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You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: An Account of the Foxglove and some of its Medical Uses + With Practical Remarks on Dropsy and Other Diseases + +Author: William Withering + +Release Date: March 21, 2008 [EBook #24886] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK AN ACCOUNT OF THE FOXGLOVE *** + + + + +Produced by David Starner, Irma Spehar and the Online +Distributed Proofreading Team at http://www.pgdp.net + + + + + + +</pre> + +<h1><span style="font-size: 50%">AN</span><br /> +<span style="font-size: 90%">ACCOUNT</span><br /> +<span style="font-size: 50%">OF THE</span><br /> +FOXGLOVE,<br /> + +<span style="font-size: 50%">AND</span><br /> + +<span style="font-size: 70%; letter-spacing: 0ex">Some of its Medical Uses:</span><br /> + +<span style="font-size: 50%">WITH</span><br /> + +<span style="font-size: 70%; letter-spacing: 0ex; line-height: 100%">PRACTICAL REMARKS ON DROPSY,<br /> +AND OTHER DISEASES.</span></h1> + +<p class="center" style="padding-top: 2em; letter-spacing: 0.20ex; font-size: 110%">BY</p> + +<p class="center" style="letter-spacing: 0.20ex; font-size: 140%">WILLIAM WITHERING, M. D.<br /> + +<span style="font-size: 60%; letter-spacing: 0ex">Physician to the General Hospital at Birmingham.</span></p> + +<p class="center" style="padding-top: 1em"><i>—— nonumque prematur in annum.</i></p> + +<p class="right" style="padding-right: 30%"> +<span class="smcap">Horace.</span></p> + +<p class="publisher">BIRMINGHAM: PRINTED BY M. SWINNEY;<br /> + +<small>FOR</small><br /> + +<span class="smcap">G. G. J. and J. Robinson, Paternoster-Row, London.</span></p> + +<hr class="title" /> + +<p class="center" style="font-size: 80%">M,DCC,LXXXV.</p> + + + +<h2><a name="PREFACE" id="PREFACE"></a>PREFACE.<span class='pagenum'><a name="Page_v" id="Page_v">[v]</a></span></h2> + +<hr class="chapter" /> + +<p class="newchapter"><span class="firstword"><span class="dropcap">A</span>fter</span> being frequently urged to write +upon this subject, and as often declining +to do it, from apprehension of my own +inability, I am at length compelled to take +up the pen, however unqualified I may still +feel myself for the task.</p> + +<p>The use of the Foxglove is getting abroad, +and it is better the world should derive +some instruction, however imperfect, from +my experience, than that the lives of men +should be hazarded by its unguarded exhibition, +or that a medicine of so much efficacy +should be condemned and rejected as dangerous +and unmanageable.<span class='pagenum'><a name="Page_vi" id="Page_vi">[vi]</a></span></p> + +<p>It is now about ten years since I first began +to use this medicine. Experience and +cautious attention gradually taught me how +to use it. For the last two years I have not +had occasion to alter the modes of management; +but I am still far from thinking +them perfect.</p> + +<p>It would have been an easy task to have +given select cases, whose successful treatment +would have spoken strongly in favour of the +medicine, and perhaps been flattering to my +own reputation. But Truth and Science +would condemn the procedure. I have +therefore mentioned every case in which I +have prescribed the Foxglove, proper or improper, +successful or otherwise. Such a +conduct will lay me open to the censure of +those who are disposed to censure, but it +will meet the approbation of others, who are +the best qualified to be judges.</p> + +<p>To the Surgeons and Apothecaries, with +whom I am connected in practice, both in +this town and at a distance, I beg leave to<span class='pagenum'><a name="Page_vii" id="Page_vii">[vii]</a></span> +make this public acknowledgment, for the +assistance they so readily afforded me, in perfecting +some of the cases, and in communicating +the events of others.</p> + +<p>The ages of the patients are not always +exact, nor would the labour of making them +so have been repaid by any useful consequences. +In a few instances accuracy in that +respect was necessary, and there it has been +attempted; but in general, an approximation +towards the truth, was supposed to be +sufficient.</p> + +<p>The cases related from my own experience, +are generally written in the shortest +form I could contrive, in order to save time +and labour. Some of them are given more +in detail, when particular circumstances +made such detail necessary; but the cases +communicated by other practitioners, are +given in their own words.</p> + +<p>I must caution the reader, who is not a +practitioner in physic, that no general deductions, +decisive upon the failure or success<span class='pagenum'><a name="Page_viii" id="Page_viii">[viii]</a></span> +of the medicine, can be drawn from the +cases I now present to him. These cases +must be considered as the most hopeless and +deplorable that exist; for physicians are seldom +consulted in chronic diseases, till the +usual remedies have failed: and, indeed, for +some years, whilst I was less expert in the +management of the Digitalis, I seldom prescribed +it, but when the failure of every other +method compelled me to do it; so that upon +the whole, the instances I am going to adduce, +may truly be considered as cases lost to +the common run of practice, and only +snatched from destruction, by the efficacy +of the Digitalis; and this in so remarkable +a manner, that, if the properties of that +plant had not been discovered, by far the +greatest part of these patients must have +died.</p> + +<p>There are men who will hardly admit of any +thing which an author advances in support of +a favorite medicine, and I allow they may +have some cause for their hesitation; nor do +I expect they will wave their usual modes of<span class='pagenum'><a name="Page_ix" id="Page_ix">[ix]</a></span> +judging upon the present occasion. I could +wish therefore that such readers would pass +over what I have said, and attend only to +the communications from correspondents, +because they cannot be supposed to possess +any unjust predilection in favour of the medicine: +but I cannot advise them to this step, +for I am certain they would then close the +book, with much higher notions of the efficacy +of the plant than what they would have +learnt from me. Not that I want faith in +the discernment or in the veracity of my +correspondents, for they are men of established +reputation; but the cases they have +sent me are, with some exceptions, too +much selected. They are not upon this account +less valuable in themselves, but they +are not the proper premises from which to +draw permanent conclusions.</p> + +<p>I wish the reader to keep in view, that it +is not my intention merely to introduce a +new diuretic to his acquaintance, but one +which, though not infallible, I believe to be +much more certain than any other in present +use.<span class='pagenum'><a name="Page_x" id="Page_x">[x]</a></span></p> + +<p>After all, in spite of opinion, prejudice, +or error, <span class="smcap">Time</span> will fix the real value upon +this discovery, and determine whether I have +imposed upon myself and others, or contributed +to the benefit of science and mankind.</p> + +<p style="padding-top: 1em; padding-left: 1em"> +<i>Birmingham, 1st July,</i><br /> +<span style="margin-left: 4em; letter-spacing: 0.25ex">1785.</span></p> + + + +<h2><a name="INTRODUCTION" id="INTRODUCTION"></a>INTRODUCTION.<span class='pagenum'><a name="Page_xi" id="Page_xi">[xi]</a></span></h2> + +<hr class="chapter" /> + +<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Foxglove is a plant sufficiently common in +this island, and as we have but one species, +and that so generally known, I should have +thought it superfluous either to figure or describe it; +had I not more than once seen the leaves of Mullein<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a> +gathered for those of Foxglove. On the continent +of Europe too, other species are found, and +I have been informed that our species is very rare +in some parts of Germany, existing only by means +of cultivation, in gardens.</p> + +<p>Our plant is the <i>Digitalis purpurea</i><a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a> of Linnæus. +It belongs to the 2d order of the 14th class, or the +<span class="smcap">Didynamia Angiospermia</span>. The <i>essential characters</i> +of the genus are, <i>Cup with 5 divisions. Blossom +bell-shaped, bulging. Capsule egg-shaped, 2-celled.</i>—<span class="smcap">Linn.</span></p> + +<p><span style="letter-spacing: 0.25ex">DIGITA'LIS</span> <i>purpu'rea</i>. Little leaves of the +empalement egg-shaped, sharp. Blossoms blunt; +the upper lip entire. <span class="smcap">Linn.</span></p> + +<p><span class='pagenum'><a name="Page_xii" id="Page_xii">[xii]</a></span></p><p><span class="smcap">References to Figures.</span> These are disposed in +the order of comparative excellence.</p> + +<ul class="reference"> +<li><i>Rivini monopet.</i> 104.</li> +<li><i>Flora danica</i>, 74, <i>parts of fructification</i>.</li> +<li><i>Tournefort Institutiones.</i> 73, <i>A, E, L, M</i>.</li> +<li><i>Fuchsii Hist. Plant.</i> 893, <i>copied in</i></li> +<li><i>Tragi stirp. histor.</i> 889.</li> +<li><i>J. Bauhini histor. Vol. ii.</i> 812. 3, <i>and</i></li> +<li><i>Lonicera</i> 74, 1.</li> +<li><i>Blackwell. auct.</i> 16.</li> +<li><i>Dodonœi pempt. stirp. hist.</i> 169, <i>reprinted in</i></li> +<li><i>Gerard emacul.</i> 790, 1, <i>and copied in</i></li> +<li><i>Parkinson Theatr. botanic.</i> 653, 1.</li> +<li><i>Gerard, first edition</i>, 646, 1.</li> +<li><i>Histor. Oxon. Morison. V.</i> 8, <i>row</i> 1. 1.</li> +<li><i>Flor. danic.</i> 74, <i>the reduced figure</i>.</li> +</ul> + +<p><i>Blossom.</i> The bellying part on the inside sprinkled +with spots like little eyes. <i>Leaves</i> wrinkled. <span class="smcap">Linn.</span></p> + +<p class="negative"><span class="smcap">Blossom.</span> Rather tubular than bell-shaped, bulging +on the under side, purple; the narrow tubular +part at the base, white. <i>Upper lip</i> sometimes +slightly cloven.</p> + +<p class="negative"><span class="smcap">Chives.</span> <i>Threads</i> crooked, white. <i>Tips</i> yellow.</p> + +<p class="negative"><span class="smcap">Pointal.</span> <i>Seed-bud</i> greenish. <i>Honey-cup</i> at its base +more yellow. <i>Summit</i> cloven.</p> + +<p class="negative"><span class="smcap">S. Vess.</span> <i>Capsule</i> not quite so long as the cup.</p> + +<p class="negative"><span class="smcap">Root.</span> Knotty and fibrous.<span class='pagenum'><a name="Page_xiii" id="Page_xiii">[xiii]</a></span></p> + +<p><span class="smcap">Stem.</span> About 4 feet high; obscurely angular; leafy.</p> + +<p class="negative"><span class="smcap">Leaves.</span> Slightly but irregularly serrated, wrinkled; +dark green above, paler underneath. <i>Lower +leaves</i> egg-shaped; upper leaves spear-shaped. +<i>Leaf-stalks</i> fleshy; bordered.</p> + +<p class="negative"><span class="smcap">Flowers.</span> Numerous, mostly growing from one side +of the stem and hanging down one over another. +<i>Floral-leaves</i> sitting, taper-pointed. The numerous +purple blossoms hanging down, mottled +within; as wide and nearly half as long as the +finger of a common-sized glove, are sufficient +marks whereby the most ignorant may distinguish +this from every other British plant; and the +leaves ought not to be gathered for use but when +the plant is in blossom.</p> + +<p class="negative"><span class="smcap">Place.</span> Dry, gravelly or sandy soils; particularly on +sloping ground. It is a biennial, and flowers +from the middle of <i>June</i> to the end of <i>July</i>.</p> + +<p>I have not observed that any of our cattle eat it. +The root, the stem, the leaves, and the flowers have +a bitter herbaceous taste, but I don't perceive that +nauseous bitter which has been attributed to it.</p> + +<p>This plant ranks amongst the LURIDÆ, one of +the Linnæan orders in a natural system. It has for +congenera, <span class="smcap">Nicotiana</span>, <span class="smcap">Atropa</span>, <span class="smcap">Hyoscyamus</span>, <span class="smcap">Datura</span>, +<span class="smcap">Solanum</span>, &c. so that from the knowledge we +possess of the virtues of those plants, and reasoning +from botanical analogy, we might be led to guess at +something of its properties.<span class='pagenum'><a name="Page_xiv" id="Page_xiv">[xiv]</a></span></p> + +<p>I intended in this place to have traced the +history of its effects in diseases from the time of Fuchsius, +who first describes it, but I have been anticipated +in this intention by my very valuable friend, +Dr. Stokes of Stourbridge, who has lately sent me +the following</p> + + +<h4><span class="smcap">Historical View</span> of the Properties of +Digitalis.</h4> + +<p><span class="smcap">Fuchsius</span> in his <i>hist. stirp.</i> 1542, is the first author +who notices it. From him it receives its name of +<span class="smcap">Digitalis</span>, in allusion to the German name of <i>Fingerhut</i>, +which signifies a finger-stall, from the blossoms +resembling the finger of a glove.</p> + +<p><span class="smcap">Sensible Qualities.</span> Leaves bitterish, very nauseous. +<span class="smcap">Lewis</span> <i>Mat. med.</i> i. 342.</p> + +<p><span class="smcap">Sensible Effects.</span> Some persons, soon after eating +of a kind of omalade, into which the leaves of +this, with those of several other plants, had entered +as an ingredient, found themselves much indisposed, +and were presently after attacked with vomitings. +<span class="smcap">Dodonæus</span> <i>pempt.</i> 170.</p> + +<p>It is a medicine which is proper only for strong +constitutions, as it purges very violently, and excites +excessive vomitings. <span class="smcap">Ray.</span> <i>hist.</i> 767.</p> + +<p><span class="smcap">Boerhaave</span> judges it to be of a poisonous nature, +<i>hist. plant.</i> but <span class="smcap">Dr. Alston</span> ranks it among those indigenous +vegetables, "which, though now disregarded,<span class='pagenum'><a name="Page_xv" id="Page_xv">[xv]</a></span> +are medicines of great virtue, and scarcely +inferior to any that the Indies afford." <span class="smcap">Lewis</span> +<i>Mat. med.</i> i. <i>p.</i> 343.</p> + +<p>Six or seven spoonfuls of the decoction produce +nausea and vomiting, and purge; not without +some marks of a deleterious quality. <span class="smcap">Haller</span> <i>hist. n.</i> +330 from <i>Aerial Infl. p.</i> 49, 50.</p> + + +<h4>The following is an abridged <span class="smcap">Account</span> of +its <span class="smcap">Effects</span> upon <span class="smcap">Turkeys</span>.</h4> + +<p><span class="smcap">M. Salerne</span>, a physician at Orleans, having heard +that several turkey pouts had been killed by being +fed with Foxglove leaves, instead of mullein, he +gave some of the same leaves to a large vigorous +turkey. The bird was so much affected that he +could not stand upon his legs, he appeared drunk, +and his excrements became reddish. Good nourishment +restored him to health in eight days.</p> + +<p>Being then determined to push the experiment +further, he chopped some more leaves, mixed them +with bran, and gave them to a vigorous turkey cock +which weighed seven pounds. This bird soon appeared +drooping and melancholy; his feathers stared, +his neck became pale and retracted. The leaves +were given him for four days, during which time +he took about half a handful. These leaves had +been gathered about eight days, and the winter was +far advanced. The excrements, which are naturally<span class='pagenum'><a name="Page_xvi" id="Page_xvi">[xvi]</a></span> +green and well formed, became, from the first, +liquid and reddish, like those of a dysenteric patient.</p> + +<p>The animal refusing to eat any more of this mixture +which had done him so much mischief, I was +obliged to feed him with bran and water only; but +notwithstanding this, he continued drooping, and +without appetite. At times he was seized with convulsions, +so strong as to throw him down; in the +intervals he walked as if drunk; he did not attempt +to perch, he uttered plaintive cries. At length he +refused all nourishment. On the fifth or sixth day +the excrements became as white as chalk; afterwards +yellow, greenish, and black. On the eighteenth +day he died, greatly reduced in flesh, for he +now weighed only three pounds.</p> + +<p>On opening him we found the heart, the lungs, +the liver, and gall-bladder shrunk and dried up; +the stomach was quite empty, but not deprived of +its villous coat. <i>Hist. de l'Academ.</i> 1748. <i>p.</i> 84.</p> + +<p style="margin-bottom: 0em"><span class="smcap">Epilepsy.</span>—"It hath beene of later experience +found also to be effectual against the falling sicknesse, +that divers have been cured thereby; for +after the taking of the <i>Decoct. manipulor. ii. c. polypod. +quercin. contus. ℥iv. in cerevisia</i>, they that have +been troubled with it twenty-six years, and have +fallen once in a weeke, or two or three times in a +moneth, have not fallen once in fourteen or fifteen +moneths, that is until the writing hereof."</p> + +<p class="signature"><i>Parkinson</i>, <i>p.</i> 654.<span class='pagenum'><a name="Page_xvii" id="Page_xvii">[xvii]</a></span></p> + +<p><span class="smcap">Scrophula.</span>—"The herb bruised, or the juice +made up into an ointment, and applied to the +place, hath been found by late experience to be +availeable for the King's Evill." <span class="smcap">Park.</span> p. 654.</p> + +<p>Several hereditary instances of this disease said +to have been cured by it. <span class="smcap">Aereal Influences</span>, <i>p.</i> +49, 50, quoted by <span class="smcap">Haller</span>, <i>hist. n.</i> 330.</p> + +<p>A man with <i>scrophulous ulcers</i> in various parts of +the body, and which in the right leg were so virulent +that its amputation was proposed, cured by +<i>succ. express. cochl. i. bis intra xiv. dies, in ½ pintæ +cerevisiæ calidæ</i>.</p> + +<p>The leaves remaining after the pressing out of the +juice, were applied every day to the ulcers. <i>Pract. +ess. p.</i> 40. quoted by <span class="smcap">Murray</span> <i>apparat. medicam. i. p.</i> +491.</p> + +<p>A young woman with a <i>scrophulous tumour of the +eye</i>, a remarkable <i>swelling of the upper lip, and painful +tumours of the joints of the fingers</i>, much relieved; +but the medicine was left off, on account of its violent +effects on the constitution. <i>Ib. p.</i> 42 quoted as +above.</p> + +<p>A man with <i>scrophulous tumour of the right elbow</i>, +attended for three years <i>with excruciating pains</i>, was +nearly cured by four doses of the juice taken once +a month. <i>Ib. p.</i> 43. as above.</p> + +<p>The physicians and surgeons of the Worcester Infirmary +have employed it in ointments and poultices +with remarkable efficacy. <i>Ib. p.</i> 44. It was recommended<span class='pagenum'><a name="Page_xviii" id="Page_xviii">[xviii]</a></span> +to them by Dr. Baylies of Evesham, +now of Berlin, as a remedy for this disease. Dr. +Wall gave it a tryal, as well externally as internally, +but their experiments did not lead them to +observe any other properties in it, than those of a +highly nauseating medicine and drastic purgative.</p> + +<p><span class="smcap">Wounds.</span> In considerable estimation for the +healing all kinds of wounds, <i>Lobel. adv.</i> 245.</p> + +<p>Principally of use in ulcers, which discharge considerably, +being of little advantage in such as are +dry. <span class="smcap">Hulse</span>, in R. hist. 768.</p> + +<p><span class="smcap">Doctor Baylies</span>, physician to his Prussian Majesty, +informed me, when at Berlin, that he employed it +with great success in caries, and obstinate sore legs.</p> + +<p><span class="smcap">Dyspnœa</span> <i>Pituitosa</i> 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." <span class="smcap">Gerarde</span> hist. +ed. I p. 647.</p> + +<p style="margin-bottom: 0em">"Whensoever there is need of a rarefying or +extenuating of tough flegme or viscous humours +troubling the chest,—the decoction or juice hereof +made up with sugar or honey is availeable, as +also to clense and purge the body both upwards<span class='pagenum'><a name="Page_xix" id="Page_xix">[xix]</a></span> +and downwards sometimes, of tough flegme, and +clammy humours, notwithstanding that these +qualities are found to bee in it, there are but few +physitions in our times that put it to these uses, +but it is in a manner wholly neglected."</p> + +<p class="signature"><span class="smcap">Parkinson</span>, p. 654.</p> + +<p>Previous to the year 1777, you informed me of +the great success you had met with in curing dropsies +by means of the fol. Digitalis, which you then +considered as a more certain diuretic than any you +had ever tried. Some time afterwards, Mr. Russel, +surgeon, of Worcester, having heard of the success +which had attended some cases in which you +had given it, requested me to obtain for him any +information you might be inclined to communicate +respecting its use. In consequence of this application, +you wrote to me in the following terms.<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a></p> + +<p>In a letter which I received from you in London, +dated <i>September</i> 29, 1778, you write as follows:—"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."—</p> +<p><span class='pagenum'><a name="Page_xx" id="Page_xx">[xx]</a></span></p> +<p>In my notes I find the following memorandum—"<i>February</i> +20th, 1779, gave an account of Doctor +Withering's practice, with the precautions necessary +to its success, to the Medical Society at +Edinburgh."—In the course of that year, the Digitalis +was prescribed in the Edinburgh Infirmary, by +Dr. Hope, and in the following year, whilst I was +Clerk to Dr. Home, as Clinical Professor, I had a +favourable opportunity of observing its sensible effects.</p> + +<p>In one case in which it was given properly at first, +the urine began to flow freely on the second day. +On the third, the swellings began to subside. The +dose was then increased more than <i>quadruple</i> in the +twenty-four hours. On the fifth day sickness came +on, and much purging, but the urine still increased +though the pulse sunk to 50. On the 7th day, a +<i>quadruple</i> dose of the infusion was ordered to be taken +every third hour, so as to bring on nausea again. +The pulse fell to forty-four, and at length to thirty-five +in a minute. The patient gradually sunk and +died on the sixteenth day; but previous to her +death, for two or three days, her pulse rose to near +one hundred.—It is needless to observe to you, how +widely the treatment of this case differed from the +method which you have found so successful.<span class='pagenum'><a name="Page_xxi" id="Page_xxi">[xxi]</a></span></p> + + + +<h2><a name="OF_THE_PLATE" id="OF_THE_PLATE"></a>OF THE PLATE.</h2> + +<hr class="chapter" /> + +<p class="figcenter"><a href="images/frontispiece.jpg"><img src="images/frontispiece_th.jpg" +alt="" title="" /></a></p> + +<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> figure of the Foxglove, facing the Title +Page, is copied by the permission and under +the inspection of Mr. Curtis, from his admirable +work, entitled <span class="smcap">Flora Londinensis</span>. The accuracy +of the drawings, the beauty of the colouring, the full +descriptions, the accurate specific distinctions, and +the uses of the different plants, cannot fail to recommend +that work to the patronage of all who are interested +in the encouragement of genius, or the +promotion of useful knowledge.</p> + +<hr /> + +<h4>EXPLANATION.</h4> + +<div class="blockquot"> +<p class="negative">Fig. 1. The Empalement.</p> + +<p class="negative">Fig. 2, 3, 4. Four <span class="smcap">Chives</span> two long and two short. +<span class="smcap">Tips</span> at first large, turgid, oval, touching at +bottom, of a yellowish colour, and often spotted; +lastly changing both their form and situation +in a singular manner.</p> + +<p class="negative">Fig. 5, 6, 7. <span class="smcap">Seed-bud</span> rather conical, of a yellow +green colour. <i>Shaft</i> simple. <i>Summit</i> cloven.</p> + +<p class="negative">Fig. 8. <i>Honey-cup</i> a gland, surrounding the bottom +of the Seed-bud.</p> + +<p class="negative">Fig. 9. <span class="smcap">Seed-vessel</span>, a pointed oval <i>Capsule</i>, of two +cells and two valves, the lowermost valve splitting +in two.</p> + +<p class="negative">Fig. 10. <span class="smcap">Seeds</span> numerous, blackish, small, lopped +at each end.</p></div> + + + +<div class="footnotes"><h3>FOOTNOTES:</h3> + +<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> Verbascum of Linnæus.</p></div> + +<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> The trivial name <i>purpurea</i> is not a very happy one, for the +blossoms though generally purple, are sometimes of a pure white.</p></div> + +<div class="footnote"><p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> See the extract from this letter at <a href="#Page_5">page 5</a>.