v. tinctur. Rhei spirit. &#8485;ii. spirit
+vitriol. dulc. &#658;ii. syr. zinzib. &#658;vi. m. cap.
+cochl. iii. larg. ter in die.
+</p></div>
+
+<p>He soon gained sufficient strength to enable him
+to go a journey, and returned home in much better<span class='pagenum'><a name="Page_141" id="Page_141">[141]</a></span>
+health than he had been from the time he was
+affected with the paralytic stroke, and excepting
+some return of his asthmatic complaint in the winter,
+hath continued so ever since.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3>
+
+<p>R&mdash;&mdash; Howgate, a man much addicted to intemperance,
+particularly in the use of spirituous liquors,
+&AElig;t. 60, was admitted into the Hospital near
+Birmingham, <i>May</i> 17, 1783. He complained of
+difficulty of breathing, attended with cough, particularly
+troublesome on lying down; drowsiness and
+frequent dozing, from which he was roused by
+startings, accompanied with great anxiety and oppression
+about the breast; &oelig;dematous swellings of
+the legs; constant desire to make water, which
+he passed with difficulty, and only by drops; pulse
+weak and irregular; body rather costive; face much
+emaciated; no appetite for food.&mdash;Cap. pil. scil. iii.
+ter in die.<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a></p>
+
+<p><i>May</i> 20th. The pills have had no effect.&mdash;Cap.
+mistur. c.<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a> Decoct. Digital. &amp;c. cochl. ii. larg. 3tia
+quaque hora, ad 3tiam vicem.</p>
+
+<p><i>May</i> 21st. Made near two quarts of water in the
+night, without being in the least sick. He continued
+<span class='pagenum'><a name="Page_142" id="Page_142">[142]</a></span>the use of the mixture three times in the day till
+the 30th, and made about three pints of water daily,
+by which means the swellings were entirely taken
+away; and his other complaints so much relieved,
+that on the 6th of June he was dismissed free from
+complaint, except a slight cough. But returning to
+his old course of life, he hath had frequent attacks
+of his disorder, which have been always removed by
+using the Digitalis.</p>
+
+
+<h4>Extract of a letter from Mr. <span class="smcap">Lyon</span>, Surgeon,
+at Tamworth.</h4>
+
+<p>&mdash;Mr. Moggs was about 54 years of age, his disease
+a dropsy of the abdomen, attended with
+anasarcous swellings of the limbs, &amp;c. brought on by
+excessive drinking. I believe the first symptoms of
+the disease appeared the beginning of November,
+1776; the medicines he took before you saw him,
+were squills in different forms, sal diureticus and
+calomel, but without any good effect; he begun the
+Digitalis on the 10th of July 1777; a few doses of
+it caused a giddiness in the head, and almost deprived
+him of sight, with very great nausea, but
+very little vomiting, after which a considerable flow of
+urine ensued, and in a very short time, a very little
+water remained either in the cavity of the abdomen,
+or the membrana adiposa, but he remained excessive
+weak, with a fluttering pulse at the rate of 150 or
+frequently 160 in a minute; he kept pretty free
+from water for upwards of twelve months; it then<span class='pagenum'><a name="Page_143" id="Page_143">[143]</a></span>
+collected, and neither the Digitalis nor any other
+medicine would carry it off. I tapped him the 2d
+of August 1779 in the usual place, and took some
+gallons of water from him, but he very soon filled
+again, and as he had a very large rupture, a considerable
+quantity of the water lodged in the scrotum,
+and could not be got away by tapping in the usual
+place. I therefore (on the 28th of the same month)
+made an incision into the lower part of the scrotum,
+and drained off all the water that way, but he was
+so very much reduced, that he died the 8th or 9th
+of <i>September</i> following, which was about two years
+and two months after he first begun the Digitalis.</p>
+
+<p>I have had several dropsical patients relieved, and
+some perfectly recovered by the Digitalis, since you
+attended Mr. Moggs, but as I did not take any notes
+or make any memorandums of them, cannot give
+you any of them.</p>
+
+
+<h4>Communications from Dr. <span class="smcap">Stokes</span>, Physician,
+in Stourbridge.</h4>
+
+<div class="blockquot">
+
+<p>Dear <span class="smcap">Sir</span>,</p>
+
+<p>I accept with pleasure your
+invitation to communicate what I know respecting
+the properties of <i>Digitalis</i>; and if an account of
+what others had discovered before you,<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a> with a detail
+<span class='pagenum'><a name="Page_144" id="Page_144">[144]</a></span>of my own experience, shall be allowed the
+merit of at least a well meant acknowledgment, for
+the early communication you were so kind to make
+me, of the valuable properties you had found in it;
+I shall consider my time as well employed. A knowledge
+of what has been already done is the best
+ground work of future experiment; on which account
+I have been the more full on this subject, in
+hopes that given with the cautions which you mean
+to lay down in the cure of dropsies, it may prove
+alike useful in that of other diseases, one of which
+stands foremost among the <i>opprobria</i> of medicine.</p>
+
+<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3>
+
+<p>Mrs. M&mdash;&mdash;. Orthopnea, pain, and excessive
+oppression at the bottom of the sternum. Pulse
+irregular, with frequent intermissions. Appetite
+very much impaired. Legs anasarcous.</p>
+
+<div class="recipe"><p>
+<i>Empl. vesicator. pectori dolent.</i><br />
+<i>Infus. Digital. e &#658;iii. ad. aq. &amp;c. &#8485;viii. cochl. j. o.
+h. donec nausea excitetur vel diuresis satis copiosa
+proveniat.</i>
+</p>
+</div>
+
+<p>I ordered it of the above strength, and to be repeated
+often, on account of the great emergency of
+the case, but the nausea excited by the first dose prevented
+its being given at such short intervals. A 3d
+dose I found had been given, which was followed by
+vomitings. All her complaints gradually abated,<span class='pagenum'><a name="Page_145" id="Page_145">[145]</a></span>
+but in about a fortnight recurred, notwithstanding
+the use of infus. amar. &amp;c.</p>
+
+<div class="recipe"><p>
+<i>Dec. 2. Infus. Digit. e. &#658;iss ad aq. &amp;c. &#8485;viii. cochl.
+ii. horis &amp;c. u. a.</i></p></div>
+
+<p>Complaints gradually abated, swellings of the
+legs nearly gone down.</p>
+
+<p>About a month afterwards you was desired to visit
+this patient.<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a></p>
+<p><span class='pagenum'><a name="Page_146" id="Page_146">[146]</a></span></p>
+<p>On the examination of the body I noticed, among
+others, the following appearances.</p>
+
+<p>About &frac34; oz. of bloody water flowed out, on elevating
+the upper half of the scull, and a small quantity
+also was found at the base.</p>
+
+<p><span class="smcap">Brain.</span> Blood-vessels turgid with blood, and
+many of those of considerable size distended with air.</p>
+
+<p>A very slight watery effusion between the <i>Pia Mater</i>
+and <i>Tunica arachnoidea</i>. About &frac34; oz. of watery
+fluid in the <i>lateral ventricles</i>.</p>
+
+<p><span class="smcap">Thorax.</span> In the left cavity about 4 oz. of bloody
+serum; in the right but little. Lungs, the hinder parts
+loaded with blood. Adhesions of each lobe to the
+pleura. <i>Pericardium</i> containing but a very small
+quantity of fluid. <i>Heart</i> containing no coagula of
+blood. <i>Valves of the Aorta</i> of a cartilaginous texture,
+as if beginning to ossify.</p>
+
+<p><i>Abdominal Viscera</i> natural, and a profusion of <i>Fat</i>
+under the integuments of the abdomen and thorax,
+in the former to the thickness of an inch and upwards,
+and in very considerable quantity on the
+mesentery, omentum, kidneys, &amp;c.</p>
+
+<p><span class="smcap">Obs.</span> The intermitting pulse should seem to have
+been owing to effusions of water in some of the cavities
+of the breast, as it disappeared on the removal
+of the waters.<span class='pagenum'><a name="Page_147" id="Page_147">[147]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3>
+
+<p>Mrs. C&mdash;&mdash; of K&mdash;&mdash;, &AElig;t. 80. Orthopn&oelig;a,
+with sense of oppression about the pr&oelig;cordia. Unable
+to lie down in bed for some nights past. Anasarca
+of the lower extremities. Urine very scanty.
+Complaints of six weeks standing. Had taken <i>sal.
+diuret. c. ol. junip.&mdash;Calom. c. jalap, et gambog.&mdash;Et ol.
+junip. c. ol. Terebinth.</i> without effect.</p>
+
+<p><i>Feb.</i> 7. <i>Infus. Digital. e. &#658;iii. ad aq. &amp;c. &#8485;viii.
+cochl. ii. 4tis horis.</i> Ordered to drink largely of <i>infus.
+baccar. junip.</i> The third dose produced great
+nausea which continued ten hours, during which
+time the urine made was about a quart. The next
+day her apothecary directed her to begin again with
+it. The second dose produced vomiting. During
+the next twenty hours she made two quarts of water,
+about four times as much as she drank.</p>
+
+<p>From this time she took no more of the <i>infus. Digital.</i>
+but continued the <i>inf. bacc. junip.</i> until about
+<i>March</i> 2d, when all the swellings were gone down,
+her respiration perfectly free, and she herself quite
+restored to her former state of health. On the 29th
+she had an attack of jaundice which was some time
+after removed; since which she has enjoyed a good
+state of health, excepting that for some little time
+past her ancles have been slightly &oelig;dematous, which
+will I trust soon yield to strengthening medicines.<span class='pagenum'><a name="Page_148" id="Page_148">[148]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3>
+
+<p>Mrs. M&mdash;&mdash; G&mdash;&mdash;, &AElig;t. 64. Has had sore legs
+for these thirty-four years past. Orthopn&oelig;a. Sense
+of oppression at the pr&oelig;cordia. Pulse intermitting.
+Legs anasarcous. Urine scanty, high-coloured.</p>
+
+<div class="recipe"><p><i>Infus. Digital. c. &#658;iss ad aq. bull. &#8485;viii. cochl. ii.
+4tis horis.</i></p></div>
+
+<p>Took six doses, when nausea was excited. Urine
+a quart during the course of the night. The flow
+of urine continued, and complaints relieved. Sal.
+Mart. c. extr. gent. and afterwards with the addition
+of extr. cort. for which last ingredient she had a
+predilection, confirmed the cure.</p>
+
+<p>On the same day the next year I was called in to
+her for a similar train of symptoms, excepting that
+the pulse was but just perceptibly irregular.</p>
+
+<div class="recipe"><p><i>Infus. Digital. u. a. pr&aelig;script.</i></p></div>
+
+<p>The directions on the phial not being attended
+to, <i>two doses of it were given after a nausea had been
+excited</i>, which, with occasional vomitings, became
+exceedingly oppressive. A saline draught, given
+in Dr. Hulme's method, a draught <i>sal. c. c. gr.
+xii. c. conf. card. gr. x.</i> produced no immediate
+effect, but the nausea gradually abating, inf. bacc.
+junip. was ordered; but this appeared to augment it,<span class='pagenum'><a name="Page_149" id="Page_149">[149]</a></span>
+and a great propensity to sleep coming on, I directed
+<i>sal. c. c. conf. card, aa gr. viii. 4tis horis</i>, which
+removed the unpleasant symptoms and <i>myrrh. c. sal.
+mart.</i> completed the cure. During the use of the
+above medicines, the urine was augmented, and the
+pulmonary complaints removed, even before the nausea
+left her; and the sores of her legs which were much
+inflamed before she began with the infus. Digital.
+in a day's time assumed a much healthier appearance,
+and on her other complaints going off, they
+shewed a greater tendency to heal than she had
+ever observed in them for twenty years before. This
+instance is a very pleasing confirmation of the experience
+of Hulse and Dr. Baylies, and of the advantage
+to be derived from a medicine, which,
+while it helps to heal the ulcers, removes that from
+the constitution which often renders the healing of
+them improper.</p>
+
+<p>In one case in which I ordered it, the infusion,
+instead of digesting three hours as I had directed,
+was suffered to stand upon the leaves all night. The
+consequence was that the first dose produced considerable
+nausea.</p>
+
+<p>The two following cases, with which I have been
+favoured by a physician very justly eminent, convince
+me of the necessity there is that every one who
+discovers a new medicine, or new virtues in an old
+one, should, in announcing such discoveries, publish
+to the world the exact manner in which he exhibits<span class='pagenum'><a name="Page_150" id="Page_150">[150]</a></span>
+such medicines, with all the precautions necessary
+to obtain the promised success.</p>
+
+<p>In these (says my correspondent) "the infusion
+was given in small doses, repeated every hour or
+two, till a nausea was raised, when it was omitted
+for a day or perhaps two, and then repeated
+in the same manner.</p>
+
+<p>"An <span class="smcap">Ascites</span> emptied by it, but filled again
+very speedily, though <i>its use was never discontinued</i>,
+and who afterwards found no salutary effects
+from it. Ended fatally.</p>
+
+<p>"In an <span class="smcap">Anasarca</span> it sometimes increased the
+quantity of urine, and abated the swelling, but
+which as often returned in as great a degree as
+before, though <i>the medicine was still given</i>, and always
+increased in quantity so as to excite nausea.
+Ended fatally.</p>
+
+<p>"I have tried it in many other cases, but found
+very little difference in the success attending it."</p>
+
+<p>May we not be allowed to conjecture that the inefficacy
+of <i>its continued use</i> is owing to its narcotic property
+gradually diminishing the irritability of the
+muscular fibres of the absorbents, or possibly of the
+whole vascular system, and thus adding to that
+weakened action which seems to be the cause of the
+generality of dropsies, which leads us to caution
+the medical experimenter against trying it, at least<span class='pagenum'><a name="Page_151" id="Page_151">[151]</a></span>
+<i>against its continued use, even in small doses</i>, in other
+diseases of diminished energy, as continued fever,
+palsy, &amp;c.</p>
+
+<p class="right"><span style="padding-right: 4em">I remain with the greatest truth,</span><br />
+<span style="padding-right: 2em">Your obliged and affectionate friend,</span><br />
+<span style="letter-spacing: 0.25ex">JONATHAN STOKES</span>.</p>
+
+<p style="text-indent: 0.5em">Stourbridge,<br />
+May 17, 1785.</p>
+</div>
+
+
+<h4 style="padding-left: 1em; text-indent: -1em; text-align: left; margin-left: 20%; margin-right: 20%">The three following Hospital Cases, which
+Dr. <span class="smcap">Stokes</span> had an opportunity of observing,
+are related as instances of bad practice,
+and tend to demonstrate how necessary
+it is when one physician adopts the
+medicine of another, that he should also
+at first rigidly adopt his method.</h4>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3>
+
+<p>Esther K&mdash;&mdash;, &AElig;t. 33. General anasarca,
+ascites, and dyspn&oelig;a, of seven months duration.</p>
+
+<p><i>Decoct. c Digit. &#658;iv. c. aq. &#8468;i. coquend. ad &#8468;ss. cap.
+&#8485;i. 2dis. horis.</i> 1st <span class="smcap">Day</span>. 4th dose made her sick.
+2d <span class="smcap">Day</span>. The first dose she took to-day produced
+vomiting.<span class='pagenum'><a name="Page_152" id="Page_152">[152]</a></span></p>
+
+<p>3d <span class="smcap">Day</span>. <i>Minuatur dosis ad &#8485;ss.</i> This stayed upon
+her stomach, but produced an almost constant sickness.
+Stools more frequent, water scarce sensibly
+increased; and her swellings not at all reduced.</p>
+
+<p>4th <span class="smcap">Day</span>. <i>Cap. Calomel. gambog. scill. &amp;c.</i></p>
+
+<p><span class="smcap">Obs.</span> Sufficient time was not allowed to observe
+its effects, neither was the patient enjoined the free
+use of diluents. The disease terminated fatally.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3>
+
+<p>William T&mdash;&mdash;, &AElig;t. 42. Ascites, with cough
+and dyspn&oelig;a. Abdomen very much distended.
+The rest of his body highly emaciated. Urine thick,
+high coloured, and in very small quantity.</p>
+
+<div class="recipe"><p><i>Decoct. Digit. (u. in Esther K&mdash;&mdash;,) 4tis horis.</i></p></div>
+
+<p>1st <span class="smcap">Day</span> of taking it. The 4th dose produced
+sickness.</p>
+
+<p>2d. Vomiting after the second dose.</p>
+
+<p>10th. Urine increased to &#8468;vi.</p>
+
+<p>11th. Flow of urine continues. Abdomen quite
+flaccid.<span class='pagenum'><a name="Page_153" id="Page_153">[153]</a></span></p>
+
+<p>12th. Abdomen not diminished.</p>
+
+<p>15th: A smart purging came on, and the flow of
+urine diminished.</p>
+
+<p>23d. Belly much bound. Took a cathart. powder,
+which was followed by a diminution of the
+abdomen.</p>
+
+<p>29th. To take a cathart. powder every 4th morning,
+continuing the decoct. Digit.</p>
+
+<p>32d. Urine exceedingly scanty.</p>
+
+<p>35th. <i>Vin. scill. &#8485;ss. o. m. &amp;c.</i> This produced
+diuretic effects.</p>
+
+<p>44th. Tapped. Terminated fatally.</p>
+
+<p><span class="smcap">Obs.</span> Here the medicine was <i>continued till it ceased
+to produce diuretic effects</i>; and these effects were not
+aided by any strengthening remedies.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3>
+
+<p>George R&mdash;&mdash;, &AElig;t. 52. Ascites, general anasarca,
+and dyspn&oelig;a. His legs so greatly distended
+that it was with great difficulty he could draw the
+one after the other.<span class='pagenum'><a name="Page_154" id="Page_154">[154]</a></span></p>
+
+<div class="recipe"><p>
+<i>Infus. Digital. &#658;iiiss. ad. aq. &#8468;ss. cap. &#8485;i. altern.
+horis donec nauseam excitaverit.</i> <i>Rep. 3tiis diebus.</i>
+<i>tempore intermedio cap. sol. guaic. &#8485;i. ter in</i>
+<i>die ex inf. sinap.</i></p></div>
+
+<p>1st <span class="smcap">Day</span> of taking it. Became sickish towards
+night.</p>
+
+<p>2d <span class="smcap">Day</span>. Made a great quantity of water during
+the night, and spat up a great deal of watery phlegm.
+The first dose he took in the morning has produced
+a sickness which has continued all day, but he has
+never vomited.</p>
+
+<p>3d. <span class="smcap">Day</span>. The change in his appearance so great
+as to make it difficult to conceive him to be the
+same person. Instead of a large corpulent man, he
+appeared tall, thin, and rather aged. Breathes
+freely, and can walk up and down stairs without inconvenience.</p>
+
+<p>4th <span class="smcap">Day</span>. <i>Decoct. bacc. junip. and cyder for common
+drink.</i></p>
+
+<p>6th <span class="smcap">Day</span>. A second course of his medicine produced
+a flow of urine almost as plentiful as the former,
+though he drank little or nothing at the time.
+In a day or two after he walked to some distance.</p>
+
+<p>12th <span class="smcap">Day</span>. <i>Pot. purgans illico.</i></p>
+
+<p>14th <span class="smcap">Day</span>. <i>Pot. purg. c. jalap. &#658;ss. 4tis diebus.</i><br />
+<span style="padding-left: 5em"><i>Infus. Dig. 3tiis diebus.</i></span>
+<span class='pagenum'><a name="Page_155" id="Page_155">[155]</a></span></p>
+
+<p>
+17th <span class="smcap">Day</span>. <i>R. Gamb. gr. iii. calom. gr. ii. camph.
+gr. i. syr. simpl. fiat pil. o. n. sum.</i><br />
+<span style="padding-left: 5em"><i>Infus. Digit. 3tiis diebus.</i></span></p>
+
+<p>21st <span class="smcap">Day</span>. Made an out-patient. The super-abundant
+flow of urine continued for the first three
+days after his last course; but since, the flow of saliva
+has been nearly equal to that of urine.</p>
+
+<p>The smalls of his legs not quite reduced, and are
+fuller at night. He has shrunk round the middle
+from four feet two inches to three feet six inches;
+and in the calves of his legs, from seventeen inches
+to thirteen and a half.<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a></p>
+
+<p><span class="smcap">Obs.</span> The waters were here very successfully evacuated,
+but as you remarked to me, on communicating
+the case to you at the time, tonic medicines
+should have been given, to second the ground that
+had been gained, instead of weakening the patient
+by drastic purgatives.</p>
+<p><span class='pagenum'><a name="Page_156" id="Page_156">[156]</a></span></p>
+
+<h4>A CASE from Mr. <span class="smcap">Shaw</span>, Surgeon, at<br />
+Stourbridge.&mdash;Communicated by Doctor
+<span class="smcap">Stokes</span>.</h4>
+
+<p>Matth. D&mdash;&mdash;, &AElig;t. 71. Tall and thin. Disease a
+general anasarca, with great difficulty of breathing.
+The lac ammoniac. somewhat relieved his breath;
+but the swellings increased, and his urine was not
+augmented. I considered it as a lost case, but having
+seen the good effects of the Digitalis, as ordered
+by Dr. Stokes in the case of Mrs. G&mdash;&mdash;, I gave
+him one spoonful of an infusion of &#658;ii to half a pint,
+twice a day. His breath became much easier, his
+urine increased considerably, and the swellings gradually
+disappeared; since which his health has been
+pretty good, except that about three weeks ago, he
+had a slight dyspn&oelig;a, with pain in his stomach,
+which were soon removed by a repetition of the
+same medicine.</p>
+
+<p>Mr. Shaw likewise informs me, that he has removed
+pains in the stomach and bowels, by giving
+a spoonful of the infusion, &#658;iss. to &#8485;viii. morning
+and night.<span class='pagenum'><a name="Page_157" id="Page_157">[157]</a></span></p>
+
+
+<h4>A Letter from Mr. <span class="smcap">Vaux</span>, Surgeon, in
+Birmingham.</h4>
+
+<div class="blockquot">
+<p>
+Dear <span class="smcap">Sir</span>,</p>
+
+<p>I send you the two following cases,
+wherein the Digitalis had very powerful and sensible
+effects, in the cure of the different patients.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3>
+
+<p>Mrs. O&mdash;&mdash; of L&mdash;&mdash; street, in this town,
+aged 28, naturally of a thin, spare habit, and her
+family inclinable to phthisis, sent for me on the 11th of
+June, 1779, at which time she complained of great
+pain in her side, a constant cough, expectorated
+much, which sunk in water; had colliquative sweats
+and frequent purging stools; the lower extremities
+and belly full of water, and from the great difficulty
+she had in breathing, I concluded there was water
+in the chest also. The quantity of water made at a
+time for three weeks before I saw her, never amounted
+to more than a tea-cup full, frequently not so
+much. Finding her in so alarming a situation, I gave
+it as my opinion she could receive no benefit from
+medicine, and requested her not to take any; but
+she being very desirous of my ordering her something,
+I complied, and sent her a box of gum pills
+with squills, and a mixture with salt of tartar: these
+medicines she took until the sixteenth, without any
+good effects: the water in her legs now began to exsude<span class='pagenum'><a name="Page_158" id="Page_158">[158]</a></span>
+through the skin, and a small blister on one of
+her legs broke. Believing she could not exist much
+longer, unless an evacuation of the water could be
+procured; after fully informing her of her situation,
+and the uncertainty of her surviving the use of the
+medicine, I ventured to propose her taking the Digitalis,
+which she chearfully agreed to. I accordingly
+sent her a pint mixture, made as under, of
+the fresh leaves of the Digitalis. Three drams infused
+in one pint of boiling water, when cold strained
+off, without pressing the leaves, and two ounces
+of the strong juniper water added to it: of this
+mixture she was ordered four table spoonfuls every
+third hour, till it either made her sick, purged her,
+or had a sensible effect on the kidneys. This mixture
+was sent on the seventeenth, and she began
+taking it at noon on the eighteenth. At one o'clock
+the following morning I was called up, and informed
+she was dying. I immediately attended
+her, and was agreeably surprised to find their fright
+arose from her having fainted, in consequence of the
+sudden loss of twelve quarts of water she had made
+in about two hours. I immediately applied a roller
+round her belly, and, as soon as they could be made, 2
+others, which were carried from the toes quite up the
+thighs. The relief afforded by these was immediate;
+but the medicine now began to affect her stomach so
+much, that she kept nothing on it many minutes together.
+I ordered her to drink freely of beef tea, which
+she did, but kept it on her stomach but a very short
+time. A neutral draught in a state of effervescence was
+taken to no good purpose: She therefore continued<span class='pagenum'><a name="Page_159" id="Page_159">[159]</a></span>
+the beef tea, and took no other medicine for five
+days, when her sickness went off: her cough abated,
+but the pain in her side still continuing, I applied a
+blister which had the desired effect: her urine after
+the first day flowed naturally. Her cure was compleated
+by the gum pills with steel and the bitter
+infusion. It must be observed she never had any
+collection of water afterwards.</p>
+
+<p>It affords me great pleasure to inform you that
+she is now living, and has since had four children;
+all of whom, I think I may justly say, are indebted
+to the Digitalis for their existence.</p>
+
+<p>There appears in this case a striking proof of the
+utility of emetics in some kinds of consumptions, as
+it appears to me the dropsy was brought on by the
+cough, &amp;c. and I believe these were cured by the
+continual vomitings, occasioned by the medicine.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3>
+
+<p>Mr. H&mdash;&mdash;, a publican, aged about 48 years,
+sent for me in <i>March</i>, 1778. He complained of a
+cough, shortness of breathing, which prevented him
+from laying down in bed; his belly, thighs and legs
+very much distended with water; the quantity of
+urine made at a time seldom exceeded a spoonful.
+I requested him to get some of the Digitalis, and as
+they had no proper weights in the house, I told them
+to put as much of the fresh leaves as would weigh
+down a guinea, into half a pint of boiling water;<span class='pagenum'><a name="Page_160" id="Page_160">[160]</a></span>
+to let it stand till cold, then to pour off the clear liquor,
+and add a glass of gin to it, and to take three
+table spoonfuls every third hour, until it had some
+sensible effect upon him.</p>
+
+<p>Before he had taken all the infusion, the quantity
+of urine made increased, (he therefore left off
+taking it), and it continued to do so until all the
+water was evacuated. His breathing became much
+better, his cough abated, though it never quite left
+him; he being for some time before asthmatic.
+By taking some tonic pills he continued quite well
+until the next spring, when he had a return of his
+complaint, which was carried off by the same means.
+Two years after, he had a third attack, and this also
+gave way to the medicine. Last year he died of
+a pleurisy.</p>
+
+<p class="right">
+<span style="padding-right: 6em">I am, &amp;c.</span><br />
+<span style="letter-spacing: 0.25ex">JER. VAUX</span></p>
+
+<p>Moor-Street, 8th May,<br />
+<span style="padding-left: 4em">1785.</span></p>
+
+<p>P.&nbsp;S. You must well recollect the case of Mrs.
+F&mdash;&mdash;.&mdash;It was "a general dropsy&mdash;every time
+she took the medicine its effects were similar, viz.
+The discharge of urine came on gradually at first,
+increased afterwards, and the whole of the water
+both in the belly, legs, &amp;c. was perfectly evacuated.
