diff options
Diffstat (limited to '24886-0.txt')
| -rw-r--r-- | 24886-0.txt | 6432 |
1 files changed, 6432 insertions, 0 deletions
diff --git a/24886-0.txt b/24886-0.txt new file mode 100644 index 0000000..b73befd --- /dev/null +++ b/24886-0.txt @@ -0,0 +1,6432 @@ +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' + + + + + +End of the Project Gutenberg EBook of An Account of the Foxglove and some of +its Medical Uses, by William Withering + +*** END OF THIS PROJECT GUTENBERG EBOOK AN ACCOUNT OF THE FOXGLOVE *** + +***** This file should be named 24886-0.txt or 24886-0.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/4/8/8/24886/ + +Produced by David Starner, Irma Spehar and the Online +Distributed Proofreading Team at http://www.pgdp.net + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +http://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +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 + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at http://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +http://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at http://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit http://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including checks, online payments and credit card donations. +To donate, please visit: http://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart is the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + http://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. |