</p></div> +</div> + + +<h2 style="line-height: 150%"><a name="AN" id="AN"></a><span style="font-size: 70%">AN</span><span class='pagenum'><a name="Page_1" id="Page_1">[1]</a></span><br /> +ACCOUNT<br /> +<span style="font-size: 70%">OF THE</span><br /> +INTRODUCTION of FOXGLOVE<br /> +<span style="font-size: 70%">INTO</span><br /> +<small>MODERN PRACTICE.</small></h2> + + +<p class="newchapter"><span class="firstword"><span class="dropcap">A</span>s</span> the more obvious and sensible properties of +plants, such as colour, taste, and smell, have +but little connexion with the diseases they are adapted +to cure; so their peculiar qualities have no certain +dependence upon their external configuration. Their +chemical examination by fire, after an immense +waste of time and labour, having been found useless, +is now abandoned by general consent. Possibly +other modes of analysis will be found out, +which may turn to better account; but we have hitherto +made only a very small progress in the chemistry +of animal and vegetable substances. Their +virtues must therefore be learnt, either from observing +their effects upon insects and quadrupeds; from +analogy, deduced from the already known powers +of some of their congenera, or from the empirical +usages and experience of the populace.</p> + +<p>The first method has not yet been much attended +to; and the second can only be perfected in proportion +as we approach towards the discovery of a truly +natural system; but the last, as far as it extends, lies<span class='pagenum'><a name="Page_2" id="Page_2">[2]</a></span> +within the reach of every one who is open to information, +regardless of the source from whence it +springs.</p> + +<p>It was a circumstance of this kind which first fixed +my attention on the Foxglove.</p> + +<p>In the year 1775, my opinion was asked concerning +a family receipt for the cure of the dropsy. I +was told that it had long been kept a secret by an +old woman in Shropshire, who had sometimes made +cures after the more regular practitioners had failed. +I was informed also, that the effects produced were +violent vomiting and purging; for the diuretic effects +seemed to have been overlooked. This medicine +was composed of twenty or more different herbs; +but it was not very difficult for one conversant in +these subjects, to perceive, that the active herb could +be no other than the Foxglove.</p> + +<p>My worthy predecessor in this place, the very humane +and ingenious Dr. Small, had made it a practice +to give his advice to the poor during one hour +in a day. This practice, which I continued until +we had an Hospital opened for the reception of the +sick poor, gave me an opportunity of putting my +ideas into execution in a variety of cases; for the +number of poor who thus applied for advice, +amounted to between two and three thousand annually. +I soon found the Foxglove to be a very +powerful diuretic; but then, and for a considerable +time afterwards, I gave it in doses very much too<span class='pagenum'><a name="Page_3" id="Page_3">[3]</a></span> +large, and urged its continuance too long; for misled +by reasoning from the effects of the squill, which +generally acts best upon the kidneys when it excites +nausea, I wished to produce the same effect by the +Foxglove. In this mode of prescribing, when I had +so many patients to attend to in the space of one, +or at most of two hours, it will not be expected that +I could be very particular, much less could I take +notes of all the cases which occurred. Two or three +of them only, in which the medicine succeeded, I +find mentioned amongst my papers. It was from +this kind of experience that I ventured to assert, in +the Botanical Arrangement published in the course of +the following spring, that the Digitalis purpurea +"merited more attention than modern practice bestowed +upon it."</p> + +<p>I had not, however, yet introduced it into the more +regular mode of prescription; but a circumstance +happened which accelerated that event. My truly +valuable and respectable friend, Dr. Ash, informed +me that Dr. Cawley, then principal of Brazen Nose +College, Oxford, had been cured of a Hydrops Pectoris, +by an empirical exhibition of the root of the +Foxglove, after some of the first physicians of the age +had declared they could do no more for him. I was +now determined to pursue my former ideas more +vigorously than before, but was too well aware of +the uncertainty which must attend on the exhibition +of the <i>root</i> of a <i>biennial</i> plant, and therefore continued +to use the <i>leaves</i>. These I had found to vary +much as to dose, at different seasons of the year;<span class='pagenum'><a name="Page_4" id="Page_4">[4]</a></span> +but I expected, if gathered always in one condition +of the plant, viz. when it was in its flowering state, +and carefully dried, that the dose might be ascertained +as exactly as that of any other medicine; nor +have I been disappointed in this expectation. The +more I saw of the great powers of this plant, the +more it seemed necessary to bring the doses of it to +the greatest possible accuracy. I suspected that this +degree of accuracy was not reconcileable with the +use of a <i>decoction</i>, as it depended not only upon the +care of those who had the preparation of it, but it +was easy to conceive from the analogy of another +plant of the same natural order, the tobacco, that +its active properties might be impaired by long boiling. +The decoction was therefore discarded, and +the <i>infusion</i> substituted in its place. After this I began +to use the leaves in <i>powder</i>, but I still very often +prescribe the infusion.</p> + +<p>Further experience convinced me, that the <i>diuretic</i> +effects of this medicine do not at all depend upon +its exciting a nausea or vomiting; but, on the +contrary, that though the increased secretion of +urine will frequently succeed to, or exist along with +these circumstances, yet they are so far from being +friendly or necessary, that I have often known the +discharge of urine checked, when the doses have +been imprudently urged so as to occasion sickness.</p> + +<p>If the medicine purges, it is almost certain to fail +in its desired effect; but this having been the case, +I have seen it afterwards succeed when joined with<span class='pagenum'><a name="Page_5" id="Page_5">[5]</a></span> +small doses of opium, so as to restrain its action on +the bowels.</p> + +<p>In the summer of the year 1776, I ordered a +quantity of the leaves to be dried, and as it then +became possible to ascertain its doses, it was gradually +adopted by the medical practitioners in the circle +of my acquaintance.</p> + +<p>In the month of <i>November</i> 1777, in consequence +of an application from that very celebrated surgeon, +Mr. Russel, of Worcester, I sent him the following +account, which I choose to introduce here, as shewing +the ideas I then entertained of the medicine, +and how much I was mistaken as to its real dose.—"I +generally order it in decoction. Three drams of +the dried leaves, collected at the time of the blossoms +expanding, boiled in twelve to eight ounces of +water. Two spoonfuls of this medicine, given every +two hours, will sooner or later excite a nausea. +I have sometimes used the green leaves gathered in +winter, but then I order three times the weight; +and in one instance I used three ounces to a pint +decoction, before the desired effect took place. I +consider the Foxglove thus given, as the most certain +diuretic I know, nor do its diuretic effects +depend merely upon the nausea it produces, for +in cases where squill and ipecac. have been so +given as to keep up a nausea several days together, +and the flow of urine not taken place, I have found +the Foxglove to succeed; and I have, in more than +one instance, given the Foxglove in smaller and<span class='pagenum'><a name="Page_6" id="Page_6">[6]</a></span> +more distant doses, so that the flow of urine has +taken place without any sensible affection of the +stomach; but in general I give it in the manner +first mentioned, and order one dose to be taken +after the sickness commences. I then omit all medicines, +except those of the cordial kind are wanted, +during the space of three, four, or five days. By +this time the nausea abates, and the appetite becomes +better than it was before. Sometimes the +brain is considerably affected by the medicine, and +indistinct vision ensues; but I have never yet +found any permanent bad effects from it."—</p> + +<p>"I use it in the Ascites, Anasarca, and Hydrops +Pectoris; and so far as the removal of the water +will contribute to cure the patient, so far may be +expected from this medicine: but I wish it not to +be tried in ascites of female patients, believing +that many of these cases are dropsies of the ovaria; +and no sensible man will ever expect to see these +encysted fluids removed by any medicine."</p> + +<p>"I have often been obliged to evacuate the water +repeatedly in the same patient, by repeating the +decoction; but then this has been at such distances +of time as to allow of the interference of other +medicines and a proper regimen, so that the patient +obtains in the end a perfect cure. In these cases +the decoction becomes at length so very disagreeable, +that a much smaller quantity will produce the +effect, and I often find it necessary to alter its +taste by the addition of Aq. Cinnam. sp. or Aq. +Juniper. composita."<span class='pagenum'><a name="Page_7" id="Page_7">[7]</a></span></p> + +<p>"I allow, and indeed enjoin my patients to drink +very plentifully of small liquors through the whole +course of the cure; and sometimes, where the evacuations +have been very sudden, I have found a +bandage as necessary as in the use of the trochar."—</p> + +<p>Early in the year 1779, a number of dropsical +cases offered themselves to my attention, the consequences +of the scarlet fever and sore throat which +had raged so very generally amongst us in the preceding +year. Some of these had been cured by +squills or other diuretics, and relapsed; in others, +the dropsy did not appear for several weeks after the +original disease had ceased: but I am not able to +mention many particulars, having omitted to make +notes. This, however, is the less to be regretted, +as the symptoms in all were very much alike, and +they were all without an exception cured by the Foxglove.</p> + +<p>This last circumstance encouraged me to use the +medicine more frequently than I had done heretofore, +and the increase of practice had taught me to +improve the management of it.</p> + +<p>In <i>February</i> 1779, my friend, Dr. Stokes, communicated +to the Medical Society at Edinburgh the result +of my experience of the Foxglove; and, in a letter +addressed to me in <i>November</i> following, he says, +"Dr. Hope, in consequence of my mentioning its +use to my friend, Dr. Broughton, has tried the +Foxglove in the Infirmary with success." Dr.<span class='pagenum'><a name="Page_8" id="Page_8">[8]</a></span> +Stokes also tells me that Dr. Hamilton cured Dropsies +with it in the year 1781.</p> + +<p>I am informed by my very worthy friend Dr. +Duncan, that Dr. Hamilton, who learnt its use from +Dr. Hope, has employed it very frequently in the +Hospital at Edinburgh. Dr. Duncan also tells me, +that the late very ingenious and accomplished Mr. +Charles Darwin, informed him of its being used by +his father and myself, in cases of Hydrothorax, and +that he has ever since mentioned it in his lectures, +and sometimes employed it in his practice.</p> + +<p>At length, in the year 1783, it appeared in the +new edition of the Edinburgh 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.</p> + +<p>In the following cases the reader will find other +diseases besides dropsies; particularly several cases +of consumption. I was induced to try it in these, +from being told, that it was much used in the West +of England, in the Phthisis Pulmonalis, by the +common people. In this disease, however, in my +hands, it has done but little service, and yet I am +disposed to wish it a further trial, for in a copy of +Parkinson's Herbal, which I saw about two years ago,<span class='pagenum'><a name="Page_9" id="Page_9">[9]</a></span> +I found the following manuscript note at the article +Digitalis, written, I believe, by a Mr. Saunders, who +practised for many years with great reputation as a +surgeon and apothecary at Stourbridge, in Worcestershire.</p> + +<p>"Consumptions are cured infallibly by weak decoction +of Foxglove leaves in water, or wine and +water, and drank for constant drink. Or take of +the juice of the herb and flowers, clarify it, and +make a fine syrup with honey, of which take +three spoonfuls thrice in a day, at physical hours. +The use of these two things of late has done, in +consumptive cases, great wonders. But be cautious +of its use, for it is of a vomiting nature. In +these things begin sparingly, and increase the dose +as the patient's strength will bear, least, instead of +a sovereign medicine, you do real damage by this +infusion or syrup."</p> + +<p>The precautions annexed to his encomiums of this +medicine, lead one to think that he has spoken from +his own proper experience.</p> + +<p>I have lately been told, that a person in the neighbourhood +of Warwick, possesses a famous family receipt +for the dropsy, in which the Foxglove is the +active medicine; and a lady from the western part +of Yorkshire assures me, that the people in her country +often cure themselves of dropsical complaints by +drinking Foxglove tea. In confirmation of this, I +recollect about two years ago being desired to visit a<span class='pagenum'><a name="Page_10" id="Page_10">[10]</a></span> +travelling Yorkshire tradesman. I found him incessantly +vomiting, his vision indistinct, his pulse forty +in a minute. Upon enquiry it came out, that his +wife had stewed a large handful of green Foxglove +leaves in half a pint of water, and given him the +liquor, which he drank at one draught, in order to +cure him of an asthmatic affection. This good woman +knew the medicine of her country, but not +the dose of it, for her husband narrowly escaped +with his life.</p> + +<p>It is probable that this rude mode of exhibiting +the Foxglove has been more general than I am at +present aware of; but it is wonderful that no author +seems to have been acquainted with its effects as a +diuretic.<span class='pagenum'><a name="Page_11" id="Page_11">[11]</a></span></p> + + + +<h2><a name="CASES" id="CASES"></a>CASES,<br style="line-height: 2em" /> + +<span style="letter-spacing: 0ex; font-size: 90%">In which the Digitalis was given by the</span><br /> +<span style="letter-spacing: 0ex; font-size: 90%">Direction of the Author.</span></h2> + + +<h3>1775.</h3> + +<p class="newchapter"><span class="firstword"><span class="dropcap">I</span>t</span> was in the course of this year that I began to +use the Digitalis in dropsical cases. The patients +were such as applied at my house for advice +gratis. I cannot pretend to charge my memory with +particular cases, or particular effects, and I had not +leisure to make notes. Upon the whole, however, +it may be concluded, that the medicine was found +useful, or I should not have continued to employ +it.</p> + + +<h3>CASE I.</h3> + +<p><i>December</i> 8th. A man about fifty years of age, +who had formerly been a builder, but was now much +reduced in his circumstances, complained to me of +an asthma which first attacked him about the latter +end of autumn. His breath was very short, his +countenance was sunken, his belly large; and, upon +examination, a fluctuation in it was very perceptible. +His urine for some time past had been small +in quantity. I directed a decoction of Fol. Digital. +recent. which made him very sick, the sickness recurring +at intervals for several days, during which +time he made a large quantity of water. His breath +gradually drew easier, his belly subsided, and in<span class='pagenum'><a name="Page_12" id="Page_12">[12]</a></span> +about ten days he began to eat with a keen appetite. +He afterwards took steel and bitters.</p> + + +<h3>1776.<br /> + +CASE <span style="letter-spacing: 0ex">II.</span></h3> + +<p><i>January</i> 14th. A poor man labouring under an +ascites and anasarca, was directed to take a decoction +of Digitalis every four hours. It purged him smartly, +but did not relieve him. An opiate was now +ordered with each dose of the medicine, which then +acted upon the kidneys very freely, and he soon lost +all his complaints.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3> + +<p><i>March</i> 15th. A poor boy, about nine years of +age, was brought for my advice. His countenance +was pale, his pulse quick and feeble, his body greatly +emaciated, except his belly, which was very large, +and, upon examination, contained a fluid. The +case had been considered as arising from worms. He +was directed to take the decoction of Digitalis night +and morning. It operated as a diuretic, never made +him sick, and he got well without any other medicine.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">IV.</span></h3> + +<p><i>July</i> 25th. Mrs. H——, 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,<span class='pagenum'><a name="Page_13" id="Page_13">[13]</a></span> +copious expectoration. On the 4th of <i>June</i>, Dr. +Darwin,<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a> was called to her. I have not heard what +was then done for her, but, between the 15th of <i>June</i>, +and 25th of <i>July</i>, the Doctor, at his different visits, +gave her various medicines of the deobstruent, tonic, +antispasmodic, diuretic, and evacuant kinds.</p> + +<p>On the 25th of <i>July</i> I was desired to meet Dr. +Darwin at the lady's house. I found her nearly in +a state of suffocation; her pulse extremely weak and +irregular, her breath very short and laborious, her +countenance sunk, her arms of a leaden colour, +clammy and cold. She could not lye down in bed, +and had neither strength nor appetite, but was extremely +thirsty. Her stomach, legs, and thighs +were greatly swollen; her urine very small in quantity, +not more than a spoonful at a time, and that +very seldom. It had been proposed to scarify her +legs, but the proposition was not acceded to.</p> + +<p>She had experienced no relief from any means that +had been used, except from ipecacoanha vomits; the +dose of which had been gradually increased from 15 +to 40 grains, but such was the insensible state of her +stomach for the last few days, that even those very +large doses failed to make her sick, and consequently +purged her. In this situation of things I knew +of nothing likely to avail us, except the Digitalis: +but this I hesitated to propose, from an apprehension that +little could be expected from any thing; +that an unfavourable termination would tend to +<span class='pagenum'><a name="Page_14" id="Page_14">[14]</a></span>discredit a medicine which promised to be of great +benefit to mankind, and I might be censured for a +prescription which could not be countenanced by +the experience of any other regular practitioner. +But these considerations soon gave way to the desire +of preserving the life of this valuable woman, and +accordingly I proposed the Digitalis to be tried; +adding, that I sometimes had found it to succeed +when other, even the most judicious methods, had +failed. Dr. Darwin very politely, acceded immediately +to my proposition, and, as he had never +seen it given, left the preparation and the dose to +my direction. We therefore prescribed as follows:</p> + +<div class="recipe"> +<p>R. Fol. Digital. purp. recent. ℥iv. coque ex</p> + +<p style="padding-left: 1em">Aq. fontan. puræ ℔iss ad ℔i. et cola.</p> + +<p>R. Decoct. Digital. ℥iss.</p> + +<p style="padding-left: 1em">Aq. Nuc. Moschat. ʒii. M. fiat. haust. 2dis +horis sumend.</p> +</div> + +<p>The patient took five of these draughts, which +made her very sick, and acted very powerfully upon +the kidneys, for within the first twenty-four +hours she made upwards of eight quarts of water. +The sense of fulness and oppression across her stomach +was greatly diminished, her breath was eased, +her pulse became more full and more regular, and +the swellings of her legs subsided.</p> + +<p>26th. Our patient being thus snatched from impending +destruction, Dr. Darwin proposed to give +her a decoction of pareira brava and guiacum shavings,<span class='pagenum'><a name="Page_15" id="Page_15">[15]</a></span> +with pills of myrrh and white vitriol; and, +if costive, a pill with calomel and aloes. To these +propositions I gave a ready assent.</p> + +<p>30th. This day Dr. Darwin saw her, and directed +a continuation of the medicines last prescribed.</p> + +<p><i>August</i> 1st. I found the patient perfectly free +from every appearance of dropsy, her breath quite +easy, her appetite much improved, but still very +weak. Having some suspicion of a diseased liver, +I directed pills of soap, rhubarb, tartar of vitriol, +and calomel to be taken twice a day, with a neutral +saline draught.</p> + +<p>9th. We visited our patient together, and repeated +the draughts directed on the 26th of <i>June</i>, +with the addition of tincture of bark, and also ordered +pills of aloes, guiacum, and sal martis to be taken +if costive.</p> + +<p><i>September</i> 10th. From this time the management +of the case fell entirely under my direction, and +perceiving symptoms of effusion going forwards, I +desired that a solution of merc. subl. corr. might be +given twice a day.</p> + +<p>19th. The increase of the dropsical symptoms +now made it necessary to repeat the Digitalis. The +dried leaves were used in infusion, and the water +was presently evacuated, as before.<span class='pagenum'><a name="Page_16" id="Page_16">[16]</a></span></p> + +<p>It is now almost nine years since the Digitalis was +first prescribed for this lady, and notwithstanding I +have tried every preventive method I could devise, +the dropsy still continues to recur at times; but is +never allowed to increase so as to cause much distress, +for she occasionally takes the infusion and relieves +herself whenever she chooses. Since the first +exhibition of that medicine, very small doses have +been always found sufficient to promote the flow of +urine.</p> + +<p>I have been more particular in the narrative of +this case, partly because Dr. Darwin has related it rather +imperfectly in the notes to his son's posthumous +publication, trusting, I imagine, to memory, and +partly because it was a case which gave rise to a very +general use of the medicine in that part of Shropshire.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">V.</span></h3> + +<p><i>December</i> 10th. Mr. L——, 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.<span class='pagenum'><a name="Page_17" id="Page_17">[17]</a></span></p> + +<p>In <i>October</i> 1777, in consequence of having pursued +his intemperate mode of living, his dropsy returned, +accompanied by evident marks of diseased +viscera. A decoction of two drams of Fol. Digital. +siccat. to a pint, once more removed the dropsy. He +took a wine glass full thrice a day.</p> + +<p>In <i>January</i> 1778, I was desired to visit him again. +I found he had gone on in his usual intemperate life, +his countenance jaundiced, and the dropsy coming +on apace. After giving some deobstruent medicines, +I again directed the Digitalis, which again +emptied the water; but he did not survive many +weeks.</p> + + +<h3>1777.<br /> + +<a name="CASEvi" id="CASEvi"></a>CASE <span style="letter-spacing: 0ex">VI.</span></h3> + +<p><i>February</i>—. 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<span class='pagenum'><a name="Page_18" id="Page_18">[18]</a></span> +the medicine been given in a case seemingly so favourable +as this, and had the patient died under its +use, is it not probable that the death would have +been attributed to it?</p> + + +<h3>CASE <span style="letter-spacing: 0ex">VII.</span></h3> + +<p><i>February</i> 11th. Mr. E——, 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.</p> + +<p>Perhaps this patient might have been saved, if I +had been well acquainted with the management and<span class='pagenum'><a name="Page_19" id="Page_19">[19]</a></span> +real doses of the medicine, which was certainly in +this instance made very much too strong; and notwithstanding +the caution to stop the further exhibition +when certain effects should take place, it seems the +quantity previously swallowed was sufficient to distress +him exceedingly.</p> + + +<h3><a name="CASEviii" id="CASEviii"></a>CASE <span style="letter-spacing: 0ex">VIII.</span></h3> + +<p><i>March</i> 11th. Mrs. H——, Æt. 32. A few +days after a tedious labour, had her legs and thighs +swelled to a very great degree; pale and semi-transparent,<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a> +with pain in both groins. After a purge of +calomel and rhubarb, ung. merc. was ordered to be +rubbed upon the groins, and the following decoction +was directed:</p> + +<div class="recipe"> +<p>R. Fol. Digital. purp. recent. ℥ii.