+Although the effects were only temporary, they
+were exceedingly agreeable to the patient, making
+her time much more comfortable."&mdash;(<i>See Case</i>
+<a href="#CASExliii">XLIII</a>.)<span class='pagenum'><a name="Page_161" id="Page_161">[161]</a></span></p>
+</div>
+
+
+<h4>A Letter from Mr. <span class="smcap">Wainwright</span>, Surgeon,
+in Dudley.</h4>
+
+<div class="blockquot">
+<p>Dear <span class="smcap">Sir</span>,</p>
+
+<p>It gives me great pleasure to
+find you intend to publish your observations on
+the Digitalis purpurea.</p>
+
+<p>Several years are now elapsed since you communicated
+to me the high opinion you entertained of
+the diuretic qualities of this noble plant. To ensure
+success, due attention was recommended to its <i>preparation</i>,
+its <i>dose</i>, and its <i>effects</i> upon the system.</p>
+
+<p>I always gave the infusion of the dried leaves;
+the dose the same as in the prescriptions returned.
+If the medicine operated on the stomach or bowels,
+it was thought prudent to forbear. When the kidneys
+began to perform their proper functions, and
+the urine to be discharged, a continuance of its farther
+use was unnecessary.</p>
+
+<p>These remarks you made in the case of the first
+patient for whom you prescribed the Digitalis in our
+neighbourhood, and I have found them all necessary
+at this present period. From the <i>decided</i> good effects
+that followed from its use, in those cases where the
+most powerful remedies had failed, I was soon convinced
+it was a most valuable addition to the materia
+medica.<span class='pagenum'><a name="Page_162" id="Page_162">[162]</a></span></p>
+
+<p>The want of a certain diuretic, has long been one
+of the desiderata of medicine. The Digitalis is undoubtedly
+at the head of that class, and will seldom,
+if properly administered, disappoint the expectation.
+I can speak with the more confidence, having, in an
+extensive practice, been a happy witness to its good
+qualities.</p>
+
+<p>For several years, I have given the infusion in
+a variety of cases, where there was a deficiency
+in the secretion of the urine, with the greatest success.
+In recent obstructions, I do not recollect
+many failures. In anasarcous diseases, and in the
+anasarca, when combined with the ascites; in swellings
+of the limbs, and in diseases of the chest, when
+there was the greatest reason to believe an accumulation
+of serum, the most beneficial consequences
+have followed from its use.</p>
+
+<p>Had I been earlier acquainted with your intention
+to publish an account of the Digitalis, I could
+have transmitted some cases, which might have
+served to corroborate these assertions: but I am
+convinced the Digitalis needs not my assistance to
+procure a favorable reception. Its own merit will
+ensure success, more than a hundred recited cases.</p>
+
+<p>I could wish those gentlemen who intend to make
+use of this plant, to collect it in a hot dry day, when
+the petals fall, and the seed-vessels begin to swell.<span class='pagenum'><a name="Page_163" id="Page_163">[163]</a></span></p>
+
+<p>The leaves kept to the second year are weaker,
+and their diuretic qualities much diminished. It
+will therefore be necessary to gather the plant fresh
+every season.</p>
+
+<p>These cautions are unnecessary to the accurate
+botanist, who well knows, that a plant in the spring,
+though more succulent and full of juices, is destitute
+of those qualities which may be expected when that
+plant has attained its full vigour, and the seed-vessels
+begin to be manifest. But for want of attention
+to these particulars, its virtues may be thought
+exaggerated, or doubtful, if beneficial consequences
+do not always flow from its use. There are diseases
+it cannot cure; and in several of those patients in
+this town, who first took the Digitalis by your
+orders, there was the most positive proof of the
+viscera being unsound. In these desperate cases
+it often procured a plentiful flow of urine, and
+palliated a disease which medicine could not remove.</p>
+
+<p>At a remote distance, physicians are seldom applied
+to for advice in trifling disorders. Many
+remedies have been tried without relief, and the
+disease is generally obstinate or confirmed.&mdash;It
+would not be fair to try the merits of the Digitalis
+in this scale. It might often fail of promoting
+the end desired. I flatter myself the reputation
+of this plant will be equal to its merit, and that it
+will meet with a candid reception.<span class='pagenum'><a name="Page_164" id="Page_164">[164]</a></span></p>
+
+<p>As there is no pleasure equal to relieving the miseries
+and distresses of our fellow-creatures, I hope
+you will long enjoy that peculiar felicity.</p>
+
+<p>Permit me to return my thankful acknowledgments,
+for your free communication of a medicine,
+by which means, through the blessing of providence,
+I have been enabled to restore health and happiness
+to many miserable objects.</p>
+
+<p class="right">
+<span style="padding-right: 8em">I am, &amp;c.</span><br />
+<span style="padding-right: 6em">Yours,</span><br />
+<span style="letter-spacing: 0.25ex">J. WAINWRIGHT</span>.</p>
+
+<p>Dudley, April 26th,<br />
+<span style="padding-left: 3em">1785.</span></p>
+</div>
+
+
+<h4><span style="letter-spacing: 0.25ex">CASE</span> of Mr. <span class="smcap">Ward</span>, Surgeon, in
+Birmingham.&mdash;Related by himself.</h4>
+
+<p>In <i>September</i>, 1782, I was seized with a difficulty
+of breathing, and oppression in my chest, in
+consequence of taking cold from being called out in
+the night. My tongue was foul; my urine small
+in quantity; my breath laborious and distressing on
+the slightest exercise. I tried the medicines most generally
+recommended, such as emetics, blisters, lac
+ammoniacum, oxymel of squills, &amp;c. but finding
+little or no relief, I consulted Dr. Withering, who
+advised me to try the following prescription.<span class='pagenum'><a name="Page_165" id="Page_165">[165]</a></span></p>
+
+<div class="recipe"><p>R. Fol. Digital. purp. siccat. &#658;iss.<br />
+Aq. bullientis &#8485;iv.<br />
+Aq. cinn. sp. &#8485;ss. digere per horas quatuor, et colatur&aelig; capiat cochlear. i. nocte maneque.</p></div>
+
+<p>He also desired me to take fifty drops of tincture
+of cantharides three or four times a day.</p>
+
+<p>After taking eight ounces of the infusion, and
+about twelve drams of the drops, I was perfectly
+cured, and have had no return since. The medicine
+did not occasion sickness or vertigo, nor had
+they any other sensible effect than in changing the
+appearance, and increasing the quantity of the urine,
+and rendering the tongue clean. After the last dose
+or two indeed, I had a little nausea, which was immediately
+removed by a small glass of brandy.</p>
+
+<p>
+Birmingham, 1st July, 1785.</p>
+
+
+<h4>Communications from Mr. <span class="smcap">Yonge</span>, Surgeon,
+in Shiffnall, Shropshire.</h4>
+
+<div class="blockquot">
+<p>
+Dear <span class="smcap">Sir</span>,</p>
+
+<p>I have great satisfaction in
+complying with your just claim, by transcribing outlines
+of the subsequent cases, for insertion in your long
+requested tract on the Digitalis purpurea. The two
+first of these you will easily recollect, the cures having
+been conducted immediately under your own management,<span class='pagenum'><a name="Page_166" id="Page_166">[166]</a></span>
+and the whole may add to that weight of evidence
+which long experience enables you to adduce
+of the efficacy of that valuable medicine. I
+have recited the only instances of its failure which
+occur to me, but many other, though successful
+cases, wherein its utility might seem dubious, and
+also the accounts received from people whose accuracy
+might be suspected, I shall not for obvious reasons
+trouble you with.</p>
+
+<p class="right">
+<span style="padding-right: 8em">I am, dear Sir,</span><br />
+<span style="padding-right: 4em">Your obliged friend,</span><br />
+<span style="letter-spacing: 0.25ex">WILLIAM YONGE</span>.</p>
+
+<p>Shiffnall,<br />
+<i>May</i> 1, 1785.</p>
+</div>
+
+<h3><a name="CASEyi" id="CASEyi"></a>CASE <span style="letter-spacing: 0ex">I.</span></h3>
+
+<p>A Gentleman aged 49, on the night of the
+21st of August, 1784, awaked with a sense of suffocation,
+which obliged him to rise up suddenly in
+bed. I found him complaining of difficult respiration,
+particularly on lying down; the countenance
+pale, and the pulse smaller and quicker than
+usual. Some brandy and water having been given,
+the symptoms gradually abated, so that he slept in a
+half recumbent posture. The following day he
+expressed a sense of anxiety and weight in the chest,
+attended by quicker breathing upon motion of the
+body. That evening an emetic of ipecacoanha was
+given, and afterwards a draught, with vitriolic &aelig;ther<span class='pagenum'><a name="Page_167" id="Page_167">[167]</a></span>
+and confect. card. aa &#658;i to be repeated as the symptoms
+should require it. He continued to be affected
+with slighter returns of the dyspn&oelig;a at irregular
+intervals, until <i>September</i> 15th, when upon a more
+severe attack, the emetic was repeated. He now
+recollected some slight pain in his arms which had
+affected him previous to this last seizure, and was
+disposed to consider his complaint as rheumatic.
+Pills with gum ammoniac. gum guaiac. and antimonial
+powder were directed, with infus. amar. simpl.
+twice a day. The bowels were regulated by aperient
+pills of pulv. jalap. aloes and sal. tartar. and
+&#658;iss balsam peruv. was given occasionally to alleviate
+the paroxysms of dyspn&oelig;a.</p>
+
+<p>From this period until the beginning of November,
+little amendment or variation happened,
+except that respiration became more permanently
+difficult, and particularly oppressed upon motion,
+nor was it relieved by the expectoration of a mucous
+discharge, which now increased considerably.
+Squills, musk, ol. succini, &aelig;ther, with other medicines
+of the same kind, were now used, but without
+success. The effects of opium and ven&aelig;fection
+were tried. The appetite diminished, and his
+sleep became short and disturbed. He sometimes
+slept lying upon his back, but generally upon his
+left side. The urine which had hitherto been of
+good colour, and sufficient quantity, now became
+diminished, and lateritious; and the ancles &oelig;dematous.<span class='pagenum'><a name="Page_168" id="Page_168">[168]</a></span></p>
+
+<p>On the 15th of <i>November</i> a blister was laid over
+the sternum, and &#658;iss of oxymel scillitic. was given
+every eight hours.</p>
+
+<p>On the 18th, a more copious discharge of urine
+took place; the swelling of the feet soon disappeared,
+and the respiration became gradually relieved.</p>
+
+<p>On the 30th &#658;i tinct. cantharidum twice a day in
+pyrmont water, with pills of ammoniac, sal tartar.
+et extract. gentian. were substituted, but</p>
+
+<p>On the 7th of <i>December</i>, from some symptoms
+of relapse, the oxymel was used as before, and continued
+to be taken until the 27th, in doses as large
+as could be dispensed with on account of the great
+nausea which attended its exhibition: The urine
+was made in the quantity of four or five pints each
+day, during the whole time; the quantity then
+drank being seldom more than three pints. But
+now the sickness being exceedingly depressing, the
+strength failing, and the diuretic effects beginning
+to cease, the following prescription was directed.</p>
+
+<div class="recipe"><p>
+R. Fol. Digitalis purpur. pulv. &#8456;ss.<br />
+Spec. Aromatic. &#8456;i. sp. lav. c. f. pilul. no. x.
+capiat i. nocte maneque, et alternis diebus sensim augeatur
+dosin.</p></div>
+
+<p>In three days the effect of this medicine became
+visible, and when the dose of the Digitalis had been<span class='pagenum'><a name="Page_169" id="Page_169">[169]</a></span>
+increased to six grains per day, the flow of urine
+generally amounted to seven pints every twenty-four
+hours. Not the least sickness, nor any other
+disagreeable symptom supervened, though he persevered
+in this plan until the end of <i>January</i> at
+which time the dyspn&oelig;a was removed, and he has
+continued gradually to regain his flesh, strength,
+and appetite, without any relapse.</p>
+
+
+<h3><a name="CASEyii" id="CASEyii"></a>CASE <span style="letter-spacing: 0ex">II.</span></h3>
+
+<p>About the middle of the year 1784 a lady aged 48,
+returned from London, to her native air in Shropshire,
+under symptoms of complicated disease. It
+was your opinion that the plethoric state, consequent
+to that period, when menstruation first begins
+to cease, had under various appearances, laid the
+foundation of that deplorable state which now presented
+itself. The skin was universally of a pale,
+leaden colour; her person much emaciated, and her
+strength so reduced, as to disable her from walking
+without support. The appetite fluctuating, the digestion
+impaired so much, that solids passed the
+intestines with little appearance of solution: She
+had generally eight or ten alvine evacuations every
+day, and without this number, febrile symptoms,
+attended with severe vertiginous affection, and
+vomiting regularly ensued. The stools were of a
+pale ash colour. The urine generally pale, and at
+first in due quantity. The region of the stomach<span class='pagenum'><a name="Page_170" id="Page_170">[170]</a></span>
+had a tense feel, without soreness: the feet and
+ancles &oelig;dematous, her sleep was uncertain: the
+pulse varying between 94 and 100, and feeble,
+except upon the approach of the menstrual periods,
+which were now only marked by its increased
+strength, and exacerbation of other febrile symptoms.
+Emetics, saline medicines, and gentle aperients
+were necessary to alleviate these. Six grains
+of ipecac, operated with sufficient power, and half
+a grain of calomel would have purged with great
+violence.</p>
+
+<p>From the time of her arrival till the middle of
+<i>August</i>, mercury had been continued in various
+forms, and in doses such as the irritable state of her
+stomach and bowels would admit of. Spirit. nitri
+dulc.; sal. tartar, squill, and cantharides were
+alternately employed as diuretics, but without success,
+to retard the progress of an universal anasarca
+which was then advanced to such degree and accompanied
+by so great debility, and other dreadful concomitants,
+as to threaten a speedy and fatal catastrophe.</p>
+
+<p>On the 16th of <i>August</i> you first saw her, and
+directed thus.</p>
+
+<div class="recipe"><p>
+R. Mercur. cinerei gr. ii.<br />
+Fol. Digital, purpur. pulv. &#8456;i. f. mass. in
+pill. no. xvi. dividend.&mdash;sumat unam hora meridiana,
+<span class='pagenum'><a name="Page_171" id="Page_171">[171]</a></span>iterumque hora quinta pomeridiana quotidie.</p>
+</div>
+
+<div class="recipe">
+<p>Capiat lixivii saponac. gutt. L. in haust. juscul.
+sine sale parati omni nocte.</p></div>
+
+<p>On the 20th the flow of urine began to increase,
+and she continued the medicine in the same dose
+until the 20th of <i>September</i>, discharging from six to
+eight pints of water each day for the first week, and
+which quantity gradually diminished as she became
+empty. During this period she complained not of
+any sickness, except from the lixivium, which was
+after the first dose reduced to 20 drops; and her appetite
+and strength increased daily, though it was
+evident that no bile had yet flowed into the bowels,
+nor was the digestion at all improved. The anasarcous
+appearances being then removed, the Digitalis
+was omitted, and pills, composed of mercur.
+cinereus, aloes, and sal tartari directed twice a day,
+with &#658;i. of vin. chalybeat. in infus. amar. simpl.</p>
+
+<p>Her amendment in other respects proceeded
+slowly, but regularly, from that time until the 9th
+of October; when the state of plethora again recurring,
+with its usual attendant symptoms, &#8485;iv. of
+blood were taken from the arm; and this was upon
+the same occasion, repeated in the following month,
+with manifest good consequences; though in both
+instances the colour of the blood, as flowing from
+the vein could hardly be called red, and the coagulum
+was as weak in its cohesion as possible. The
+state of the stomach and bowels was by this time
+greatly improved, in common with other parts of<span class='pagenum'><a name="Page_172" id="Page_172">[172]</a></span>
+the system; but no intromission of bile had yet
+happened: the hardness about the hypogastric region,
+though less, continued in a considerable degree,
+and you ordered pills of mercury rubbed
+down, and rust of iron, to be taken twice a day,
+with a decoction of dandelion and sal sod&aelig;.</p>
+
+<p>A cataplasm of linseed was applied every night
+over the stomach and right side; and, with little
+deviation from this plan, she continued to the end
+of the year, improving in her general health, but
+the hepatic affection yet remaining. It was then
+determined to try the effects of electricity, and
+gentle shocks were passed through the body daily,
+and as nearly as could be through the liver, in various
+directions.</p>
+
+<p>On the fifth day there was reason to think that
+some gall had been secreted and poured out, and
+this became every day more evident; but it flowed
+only in small quantity, and irregularly into the
+bowels, as appeared from the f&aelig;ces being partially
+tinged by it.</p>
+
+<p>In <i>February</i> the lady left this neighbourhood, and
+though convalescent, yet so nearly well as to promise
+us the satisfaction of seeing her perfectly restored.</p>
+
+<p><i>June</i> 29. The bile is now secreted in pretty good
+quantity, her appetite is perfectly good, her strength
+equal to almost any degree of exercise, and her<span class='pagenum'><a name="Page_173" id="Page_173">[173]</a></span>
+health in general better than it has been for some
+years.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3>
+
+<p>Mr. W&mdash;&mdash;, aged&mdash;. In <i>June</i>, 1782, was
+affected with slight difficulty in respiration, upon taking
+exercise or lying down in bed. These symptoms
+increased gradually until the end of <i>July</i>,
+when he complained of sense of weight and uneasiness
+about the pr&oelig;cordia; loss of appetite; and
+costiveness. The urine was small in quantity, and
+high coloured; his pulse feeble, and intermitting;
+he breathed with difficulty when in bed, and slept
+little. After the exhibition of an emetic, and an
+opening medicine of rhubarb, sena, and sal tartari,
+he was directed to take half a dram of squill pill,
+pharm. Edinburg. night and morning, with &#658;ss sal.
+sod&aelig; in &#8485;iss. infus. amar. simpl. twice a day; and
+these medicines were continued during ten days,
+without any sensible effect. A blister was then applied
+to the sternum, and six grains of calomel given
+in the evening. The symptoms were now increased
+very considerably, in every particular; and
+the following infusion was substituted for the former
+medicines.</p>
+
+<div class="recipe"><p>R. Fol. Digital. purpur. &#658;iii.<br />
+Cort. limon. &#658;ii. infund.<br />
+Aq. bullient. &#8468;i. per hor. 2 et cola. sumat
+cochl. i. primo mane et repet. omni hora.</p></div>
+
+<p>Sometime in the night considerable nausea occurred,<span class='pagenum'><a name="Page_174" id="Page_174">[174]</a></span>
+and the following day he began to make water
+in great quantity, which he continued to do for
+three or four days. The pulse in a few hours became
+regular, slower, and stronger, and, in the
+course of a week, all the symptoms entirely vanished,
+and an electuary of cort. peruvian, sal martis,
+and spec. aromatic. confirmed his cure.</p>
+
+<p>In <i>February</i>, 1784, this gentleman had a relapse
+of his disease, from which he again soon recovered
+by the same means, and is now perfectly well.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">IV.</span></h3>
+
+<p>G&mdash;&mdash; A&mdash;&mdash;, a husbandman, aged 57. Was
+in the year 1782 affected with a slight, but constant
+pain in his breast, with difficult respiration. His
+countenance was yellow; the abdomen swelled, and
+hard; his urine high coloured, and in small quantity;
+appetite and sleep little. Complained of frequent
+nausea, and of sudden profuse sweatings,
+which seemed for a short time to relieve the dyspn&oelig;a.</p>
+
+<p>After the exhibition of an emetic, six grains of
+calomel were given, with a purge of jalap in the
+morning, and repeated in a few days, with some appearance
+of advantage. He was then directed to
+take some pills of squill, soap, and rhubarb, with a
+draught twice a day, consisting of infus. amar. simp.
+and sal tartari. The skin soon became clearer and<span class='pagenum'><a name="Page_175" id="Page_175">[175]</a></span>
+the pain in his breast considerably diminished. But
+every other circumstance remaining the same, and
+a fluctuation in the belly being now more evident,
+the infusion of Digitalis as prescribed in case third,
+was given in the dose of one ounce twice a day.</p>
+
+<p>On the 5th day the effects were apparent, and he
+continued his medicine for a fortnight without nausea,
+making four or five pints of water every night,
+but little in the day, and gradually losing the symptoms
+of his disease.</p>
+
+<p>In 1784, this person had a relapse, and was again
+cured by similar treatment.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">V.</span></h3>
+
+<p>R&mdash;&mdash; H&mdash;&mdash;, Aged 43. Towards the end of the
+year 1783, became affected with slight cough and expectoration
+of purulent matter. In December his
+skin became universally of a pale yellow colour.
+The abdomen was swelled and hard; his appetite
+little, and he complained of a violent and constant
+palpitation of the heart, which prevented him from
+sleeping. The urine pale, and in small quantity.
+The pulse exceedingly strong, and rebounding;
+beating 114 to 120 strokes every minute. He suffered
+violent pain of his head, and was very feeble and
+emaciated. After bleeding, and the use of gentle
+aperient medicines, he continued to take the infusion
+of Digitalis for some days, without any sensible
+effect. Other diuretics were tried to as little purpose.<span class='pagenum'><a name="Page_176" id="Page_176">[176]</a></span>
+Repeated bleeding had no effect in diminishing
+the violent action of the heart. He died in
+January following, under complicated symptoms of
+phthisis and ascites.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">VI.</span></h3>
+
+<p>A man aged 57, who had lived freely in the summer
+of 1784, became affected with &oelig;dematous
+swelling of his legs, for which he was advised to
+drink Fox Glove Tea. He took a four ounce bason
+of the infusion made strong with the green leaves,
+every morning for four successive days.</p>
+
+<p>On the 5th he was suddenly seized with faintness
+and cold sweatings. I found him with a pale countenance,
+complaining of weakness, and of pain,
+with a sense of great heat in his stomach and
+bowels. The swelling of the legs was entirely gone,
+he having evacuated urine in very large quantities
+for the two preceding days. He was affected with
+frequent diarrh&oelig;a. The pulse was very quick and
+small, and his extremities cold.</p>
+
+<p>A small quantity of broth was directed to be given
+him every half hour, and blisters were applied
+to the ancles, by which his symptoms became gradually
+alleviated, and he recovered perfectly in the
+space of three weeks; except a relapse of the anasarca,
+for which the Digitalis was afterwards successfully
+employed, in small doses, without any disagreeable
+consequence.<span class='pagenum'><a name="Page_177" id="Page_177">[177]</a></span></p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">VII.</span></h3>
+
+<p>S&mdash;&mdash; D&mdash;&mdash;, a middle aged single woman,
+was affected in the year eighty-one, with a painful
+rigidity and slight inflammation of the integuments
+on the left side, extending from the ear to the shoulder.
+In every other particular she was healthy.
+The use of warm fomentations, and opium, with
+two or three doses of mercurial physic, afforded her
+ease and the inflammation disappeared, but was succeeded
+by an &oelig;dematous swelling of the part, which
+very gradually extended along the arm, and downward
+to the breast, back, and belly. Friction,
+electricity and mercurial ointment were amongst the
+number of applications unsuccessfully employed to
+relieve her for the space of three months, during
+which time she continued in good general health.</p>
+
+<p>In <i>November</i> she became ascitic, passing small
+quantities of urine, and soon afterwards a sudden
+dyspn&oelig;a gave occasion to suppose an effusion of water
+in the thorax. The Digitalis, squills, and cantharides
+were given in very considerable doses without
+effect. She died the latter end of December following.</p>
+
+
+<h3>CASE <span style="letter-spacing: 0ex">VIII.</span></h3>
+
+<p>W&mdash;&mdash; C&mdash;&mdash;, a collier aged 58, was attacked
+in the spring of 1783 with a tertian ague,
+which he attributed to cold, by sleeping in a coal<span class='pagenum'><a name="Page_178" id="Page_178">[178]</a></span>
+pit, and from which he recovered in a few days,
+except a swelling of the lower extremities, which
+had appeared about that time, and gradually increased
+for two or three months. The legs and
+thighs were greatly enlarged and &oelig;dematous. His
+belly was swelled, but no fluctuation perceptible. He
+made small quantities of high coloured water. The
+appetite bad, and pulse feeble. He had taken many
+medicines without relief, and was now so reduced
+in strength, as to sit up with difficulty. An infusion
+of the Digitalis was directed for him, in the
+proportion of one ounce of the fresh leaves to a pint
+of water, two ounces to be taken three times a day,
+until the stomach or bowels became affected. Upon
+the exhibition of the sixth dose, nausea supervened,
+and continued to oppress him at intervals for two or
+three days, during which he passed large quantities of
+pale urine. The swelling, assisted by moderate
+bandage rapidly diminished, and without any repetition
+of his medicine, at the expiration of sixteen
+days, he returned to his labour perfectly recovered.<span class='pagenum'><a name="Page_179" id="Page_179">[179]</a></span></p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> R. Rad. scil. recent. sapon. castiliens. pulv. Rhei opt. aa. &#8456;i.
+ol. junip. gutt. xvi. syr. bals. q. s. f. mass. in pil. xxiv. divid.</p></div>
+
+<div class="footnote"><p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Prepared in the same manner as in the former case.</p></div>
+
+<div class="footnote"><p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> See this account in the <a href="#INTRODUCTION">Introduction</a>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> For reasons assigned at <a href="#Page_100">p. 100</a>, I did not intend to introduce
+any case, occurring under my own inspection, in the course of the
+present year; but it may be satisfactory to continue the history of
+this disease, as Dr. Stokes's narrative would otherwise be incomplete.
+</p>
+
+<p class="center">1785.</p>
+
+<p class="center">CASE.</p>
+
+<p><i>Jan.</i> 5th. Mrs. M&mdash;&mdash;, &AElig;t. 48. Hydrothorax and anasarcous
+legs, of eight months duration. She had taken jallap, squill,
+salt of tartar, and various other medicines. I found her in a very
+reduced state, and therefore directed only a grain and half of the
+Pulv. Digital. to be given night and morning. This in a few
+days encreased the secretion of urine, removed her difficulty of
+breathing, and reduced the swelling of her legs, without any disturbance
+to her system.
+</p><p>
+Three months afterwards, a severe attack of gout in her legs
+and arms, removing to her head, she died.