</p> + +<p style="padding-left: 1em">Aq. puræ. ℔i. coque ad ℔iss et colatur. adde.</p> + +<p style="padding-left: 1em">Aq. cinn. sp. ℥iv. M. capiat. cyath. vinos. parv. bis quotidie.</p> +</div> + +<p>The decoction presently increased the secretion +of urine, and abated the distension of the legs: in +a fortnight the swelling was gone; but some days +after leaving her bed, her legs swelled again about +the ancles, which was removed by another bottle +of the decoction on the 21st of <i>April</i>.</p> +<p><span class='pagenum'><a name="Page_20" id="Page_20">[20]</a></span></p> + +<h3>CASE <span style="letter-spacing: 0ex">IX.</span></h3> + +<p><i>March</i> 29th. Mr. G——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">X.</span></h3> + +<p><i>April</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XI.</span></h3> + +<p><i>July</i> 10th. Mr. M—— of T——, Æt. 54. A +very hard drinker; had been affected since <i>November</i> +last with ascites and anasarca, for which he had +taken several medicines without benefit. A decoction +of the recent leaves of the Digitalis was then +directed, an ounce and half to a pint, one eighth +of which I ordered to be given every fourth hour. +A few doses brought on great nausea, indistinct vision, +and a great flow of urine, so as presently to +empty him of all the dropsical water. Indeed the +evacuation was so rapid and so complete, that it became +necessary to apply a bandage round the belly, +and to support him with cordials.<span class='pagenum'><a name="Page_21" id="Page_21">[21]</a></span></p> + +<p>In something more than a year and a half, his +dropsy returned, but the Digitalis did not then +succeed to our wishes. In <i>August</i>, 1779, he was +tapped, and lived afterwards only about five weeks.</p> + +<p>For more particulars, see the extract of a letter +from Mr. Lyon.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XII.</span></h3> + +<p><i>September</i> 12th. Miss C—— 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 <i>August</i>. She was greatly +emaciated, and had almost a total loss of appetite. +I first tried small doses of Merc. sublim. corr. in +solution, with decoction of burdock roots, and blisters +to the thighs. No advantage attending the +use of this plan, I directed a decoction of Fol. +Digit. a dram and half to a pint; one ounce to be +taken twice a day. It presently reduced the anasarcous +swellings, but made no alteration in the distension +of the abdomen.<span class='pagenum'><a name="Page_22" id="Page_22">[22]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XIII.</span></h3> + +<p><i>October</i> 9th. Mrs. B——, Æt. 40. An ovarium +dropsy. Took a decoction of Digitalis without +effect. Her life was preserved for some years by repeated +tapping.</p> + + +<h3>1778.<br /> + +CASE <span style="letter-spacing: 0ex">XIV.</span></h3> + +<p><i>February</i> 8th. Mr. R—— 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XV.</span></h3> + +<p><i>March</i> 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.</p> + +<p>17th. Gum-ammoniac and squill, with elixir +paregor. at night.—26th, Squill and decoction of +seneka.—30th, His complaints still increasing, decoction<span class='pagenum'><a name="Page_23" id="Page_23">[23]</a></span> +of Digitalis was then directed, which relieved +him in a few days; but his complaints returned +again, and he died in the month of <i>June</i>.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XVI.</span></h3> + +<p><i>August</i> 18th. Mr. B——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XVII.</span></h3> + +<p><i>September</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XVIII.</span></h3> + +<p><i>October</i> 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.</p> + +<div class="recipe"> +<p>R. Fol. Digit. purp. siccat. ʒiii.</p> + +<p style="padding-left: 1em">Aq. bull. ℔i. digere per horas duas, et colat. +adde aq. junip. comp. ℥iii.</p> +</div> + +<p>He was directed to take one ounce of this infusion<span class='pagenum'><a name="Page_24" id="Page_24">[24]</a></span> +every two hours until it should make him sick. +This was on Wednesday. The fifth dose made +him vomit. On Thursday afternoon he vomited +again very freely, without having taken any more +of the medicine. On Friday and Saturday he made +more water than he had done for a week before, +and the swellings of his face and body were considerably +abated. He was directed to omit all medicine +so long as the urine continued to flow freely, +and also to keep an account of the quantity he made +in twenty-four hours.</p> + +<p>These were his reports:</p> + +<table summary="report"> +<tr><td><i>October</i></td><td class="rightalign">31st.</td><td>Saturday,</td><td>5 half pints.</td></tr> +<tr><td><i>November</i></td><td class="rightalign">1st.</td><td>Sunday,</td><td>6</td></tr> +<tr><td> </td><td class="rightalign">2d.</td><td>Monday,</td><td>8</td></tr> +<tr><td> </td><td class="rightalign">3d.</td><td>Tuesday,</td><td>8</td></tr> +<tr><td> </td><td class="rightalign">4th.</td><td>Wednesday,</td><td>7</td></tr> +<tr><td> </td><td class="rightalign">5th.</td><td>Thursday,</td><td>8</td></tr> +</table> + +<p>On Wednesday he began to purge, and the +purging still continues, but his appetite is better +than he has known it for a long time. No swelling +remains but about his ancles, extending at night +half way up his legs.</p> + +<p>Omit all medicines at present.</p> + +<table summary="report"> +<tr><td style="padding-left: 3.5em"> </td><td class="rightalign">7th.</td><td>Saturday,</td><td>7½ half pints.</td></tr> +<tr><td style="padding-left: 3.5em"> </td><td class="rightalign">8th.</td><td>Sunday,</td><td>8</td></tr> +<tr><td style="padding-left: 3.5em"> </td><td class="rightalign">9th.</td><td>Monday,</td><td>6¾</td></tr> +<tr><td style="padding-left: 3.5em"> </td><td class="rightalign">10th.</td><td>Tuesday,</td><td>6½</td></tr> +<tr><td style="padding-left: 3.5em"> </td><td class="rightalign">11th.</td><td>Wednesday,</td><td>6</td></tr> +<tr><td style="padding-left: 3.5em"> </td><td class="rightalign">12th.</td><td>Thursday,</td><td>6¼</td></tr> +</table> + +<p>On Tuesday the 17th, some swelling still remained<span class='pagenum'><a name="Page_25" id="Page_25">[25]</a></span> +about his ancles, but he was in every other respect +perfectly well.</p> + +<p>He took a few more doses of the infusion, and no +other medicine.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XIX.</span></h3> + +<p><i>December</i> 8th. W—— 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.</p> + + +<h3>1779.</h3> + +<p>In the beginning of this year we had many dropsies +in children, who had suffered from the Scarlatina +Anginosa; they all yielded very readily to the Digitalis, +but in some the medicine purged, and then +it did not prove diuretic, nor did it remove the +dropsy until opium was joined with it, so as to prevent +it purging.—I did not keep notes of these +cases, but I do not recollect a single instance in +which the Digitalis failed to effect a cure.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XX.</span></h3> + +<p><i>January</i> 1st. Mr. H——. Hydrops Pectoris; +legs and thighs prodigiously anasarcous; a very distressing +sense of fulness and tightness across his stomach; +urine in small quantity; pulse intermitting; +breath very short.<span class='pagenum'><a name="Page_26" id="Page_26">[26]</a></span></p> + +<p>He had taken various medicines, and been blistered, +but without relief. His complaints continuing +to increase, I directed an infusion of Digitalis, +which made him very sick; acted powerfully as a +diuretic, and removed all his symptoms.</p> + +<p>About three months afterwards he was out upon +a journey, and, after taking cold, was suddenly +seized with difficulty of breathing, and violent palpitation +of his heart: he sent for me, and I ordered +the infusion as before, which very soon removed +his complaints. He is now active and well; but, +whenever he takes cold, finds some return of difficult +breathing, which he soon removes by a dose or two +of the infusion.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXI.</span></h3> + +<p><i>January</i> 5th. Mrs. M——, 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 <i>June</i> and <i>October</i> following, +which was each time removed by the same medicine.<span class='pagenum'><a name="Page_27" id="Page_27">[27]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXII.</span></h3> + +<p><i>January</i> 11th. Mr. H——, 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.</p> + +<p>This case, as well as <a href="#CASEvi">case VI.</a> is mentioned with +a view to demonstrate to younger practitioners, how +sudden and unexpected the deaths of dropsical patients +sometimes happen, and how cautious we should +be in assigning causes for effects.</p> + + +<h3><a name="CASExxiii" id="CASExxiii"></a>CASE <span style="letter-spacing: 0ex">XXIII.</span></h3> + +<p><i>August</i> 31st. Mr. C——, Æt. 57. Diseased +viscera, jaundice, ascites and anasarca. After trying<span class='pagenum'><a name="Page_28" id="Page_28">[28]</a></span> +calomel, saline draughts, jallap purges, chrystals +of tartar, pills of gum ammoniac, squills, and +soap, sal succini, eleterium, &c. infusion of Digitalis +was directed, which removed all his urgent +symptoms, and he recovered a pretty good state of +health.</p> + + +<h3><a name="CASExxiv" id="CASExxiv"></a>CASE <span style="letter-spacing: 0ex">XXIV.</span></h3> + +<p><i>September</i> 11th. I was desired to visit Mr. L——, +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<span class='pagenum'><a name="Page_29" id="Page_29">[29]</a></span> +days in bed, he feels not the least difficulty in +breathing.</p> + +<p>Apprehending that the insanity might be owing +to the same cause which had heretofore occasioned +the asthma, and that this cause was water; I ordered +a decoction of the Fol. siccat Digital, three drams to +half a pint; three spoonfuls to be taken every third +hour: the fourth dose made him sick; the medicine +was then stopped; the sickness continued at intervals, +more or less, for four days, during which time +he made a great quantity of water, and gradually +became more rational. On the fifth day his appetite +began to return, and the sickness ceased, but +the flow of urine still continued.</p> + +<p>A week afterwards I saw him again, and examined +him particularly; his head was then perfectly rational, +appetite very good, breath quite easy, permitting +him to lie down in bed without inconvenience, +makes plenty of water, coughs a little, and +expectorates freely. He took no other medicine, +except a little rhubarb when costive.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXV.</span></h3> + +<p><i>September</i> 15th. Mr. J. R——, 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 <i>July</i> he +took G. ammon. squill and seneka, with infus. +amarum and fossil alkaly. In <i>August</i>, infusum amar.<span class='pagenum'><a name="Page_30" id="Page_30">[30]</a></span> +with vin. chalyb. and at bed-time pil. styr. and +squill. His complaints increasing, the squill was +pushed as far as could be borne, but without any +good effect. <i>September</i> 15th, an infusion of Digitalis +was directed, but he died the next morning.</p> + + +<h3><a name="CASExxvi" id="CASExxvi"></a>CASE <span style="letter-spacing: 0ex">XXVI.</span></h3> + +<p><i>September</i> 18th. Mrs. R——, 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 <a href="#CASEviii">No. VIII.</a> I determined +upon a similar method of treatment; but as this patient +had an inflammatory sore throat also, I wished +to get that removed first, and in three or four days +it was done. I then directed an infusion of Digitalis, +which soon increased the urinary secretion, +and reduced the swellings, without any disturbance +of her stomach.</p> + +<p>A few days after quitting her bed and coming +down stairs, some degree of swelling in her legs returned, +which was removed by calomel, an opening +electuary, and the application of rollers.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXVII.</span></h3> + +<p><i>October</i> 7th. Mr. F——, a little man, with a +spine and thorax greatly deformed; for more than +a year past had complained of difficult respiration, +and a sense of fulness about his stomach; these complaints +increasing, his abdomen gradually enlarged,<span class='pagenum'><a name="Page_31" id="Page_31">[31]</a></span> +and a fluctuation in it became perceptible. He had +no anasarca, no appearance of diseased viscera, and +no great paucity of urine. Purges and diuretics of +different kinds affording him no relief, my assistance +was desired. After trying squill medicines without +effect, he was ordered to take Pulv. fol. Digital. in +small doses. These producing no sensible effect, +the doses were gradually increased until nausea was +excited; but there was no alteration in the quantity +of urine, and consequently no relief to his complaints. +I then advised tapping, but he would not +hear of it; however, the distress occasioned by the +increasing fulness of his belly at length compelled +him to submit to the operation on the 20th of <i>November</i>. +It was necessary to draw off the water again +upon the following days:</p> + +<table summary="report"> +<tr><td rowspan="5">1780.</td><td><i>December</i> the</td><td class="rightalign">8th.</td></tr> +<tr><td>— —</td><td class="rightalign">27th.</td></tr> +<tr><td><i>February</i> the</td><td class="rightalign">4th.</td></tr> +<tr><td>— —</td><td class="rightalign">23d.</td></tr> +<tr><td><i>March</i> the</td><td class="rightalign">9th.</td></tr> +</table> + +<p>During the intervals, no method I could think of +was omitted to prevent the return of the disease, +but nothing seemed to avail. In the operation of +<i>February</i> 23d, his strength was so much reduced, +that the water was not entirely removed; and on +the 9th of March, before his belly was half emptied, +notwithstanding the most judicious application +of bandage, his debility was so great, that it was +judged prudent to stop. After being placed in bed, +the faintness and sickness continued; severe rigors<span class='pagenum'><a name="Page_32" id="Page_32">[32]</a></span> +ensued, and violent vomiting; these vomitings continued +through the night, and in the intervals he +lay in a state nearly approaching to syncope. The +next day I found him with nearly the same symptoms, +but remarked that the quantity of fluid he +had thrown up was very much more than what he +had taken, and that his abdomen was considerably +fallen; in the course of two or three days more, he +discharged the whole of the effused fluid; his strength +and appetite gradually returned, and he was in all +respects much better than he had been before the +last operation.</p> + +<p>Some time afterwards, his belly began to fill +again, and he again applied to me; upon an accurate +examination, I judged the quantity of fluid +might then be about four or five quarts. Nature +had pointed out the true method of cure in this +case; I therefore ordered him to bed, and directed +ipecacoanha vomits to be given night and morning: +in two or three days the whole of the water was +removed by vomiting, for he never purged, nor +was the quantity of his urine increased; his appetite +and strength gradually returned; he never had +any further relapse, and is now an active healthy +man. I must leave the reader to make his own reflections +on this singular case.<span class='pagenum'><a name="Page_33" id="Page_33">[33]</a></span></p> + + +<h3>1780.<br /> + +CASE <span style="letter-spacing: 0ex">XXVIII.</span></h3> + +<p><i>January</i> 11th. Captain V——, 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.<span class='pagenum'><a name="Page_34" id="Page_34">[34]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXIX.</span></h3> + +<p><i>February</i> 6th. Mr. H——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXX.</span></h3> + +<p><i>February</i> 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.</p> + + +<h3><a name="CASExxxi" id="CASExxxi"></a>CASE <span style="letter-spacing: 0ex">XXXI.</span></h3> + +<p><i>March</i> 5th. I was desired to visit Mrs. H——, +a very delicate woman, who after a severe lying-in, +had her legs and thighs swollen to a very great degree;<span class='pagenum'><a name="Page_35" id="Page_35">[35]</a></span> +pale and semi-transparent. I found her extremely +faint, her pulse very small and slow; vomiting +violently, and frequently purging. She was attended +by a gentleman who had seen me give the +Digitalis in a similar case of swelled legs after a lying-in +(see <a href="#CASExxvi">Case XXVI.</a>) about six months before. He +had not considered that this patient was delicate, +the other robust; nor had he attended to stop the +exhibition of the medicine when its effects began to +take place. The great distress of her situation was +evidently owing to the imprudent and unlimited +use of the Digitalis. I was very apprehensive for +her safety; ordered her cordials and volatiles; a free +supply of wine, chamomile tea with brandy for +common drink, and blisters. The next day the situation +of things was much the same, but with all this +disturbance no increased secretion of urine. The same +methods were continued; an opiate ordered at night, +and liniment. volatile upon flannel applied to the +groins, as she now complained of great pain in those +parts. The third day the nausea was less urgent, +the vomitings less frequent, the pulse not so slow. +Camphorated spirit, with caustic volatile alkaly, was +applied to the stomach, emulsion given for common +drink, and the same medicines repeated. From +this time, the intervals became gradually longer between +the fits of vomiting, the flow of urine increased, +the swellings subsided, the appetite returned, +and she recovered perfectly.<span class='pagenum'><a name="Page_36" id="Page_36">[36]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXXII.</span></h3> + +<p><i>March</i> 16th. Mr. D——, 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 <i>August</i> 1782, and +without any return of the dropsy.</p> + + +<h3><a name="CASExxxiii" id="CASExxxiii"></a>CASE <span style="letter-spacing: 0ex">XXXIII.</span></h3> + +<p><i>March</i> 18th. Miss S——, 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.<span class='pagenum'><a name="Page_37" id="Page_37">[37]</a></span></p> + + +<h3><a name="CASExxxiv" id="CASExxxiv"></a>CASE <span style="letter-spacing: 0ex">XXXIV.</span></h3> + +<p><i>March</i> 19th. A young lady, soon after the birth +of an illegitimate child, became insane. After being +near a month under my care, swellings of her +legs, which at first had been attributed to weakness, +extended to her thighs and belly; her urine became +foul, and small in quantity, and the insanity remained +nearly the same. As it had been very difficult +to procure evacuations by any means, I ordered +half an ounce of Fol. Digital. siccat. in a +pint infusion, and directed two spoonfuls to be given +every two hours: this had the desired effect; +the dropsy and the insanity disappeared together, +and she had afterwards no other medicine but some +aperient pills to take occasionally.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXXV.</span></h3> + +<p><i>April</i> 12th. Mr. R——, 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 <i>June</i> +following he had a relapse, and took two grains of +the Pulv. fol. Digit. three times a day, which cured +him after taking forty grains, and he has never had +a return.<span class='pagenum'><a name="Page_38" id="Page_38">[38]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXXVI.</span></h3> + +<p><i>May</i> 15th. Mrs. H——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXXVII.</span></h3> + +<p><i>May</i> 26th. R—— B——, Æt. 12. Scrophulous, +consumptive, and at length anasarcous. Took +Infus. Digital. without advantage. Died the <i>July</i> +following.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXXVIII.</span></h3> + +<p><i>June</i> 4th. Mrs. S——, 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 <i>May</i>; we directed +an electuary of chrystals of tartar, and Seltzer +water for common drink; this plan failing, as others +had done before, we ordered the Infus. Digital. which +in a few days nearly removed the dropsy. I then +left her to the care of her physician; but her constitution +was too much impaired to admit of restoration +to health, and I understand she died a few +weeks afterwards.<span class='pagenum'><a name="Page_39" id="Page_39">[39]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXXIX.</span></h3> + +<p><i>June</i> 13th. Mr. P——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XL.</span></h3> + +<p><i>June</i> 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.</p> + +<p>In the course of the following winter he became +hectic, and died consumptive about a year afterwards.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XLI.</span></h3> + +<p><i>July</i> 6th. Mr. E——, Æt. 57. Hydrothorax +and anasarca; his breath so short that he could not<span class='pagenum'><a name="Page_40" id="Page_40">[40]</a></span> +lie down. After a trial of squill, fixed alkaly, and +dulcified spirit of nitre, I directed Pulv. Digital. +gr. 2, thrice a day. In four days he was able to +come down stairs; in three days more no appearance +of disease remained; and under the use of aromatics +and small doses of opium, he soon recovered his +strength.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XLII.</span></h3> + +<p><i>July</i> 7th. Miss H—— of T——, Æt. 39. In +the last stage of a phthisis pulmonalis became dropsical. +She took the Digitalis without being relieved.</p> + + +<h3><a name="CASExliii" id="CASExliii"></a>CASE <span style="letter-spacing: 0ex">XLIII.</span></h3> + +<p><i>July</i> 9th. Mrs. F——, 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,<span class='pagenum'><a name="Page_41" id="Page_41">[41]</a></span> +chrystals of tartar, squill and cordial medicines were +successively exhibited, but with no advantage. I +then directed Pulv. Fol. Digital. two grains every +four hours. After taking eighteen grains, the urine +began to increase. The medicine was then stopped. +The discharge of urine continued to increase, and +in five or six days the whole of the dropsical water +passed off, without any disturbance to the stomach +or bowels. As the distension of the belly had been +very great, a swathe was applied, and drawn gradually +tighter as the water was evacuated. As no pains +were spared to prevent the return of the dropsy, +and as the best means I could devise proved unequal +to my wishes, both in this and in some other cases, +I shall take the liberty to point out the methods +I tried at different times in as concise a manner as +possible, for the knowledge of what will not do, may +sometimes assist us to discover what will.</p> + +<div class="timeline"> +<p style="padding-left: 2em">1780.</p> + +<p><i>July</i> 18th. Infusum amarum, steel, Seltzer water.</p> + +<p><i>September</i> 22d. Neutral saline draughts, with tinct. +canthar.</p> + +<p>26th. Pills of soap, garlic and millepedes.</p> + +<p>30th. The same pills, with infusum amarum.</p> + +<p><i>October</i> 11th. Pills of aloes, assafetida, and sal martis, +in the day-time, and mercury rubbed down, +at night.</p> + +<p><i>December</i> 21st. The accumulation of water now required +a repetition of the Digitalis. It was directed +in infusion, a dram and half to eight ounces, +and an ounce and half given every fourth hour,<span class='pagenum'><a name="Page_42" id="Page_42">[42]</a></span> +until its effects began to appear. The water was +soon carried off.</p> + +<p>30th. Sal diuretic. twice a day. To eat preserved +garlic frequently.</p> + +<p style="padding-left: 2em; padding-top: 1em">1781.</p> + +<p><i>February</i> 1st. Pills of calomel, squill and gum ammoniac.</p> + +<p>3d. Infusion of Digitalis repeated, and after the +water was carried off, Dover's powder was tried +as a sudorific.</p> + +<p><i>March</i> 18th. Infus. Digital. repeated.</p> + +<p>26th. Pills of sal martis and aromatic species, with +infusum amarum.</p> + +<p><i>May</i> 5th. Being feverish; James's powder and +saline draughts.</p> + +<p>10th. Laudanum every night, and an opening +tincture to obviate costiveness.</p> + +<p>24th. Infus. Digitalis, one ounce only every fourth +hour, which soon procured a perfect evacuation +of the water.</p> + +<p><i>August</i> 11th. Infus. Digitalis.</p> + +<p><i>October</i> 19th. An emetic, and fol. Cicut. pulv. +ten grains every six hours.</p> + +<p><i>November</i> 8th. A mercurial bolus at bed-time.</p> + +<p>16th. Infus. Digitalis.</p> + +<p><i>December</i> 23d. An emetic—Pills of seneka and gum +ammoniac—Vitriolic acid in every thing she +drinks.</p> + +<p>25th. Squill united to small doses of opium.</p> + +<p style="padding-left: 2em; padding-top: 1em">1782.</p> + +<p><i>January</i> 2d. A troublesome cough—Syrup of garlic +and oxymel of squills. A blister to the back.<span class='pagenum'><a name="Page_43" id="Page_43">[43]</a></span></p> + +<p>4th. Tincture of cantharides and paregoric elixir.</p> + +<p>28th. Infus. Digitalis, half an ounce every morning, +and one ounce every night, was now sufficient +to empty her.</p> + +<p><i>March</i> 26th. Infus. Digitalis; and when emptied, +vitriol of copper twice a day.</p> + +<p><i>April</i> 1st. A cordial mixture for occasional use.</p> + +<p>Two months afterwards a purging came on, which +every now and then returned, inducing great +weakness—her appetite failed, and she died +in <i>July</i>.</p></div> + + +<h3>INTERVALS.</h3> + +<ul> +<li>From <i>July</i> 9th, 1780, to <i>December</i> 21st, 171 days.</li> +<li>From <i>December</i> 21st to <i>February</i> 3d, 1781, 34 days.</li> +<li>From <i>February</i> 3d to <i>March</i> 18th, 44 days.</li> +<li>From <i>March</i> 18th to <i>May</i> 24th, 66 days.</li> +<li>From <i>May</i> 24th to <i>August</i> 11th, 79 days.</li> +<li>From <i>August</i> 11th to <i>November</i> 16th, 98 days.</li> +<li>From <i>November</i> 16th to <i>January</i> 28th, 1782, 74 days.</li> +<li>From <i>January</i> 28th to <i>March</i> 26th, 57 days.</li> +</ul> + +<p>None of the accumulations of water were at all +equal to that which existed when I first saw her, for +finding so easy a mode of relief, she became impatient +under a small degree of pressure, and often +insisted upon taking her medicine sooner than I +thought it necessary. After the 26th of <i>March</i> the +degree of effusion was inconsiderable, and at the +time of her death very trifling, being probably carried +off by the diarrhœa.<span class='pagenum'><a name="Page_44" id="Page_44">[44]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XLIV.</span></h3> + +<p><i>July</i> 12th. Mr. H——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XLV.</span></h3> + +<p><i>July</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XLVI.</span></h3> + +<p><i>August</i> 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.</p> + + +<h3><a name="CASExlvii" id="CASExlvii"></a>CASE <span style="letter-spacing: 0ex">XLVII.</span></h3> + +<p><i>August</i> 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<span class='pagenum'><a name="Page_45" id="Page_45">[45]</a></span> +lost all relish for animal food, and his only support +had been an ounce or two of bread and cheese, or +a small slice of seed-cake, with three or four pints +of mild ale, in the twenty-four hours. After trying +chrystals of tartar, fixed alkaly, squills, &c. I +directed three grains of Pulv. fol. Digital. made +into pills, with G. ammoniac, to be given every six +hours; this presently occasioned copious discharges +of urine, removed his swellings, and restored him +to his usual standard of health.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XLVIII.</span></h3> + +<p><i>August</i> 17th. T—— 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XLIX.</span></h3> + +<p><i>August</i> 23d. Mr. C——, Æt. 58. (The person +mentioned at <a href="#CASExxiii">Case XXIII.</a>) He had continued free +from dropsy until within the last six weeks; his appetite +was now totally gone, his strength extremely +reduced, and the yellow of his jaundice changed to a +blackish hue. The Digitalis was now tried in vain, +and he died shortly afterwards.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">L.</span></h3> + +<p><i>August</i> 24th. Mrs. W——, Æt. 39. Anasarcous +legs and symptoms of hydrothorax, consequent<span class='pagenum'><a name="Page_46" id="Page_46">[46]</a></span> +to a tertian ague. Three grains of Pulv. Digitalis, +given every fourth hour, occasioned a very copious +flow of urine, and she got well without any other +medicine.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LI.</span></h3> + +<p><i>August</i> 28th. Mr. J—— 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LII.</span></h3> + +<p><i>September</i> 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.<span class='pagenum'><a name="Page_47" id="Page_47">[47]</a></span> +fol. Digital. made into pills, with gum ammoniac +and aromatic species, soon relieved his breathing. +Attempts were then made to assist him in other respects, +but with little good effect, and some months +afterwards he died, with every appearance of a +worn out constitution.</p> + +<p>About two years after this gentleman's death, I was +talking to a pump-maker, who, in the course of conversation, +mentioned the corrosion of leaden pumps, +by some of the water in this town, and instanced +that at the house of Mr. S——, 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.</p> + +<p>The deleterious effects of lead seem to be considerably +modified by the constitution of the patient; +for in some families only one or two individuals +shall suffer from it, whilst the rest receive it with +impunity. In the spring of the year 1776, I was +desired to visit Mrs. H——, 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<span class='pagenum'><a name="Page_48" id="Page_48">[48]</a></span> +escaped severe attacks twice or thrice in a year; she +had also frequent pains in her joints. I could not +find any traces of similar complaints either in Mr. +H——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LIII.</span></h3> + +<p><i>September</i> 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.<span class='pagenum'><a name="Page_49" id="Page_49">[49]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">LIV.</span></h3> + +<p><i>September</i> 30th. Mr. A——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LV.</span></h3> + +<p><i>November</i> 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 <i>September</i> +I frequently saw him, and observed a gradual +and regular increase of all his complaints, notwithstanding +the use of the most powerful medicines I +could prescribe. He took chrystals of tartar, seneka, +gum ammoniac, saline draughts, emetics, tinct. of +cantharides, spirits of nitre dulcified, squills in all +forms, volatile alkaly, calomel, Dover's powder, +&c. Blisters and drastic purgatives were tried, interposing +salt of steel and gentian. I had all along +felt a reluctance to prescribe the Digitalis in this +case, from a persuasion that it would not succeed.<span class='pagenum'><a name="Page_50" id="Page_50">[50]</a></span> +At length I was compelled to it, and directed one +grain to be given every two hours until it should +excite nausea. This it did; but, as I expected, it +did no more. The reason of this belief will be +mentioned hereafter. Five days after this last trial +I gave him assafetida in large quantity, flattered by a +hope that his extreme sufferings from the state of his +respiration, might perhaps arise in part from spasm, +but my hopes were in vain. I now thought of using +an infusion of tobacco, and prescribed the following:</p> + +<div class="recipe"> +<p>R. Fol. Nicotian. incis. ʒii.</p> +<p style="padding-left: 1em">Aq. bull. ℔ss.</p> + +<p style="padding-left: 1em">Sp. Vini rectif. ℥i digere per horam.</p> +</div> + +<p>I directed a spoonful of this to be given every two +hours until it should vomit. This medicine had no +better effect than the former ones, and he died +some days afterwards.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LVI.</span></h3> + +<p><i>November</i> 6th. Mr. H——, 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.<span class='pagenum'><a name="Page_51" id="Page_51">[51]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">LVII.</span></h3> + +<p><i>November</i> 16th. Mrs. F——, Æt. 53. In +<i>August</i> last was suddenly seized with epileptic fits, +which continued to recur at uncertain intervals. Her +belly had long been larger than natural, but without +any perceptible fluctuation. Her legs and thighs +swelled very considerably the beginning of this +month, and now there was evidently water in the +abdomen. The medicines hitherto in vain directed +against the epileptic attacks, were now suspended, +and two grains of the Pulv. fol. Digital. directed to +be taken every six hours. The effects were most +favourable, and the dropsical symptoms were soon +removed by copious urinary discharges.</p> + +<p>The attacks of epilepsy ceased soon afterwards. +In <i>February</i>, 1781, there was some return of the +swellings, which were soon removed, and she now +enjoys very good health. Does not the narrative +of this case throw light upon the nature of the epilepsy +which sometimes attacks women, soon after +the cessation of the menstrual flux?</p> + + +<h3>1781.<br /> + +CASE <span style="letter-spacing: 0ex">LVIII.</span></h3> + +<p><i>January</i> 1st. Mrs. G——, 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.<span class='pagenum'><a name="Page_52" id="Page_52">[52]</a></span> +Digital. every six hours, but it produced no effect. +Other Medicines were then tried to as little purpose. +About the end of <i>February</i>, I directed an +infusion of the Fol. Digital. but with no better success. +Other methods were thought of, but none +proved efficacious, and she died a few weeks afterwards.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LIX.</span></h3> + +<p><i>January</i> 3d. Mrs. B——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LX.</span></h3> + +<p><i>January</i> 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.</p> + + +<h3><a name="CASElxi" id="CASElxi"></a>CASE <span style="letter-spacing: 0ex">LXI.</span></h3> + +<p><i>February</i> 2d. I was desired by the late learned +and ingenious Dr. Groome, to visit Miss S——, a<span class='pagenum'><a name="Page_53" id="Page_53">[53]</a></span> +young lady in the last state of emaciation from a +dropsy. Every probable means to relieve her had +been attempted by Dr. Groome, but to no purpose; +and she had undergone the operation of the +paracentesis repeatedly. The Doctor knew, he said, +that I had cured many cases of dropsy, by the Digitalis, +after other more usual methods had been +attempted without success, and he wished this lady +to try that medicine under my direction; after examining +the patient, and enquiring into the history +of the disease, I was satisfied that the dropsy was +encysted, and that no medicine could avail. The +Digitalis, however, was directed, and she took it, +but without advantage. She had determined not to +be tapped again, and neither persuasion, nor distress +from the distension, could prevail upon her: I at length +proposed to make an opening into the sac, by means of +a caustic, which was done under the judicious management +of Mr. Wainwright, surgeon, at Dudley. +The water was evacuated without any accident, and +the patient afterwards let it out herself from time to +time as the pressure of it became troublesome, until +she died at length perfectly exhausted.</p> + +<p><i>Query.</i> Is there not a probability that this method, +assisted by bandage, might be used so as to +effect a cure, in the earlier stages of ovarium dropsy?</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXII.</span></h3> + +<p><i>February</i> 27th. Mrs. O——, of T——, Æt. 52, +with a constitution worn out by various complicated<span class='pagenum'><a name="Page_54" id="Page_54">[54]</a></span> +disorders, at length became dropsical. The Digitalis +was given in small doses, in hopes of temporary +benefit, and it did not fail to fulfil our expectations.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXIII.</span></h3> + +<p><i>March</i> 16th. Mrs. P——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXIV.</span></h3> + +<p><i>March</i> 18th. Mr. W——, in the last stage +of a pulmonary consumption became dropsical. The +Digitalis was given, but without any good effect.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXV.</span></h3> + +<p><i>April</i> 6th. Mr. B——, 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<span class='pagenum'><a name="Page_55" id="Page_55">[55]</a></span> +exceedingly. Alkaline salts, and other diuretics +failing of their effects, I ordered him to take an infus. +of Digitalis. It operated so powerfully that it became +necessary to support him with cordials and +blisters, but it freed him from the dropsy, and his +breath became quite easy. He then took soap, rhubarb, +tartar of vitriol, and steel, and gradually attained +a good state of health, which he still continues +to enjoy.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXVI.</span></h3> + +<p><i>April</i> 8th. Mr. B——, 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.<span class='pagenum'><a name="Page_56" id="Page_56">[56]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXVII.</span></h3> + +<p><i>April</i> 24th. Mr. M——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXVIII.</span></h3> + +<p><i>April</i> 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.</p> + + +<h3><a name="CASElxix" id="CASElxix"></a>CASE <span style="letter-spacing: 0ex">LXIX.</span></h3> + +<p><i>May</i> 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<span class='pagenum'><a name="Page_57" id="Page_57">[57]</a></span> +ointment to be rubbed into the legs every +day. Five days afterwards, finding the febrile symptoms +very much abated, and judging the remaining +disease to be the effect of effusion, I directed a scruple +of Fol. Digital. siccat. to be infused in three +ounces of water, and a table spoonful of the infusion +to be given every third or fourth hour, until +its action should be someway sensible. The effect +was, an increased secretion of urine; and the patient +soon recovered.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXX.</span></h3> + +<p><i>May</i> 3d. Mrs. B——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXI.</span></h3> + +<p><i>May</i> 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.<span class='pagenum'><a name="Page_58" id="Page_58">[58]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXII.</span></h3> + +<p><i>May</i> 24th. Joseph B——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXIII.</span></h3> + +<p><i>June</i> 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.</p> + +<p>The following winter his breathing grew bad again, +his appetite totally failed, and he died, but without +any return of the ascites.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXIV.</span></h3> + +<p><i>June</i> 29th. Mr. A——, 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:<span class='pagenum'><a name="Page_59" id="Page_59">[59]</a></span> +a few doses occasioned a plentiful flow of urine, relieved +his breath, and reduced his swellings; but, +on account of his great weakness, it was judged imprudent +to urge the medicine to the entire evacuation +of the water. He was so much relieved as to +be able to come down stairs and to walk about, but +his want of appetite and jaundice continuing, and +his debility increasing, he died in about two +months.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXV.</span></h3> + +<p><i>July</i> 18th. Mrs. B——, 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.</p> + +<p>The usual modes of practice failing, the Digitalis +was tried, but with no better success, and in about a +month she died; not without suspicion of her death +having been accelerated a few days, by her taking +half a grain of opium. This may be a caution to +young practitioners to be careful how they venture +upon even small doses of opium in such constitutions, +however much they may be urged by the patient +to prescribe something that may procure a little +rest and ease.<span class='pagenum'><a name="Page_60" id="Page_60">[60]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXVI.</span></h3> + +<p><i>August</i> 12th. Mr. L——, Æt. 65, the person +whose Case is recorded at <a href="#CASExxiv">No. XXIV</a>, had a return +of his insanity, after near two years perfect +health. He was extremely reduced when I saw him, +and the medicine which cured him before was now +administered without effect, for his weakness was +such that I did not dare to urge it.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXVII.</span></h3> + +<p><i>September</i> 10th. Mr. V——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXVIII.</span></h3> + +<p><i>September</i> 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<span class='pagenum'><a name="Page_61" id="Page_61">[61]</a></span> +easy to say what the disease was, and the patient +living at a distance, I never learnt the future progress +or termination of it.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXIX.</span></h3> + +<p><i>September</i> 26th. Mr. D——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXX.</span></h3> + +<p><i>September</i> 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.<span class='pagenum'><a name="Page_62" id="Page_62">[62]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXXI.</span></h3> + +<p><i>October</i> 28th. Mr. B——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXXII.</span></h3> + +<p><i>November</i> 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.<span class='pagenum'><a name="Page_63" id="Page_63">[63]</a></span></p> + + +<h3>1782.<br /> + +CASE <span style="letter-spacing: 0ex">LXXXIII.</span></h3> + +<p><i>January</i> 23d. Mr. Q——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXXIV.</span></h3> + +<p><i>January</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXXV.</span></h3> + +<p><i>January</i> 28th. Mr. D——, Æt. 35. A publican +and a hard drinker. Ascites, anasarca, diseased<span class='pagenum'><a name="Page_64" id="Page_64">[64]</a></span> +viscera, and slight attacks of 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXXVI.</span></h3> + +<p><i>January</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXXVII.</span></h3> + +<p><i>January</i> 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,<span class='pagenum'><a name="Page_65" id="Page_65">[65]</a></span> +one spoonful to be taken every morning, and two +at night. He only took this quantity; for in four +days he could lie down, and soon afterwards quitted +his chamber. In a month he had a return of his +complaints, and was relieved as before.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXXVIII.</span></h3> + +<p><i>January</i> 31st. Mrs. J——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">LXXXIX.</span></h3> + +<p><i>February</i> 2d. Mr. B——, Æt. 73. An universal +dropsy. He took various medicines, and Digitalis +in small doses, but without any good effect.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XC.</span></h3> + +<p><i>February</i> 24th. Master M——, 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<span class='pagenum'><a name="Page_66" id="Page_66">[66]</a></span> +half pint infusion, which made no alteration in his +complaint.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCI.</span></h3> + +<p><i>March</i> 6th. Mr. H——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCII.</span></h3> + +<p><i>May</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCIII.</span></h3> + +<p><i>May</i> 22d. Mr. O——, of B——, Æt. 61. A +very large man, and a free liver; after an attack of<span class='pagenum'><a name="Page_67" id="Page_67">[67]</a></span> +hemiplegia early in the spring, from which he only +partially recovered, became dropsical. The dropsy +occupied both legs and thighs, and the arm of the +affected side. I directed an Infusion of Digitalis in +small doses, so as not to affect his stomach. The +swellings gradually subsided, and in the course of +the summer he recovered perfectly from the palsy.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCIV.</span></h3> + +<p><i>July</i> 5th. Mr. C——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCV.</span></h3> + +<p><i>March</i> 6th. Mrs. W——, Æt. 36. In the last +stage of a pulmonary consumption, took the Infus. +Digitalis, but without any advantage.<span class='pagenum'><a name="Page_68" id="Page_68">[68]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCVI.</span></h3> + +<p><i>August</i> 20th. Mr. P——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCVII.</span></h3> + +<p><i>September</i> 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 <a href="#CASEviii">No. VIII</a>, +<a href="#CASExxvi">XXVI</a>, and <a href="#CASExxxi">XXXI</a>. A considerable degree of swelling +still remained; the limb was heavy to her feeling, +and not devoid of pain. I directed a bolus of +five grains of Pulv. Digitalis, and twenty-five of +crude quicksilver rubbed down, with conserve of cynosbat. +to be taken at bed-time, and afterwards an +Infusion of red bark and Fol. Digitalis to be taken +twice a day. There was half an ounce of bark and +half a dram of the leaves in a pint infusion: the +dose two ounces.</p> + +<p>The leg soon began to mend, and two pints of the +infusion finished the cure.<span class='pagenum'><a name="Page_69" id="Page_69">[69]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCVIII.</span></h3> + +<p><i>September</i> 25th. Mr. R——, 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.</p> + +<p>It should be observed, that I had frequently seen +the Digitalis remove sickness, though prescribed for +very different complaints.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XCIX.</span></h3> + +<p><i>September</i> 30th. Mrs. A——, Æt. 38. Hydrothorax +and anasarca. Her chest was very considerably +deformed. One half pint of the Digitalis Infusion +entirely cured her.<span class='pagenum'><a name="Page_70" id="Page_70">[70]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">C.</span></h3> + +<p><i>September</i> 30th. Mr. R——, 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.</p> + +<p>This plan succeeded perfectly. About a month +afterwards he had some rheumatic affections, which +were removed by guiacum.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CI.</span></h3> + +<p><i>October</i> 2d. Mrs. R——, 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.</p> + + +<h3><a name="CASEcii" id="CASEcii"></a>CASE <span style="letter-spacing: 0ex">CII.</span></h3> + +<p><i>October</i> 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<span class='pagenum'><a name="Page_71" id="Page_71">[71]</a></span> +soap, containing two grains of Pulv. fol. Digital, in +each dose, and, as he was costive, two grains of +jallap. He took them twice a day, and in a week +was free from every appearance of dropsy. The +jaundice soon afterwards vanished, and tonics restored +him to perfect health.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CIII.</span></h3> + +<p><i>October</i> 12th. Mr. B——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CIV.</span></h3> + +<p><i>October</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CV.</span></h3> + +<p><i>October</i> 30th. Mr. G——, of W——, Æt. 88. +The gentleman mentioned in <a href="#CASExlvii">No. XLVII</a>. His +complaints and manner of living the same as there<span class='pagenum'><a name="Page_72" id="Page_72">[72]</a></span> +mentioned. I ordered an Infusion of the Digitalis, +a dram and half to half a pint; one ounce to be +taken twice a day; which cured him in a short time.</p> + +<p>On <i>March</i> the 23d, 1784, he sent for me again. +His complaints were the same, but he was much +more feeble. On this account I directed a dram of +the Fol. Digitalis to be infused for a night in four +ounces of spirituous cinnamon water, a spoonful to +be taken every night. This had not a sufficient effect; +therefore, on the 22d of <i>April</i>, I ordered the +infusion prescribed two years before, which soon removed +his complaints.</p> + +<p>He died soon afterwards, fairly worn out, in his +ninetieth year.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CVI.</span></h3> + +<p><i>November</i> 2d. Mr. S——, 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.<span class='pagenum'><a name="Page_73" id="Page_73">[73]</a></span></p> + +<p>The sickness which followed was truly alarming; +it continued at intervals for many days, his pulse +sunk down to forty in a minute, every object appeared +green to his eyes, and between the exertions +of reaching he lay in a state approaching to syncope. +The strongest cordials, volatiles, and repeated blisters +barely supported him. At length, however, +he did begin to emerge out of the extreme danger +into which his folly had plunged him; and by generous +living and tonics, in about two months he +came to enjoy a perfect state of health.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CVII.</span></h3> + +<p><i>November</i> 19th. Master S——, 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.</p> + + +<h3>1783.</h3> + +<p>The reader will perhaps remark, that from the +middle of <i>January</i> to the first of <i>May</i>, not a single +case occurs, and that the amount of cases is likewise +less than in the preceding or ensuing years; to prevent +erroneous conjectures or conclusions, it may +be expedient to mention, that the ill state of my +own health obliged me to retire from business for +some time in the spring of the year, and that I did +not perfectly recover until the following summer.