+</p><p>
+Dr. Stokes had an opportunity of examining the dead body,
+and I had the satisfaction to learn from him, that there did not
+appear to have been any return of the dropsy.</p></div>
+
+<div class="footnote"><p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> In the three last recited cases, the medicine was directed in
+doses quite too strong, and repeated too frequently. If Esther
+K&mdash;&mdash; could have survived the extreme sickness, the diuretic
+effects would probably have taken place, and, from her time of
+life, I should have expected a recovery. Wm. T&mdash;&mdash; seems to
+have been a bad case, and I think would not have been cured under
+any management. G. R&mdash;&mdash; certainly possessed a good constitution,
+or he must have shared the fate of the other two.</p></div>
+</div>
+
+
+
+<h2 style="line-height: 150%"><a name="OF_THE" id="OF_THE"></a><span style="font-size: 70%">OF THE</span><br />
+PREPARATIONS and DOSES,<br />
+<span style="font-size: 70%">OF THE</span><br />
+FOXGLOVE.</h2>
+
+<hr class="chapter" />
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">E</span>very</span> part of the plant has more or less of
+the same bitter taste, varying, however, as
+to strength, and changing with the age of the plant
+and the season of the year.</p>
+
+<p><span style="letter-spacing: 0.25ex">ROOT</span>.&mdash;This varies greatly with the age of
+the plant. When the stem has shot up for flowering,
+which it does the second year of its growth,
+the root becomes dry, nearly tasteless, and inert.</p>
+
+<p>Some practitioners, who have used the root, and
+been so happy as to cure their patients without exciting
+sickness, have been pleased to communicate
+the circumstance to me as an improvement in the
+use of the plant. I have no doubt of the truth of
+their remarks, and I thank them. But the case of
+Dr. Cawley puts this matter beyond dispute. The
+fact is, they have fortunately happened to use the
+root in its approach to its inert state, and consequently
+have not over dosed their patients. I could,<span class='pagenum'><a name="Page_180" id="Page_180">[180]</a></span>
+if necessary, bring other proof to shew that the root
+is just as capable as the leaves, of exciting nausea.</p>
+
+<p><span style="letter-spacing: 0.25ex">STEM</span>.&mdash;The stem has more taste than the root
+has, in the season the stem shoots out, and less taste
+than the leaves. I do not know that it has been
+particularly selected for use.</p>
+
+<p><span style="letter-spacing: 0.25ex">LEAVES</span>.&mdash;These vary greatly in their efficacy
+at different seasons of the year, and, perhaps,
+at different stages of their growth; but I am not
+certain that this variation keeps pace with the greater
+or lesser intensity of their bitter taste.</p>
+
+<p>Some who have been habituated to the use of
+the recent leaves, tell me, that they answer their
+purpose at every season of the year; and I believe
+them, notwithstanding I myself have found very
+great variations in this respect. The solution of
+this difficulty is obvious. They have used the leaves
+in such large proportion, that the doses have been
+sufficient, or more than sufficient, even in their
+most inefficacious state. <i>The Leaf-stalks</i> seem, in
+their sensible properties, to partake of an intermediate
+state between the leaves and the stem.</p>
+
+<p><span style="letter-spacing: 0.25ex">FLOWERS</span>.&mdash;The petals, the chives, and the
+pointal have nearly the taste of the leaves, and it
+has been suggested to me, by a very sensible and
+judicious friend, that it might be well to fix on the
+flower for internal use. I see no objection to the
+proposition; but I have not tried it.<span class='pagenum'><a name="Page_181" id="Page_181">[181]</a></span></p>
+
+<p><span style="letter-spacing: 0.25ex">SEEDS</span>.&mdash;These I believe are equally untried.</p>
+
+<p>From this view of the different parts of the plant,
+it is sufficiently obvious why I still continue to prefer
+the leaves.</p>
+
+<p>These should be gathered after the flowering stem
+has shot up, and about the time that the blossoms
+are coming forth.</p>
+
+<p>The leaf-stalk and mid-rib of the leaves should
+be rejected, and the remaining part should be dried,
+either in the sun-shine, or on a tin pan or pewter
+dish before a fire.</p>
+
+<p>If well dried, they readily rub down to a beautiful
+green powder, which weighs something less than
+one-fifth of the original weight of the leaves. Care
+must be taken that the leaves be not scorched in
+drying, and they should not be dried more than
+what is requisite to allow of their being readily reduced
+to powder.</p>
+
+<p>I give to adults, from one to three grains of this
+powder twice a day. In the reduced state in which
+physicians generally find dropsical patients, four
+grains a day are sufficient. I sometimes give the
+powder alone; sometimes unite it with aromatics,
+and sometimes form it into pills with a sufficient
+quantity of soap or gum ammoniac.<span class='pagenum'><a name="Page_182" id="Page_182">[182]</a></span></p>
+
+<p>If a liquid medicine be preferred, I order a dram
+of these dried leaves to be infused for four hours
+in half a pint of boiling water, adding to the strained
+liquor an ounce of any spirituous water. One ounce
+of this infusion given twice a day, is a medium dose
+for an adult patient. If the patient be stronger than
+usual, or the symptoms very urgent, this dose may
+be given once in eight hours; and on the contrary
+in many instances half an ounce at a time will be
+quite sufficient. About thirty grains of the powder
+or eight ounces of the infusion, may generally be
+taken before the nausea commences.</p>
+
+<p>The ingenuity of man has ever been fond of exerting
+itself to vary the forms and combinations of
+medicines. Hence we have spirituous, vinous, and
+acetous tinctures; extracts hard and soft, syrups
+with sugar or honey, &amp;c. but the more we multiply
+the forms of any medicine, the longer we shall
+be in ascertaining its real dose. I have no lasting
+objection however to any of these formul&aelig; except
+the extract, which, from the nature of its preparation
+must ever be uncertain in its effects; and a
+medicine whose fullest dose in substance does not
+exceed three grains, cannot be supposed to stand in
+need of condensation.</p>
+
+<p>It appears from several of the cases, that when the
+Digitalis is disposed to purge, opium may be joined
+with it advantageously; and when the bowels are
+too tardy, jalap may be given at the same time,<span class='pagenum'><a name="Page_183" id="Page_183">[183]</a></span>
+without interfering with its diuretic effects; but I
+have not found benefit from any other adjunct.</p>
+
+<p>From this view of the doses in which the Digitalis
+really ought to be exhibited, and from the evidence
+of many of the cases, in which it appears to
+have been given in quantities six, eight, ten or even
+twelve times more than necessary, we must admit
+as an inference either that this medicine is perfectly
+safe when given as I advise, or that the medicines
+in daily use are highly dangerous.<span class='pagenum'><a name="Page_184" id="Page_184">[184]</a></span></p>
+
+
+
+<h2><a name="EFFECTS_RULES_and_CAUTIONS" id="EFFECTS_RULES_and_CAUTIONS"></a>EFFECTS, RULES, <span style="letter-spacing: 0ex">and</span> CAUTIONS.</h2>
+
+<hr class="chapter" />
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Foxglove when given in very large and quickly-repeated
+doses, occasions sickness, vomiting,
+purging, giddiness, confused vision, objects appearing
+green or yellow; increased secretion of urine,
+with frequent motions to part with it, and sometimes
+inability to retain it; slow pulse, even as slow as 35
+in a minute, cold sweats, convulsions, syncope,
+death.<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a></p>
+
+<p>When given in a less violent manner, it produces
+most of these effects in a lower degree; and
+it is curious to observe, that the sickness, with a certain
+dose of the medicine, does not take place for many
+hours after its exhibition has been discontinued;
+that the flow of urine will often precede, sometimes
+accompany, frequently follow the sickness at the
+distance of some days, and not unfrequently be
+checked by it. The sickness thus excited, is extremely
+different from that occasioned by any other
+medicine; it is peculiarly distressing to the patient;
+it ceases, it recurs again as violent as before; and
+thus it will continue to recur for three or four days,
+at distant and more distant intervals.</p>
+<p><span class='pagenum'><a name="Page_185" id="Page_185">[185]</a></span></p>
+<p>These sufferings of the patient are generally rewarded
+by a return of appetite, much greater than
+what existed before the taking of the medicine.</p>
+
+<p>But these sufferings are not at all necessary;
+they are the effects of our inexperience, and would
+in similar circumstances, more or less attend the exhibition
+of almost every active and powerful medicine
+we use.</p>
+
+<p>Perhaps the reader will better understand how it
+ought to be given, from the following detail of my
+own improvement, than from precepts peremptorily
+delivered, and their source veiled in obscurity.</p>
+
+<p>At first I thought it necessary <i>to bring on and
+continue the sickness, in order to ensure the diuretic
+effects</i>.</p>
+
+<p>I soon learnt that the nausea being once excited,
+it was unnecessary to repeat the medicine, as it was
+certain to recur frequently, at intervals more or less
+distant.</p>
+
+<p>Therefore my patients were ordered <i>to persist
+until the nausea came on, and then to stop</i>. But it
+soon appeared that the diuretic effects would often
+take place first, and sometimes be checked when the
+sickness or a purging supervened.<span class='pagenum'><a name="Page_186" id="Page_186">[186]</a></span></p>
+
+<p>The direction was therefore enlarged thus&mdash;<i>Continue
+the medicine until the urine flows, or sickness or
+purging take place</i>.</p>
+
+<p>I found myself safe under this regulation for two
+or three years; but at length cases occurred in
+which the pulse would be retarded to an alarming
+degree, without any other preceding effect.</p>
+
+<p>The directions therefore required an additional
+attention to the state of the pulse, and it was moreover
+of consequence not to repeat the doses too
+quickly, but to allow sufficient time for the effects
+of each to take place, as it was found very possible
+to pour in an injurious quantity of the medicine,
+before any of the signals for forbearance appeared.</p>
+
+<p><i>Let the medicine therefore be given in the doses, and
+at the intervals mentioned above:&mdash;let it be continued
+until it either acts on the kidneys, the stomach, the pulse,
+or the bowels; let it be stopped upon the first appearance
+of any one of these effects</i>, and I will maintain that
+the patient will not suffer from its exhibition, nor
+the practitioner be disappointed in any reasonable
+expectation.</p>
+
+<p>If it purges, it seldom succeeds well.</p>
+
+<p>The patients should be enjoined to drink very
+freely during its operation. I mean, they should
+drink whatever they prefer, and in as great quantity<span class='pagenum'><a name="Page_187" id="Page_187">[187]</a></span>
+as their appetite for drink demands. This direction
+is the more necessary, as they are very generally
+prepossessed with an idea of drying up a
+dropsy, by abstinence from liquids, and fear to add
+to the disease, by indulging their inclination to
+drink.</p>
+
+<p>In cases of ascites and anasarca; when the patients
+are weak, and the evacuation of the water
+rapid; the use of proper bandage is indispensably
+necessary to their safety.</p>
+
+<p>If the water should not be wholly evacuated,
+it is best to allow an interval of several days before
+the medicine be repeated, that food and tonics maybe
+administered; but truth compels me to say, that
+the usual tonic medicines have in these cases very
+often deceived my expectations.</p>
+
+<p>From some cases which have occurred in the
+course of the present year, I am disposed to believe
+that the Digitalis may be given in small doses, viz.
+two or three grains a day, so as gradually to remove
+a dropsy, without any other than mild diuretic effects,
+and without any interruption to its use until
+the cure be compleated.</p>
+
+<p>If inadvertently the doses of the Foxglove should
+be prescribed too largely, exhibited too rapidly, or
+urged to too great a length; the knowledge of a
+remedy to counteract its effects would be a desirable<span class='pagenum'><a name="Page_188" id="Page_188">[188]</a></span>
+thing. Such a remedy may perhaps in time be
+discovered. The usual cordials and volatiles are
+generally rejected from the stomach; aromatics and
+strong bitters are longer retained; brandy will sometimes
+remove the sickness when only slight; I have
+sometimes thought small doses of opium useful, but I
+am more confident of the advantage from blisters.
+Mr. Jones (<a href="#Page_135"><i>Page</i> 135</a>) in one case, found mint tea to
+be retained longer than other things.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> I am doubtful whether it does not sometimes excite a copious
+flow of saliva.&mdash;See cases at pages <a href="#Page_115">115</a>, <a href="#Page_154">154</a>, and <a href="#Page_155">155</a>.</p></div>
+</div>
+
+
+<h2><a name="CONSTITUTION_of_PATIENTS" id="CONSTITUTION_of_PATIENTS"></a>CONSTITUTION <span style="letter-spacing: 0ex">of</span> PATIENTS.<span class='pagenum'><a name="Page_189" id="Page_189">[189]</a></span></h2>
+
+<hr class="chapter" />
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">I</span>ndependent</span> of the degree of disease, or
+of the strength or age of the patient, I have
+had occasion to remark, that there are certain constitutions
+favourable, and others unfavourable to
+the success of the Digitalis.</p>
+
+<p>From large experience, and attentive observation,
+I am pretty well enabled to decide <i>a priori</i>
+upon this matter, and I wish to enable others to do
+the same: but I feel myself hardly equal to the undertaking.
+The following hints, however, aiding
+a degree of experience in others, may lead them
+to accomplish what I yet can describe but imperfectly.</p>
+
+<p>It seldom succeeds in men of great natural
+strength, of tense fibre, of warm skin, of florid
+complexion, or in those with a tight and cordy
+pulse.</p>
+
+<p>If the belly in ascites be tense, hard, and circumscribed,
+or the limbs in anasarca solid and resisting,
+we have but little to hope.</p>
+
+<p>On the contrary, if the pulse be feeble or intermitting,
+the countenance pale, the lips livid, the
+skin cold, the swollen belly soft and fluctuating, or<span class='pagenum'><a name="Page_190" id="Page_190">[190]</a></span>
+the anasarcous limbs readily pitting under the pressure
+of the finger, we may expect the diuretic effects
+to follow in a kindly manner.</p>
+
+<p>In cases which foil every attempt at relief, I have
+been aiming, for some time past, to make such a
+change in the constitution of the patient, as might
+give a chance of success to the Digitalis.</p>
+
+<p>By blood-letting, by neutral salts, by chrystals
+of tartar, squills, and occasional purging, I have
+succeeded, though imperfectly. Next to the use
+of the lancet, I think nothing lowers the tone of
+the system more effectually than the squill, and consequently
+it will always be proper, in such cases, to
+use the squill; for if that fail in its desired effect, it
+is one of the best preparatives to the adoption of the
+Digitalis.</p>
+
+<p>A tendency to paralytic affections, or a stroke of
+the palsy having actually taken place, is no objection
+to the use of the Digitalis; neither does a
+stone existing in the bladder forbid its use. Theoretical
+ideas of sedative effects in the former, and
+apprehensions of its excitement of the urinary organs
+in the latter case, might operate so as to
+make us with-hold relief from the patient; but experience
+tells me, that such apprehensions are
+groundless.<span class='pagenum'><a name="Page_191" id="Page_191">[191]</a></span></p>
+
+
+
+<h3><a name="INFERENCES" id="INFERENCES"></a>INFERENCES.</h3>
+
+
+<p>To prevent any improper influence, which the
+above recitals of the efficacy of the medicine, aided
+by the novelty of the subject, may have upon the
+minds of the younger part of my readers, in raising
+their expectations to too high a pitch, I beg leave to
+deduce a few inferences, which I apprehend the
+facts will fairly support.</p>
+
+<p>I. That the Digitalis will not universally act as a
+diuretic.</p>
+
+<p>II. That it does do so more generally than any
+other medicine.</p>
+
+<p>III. That it will often produce this effect after
+every other probable method has been fruitlessly
+tried.</p>
+
+<p>IV. That if this fails, there is but little chance
+of any other medicine succeeding.</p>
+
+<p>V. That in proper doses, and under the management
+now pointed out, it is mild in its operation,
+and gives less disturbance to the system, than squill,
+or almost any other active medicine.</p>
+
+<p>VI. That when dropsy is attended by palsy, unsound
+viscera, great debility, or other complication
+of disease, neither the Digitalis, nor any other diuretic<span class='pagenum'><a name="Page_192" id="Page_192">[192]</a></span>
+can do more than obtain a truce to the urgency
+of the symptoms; unless by gaining time, it may
+afford opportunity for other medicines to combat
+and subdue the original disease.</p>
+
+<p>VII. That the Digitalis may be used with advantage
+in every species of dropsy, except the encysted.</p>
+
+<p>VIII. That it may be made subservient to the
+cure of diseases, unconnected with dropsy.</p>
+
+<p>IX. That it has a power over the motion of the
+heart, to a degree yet unobserved in any other medicine,
+and that this power may be converted to salutary
+ends.<span class='pagenum'><a name="Page_193" id="Page_193">[193]</a></span></p>
+
+
+
+<h2 style="line-height: 150%"><a name="PRACTICAL" id="PRACTICAL"></a><span style="font-size: 70%">PRACTICAL</span><br />
+REMARKS ON DROPSY,<br />
+<span style="font-size: 80%">AND SOME OTHER DISEASES.</span></h2>
+
+<hr class="chapter" />
+
+<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> following remarks consist partly of matter
+of fact, and partly of opinion. The former
+will be permanent; the latter must vary with the
+detection of error, or the improvement of knowledge.
+I hazard them with diffidence, and hope
+they will be examined with candour; not by a contrast
+with other opinions, but by an attentive comparison
+with the ph&oelig;nomena of disease.</p>
+
+
+<h3>ANASARCA.</h3>
+
+<p><a name="sect_1" id="sect_1"></a>&sect; 1. The anasarca is generally curable when seated
+in the sub-cutaneous cellular membrane, or in
+the substance of the lungs.</p>
+
+<p><a name="sect_2" id="sect_2"></a>&sect; 2. When the abdominal viscera in general are
+greatly enlarged, which they sometimes are, without
+effused fluid in the cavity of the abdomen; the
+disease is incurable. After death, the more solid
+viscera are found very large and pale. If the cavity
+contains water, that water may be removed by
+diuretics.<span class='pagenum'><a name="Page_194" id="Page_194">[194]</a></span></p>
+
+<p><a name="sect_3" id="sect_3"></a>&sect; 3. In swollen legs and thighs, where the resistance
+to pressure is considerable, the tendency to
+transparency in the skin not obvious, and where the
+alteration of posture occasions but little alteration
+in the state of distension, the cure cannot be effected
+by diuretics.</p>
+
+<p>Is this difficulty of cure occasioned by spissitude
+in the effused fluids, by want of proper communication
+from cell to cell, or is the disease rather caused
+by a morbid growth of the solids, than by an accumulation
+of fluid?</p>
+
+<p>Is not this disease in the limbs similar to that of
+the viscera (<a href="#sect_2">&sect; 2</a>)?</p>
+
+<p>&sect; 4. Anasarcous swellings often take place in palsied
+limbs, in arms as well as legs; so that the swelling
+does not depend merely upon position.</p>
+
+<p>&sect; 5. Is there not cause to suspect that many dropsies
+originate from paralytic affections of the lymphatic
+absorbents? And if so, is it not probable
+that the Digitalis, which is so effectual in removing
+dropsy, may also be used advantageously in some
+kinds of palsy?</p>
+
+
+<h3>ASCITES.</h3>
+
+<p>&sect; 6. If existing alone, (<i>i.&nbsp;e.</i>) without accompanying
+anasarca, is in children curable; in adults
+generally incurable by medicines. Tapping may be<span class='pagenum'><a name="Page_195" id="Page_195">[195]</a></span>
+used here with better chance for success than in
+more complicated dropsies. Sometimes cured by
+vomiting.</p>
+
+
+<h3>ASCITES <span style="letter-spacing: 0ex">and</span> ANASARCA.</h3>
+
+<p>&sect; 7. Incurable if dependant upon
+irremediably diseased viscera, or on a gouty constitution,
+so debilitated, that the gouty paroxysms no
+longer continue to be formed.</p>
+
+<p>In every other situation the disease yields to diuretics
+and tonics.</p>
+
+
+<h3>ASCITES, ANASARCA, <span style="letter-spacing: 0ex">and</span>
+HYDROTHORAX.</h3>
+
+<p>&sect; 8. Under this complication, though the
+symptoms admit of relief, the restoration of the
+constitution can hardly be hoped for.</p>
+
+
+<h3>ASTHMA.</h3>
+
+<p><a name="sect_9" id="sect_9"></a>&sect; 9. The true spasmodic asthma, a rare disease&mdash;is
+not relieved by Digitalis.</p>
+
+<p><a name="sect_10" id="sect_10"></a>&sect; 10. In the greater part of what are called
+asthmatical cases, the real disease is anasarca of the
+lungs, and is generally to be cured by diuretics. (See
+<a href="#sect_1">&sect; 1</a>.) This is almost always combined with some
+swelling of the legs.<span class='pagenum'><a name="Page_196" id="Page_196">[196]</a></span></p>
+
+<p><a name="sect_11" id="sect_11"></a>&sect; 11. There is another kind of asthma, in which
+change of posture does not much affect the patient.
+I believe it to be caused by an infarction of the
+lungs. It is incurable by diuretics; but it is often
+accompanied with a degree of anasarca, and so far
+it admits of relief.</p>
+
+<p>Is not this disease similar to that in the limbs at
+(<a href="#sect_3">&sect; 3</a>,) and also to that of the abdominal viscera at
+(<a href="#sect_2">&sect; 2</a>.)?</p>
+
+
+<h3>ASTHMA<span style="letter-spacing: 0ex"> and</span> ANASARCA.</h3>
+
+<p>&sect; 12. If the asthma be of the kind mentioned at
+(&sect;<a href="#sect_9">&sect; 9</a> and <a href="#sect_11">11</a>,) diuretics can only remove the accompanying
+anasarca. But if the affection of the
+breath depends also upon cellular effusion, as it
+mostly does, the patient may be taught to expect a
+recovery.</p>
+
+
+<h3>ASTHMA <span style="letter-spacing: 0ex">and</span> ASCITES.</h3>
+
+<p>&sect; 13. A rare combination, but not incurable
+if the abdominal viscera are sound. The
+asthma is here most probably of the anasarcous
+kind (<a href="#sect_10">&sect; 10</a>;) and this being seldom confined to the
+lungs only, the disease generally appears in the following
+form.<span class='pagenum'><a name="Page_197" id="Page_197">[197]</a></span></p>
+
+
+<h3>ASTHMA, ASCITES, <span style="letter-spacing: 0ex">and</span> ANASARCA.</h3>
+
+<p>&sect; 14. The curability of this combination will
+depend upon the circumstances mentioned in the
+preceding section, taking also into the account the
+strength or weakness of the patient.</p>
+
+
+<h3>EPILEPSY.</h3>
+
+<p>&sect; 15. In epilepsy dependant upon effusion, the
+Digitalis will effect a cure; and in the cases alluded
+to, the dropsical symptoms were unequivocal. It
+has not had a sufficient trial in my hands, to determine
+what it can do in other kinds of epilepsy.</p>
+
+
+<h3>HYDATID DROPSY.</h3>
+
+<p>&sect; 16. This may be distinguished from common
+ascites, by the want of evident fluctuation. It is
+common to both sexes. It does not admit of a
+cure either by tapping or by medicine.</p>
+
+
+<h3>HYDROCEPHALUS.</h3>
+
+<p>&sect; 17. This disease, which has of late so much
+attracted the attention of the medical world, I believe,
+originates in inflammation; and that the water
+found in the ventricles of the brain after death,
+is the consequence, and not the cause of the illness.</p>
+
+<p>It has seldom happened to me to be called upon
+in the earlier stages of this complaint, and the symptoms<span class='pagenum'><a name="Page_198" id="Page_198">[198]</a></span>
+are at first so similar to those usually attendant
+upon dentition and worms, that it is very difficult
+to pronounce decidedly upon the real nature of the
+disease; and it is rather from the failure of the usual
+modes of relief, than from any other more decided
+observation, that we at length dare to give it a name.</p>
+
+<p>At first, the febrile symptoms are sometimes so
+unsteady, that I have known them mistaken for the
+symptoms of an intermittent, and the cure attempted
+by the bark.</p>
+
+<p>In the more advanced stages, the diagnostics obtrude
+themselves upon our notice, and put the situation
+of the patient beyond a doubt. But this does
+not always happen. The variations of the pulse,
+so accurately described by the late Dr. Whytt, do
+not always ensue. The dilatation of the pupils,
+the squinting, and the aversion to light, do not
+universally exist. The screaming upon raising the
+head from the pillow or the lap, and the flushing of
+the cheeks, I once considered as affording indubitable
+marks of the disease; but in a child which I
+sometime since attended with Dr. Ash, the pulse
+was uniformly about 85, (except during the first
+week, before we had the care of the patient.) The
+child never shewed any aversion to the light; never
+had dilated pupils, never squinted, never screamed
+when raised from the lap or taken out of the bed,
+nor did we observe any remarkable flushing of the
+cheeks; and the sleep was quiet, but sometimes
+moaning.<span class='pagenum'><a name="Page_199" id="Page_199">[199]</a></span></p>
+
+<p>Frequent vomiting existed from the first, but
+ceased for several days towards the conclusion. One
+or two worms came away during the illness, and it
+was all along difficult to purge the child. Three
+days before death, the right side became slightly
+paralytic, and the pupil of that eye somewhat dilated.</p>
+
+<p>After death, about two ounces and a half of water
+were found in the ventricles of the brain, and
+the vessels of the dura mater were turgid with blood.</p>
+
+<p>If I am right as to the nature of hydrocephalus,
+that it is at first dependant upon inflammation, or
+congestion; and that the water in the ventricles is
+a consequence, and not a cause of the disease; the
+curative intentions ought to be extremely different
+in the first and the last stages.</p>
+
+<p>It happens very rarely that I am called to patients
+at the beginning, but in two instances wherein I was
+called at first, the patients were cured by repeated
+topical bleedings, vomits, and purges.</p>
+
+<p>Some years ago I mentioned these opinions, and
+the success of the practice resulting from them, to
+Dr. Quin, now physician at Dublin. That gentleman
+had lately taken his degree, and had chosen
+hydrocephalus for the subject of his thesis in the
+year 1779. In this very ingenious essay, which he
+gave me the same morning, I was much pleased to
+find that the author had not only held the same<span class='pagenum'><a name="Page_200" id="Page_200">[200]</a></span>
+ideas relative to the nature of the disease, but had
+also confirmed them by dissections.</p>
+
+<p>In the year 1781, another case in the first stage
+demanded my attention. The reader is referred
+back to <a href="#CASElxix">Case LXIX</a> for the particulars.</p>
+
+<p>I have not yet been able to determine whether the
+Digitalis can or cannot be used with advantage in
+the second stage of the hydrocephalus. In <a href="#CASExxxiii">Case
+XXXIII</a>. the symptoms of death were at hand; in
+<a href="#CASElxix">Case LXIX</a>. the practice, though successful, was too
+complicated, and in <a href="#CASEcli">Case CLI</a>. the medicine was
+certainly stopped too soon.</p>
+
+<p>When we consider what enormous quantities of
+mercury may be used in this complaint, without affecting
+the salivary glands, it seems probable that
+other parts may be equally insensible to the action
+of their peculiar stimuli, and therefore that the Digitalis
+ought to be given in much larger doses in this,
+than in other diseases.</p>
+
+
+<h3>HYDROTHORAX.</h3>
+
+<p>&sect; 18. Under this name I also include the
+dropsy of the pericardium.</p>
+
+<p>The intermitting pulse, and pain in the arms, sufficiently
+distinguish this disease from asthma, and
+from anasarcous lungs.</p>
+
+<p>It is very universally cured by the Digitalis.<span class='pagenum'><a name="Page_201" id="Page_201">[201]</a></span></p>
+
+<p>&sect; 19. I lately met with two cases which had been
+considered and treated as angina pectoris. They
+both appeared to me to be cases of hydrothorax.
+One subject was a clergyman, whose strength had
+been so compleatly exhausted by the continuance of
+the disease, and the attempts to relieve it, that he
+did not survive many days. The other was a lady,
+whose time of life made me suspect effusion. I directed
+her to take small doses of the pulv. Digitalis,
+which in eight days removed all her complaints.