<span class='pagenum'><a name="Page_74" id="Page_74">[74]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CVIII.</span></h3> + +<p><i>January</i> 15th. Mrs. G——, Æt. 57. A very +fat woman; has been dropsical since <i>November</i> last; +with symptoms of diseased viscera. Various remedies +having been taken without effect, an Infusion +of Digitalis was directed twice a day, with a view +to palliate the more urgent symptoms. She took it +four days without relief, and as her recovery seemed +impossible it was urged no farther.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CIX.</span></h3> + +<p><i>May</i> 1st. Mrs. D——, 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.<span class='pagenum'><a name="Page_75" id="Page_75">[75]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CX.</span></h3> + +<p><i>May</i> 18th. I was desired to prescribe for Mary +Bowen, a poor girl at Hagley. Her disease appeared +to me to be an ovarium dropsy. In other respects +she was in perfect health. I directed the Digitalis +to be given, and gradually pushed so as to affect her +very considerably. It was done; but the patient +still carries her big belly, and is otherwise very +well.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXI.</span></h3> + +<p><i>May</i> 25th. Mr. G——, Æt. 28. In the last +stage of a pulmonary consumption of the scrophulous +kind, took an Infusion of Digitalis, but without +any advantage.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXII.</span></h3> + +<p><i>May</i> 31st. Mr. H——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXIII.</span></h3> + +<p><i>June</i> 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<span class='pagenum'><a name="Page_76" id="Page_76">[76]</a></span> +flesh wasted, his strength failed, and some weeks afterwards +he died tabid.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXIV.</span></h3> + +<p><i>June</i> 19th. Mrs. L——, Æt. 28. A dropsy in +the last stage of a phthisis. Infusum Digitalis was +tried to no purpose.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXV.</span></h3> + +<p><i>June</i> 20th. Mrs. H——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXVI.</span></h3> + +<p><i>June</i> 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.<span class='pagenum'><a name="Page_77" id="Page_77">[77]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXVII.</span></h3> + +<p><i>July</i> 22d. Mr. F——, 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<span class='pagenum'><a name="Page_78" id="Page_78">[78]</a></span> +altogether, or suspended upon its first effects upon +the pulse being observed, he might perhaps have +existed a week longer.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXVIII.</span></h3> + +<p><i>July</i> 26th. Mr. W——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXIX.</span></h3> + +<p><i>August</i> 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<span class='pagenum'><a name="Page_79" id="Page_79">[79]</a></span> +a day. The effect was a powerful action on the kidneys, +and a reduction of the swellings, but without +sickness. A degree of appetite returned, but still +the tendency to 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.</p> + +<p>The case now became totally unmanageable in +my hands, and, after a fortnight, I was dismissed, +and another physician called in; but she did not +long survive.</p> + +<p>This was not the first, nor the last instance, in which +I have seen too large a dose of the medicine, defeat +the very purpose for which it was directed.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXX.</span></h3> + +<p><i>August</i> 22d. Mrs. S——, 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<span class='pagenum'><a name="Page_80" id="Page_80">[80]</a></span> +more urgent symptoms were caused by water in the +lungs, I directed an Infusion of Digitalis, with an +ounce of diacodium to the half pint to prevent it +purging, a wine glass full to be taken every night at +bed-time, and a mixture with confect. cardiac. and +pulv. ipecac. to be given in small doses after every +loose stool.</p> + +<p>On the fourth day she was better in all respects; +had made a large quantity of water and did not purge. +In a few days more she lost all her complaints, except +the cough, which gradually left her, without +any further assistance.</p> + +<p>I was agreeably deceived in the event of this case, +for I expected after the water was removed, to have +had a phthisis to contend with.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXI.</span></h3> + +<p><i>August</i> 25th. T—— 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<span class='pagenum'><a name="Page_81" id="Page_81">[81]</a></span> +to point out the great effect the Digitalis has upon +the action of the heart; for the pulse came down to +96. He was afterwards tapped, and continued, for some +time under our joint attendance, but the pulse +never became quicker, nor did the swelling return.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXII.</span></h3> + +<p><i>September</i> 7th. Mr. L——, 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.</p> + + +<h3>1784.<br /> + +CASE <span style="letter-spacing: 0ex">CXXIII.</span></h3> + +<p><i>February</i> 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<span class='pagenum'><a name="Page_82" id="Page_82">[82]</a></span> +blood, had taken calomel purges with jallap; pills +of soap, rhubarb and calomel; saline julep with +acet. scillit. nitrous decoction, garlic, mercury rubbed +down, infus. amarum purg. &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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXIV.</span></h3> + +<p><i>March</i> 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<span class='pagenum'><a name="Page_83" id="Page_83">[83]</a></span> +secretion of urine, a considerable relief to her breath, +and some return of appetite; but soon afterwards +she became hectic, spat purulent matter, and died +in a few weeks.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXV.</span></h3> + +<p><i>April</i> 12th. Mrs. H——, of L——, Æt. 61. +In <i>December</i> last this Lady, then upon a visit in London, +was attacked with severe symptoms of peripneumony. +She was treated as an asthmatic +patient, but finding no relief, she made an effort +to return to her home to die. In her way through +this place, the latter end of December, I was desired +to see her. By repeated bleedings, blisters, and +other usual methods, she was so far relieved, that +she wished to remain under my care. After a +while she began to spit matter and became hectic. +With great difficulty she was kept alive during the +discharge of the abscess, and about the end of March +she had swelled legs, and unequivocal symptoms of +dropsy in the chest. Other diuretics failing, on the +12th of April I was induced to give her the Digitalis +in small doses. The relief was great and effectual. +After an interval of fifteen days, some swellings +still remaining in the legs, I repeated the +medicine, and with such good effect, that she lost +all her complaints, got a keen appetite, recovered +her strength, and about the end of May undertook +a journey of fifty miles to her own home, where she +still remains in perfect health.<span class='pagenum'><a name="Page_84" id="Page_84">[84]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXVI.</span></h3> + +<p><i>April</i> 17th. Mr. F——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXVII.</span></h3> + +<p><i>May</i> 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<span class='pagenum'><a name="Page_85" id="Page_85">[85]</a></span> +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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXVIII.</span></h3> + +<p><i>June</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXIX.</span></h3> + +<p><i>June</i> 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<span class='pagenum'><a name="Page_86" id="Page_86">[86]</a></span> +pulv. Digital. to be taken every night, and as he was +costive, jallap made a part of the composition. He +was also directed to take mustardseed every morning +and a solution of assafetida twice in the day. The +effect of this plan was perfectly to our wishes, and +in a short time he recovered his usual health. About +half a year afterwards he died apoplectic.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXX.</span></h3> + +<p><i>Mary</i> B——. A young unmarried woman. Her +disease appeared to me a dropsy of the right ovarium. +She took an infusion of Digitalis, but, as I expected +with no good effect. She is still, I am +informed nearly in the same state.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXI.</span></h3> + +<p><i>July</i> 12th. Mrs. A——, 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,<span class='pagenum'><a name="Page_87" id="Page_87">[87]</a></span> +that she was able soon afterwards to come down +stairs; but her constitution was too much broken to +admit of a recovery.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXII.</span></h3> + +<p><i>July</i> 16th. Mr. B——, 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<span class='pagenum'><a name="Page_88" id="Page_88">[88]</a></span> +allow of being put into bed, but was raised high +with pillows. Omit the infusion. That night he +parted with six quarts of water, and the next night +could lie down and slept comfortably. <i>July</i> 21st. +he took a mild mercurial bolus. On the 25th. the +diuretic effects of the Digitalis having nearly ceased, +he was ordered to take three grains of the pulv. +Digital. night and morning, for five days, and a +draught with half an ounce of vin. chalyb. twice a +day. <i>August</i> 15th. He took a purge of calomel and +jallap, and some swelling still remaining in his legs, +the Digitalis infusion was repeated. The water +having been thus entirely evacuated, he was ordered +saline draughts with acetum scilliticum and +pills of salt of steel and extract of gentian. About +a month after this, he returned home perfectly well.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXIII.</span></h3> + +<p><i>July</i> 28th. Mr. A—— 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXIV.</span></h3> + +<p><i>July</i> 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.<span class='pagenum'><a name="Page_89" id="Page_89">[89]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXV.</span></h3> + +<p><i>August</i> 6th. Mr. C—— 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXVI.</span></h3> + +<p><i>August</i> 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.</p> + +<p>Before the Digitalis was prescribed, he had taken +jallap purges, soluble tartar, salt of steel, vitriol of +copper, <span class='pagenum'><a name="Page_90" id="Page_90">[90]</a></span>&c.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXVII.</span></h3> + +<p><i>August</i> 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.</p> + +<p>I must here bear witness to the efficacy of Cotunnius's +method of blistering in the sciatica, having +used it in a great number of cases, and generally +with success.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXVIII.</span></h3> + +<p><i>August</i> 16th. Mrs. A—— 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<span class='pagenum'><a name="Page_91" id="Page_91">[91]</a></span> +more than half one at a time, for they purged her, +and she disliked them. The pills she took regularly, +and with the happiest effect, for she could lie down, +her breath was very much relieved, and a degree of +appetite returned. <i>Sept.</i> 4th, some return of her +symptoms demanded the further use of diuretics. +I was afraid to push the Digitalis in so hazardous a +subject, and therefore directed tinct. amara with tinct. +canthar. and pills of squill, seneka, salt of tartar and +gum ammoniac. These medicines did not at all +check the progress of the disease, and on the 26th +it became necessary to give the Digitalis again. The +pills were therefore repeated as before, and infus. +amarum with fixed alkaly ordered to be taken twice +a day. The event was as favorable as before; and +from this time she had no considerable return of +dropsy, but languished under various nameless +symptoms, until the middle or end of November.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXXXIX.</span></h3> + +<p><i>Aug.</i> 16th. Mrs. P—— of S——, Æt. 50. For +a particular account of this patient, <a href="#CASEyii">see Mr. Yonge's +second Case</a>.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXL.</span></h3> + +<p><i>Sept.</i> 20th. B—— 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<span class='pagenum'><a name="Page_92" id="Page_92">[92]</a></span> +give him an infusion of the Digitalis. It was continued +until nausea came on, but procured no relief.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXLI.</span></h3> + +<p><i>October</i> 5th. Mr. R——, Æt. 43. <i>(The patient +mentioned at <a href="#CASEcii">No. 102</a>.)</i> He had pursued his former +mode of life, and had now a return of his complaints, +with evident marks of diseased viscera. His +belly not very large, but uncommonly tense. From +this circumstance I did not expect the Digitalis to +succeed, and therefore tried for some time to relieve +him by the saline julep, with acet. scillitic. +jallap, mercury, syrup of squill, with aq. cinnam. decoction +of Dandelion, &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.<span class='pagenum'><a name="Page_93" id="Page_93">[93]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXLII.</span></h3> + +<p><i>October</i> 19th. Mrs. R——, 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.</p> + +<p>In <i>April</i> 1785, she had a slight return, but not +such as to confine her to her chamber. She experienced +the same relief from the same medicine, but +continuing it for seven days without interruption, it +excited nausea.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXLIII.</span></h3> + +<p><i>October</i> 28th. Mr. A——, subject to nephritis +calculosa: After an attack of that kind, had still a +troublesome sense of weight about his loins, now and +then rising to pain, and a degree of dysuria, together +with a want of appetite. These symptoms not +readily yielding to the usual methods of treatment, +I directed an infusion of Digitalis. The fourth dose<span class='pagenum'><a name="Page_94" id="Page_94">[94]</a></span> +caused a copious flow of urine; the sixth made him +sick, and he was more or less sick at times for three +days; but felt no more of his complaints.</p> + +<p>I don't believe it is at all necessary to bring on +sickness in these cases, but an unexpected absence +from town prevented me from seeing him time +enough to stop the exhibition of the medicine.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXLIV.</span></h3> + +<p><i>October</i> 31st. Mrs. C——, 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.<span class='pagenum'><a name="Page_95" id="Page_95">[95]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXLV.</span></h3> + +<p><i>Nov.</i> 2d. Miss B—— 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.</p> + +<p>The further progress of the disease confirmed my +first opinion, and she died consumptive.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXLVI.</span></h3> + +<p><i>Nov.</i> 4th. Mr. P—— 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.<span class='pagenum'><a name="Page_96" id="Page_96">[96]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXLVII.</span></h3> + +<p><i>Nov.</i> 4th. Mr. B—— 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CXLVIII.</span></h3> + +<p><i>Nov.</i> 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.</p> + + +<h3><a name="CASEcxlix" id="CASEcxlix"></a>CASE <span style="letter-spacing: 0ex">CXLIX.</span></h3> + +<p><i>Nov.</i> 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<span class='pagenum'><a name="Page_97" id="Page_97">[97]</a></span> +ceased, nor could it be excited again, tho' +at last the medicine was pushed so as to occasion +sickness, which continued at intervals for three +days.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CL.</span></h3> + +<p><i>Nov.</i> 20th. Mrs. B——, 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.</p> + + +<h3><a name="CASEcli" id="CASEcli"></a>CASE <span style="letter-spacing: 0ex">CLI.</span></h3> + +<p><i>Nov.</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLII.</span></h3> + +<p><i>Nov.</i> 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<span class='pagenum'><a name="Page_98" id="Page_98">[98]</a></span> +her much harassed by a cough, which occasioned her +to expectorate a little: the least motion increased her +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.</p> + +<p>It is not improbable that the squill might have +some share in this cure.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLIII.</span></h3> + +<p><i>December</i> 7th. Mr. H——, 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.<span class='pagenum'><a name="Page_99" id="Page_99">[99]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLIV.</span></h3> + +<p><i>December</i> 27th. Mr. B——, 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 <i>March</i> following he had some slight +symptoms of relapse, which were soon removed by +the same medicine, and he now enjoys good health. +For a more particular narrative <a href="#CASEyi">see case the first, +communicated by Mr. Yonge</a>.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLV.</span></h3> + +<p><i>December</i> 31st. Mrs. B——, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLVI.</span></h3> + +<p>A poor man in this town, after his kidneys had +ceased to secrete urine for several days, was seized +with hickup, fits of vomiting, and transient delirium. +After examination I was satisfied the disease was +the same as that mentioned at <a href="#CASEcxlix">CXLIX</a>. A very experienced +apothecary having tried various methods to +relieve him, I despaired of any success, but determined +to try the Digitalis. It was accordingly given<span class='pagenum'><a name="Page_100" id="Page_100">[100]</a></span> +in infusion. At first it checked the vomitings, but +did not occasion any secretion of urine.</p> + + +<h3>1785.</h3> + +<p>The cases which have occurred to me in the course +of this year, are numerous; but as the events of +some of them are not yet sufficiently ascertained, I +think it better to with-hold them at present.<span class='pagenum'><a name="Page_101" id="Page_101">[101]</a></span></p> + +<div class="footnotes"><h3>FOOTNOTES:</h3> + +<div class="footnote"><p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Then resident at Lichfield, now at Derby.</p></div> + +<div class="footnote"><p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> This disease has lately been well described by Mr. White, +of Manchester.</p></div> +</div> + + +<h2><a name="HOSPITAL_CASES" id="HOSPITAL_CASES"></a>HOSPITAL CASES,<br style="line-height: 2em" /> + +<span style="letter-spacing: 0ex; font-size: 90%">Under the Direction of the Author.</span></h2> + +<hr class="chapter" /> + +<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> four following cases were drawn out at my +request by Mr. Cha. Hinchley, late apothecary +to the Birmingham Hospital. They are all the +Hospital cases for which the Digitalis was prescribed +by me, whilst he continued in that office.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLVII.</span></h3> + +<p><i>March</i> 15th, 1780. John Butler, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLVIII.</span></h3> + +<p><i>November</i> 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.<span class='pagenum'><a name="Page_102" id="Page_102">[102]</a></span></p> + +<div class="recipe"> +<p>R. Aq. cinn. spt. ℥iv.</p> + +<p style="padding-left: 1em">Oxymel. scillit.</p> + +<p style="padding-left: 1em">Syr. scillit. aa. ℥i. m. cap. cochlear. larg. sexta quaque horâ.</p> +</div> + +<p>This medicine producing no increased discharge +of urine, on the 25th you ordered the infusion of +Digitalis, two spoonfuls every four hours. After +taking this for thirty six hours, his urine was discharged +in very great quantity; his breath became +easy, and the swellings disappeared in a few days, +though he took no more of the medicine. On the +2d of <i>December</i> he was ordered myrrh and lac ammoniacum, +which he continued until the 23d, when +he was discharged cured, and is now in good health.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLIX.</span></h3> + +<p><i>November</i> 3d, 1781. Mary Crockett, 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLX.</span></h3> + +<p><i>March</i> 16th, 1782. Mary Bird, Æt. 61. Great +fullness about the stomach; diseased liver, and anasarcous<span class='pagenum'><a name="Page_103" id="Page_103">[103]</a></span> +legs and thighs. For the first week squill +was tried in more forms than one, but without advantage. +On the 22d she began with the Digitalis, +which presently removed all the swelling.</p> + +<p>She was then put upon the use of aperient medicines +and tonics, and on the first of <i>August</i> was discharged +perfectly cured.</p> + +<hr style="margin-bottom: 1em" /> + +<p>The three following Cases were drawn up and communicated +to me by Mr. Bayley, who succeeded +Mr. Hinchley as apothecary to the Hospital at +Birmingham:</p> + +<div class="blockquot"> + +<p class="right"> +Shiffnall, April 26th, 1785.</p> + +<p><span class="smcap">Dear Sir</span>,</p> + +<p>During my residence in the +Birmingham General Hospital, I had frequent opportunities +of seeing the great effects of the Digitalis +in dropsy. As the exhibition of it was in the following +instances immediately under your own direction, +I have drawn them up for your inspection, +previous to your publishing upon that excellent +diuretic. Of its efficacy in dropsy I have considerable +evidence in my possession, but consider myself +not at liberty to send you any other cases except +those you had yourself the conduct of. The +Digitalis is a very valuable acquisition to medicine; +and, I trust, it will cease to be dreaded when it is +well understood.</p> + +<p class="right"> +<span style="padding-right: 2em">I am, Sir, your obedient,</span><br /> +<span style="padding-right: 1em">And very humble servant,</span><br /> +<span style="letter-spacing: 0.25ex">W. BAYLEY</span>.</p> +</div> + + + +<h3>CASE <span style="letter-spacing: 0ex">CLXI.</span><span class='pagenum'><a name="Page_104" id="Page_104">[104]</a></span></h3> + +<p>Mary Hollis, aged 62, was admitted an out patient +of the Birmingham General Hospital <i>February</i> +12th, 1784, labouring under all the effects of hydrothorax; +her dread of suffocation during sleep +was so great, that she always reposed in an elbow +chair. She was directed to take two grains of Digitalis +in powder every night and morning, and for +a few days found great relief; but, on the eighth +day, as she had complained of sickness, and had +been considerably purged, she was ordered to desist +taking any more of her powders. On the 14th day +she was ordered an ounce of the following infusion +twice in a day: R. Fol. Digital. purp. sicc. 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 <i>May</i> was discharged +perfectly cured. The diuretic effects of the +Digitalis were in this instance immediate.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLXII.</span></h3> + +<p>Edward James, Æt. 21. Admitted <i>March</i> 20th, +1784. Complained of great difficulty of breathing, +pain in his head, and tightness about the stomach, +with a trifling swelling of his legs. Ordered +pil. scillit. ℈i. ter de die. On the third day his legs +much more swelled, his breathing more difficult, +and in every respect worse; his pulse very small<span class='pagenum'><a name="Page_105" id="Page_105">[105]</a></span> +and quick, complained when he turned in bed, of +something like water rolling from one side of the +thorax to the other. A remarkable blueness about +the mouth and eyes, and purged considerably from +the pil. scill. Ordered to omit the pills and to +take ℥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.</p> + +<p>54th day. To this period there was not the least +probability of his existing; his legs and thighs were<span class='pagenum'><a name="Page_106" id="Page_106">[106]</a></span> +one continued blubber, his thorax quite flat, and +his belly so large that it measured within one inch +as much as a woman's in this Hospital the day she +was tapped, and from whom twenty seven pounds +of coagulable lymph were taken. He made about +three ounces of water in twenty-four hours: his +penis and scrotum were astonishingly swelled, and +no discharge from the sores upon his legs. Ordered +to take a pill with two grains of powdered Foxglove +night and morning. For a few days no sensible +effect, but about the 60th day he complained of +being continually giddy, and had some little pain +in his stomach. He now made much more water, +and dared to sleep. His appetite which through the +whole of his illness had been very bad, was also better. +66th day. Breathing very much relieved, the +quantity of water he made was three chamber pots +full in a day and a night, each pot containing two +quarts and four ounces, moderately full. Ordered +to continue his pills, and his legs which were very +flabby, to be rolled.