+This happened six months ago, and she remains
+perfectly well.</p>
+
+
+<h3>HYDROTHORAX <span style="letter-spacing: 0ex">and</span> ANASARCA.</h3>
+
+<p>&sect; 20. This combination is very frequent, and,
+I believe, may always be cured by the Digitalis.</p>
+
+<p>&sect; 21. Dropsies in the chest either with or without
+anasarcous limbs, are much more curable than those
+of the belly. Probably because the abdominal viscera
+are more frequently diseased in the latter than
+in the former cases.</p>
+
+
+<h3>INSANITY.</h3>
+
+<p>&sect; 22. I apprehend this disease to be more
+frequently connected with serous effusion than has
+been commonly imagined.</p>
+
+<p>&sect; 23. Where appearances of anasarca point out the
+true cause of the complaint, as in cases <a href="#CASExxiv">XXIV</a>. and<span class='pagenum'><a name="Page_202" id="Page_202">[202]</a></span>
+<a href="#CASExxxiv">XXXIV</a>. the happiest effects may be expected from
+the Digitalis; and men of more experience than myself
+in cases of insanity, will probably employ it successfully
+in other less obvious circumstances.</p>
+
+
+<h3>NEPHRITIS CALCULOSA.</h3>
+
+<p>&sect; 24. We have had sufficient evidence of the efficacy
+of the Foxglove in removing the Dysuria and
+other symptoms of this disease; but probably it is
+not in these cases preferable to the tobacco.<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a></p>
+
+
+<h3>OVARIUM DROPSY.</h3>
+
+<p>&sect; 25. This species of encysted dropsy is not without
+difficulty distinguishable from an ascites; and
+yet it is necessary to distinguish them, because the
+two diseases require different treatment and because
+the probality of a cure is much greater in one than
+in the other.</p>
+
+<p>&sect; 26. The ovarium dropsy is generally slow in its
+progress; for a considerable time the patient though
+somewhat emaciated, does not lose the appearance
+of health, and the urine flows in the usual quantity.
+It is seldom that the practitioner is called in early
+enough to distinguish by the feel on which side the
+cyst originated, and the patients do not attend to
+that circumstance themselves. They generally menstruate
+<span class='pagenum'><a name="Page_203" id="Page_203">[203]</a></span>regularly in the incipient state of the disease,
+and it is not until the pressure from the sac becomes
+very great, that the urinary secretion diminishes.
+In this species of dropsy, the patients,
+upon being questioned, acknowledge even from a
+pretty early date, pains in the upper and inner
+parts of the thighs, similar to those which women
+experience in a state of pregnancy. These pains
+are for a length of time greater in one thigh than in
+the other, and I believe it will be found that the
+disease originated on that side.</p>
+
+<p>&sect; 27. The ovarium dropsy defies the power of
+medicine. It admits of relief, and sometimes of a
+cure, by tapping. I submit to the consideration of
+practitioners, how far we may hope to cure this disease
+by a seton or a caustic.&mdash;In the<a href="#CASElxi"> LXIst
+case</a> the patient was too much reduced, and the
+disease too far advanced to allow of a cure by any
+method; but it teaches us that a caustic may be
+used with safety.</p>
+
+<p>&sect; 28. When tapping becomes necessary, I always
+advise the adoption of the waistcoat bandage
+or belt, invented by the late very justly celebrated
+Dr. Monro, and described in the first volume of
+the Medical Essays. I also enjoin my patients to
+wear this bandage afterwards, from a persuasion
+that it retards the return of the disease. The proper
+use of bandage, when the disorder first discovers
+itself, certainly contributes much to prevent its
+increase.<span class='pagenum'><a name="Page_204" id="Page_204">[204]</a></span></p>
+
+
+<h3>OVARIUM DROPSY <span style="letter-spacing: 0ex">with</span> ANASARCA.</h3>
+
+<p>&sect; 29. The anasarca does not appear until the encysted
+dropsy is very far advanced. It is then probably
+caused by weakness and pressure. The Digitalis
+removes it for a time.</p>
+
+
+<h3>PHTHISIS PULMONALIS.</h3>
+
+<p>&sect; 30. This is a very increasing malady in the present
+day. It is no longer limited to the middle part
+of life: children at five years of age die of it, and
+old people at sixty or seventy. It is not confined
+to the flat-chested, the fair-skinned, the blue eyed,
+the light-haired, or the scrophulous: it often attacks
+people with full chests, brown skins, dark hair and
+eyes, and those in whose family no scrophulous taint
+can be traced. It is certainly infectious. The very
+strict laws still existing in Italy to prevent the infection
+from consumptive patients, were probably not
+enacted originally without a sufficient cause. We
+seem to be approaching to that state which first
+made such restrictions necessary, and in the further
+course of time, the disease will probably fall off
+again, both in virulency and frequency.</p>
+
+<p>&sect; 31. The younger part of the female sex are
+liable to a disease very much resembling a true consumption,
+and from which it is difficult to distinguish
+it; but this disease is curable by steel and bitters.
+A criterion of true phthisis has been sought for in the<span class='pagenum'><a name="Page_205" id="Page_205">[205]</a></span>
+state of the teeth; but the exceptions to that rule
+are numerous. An unusual dilatation of the pupil
+of the eye, is the most certain characteristic.<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a></p>
+
+<p>&sect; 32. Sydenham asserts, that the bark did not
+more certainly cure an intermittent, than riding did
+a consumption. We must not deny the truth of an
+assertion, from such authority, but we must conclude
+that the disease was more easily curable a century
+ago than it is at present.</p>
+
+<p>&sect; 33. If the Digitalis is no longer useful in consumptive
+cases, it must be that I know not how to
+manage it, or that the disease is more fatal than formerly;
+for it would be hard to deny the testimony
+cited at page 9. I wish others would undertake
+the enquiry.</p>
+
+<p>&sect; 34. When phthisis is accompanied with anasarca,
+or when there is reason to suspect hydrothorax, the
+Digitalis will often relieve the sufferings, and prolong
+the life of the patient.</p>
+<p><span class='pagenum'><a name="Page_206" id="Page_206">[206]</a></span></p>
+<p>&sect; 35. Many years ago, during an attendance upon
+Mr. B&mdash;&mdash;, of a consumptive family, and himself
+in the last stage of a phthisis; after he was so ill as
+to be confined to his chamber, his breathing became
+so extremely difficult and distressing, that he
+wished rather to die than to live, and urged me
+warmly to devise some mode to relieve him. Suspecting
+serous effusion to be the cause of this symptom,
+and he being a man of sense and resolution,
+I fully explained my ideas to him, and told him
+what kind of operation might afford him a chance
+of relief; for I was then but little acquainted with
+the Digitalis. He was earnest for the operation to
+be tried, and with the assistance of Mr. Parrott, a
+very respectable surgeon of this place, I got an
+opening made between the ribs upon the lower and
+hinder part of the thorax. About a pint of fluid
+was immediately discharged, and his breath became
+easy. This fluid coagulated by heat.</p>
+
+<p>After some days a copious purulent discharge issued
+from the opening, his cough became less troublesome,
+his expectoration less copious, his appetite
+and strength returned, he got abroad, and the wound,
+which became very troublesome, was allowed to heal.</p>
+
+<p>He then undertook a journey to London; whilst
+there he became worse: returned home, and died
+consumptive some weeks afterwards.<span class='pagenum'><a name="Page_207" id="Page_207">[207]</a></span></p>
+
+
+<h3>PUERPERAL ANASARCA.</h3>
+
+<p>&sect; 36. This disease admits of an easy and certain
+cure by the Digitalis.</p>
+
+<p>&sect; 37. This species of dropsy may originate from
+other causes than child birth. In the beginning of
+last <i>March</i>, a gentleman at Wolverhampton desired
+my advice for very large and painful swelled legs and
+thighs. He was a temperate man, not of a dropsical
+habit, had great pain in his groins, and attributed
+his complaints to a fall from his horse. He
+had taken diuretics, and the strongest drastic purgatives
+with very little benefit. Considering the
+anasarca as caused by the diseased inguinal glands,
+I ordered common poultice and mercurial ointment
+to the groins, three grains of pulv. fol. Digitalis
+night and morning, and a cooling diuretic decoction
+in the day-time. He soon lost his pain, and the
+swellings gradually subsided.</p>
+
+
+<p class="center" style="padding-top: 2em; letter-spacing: 0.25ex">THE END.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> See an original and valuable treatise by Dr. Fowler, entitled,
+<i>Medical Reports of the Effects of Tobacco</i>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Many years ago I communicated to my friend, Dr. Percival,
+an account of some trials of breathing fixed air in consumptive
+cases. The results were published by him in the second Vol. of
+his very useful Essays Medical and Experimental, and have since
+been copied into other publications. I take this opportunity of
+acknowledging that I suspect myself to have been mistaken in the
+nature of the disease there mentioned to have been cured. I believe
+it was a case of <i>Vomica</i>, and not a true <i>Phthisis</i> that was cured.
+The Vomica is almost always curable. The fixed air corrects the
+smell of the matter, and very shortly removes the hectic fever.
+My patients not only inspire it, but I keep large jars of the effervescing
+mixture constantly at work in their chambers.</p></div>
+</div>
+
+
+<div class="advertisements">
+
+<p><span style="font-size: 150%; letter-spacing: 0.25ex">BOOKS</span>,<br style="line-height: 3em" />
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+
+<span style="font-size: 90%">Particularly as it appeared at <span style="letter-spacing: 0.25ex">BIRMINGHAM</span> in</span><br />
+<span style="font-size: 90%">the Year 1778.</span></p>
+
+<p>By <span style="letter-spacing: 0.25ex">WILLIAM WITHERING</span>, M.&nbsp;D.</p>
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+
+<span style="font-size: 90%">Translated from the original of Sir <span class="smcap">Torbern
+Bergman</span>; with <span style="letter-spacing: 0.25ex">NOTES</span>,</span></p>
+
+<p>By <span style="letter-spacing: 0.25ex">WILLIAM WITHERING</span>, M.&nbsp;D.</p>
+
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+
+<hr />
+
+<p><span style="font-size: 90%">In the Spring of the Year 1786, will be published, by</span><br />
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+<span style="font-size: 80%">large Octavo.</span></p>
+</div>
+
+<div class="note">
+
+<h3><b>Transcriber's Notes</b></h3>
+
+<p>Obvious printer's errors have been fixed. For the detailed list, please
+see below. The frontispiece has been moved from the beginning of the book
+to the section explaining it.</p>
+
+<h4>Errors fixed</h4>
+
+<ul>
+<li>page <a href="#Page_xvi">xvi</a>&mdash;typo fixed: changed 'afterterwards' to 'afterwards'</li>
+<li>page <a href="#Page_29">029</a>&mdash;typo fixed: changed 'apetite' to 'appetite'</li>
+<li>page <a href="#Page_43">043</a>&mdash;typo fixed: removed an extra 'in' after 'and she died'</li>
+<li>page <a href="#Page_62">062</a>&mdash;typo fixed: changed 'Dovers' to 'Dover's' after 'seneka'</li>
+<li>page <a href="#Page_95">095</a>&mdash;typo fixed: changed 'ef' to 'of' after 'whilst the rest'</li>
+<li>page <a href="#Page_98">098</a>&mdash;typo fixed: changed 'harrassed' to 'harassed'</li>
+<li>page <a href="#Page_103">103</a>&mdash;typo fixed: changed 'Shiffnal' to 'Shiffnall'</li>
+<li>page <a href="#Page_106">106</a>&mdash;spelling normalized: changed 'Fox-glove' to 'Foxglove'</li>
+<li>page <a href="#Page_110">110</a>&mdash;typo fixed: changed 'suceed' to 'succeed' after 'hope it might'</li>
+<li>page <a href="#Page_111">111</a>&mdash;typo fixed: changed 'atttention' to 'attention' after 'repeated without'</li>
+<li>page <a href="#Page_114">114</a>&mdash;typo fixed: changed 'disgreeable' to 'disagreeable' after 'or any other'</li>
+<li>page <a href="#Page_115">115</a>&mdash;typo fixed: removed an extra 'the' in front of '7th of April'</li>
+<li>page <a href="#Page_123">123</a>&mdash;typo fixed: changed 'susspended' to 'suspended' after 'the medicine to be'</li>
+<li>page <a href="#Page_135">135</a>&mdash;typo fixed: changed 'vomitted' to 'vomited' after 'that she'</li>
+<li>page <a href="#Page_141">141</a>&mdash;typo fixed: changed 'contiued' to 'continued' after 'He'</li>
+<li>page <a href="#Page_148">148</a>&mdash;typo fixed: changed 'praecordia' to 'pr&oelig;cordia'</li>
+<li>page <a href="#Page_158">158</a>&mdash;typo fixed: changed 'spoonfulls' to 'spoonfuls'</li>
+<li>page <a href="#Page_163">163</a>&mdash;typo fixed: changed 'mecine' to 'medicine'</li>
+<li>page <a href="#Page_164">164</a>&mdash;typo fixed: changed 'slighest' to 'slightest' after 'distressing on the'</li>
+<li>page <a href="#Page_166">166</a>&mdash;typo fixed: changed 'ipecacohana' to 'ipecacoanha'</li>
+<li>page <a href="#Page_170">170</a>&mdash;typo fixed: changed 'meridiaana' to 'meridiana'</li>
+<li>page <a href="#Page_196">196</a>&mdash;typo fixed: removed an extra 'the' in front of 'abdominal viscera'</li>
+<li>page <a href="#Page_200">200</a>&mdash;typo fixed: removed an extra 'and' after 'from asthma'</li>
+</ul>
+
+</div>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of An Account of the Foxglove and some of
+its Medical Uses, by William Withering
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+</html>
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+The Project Gutenberg EBook of An Account of the Foxglove and some of its
+Medical Uses, by William Withering
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: An Account of the Foxglove and some of its Medical Uses
+       With Practical Remarks on Dropsy and Other Diseases
+
+Author: William Withering
+
+Release Date: March 21, 2008 [EBook #24886]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK AN ACCOUNT OF THE FOXGLOVE ***
+
+
+
+
+Produced by David Starner, Irma Spehar and the Online
+Distributed Proofreading Team at http://www.pgdp.net
+
+
+
+
+
+                                  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. After examination I was satisfied the disease was
+the same as that mentioned at CXLIX. A very experienced apothecary
+having tried various methods to relieve him, I despaired of any
+success, but determined to try the Digitalis. It was accordingly
+given in infusion. At first it checked the vomitings, but did not
+occasion any secretion of urine.
+
+
+                                 1785.
+
+The cases which have occurred to me in the course of this year, are
+numerous; but as the events of some of them are not yet sufficiently
+ascertained, I think it better to with-hold them at present.
+
+
+
+
+                            HOSPITAL CASES,
+                  Under the Direction of the Author.
+
+
+The four following cases were drawn out at my request by Mr. Cha.
+Hinchley, late apothecary to the Birmingham Hospital. They are all the
+Hospital cases for which the Digitalis was prescribed by me, whilst he
+continued in that office.
+
+
+                              CASE CLVII.
+
+_March_ 15th, 1780. John Butler, AEt. 30. Asthma and swelled legs. He
+was directed to take myrrh and steel every day, and three spoonfuls of
+infusum Digitalis every night. On the 8th of April he was discharged,
+cured of the swellings and something relieved of his asthmatic
+affections.
+
+
+                             CASE CLVIII.
+
+_November_ 18th, 1780. Henry Warren, AEt. 60. This man had a general
+anasarca and ascites, and was moreover so asthmatic, that, neither
+being able to sit in a chair nor lie in bed, he was obliged constantly
+to walk about, or to lean forward against a window or table. You
+prescribed for him thus.
+
+    R. Aq. cinn. spt. [Symbol: ounce]iv.
+    Oxymel. scillit.
+    Syr. scillit. aa. [Symbol: ounce]i. m. cap. cochlear. larg.
+    sexta quaque hora.
+
+This medicine producing no increased discharge of urine, on the 25th
+you ordered the infusion of Digitalis, two spoonfuls every four hours.
+After taking this for thirty six hours, his urine was discharged in
+very great quantity; his breath became easy, and the swellings
+disappeared in a few days, though he took no more of the medicine. On
+the 2d of _December_ he was ordered myrrh and lac ammoniacum, which he
+continued until the 23d, when he was discharged cured, and is now in
+good health.
+
+
+                              CASE CLIX.
+
+_November_ 3d, 1781. Mary Crockett, AEt. 40. Ascites and universal
+anasarca. For one week she took sal. diureticus and tincture of
+cantharides, but without advantage. On the 10th you directed the
+infusion of Digitalis, a dram and half to half a pint, an ounce to be
+taken every fourth hour. Before this quantity was quite finished, the
+urine began to be discharged very copiously. The medicine was then
+stopped as you had directed. On the 15th, being costive, she took a
+jallap purge, and on the 24th she was discharged cured.
+
+
+                               CASE CLX.
+
+_March_ 16th, 1782. Mary Bird, AEt. 61. Great fullness about the
+stomach; diseased liver, and anasarcous legs and thighs. For the
+first week squill was tried in more forms than one, but without
+advantage. On the 22d she began with the Digitalis, which presently
+removed all the swelling.
+
+She was then put upon the use of aperient medicines and tonics, and on
+the first of _August_ was discharged perfectly cured.
+
+       *       *       *       *       *
+
+    The three following Cases were drawn up and communicated to
+    me by Mr. Bayley, who succeeded Mr. Hinchley as apothecary to
+    the Hospital at Birmingham:
+
+
+                                    Shiffnall, April 26th, 1785.
+    DEAR SIR,
+
+During my residence in the Birmingham General Hospital, I had frequent
+opportunities of seeing the great effects of the Digitalis in dropsy.
+As the exhibition of it was in the following instances immediately
+under your own direction, I have drawn them up for your inspection,
+previous to your publishing upon that excellent diuretic. Of its
+efficacy in dropsy I have considerable evidence in my possession, but
+consider myself not at liberty to send you any other cases except
+those you had yourself the conduct of. The Digitalis is a very
+valuable acquisition to medicine; and, I trust, it will cease to be
+dreaded when it is well understood.
+
+                                     I am, Sir, your obedient,
+                                        And very humble servant,
+                                                      W. BAYLEY.
+
+
+                              CASE CLXI.
+
+Mary Hollis, aged 62, was admitted an out patient of the Birmingham
+General Hospital _February_ 12th, 1784, labouring under all the
+effects of hydrothorax; her dread of suffocation during sleep was so
+great, that she always reposed in an elbow chair. She was directed to
+take two grains of Digitalis in powder every night and morning, and
+for a few days found great relief; but, on the eighth day, as she had
+complained of sickness, and had been considerably purged, she was
+ordered to desist taking any more of her powders. On the 14th day she
+was ordered an ounce of the following infusion twice in a day: R. Fol.
+Digital. purp. sicc. [Symbol: dram]iss. aq. bullient. [Symbol: pound]ss.
+digere per semi-horam, colaturae adde tinct. aromatic [Symbol: ounce]i.
+This infusion did not purge, but sometimes excited nausea, though not
+sufficient to prevent her from continuing its use. She grew gradually
+better, and on the 6th of _May_ was discharged perfectly cured. The
+diuretic effects of the Digitalis were in this instance immediate.
+
+
+                              CASE CLXII.
+
+Edward James, AEt. 21. Admitted _March_ 20th, 1784. Complained of great
+difficulty of breathing, pain in his head, and tightness about the
+stomach, with a trifling swelling of his legs. Ordered pil. scillit.
+[Symbol: scruple]i. ter de die. On the third day his legs much more
+swelled, his breathing more difficult, and in every respect worse; his
+pulse very small and quick, complained when he turned in bed, of
+something like water rolling from one side of the thorax to the other.
+A remarkable blueness about the mouth and eyes, and purged considerably
+from the pil. scill. Ordered to omit the pills and to take
+[Symbol: ounce]i. of infus. Digitalis every eight hours; the proportion
+[Symbol: dram]iss. to eight ounces of water and [Symbol: ounce]i. of
+aq. n. m. sp.--7th Day, The infusion had neither purged, nor vomited
+him: he only complained once or twice of giddiness. His belly was now
+very hard, rather black on the right side the navel, and his legs
+amazingly swelled. Ordered a bolus with rhubarb and calomel, to be
+taken in the morning, and [Symbol: ounce]ii. julep salin. cum tinct.
+canthar. gutt. forty ter die.--12th Day, nearly in the same state,
+except his breathing which was somewhat more difficult, being now
+obliged to have his head considerably raised. Persistat--From this day
+to the 32d day he became hourly worse. His belly which at first was
+only hard, now evidently contained a large quantity of water, his legs
+were more swelled, and a large sphacelated sore appeared upon each
+outer ancle. Respiration was so much obstructed, that he was obliged
+to sit quite upright to prevent suffocation. He made very little
+water, not more than eight ounces in a day and a night, and was much
+emaciated. Ordered his purging bolus again, and [Symbol: ounce]ii. of
+a mixture with sal diuretic, [Symbol: ounce]ss. to [Symbol: ounce]xii.
+three times in a day, and a poultice with ale grounds to his legs.
+
+54th day. To this period there was not the least probability of his
+existing; his legs and thighs were one continued blubber, his thorax
+quite flat, and his belly so large that it measured within one inch as
+much as a woman's in this Hospital the day she was tapped, and from
+whom twenty seven pounds of coagulable lymph were taken. He made about
+three ounces of water in twenty-four hours: his penis and scrotum were
+astonishingly swelled, and no discharge from the sores upon his legs.
+Ordered to take a pill with two grains of powdered Foxglove night and
+morning. For a few days no sensible effect, but about the 60th day he
+complained of being continually giddy, and had some little pain in his
+stomach. He now made much more water, and dared to sleep. His appetite
+which through the whole of his illness had been very bad, was also
+better. 66th day. Breathing very much relieved, the quantity of water
+he made was three chamber pots full in a day and a night, each pot
+containing two quarts and four ounces, moderately full. Ordered to
+continue his pills, and his legs which were very flabby, to be rolled.
+
+69th day. His belly nearly reduced to its natural size, still made a
+prodigious quantity of water, his appetite very good, habit of body
+rather lax, and his complexion ruddy. On the 2d of _June_, being still
+rather weak, he was ordered decoct. cort. [Symbol: ounce]ii. ter de
+die; and on the 12th was discharged from this Hospital perfectly
+cured.
+
+                                                      W. BAYLEY.
+
+
+     Mr. Bayley's respectful compliments to Doctor Withering: he
+     sends the case of Edward James, which he believes is pretty
+     correct. He laments not having it in his power to send the
+     measure of his belly, having unfortunately, mislaid the
+     tape: he heard from James yesterday, and he is perfectly
+     well.
+
+     _General Hospital, August 5, 1784._
+
+
+                             CASE CLXIII.
+
+On the 26th _February_, 1785, Sarah Ford, aged 42, was admitted an
+out-patient of the Birmingham General Hospital: she complained of
+considerable pain in her chest, and great difficulty of breathing, her
+face was much swelled and her thighs and legs were anasarcous. She had
+extreme difficulty in making water, and with many painful efforts she
+did not void more than six ounces in twenty-four hours. She had been
+in this situation about six weeks, during which time she had taken
+ammoniacum, olibanum, and large quantities of squills, without any
+other effect than frequent sickness. Upon her commencing an Hospital
+patient, the following medicine was exhibited. R. gum ammoniac
+[Symbol: dram]ii. pulv. fol. Digital. purp. [Symbol: scruple]ii. sp.
+lavand. comp. ut fiat pil. 40. cap. ii. nocte maneque. She continued
+the use of these pills for a few days, without any sensible effect. On
+the eighth day her breathing was much relieved, her legs and thighs
+were not so much swelled, and in a day and a night she made five
+pints of water. By the 12th day her legs and thighs were nearly
+reduced to their natural size. She continued to make water in large
+quantities, and had lost her pain in the thorax. To the 20th of
+_March_, she made rapid advances towards health, when not a symptom of
+disease remaining, she was discharged.
+
+
+
+
+                  COMMUNICATIONS FROM CORRESPONDENTS.
+
+
+                                       London, Norfolk-street,
+                                                 May 31st, 1785.
+
+SIR,
+
+I had the favour of your letter last week; and I shall be very happy
+if I can give you any intelligence relating to the Foxglove, that can
+answer the purpose in which you are so laudably engaged.
+
+It is true that my brother, the late Dr. Cawley, was greatly relieved,
+and his life, perhaps, prolonged for a year, by a decoction of the
+Foxglove root; but why it had not a more lasting effect, it is
+necessary I should tell you that he had all the signs of a distempered
+viscera, long before any watery swellings appeared; it was manifest
+that his dropsy was merely symptomatic, and he could therefore only
+from time to time have any relief from medicine. In the year 1776, he
+returned from London to Oxon. having consulted several physicians at
+the former place, and Dr. Vivian at the latter, but without any
+success; and he was then told of a carpenter at Oxon. that had been
+cured of a Hydrops pectoris by the Foxglove root, and as he was a
+younger, and in other respects an healthy man, his cure, I believe,
+remains a perfect one.
+
+I did not attend my brother whilst he took the medicine, and therefore
+I cannot speak precisely to the operation of it; but I remember, by
+his letters, that he was dreadfully sick and ill for several days
+before the secretion of urine came on, but which it did do to a great
+degree; relieved his breath, and greatly lessened the swelling in his
+legs and thighs; but the two instances I have lately seen in this part
+of the world, are much stronger proofs of the efficacy of it than my
+brother's case.
+
+                                               I am, &c.
+                                                  ROBERT CAWLEY.
+
+N. B. Whenever I have another opportunity of giving the Foxglove, it
+shall be in small doses:--In which I should hope it might succeed,
+although it might be more slowly. If you should try it with success, I
+should be glad to know what mode you made use of.
+
+
+                      Dr. Cawley's prescription.
+
+    R. Rad. Digital. purpur. siccat. et contus. [Symbol: ounce]ii.
+
+    Coque ex aq. font. [Symbol: pound]ii. ad [Symbol: pound]i.
+    colat. liquor. adde aq. junip. comp. [Symbol: ounce]ii.
+
+    Mell. anglic [Symbol: ounce]i. m. sumat cochl. iv. omni nocte h. s. et
+    mane.
+
+--I have elsewhere remarked, that when the Digitalis has been properly
+given, and the diuretic effects produced, that an accidental over-dose
+bringing on sickness, has stopped the secretion of urine. In the
+present instance it likewise appears, that violent sickness may be
+excited, and continue for several days without being accompanied by a
+flow of urine; and it is probable that the latter circumstance did not
+take place, until the severity of the former abated. If Dr. Cawley had
+not had a constitution very retentive of life, I think he must have
+died from the enormous doses he took; and he probably would have died
+previous to the augmentation of the urinary discharge. For if the root
+from which his medicine was prepared, was gathered in its active
+state, he did not take at each dose less than _twelve_ times the
+quantity a strong man ought to have taken. Shall we wonder then that
+patients refuse to repeat such a medicine, and that practitioners
+tremble to prescribe it? Were any of the active and powerful medicines
+in daily use to be given in doses _twelve_ times greater than they
+are, and these doses to be repeated without attention to the effects,
+would not the patients die, and the medicines be condemned as
+dangerous and deleterious?--Yet such has been the fate of Foxglove!
+
+
+     A Letter to the Author, from Mr. BODEN, Surgeon, at Broseley,
+                            in Shropshire.
+
+                                       Broseley, 25th May, 1785.
+     Dear SIR,
+
+Have inclosed the prescriptions that contained the fol. Digital. which
+I gave to Thomas Cooke and Thomas Roberts.
+
+Thomas Cooke, AEt. 49, had been ill about two or three weeks. When I saw
+him he had no appetite, and a constant thirst: a fullness and load in
+the stomach: the thighs, legs and hands, much swell'd, and the face and
+throat in a morning; was costive, and made but little water, which was
+high coloured; the pulse very weak, and his breath exceeding bad. _June_
+17th. R. Argent, viv [Symbol: dram]i. cons. cynosbat. [Symbol: scruple]ii.
+fol. Digital. pulv. gr. xv. f. pil. xxiv. capt. ii. omni nocte hora
+decubitus. He was likewise purged by a bolus of argent. viv. jallap,
+Digit. elaterium and calomel, which was repeated on the fourth day, to
+the third time. From _June_ 17th to the 29th, the symptoms were mostly
+removed, making water freely, and having plenty of stools; in a week
+after he was perfectly well, and remains so ever since. The cure was
+finished by steel and bitters.
+
+Thomas Roberts, AEt. 40, had a deformed chest, was obliged to be almost
+in an erect posture when in bed; the other symptoms were nearly the
+same as Cooke's. _August_ 3d. The pills prescribed _June_ 17th for
+Cooke.--17th. A purging bolus of jalap and Digitalis, once a week. He
+continued the medicines till the latter end of _August_, when he got
+very well; but the complaint returned in _Jan._ worse than before. He
+is now much better, but I have great reason to believe the liver to be
+diseased.
+
+                            I am, with the greatest respect,
+
+                             Your very obliged humble servant,
+
+                                                   DANIEL BODEN.
+
+P. S. The second patient, on his relapse, took Digitalis again,
+combined with other things.
+
+
+
+       CASE communicated by Mr. CAUSER, Surgeon, at Stourbridge,
+                            Worcestershire.
+
+
+Mr. P---- of H---- M----, in the parish of Kingswinford, aged about
+60; had been a strong healthy, robust, corpulent man; worked hard
+early in life at edge-tool making, and drank freely of strong malt
+liquor; for many years had been subject to gout in the extremities;
+for a few years past had been very asthmatic, and the gout in the
+extremities gradually decreased. When I first saw him, which was
+_Sept._ 12, 1779, his legs were anasarcous, his belly much swelled,
+and an evident fluctuation of water. His breathing very bad, an
+irregular pulse, and unable to lie down. His easiest posture was
+standing with his body leaning over a chair, in which situation he
+would continue many hours together, labouring for breath, with the
+sweat trickling down his face very profusely; the urine in very small
+quantity. Diuretics of every kind I could think of were used with very
+little or no advantage. Blisters applied to the legs relieved very
+considerably for a time, but by no means could I increase the urinary
+discharge. Warm stomachic medicines were given, and at the same time
+sinapisms applied to the feet, in hopes of enticing gout to the
+extremities, but without any good effect.--_November_ 22d. The
+swelling considerably increasing, an emetic of acet. scillitic. was
+given, which acted very violently, and increased the urinary discharge
+considerably. He continued better and worse, using different kinds of
+diuretic and expectorating medicines until _September_ 1781, when the
+disease was so much worse, I did not expect he could live many days.
+The acet. scillitic. was repeated, a table spoonful every half hour,
+till it acted briskly upwards and downwards; but without increasing the
+urinary discharge.--On the 17th of _September_ I infused [Symbol: dram]iii.
+of the fol. Digitalis in [Symbol: ounce]vi. of boiling water, for four
+hours; then strained it, and added [Symbol: ounce]i. of tinct.
+aromatica.--On the 18th he began by taking one spoonful, which he was
+to repeat every half hour, till it made him very sick, unless
+giddiness, loss of sight, or any other disagreeable effect took place.
+I had never given the medicine before, and had prepared him to expect
+the operation to be very severe. I saw him again on the 21st; he had
+taken the medicine regularly, till the whole quantity was consumed,
+without perceiving the least effect of any kind from it, and continued
+well till the evening of the following day, when a little sickness
+took place, which increased, but never so as to occasion either
+vomiting or purging, but a surprising discharge of urine. The saliva
+increased so as to run out of his mouth, and a watery discharge from
+his eyes; these discharges continued, with a continual sickness, till
+the swelling was totally gone, which happened in three or four days.
+He afterwards took steel and bitters; and continued very comfortably,
+without any return of his dropsy, until the 7th of _April_ 1782, when
+he was seized with an epidemic cough, which was very frequent with us
+at that time. His swellings now returned very rapidly, with the
+greatest difficulty in breathing, and he died in a few days. Blisters
+and expectorating medicines were used on this last return.
+
+
+                 Extract of a Letter from Mr. CAUSER.
+
+Mrs. S----, the subject of the following Case, was as ill as it is
+possible for woman to be and recover; from the inefficacy of the
+medicines used, I am convinced no medicine would have saved her but
+the Digitalis. I never saw so bad a case recovered; and it shews, that
+in the most reduced state of body, the medicine in small doses, will
+prove safe and efficacious.
+
+N. B. The Digitalis, in pills, never occasioned the least sickness.
+She took two boxes of them.
+
+
+                                 CASE.
+
+_January_ 2d, 1785. Mrs. S----, of W----, near Kidderminster, aged 38,
+has been affected with dropsical swellings of her legs and thighs,
+about six weeks, which have gradually grown worse; has now great
+difficulty in breathing, which is much increased on moving; a very
+irregular, intermittent pulse, urine in very small quantity, and in
+the seventh month of her pregnancy: a woman of very delicate
+constitution, with tender lungs from her infancy and very subject to
+long continued coughs.
+
+    R. Pulv. scillae gr. iii.
+    Jalap gr. x. syr. rosar. solut. tinct. senn. aa [Symbol:
+    dram]ii. aq. menth. v. simpl. [Symbol: ounce]iss. m. mane
+    sumend.
+
+    R. pulv. scillae [Symbol: scruple]i. G. ammoniac, sapon.
+    venet. aa [Symbol: dram]iss. syr. q. s. f. pilul. 42 cap.
+    iii. nocte maneque.
+
+On the 7th found her worse, and the swelling increased; the urine
+about [Symbol: ounce]x in the twenty-four hours.
+
+    R. Fol. siccat. Digital. [Symbol: dram]iii. coque in. aq.
+    fontan. [Symbol: ounce]xii. ad [Symbol: ounce]vi. cola et
+    adde. aq. juniper. comp. [Symbol: ounce]ii. sacchar. alb.
+    [Symbol: ounce]ss. m. cap. cochlear. i. larg. 4tis horis.
+
+She took about three parts of the medicine before any effect took
+place. The first was sickness, succeeded by a considerable discharge
+of urine. She continued the medicine till the whole was consumed,
+which caused a good deal of sickness for three or four days.
+
+I saw her again on the 12th. The quantity of urine was much increased,
+and the swelling diminished. Pulse and breathing better.
+
+    R. Fol. sicc. Digital. G. assafetid. aa [Symbol: dram]i.
+    calomel. pp. gr. x. sp. lavand. comp. q. s. fiat pilul.
+    xxxii. cap. ii. omni nocte hora somni.
+
+A plentiful discharge of urine attended the use of these pills, and
+she got perfectly free from her dropsical complaints.
+
+_March_ 15th she was delivered: had a good labour, was treated as is
+usual, except in not having her breasts drawn, not intending see
+should suckle her child, being in so reduced a state. Continued going
+on well till the 18th, when she was seized with very violent pains
+across her loins, at times so violent as to make her cry out as much
+as labour pains. Enema cathartic. Fot. papav. applied to the part.
+
+    R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s. fiat
+    pilul. vi. capt. i. 2da quaque hora durante dolore.
+
+    R. Julep, e camphor, sp. minder. aa [Symbol: ounce]ii. capt.
+    cochlear, i. larg. post singul. pilul.
+
+19th. Breathing short, unable to lie down, very irregular low pulse
+scarcely to be felt, fainty, and a universal cold sweat: no appetite
+nor thirst, spasmodic pains at times across the loins very violent,
+but not so frequent as on the preceding day.
+
+    R. Gum ammoniac, assafetid. aa [Symbol: dram]i. camphor. gr. xii. fiat
+    pilul. 24. capt. ii. 3tia quaque hora in cochlear. ii.
+    mixtur. seq.
+
+    R. Balsam. peruv. [Symbol: dram]iii. mucilag. G. arab. q. s.
+    flor. zinci g. vi. aq. menth. simp. [Symbol: pound]ss. m.
+
+    Applic. Emp. vesicat. femorib. internis.
+
+    R. Sp. vol. foetid. elixir. paregor. balsam. Traumatic. aa
+    [Symbol: dram]iii. capt. cochlear. parv. urgente languore.
+
+20th. Much the same; makes very little water, and the legs begin to
+swell.--Applic. Emp. e pice burgund. lumbis.
+
+23d. The swelling very much increased.--Capt. gutt. xv. acet.
+scillitic. ter die in two spoonfuls of the following mixture.
+
+    R. Infus. baccar. juniper, [Symbol: ounce]vi. tinct. amar. tinct.
+    stomachic. aa [Symbol: ounce]i. m.
+
+25th. Much the same.
+
+28th. The swelling considerably increased, in other respects very much
+the same.
+
+30th. Breathing very bad, with cough and pain across the sternum,
+unable to lie down, legs, thighs, and body very much swelled, urine
+not more than four or five ounces in the twenty-four hours; hot and
+feverish, with thirst.
+
+    Applic. Emp. vesicat. stomacho et sterno.
+
+    R. G. assafetid. [Symbol: scruple]ii. pulv. jacob. [Symbol:
+    scruple]i. rad. scill. recent. gr. xii. extract. thebaic. gr.
+    iv. f. pilul. xvi. cap. iv. omni nocte.
+
+    R. Sal. nitr. sal. diuretic. aa [Symbol: dram]ii. pulv. e
+    contrayerv. comp. [Symbol: dram]i. sacchar. [Symbol: ounce]i.
+    emuls. commun. [Symbol: pound]i. aq. cinnam. simpl. [Symbol: ounce]i.
+    m. capt. cochlear. iv. ter die.
+
+_April_ 2d. Much the same, no increase of urine.
+
+3d. Breathing much relieved by the blister, which runs profusely.
+Repeated the medicines, and continued them till the
+
+12th. The cough very bad, pulse irregular, swelling much increased,
+urine in very small quantity, not at all increased; great lowness and
+fainting. She desired to have some of the pills which relieved her so
+much when with child. I was almost afraid to give them, but the
+inefficacy of the other medicines gave me no hopes of a cure from
+continuing them, which made me venture to comply with her request.
+
+    R. Fol. siccat. Digital. G. assafetid. aa [Symbol: dram]i. sp. lavand.
+    comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node
+    cap. pilul. e styrace gr. vi.
+
+17th. Considerable increase of urine.
+
+21st. Swelling a good deal diminished; urine near four pints in
+twenty-four hours, which is more than double the quantity she drinks.
+
+    Applic. Emp. vesicat. femoribus internis.
+
+The Digitalis pills and opiate at bed-time continued. Takes a tea cup
+of cold chamomile tea every morning.
+
+25th. Swelling much diminished, makes plenty of water, appetite much
+mended, cough and breathing better. She omitted the medicine for three
+days; the urine began to diminish, the swelling and shortness of
+breathing worse. On repeating it for two days, the discharge was again
+augmented, and a diminution of the swelling succeeded. She has
+continued the pills ever since till the 14th of _May_; the dropsical
+symptoms and cough are entirely gone, the water is in sufficient
+quantity, her strength is recovered, and she has a good appetite. All
+she now complains of is a weight across her stomach, which is worse at
+times, and she thinks, unless it can be removed, she shall have a
+return of her dropsy.
+
+
+                Extract of a Letter from Doctor FOWLER,
+                        Physician, at Stafford.
+
+I understand you are going to publish on the Digitalis, which I am
+glad to hear, for I have long wished to see your ideas in print about
+it, and I know of no one (from the great attention you have paid to
+the subject) qualified to treat on it but yourself. There are
+gentlemen of the faculty who give verbal directions to poor patients,
+for the preparing and taking of an infusion or decoction of the green
+plant. Would one suppose that such gentlemen had ever attended to the
+nature and operation of a sedative power on the functions,
+_particularly_ the _vital_? Is not such a vague and unscientific mode
+of proceeding putting a two edged sword into the the hands of the
+ignorant, and the most likely method to damn the reputation of any
+very active and powerful medicine? And is it not more than probable
+that the _neglect_ of adhereing to a _certain_ and _regular_
+preparation of the nicotiana, and the _want_ (of what you
+_emphatically_ call) a _practicable_ dose, have been the chief causes
+of the once rising reputation of that noted plant being damned above
+a century ago? In short, the Digitalis is beginning to be used in
+dropsies, (although some patients are said to go off suddenly under
+its administration) somewhat in the style of broom ashes; and, in my
+humble opinion, the public, at this very instant, stand in great need
+of your _precepts_, _guards_, and _cautions_ towards the safe and
+successful use of such a powerful sedative diuretic; and I have no
+doubt of your minute attention to those particulars, from a regard to
+the good and welfare of mankind, as well as to your own reputation
+with respect to that medicine.
+
+I remember an officer in the Staffordshire militia, who died here of a
+dropsy five years ago. The Digitalis relieved him a number of times in
+a wonderful manner, so that in all probability he might have obtained
+a radical cure, if he would have refrained from hard drinking. I
+understood it was first ordered for him by a medical gentleman, and
+its sedative effects proved so mild, and diuretic operation so
+powerful, that he used to prepare it afterwards for himself, and would
+take it with as little ceremony as he would his tea. It is said, that
+he was so certain of its successful operation, that he would boast to
+his bacchanalian companions, when much swelled, you shall see me in
+two days time quite another man.
+
+
+                  CASES communicated by Mr. J. FREER,
+                     jun. Surgeon, in Birmingham.
+
+
+                                CASE I.
+
+_Nov._ 1780. Mary Terry, aged 60. Had been subject to asthma for
+several years; after a severe fit of it her legs began to swell, and
+the quantity of urine to diminish. In six weeks she was much troubled
+with the swellings in her thighs and abdomen, which decreased very
+little when she lay down: she made not quite a pint of water in the
+twenty-four hours. I ordered her to take two spoonfuls of the infusion
+of Foxglove every three hours. By the time she had taken eight doses
+her urine had increased to the quantity of two quarts in the day and
+night, but as she complained of nausea, and had once vomited, I
+ordered the use of the medicine to be suspended for two days. The
+nausea being then removed, she again had recourse to it, but at
+intervals of six hours. The urine continued to discharge freely, and
+in three weeks she was perfectly cured of her swellings.
+
+
+                               CASE II.
+
+_December_, 1782. A poor woman, who had been afflicted with an ague
+during the whole of her pregnancy, and for two months with dropsical
+swellings of the feet, legs, thighs, abdomen, and labia pudenda; was
+at the expiration of the seventh month taken in labour. On the day
+after her delivery the ague returned, with so much violence as to
+endanger her life. As soon as the fit left her, I began to give her
+the red bark in substance, which had the desired effect of preventing
+another paroxysm. She continued to recover her health for a fortnight,
+but did not find any diminution in the swellings; her legs were now so
+large as to oblige her to keep constantly on the bed, and she made
+very little water. I ordered her the infusion of Foxglove three times
+a day, which, on the third day, produced a very copious discharge of
+urine, without any sickness; she continued the use of it for ten days,
+and was then able to walk. Having lost all her swellings, and no
+complaint remaining but weakness, the bark and steel compleated the
+cure.
+
+
+                Extract of a Letter from Doctor JONES,
+                       Physician, in Lichfield.
+
+Anxious to procure authentic accounts from the patients, to whom I
+gave the Foxglove, I have unavoidably been delayed in answering your
+last favour. However, I hope the delay will be made up by the efficacy
+of the plant being confirmed by the enquiry. Long cases are tedious,
+and seldom read, and as seldom is it necessary to describe every
+symptom; for every case would be a history of dropsy. I shall
+therefore content myself with specifying the nature of the disease,
+and when the dropsy is attended with any other affection shall notice
+it.
+
+Two years have scarcely elapsed since I first employed the Digitalis;
+and the success I have had has induced me to use it largely and
+frequently.
+
+
+                                CASE I.
+
+Ann Willott, 50 years of age, became a patient of the Dispensary on
+the 11th of April 1783. She then complained of an enlargement of the
+abdomen, difficulty of breathing, particularly when lying, and
+costiveness. She passed small quantities of high-coloured urine; and
+had an evident fluctuation in the belly. Her legs were oedematous.
+Chrystals of tartar, squills, &c. had no effect. The 13th of _June_
+she took two spoonfuls of a decoction of Foxglove, containing three
+drams of the dry leaves, in eight ounces, three times a day. Her urine
+soon increased, and in a few days she passed it freely, which
+continued, and her breath returned.
+
+
+                               CASE II.
+
+Mr. ----, 45 years of age, had been long subject to dropsical
+swellings of the legs, and made little water. Two spoonfuls of the
+same decoction twice a day, soon relieved him.
+
+
+                               CASE III.
+
+Mrs. ----, aged 70 years. A lady frequently afflicted with the gout,
+and an asthmatical cough. After a long continuance of the latter, she
+had a great diminution of urine, and considerable difficulty of
+breathing, particularly on motion, or when lying. Her body was much
+bound. There was, however, no apparent swelling. She took three
+spoonfuls of an aperient decoction of forty-five grains in six ounces
+and a half, every other morning. The urine was plentiful those days,
+and her breathing much relieved. In two or three weeks after the use
+of it she was perfectly restored. The purgative medicine neither
+increased the urine, nor relieved the breathing, till the Foxglove was
+added.
+
+This spring she long laboured with the gout in her stomach, which
+terminated in a fit in her hand. During the whole of this tedious
+illness, of nearly three months, she passed little urine, and her
+breathing was again short.
+
+She took the same preparation of Foxglove without any diuretic effect,
+and afterwards two and three grains of the powder twice a day with as
+little. The dulcified spirits of vitriol, however, quickly promoted
+the urinary secretion.
+
+
+                               CASE IV.
+
+Mr. C----, 46 years of age, had dropsical swellings of the legs, and
+passed little urine. He took the decoction with three drams, and was
+soon relieved.
+
+
+                                CASE V.
+
+Lady----, took three grains of the dried leaves twice a day, for
+swelled legs, and scantiness of urine, without effect.
+
+
+                               CASE VI.
+
+Mrs. Slater, aged 36 years. For dropsy of the belly and legs, and
+scantiness of urine, of several weeks standing, took three grains of
+the powder twice a day, and was quite restored in ten days. She took
+many medicines without effect.
+
+
+                               CASE VII.
+
+Mrs. P----, in her 70th year, took three grains of the powder twice a
+day, for scantiness of urine, and swelled legs, without effect.
+
+
+                              CASE VIII.
+
+Ann Winterleg, in her 26th year, had dropsical swellings of the legs,
+and passed little urine: she was relieved by two drams, in an eight
+ounce decoction.
+
+
+                               CASE IX.
+
+William Brown, aged 76. In the last stage of dropsy of the belly and
+legs, found a considerable increase of his urine by a decoction of
+Foxglove, but it was not permanent.
+
+
+                                CASE X.
+
+Mr. ----, -- years of age, and of very gross habit of body, became
+highly dropsical, and took various medicines, without effect. One
+ounce of the decoction, with three drams of the dry leaves in eight
+ounces, twice or three times a day, increased his urine prodigiously.
+He was evidently better, but a little attendant nausea overcame his
+resolution, and in the course of some weeks afterwards he fell a
+victim to his obstinacy.
+
+
+                               CASE XI.
+
+Mrs. Smith, about 50 years of age, after a tedious illness of many
+weeks, had a jaundice, and became dropsical in the legs. Two spoonfuls
+of the decoction, with three drams twice a day, increased her urine,
+and abated the swelling.
+
+
+                               CASE XII.
+
+Widow Chatterton, about 60 years of age. Took the decoction in the
+same way for dropsy of the legs, with little effect.
+
+
+                              CASE XIII.
+
+---- Genders, about thirty-four years of age, was delivered of three
+children, and became dropsical of the abdomen. She passed little or no
+urine, had constant thirst, and no appetite. She took two spoonfuls of
+an eight ounce decoction, with three drams twice a day. By the time
+she had finished the bottle, (which must have been on the fourth day,)
+she had evacuated all her water, and could go about. Her appetite
+increased with every dose, and she recovered without farther help.
+
+
+                               CASE XIV.
+
+Miss M---- M----, in her 20th year. Had been infirm from her cradle,
+and, after various sufferings, had an astonishing oedematous
+swelling of one leg and thigh, of many weeks standing. She passed
+little or no urine, and had all her other complaints. She took 2
+spoonfuls of an eight oz. decoction of two drams, twice a day. Her
+urine immediately increased; and, on the third day, the swelling had
+entirely subsided.
+
+
+                               CASE XV.
+
+Mr. P----, 65 years of age, and of a full habit of body. Had lived
+freely in his youth, and for many years led rather an inactive life.
+His health was much impaired several months, and he had a considerable
+distention, and evident fluctuation in the abdomen, and a very great
+oedema of the legs and thighs. His breathing was very short, and
+rather laborious, appetite bad, and thirst considerable. His belly was
+bound, and he passed very small quantities of high-coloured urine,
+that deposited a reddish matter. He had taken medicines some time,
+and, I believe, the Digitalis; and had been better.
+
+A blister was applied to the upper and inside of each thigh; he took
+two spoonfuls of the decoction, with three drams of the dry leaves,
+two or three times a day; and some opening physic occasionally.
+
+He lived at a considerable distance, and I did not visit him a second
+time; but I was well informed, about ten days or a fortnight
+afterwards, that his urine increased amazingly upon taking the
+decoction, and that the water was entirely evacuated.
+
+
+                               CASE XVI.
+
+Mrs. G----, aged 50 years. After being long ailing, had a large
+collection of water in the abdomen and lower extremities. Her urine
+was high-coloured, in small quantities, and had a reddish sediment.
+She took the decoction of Digitalis, squills, &c. without any effect.
+The chrystals of tartar, however, cured her speedily.
+
+
+                              CASE XVII.
+
+Mr. ----, about 50 years of age, complained of great tension and pain
+across the abdomen, and of loss of appetite; his urine, he thought,
+was less than usual, but the difference was so trifling he could speak
+with no certainty: his belly seemed to fluctuate. Among other things
+he tried the Foxglove leaves dried, twice a day; and, although it
+appeared to afford him relief, yet the effect was not permanent.
+
+
+                              CASE XVIII.
+
+Mr. W----, aged between 60 and 70 years; and rather corpulent: was
+considerably dropsical, both of the belly and legs, and his urine in
+small quantities. Three grains of the dry leaves, twice a day,
+evacuated the water in less than a fortnight.
+
+
+                               CASE XIX.
+
+Sarah Taylor, 40 years of age, was admitted into the Dispensary for
+dropsy of the abdomen and legs; and was relieved by the Decoctum
+digitalianum.
+
+
+                               CASE XX.
+
+Lydia Smith, aged 60. Dispensary. Laboured many years under an asthma,
+and became dropsical. She took the decoction without effect.
+
+
+                               CASE XXI.
+
+John Leadbeater, aged 15 years. Had a quotidian intermittent, which
+was removed by the humane assistance of an amiable young lady. His
+intermittent was soon attended by a very considerable ascites; for
+which he became a patient of the Dispensary. He took a decoction of
+Foxglove night and morning. His urine increased immediately, and he
+lost all his complaints in four days.
+
+
+                              CASE XXII.
+
+William Millar, aged 50 years. Admitted into the Dispensary for a
+tertian ague, and general dropsy. The dropsy continuing after the ague
+was removed, and his urine being still passed in small quantities; he
+took the powdered leaves, and recovered his health in five days.
+
+
+                              CASE XXIII.
+
+Ann Wakelin, 10 years of age. Had for several weeks a dropsy of the
+belly after an ague. She took a decoction of Foxglove, which removed
+all complaint by the fourth day.
+
+
+                              CASE XXIV.
+
+Ann Meachime; a Dispensary patient. Had an ascites and scantiness of
+urine. She took the powder of Foxglove, and evacuated all her water
+in three days.
+
+It may not be improper to observe, 1st. That various diuretics had
+long been given in many of these cases before I was consulted. And,
+2dly. That the exhibition of the Foxglove was but seldom attended with
+sickness.
+
+
+                               REMARKS.
+
+These Cases, thus liberally communicated by my friend, Dr. Jones, are
+more acceptable, as they seem to contain a faithful abstract from his
+notes, both of the unsuccessful as well as the successful Cases.
+
+     The following Tabular View of them will give us some Idea of
+     the efficacy of the Medicine.
+
+    Anasarca                            7 Cases   Cured     3
+                                                  Relieved  1
+                                                  Failed    3
+    Ascites                             5 Cases   Cured     4
+                                                  Relieved  1
+    OEdematous leg                       1 Case    Cured     1
+    Ascites and anasarca                7 Cases   Cured     4
+                                                  Relieved  2
+                                                  Failed    1
+    Asthma and dropsy                   1 Case    Failed    1
+    Hydrothorax and gout                1 Case    Cured     1
+    ----, ascites and anasarca--        2 Cases   Cured     2
+
+
+                A CASE of Anasarca communicated by Mr.
+                    JONES, Surgeon, in Birmingham.
+
+     Dear SIR,
+
+Having lately experienced the diuretic powers of the Foxglove, in a
+case of anasarca; I do myself the pleasure of communicating a short
+history of the treatment to you.
+
+                                                I am, &c.
+                                                       W. JONES.
+
+         Birmingham,
+     May 17th, 1785.
+
+My patient, Mrs. C----, who is in her 51st year, had the following
+symptoms, viz. alternate swelling of the legs and abdomen, a little
+cough, shortness of breath in a morning, thirst, weak pulse, and her
+urine, which was so small in quantity as seldom to amount to half a
+pint in twenty-four hours, deposited a clay-coloured sediment.
+
+_April_ 16th, 1785, I directed the following form:
+
+    R. Fol. Digitalis siccat. [Symbol: dram]ii.
+    Aq. fontanae bullient. [Symbol: ounce]viii. f. infus. et cola.
+    Sumat cochl. larga iii. o. n. et mane.
+
+On the 17th she had taken twice of the infusion, and though by mistake
+only two tea spoonfuls for a dose, yet the quantity of urine was
+increased to about a pint in the twenty-four hours. She was then
+directed to take two table spoonfuls night and morning. And.
+
+On the 18th, a degree of nausea was produced. A pint and half of urine
+was made in the last twenty-four hours. During the time above
+specified she had two or three stools every day. The infusion was now
+omitted.
+
+On the 19th the swelling of the legs was removed. A degree of nausea
+took place in the morning, and increased so much during the day, that
+she vomited up all her food and medicine. As she was very low, and
+complained of want of appetite, a cordial julep was directed to be
+taken occasionally, as well as red port and water, mint tea, &c. She
+informed me that whatever she took generally staid about an hour
+before it came up again, and that the mint tea staid longest on the
+stomach. The vomiting decreased gradually, and ceased on the 22d. The
+discharge of urine remained considerable during the three following
+days, but its quantity was not measured.
+
+22d. A dose of neutral saline julep was directed to be taken every
+fourth hour.
+
+On the 23d she complained of thirst, and thought the discharge of
+urine not so copious as on the preceding days, therefore the saline
+julep was continued every fourth hour, with the addition of thirty
+drops of the following medicine:
+
+    R. Aceti scillitic. [Symbol: dram]vi.