</p> + +<p>69th day. His belly nearly reduced to its natural +size, still made a prodigious quantity of water, his +appetite very good, habit of body rather lax, and +his complexion ruddy. On the 2d of <i>June</i>, being +still rather weak, he was ordered decoct. cort. ℥ii. +ter de die; and on the 12th was discharged from +this Hospital perfectly cured.</p> + +<p class="right"><span style="letter-spacing: 0.25ex">W. BAYLEY</span>. +<span class='pagenum'><a name="Page_107" id="Page_107">[107]</a></span></p> + +<p class="negative">Mr. Bayley's respectful compliments to Doctor +Withering: he sends the case of Edward James, +which he believes is pretty correct. He laments +not having it in his power to send the +measure of his belly, having unfortunately, +mislaid the tape: he heard from James yesterday, +and he is perfectly well.</p> + +<p style="text-indent: 0em"> +<i>General Hospital, August 5, 1784.</i></p> + + +<h3>CASE <span style="letter-spacing: 0ex">CLXIII.</span></h3> + +<p>On the 26th <i>February</i>, 1785, Sarah Ford, aged +42, was admitted an out-patient of the Birmingham +General Hospital: she complained of considerable +pain in her chest, and great difficulty of +breathing, her face was much swelled and her +thighs and legs were anasarcous. She had extreme +difficulty in making water, and with many painful +efforts she did not void more than six ounces in +twenty-four hours. She had been in this situation +about six weeks, during which time she had taken +ammoniacum, olibanum, and large quantities of +squills, without any other effect than frequent sickness. +Upon her commencing an Hospital patient, +the following medicine was exhibited. R. gum ammoniac +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<span class='pagenum'><a name="Page_108" id="Page_108">[108]</a></span> +a night she made five pints of water. By the 12th +day her legs and thighs were nearly reduced to their +natural size. She continued to make water in large +quantities, and had lost her pain in the thorax. To +the 20th of <i>March</i>, she made rapid advances towards +health, when not a symptom of disease remaining, +she was discharged.<span class='pagenum'><a name="Page_109" id="Page_109">[109]</a></span></p> + + + +<h2><a name="COMMUNICATIONS" id="COMMUNICATIONS"></a>COMMUNICATIONS<br style="line-height: 2em" /> +<span style="letter-spacing: 0em; font-size: 90%">FROM CORRESPONDENTS.</span></h2> + +<hr class="chapter" /> + +<div class="blockquot"> +<p class="right"> +<span style="padding-right: 1em">London, Norfolk-street,</span><br /> +May 31st, 1785.</p> + +<p><span class="smcap">Sir</span>,</p> + +<p>I had the favour of your letter last week; +and I shall be very happy if I can give you any +intelligence relating to the Foxglove, that can answer +the purpose in which you are so laudably engaged.</p> + +<p>It is true that my brother, the late Dr. Cawley, +was greatly relieved, and his life, perhaps, prolonged +for a year, by a decoction of the Foxglove +root; but why it had not a more lasting effect, it is +necessary I should tell you that he had all the signs +of a distempered viscera, long before any watery +swellings appeared; it was manifest that his dropsy +was merely symptomatic, and he could therefore only +from time to time have any relief from medicine. +In the year 1776, he returned from London +to Oxon. having consulted several physicians +at the former place, and Dr. Vivian at the latter, +but without any success; and he was then told of +a carpenter at Oxon. that had been cured of a +Hydrops pectoris by the Foxglove root, and as he<span class='pagenum'><a name="Page_110" id="Page_110">[110]</a></span> +was a younger, and in other respects an healthy +man, his cure, I believe, remains a perfect one.</p> + +<p>I did not attend my brother whilst he took the +medicine, and therefore I cannot speak precisely to +the operation of it; but I remember, by his letters, +that he was dreadfully sick and ill for several +days before the secretion of urine came on, but +which it did do to a great degree; relieved his +breath, and greatly lessened the swelling in his legs +and thighs; but the two instances I have lately seen +in this part of the world, are much stronger proofs +of the efficacy of it than my brother's case.</p> + +<p class="right"> +<span style="padding-right: 8em">I am, &c.</span><br /> +<span style="letter-spacing: 0.25ex">ROBERT CAWLEY</span>.</p> + + +<p>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.</p> +</div> + +<p class="center" style="padding-top: 1em">Dr. Cawley's prescription.</p> + +<div class="recipe"> +<p>R. Rad. Digital. purpur. siccat. et contus. ℥ii.</p> +<p style="padding-left: 1em">Coque ex aq. font. ℔ii. ad ℔i. colat. liquor. +adde aq. junip. comp. ℥ii.</p> +<p style="padding-left: 1em">Mell. anglic ʒi. m. sumat cochl. iv. omni nocte h. s. et mane. +<span class='pagenum'><a name="Page_111" id="Page_111">[111]</a></span></p> +</div> + +<p>—I have elsewhere remarked, that when the Digitalis +has been properly given, and the diuretic effects +produced, that an accidental over-dose bringing +on sickness, has stopped the secretion of urine. +In the present instance it likewise appears, that violent +sickness may be excited, and continue for several +days without being accompanied by a flow of +urine; and it is probable that the latter circumstance +did not take place, until the severity of the +former abated. If Dr. Cawley had not had a constitution +very retentive of life, I think he must +have died from the enormous doses he took; and +he probably would have died previous to the augmentation +of the urinary discharge. For if the +root from which his medicine was prepared, was +gathered in its active state, he did not take at each +dose less than <i>twelve</i> times the quantity a strong man +ought to have taken. Shall we wonder then that +patients refuse to repeat such a medicine, and that +practitioners tremble to prescribe it? Were any of +the active and powerful medicines in daily use to +be given in doses <i>twelve</i> times greater than they are, +and these doses to be repeated without attention to +the effects, would not the patients die, and the +medicines be condemned as dangerous and deleterious?—Yet +such has been the fate of Foxglove!<span class='pagenum'><a name="Page_112" id="Page_112">[112]</a></span></p> + +<h4>A Letter to the Author, from Mr. <span class="smcap">Boden</span>,<br /> +Surgeon, at Broseley, in Shropshire.</h4> + +<div class="blockquot"> + +<p class="right"> +Broseley, 25th May, 1785.</p> + +<p>Dear <span class="smcap">Sir</span>,</p> + +<p>Have inclosed the prescriptions that contained +the fol. Digital. which I gave to Thomas Cooke and +Thomas Roberts.</p> + +<p>Thomas Cooke, 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. <i>June</i> 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 <i>June</i> 17th to +the 29th, the symptoms were mostly removed, +making water freely, and having plenty of stools; +in a week after he was perfectly well, and remains +so ever since. The cure was finished by steel and +bitters.</p> + +<p>Thomas Roberts, 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. <i>August</i> 3d. The pills prescribed <i>June</i><span class='pagenum'><a name="Page_113" id="Page_113">[113]</a></span> +17th for Cooke.—17th. A purging bolus of jalap +and Digitalis, once a week. He continued the medicines +till the latter end of <i>August</i>, when he got +very well; but the complaint returned in <i>Jan.</i> worse +than before. He is now much better, but I have great +reason to believe the liver to be diseased.</p> + +<p class="right"> +<span style="padding-right: 4em">I am, with the greatest respect,</span><br /> + +<span style="padding-right: 2em">Your very obliged humble servant,</span><br /> + +<span style="letter-spacing: 0.25ex">DANIEL BODEN</span>.</p> + +<p>P. S. The second patient, on his relapse, took +Digitalis again, combined with other things.</p> +</div> + + +<h4>CASE communicated by Mr. <span class="smcap">Causer</span>,<br /> +Surgeon, at Stourbridge, Worcestershire.</h4> + +<p>Mr. P—— 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 <i>Sept.</i> 12, 1779, his legs were anasarcous, +his belly much swelled, and an evident fluctuation +of water. His breathing very bad, an irregular +pulse, and unable to lie down. His easiest<span class='pagenum'><a name="Page_114" id="Page_114">[114]</a></span> +posture was standing with his body leaning over a +chair, in which situation he would continue many +hours together, labouring for breath, with the sweat +trickling down his face very profusely; the urine +in very small quantity. Diuretics of every kind I +could think of were used with very little or no advantage. +Blisters applied to the legs relieved very +considerably for a time, but by no means could I +increase the urinary discharge. Warm stomachic +medicines were given, and at the same time sinapisms +applied to the feet, in hopes of enticing gout +to the extremities, but without any good effect.—<i>November</i> +22d. The swelling considerably increasing, +an emetic of acet. scillitic. was given, which acted +very violently, and increased the urinary discharge +considerably. He continued better and worse, using +different kinds of diuretic and expectorating medicines +until <i>September</i> 1781, when the disease was so +much worse, I did not expect he could live many +days. The acet. scillitic. was repeated, a table +spoonful every half hour, till it acted briskly upwards +and downwards; but without increasing the +urinary discharge.—On the 17th of <i>September</i> 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<span class='pagenum'><a name="Page_115" id="Page_115">[115]</a></span> +had taken the medicine regularly, till the whole +quantity was consumed, without perceiving the least +effect of any kind from it, and continued well till +the evening of the following day, when a +little sickness took place, which increased, but +never so as to occasion either vomiting or purging, +but a surprising discharge of urine. The saliva increased +so as to run out of his mouth, and a watery +discharge from his eyes; these discharges continued, +with a continual sickness, till the swelling was totally +gone, which happened in three or four days. +He afterwards took steel and bitters; and continued +very comfortably, without any return of his +dropsy, until the 7th of <i>April</i> 1782, when he +was seized with an epidemic cough, which was very +frequent with us at that time. His swellings now +returned very rapidly, with the greatest difficulty +in breathing, and he died in a few days. Blisters +and expectorating medicines were used on this last +return.</p> + + +<h4>Extract of a Letter from Mr. <span class="smcap">Causer</span>.</h4> + +<p>Mrs. S——, the subject of the following Case, +was as ill as it is possible for woman to be and recover; +from the inefficacy of the medicines used, I +am convinced no medicine would have saved her +but the Digitalis. I never saw so bad a case recovered; +and it shews, that in the most reduced state +of body, the medicine in small doses, will prove +safe and efficacious.<span class='pagenum'><a name="Page_116" id="Page_116">[116]</a></span></p> + +<p>N. B. The Digitalis, in pills, never occasioned the +least sickness. She took two boxes of them.</p> + + +<h3>CASE.</h3> + +<p><i>January</i> 2d, 1785. Mrs. S——, 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.</p> + +<div class="recipe"> +<p>R. Pulv. scillæ gr. iii.</p> + +<p style="padding-left: 2em">Jalap gr. x. syr. rosar. solut. tinct. senn. aa +ʒii. aq. menth. v. simpl. ℥iss. m. mane sumend.</p> +</div> + +<div class="recipe"> +<p>R. pulv. scillæ ℈i. G. ammoniac, sapon. venet. +aa ʒiss. syr. q. s. f. pilul. 42 cap. iii. nocte maneque.</p> +</div> + +<p>On the 7th found her worse, and the swelling +increased; the urine about ℥x in the twenty-four +hours.</p> + +<div class="recipe"> +<p>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.</p> +</div> + +<p>She took about three parts of the medicine before<span class='pagenum'><a name="Page_117" id="Page_117">[117]</a></span> +any effect took place. The first was sickness, +succeeded by a considerable discharge of urine. +She continued the medicine till the whole was consumed, +which caused a good deal of sickness for +three or four days.</p> + +<p>I saw her again on the 12th. The quantity of +urine was much increased, and the swelling diminished. +Pulse and breathing better.</p> + +<div class="recipe"> +<p>R. Fol. sicc. Digital. G. assafetid. aa ʒi. calomel. +pp. gr. x. sp. lavand. comp. q. s. fiat pilul. +xxxii. cap. ii. omni nocte horâ somni. +</p> +</div> + +<p>A plentiful discharge of urine attended the use +of these pills, and she got perfectly free from her +dropsical complaints.</p> + +<p><i>March</i> 15th she was delivered: had a good labour, +was treated as is usual, except in not having +her breasts drawn, not intending see should +suckle her child, being in so reduced a state. Continued +going on well till the 18th, when she was seized +with very violent pains across her loins, at times so +violent as to make her cry out as much as labour +pains. Enema cathartic. Fot. papav. applied to +the part.</p> + +<div class="recipe"><p> +R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s. +fiat pilul. vi. capt. i. 2da quaque horâ durante +dolore. +<span class='pagenum'><a name="Page_118" id="Page_118">[118]</a></span></p> +</div> + +<div class="recipe"><p> +R. Julep, e camphor, sp. minder. aa ℥ii. capt. +cochlear, i. larg. post singul. pilul. +</p></div> + +<p>19th. Breathing short, unable to lie down, very +irregular low pulse scarcely to be felt, fainty, and +a universal cold sweat: no appetite nor thirst, spasmodic +pains at times across the loins very violent, +but not so frequent as on the preceding day.</p> + +<div class="recipe"><p> +R. Gum ammoniac, assafetid. aa ʒi. camphor. +gr. xii. fiat pilul. 24. capt. ii. 3tia quaque +horâ in cochlear. ii. mixtur. seq. +</p></div> + +<div class="recipe"><p>R. Balsam. peruv. ʒiii. mucilag. G. arab. q. s. +flor. zinci g. vi. aq. menth. simp. ℔ss. m.</p></div> + +<div class="recipe"><p>Applic. Emp. vesicat. femorib. internis.</p></div> + + +<div class="recipe"> +<p>R. Sp. vol. fœtid. elixir. paregor. balsam.<br /> +Traumatic. aa ʒiii. capt. cochlear. parv. urgente +languore. +</p></div> + +<p>20th. Much the same; makes very little water, +and the legs begin to swell.—Applic. Emp. e pice +burgund. lumbis.</p> + +<p>23d. The swelling very much increased.—Capt. +gutt. xv. acet. scillitic. ter die in two spoonfuls of +the following mixture.</p> + +<div class="recipe"><p> +R. Infus. baccar. juniper, ℥vi. tinct. amar. tinct. +stomachic. aa ℥i. m. +</p></div> + +<p>25th. Much the same.<span class='pagenum'><a name="Page_119" id="Page_119">[119]</a></span></p> + +<p>28th. The swelling considerably increased, in +other respects very much the same.</p> + +<p>30th. Breathing very bad, with cough and pain +across the sternum, unable to lie down, legs, thighs, +and body very much swelled, urine not more than +four or five ounces in the twenty-four hours; hot +and feverish, with thirst.</p> + +<div class="recipe"><p>Applic. Emp. vesicat. stomacho et sterno.</p></div> + + +<div class="recipe"><p>R. G. assafetid. ℈ii. pulv. jacob. ℈i. rad. scill. recent. +gr. xii. extract. thebaic. gr. iv. f. pilul. +xvi. cap. iv. omni nocte.</p></div> + +<div class="recipe"><p>R. Sal. nitr. sal. diuretic. aa ʒii. pulv. e contrayerv. +comp. ʒi. sacchar. ℥i. emuls. commun. ℔i. +aq. cinnam. simpl. ℥i. m. capt. cochlear. iv. +ter die. +</p></div> + +<p><i>April</i> 2d. Much the same, no increase of urine.</p> + +<p>3d. Breathing much relieved by the blister, which +runs profusely. Repeated the medicines, and continued +them till the</p> + +<p>12th. The cough very bad, pulse irregular, swelling +much increased, urine in very small quantity, +not at all increased; great lowness and fainting. +She desired to have some of the pills which relieved<span class='pagenum'><a name="Page_120" id="Page_120">[120]</a></span> +her so much when with child. I was almost afraid +to give them, but the inefficacy of the other medicines +gave me no hopes of a cure from continuing +them, which made me venture to comply with +her request.</p> + +<div class="recipe"><p>R. Fol. siccat. Digital. G. assafetid. aa ʒi. sp. lavand. +comp. q. s. f. pilul. xxxii. cap. ii. omni +mane; et omni node cap. pilul. e styrace +gr. vi.</p></div> + +<p>17th. Considerable increase of urine.</p> + +<p>21st. Swelling a good deal diminished; urine +near four pints in twenty-four hours, which is more +than double the quantity she drinks.</p> + +<div class="recipe"><p>Applic. Emp. vesicat. femoribus internis.</p></div> + +<p>The Digitalis pills and opiate at bed-time continued. +Takes a tea cup of cold chamomile tea every +morning.</p> + +<p>25th. Swelling much diminished, makes plenty +of water, appetite much mended, cough and breathing +better. She omitted the medicine for three +days; the urine began to diminish, the swelling +and shortness of breathing worse. On repeating it +for two days, the discharge was again augmented, +and a diminution of the swelling succeeded. She +has continued the pills ever since till the 14th of<span class='pagenum'><a name="Page_121" id="Page_121">[121]</a></span> +<i>May</i>; the dropsical symptoms and cough are entirely +gone, the water is in sufficient quantity, her +strength is recovered, and she has a good appetite. +All she now complains of is a weight across her stomach, +which is worse at times, and she thinks, unless +it can be removed, she shall have a return of +her dropsy.</p> + + +<h4>Extract of a Letter from Doctor <span class="smcap">Fowler</span>,<br /> +Physician, at Stafford.</h4> + +<p>I understand you are going to publish +on the Digitalis, which I am glad to hear, for I have +long wished to see your ideas in print about it, and +I know of no one (from the great attention you +have paid to the subject) qualified to treat on it but +yourself. There are gentlemen of the faculty who +give verbal directions to poor patients, for the preparing +and taking of an infusion or decoction of the +green plant. Would one suppose that such gentlemen +had ever attended to the nature and operation +of a sedative power on the functions, <i>particularly</i> +the <i>vital</i>? Is not such a vague and unscientific mode +of proceeding putting a two edged sword into the +the hands of the ignorant, and the most likely method +to damn the reputation of any very active and +powerful medicine? And is it not more than probable +that the <i>neglect</i> of adhereing to a <i>certain</i> and <i>regular</i> +preparation of the nicotiana, and the <i>want</i> (of what +you <i>emphatically</i> call) a <i>practicable</i> dose, have been +the chief causes of the once rising reputation of<span class='pagenum'><a name="Page_122" id="Page_122">[122]</a></span> +that noted plant being damned above a century +ago? In short, the Digitalis is beginning to be used +in dropsies, (although some patients are said to go +off suddenly under its administration) somewhat +in the style of broom ashes; and, in my humble +opinion, the public, at this very instant, stand in +great need of your <i>precepts</i>, <i>guards</i>, and <i>cautions</i> towards +the safe and successful use of such a powerful +sedative diuretic; and I have no doubt of your +minute attention to those particulars, from a regard +to the good and welfare of mankind, as well as to +your own reputation with respect to that medicine.</p> + +<p>I remember an officer in the Staffordshire militia, +who died here of a dropsy five years ago. The Digitalis +relieved him a number of times in a wonderful +manner, so that in all probability he might have +obtained a radical cure, if he would have refrained +from hard drinking. I understood it was first ordered +for him by a medical gentleman, and its sedative +effects proved so mild, and diuretic operation +so powerful, that he used to prepare it afterwards +for himself, and would take it with as little +ceremony as he would his tea. It is said, that he +was so certain of its successful operation, that he +would boast to his bacchanalian companions, when +much swelled, you shall see me in two days time +quite another man.<span class='pagenum'><a name="Page_123" id="Page_123">[123]</a></span></p> + + +<h4>CASES communicated by Mr. <span class="smcap">J. Freer</span>,<br /> +jun. Surgeon, in Birmingham.</h4> + + +<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3> + +<p><i>Nov.</i> 1780. Mary Terry, aged 60. Had been subject +to asthma for several years; after a severe fit of it her +legs began to swell, and the quantity of urine +to diminish. In six weeks she was much troubled +with the swellings in her thighs and abdomen, which +decreased very little when she lay down: she made +not quite a pint of water in the twenty-four hours. +I ordered her to take two spoonfuls of the infusion +of Foxglove every three hours. By the time she +had taken eight doses her urine had increased to +the quantity of two quarts in the day and night, +but as she complained of nausea, and had once vomited, +I ordered the use of the medicine to be suspended +for two days. The nausea being then removed, +she again had recourse to it, but at intervals +of six hours. The urine continued to discharge +freely, and in three weeks she was perfectly cured +of her swellings.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3> + +<p><i>December</i>, 1782. A poor woman, who had been +afflicted with an ague during the whole of her pregnancy, +and for two months with dropsical swellings +of the feet, legs, thighs, abdomen, and labia pudenda; +was at the expiration of the seventh month<span class='pagenum'><a name="Page_124" id="Page_124">[124]</a></span> +taken in labour. On the day after her delivery +the ague returned, with so much violence as to endanger +her life. As soon as the fit left her, I began +to give her the red bark in substance, which +had the desired effect of preventing another paroxysm. +She continued to recover her health for a +fortnight, but did not find any diminution in the +swellings; her legs were now so large as to oblige +her to keep constantly on the bed, and she made +very little water. I ordered her the infusion of +Foxglove three times a day, which, on the third +day, produced a very copious discharge of urine, +without any sickness; she continued the use of it +for ten days, and was then able to walk. Having +lost all her swellings, and no complaint remaining +but weakness, the bark and steel compleated the +cure.</p> + + +<h4>Extract of a Letter from Doctor <span class="smcap">Jones</span>,<br /> +Physician, in Lichfield.</h4> + +<p>Anxious to procure authentic accounts from +the patients, to whom I gave the Foxglove, I have +unavoidably been delayed in answering your last +favour. However, I hope the delay will be made +up by the efficacy of the plant being confirmed by +the enquiry. Long cases are tedious, and seldom +read, and as seldom is it necessary to describe every +symptom; for every case would be a history of +dropsy. I shall therefore content myself with specifying<span class='pagenum'><a name="Page_125" id="Page_125">[125]</a></span> +the nature of the disease, and when the dropsy +is attended with any other affection shall notice +it.</p> + +<p>Two years have scarcely elapsed since I first employed +the Digitalis; and the success I have had +has induced me to use it largely and frequently.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3> + +<p>Ann Willott, 50 years of age, became a patient +of the Dispensary on the 11th of April 1783. She +then complained of an enlargement of the abdomen, +difficulty of breathing, particularly when lying, +and costiveness. She passed small quantities +of high-coloured urine; and had an evident fluctuation +in the belly. Her legs were œdematous. +Chrystals of tartar, squills, &c. had no effect. The +13th of <i>June</i> she took two spoonfuls of a decoction +of Foxglove, containing three drams of the dry +leaves, in eight ounces, three times a day. Her +urine soon increased, and in a few days she passed +it freely, which continued, and her breath returned.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3> + +<p>Mr. ——, 45 years of age, had been long +subject to dropsical swellings of the legs, and made +little water. Two spoonfuls of the same decoction +twice a day, soon relieved him.