+    Tinct. aromat. [Symbol: dram]ii.
+    Tinct. thebaic. gutt. xx. m.
+
+The bowels have been kept open from the 19th, by the occasional use of
+emollient injections.
+
+On the 24th the legs were much swelled again; she complained of
+languor and a degree of nausea. The discharge of urine increased a
+little since the 23d. Her pulse was low and her tongue white. The
+urine, which had been rendered clear by the infusion of Foxglove, now
+deposited a whitish sediment.
+
+On the 25th her appetite began to return, the swelling of the legs
+diminished, and she thought herself much relieved. The urine was
+considerable in quantity, and clear.
+
+On the 26th she was thirsty and languid. The swelling was removed; the
+quantity of urine discharged in the last twenty-four hours was about a
+pint. She continued to mend from this time, and is now in good health.
+
+A giddiness of the head, more or less remarkable at times, was
+observed to follow the use of the Foxglove, and it lasted nine or ten
+days.
+
+This is the second time that I have relieved this patient by the
+infusion of Foxglove. I used the same proportion of the fresh leaves
+the first time as I did of the dried ones the last. The violent
+vomiting which followed the use of the infusion made with the dried
+leaves, did not take place with the fresh though she took near a pint
+made with the same proportion of the herb fresh gathered.
+
+
+                               REMARKS.
+
+The above is a very instructive case, as it teaches us how small a
+quantity of the infusion was necessary to effect every desirable
+purpose. At first sight it may appear from the concluding paragraph,
+that the green leaves ought to be preferred to the dried ones, as
+being so much milder in their operation; but let it be noticed, that
+the same quantity of infusion was prepared from the same weight of the
+green as of the dried leaves, and consequently, as will appear
+hereafter, the infusion with the dried leaves was five times the
+strength of that before prepared from the green ones. We need not
+wonder, therefore, that the effects of the former were so
+disagreeable, when the dose was five times greater than it ought to
+have been. But what makes this matter still more obvious, is the
+mistake mentioned at first, of two tea spoonfuls only being given for
+a dose. Now a tea spoonful, containing about a fourth or a fifth part
+of the contents of a table spoon, the dose then given, was very nearly
+the same as that which had before been taken of the infusion of the
+green leaves, and it produced precisely the same effects for it
+increased the urinary discharge, without exciting the violent
+vomiting.
+
+
+                     Letter from Doctor JOHNSTONE,
+                       Physician, in Birmingham.
+
+     Dear SIR,
+
+The following cases are selected from many others in which I have
+given the Digitalis purpurea; and from repeated experience of its
+efficacy after other diuretics have failed. I can recommend it as an
+effectual, and when properly managed, a safe medicine.
+
+                                            I am, &c.
+                                                   E. JOHNSTONE.
+
+     Birmingham, May 26,
+     1785.
+
+_March_ 8th, 1783, I was called to attend Mr. G----, a gentleman of a
+robust habit, who had led a regular and temperate life, AEt. 68. He was
+affected with great difficulty of respiration, and cough particularly
+troublesome on attempting to lie down, oedematous swellings of the
+legs and thighs, abdomen tense and sore on being pressed, pain
+striking from the pit of the stomach to the back and shoulders; almost
+constant nausea, especially after taking food, which he frequently
+threw up; water thick and high-coloured, passed with difficulty and
+in small quantity; body costive; pulse natural; face much emaciated,
+eyes yellow and depressed. He had been subject to cough and difficulty
+of breathing in the winter for several years; and about four years
+before this time, after being exposed to cold, was suddenly deprived
+of his speech and the use of the right side, which he recovered as the
+warm weather came on; but since that time had been remarkably costive,
+and was in every respect much debilitated. He first perceived his legs
+swell about a year ago; by the use of medicines and exercise, the
+swellings subsided during the summer, but returned on the approach of
+winter, and gradually increased to the state in which I found them,
+notwithstanding he had used different preparations of squills and a
+great variety of other diuretic medicines. I ordered the following
+mixture.
+
+    R. Foliorum Digitalis purpur. recent. [Symbol: dram]iii.
+    decoque ex aq. fontan. [Symbol: ounce]xii ad [Symbol:
+    ounce]vi colaturae adde Tinctur. aromatic.
+
+    Syr. zinzib. aa [Symbol: ounce]i. m. capt. cochl. duo larga
+    secunda quaque hora ad quartam vicem nisi prius nausea
+    supervenerit.
+
+_March_ 9th. He took four doses of the mixture without being in the
+least sick, and made, during the night upwards of two quarts of
+natural coloured water.
+
+10th. Took the remainder of the mixture yesterday afternoon and
+evening, and was sick for a short time, but made nearly the same
+quantity of water as before, the swellings are considerably
+diminished, his appetite increased, but he is still costive.
+
+    R. Argent, viv. balsam peruv. aa [Symbol: dram]ss tere ad
+    extinctionem merc. et adde gum. ammon. [Symbol: scruple]iii aloes
+    socotorin. [Symbol: dram]ss rad. scil. recent. [Symbol: scruple]ss
+    syr. simpl. q. s. f. mass. in pil. xxxii divid. cap. iii. bis in die.
+
+14th. Continues to make water freely. The swellings of his legs have
+gradually decreased; soreness and tension of the abdomen considerably
+less.
+
+    Omittant. pil. cap. mistur. c. decoct. Digitalis. &c. 3tia
+    quaque hora ad 3tiam vicem.
+
+15th. Made a pint and a half of water last night, without being in the
+least sick, and is in every respect considerably better. Repet.
+Pillul. ut antea.
+
+21st. Makes water as usual when in health, and the swellings are
+entirely gone.
+
+    R. Infus. amar. [Symbol: ounce]v. tinctur. Rhei spirit.
+    [Symbol: ounce]ii. spirit vitriol. dulc. [Symbol: dram]ii.
+    syr. zinzib. [Symbol: dram]vi. m. cap. cochl. iii. larg. ter
+    in die.
+
+He soon gained sufficient strength to enable him to go a journey, and
+returned home in much better health than he had been from the time he
+was affected with the paralytic stroke, and excepting some return of
+his asthmatic complaint in the winter, hath continued so ever since.
+
+
+                               CASE II.
+
+R---- Howgate, a man much addicted to intemperance, particularly in
+the use of spirituous liquors, AEt. 60, was admitted into the Hospital
+near Birmingham, _May_ 17, 1783. He complained of difficulty of
+breathing, attended with cough, particularly troublesome on lying
+down; drowsiness and frequent dozing, from which he was roused by
+startings, accompanied with great anxiety and oppression about the
+breast; oedematous swellings of the legs; constant desire to make
+water, which he passed with difficulty, and only by drops; pulse weak
+and irregular; body rather costive; face much emaciated; no appetite
+for food.--Cap. pil. scil. iii. ter in die.[6]
+
+    [Footnote 6: R. Rad. scil. recent. sapon. castiliens. pulv.
+    Rhei opt. aa. [Symbol: scruple]i. ol. junip. gutt. xvi. syr.
+    bals. q. s. f. mass. in pil. xxiv. divid.]
+
+_May_ 20th. The pills have had no effect.--Cap. mistur. c.[7] Decoct.
+Digital. &c. cochl. ii. larg. 3tia quaque hora, ad 3tiam vicem.
+
+    [Footnote 7: Prepared in the same manner as in the former
+    case.]
+
+_May_ 21st. Made near two quarts of water in the night, without being
+in the least sick. He continued the use of the mixture three times in
+the day till the 30th, and made about three pints of water daily, by
+which means the swellings were entirely taken away; and his other
+complaints so much relieved, that on the 6th of June he was dismissed
+free from complaint, except a slight cough. But returning to his old
+course of life, he hath had frequent attacks of his disorder, which
+have been always removed by using the Digitalis.
+
+
+                  Extract of a letter from Mr. LYON,
+                         Surgeon, at Tamworth.
+
+--Mr. Moggs was about 54 years of age, his disease a dropsy of the
+abdomen, attended with anasarcous swellings of the limbs, &c. brought
+on by excessive drinking. I believe the first symptoms of the disease
+appeared the beginning of November, 1776; the medicines he took before
+you saw him, were squills in different forms, sal diureticus and
+calomel, but without any good effect; he begun the Digitalis on the
+10th of July 1777; a few doses of it caused a giddiness in the head,
+and almost deprived him of sight, with very great nausea, but very
+little vomiting, after which a considerable flow of urine ensued, and
+in a very short time, a very little water remained either in the
+cavity of the abdomen, or the membrana adiposa, but he remained
+excessive weak, with a fluttering pulse at the rate of 150 or
+frequently 160 in a minute; he kept pretty free from water for upwards
+of twelve months; it then collected, and neither the Digitalis nor
+any other medicine would carry it off. I tapped him the 2d of August
+1779 in the usual place, and took some gallons of water from him, but
+he very soon filled again, and as he had a very large rupture, a
+considerable quantity of the water lodged in the scrotum, and could
+not be got away by tapping in the usual place. I therefore (on the
+28th of the same month) made an incision into the lower part of the
+scrotum, and drained off all the water that way, but he was so very
+much reduced, that he died the 8th or 9th of _September_ following,
+which was about two years and two months after he first begun the
+Digitalis.
+
+I have had several dropsical patients relieved, and some perfectly
+recovered by the Digitalis, since you attended Mr. Moggs, but as I did
+not take any notes or make any memorandums of them, cannot give you
+any of them.
+
+
+                    Communications from Dr. STOKES,
+                      Physician, in Stourbridge.
+
+     Dear SIR,
+
+I accept with pleasure your invitation to communicate what I know
+respecting the properties of _Digitalis_; and if an account of what
+others had discovered before you,[8] with a detail of my own
+experience, shall be allowed the merit of at least a well meant
+acknowledgment, for the early communication you were so kind to make
+me, of the valuable properties you had found in it; I shall consider
+my time as well employed. A knowledge of what has been already done is
+the best ground work of future experiment; on which account I have
+been the more full on this subject, in hopes that given with the
+cautions which you mean to lay down in the cure of dropsies, it may
+prove alike useful in that of other diseases, one of which stands
+foremost among the _opprobria_ of medicine.
+
+    [Footnote 8: See this account in the Introduction.]
+
+
+                                CASE I.
+
+Mrs. M----. Orthopnea, pain, and excessive oppression at the bottom of
+the sternum. Pulse irregular, with frequent intermissions. Appetite
+very much impaired. Legs anasarcous.
+
+    _Empl. vesicator. pectori dolent._
+    _Infus. Digital. e [Symbol: dram]iii. ad. aq. &c. [Symbol: ounce]viii.
+    cochl. j. o. h. donec nausea excitetur vel diuresis satis copiosa
+    proveniat._
+
+I ordered it of the above strength, and to be repeated often, on
+account of the great emergency of the case, but the nausea excited by
+the first dose prevented its being given at such short intervals. A 3d
+dose I found had been given, which was followed by vomitings. All her
+complaints gradually abated, but in about a fortnight recurred,
+notwithstanding the use of infus. amar. &c.
+
+    _Dec. 2. Infus. Digit. e. [Symbol: dram]iss ad aq. &c.
+    [Symbol: ounce]viii. cochl. ii. horis &c. u. a._
+
+Complaints gradually abated, swellings of the legs nearly gone down.
+
+About a month afterwards you was desired to visit this patient.[9]
+
+    [Footnote 9: For reasons assigned at p. 100, I did not intend
+    to introduce any case, occurring under my own inspection, in
+    the course of the present year; but it may be satisfactory to
+    continue the history of this disease, as Dr. Stokes's
+    narrative would otherwise be incomplete.
+
+
+                                 1785.
+
+                                 CASE.
+
+    _Jan._ 5th. Mrs. M----, AEt. 48. Hydrothorax and anasarcous
+    legs, of eight months duration. She had taken jallap, squill,
+    salt of tartar, and various other medicines. I found her in a
+    very reduced state, and therefore directed only a grain and
+    half of the Pulv. Digital. to be given night and morning.
+    This in a few days encreased the secretion of urine, removed
+    her difficulty of breathing, and reduced the swelling of her
+    legs, without any disturbance to her system.
+
+    Three months afterwards, a severe attack of gout in her legs
+    and arms, removing to her head, she died.
+
+    Dr. Stokes had an opportunity of examining the dead body, and
+    I had the satisfaction to learn from him, that there did not
+    appear to have been any return of the dropsy.]
+
+On the examination of the body I noticed, among others, the following
+appearances.
+
+About 3/4 oz. of bloody water flowed out, on elevating the upper half
+of the scull, and a small quantity also was found at the base.
+
+BRAIN. Blood-vessels turgid with blood, and many of those of
+considerable size distended with air.
+
+A very slight watery effusion between the _Pia Mater_ and _Tunica
+arachnoidea_. About 3/4 oz. of watery fluid in the _lateral
+ventricles_.
+
+THORAX. In the left cavity about 4 oz. of bloody serum; in the right
+but little. Lungs, the hinder parts loaded with blood. Adhesions of
+each lobe to the pleura. _Pericardium_ containing but a very small
+quantity of fluid. _Heart_ containing no coagula of blood. _Valves of
+the Aorta_ of a cartilaginous texture, as if beginning to ossify.
+
+_Abdominal Viscera_ natural, and a profusion of _Fat_ under the
+integuments of the abdomen and thorax, in the former to the thickness
+of an inch and upwards, and in very considerable quantity on the
+mesentery, omentum, kidneys, &c.
+
+OBS. The intermitting pulse should seem to have been owing to
+effusions of water in some of the cavities of the breast, as it
+disappeared on the removal of the waters.
+
+
+                               CASE II.
+
+Mrs. C---- of K----, AEt. 80. Orthopnoea, with sense of oppression
+about the proecordia. Unable to lie down in bed for some nights
+past. Anasarca of the lower extremities. Urine very scanty. Complaints
+of six weeks standing. Had taken _sal. diuret. c. ol. junip.--Calom.
+c. jalap, et gambog.--Et ol. junip. c. ol. Terebinth._ without effect.
+
+_Feb._ 7. _Infus. Digital. e. [Symbol: dram]iii. ad aq. &c.
+[Symbol: ounce]viii. cochl. ii. 4tis horis._ Ordered to drink largely
+of _infus. baccar. junip._ The third dose produced great nausea which
+continued ten hours, during which time the urine made was about a
+quart. The next day her apothecary directed her to begin again with
+it. The second dose produced vomiting. During the next twenty hours
+she made two quarts of water, about four times as much as she drank.
+
+From this time she took no more of the _infus. Digital._ but continued
+the _inf. bacc. junip._ until about _March_ 2d, when all the swellings
+were gone down, her respiration perfectly free, and she herself quite
+restored to her former state of health. On the 29th she had an attack
+of jaundice which was some time after removed; since which she has
+enjoyed a good state of health, excepting that for some little time
+past her ancles have been slightly oedematous, which will I trust
+soon yield to strengthening medicines.
+
+
+                               CASE III.
+
+Mrs. M---- G----, AEt. 64. Has had sore legs for these thirty-four
+years past. Orthopnoea. Sense of oppression at the proecordia.
+Pulse intermitting. Legs anasarcous. Urine scanty, high-coloured.
+
+    _Infus. Digital. c. [Symbol: dram]iss ad aq. bull. [Symbol: ounce]viii.
+    cochl. ii. 4tis horis._
+
+Took six doses, when nausea was excited. Urine a quart during the
+course of the night. The flow of urine continued, and complaints
+relieved. Sal. Mart. c. extr. gent. and afterwards with the addition
+of extr. cort. for which last ingredient she had a predilection,
+confirmed the cure.
+
+On the same day the next year I was called in to her for a similar
+train of symptoms, excepting that the pulse was but just perceptibly
+irregular.
+
+    _Infus. Digital. u. a. praescript._
+
+The directions on the phial not being attended to, _two doses of it
+were given after a nausea had been excited_, which, with occasional
+vomitings, became exceedingly oppressive. A saline draught, given in
+Dr. Hulme's method, a draught _sal. c. c. gr. xii. c. conf. card. gr.
+x._ produced no immediate effect, but the nausea gradually abating,
+inf. bacc. junip. was ordered; but this appeared to augment it, and a
+great propensity to sleep coming on, I directed _sal. c. c. conf.
+card, aa gr. viii. 4tis horis_, which removed the unpleasant symptoms
+and _myrrh. c. sal. mart._ completed the cure. During the use of the
+above medicines, the urine was augmented, and the pulmonary complaints
+removed, even before the nausea left her; and the sores of her legs
+which were much inflamed before she began with the infus. Digital. in
+a day's time assumed a much healthier appearance, and on her other
+complaints going off, they shewed a greater tendency to heal than she
+had ever observed in them for twenty years before. This instance is a
+very pleasing confirmation of the experience of Hulse and Dr. Baylies,
+and of the advantage to be derived from a medicine, which, while it
+helps to heal the ulcers, removes that from the constitution which
+often renders the healing of them improper.
+
+In one case in which I ordered it, the infusion, instead of digesting
+three hours as I had directed, was suffered to stand upon the leaves
+all night. The consequence was that the first dose produced
+considerable nausea.
+
+The two following cases, with which I have been favoured by a
+physician very justly eminent, convince me of the necessity there is
+that every one who discovers a new medicine, or new virtues in an old
+one, should, in announcing such discoveries, publish to the world the
+exact manner in which he exhibits such medicines, with all the
+precautions necessary to obtain the promised success.
+
+    In these (says my correspondent) "the infusion was given in
+    small doses, repeated every hour or two, till a nausea was
+    raised, when it was omitted for a day or perhaps two, and
+    then repeated in the same manner.
+
+    "An ASCITES emptied by it, but filled again very speedily,
+    though _its use was never discontinued_, and who afterwards
+    found no salutary effects from it. Ended fatally.
+
+    "In an ANASARCA it sometimes increased the quantity of urine,
+    and abated the swelling, but which as often returned in as
+    great a degree as before, though _the medicine was still
+    given_, and always increased in quantity so as to excite
+    nausea. Ended fatally.
+
+    "I have tried it in many other cases, but found very little
+    difference in the success attending it."
+
+May we not be allowed to conjecture that the inefficacy of _its
+continued use_ is owing to its narcotic property gradually diminishing
+the irritability of the muscular fibres of the absorbents, or possibly
+of the whole vascular system, and thus adding to that weakened action
+which seems to be the cause of the generality of dropsies, which leads
+us to caution the medical experimenter against trying it, at least
+_against its continued use, even in small doses_, in other diseases of
+diminished energy, as continued fever, palsy, &c.
+
+             I remain with the greatest truth,
+
+                       Your obliged and affectionate friend,
+
+                                                JONATHAN STOKES.
+
+     Stourbridge,
+     May 17, 1785.
+
+
+    The three following Hospital Cases, which Dr. STOKES had an
+    opportunity of observing, are related as instances of bad
+    practice, and tend to demonstrate how necessary it is when
+    one physician adopts the medicine of another, that he should
+    also at first rigidly adopt his method.
+
+
+                                CASE I.
+
+Esther K----, AEt. 33. General anasarca, ascites, and dyspnoea, of
+seven months duration.
+
+_Decoct. c Digit. [Symbol: dram]iv. c. aq. [Symbol: pound]i. coquend.
+ad [Symbol: pound]ss. cap. [Symbol: ounce]i. 2dis. horis._ 1st DAY.
+4th dose made her sick. 2d DAY. The first dose she took to-day
+produced vomiting.
+
+3d DAY. _Minuatur dosis ad [Symbol: ounce]ss._ This stayed upon her
+stomach, but produced an almost constant sickness. Stools more
+frequent, water scarce sensibly increased; and her swellings not at
+all reduced.
+
+4th DAY. _Cap. Calomel. gambog. scill. &c._
+
+OBS. Sufficient time was not allowed to observe its effects, neither
+was the patient enjoined the free use of diluents. The disease
+terminated fatally.
+
+
+                               CASE II.
+
+William T----, AEt. 42. Ascites, with cough and dyspnoea. Abdomen
+very much distended. The rest of his body highly emaciated. Urine
+thick, high coloured, and in very small quantity.
+
+    _Decoct. Digit. (u. in Esther K----,) 4tis horis._
+
+1st DAY of taking it. The 4th dose produced sickness.
+
+2d. Vomiting after the second dose.
+
+10th. Urine increased to [Symbol: pound]vi.
+
+11th. Flow of urine continues. Abdomen quite flaccid.
+
+12th. Abdomen not diminished.
+
+15th: A smart purging came on, and the flow of urine diminished.
+
+23d. Belly much bound. Took a cathart. powder, which was followed by a
+diminution of the abdomen.
+
+29th. To take a cathart. powder every 4th morning, continuing the
+decoct. Digit.
+
+32d. Urine exceedingly scanty.
+
+35th. _Vin. scill. [Symbol: ounce]ss. o. m. &c._ This produced
+diuretic effects.
+
+44th. Tapped. Terminated fatally.
+
+OBS. Here the medicine was _continued till it ceased to produce
+diuretic effects_; and these effects were not aided by any
+strengthening remedies.
+
+
+                               CASE III.
+
+George R----, AEt. 52. Ascites, general anasarca, and dyspnoea. His
+legs so greatly distended that it was with great difficulty he could
+draw the one after the other.
+
+    _Infus. Digital. [Symbol: dram]iiiss. ad. aq. [Symbol: pound]ss.
+    cap. [Symbol: ounce]i. altern. horis donec nauseam
+    excitaverit._ _Rep. 3tiis diebus. tempore intermedio cap.
+    sol. guaic. [Symbol: ounce]i. ter in die ex inf. sinap._
+
+1st DAY of taking it. Became sickish towards night.
+
+2d DAY. Made a great quantity of water during the night, and spat up a
+great deal of watery phlegm. The first dose he took in the morning has
+produced a sickness which has continued all day, but he has never
+vomited.
+
+3d. DAY. The change in his appearance so great as to make it difficult
+to conceive him to be the same person. Instead of a large corpulent
+man, he appeared tall, thin, and rather aged. Breathes freely, and can
+walk up and down stairs without inconvenience.
+
+4th DAY. _Decoct. bacc. junip. and cyder for common drink._
+
+6th DAY. A second course of his medicine produced a flow of urine
+almost as plentiful as the former, though he drank little or nothing
+at the time. In a day or two after he walked to some distance.
+
+12th DAY. _Pot. purgans illico._
+
+14th DAY. _Pot. purg. c. jalap. [Symbol: dram]ss. 4tis diebus._
+          _Infus. Dig. 3tiis diebus._
+
+17th DAY. _R. Gamb. gr. iii. calom. gr. ii. camph.
+          gr. i. syr. simpl. fiat pil. o. n. sum._
+          _Infus. Digit. 3tiis diebus._
+
+21st DAY. Made an out-patient. The super-abundant flow of urine
+continued for the first three days after his last course; but since,
+the flow of saliva has been nearly equal to that of urine.
+
+The smalls of his legs not quite reduced, and are fuller at night. He
+has shrunk round the middle from four feet two inches to three feet
+six inches; and in the calves of his legs, from seventeen inches to
+thirteen and a half.[10]
+
+
+    [Footnote 10: In the three last recited cases, the medicine
+    was directed in doses quite too strong, and repeated too
+    frequently. If Esther K---- could have survived the extreme
+    sickness, the diuretic effects would probably have taken
+    place, and, from her time of life, I should have expected a
+    recovery. Wm. T---- seems to have been a bad case, and I
+    think would not have been cured under any management. G.
+    R---- certainly possessed a good constitution, or he must
+    have shared the fate of the other two.]
+
+OBS. The waters were here very successfully evacuated, but as you
+remarked to me, on communicating the case to you at the time, tonic
+medicines should have been given, to second the ground that had been
+gained, instead of weakening the patient by drastic purgatives.
+
+
+                   A CASE from Mr. SHAW, Surgeon, at
+             Stourbridge.--Communicated by Doctor STOKES.
+
+Matth. D----, AEt. 71. Tall and thin. Disease a general anasarca, with
+great difficulty of breathing. The lac ammoniac. somewhat relieved his
+breath; but the swellings increased, and his urine was not augmented.
+I considered it as a lost case, but having seen the good effects of
+the Digitalis, as ordered by Dr. Stokes in the case of Mrs. G----, I
+gave him one spoonful of an infusion of [Symbol: dram]ii to half a
+pint, twice a day. His breath became much easier, his urine increased
+considerably, and the swellings gradually disappeared; since which his
+health has been pretty good, except that about three weeks ago, he had
+a slight dyspnoea, with pain in his stomach, which were soon removed
+by a repetition of the same medicine.
+
+Mr. Shaw likewise informs me, that he has removed pains in the stomach
+and bowels, by giving a spoonful of the infusion, [Symbol: dram]iss.
+to [Symbol: ounce]viii. morning and night.
+
+
+            A Letter from Mr. VAUX, Surgeon, in Birmingham.
+
+     Dear SIR,
+
+I send you the two following cases, wherein the Digitalis had very
+powerful and sensible effects, in the cure of the different patients.
+
+
+                                CASE I.
+
+Mrs. O---- of L---- street, in this town, aged 28, naturally of a
+thin, spare habit, and her family inclinable to phthisis, sent for me
+on the 11th of June, 1779, at which time she complained of great pain
+in her side, a constant cough, expectorated much, which sunk in water;
+had colliquative sweats and frequent purging stools; the lower
+extremities and belly full of water, and from the great difficulty she
+had in breathing, I concluded there was water in the chest also. The
+quantity of water made at a time for three weeks before I saw her,
+never amounted to more than a tea-cup full, frequently not so much.
+Finding her in so alarming a situation, I gave it as my opinion she
+could receive no benefit from medicine, and requested her not to take
+any; but she being very desirous of my ordering her something, I
+complied, and sent her a box of gum pills with squills, and a mixture
+with salt of tartar: these medicines she took until the sixteenth,
+without any good effects: the water in her legs now began to exsude
+through the skin, and a small blister on one of her legs broke.
+Believing she could not exist much longer, unless an evacuation of the
+water could be procured; after fully informing her of her situation,
+and the uncertainty of her surviving the use of the medicine, I
+ventured to propose her taking the Digitalis, which she chearfully
+agreed to. I accordingly sent her a pint mixture, made as under, of
+the fresh leaves of the Digitalis. Three drams infused in one pint of
+boiling water, when cold strained off, without pressing the leaves,
+and two ounces of the strong juniper water added to it: of this
+mixture she was ordered four table spoonfuls every third hour, till it
+either made her sick, purged her, or had a sensible effect on the
+kidneys. This mixture was sent on the seventeenth, and she began
+taking it at noon on the eighteenth. At one o'clock the following
+morning I was called up, and informed she was dying. I immediately
+attended her, and was agreeably surprised to find their fright arose
+from her having fainted, in consequence of the sudden loss of twelve
+quarts of water she had made in about two hours. I immediately applied
+a roller round her belly, and, as soon as they could be made, 2
+others, which were carried from the toes quite up the thighs. The
+relief afforded by these was immediate; but the medicine now began to
+affect her stomach so much, that she kept nothing on it many minutes
+together. I ordered her to drink freely of beef tea, which she did,
+but kept it on her stomach but a very short time. A neutral draught in
+a state of effervescence was taken to no good purpose: She therefore
+continued the beef tea, and took no other medicine for five days,
+when her sickness went off: her cough abated, but the pain in her side
+still continuing, I applied a blister which had the desired effect:
+her urine after the first day flowed naturally. Her cure was
+compleated by the gum pills with steel and the bitter infusion. It
+must be observed she never had any collection of water afterwards.