<span class='pagenum'><a name="Page_126" id="Page_126">[126]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3> + +<p>Mrs. ——, aged 70 years. A lady frequently afflicted +with the gout, and an asthmatical cough. After a +long continuance of the latter, she had a great diminution +of urine, and considerable difficulty of +breathing, particularly on motion, or when lying. +Her body was much bound. There was, however, +no apparent swelling. She took three spoonfuls of +an aperient decoction of forty-five grains in six +ounces and a half, every other morning. The urine +was plentiful those days, and her breathing much +relieved. In two or three weeks after the use of it +she was perfectly restored. The purgative medicine +neither increased the urine, nor relieved the breathing, +till the Foxglove was added.</p> + +<p>This spring she long laboured with the gout in +her stomach, which terminated in a fit in her hand. +During the whole of this tedious illness, of nearly +three months, she passed little urine, and her breathing +was again short.</p> + +<p>She took the same preparation of Foxglove without +any diuretic effect, and afterwards two and three +grains of the powder twice a day with as little. The +dulcified spirits of vitriol, however, quickly promoted +the urinary secretion.<span class='pagenum'><a name="Page_127" id="Page_127">[127]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">IV.</span></h3> + +<p>Mr. C——, 46 years of age, had dropsical swellings +of the legs, and passed little urine. He took +the decoction with three drams, and was soon relieved.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">V.</span></h3> + +<p>Lady——, took three grains of the dried +leaves twice a day, for swelled legs, and scantiness +of urine, without effect.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">VI.</span></h3> + +<p>Mrs. Slater, aged 36 years. For dropsy of the +belly and legs, and scantiness of urine, of several +weeks standing, took three grains of the powder +twice a day, and was quite restored in ten days. +She took many medicines without effect.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">VII.</span></h3> + +<p>Mrs. P——, in her 70th year, took three +grains of the powder twice a day, for scantiness of +urine, and swelled legs, without effect.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">VIII.</span></h3> + +<p>Ann Winterleg, in her 26th year, had dropsical +swellings of the legs, and passed little urine: she +was relieved by two drams, in an eight ounce decoction.<span class='pagenum'><a name="Page_128" id="Page_128">[128]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">IX.</span></h3> + +<p>William Brown, aged 76. In the last stage of +dropsy of the belly and legs, found a considerable +increase of his urine by a decoction of Foxglove, +but it was not permanent.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">X.</span></h3> + +<p>Mr. ——, — years of age, and of very gross +habit of body, became highly dropsical, and took +various medicines, without effect. One ounce of +the decoction, with three drams of the dry leaves +in eight ounces, twice or three times a day, increased +his urine prodigiously. He was evidently better, +but a little attendant nausea overcame his resolution, +and in the course of some weeks afterwards he fell +a victim to his obstinacy.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XI.</span></h3> + +<p>Mrs. Smith, about 50 years of age, after a tedious +illness of many weeks, had a jaundice, and became +dropsical in the legs. Two spoonfuls of the +decoction, with three drams twice a day, increased +her urine, and abated the swelling.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XII.</span></h3> + +<p>Widow Chatterton, about 60 years of age. Took +the decoction in the same way for dropsy of the legs, +with little effect.<span class='pagenum'><a name="Page_129" id="Page_129">[129]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XIII.</span></h3> + +<p>—— Genders, about thirty-four years of age, +was delivered of three children, and became dropsical +of the abdomen. She passed little or no urine, +had constant thirst, and no appetite. She took two +spoonfuls of an eight ounce decoction, with three +drams twice a day. By the time she had finished +the bottle, (which must have been on the fourth +day,) she had evacuated all her water, and could +go about. Her appetite increased with every dose, +and she recovered without farther help.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XIV.</span></h3> + +<p>Miss M—— 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XV.</span></h3> + +<p>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<span class='pagenum'><a name="Page_130" id="Page_130">[130]</a></span> +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.</p> + +<p>A blister was applied to the upper and inside of +each thigh; he took two spoonfuls of the decoction, +with three drams of the dry leaves, two or three +times a day; and some opening physic occasionally.</p> + +<p>He lived at a considerable distance, and I did not +visit him a second time; but I was well informed, +about ten days or a fortnight afterwards, that his +urine increased amazingly upon taking the decoction, +and that the water was entirely evacuated.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XVI.</span></h3> + +<p>Mrs. G——, 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.<span class='pagenum'><a name="Page_131" id="Page_131">[131]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XVII.</span></h3> + +<p>Mr. ——, about 50 years of age, complained +of great tension and pain across the abdomen, and +of loss of appetite; his urine, he thought, was less +than usual, but the difference was so trifling he +could speak with no certainty: his belly seemed to +fluctuate. Among other things he tried the Foxglove +leaves dried, twice a day; and, although it +appeared to afford him relief, yet the effect was not +permanent.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XVIII.</span></h3> + +<p>Mr. W——, aged between 60 and 70 years; +and rather corpulent: was considerably dropsical, +both of the belly and legs, and his urine in small +quantities. Three grains of the dry leaves, twice +a day, evacuated the water in less than a fortnight.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XIX.</span></h3> + +<p>Sarah Taylor, 40 years of age, was admitted into +the Dispensary for dropsy of the abdomen and +legs; and was relieved by the Decoctum digitalianum.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XX.</span></h3> + +<p>Lydia Smith, aged 60. Dispensary. Laboured +many years under an asthma, and became dropsical. +She took the decoction without effect.<span class='pagenum'><a name="Page_132" id="Page_132">[132]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXI.</span></h3> + +<p>John Leadbeater, aged 15 years. Had a quotidian +intermittent, which was removed by the humane +assistance of an amiable young lady. His +intermittent was soon attended by a very considerable +ascites; for which he became a patient of the +Dispensary. He took a decoction of Foxglove night +and morning. His urine increased immediately, +and he lost all his complaints in four days.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXII.</span></h3> + +<p>William Millar, aged 50 years. Admitted into +the Dispensary for a tertian ague, and general dropsy. +The dropsy continuing after the ague was removed, +and his urine being still passed in small +quantities; he took the powdered leaves, and recovered +his health in five days.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXIII.</span></h3> + +<p>Ann Wakelin, 10 years of age. Had for several +weeks a dropsy of the belly after an ague. She +took a decoction of Foxglove, which removed all +complaint by the fourth day.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">XXIV.</span></h3> + +<p>Ann Meachime; a Dispensary patient. Had an +ascites and scantiness of urine. She took the powder<span class='pagenum'><a name="Page_133" id="Page_133">[133]</a></span> +of Foxglove, and evacuated all her water in +three days.</p> + +<p>It may not be improper to observe, 1st. That +various diuretics had long been given in many of +these cases before I was consulted. And, 2dly. +That the exhibition of the Foxglove was but seldom +attended with sickness.</p> + + +<h3>REMARKS.</h3> + +<p>These Cases, thus liberally communicated by my +friend, Dr. Jones, are more acceptable, as they +seem to contain a faithful abstract from his notes, +both of the unsuccessful as well as the successful +Cases.</p> + +<p class="negative">The following Tabular View of them will give us +some Idea of the efficacy of the Medicine.</p> + +<table summary="diseases" cellpadding="2"> +<tr><td>Anasarca</td><td style="padding-left: 1em">7 Cases</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">3</td></tr> +<tr><td> </td><td> </td><td style="padding-left: 1em">Relieved</td><td style="padding-left: 1em">1</td></tr> +<tr><td> </td><td> </td><td style="padding-left: 1em">Failed</td><td style="padding-left: 1em">3</td></tr> +<tr><td>Ascites</td><td style="padding-left: 1em">5 Cases</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">4</td></tr> +<tr><td> </td><td> </td><td style="padding-left: 1em">Relieved</td><td style="padding-left: 1em">1</td></tr> +<tr><td>Œdematous leg</td><td style="padding-left: 1em">1 Case</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">1</td></tr> +<tr><td>Ascites and anasarca</td><td style="padding-left: 1em">7 Cases</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">4</td></tr> +<tr><td> </td><td> </td><td style="padding-left: 1em">Relieved</td><td style="padding-left: 1em">2</td></tr> +<tr><td> </td><td> </td><td style="padding-left: 1em">Failed</td><td style="padding-left: 1em">1</td></tr> +<tr><td>Asthma and dropsy</td><td style="padding-left: 1em">1 Case</td><td style="padding-left: 1em">Failed</td><td style="padding-left: 1em">1</td></tr> +<tr><td>Hydrothorax and gout</td><td style="padding-left: 1em">1 Case</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">1</td></tr> +<tr><td> - - - - -, ascites and anasarca</td><td style="padding-left: 1em">2 Cases</td><td style="padding-left: 1em">Cured</td><td style="padding-left: 1em">2</td></tr> +</table> + + +<h4>A CASE of Anasarca communicated by Mr.<br /><span class='pagenum'><a name="Page_134" id="Page_134">[134]</a></span> +<span class="smcap">Jones</span>, Surgeon, in Birmingham.</h4> + +<div class="blockquot"> +<p>Dear <span class="smcap">Sir</span>,</p> + +<p>Having lately experienced +the diuretic powers of the Foxglove, in a case of +anasarca; I do myself the pleasure of communicating +a short history of the treatment to you.</p> + +<p class="right"> +<span style="padding-right: 4em">I am, &c.</span><br /> +<span style="letter-spacing: 0.25ex">W. JONES</span>.</p> + +<p>Birmingham,<br /> +May 17th, 1785.</p> +</div> + +<p>My patient, Mrs. C——, who is in her 51st +year, had the following symptoms, viz. alternate +swelling of the legs and abdomen, a little cough, +shortness of breath in a morning, thirst, weak pulse, +and her urine, which was so small in quantity as +seldom to amount to half a pint in twenty-four +hours, deposited a clay-coloured sediment.</p> + +<p><i>April</i> 16th, 1785, I directed the following form:</p> + +<div class="recipe"><p>R. Fol. Digitalis siccat. ʒii.<br /> +Aq. fontanæ bullient. ℥viii. f. infus. et cola. +Sumat cochl. larga iii. o. n. et mane.</p></div> + +<p>On the 17th she had taken twice of the infusion, +and though by mistake only two tea spoonfuls for a<span class='pagenum'><a name="Page_135" id="Page_135">[135]</a></span> +dose, yet the quantity of urine was increased to +about a pint in the twenty-four hours. She was +then directed to take two table spoonfuls night and +morning. And.</p> + +<p>On the 18th, a degree of nausea was produced. +A pint and half of urine was made in the last twenty-four +hours. During the time above specified she +had two or three stools every day. The infusion +was now omitted.</p> + +<p>On the 19th the swelling of the legs was removed. +A degree of nausea took place in the morning, +and increased so much during the day, that she vomited +up all her food and medicine. As she was +very low, and complained of want of appetite, a +cordial julep was directed to be taken occasionally, +as well as red port and water, mint tea, &c. She +informed me that whatever she took generally staid +about an hour before it came up again, and that the +mint tea staid longest on the stomach. The vomiting +decreased gradually, and ceased on the 22d. +The discharge of urine remained considerable during +the three following days, but its quantity was +not measured.</p> + +<p>22d. A dose of neutral saline julep was directed +to be taken every fourth hour.</p> + +<p>On the 23d she complained of thirst, and thought +the discharge of urine not so copious as on the preceding +days, therefore the saline julep was continued<span class='pagenum'><a name="Page_136" id="Page_136">[136]</a></span> +every fourth hour, with the addition of thirty +drops of the following medicine:</p> + +<div class="recipe"><p>R. Aceti scillitic. ʒvi.<br /> +Tinct. aromat. ʒii.<br /> +Tinct. thebaic. gutt. xx. m.</p></div> + +<p>The bowels have been kept open from the 19th, +by the occasional use of emollient injections.</p> + +<p>On the 24th the legs were much swelled again; +she complained of languor and a degree of nausea. +The discharge of urine increased a little since the +23d. Her pulse was low and her tongue white. +The urine, which had been rendered clear by the +infusion of Foxglove, now deposited a whitish sediment.</p> + +<p>On the 25th her appetite began to return, the +swelling of the legs diminished, and she thought +herself much relieved. The urine was considerable +in quantity, and clear.</p> + +<p>On the 26th she was thirsty and languid. The +swelling was removed; the quantity of urine discharged +in the last twenty-four hours was about a +pint. She continued to mend from this time, and +is now in good health.</p> + +<p>A giddiness of the head, more or less remarkable +at times, was observed to follow the use of the Foxglove, +and it lasted nine or ten days.<span class='pagenum'><a name="Page_137" id="Page_137">[137]</a></span></p> + +<p>This is the second time that I have relieved this +patient by the infusion of Foxglove. I used the +same proportion of the fresh leaves the first time as +I did of the dried ones the last. The violent vomiting +which followed the use of the infusion made +with the dried leaves, did not take place with the +fresh though she took near a pint made with the +same proportion of the herb fresh gathered.</p> + + +<h3>REMARKS.</h3> + +<p>The above is a very instructive case, as it +teaches us how small a quantity of the infusion was +necessary to effect every desirable purpose. At first +sight it may appear from the concluding paragraph, +that the green leaves ought to be preferred to the +dried ones, as being so much milder in their operation; +but let it be noticed, that the same quantity +of infusion was prepared from the same weight of +the green as of the dried leaves, and consequently, +as will appear hereafter, the infusion with the dried +leaves was five times the strength of that before +prepared from the green ones. We need not wonder, +therefore, that the effects of the former were +so disagreeable, when the dose was five times greater +than it ought to have been. But what makes this +matter still more obvious, is the mistake mentioned +at first, of two tea spoonfuls only being given for a +dose. Now a tea spoonful, containing about a +fourth or a fifth part of the contents of a table +spoon, the dose then given, was very nearly the +same as that which had before been taken of the<span class='pagenum'><a name="Page_138" id="Page_138">[138]</a></span> +infusion of the green leaves, and it produced precisely +the same effects for it increased the urinary +discharge, without exciting the violent vomiting.</p> + + +<h4>Letter from Doctor <span class="smcap">Johnstone</span>, Physician, in +Birmingham.</h4> + +<div class="blockquot"> +<p> +Dear <span class="smcap">Sir</span>,<br /> +</p> + +<p>The following cases are selected +from many others in which I have given the Digitalis +purpurea; and from repeated experience of its +efficacy after other diuretics have failed. I can recommend +it as an effectual, and when properly +managed, a safe medicine.</p> + +<p class="right"> +<span style="padding-right: 4em">I am, &c.</span><br /> +<span style="letter-spacing: 0.25ex">E. JOHNSTONE</span>.</p> + +<p>Birmingham, May 26, +1785.</p> +</div> + +<p><i>March</i> 8th, 1783, I was called to attend Mr. +G——, 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<span class='pagenum'><a name="Page_139" id="Page_139">[139]</a></span> +small quantity; body costive; pulse natural; face +much emaciated, eyes yellow and depressed. He +had been subject to cough and difficulty of breathing +in the winter for several years; and about four +years before this time, after being exposed to cold, +was suddenly deprived of his speech and the use of +the right side, which he recovered as the warm weather +came on; but since that time had been remarkably +costive, and was in every respect much debilitated. +He first perceived his legs swell about a year +ago; by the use of medicines and exercise, the +swellings subsided during the summer, but returned +on the approach of winter, and gradually increased +to the state in which I found them, notwithstanding +he had used different preparations of squills and +a great variety of other diuretic medicines. I +ordered the following mixture.</p> + + +<div class="recipe"><p> +R. Foliorum Digitalis purpur. recent. ʒiii. decoque +ex aq. fontan. ℥xii ad ℥vi colaturæ adde +Tinctur. aromatic.<br /> +Syr. zinzib. aa ℥i. m. capt. cochl. duo larga secunda +quaque hora ad quartam vicem nisi +prius nausea supervenerit. +</p></div> + +<p><i>March</i> 9th. He took four doses of the mixture +without being in the least sick, and made, during +the night upwards of two quarts of natural coloured +water.<span class='pagenum'><a name="Page_140" id="Page_140">[140]</a></span></p> + +<p>10th. Took the remainder of the mixture yesterday +afternoon and evening, and was sick for a short +time, but made nearly the same quantity of water +as before, the swellings are considerably diminished, +his appetite increased, but he is still costive.</p> + +<div class="recipe"><p> +R. Argent, viv. balsam peruv. aa 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. +</p></div> + +<p>14th. Continues to make water freely. The +swellings of his legs have gradually decreased; soreness +and tension of the abdomen considerably less.</p> + +<div class="recipe"><p>Omittant. pil. cap. mistur. c. decoct. Digitalis. &c. +3tia quaque hora ad 3tiam vicem.</p></div> + +<p>15th. Made a pint and a half of water last night, +without being in the least sick, and is in every +respect considerably better. Repet. Pillul. ut +antea.</p> + +<p>21st. Makes water as usual when in health, and +the swellings are entirely gone.</p> + +<div class="recipe"><p> +R. Infus. amar. ℥v. tinctur. Rhei spirit. ℥ii. spirit +vitriol. dulc. ʒii. syr. zinzib. ʒvi. m. cap. +cochl. iii. larg. ter in die. +</p></div> + +<p>He soon gained sufficient strength to enable him +to go a journey, and returned home in much better<span class='pagenum'><a name="Page_141" id="Page_141">[141]</a></span> +health than he had been from the time he was +affected with the paralytic stroke, and excepting +some return of his asthmatic complaint in the winter, +hath continued so ever since.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3> + +<p>R—— Howgate, a man much addicted to intemperance, +particularly in the use of spirituous liquors, +Æt. 60, was admitted into the Hospital near +Birmingham, <i>May</i> 17, 1783. He complained of +difficulty of breathing, attended with cough, particularly +troublesome on lying down; drowsiness and +frequent dozing, from which he was roused by +startings, accompanied with great anxiety and oppression +about the breast; 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.<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a></p> + +<p><i>May</i> 20th. The pills have had no effect.—Cap. +mistur. c.<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a> Decoct. Digital. &c. cochl. ii. larg. 3tia +quaque hora, ad 3tiam vicem.</p> + +<p><i>May</i> 21st. Made near two quarts of water in the +night, without being in the least sick. He continued +<span class='pagenum'><a name="Page_142" id="Page_142">[142]</a></span>the use of the mixture three times in the day till +the 30th, and made about three pints of water daily, +by which means the swellings were entirely taken +away; and his other complaints so much relieved, +that on the 6th of June he was dismissed free from +complaint, except a slight cough. But returning to +his old course of life, he hath had frequent attacks +of his disorder, which have been always removed by +using the Digitalis.</p> + + +<h4>Extract of a letter from Mr. <span class="smcap">Lyon</span>, Surgeon, +at Tamworth.</h4> + +<p>—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<span class='pagenum'><a name="Page_143" id="Page_143">[143]</a></span> +collected, and neither the Digitalis nor any other +medicine would carry it off. I tapped him the 2d +of August 1779 in the usual place, and took some +gallons of water from him, but he very soon filled +again, and as he had a very large rupture, a considerable +quantity of the water lodged in the scrotum, +and could not be got away by tapping in the usual +place. I therefore (on the 28th of the same month) +made an incision into the lower part of the scrotum, +and drained off all the water that way, but he was +so very much reduced, that he died the 8th or 9th +of <i>September</i> following, which was about two years +and two months after he first begun the Digitalis.</p> + +<p>I have had several dropsical patients relieved, and +some perfectly recovered by the Digitalis, since you +attended Mr. Moggs, but as I did not take any notes +or make any memorandums of them, cannot give +you any of them.</p> + + +<h4>Communications from Dr. <span class="smcap">Stokes</span>, Physician, +in Stourbridge.</h4> + +<div class="blockquot"> + +<p>Dear <span class="smcap">Sir</span>,</p> + +<p>I accept with pleasure your +invitation to communicate what I know respecting +the properties of <i>Digitalis</i>; and if an account of +what others had discovered before you,<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a> with a detail +<span class='pagenum'><a name="Page_144" id="Page_144">[144]</a></span>of my own experience, shall be allowed the +merit of at least a well meant acknowledgment, for +the early communication you were so kind to make +me, of the valuable properties you had found in it; +I shall consider my time as well employed. A knowledge +of what has been already done is the best +ground work of future experiment; on which account +I have been the more full on this subject, in +hopes that given with the cautions which you mean +to lay down in the cure of dropsies, it may prove +alike useful in that of other diseases, one of which +stands foremost among the <i>opprobria</i> of medicine.</p> + +<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3> + +<p>Mrs. M——. Orthopnea, pain, and excessive +oppression at the bottom of the sternum. Pulse +irregular, with frequent intermissions. Appetite +very much impaired. Legs anasarcous.</p> + +<div class="recipe"><p> +<i>Empl. vesicator. pectori dolent.</i><br /> +<i>Infus. Digital. e ʒiii. ad. aq. &c. ℥viii. cochl. j. o. +h. donec nausea excitetur vel diuresis satis copiosa +proveniat.</i> +</p> +</div> + +<p>I ordered it of the above strength, and to be repeated +often, on account of the great emergency of +the case, but the nausea excited by the first dose prevented +its being given at such short intervals. A 3d +dose I found had been given, which was followed by +vomitings. All her complaints gradually abated,<span class='pagenum'><a name="Page_145" id="Page_145">[145]</a></span> +but in about a fortnight recurred, notwithstanding +the use of infus. amar. &c.</p> + +<div class="recipe"><p> +<i>Dec. 2. Infus. Digit. e. ʒiss ad aq. &c. ℥viii. cochl. +ii. horis &c. u. a.</i></p></div> + +<p>Complaints gradually abated, swellings of the +legs nearly gone down.</p> + +<p>About a month afterwards you was desired to visit +this patient.<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a></p> +<p><span class='pagenum'><a name="Page_146" id="Page_146">[146]</a></span></p> +<p>On the examination of the body I noticed, among +others, the following appearances.</p> + +<p>About 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.</p> + +<p><span class="smcap">Brain.