+
+It affords me great pleasure to inform you that she is now living, and
+has since had four children; all of whom, I think I may justly say,
+are indebted to the Digitalis for their existence.
+
+There appears in this case a striking proof of the utility of emetics
+in some kinds of consumptions, as it appears to me the dropsy was
+brought on by the cough, &c. and I believe these were cured by the
+continual vomitings, occasioned by the medicine.
+
+
+                                CASE II.
+
+Mr. H----, a publican, aged about 48 years, sent for me in _March_,
+1778. He complained of a cough, shortness of breathing, which
+prevented him from laying down in bed; his belly, thighs and legs very
+much distended with water; the quantity of urine made at a time seldom
+exceeded a spoonful. I requested him to get some of the Digitalis, and
+as they had no proper weights in the house, I told them to put as much
+of the fresh leaves as would weigh down a guinea, into half a pint of
+boiling water; to let it stand till cold, then to pour off the clear
+liquor, and add a glass of gin to it, and to take three table
+spoonfuls every third hour, until it had some sensible effect upon
+him.
+
+Before he had taken all the infusion, the quantity of urine made
+increased, (he therefore left off taking it), and it continued to do
+so until all the water was evacuated. His breathing became much
+better, his cough abated, though it never quite left him; he being for
+some time before asthmatic. By taking some tonic pills he continued
+quite well until the next spring, when he had a return of his
+complaint, which was carried off by the same means. Two years after,
+he had a third attack, and this also gave way to the medicine. Last
+year he died of a pleurisy.
+
+                                                  I am, &c.
+                                                       JER. VAUX
+
+     Moor-Street, 8th May,
+     1785.
+
+P. S. You must well recollect the case of Mrs. F----.--It was "a
+general dropsy--every time she took the medicine its effects were
+similar, viz. The discharge of urine came on gradually at first,
+increased afterwards, and the whole of the water both in the belly,
+legs, &c. was perfectly evacuated. Although the effects were only
+temporary, they were exceedingly agreeable to the patient, making her
+time much more comfortable."--(_See Case_ XLIII.)
+
+
+                     A Letter from Mr. WAINWRIGHT,
+                          Surgeon, in Dudley.
+
+     Dear SIR,
+
+It gives me great pleasure to find you intend to publish your
+observations on the Digitalis purpurea.
+
+Several years are now elapsed since you communicated to me the high
+opinion you entertained of the diuretic qualities of this noble plant.
+To ensure success, due attention was recommended to its _preparation_,
+its _dose_, and its _effects_ upon the system.
+
+I always gave the infusion of the dried leaves; the dose the same as
+in the prescriptions returned. If the medicine operated on the stomach
+or bowels, it was thought prudent to forbear. When the kidneys began
+to perform their proper functions, and the urine to be discharged, a
+continuance of its farther use was unnecessary.
+
+These remarks you made in the case of the first patient for whom you
+prescribed the Digitalis in our neighbourhood, and I have found them
+all necessary at this present period. From the _decided_ good effects
+that followed from its use, in those cases where the most powerful
+remedies had failed, I was soon convinced it was a most valuable
+addition to the materia medica.
+
+The want of a certain diuretic, has long been one of the desiderata of
+medicine. The Digitalis is undoubtedly at the head of that class, and
+will seldom, if properly administered, disappoint the expectation. I
+can speak with the more confidence, having, in an extensive practice,
+been a happy witness to its good qualities.
+
+For several years, I have given the infusion in a variety of cases,
+where there was a deficiency in the secretion of the urine, with the
+greatest success. In recent obstructions, I do not recollect many
+failures. In anasarcous diseases, and in the anasarca, when combined
+with the ascites; in swellings of the limbs, and in diseases of the
+chest, when there was the greatest reason to believe an accumulation
+of serum, the most beneficial consequences have followed from its use.
+
+Had I been earlier acquainted with your intention to publish an
+account of the Digitalis, I could have transmitted some cases, which
+might have served to corroborate these assertions: but I am convinced
+the Digitalis needs not my assistance to procure a favorable
+reception. Its own merit will ensure success, more than a hundred
+recited cases.
+
+I could wish those gentlemen who intend to make use of this plant, to
+collect it in a hot dry day, when the petals fall, and the
+seed-vessels begin to swell.
+
+The leaves kept to the second year are weaker, and their diuretic
+qualities much diminished. It will therefore be necessary to gather
+the plant fresh every season.
+
+These cautions are unnecessary to the accurate botanist, who well
+knows, that a plant in the spring, though more succulent and full of
+juices, is destitute of those qualities which may be expected when
+that plant has attained its full vigour, and the seed-vessels begin to
+be manifest. But for want of attention to these particulars, its
+virtues may be thought exaggerated, or doubtful, if beneficial
+consequences do not always flow from its use. There are diseases it
+cannot cure; and in several of those patients in this town, who first
+took the Digitalis by your orders, there was the most positive proof
+of the viscera being unsound. In these desperate cases it often
+procured a plentiful flow of urine, and palliated a disease which
+medicine could not remove.
+
+At a remote distance, physicians are seldom applied to for advice in
+trifling disorders. Many remedies have been tried without relief, and
+the disease is generally obstinate or confirmed.--It would not be fair
+to try the merits of the Digitalis in this scale. It might often fail
+of promoting the end desired. I flatter myself the reputation of this
+plant will be equal to its merit, and that it will meet with a candid
+reception.
+
+As there is no pleasure equal to relieving the miseries and distresses
+of our fellow-creatures, I hope you will long enjoy that peculiar
+felicity.
+
+Permit me to return my thankful acknowledgments, for your free
+communication of a medicine, by which means, through the blessing of
+providence, I have been enabled to restore health and happiness to
+many miserable objects.
+
+                                           I am, &c.
+                                                 Yours,
+                                                  J. WAINWRIGHT.
+
+     Dudley, April 26th,
+     1785.
+
+
+                     CASE of Mr. WARD, Surgeon, in
+                   Birmingham.--Related by himself.
+
+In _September_, 1782, I was seized with a difficulty of breathing, and
+oppression in my chest, in consequence of taking cold from being
+called out in the night. My tongue was foul; my urine small in
+quantity; my breath laborious and distressing on the slightest
+exercise. I tried the medicines most generally recommended, such as
+emetics, blisters, lac ammoniacum, oxymel of squills, &c. but finding
+little or no relief, I consulted Dr. Withering, who advised me to try
+the following prescription.
+
+    R. Fol. Digital. purp. siccat. [Symbol: dram]iss.
+    Aq. bullientis [Symbol: ounce]iv.
+    Aq. cinn. sp. [Symbol: ounce]ss. digere per horas quatuor, et colaturae
+    capiat cochlear. i. nocte maneque.
+
+He also desired me to take fifty drops of tincture of cantharides
+three or four times a day.
+
+After taking eight ounces of the infusion, and about twelve drams of
+the drops, I was perfectly cured, and have had no return since. The
+medicine did not occasion sickness or vertigo, nor had they any other
+sensible effect than in changing the appearance, and increasing the
+quantity of the urine, and rendering the tongue clean. After the last
+dose or two indeed, I had a little nausea, which was immediately
+removed by a small glass of brandy.
+
+     Birmingham, 1st July, 1785.
+
+
+                    Communications from Mr. YONGE,
+                  Surgeon, in Shiffnall, Shropshire.
+
+     Dear SIR,
+
+I have great satisfaction in complying with your just claim, by
+transcribing outlines of the subsequent cases, for insertion in your
+long requested tract on the Digitalis purpurea. The two first of these
+you will easily recollect, the cures having been conducted immediately
+under your own management, and the whole may add to that weight of
+evidence which long experience enables you to adduce of the efficacy
+of that valuable medicine. I have recited the only instances of its
+failure which occur to me, but many other, though successful cases,
+wherein its utility might seem dubious, and also the accounts received
+from people whose accuracy might be suspected, I shall not for obvious
+reasons trouble you with.
+
+                                      I am, dear Sir,
+                                        Your obliged friend,
+                                                  WILLIAM YONGE.
+
+     Shiffnall,
+     _May_ 1, 1785.
+
+
+                                CASE I.
+
+A Gentleman aged 49, on the night of the 21st of August, 1784, awaked
+with a sense of suffocation, which obliged him to rise up suddenly in
+bed. I found him complaining of difficult respiration, particularly on
+lying down; the countenance pale, and the pulse smaller and quicker
+than usual. Some brandy and water having been given, the symptoms
+gradually abated, so that he slept in a half recumbent posture. The
+following day he expressed a sense of anxiety and weight in the chest,
+attended by quicker breathing upon motion of the body. That evening an
+emetic of ipecacoanha was given, and afterwards a draught, with
+vitriolic aether and confect. card. aa [Symbol: dram]i to be repeated as the
+symptoms should require it. He continued to be affected with slighter
+returns of the dyspnoea at irregular intervals, until _September_ 15th,
+when upon a more severe attack, the emetic was repeated. He now
+recollected some slight pain in his arms which had affected him
+previous to this last seizure, and was disposed to consider his
+complaint as rheumatic. Pills with gum ammoniac. gum guaiac. and
+antimonial powder were directed, with infus. amar. simpl. twice a day.
+The bowels were regulated by aperient pills of pulv. jalap. aloes and
+sal. tartar. and [Symbol: dram]iss balsam peruv. was given occasionally to
+alleviate the paroxysms of dyspnoea.
+
+From this period until the beginning of November, little amendment or
+variation happened, except that respiration became more permanently
+difficult, and particularly oppressed upon motion, nor was it relieved
+by the expectoration of a mucous discharge, which now increased
+considerably. Squills, musk, ol. succini, aether, with other medicines
+of the same kind, were now used, but without success. The effects of
+opium and venaefection were tried. The appetite diminished, and his
+sleep became short and disturbed. He sometimes slept lying upon his
+back, but generally upon his left side. The urine which had hitherto
+been of good colour, and sufficient quantity, now became diminished,
+and lateritious; and the ancles oedematous.
+
+On the 15th of _November_ a blister was laid over the sternum, and
+[Symbol: dram]iss of oxymel scillitic. was given every eight hours.
+
+On the 18th, a more copious discharge of urine took place; the
+swelling of the feet soon disappeared, and the respiration became
+gradually relieved.
+
+On the 30th [Symbol: dram]i tinct. cantharidum twice a day in pyrmont
+water, with pills of ammoniac, sal tartar. et extract. gentian. were
+substituted, but
+
+On the 7th of _December_, from some symptoms of relapse, the oxymel
+was used as before, and continued to be taken until the 27th, in doses
+as large as could be dispensed with on account of the great nausea
+which attended its exhibition: The urine was made in the quantity of
+four or five pints each day, during the whole time; the quantity then
+drank being seldom more than three pints. But now the sickness being
+exceedingly depressing, the strength failing, and the diuretic effects
+beginning to cease, the following prescription was directed.
+
+    R. Fol. Digitalis purpur. pulv. [Symbol: scruple]ss.
+    Spec. Aromatic. [Symbol: scruple]i. sp. lav. c. f. pilul. no.
+    x. capiat i. nocte maneque, et alternis diebus sensim
+    augeatur dosin.
+
+In three days the effect of this medicine became visible, and when the
+dose of the Digitalis had been increased to six grains per day, the
+flow of urine generally amounted to seven pints every twenty-four
+hours. Not the least sickness, nor any other disagreeable symptom
+supervened, though he persevered in this plan until the end of
+_January_ at which time the dyspnoea was removed, and he has
+continued gradually to regain his flesh, strength, and appetite,
+without any relapse.
+
+
+                               CASE II.
+
+About the middle of the year 1784 a lady aged 48, returned from
+London, to her native air in Shropshire, under symptoms of complicated
+disease. It was your opinion that the plethoric state, consequent to
+that period, when menstruation first begins to cease, had under
+various appearances, laid the foundation of that deplorable state
+which now presented itself. The skin was universally of a pale, leaden
+colour; her person much emaciated, and her strength so reduced, as to
+disable her from walking without support. The appetite fluctuating,
+the digestion impaired so much, that solids passed the intestines with
+little appearance of solution: She had generally eight or ten alvine
+evacuations every day, and without this number, febrile symptoms,
+attended with severe vertiginous affection, and vomiting regularly
+ensued. The stools were of a pale ash colour. The urine generally
+pale, and at first in due quantity. The region of the stomach had a
+tense feel, without soreness: the feet and ancles oedematous, her
+sleep was uncertain: the pulse varying between 94 and 100, and feeble,
+except upon the approach of the menstrual periods, which were now only
+marked by its increased strength, and exacerbation of other febrile
+symptoms. Emetics, saline medicines, and gentle aperients were
+necessary to alleviate these. Six grains of ipecac, operated with
+sufficient power, and half a grain of calomel would have purged with
+great violence.
+
+From the time of her arrival till the middle of _August_, mercury had
+been continued in various forms, and in doses such as the irritable
+state of her stomach and bowels would admit of. Spirit. nitri dulc.;
+sal. tartar, squill, and cantharides were alternately employed as
+diuretics, but without success, to retard the progress of an universal
+anasarca which was then advanced to such degree and accompanied by so
+great debility, and other dreadful concomitants, as to threaten a
+speedy and fatal catastrophe.
+
+On the 16th of _August_ you first saw her, and directed thus.
+
+    R. Mercur. cinerei gr. ii.
+    Fol. Digital, purpur. pulv. [Symbol: scruple]i. f. mass. in
+    pill. no. xvi. dividend.--sumat unam hora meridiana,
+    iterumque hora quinta pomeridiana quotidie.
+    Capiat lixivii saponac. gutt. L. in haust. juscul. sine sale
+    parati omni nocte.
+
+On the 20th the flow of urine began to increase, and she continued the
+medicine in the same dose until the 20th of _September_, discharging
+from six to eight pints of water each day for the first week, and
+which quantity gradually diminished as she became empty. During this
+period she complained not of any sickness, except from the lixivium,
+which was after the first dose reduced to 20 drops; and her appetite
+and strength increased daily, though it was evident that no bile had
+yet flowed into the bowels, nor was the digestion at all improved. The
+anasarcous appearances being then removed, the Digitalis was omitted,
+and pills, composed of mercur. cinereus, aloes, and sal tartari
+directed twice a day, with [Symbol: dram]i. of vin. chalybeat. in
+infus. amar. simpl.
+
+Her amendment in other respects proceeded slowly, but regularly, from
+that time until the 9th of October; when the state of plethora again
+recurring, with its usual attendant symptoms, [Symbol: ounce]iv. of
+blood were taken from the arm; and this was upon the same occasion,
+repeated in the following month, with manifest good consequences;
+though in both instances the colour of the blood, as flowing from the
+vein could hardly be called red, and the coagulum was as weak in its
+cohesion as possible. The state of the stomach and bowels was by this
+time greatly improved, in common with other parts of the system; but
+no intromission of bile had yet happened: the hardness about the
+hypogastric region, though less, continued in a considerable degree,
+and you ordered pills of mercury rubbed down, and rust of iron, to be
+taken twice a day, with a decoction of dandelion and sal sodae.
+
+A cataplasm of linseed was applied every night over the stomach and
+right side; and, with little deviation from this plan, she continued
+to the end of the year, improving in her general health, but the
+hepatic affection yet remaining. It was then determined to try the
+effects of electricity, and gentle shocks were passed through the body
+daily, and as nearly as could be through the liver, in various
+directions.
+
+On the fifth day there was reason to think that some gall had been
+secreted and poured out, and this became every day more evident; but
+it flowed only in small quantity, and irregularly into the bowels, as
+appeared from the faeces being partially tinged by it.
+
+In _February_ the lady left this neighbourhood, and though
+convalescent, yet so nearly well as to promise us the satisfaction of
+seeing her perfectly restored.
+
+_June_ 29. The bile is now secreted in pretty good quantity, her
+appetite is perfectly good, her strength equal to almost any degree of
+exercise, and her health in general better than it has been for some
+years.
+
+
+                               CASE III.
+
+Mr. W----, aged--. In _June_, 1782, was affected with slight
+difficulty in respiration, upon taking exercise or lying down in bed.
+These symptoms increased gradually until the end of _July_, when he
+complained of sense of weight and uneasiness about the proecordia;
+loss of appetite; and costiveness. The urine was small in quantity,
+and high coloured; his pulse feeble, and intermitting; he breathed
+with difficulty when in bed, and slept little. After the exhibition of
+an emetic, and an opening medicine of rhubarb, sena, and sal tartari,
+he was directed to take half a dram of squill pill, pharm. Edinburg.
+night and morning, with [Symbol: dram]ss sal. sodae in [Symbol: ounce]iss.
+infus. amar. simpl. twice a day; and these medicines were continued
+during ten days, without any sensible effect. A blister was then
+applied to the sternum, and six grains of calomel given in the
+evening. The symptoms were now increased very considerably, in every
+particular; and the following infusion was substituted for the former
+medicines.
+
+    R. Fol. Digital. purpur. [Symbol: dram]iii.
+    Cort. limon. [Symbol: dram]ii. infund.
+    Aq. bullient. [Symbol: pound]i. per hor. 2 et cola. sumat
+    cochl. i. primo mane et repet. omni hora.
+
+Sometime in the night considerable nausea occurred, and the following
+day he began to make water in great quantity, which he continued to do
+for three or four days. The pulse in a few hours became regular,
+slower, and stronger, and, in the course of a week, all the symptoms
+entirely vanished, and an electuary of cort. peruvian, sal martis, and
+spec. aromatic. confirmed his cure.
+
+In _February_, 1784, this gentleman had a relapse of his disease, from
+which he again soon recovered by the same means, and is now perfectly
+well.
+
+
+                               CASE IV.
+
+G---- A----, a husbandman, aged 57. Was in the year 1782 affected with
+a slight, but constant pain in his breast, with difficult respiration.
+His countenance was yellow; the abdomen swelled, and hard; his urine
+high coloured, and in small quantity; appetite and sleep little.
+Complained of frequent nausea, and of sudden profuse sweatings, which
+seemed for a short time to relieve the dyspnoea.
+
+After the exhibition of an emetic, six grains of calomel were given,
+with a purge of jalap in the morning, and repeated in a few days, with
+some appearance of advantage. He was then directed to take some pills
+of squill, soap, and rhubarb, with a draught twice a day, consisting
+of infus. amar. simp. and sal tartari. The skin soon became clearer
+and the pain in his breast considerably diminished. But every other
+circumstance remaining the same, and a fluctuation in the belly being
+now more evident, the infusion of Digitalis as prescribed in case
+third, was given in the dose of one ounce twice a day.
+
+On the 5th day the effects were apparent, and he continued his
+medicine for a fortnight without nausea, making four or five pints of
+water every night, but little in the day, and gradually losing the
+symptoms of his disease.
+
+In 1784, this person had a relapse, and was again cured by similar
+treatment.
+
+
+                                CASE V.
+
+R---- H----, Aged 43. Towards the end of the year 1783, became
+affected with slight cough and expectoration of purulent matter. In
+December his skin became universally of a pale yellow colour. The
+abdomen was swelled and hard; his appetite little, and he complained
+of a violent and constant palpitation of the heart, which prevented
+him from sleeping. The urine pale, and in small quantity. The pulse
+exceedingly strong, and rebounding; beating 114 to 120 strokes every
+minute. He suffered violent pain of his head, and was very feeble and
+emaciated. After bleeding, and the use of gentle aperient medicines,
+he continued to take the infusion of Digitalis for some days, without
+any sensible effect. Other diuretics were tried to as little purpose.
+Repeated bleeding had no effect in diminishing the violent action of
+the heart. He died in January following, under complicated symptoms of
+phthisis and ascites.
+
+
+                               CASE VI.
+
+A man aged 57, who had lived freely in the summer of 1784, became
+affected with oedematous swelling of his legs, for which he was
+advised to drink Fox Glove Tea. He took a four ounce bason of the
+infusion made strong with the green leaves, every morning for four
+successive days.
+
+On the 5th he was suddenly seized with faintness and cold sweatings. I
+found him with a pale countenance, complaining of weakness, and of
+pain, with a sense of great heat in his stomach and bowels. The
+swelling of the legs was entirely gone, he having evacuated urine in
+very large quantities for the two preceding days. He was affected with
+frequent diarrhoea. The pulse was very quick and small, and his
+extremities cold.
+
+A small quantity of broth was directed to be given him every half
+hour, and blisters were applied to the ancles, by which his symptoms
+became gradually alleviated, and he recovered perfectly in the space
+of three weeks; except a relapse of the anasarca, for which the
+Digitalis was afterwards successfully employed, in small doses,
+without any disagreeable consequence.
+
+
+                               CASE VII.
+
+S---- D----, a middle aged single woman, was affected in the year
+eighty-one, with a painful rigidity and slight inflammation of the
+integuments on the left side, extending from the ear to the shoulder.
+In every other particular she was healthy. The use of warm
+fomentations, and opium, with two or three doses of mercurial physic,
+afforded her ease and the inflammation disappeared, but was succeeded
+by an oedematous swelling of the part, which very gradually extended
+along the arm, and downward to the breast, back, and belly. Friction,
+electricity and mercurial ointment were amongst the number of
+applications unsuccessfully employed to relieve her for the space of
+three months, during which time she continued in good general health.
+
+In _November_ she became ascitic, passing small quantities of urine,
+and soon afterwards a sudden dyspnoea gave occasion to suppose an
+effusion of water in the thorax. The Digitalis, squills, and
+cantharides were given in very considerable doses without effect. She
+died the latter end of December following.
+
+
+                              CASE VIII.
+
+W---- C----, a collier aged 58, was attacked in the spring of 1783
+with a tertian ague, which he attributed to cold, by sleeping in a
+coal pit, and from which he recovered in a few days, except a
+swelling of the lower extremities, which had appeared about that time,
+and gradually increased for two or three months. The legs and thighs
+were greatly enlarged and oedematous. His belly was swelled, but no
+fluctuation perceptible. He made small quantities of high coloured
+water. The appetite bad, and pulse feeble. He had taken many medicines
+without relief, and was now so reduced in strength, as to sit up with
+difficulty. An infusion of the Digitalis was directed for him, in the
+proportion of one ounce of the fresh leaves to a pint of water, two
+ounces to be taken three times a day, until the stomach or bowels
+became affected. Upon the exhibition of the sixth dose, nausea
+supervened, and continued to oppress him at intervals for two or three
+days, during which he passed large quantities of pale urine. The
+swelling, assisted by moderate bandage rapidly diminished, and without
+any repetition of his medicine, at the expiration of sixteen days, he
+returned to his labour perfectly recovered.
+
+
+
+
+            OF THE PREPARATIONS and DOSES, OF THE FOXGLOVE.
+
+
+Every part of the plant has more or less of the same bitter taste,
+varying, however, as to strength, and changing with the age of the
+plant and the season of the year.
+
+ROOT.--This varies greatly with the age of the plant. When the stem
+has shot up for flowering, which it does the second year of its
+growth, the root becomes dry, nearly tasteless, and inert.
+
+Some practitioners, who have used the root, and been so happy as to
+cure their patients without exciting sickness, have been pleased to
+communicate the circumstance to me as an improvement in the use of the
+plant. I have no doubt of the truth of their remarks, and I thank
+them. But the case of Dr. Cawley puts this matter beyond dispute. The
+fact is, they have fortunately happened to use the root in its
+approach to its inert state, and consequently have not over dosed
+their patients. I could, if necessary, bring other proof to shew that
+the root is just as capable as the leaves, of exciting nausea.
+
+STEM.--The stem has more taste than the root has, in the season the
+stem shoots out, and less taste than the leaves. I do not know that it
+has been particularly selected for use.
+
+LEAVES.--These vary greatly in their efficacy at different seasons of
+the year, and, perhaps, at different stages of their growth; but I am
+not certain that this variation keeps pace with the greater or lesser
+intensity of their bitter taste.
+
+Some who have been habituated to the use of the recent leaves, tell
+me, that they answer their purpose at every season of the year; and I
+believe them, notwithstanding I myself have found very great
+variations in this respect. The solution of this difficulty is
+obvious. They have used the leaves in such large proportion, that the
+doses have been sufficient, or more than sufficient, even in their
+most inefficacious state. _The Leaf-stalks_ seem, in their sensible
+properties, to partake of an intermediate state between the leaves and
+the stem.
+
+FLOWERS.--The petals, the chives, and the pointal have nearly the
+taste of the leaves, and it has been suggested to me, by a very
+sensible and judicious friend, that it might be well to fix on the
+flower for internal use. I see no objection to the proposition; but I
+have not tried it.
+
+SEEDS.--These I believe are equally untried.
+
+From this view of the different parts of the plant, it is sufficiently
+obvious why I still continue to prefer the leaves.
+
+These should be gathered after the flowering stem has shot up, and
+about the time that the blossoms are coming forth.
+
+The leaf-stalk and mid-rib of the leaves should be rejected, and the
+remaining part should be dried, either in the sun-shine, or on a tin
+pan or pewter dish before a fire.
+
+If well dried, they readily rub down to a beautiful green powder,
+which weighs something less than one-fifth of the original weight of
+the leaves. Care must be taken that the leaves be not scorched in
+drying, and they should not be dried more than what is requisite to
+allow of their being readily reduced to powder.
+
+I give to adults, from one to three grains of this powder twice a day.
+In the reduced state in which physicians generally find dropsical
+patients, four grains a day are sufficient. I sometimes give the
+powder alone; sometimes unite it with aromatics, and sometimes form it
+into pills with a sufficient quantity of soap or gum ammoniac.
+
+If a liquid medicine be preferred, I order a dram of these dried
+leaves to be infused for four hours in half a pint of boiling water,
+adding to the strained liquor an ounce of any spirituous water. One
+ounce of this infusion given twice a day, is a medium dose for an
+adult patient. If the patient be stronger than usual, or the symptoms
+very urgent, this dose may be given once in eight hours; and on the
+contrary in many instances half an ounce at a time will be quite
+sufficient. About thirty grains of the powder or eight ounces of the
+infusion, may generally be taken before the nausea commences.
+
+The ingenuity of man has ever been fond of exerting itself to vary the
+forms and combinations of medicines. Hence we have spirituous, vinous,
+and acetous tinctures; extracts hard and soft, syrups with sugar or
+honey, &c. but the more we multiply the forms of any medicine, the
+longer we shall be in ascertaining its real dose. I have no lasting
+objection however to any of these formulae except the extract, which,
+from the nature of its preparation must ever be uncertain in its
+effects; and a medicine whose fullest dose in substance does not
+exceed three grains, cannot be supposed to stand in need of
+condensation.
+
+It appears from several of the cases, that when the Digitalis is
+disposed to purge, opium may be joined with it advantageously; and
+when the bowels are too tardy, jalap may be given at the same time,
+without interfering with its diuretic effects; but I have not found
+benefit from any other adjunct.
+
+From this view of the doses in which the Digitalis really ought to be
+exhibited, and from the evidence of many of the cases, in which it
+appears to have been given in quantities six, eight, ten or even
+twelve times more than necessary, we must admit as an inference either
+that this medicine is perfectly safe when given as I advise, or that
+the medicines in daily use are highly dangerous.
+
+
+
+
+                     EFFECTS, RULES, and CAUTIONS.
+
+
+The Foxglove when given in very large and quickly-repeated doses,
+occasions sickness, vomiting, purging, giddiness, confused vision,
+objects appearing green or yellow; increased secretion of urine, with
+frequent motions to part with it, and sometimes inability to retain
+it; slow pulse, even as slow as 35 in a minute, cold sweats,
+convulsions, syncope, death.[11]
+
+    [Footnote 11: I am doubtful whether it does not sometimes
+    excite a copious flow of saliva.--See cases at pages 115,
+    154, and 155.]
+
+When given in a less violent manner, it produces most of these effects
+in a lower degree; and it is curious to observe, that the sickness,
+with a certain dose of the medicine, does not take place for many
+hours after its exhibition has been discontinued; that the flow of
+urine will often precede, sometimes accompany, frequently follow the
+sickness at the distance of some days, and not unfrequently be checked
+by it. The sickness thus excited, is extremely different from that
+occasioned by any other medicine; it is peculiarly distressing to the
+patient; it ceases, it recurs again as violent as before; and thus it
+will continue to recur for three or four days, at distant and more
+distant intervals.
+
+These sufferings of the patient are generally rewarded by a return of
+appetite, much greater than what existed before the taking of the
+medicine.
+
+But these sufferings are not at all necessary; they are the effects of
+our inexperience, and would in similar circumstances, more or less
+attend the exhibition of almost every active and powerful medicine we
+use.
+
+Perhaps the reader will better understand how it ought to be given,
+from the following detail of my own improvement, than from precepts
+peremptorily delivered, and their source veiled in obscurity.
+
+At first I thought it necessary _to bring on and continue the
+sickness, in order to ensure the diuretic effects_.
+
+I soon learnt that the nausea being once excited, it was unnecessary
+to repeat the medicine, as it was certain to recur frequently, at
+intervals more or less distant.
+
+Therefore my patients were ordered _to persist until the nausea came
+on, and then to stop_. But it soon appeared that the diuretic effects
+would often take place first, and sometimes be checked when the
+sickness or a purging supervened.
+
+The direction was therefore enlarged thus--_Continue the medicine
+until the urine flows, or sickness or purging take place_.
+
+I found myself safe under this regulation for two or three years; but
+at length cases occurred in which the pulse would be retarded to an
+alarming degree, without any other preceding effect.
+
+The directions therefore required an additional attention to the state
+of the pulse, and it was moreover of consequence not to repeat the
+doses too quickly, but to allow sufficient time for the effects of
+each to take place, as it was found very possible to pour in an
+injurious quantity of the medicine, before any of the signals for
+forbearance appeared.
+
+_Let the medicine therefore be given in the doses, and at the
+intervals mentioned above:--let it be continued until it either acts
+on the kidneys, the stomach, the pulse, or the bowels; let it be
+stopped upon the first appearance of any one of these effects_, and I
+will maintain that the patient will not suffer from its exhibition,
+nor the practitioner be disappointed in any reasonable expectation.
+
+If it purges, it seldom succeeds well.
+
+The patients should be enjoined to drink very freely during its
+operation. I mean, they should drink whatever they prefer, and in as
+great quantity as their appetite for drink demands. This direction is
+the more necessary, as they are very generally prepossessed with an
+idea of drying up a dropsy, by abstinence from liquids, and fear to
+add to the disease, by indulging their inclination to drink.
+
+In cases of ascites and anasarca; when the patients are weak, and the
+evacuation of the water rapid; the use of proper bandage is
+indispensably necessary to their safety.
+
+If the water should not be wholly evacuated, it is best to allow an
+interval of several days before the medicine be repeated, that food
+and tonics maybe administered; but truth compels me to say, that the
+usual tonic medicines have in these cases very often deceived my
+expectations.
+
+From some cases which have occurred in the course of the present year,
+I am disposed to believe that the Digitalis may be given in small
+doses, viz. two or three grains a day, so as gradually to remove a
+dropsy, without any other than mild diuretic effects, and without any
+interruption to its use until the cure be compleated.
+
+If inadvertently the doses of the Foxglove should be prescribed too
+largely, exhibited too rapidly, or urged to too great a length; the
+knowledge of a remedy to counteract its effects would be a desirable
+thing. Such a remedy may perhaps in time be discovered. The usual
+cordials and volatiles are generally rejected from the stomach;
+aromatics and strong bitters are longer retained; brandy will
+sometimes remove the sickness when only slight; I have sometimes
+thought small doses of opium useful, but I am more confident of the
+advantage from blisters. Mr. Jones (_Page_ 135) in one case, found
+mint tea to be retained longer than other things.
+
+
+
+
+                       CONSTITUTION of PATIENTS.
+
+
+Independent of the degree of disease, or of the strength or age of the
+patient, I have had occasion to remark, that there are certain
+constitutions favourable, and others unfavourable to the success of
+the Digitalis.
+
+From large experience, and attentive observation, I am pretty well
+enabled to decide _a priori_ upon this matter, and I wish to enable
+others to do the same: but I feel myself hardly equal to the
+undertaking. The following hints, however, aiding a degree of
+experience in others, may lead them to accomplish what I yet can
+describe but imperfectly.
+
+It seldom succeeds in men of great natural strength, of tense fibre,
+of warm skin, of florid complexion, or in those with a tight and cordy
+pulse.
+
+If the belly in ascites be tense, hard, and circumscribed, or the
+limbs in anasarca solid and resisting, we have but little to hope.
+
+On the contrary, if the pulse be feeble or intermitting, the
+countenance pale, the lips livid, the skin cold, the swollen belly
+soft and fluctuating, or the anasarcous limbs readily pitting under
+the pressure of the finger, we may expect the diuretic effects to
+follow in a kindly manner.
+
+In cases which foil every attempt at relief, I have been aiming, for
+some time past, to make such a change in the constitution of the
+patient, as might give a chance of success to the Digitalis.
+
+By blood-letting, by neutral salts, by chrystals of tartar, squills,
+and occasional purging, I have succeeded, though imperfectly. Next to
+the use of the lancet, I think nothing lowers the tone of the system
+more effectually than the squill, and consequently it will always be
+proper, in such cases, to use the squill; for if that fail in its
+desired effect, it is one of the best preparatives to the adoption of
+the Digitalis.
+
+A tendency to paralytic affections, or a stroke of the palsy having
+actually taken place, is no objection to the use of the Digitalis;
+neither does a stone existing in the bladder forbid its use.
+Theoretical ideas of sedative effects in the former, and apprehensions
+of its excitement of the urinary organs in the latter case, might
+operate so as to make us with-hold relief from the patient; but
+experience tells me, that such apprehensions are groundless.
+
+
+
+
+                              INFERENCES.
+
+
+To prevent any improper influence, which the above recitals of the
+efficacy of the medicine, aided by the novelty of the subject, may
+have upon the minds of the younger part of my readers, in raising
+their expectations to too high a pitch, I beg leave to deduce a few
+inferences, which I apprehend the facts will fairly support.
+
+I. That the Digitalis will not universally act as a diuretic.
+
+II. That it does do so more generally than any other medicine.
+
+III. That it will often produce this effect after every other probable
+method has been fruitlessly tried.
+
+IV. That if this fails, there is but little chance of any other
+medicine succeeding.
+
+V. That in proper doses, and under the management now pointed out, it
+is mild in its operation, and gives less disturbance to the system,
+than squill, or almost any other active medicine.
+
+VI. That when dropsy is attended by palsy, unsound viscera, great
+debility, or other complication of disease, neither the Digitalis, nor
+any other diuretic can do more than obtain a truce to the urgency of
+the symptoms; unless by gaining time, it may afford opportunity for
+other medicines to combat and subdue the original disease.
+
+VII. That the Digitalis may be used with advantage in every species of
+dropsy, except the encysted.
+
+VIII. That it may be made subservient to the cure of diseases,
+unconnected with dropsy.
+
+IX. That it has a power over the motion of the heart, to a degree yet
+unobserved in any other medicine, and that this power may be converted
+to salutary ends.
+
+
+
+
+         PRACTICAL REMARKS ON DROPSY, AND SOME OTHER DISEASES.
+
+
+The following remarks consist partly of matter of fact, and partly of
+opinion. The former will be permanent; the latter must vary with the
+detection of error, or the improvement of knowledge. I hazard them
+with diffidence, and hope they will be examined with candour; not by a
+contrast with other opinions, but by an attentive comparison with the
+phoenomena of disease.
+
+
+                               ANASARCA.
+
+Sec. 1. The anasarca is generally curable when seated in the
+sub-cutaneous cellular membrane, or in the substance of the lungs.
+
+Sec. 2. When the abdominal viscera in general are greatly enlarged, which
+they sometimes are, without effused fluid in the cavity of the
+abdomen; the disease is incurable. After death, the more solid viscera
+are found very large and pale. If the cavity contains water, that
+water may be removed by diuretics.
+
+Sec. 3. In swollen legs and thighs, where the resistance to pressure is
+considerable, the tendency to transparency in the skin not obvious,
+and where the alteration of posture occasions but little alteration in
+the state of distension, the cure cannot be effected by diuretics.
+
+Is this difficulty of cure occasioned by spissitude in the effused
+fluids, by want of proper communication from cell to cell, or is the
+disease rather caused by a morbid growth of the solids, than by an
+accumulation of fluid?
+
+Is not this disease in the limbs similar to that of the viscera (Sec. 2)?
+
+Sec. 4. Anasarcous swellings often take place in palsied limbs, in arms
+as well as legs; so that the swelling does not depend merely upon
+position.
+
+Sec. 5. Is there not cause to suspect that many dropsies originate from
+paralytic affections of the lymphatic absorbents? And if so, is it not
+probable that the Digitalis, which is so effectual in removing dropsy,
+may also be used advantageously in some kinds of palsy?
+
+
+                               ASCITES.
+
+Sec. 6. If existing alone, (_i. e._) without accompanying anasarca, is in
+children curable; in adults generally incurable by medicines. Tapping
+may be used here with better chance for success than in more
+complicated dropsies. Sometimes cured by vomiting.
+
+
+                         ASCITES and ANASARCA.
+
+Sec. 7. Incurable if dependant upon irremediably diseased viscera, or on
+a gouty constitution, so debilitated, that the gouty paroxysms no
+longer continue to be formed.
+
+In every other situation the disease yields to diuretics and tonics.
+
+
+                  ASCITES, ANASARCA, and HYDROTHORAX.
+
+Sec. 8. Under this complication, though the symptoms admit of relief, the
+restoration of the constitution can hardly be hoped for.
+
+
+                                ASTHMA.
+
+Sec. 9. The true spasmodic asthma, a rare disease--is not relieved by
+Digitalis.
+
+Sec. 10. In the greater part of what are called asthmatical cases, the
+real disease is anasarca of the lungs, and is generally to be cured by
+diuretics. (See Sec. 1.) This is almost always combined with some
+swelling of the legs.
+
+Sec. 11. There is another kind of asthma, in which change of posture does
+not much affect the patient. I believe it to be caused by an
+infarction of the lungs. It is incurable by diuretics; but it is often
+accompanied with a degree of anasarca, and so far it admits of relief.
+
+Is not this disease similar to that in the limbs at (Sec.3,) and also to
+that of the abdominal viscera at (Sec.2.)?
+
+
+                         ASTHMA and ANASARCA.
+
+Sec. 12. If the asthma be of the kind mentioned at (Sec.Sec. 9 and 11,)
+diuretics can only remove the accompanying anasarca. But if the
+affection of the breath depends also upon cellular effusion, as it
+mostly does, the patient may be taught to expect a recovery.
+
+
+                          ASTHMA and ASCITES.
+
+Sec. 13. A rare combination, but not incurable if the abdominal viscera
+are sound. The asthma is here most probably of the anasarcous kind (Sec.
+10;) and this being seldom confined to the lungs only, the disease
+generally appears in the following form.
+
+
+                    ASTHMA, ASCITES, and ANASARCA.
+
+Sec. 14. The curability of this combination will depend upon the
+circumstances mentioned in the preceding section, taking also into the
+account the strength or weakness of the patient.
+
+
+                               EPILEPSY.
+
+Sec. 15. In epilepsy dependant upon effusion, the Digitalis will effect a
+cure; and in the cases alluded to, the dropsical symptoms were
+unequivocal. It has not had a sufficient trial in my hands, to
+determine what it can do in other kinds of epilepsy.
+
+
+                            HYDATID DROPSY.
+
+Sec. 16. This may be distinguished from common ascites, by the want of
+evident fluctuation. It is common to both sexes. It does not admit of
+a cure either by tapping or by medicine.
+
+
+                            HYDROCEPHALUS.
+
+Sec. 17. This disease, which has of late so much attracted the attention
+of the medical world, I believe, originates in inflammation; and that
+the water found in the ventricles of the brain after death, is the
+consequence, and not the cause of the illness.
+
+It has seldom happened to me to be called upon in the earlier stages
+of this complaint, and the symptoms are at first so similar to those
+usually attendant upon dentition and worms, that it is very difficult
+to pronounce decidedly upon the real nature of the disease; and it is
+rather from the failure of the usual modes of relief, than from any
+other more decided observation, that we at length dare to give it a
+name.
+
+At first, the febrile symptoms are sometimes so unsteady, that I have
+known them mistaken for the symptoms of an intermittent, and the cure
+attempted by the bark.
+
+In the more advanced stages, the diagnostics obtrude themselves upon
+our notice, and put the situation of the patient beyond a doubt. But
+this does not always happen. The variations of the pulse, so
+accurately described by the late Dr. Whytt, do not always ensue. The
+dilatation of the pupils, the squinting, and the aversion to light, do
+not universally exist. The screaming upon raising the head from the
+pillow or the lap, and the flushing of the cheeks, I once considered
+as affording indubitable marks of the disease; but in a child which I
+sometime since attended with Dr. Ash, the pulse was uniformly about
+85, (except during the first week, before we had the care of the
+patient.) The child never shewed any aversion to the light; never had
+dilated pupils, never squinted, never screamed when raised from the
+lap or taken out of the bed, nor did we observe any remarkable
+flushing of the cheeks; and the sleep was quiet, but sometimes
+moaning.
+
+Frequent vomiting existed from the first, but ceased for several days
+towards the conclusion. One or two worms came away during the illness,
+and it was all along difficult to purge the child. Three days before
+death, the right side became slightly paralytic, and the pupil of that
+eye somewhat dilated.
+
+After death, about two ounces and a half of water were found in the
+ventricles of the brain, and the vessels of the dura mater were turgid
+with blood.
+
+If I am right as to the nature of hydrocephalus, that it is at first
+dependant upon inflammation, or congestion; and that the water in the
+ventricles is a consequence, and not a cause of the disease; the
+curative intentions ought to be extremely different in the first and
+the last stages.
+
+It happens very rarely that I am called to patients at the beginning,
+but in two instances wherein I was called at first, the patients were
+cured by repeated topical bleedings, vomits, and purges.
+
+Some years ago I mentioned these opinions, and the success of the
+practice resulting from them, to Dr. Quin, now physician at Dublin.
+That gentleman had lately taken his degree, and had chosen
+hydrocephalus for the subject of his thesis in the year 1779. In this
+very ingenious essay, which he gave me the same morning, I was much
+pleased to find that the author had not only held the same ideas
+relative to the nature of the disease, but had also confirmed them by
+dissections.
+
+In the year 1781, another case in the first stage demanded my
+attention. The reader is referred back to Case LXIX for the
+particulars.
+
+I have not yet been able to determine whether the Digitalis can or
+cannot be used with advantage in the second stage of the
+hydrocephalus. In Case XXXIII. the symptoms of death were at hand; in
+Case LXIX. the practice, though successful, was too complicated, and
+in Case CLI. the medicine was certainly stopped too soon.
+
+When we consider what enormous quantities of mercury may be used in
+this complaint, without affecting the salivary glands, it seems
+probable that other parts may be equally insensible to the action of
+their peculiar stimuli, and therefore that the Digitalis ought to be
+given in much larger doses in this, than in other diseases.
+
+
+                             HYDROTHORAX.
+
+Sec. 18. Under this name I also include the dropsy of the pericardium.
+
+The intermitting pulse, and pain in the arms, sufficiently distinguish
+this disease from asthma, and from anasarcous lungs.
+
+It is very universally cured by the Digitalis.
+
+Sec. 19. I lately met with two cases which had been considered and
+treated as angina pectoris. They both appeared to me to be cases of
+hydrothorax. One subject was a clergyman, whose strength had been so
+compleatly exhausted by the continuance of the disease, and the
+attempts to relieve it, that he did not survive many days. The other
+was a lady, whose time of life made me suspect effusion. I directed
+her to take small doses of the pulv. Digitalis, which in eight days
+removed all her complaints. This happened six months ago, and she
+remains perfectly well.
+
+
+                       HYDROTHORAX and ANASARCA.
+
+Sec. 20. This combination is very frequent, and, I believe, may always be
+cured by the Digitalis.
+
+Sec. 21. Dropsies in the chest either with or without anasarcous limbs,
+are much more curable than those of the belly. Probably because the
+abdominal viscera are more frequently diseased in the latter than in
+the former cases.
+
+
+                               INSANITY.
+
+Sec. 22. I apprehend this disease to be more frequently connected with
+serous effusion than has been commonly imagined.
+
+Sec. 23. Where appearances of anasarca point out the true cause of the
+complaint, as in cases XXIV. and XXXIV. the happiest effects may be
+expected from the Digitalis; and men of more experience than myself in
+cases of insanity, will probably employ it successfully in other less
+obvious circumstances.
+
+
+                         NEPHRITIS CALCULOSA.
+
+Sec. 24. We have had sufficient evidence of the efficacy of the Foxglove
+in removing the Dysuria and other symptoms of this disease; but
+probably it is not in these cases preferable to the tobacco.[12]
+
+    [Footnote 12: See an original and valuable treatise by Dr.
+    Fowler, entitled, _Medical Reports of the Effects of
+    Tobacco_.]
+
+
+                            OVARIUM DROPSY.
+
+Sec. 25. This species of encysted dropsy is not without difficulty
+distinguishable from an ascites; and yet it is necessary to
+distinguish them, because the two diseases require different treatment
+and because the probality of a cure is much greater in one than in the
+other.
+
+Sec. 26. The ovarium dropsy is generally slow in its progress; for a
+considerable time the patient though somewhat emaciated, does not lose
+the appearance of health, and the urine flows in the usual quantity.
+It is seldom that the practitioner is called in early enough to
+distinguish by the feel on which side the cyst originated, and the
+patients do not attend to that circumstance themselves. They generally
+menstruate regularly in the incipient state of the disease, and it is
+not until the pressure from the sac becomes very great, that the
+urinary secretion diminishes. In this species of dropsy, the patients,
+upon being questioned, acknowledge even from a pretty early date,
+pains in the upper and inner parts of the thighs, similar to those
+which women experience in a state of pregnancy. These pains are for a
+length of time greater in one thigh than in the other, and I believe
+it will be found that the disease originated on that side.
+
+Sec. 27. The ovarium dropsy defies the power of medicine. It admits of
+relief, and sometimes of a cure, by tapping. I submit to the
+consideration of practitioners, how far we may hope to cure this
+disease by a seton or a caustic.--In the LXIst case the patient was
+too much reduced, and the disease too far advanced to allow of a cure
+by any method; but it teaches us that a caustic may be used with
+safety.
+
+Sec. 28. When tapping becomes necessary, I always advise the adoption of
+the waistcoat bandage or belt, invented by the late very justly
+celebrated Dr. Monro, and described in the first volume of the Medical
+Essays. I also enjoin my patients to wear this bandage afterwards,
+from a persuasion that it retards the return of the disease. The
+proper use of bandage, when the disorder first discovers itself,
+certainly contributes much to prevent its increase.
+
+
+                     OVARIUM DROPSY with ANASARCA.
+
+Sec. 29. The anasarca does not appear until the encysted dropsy is very
+far advanced. It is then probably caused by weakness and pressure. The
+Digitalis removes it for a time.
+
+
+                         PHTHISIS PULMONALIS.
+
+Sec. 30. This is a very increasing malady in the present day. It is no
+longer limited to the middle part of life: children at five years of
+age die of it, and old people at sixty or seventy. It is not confined
+to the flat-chested, the fair-skinned, the blue eyed, the
+light-haired, or the scrophulous: it often attacks people with full
+chests, brown skins, dark hair and eyes, and those in whose family no
+scrophulous taint can be traced. It is certainly infectious. The very
+strict laws still existing in Italy to prevent the infection from
+consumptive patients, were probably not enacted originally without a
+sufficient cause. We seem to be approaching to that state which first
+made such restrictions necessary, and in the further course of time,
+the disease will probably fall off again, both in virulency and
+frequency.
+
+Sec. 31. The younger part of the female sex are liable to a disease very
+much resembling a true consumption, and from which it is difficult to
+distinguish it; but this disease is curable by steel and bitters. A
+criterion of true phthisis has been sought for in the state of the
+teeth; but the exceptions to that rule are numerous. An unusual
+dilatation of the pupil of the eye, is the most certain
+characteristic.[13]
+
+    [Footnote 13: Many years ago I communicated to my friend, Dr.
+    Percival, an account of some trials of breathing fixed air in
+    consumptive cases. The results were published by him in the
+    second Vol. of his very useful Essays Medical and
+    Experimental, and have since been copied into other
+    publications. I take this opportunity of acknowledging that I
+    suspect myself to have been mistaken in the nature of the
+    disease there mentioned to have been cured. I believe it was
+    a case of _Vomica_, and not a true _Phthisis_ that was cured.
+    The Vomica is almost always curable. The fixed air corrects
+    the smell of the matter, and very shortly removes the hectic
+    fever. My patients not only inspire it, but I keep large jars
+    of the effervescing mixture constantly at work in their
+    chambers.]
+
+Sec. 32. Sydenham asserts, that the bark did not more certainly cure an
+intermittent, than riding did a consumption. We must not deny the
+truth of an assertion, from such authority, but we must conclude that
+the disease was more easily curable a century ago than it is at
+present.
+
+Sec. 33. If the Digitalis is no longer useful in consumptive cases, it
+must be that I know not how to manage it, or that the disease is more
+fatal than formerly; for it would be hard to deny the testimony cited
+at page 9. I wish others would undertake the enquiry.
+
+Sec. 34. When phthisis is accompanied with anasarca, or when there is
+reason to suspect hydrothorax, the Digitalis will often relieve the
+sufferings, and prolong the life of the patient.
+
+Sec. 35. Many years ago, during an attendance upon Mr. B----, of a
+consumptive family, and himself in the last stage of a phthisis; after
+he was so ill as to be confined to his chamber, his breathing became
+so extremely difficult and distressing, that he wished rather to die
+than to live, and urged me warmly to devise some mode to relieve him.
+Suspecting serous effusion to be the cause of this symptom, and he
+being a man of sense and resolution, I fully explained my ideas to
+him, and told him what kind of operation might afford him a chance of
+relief; for I was then but little acquainted with the Digitalis. He
+was earnest for the operation to be tried, and with the assistance of
+Mr. Parrott, a very respectable surgeon of this place, I got an
+opening made between the ribs upon the lower and hinder part of the
+thorax. About a pint of fluid was immediately discharged, and his
+breath became easy. This fluid coagulated by heat.
+
+After some days a copious purulent discharge issued from the opening,
+his cough became less troublesome, his expectoration less copious, his
+appetite and strength returned, he got abroad, and the wound, which
+became very troublesome, was allowed to heal.
+
+He then undertook a journey to London; whilst there he became worse:
+returned home, and died consumptive some weeks afterwards.
+
+
+                          PUERPERAL ANASARCA.
+
+Sec. 36. This disease admits of an easy and certain cure by the
+Digitalis.
+
+Sec. 37. This species of dropsy may originate from other causes than
+child birth. In the beginning of last _March_, a gentleman at
+Wolverhampton desired my advice for very large and painful swelled
+legs and thighs. He was a temperate man, not of a dropsical habit, had
+great pain in his groins, and attributed his complaints to a fall from
+his horse. He had taken diuretics, and the strongest drastic
+purgatives with very little benefit. Considering the anasarca as
+caused by the diseased inguinal glands, I ordered common poultice and
+mercurial ointment to the groins, three grains of pulv. fol. Digitalis
+night and morning, and a cooling diuretic decoction in the day-time.
+He soon lost his pain, and the swellings gradually subsided.
+
+
+                               THE END.
+
+
+
+
+                                BOOKS,
+
+                 Printed for G. G. J. and J. ROBINSON,
+                 Booksellers, Paternoster-Row, London.
+
+                           AN ACCOUNT OF THE
+                    Scarlet Fever and Sore Throat,
+                       Or, SCARLATINA ANGINOSA;
+
+               Particularly as it appeared at BIRMINGHAM
+                           in the Year 1778.
+
+                      By WILLIAM WITHERING, M. D.
+
+                             Price 1s. 6d.
+
+
+                          Also, Price 2s. 6d.
+
+                        Outlines of MINERALOGY,
+                    Translated from the original of
+                   Sir TORBERN BERGMAN; with NOTES,
+
+                      By WILLIAM WITHERING, M. D.
+
+           Member of the Royal Medical Society at Edinburgh.
+
+
+          In the Spring of the Year 1786, will be published,
+               by the same Author, a New Edition of the
+
+                        BOTANICAL ARRANGEMENT.
+
+        With very great Additions; in Three Vols. large Octavo.
+
+
+
+
+                          TRANSCRIBER'S NOTES
+
+Obvious printer's errors have been fixed. For the detailed list,
+please see below. The frontispiece has been moved from the beginning
+of the book to the section explaining it.
+
+
+                             Errors fixed
+
+page xvi--typo fixed: changed 'afterterwards' to 'afterwards'
+page 029--typo fixed: changed 'apetite' to 'appetite'
+page 043--typo fixed: removed an extra 'in' after 'and she died'
+page 062--typo fixed: changed 'Dovers' to 'Dover's'
+page 095--typo fixed: changed 'ef' to 'of' after 'whilst the rest'
+page 098--typo fixed: changed 'harrassed' to 'harassed'
+page 103--typo fixed: changed 'Shiffnal' to 'Shiffnall'
+page 106--typo fixed: changed 'Fox-glove' to 'Foxglove'
+page 110--typo fixed: changed 'suceed' to 'succeed'
+page 111--typo fixed: changed 'atttention' to 'attention'
+page 114--typo fixed: changed 'disgreeable' to 'disagreeable'
+page 115--typo fixed: removed an extra 'the' in front of '7th of April'
+page 123--typo fixed: changed 'susspended' to 'suspended'
+page 135--typo fixed: changed 'vomitted' to 'vomited'
+page 141--typo fixed: changed 'contiued' to 'continued'
+page 148--typo fixed: changed 'praecordia' to 'proecordia'
+page 158--typo fixed: changed 'spoonfulls' to 'spoonfuls'
+page 163--typo fixed: changed 'mecine' to 'medicine'
+page 164--typo fixed: changed 'slighest' to 'slightest'
+page 166--typo fixed: changed 'ipecacohana' to 'ipecacoanha'
+page 170--typo fixed: changed 'meridiaana' to 'meridiana'
+page 196--typo fixed: removed an extra 'the' in front of 'viscera'
+page 200--typo fixed: removed an extra 'and' after 'from asthma'
+
+
+
+
+
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