</span> Blood-vessels turgid with blood, and +many of those of considerable size distended with air.</p> + +<p>A very slight watery effusion between the <i>Pia Mater</i> +and <i>Tunica arachnoidea</i>. About ¾ oz. of watery +fluid in the <i>lateral ventricles</i>.</p> + +<p><span class="smcap">Thorax.</span> In the left cavity about 4 oz. of bloody +serum; in the right but little. Lungs, the hinder parts +loaded with blood. Adhesions of each lobe to the +pleura. <i>Pericardium</i> containing but a very small +quantity of fluid. <i>Heart</i> containing no coagula of +blood. <i>Valves of the Aorta</i> of a cartilaginous texture, +as if beginning to ossify.</p> + +<p><i>Abdominal Viscera</i> natural, and a profusion of <i>Fat</i> +under the integuments of the abdomen and thorax, +in the former to the thickness of an inch and upwards, +and in very considerable quantity on the +mesentery, omentum, kidneys, &c.</p> + +<p><span class="smcap">Obs.</span> The intermitting pulse should seem to have +been owing to effusions of water in some of the cavities +of the breast, as it disappeared on the removal +of the waters.<span class='pagenum'><a name="Page_147" id="Page_147">[147]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3> + +<p>Mrs. C—— 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 <i>sal. +diuret. c. ol. junip.—Calom. c. jalap, et gambog.—Et ol. +junip. c. ol. Terebinth.</i> without effect.</p> + +<p><i>Feb.</i> 7. <i>Infus. Digital. e. ʒiii. ad aq. &c. ℥viii. +cochl. ii. 4tis horis.</i> Ordered to drink largely of <i>infus. +baccar. junip.</i> The third dose produced great +nausea which continued ten hours, during which +time the urine made was about a quart. The next +day her apothecary directed her to begin again with +it. The second dose produced vomiting. During +the next twenty hours she made two quarts of water, +about four times as much as she drank.</p> + +<p>From this time she took no more of the <i>infus. Digital.</i> +but continued the <i>inf. bacc. junip.</i> until about +<i>March</i> 2d, when all the swellings were gone down, +her respiration perfectly free, and she herself quite +restored to her former state of health. On the 29th +she had an attack of jaundice which was some time +after removed; since which she has enjoyed a good +state of health, excepting that for some little time +past her ancles have been slightly œdematous, which +will I trust soon yield to strengthening medicines.<span class='pagenum'><a name="Page_148" id="Page_148">[148]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3> + +<p>Mrs. M—— 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.</p> + +<div class="recipe"><p><i>Infus. Digital. c. ʒiss ad aq. bull. ℥viii. cochl. ii. +4tis horis.</i></p></div> + +<p>Took six doses, when nausea was excited. Urine +a quart during the course of the night. The flow +of urine continued, and complaints relieved. Sal. +Mart. c. extr. gent. and afterwards with the addition +of extr. cort. for which last ingredient she had a +predilection, confirmed the cure.</p> + +<p>On the same day the next year I was called in to +her for a similar train of symptoms, excepting that +the pulse was but just perceptibly irregular.</p> + +<div class="recipe"><p><i>Infus. Digital. u. a. præscript.</i></p></div> + +<p>The directions on the phial not being attended +to, <i>two doses of it were given after a nausea had been +excited</i>, which, with occasional vomitings, became +exceedingly oppressive. A saline draught, given +in Dr. Hulme's method, a draught <i>sal. c. c. gr. +xii. c. conf. card. gr. x.</i> produced no immediate +effect, but the nausea gradually abating, inf. bacc. +junip. was ordered; but this appeared to augment it,<span class='pagenum'><a name="Page_149" id="Page_149">[149]</a></span> +and a great propensity to sleep coming on, I directed +<i>sal. c. c. conf. card, aa gr. viii. 4tis horis</i>, which +removed the unpleasant symptoms and <i>myrrh. c. sal. +mart.</i> completed the cure. During the use of the +above medicines, the urine was augmented, and the +pulmonary complaints removed, even before the nausea +left her; and the sores of her legs which were much +inflamed before she began with the infus. Digital. +in a day's time assumed a much healthier appearance, +and on her other complaints going off, they +shewed a greater tendency to heal than she had +ever observed in them for twenty years before. This +instance is a very pleasing confirmation of the experience +of Hulse and Dr. Baylies, and of the advantage +to be derived from a medicine, which, +while it helps to heal the ulcers, removes that from +the constitution which often renders the healing of +them improper.</p> + +<p>In one case in which I ordered it, the infusion, +instead of digesting three hours as I had directed, +was suffered to stand upon the leaves all night. The +consequence was that the first dose produced considerable +nausea.</p> + +<p>The two following cases, with which I have been +favoured by a physician very justly eminent, convince +me of the necessity there is that every one who +discovers a new medicine, or new virtues in an old +one, should, in announcing such discoveries, publish +to the world the exact manner in which he exhibits<span class='pagenum'><a name="Page_150" id="Page_150">[150]</a></span> +such medicines, with all the precautions necessary +to obtain the promised success.</p> + +<p>In these (says my correspondent) "the infusion +was given in small doses, repeated every hour or +two, till a nausea was raised, when it was omitted +for a day or perhaps two, and then repeated +in the same manner.</p> + +<p>"An <span class="smcap">Ascites</span> emptied by it, but filled again +very speedily, though <i>its use was never discontinued</i>, +and who afterwards found no salutary effects +from it. Ended fatally.</p> + +<p>"In an <span class="smcap">Anasarca</span> it sometimes increased the +quantity of urine, and abated the swelling, but +which as often returned in as great a degree as +before, though <i>the medicine was still given</i>, and always +increased in quantity so as to excite nausea. +Ended fatally.</p> + +<p>"I have tried it in many other cases, but found +very little difference in the success attending it."</p> + +<p>May we not be allowed to conjecture that the inefficacy +of <i>its continued use</i> is owing to its narcotic property +gradually diminishing the irritability of the +muscular fibres of the absorbents, or possibly of the +whole vascular system, and thus adding to that +weakened action which seems to be the cause of the +generality of dropsies, which leads us to caution +the medical experimenter against trying it, at least<span class='pagenum'><a name="Page_151" id="Page_151">[151]</a></span> +<i>against its continued use, even in small doses</i>, in other +diseases of diminished energy, as continued fever, +palsy, &c.</p> + +<p class="right"><span style="padding-right: 4em">I remain with the greatest truth,</span><br /> +<span style="padding-right: 2em">Your obliged and affectionate friend,</span><br /> +<span style="letter-spacing: 0.25ex">JONATHAN STOKES</span>.</p> + +<p style="text-indent: 0.5em">Stourbridge,<br /> +May 17, 1785.</p> +</div> + + +<h4 style="padding-left: 1em; text-indent: -1em; text-align: left; margin-left: 20%; margin-right: 20%">The three following Hospital Cases, which +Dr. <span class="smcap">Stokes</span> had an opportunity of observing, +are related as instances of bad practice, +and tend to demonstrate how necessary +it is when one physician adopts the +medicine of another, that he should also +at first rigidly adopt his method.</h4> + + +<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3> + +<p>Esther K——, Æt. 33. General anasarca, +ascites, and dyspnœa, of seven months duration.</p> + +<p><i>Decoct. c Digit. ʒiv. c. aq. ℔i. coquend. ad ℔ss. cap. +℥i. 2dis. horis.</i> 1st <span class="smcap">Day</span>. 4th dose made her sick. +2d <span class="smcap">Day</span>. The first dose she took to-day produced +vomiting.<span class='pagenum'><a name="Page_152" id="Page_152">[152]</a></span></p> + +<p>3d <span class="smcap">Day</span>. <i>Minuatur dosis ad ℥ss.</i> This stayed upon +her stomach, but produced an almost constant sickness. +Stools more frequent, water scarce sensibly +increased; and her swellings not at all reduced.</p> + +<p>4th <span class="smcap">Day</span>. <i>Cap. Calomel. gambog. scill. &c.</i></p> + +<p><span class="smcap">Obs.</span> Sufficient time was not allowed to observe +its effects, neither was the patient enjoined the free +use of diluents. The disease terminated fatally.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3> + +<p>William T——, 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.</p> + +<div class="recipe"><p><i>Decoct. Digit. (u. in Esther K——,) 4tis horis.</i></p></div> + +<p>1st <span class="smcap">Day</span> of taking it. The 4th dose produced +sickness.</p> + +<p>2d. Vomiting after the second dose.</p> + +<p>10th. Urine increased to ℔vi.</p> + +<p>11th. Flow of urine continues. Abdomen quite +flaccid.<span class='pagenum'><a name="Page_153" id="Page_153">[153]</a></span></p> + +<p>12th. Abdomen not diminished.</p> + +<p>15th: A smart purging came on, and the flow of +urine diminished.</p> + +<p>23d. Belly much bound. Took a cathart. powder, +which was followed by a diminution of the +abdomen.</p> + +<p>29th. To take a cathart. powder every 4th morning, +continuing the decoct. Digit.</p> + +<p>32d. Urine exceedingly scanty.</p> + +<p>35th. <i>Vin. scill. ℥ss. o. m. &c.</i> This produced +diuretic effects.</p> + +<p>44th. Tapped. Terminated fatally.</p> + +<p><span class="smcap">Obs.</span> Here the medicine was <i>continued till it ceased +to produce diuretic effects</i>; and these effects were not +aided by any strengthening remedies.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3> + +<p>George R——, 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.<span class='pagenum'><a name="Page_154" id="Page_154">[154]</a></span></p> + +<div class="recipe"><p> +<i>Infus. Digital. ʒiiiss. ad. aq. ℔ss. cap. ℥i. altern. +horis donec nauseam excitaverit.</i> <i>Rep. 3tiis diebus.</i> +<i>tempore intermedio cap. sol. guaic. ℥i. ter in</i> +<i>die ex inf. sinap.</i></p></div> + +<p>1st <span class="smcap">Day</span> of taking it. Became sickish towards +night.</p> + +<p>2d <span class="smcap">Day</span>. Made a great quantity of water during +the night, and spat up a great deal of watery phlegm. +The first dose he took in the morning has produced +a sickness which has continued all day, but he has +never vomited.</p> + +<p>3d. <span class="smcap">Day</span>. The change in his appearance so great +as to make it difficult to conceive him to be the +same person. Instead of a large corpulent man, he +appeared tall, thin, and rather aged. Breathes +freely, and can walk up and down stairs without inconvenience.</p> + +<p>4th <span class="smcap">Day</span>. <i>Decoct. bacc. junip. and cyder for common +drink.</i></p> + +<p>6th <span class="smcap">Day</span>. A second course of his medicine produced +a flow of urine almost as plentiful as the former, +though he drank little or nothing at the time. +In a day or two after he walked to some distance.</p> + +<p>12th <span class="smcap">Day</span>. <i>Pot. purgans illico.</i></p> + +<p>14th <span class="smcap">Day</span>. <i>Pot. purg. c. jalap. ʒss. 4tis diebus.</i><br /> +<span style="padding-left: 5em"><i>Infus. Dig. 3tiis diebus.</i></span> +<span class='pagenum'><a name="Page_155" id="Page_155">[155]</a></span></p> + +<p> +17th <span class="smcap">Day</span>. <i>R. Gamb. gr. iii. calom. gr. ii. camph. +gr. i. syr. simpl. fiat pil. o. n. sum.</i><br /> +<span style="padding-left: 5em"><i>Infus. Digit. 3tiis diebus.</i></span></p> + +<p>21st <span class="smcap">Day</span>. Made an out-patient. The super-abundant +flow of urine continued for the first three +days after his last course; but since, the flow of saliva +has been nearly equal to that of urine.</p> + +<p>The smalls of his legs not quite reduced, and are +fuller at night. He has shrunk round the middle +from four feet two inches to three feet six inches; +and in the calves of his legs, from seventeen inches +to thirteen and a half.<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a></p> + +<p><span class="smcap">Obs.</span> The waters were here very successfully evacuated, +but as you remarked to me, on communicating +the case to you at the time, tonic medicines +should have been given, to second the ground that +had been gained, instead of weakening the patient +by drastic purgatives.</p> +<p><span class='pagenum'><a name="Page_156" id="Page_156">[156]</a></span></p> + +<h4>A CASE from Mr. <span class="smcap">Shaw</span>, Surgeon, at<br /> +Stourbridge.—Communicated by Doctor +<span class="smcap">Stokes</span>.</h4> + +<p>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.</p> + +<p>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.<span class='pagenum'><a name="Page_157" id="Page_157">[157]</a></span></p> + + +<h4>A Letter from Mr. <span class="smcap">Vaux</span>, Surgeon, in +Birmingham.</h4> + +<div class="blockquot"> +<p> +Dear <span class="smcap">Sir</span>,</p> + +<p>I send you the two following cases, +wherein the Digitalis had very powerful and sensible +effects, in the cure of the different patients.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">I.</span></h3> + +<p>Mrs. O—— 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<span class='pagenum'><a name="Page_158" id="Page_158">[158]</a></span> +through the skin, and a small blister on one of +her legs broke. Believing she could not exist much +longer, unless an evacuation of the water could be +procured; after fully informing her of her situation, +and the uncertainty of her surviving the use of the +medicine, I ventured to propose her taking the Digitalis, +which she chearfully agreed to. I accordingly +sent her a pint mixture, made as under, of +the fresh leaves of the Digitalis. Three drams infused +in one pint of boiling water, when cold strained +off, without pressing the leaves, and two ounces +of the strong juniper water added to it: of this +mixture she was ordered four table spoonfuls every +third hour, till it either made her sick, purged her, +or had a sensible effect on the kidneys. This mixture +was sent on the seventeenth, and she began +taking it at noon on the eighteenth. At one o'clock +the following morning I was called up, and informed +she was dying. I immediately attended +her, and was agreeably surprised to find their fright +arose from her having fainted, in consequence of the +sudden loss of twelve quarts of water she had made +in about two hours. I immediately applied a roller +round her belly, and, as soon as they could be made, 2 +others, which were carried from the toes quite up the +thighs. The relief afforded by these was immediate; +but the medicine now began to affect her stomach so +much, that she kept nothing on it many minutes together. +I ordered her to drink freely of beef tea, which +she did, but kept it on her stomach but a very short +time. A neutral draught in a state of effervescence was +taken to no good purpose: She therefore continued<span class='pagenum'><a name="Page_159" id="Page_159">[159]</a></span> +the beef tea, and took no other medicine for five +days, when her sickness went off: her cough abated, +but the pain in her side still continuing, I applied a +blister which had the desired effect: her urine after +the first day flowed naturally. Her cure was compleated +by the gum pills with steel and the bitter +infusion. It must be observed she never had any +collection of water afterwards.</p> + +<p>It affords me great pleasure to inform you that +she is now living, and has since had four children; +all of whom, I think I may justly say, are indebted +to the Digitalis for their existence.</p> + +<p>There appears in this case a striking proof of the +utility of emetics in some kinds of consumptions, as +it appears to me the dropsy was brought on by the +cough, &c. and I believe these were cured by the +continual vomitings, occasioned by the medicine.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">II.</span></h3> + +<p>Mr. H——, a publican, aged about 48 years, +sent for me in <i>March</i>, 1778. He complained of a +cough, shortness of breathing, which prevented him +from laying down in bed; his belly, thighs and legs +very much distended with water; the quantity of +urine made at a time seldom exceeded a spoonful. +I requested him to get some of the Digitalis, and as +they had no proper weights in the house, I told them +to put as much of the fresh leaves as would weigh +down a guinea, into half a pint of boiling water;<span class='pagenum'><a name="Page_160" id="Page_160">[160]</a></span> +to let it stand till cold, then to pour off the clear liquor, +and add a glass of gin to it, and to take three +table spoonfuls every third hour, until it had some +sensible effect upon him.</p> + +<p>Before he had taken all the infusion, the quantity +of urine made increased, (he therefore left off +taking it), and it continued to do so until all the +water was evacuated. His breathing became much +better, his cough abated, though it never quite left +him; he being for some time before asthmatic. +By taking some tonic pills he continued quite well +until the next spring, when he had a return of his +complaint, which was carried off by the same means. +Two years after, he had a third attack, and this also +gave way to the medicine. Last year he died of +a pleurisy.</p> + +<p class="right"> +<span style="padding-right: 6em">I am, &c.</span><br /> +<span style="letter-spacing: 0.25ex">JER. VAUX</span></p> + +<p>Moor-Street, 8th May,<br /> +<span style="padding-left: 4em">1785.</span></p> + +<p>P. 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."—(<i>See Case</i> +<a href="#CASExliii">XLIII</a>.)<span class='pagenum'><a name="Page_161" id="Page_161">[161]</a></span></p> +</div> + + +<h4>A Letter from Mr. <span class="smcap">Wainwright</span>, Surgeon, +in Dudley.</h4> + +<div class="blockquot"> +<p>Dear <span class="smcap">Sir</span>,</p> + +<p>It gives me great pleasure to +find you intend to publish your observations on +the Digitalis purpurea.</p> + +<p>Several years are now elapsed since you communicated +to me the high opinion you entertained of +the diuretic qualities of this noble plant. To ensure +success, due attention was recommended to its <i>preparation</i>, +its <i>dose</i>, and its <i>effects</i> upon the system.</p> + +<p>I always gave the infusion of the dried leaves; +the dose the same as in the prescriptions returned. +If the medicine operated on the stomach or bowels, +it was thought prudent to forbear. When the kidneys +began to perform their proper functions, and +the urine to be discharged, a continuance of its farther +use was unnecessary.</p> + +<p>These remarks you made in the case of the first +patient for whom you prescribed the Digitalis in our +neighbourhood, and I have found them all necessary +at this present period. From the <i>decided</i> good effects +that followed from its use, in those cases where the +most powerful remedies had failed, I was soon convinced +it was a most valuable addition to the materia +medica.<span class='pagenum'><a name="Page_162" id="Page_162">[162]</a></span></p> + +<p>The want of a certain diuretic, has long been one +of the desiderata of medicine. The Digitalis is undoubtedly +at the head of that class, and will seldom, +if properly administered, disappoint the expectation. +I can speak with the more confidence, having, in an +extensive practice, been a happy witness to its good +qualities.</p> + +<p>For several years, I have given the infusion in +a variety of cases, where there was a deficiency +in the secretion of the urine, with the greatest success. +In recent obstructions, I do not recollect +many failures. In anasarcous diseases, and in the +anasarca, when combined with the ascites; in swellings +of the limbs, and in diseases of the chest, when +there was the greatest reason to believe an accumulation +of serum, the most beneficial consequences +have followed from its use.</p> + +<p>Had I been earlier acquainted with your intention +to publish an account of the Digitalis, I could +have transmitted some cases, which might have +served to corroborate these assertions: but I am +convinced the Digitalis needs not my assistance to +procure a favorable reception. Its own merit will +ensure success, more than a hundred recited cases.</p> + +<p>I could wish those gentlemen who intend to make +use of this plant, to collect it in a hot dry day, when +the petals fall, and the seed-vessels begin to swell.<span class='pagenum'><a name="Page_163" id="Page_163">[163]</a></span></p> + +<p>The leaves kept to the second year are weaker, +and their diuretic qualities much diminished. It +will therefore be necessary to gather the plant fresh +every season.</p> + +<p>These cautions are unnecessary to the accurate +botanist, who well knows, that a plant in the spring, +though more succulent and full of juices, is destitute +of those qualities which may be expected when that +plant has attained its full vigour, and the seed-vessels +begin to be manifest. But for want of attention +to these particulars, its virtues may be thought +exaggerated, or doubtful, if beneficial consequences +do not always flow from its use. There are diseases +it cannot cure; and in several of those patients in +this town, who first took the Digitalis by your +orders, there was the most positive proof of the +viscera being unsound. In these desperate cases +it often procured a plentiful flow of urine, and +palliated a disease which medicine could not remove.</p> + +<p>At a remote distance, physicians are seldom applied +to for advice in trifling disorders. Many +remedies have been tried without relief, and the +disease is generally obstinate or confirmed.—It +would not be fair to try the merits of the Digitalis +in this scale. It might often fail of promoting +the end desired. I flatter myself the reputation +of this plant will be equal to its merit, and that it +will meet with a candid reception.<span class='pagenum'><a name="Page_164" id="Page_164">[164]</a></span></p> + +<p>As there is no pleasure equal to relieving the miseries +and distresses of our fellow-creatures, I hope +you will long enjoy that peculiar felicity.</p> + +<p>Permit me to return my thankful acknowledgments, +for your free communication of a medicine, +by which means, through the blessing of providence, +I have been enabled to restore health and happiness +to many miserable objects.</p> + +<p class="right"> +<span style="padding-right: 8em">I am, &c.</span><br /> +<span style="padding-right: 6em">Yours,</span><br /> +<span style="letter-spacing: 0.25ex">J. WAINWRIGHT</span>.</p> + +<p>Dudley, April 26th,<br /> +<span style="padding-left: 3em">1785.</span></p> +</div> + + +<h4><span style="letter-spacing: 0.25ex">CASE</span> of Mr. <span class="smcap">Ward</span>, Surgeon, in +Birmingham.—Related by himself.</h4> + +<p>In <i>September</i>, 1782, I was seized with a difficulty +of breathing, and oppression in my chest, in +consequence of taking cold from being called out in +the night. My tongue was foul; my urine small +in quantity; my breath laborious and distressing on +the slightest exercise. I tried the medicines most generally +recommended, such as emetics, blisters, lac +ammoniacum, oxymel of squills, &c. but finding +little or no relief, I consulted Dr. Withering, who +advised me to try the following prescription.<span class='pagenum'><a name="Page_165" id="Page_165">[165]</a></span></p> + +<div class="recipe"><p>R. Fol. Digital. purp. siccat. ʒiss.<br /> +Aq. bullientis ℥iv.<br /> +Aq. cinn. sp. ℥ss. digere per horas quatuor, et colaturæ capiat cochlear. i. nocte maneque.</p></div> + +<p>He also desired me to take fifty drops of tincture +of cantharides three or four times a day.</p> + +<p>After taking eight ounces of the infusion, and +about twelve drams of the drops, I was perfectly +cured, and have had no return since. The medicine +did not occasion sickness or vertigo, nor had +they any other sensible effect than in changing the +appearance, and increasing the quantity of the urine, +and rendering the tongue clean. After the last dose +or two indeed, I had a little nausea, which was immediately +removed by a small glass of brandy.</p> + +<p> +Birmingham, 1st July, 1785.</p> + + +<h4>Communications from Mr. <span class="smcap">Yonge</span>, Surgeon, +in Shiffnall, Shropshire.</h4> + +<div class="blockquot"> +<p> +Dear <span class="smcap">Sir</span>,</p> + +<p>I have great satisfaction in +complying with your just claim, by transcribing outlines +of the subsequent cases, for insertion in your long +requested tract on the Digitalis purpurea. The two +first of these you will easily recollect, the cures having +been conducted immediately under your own management,<span class='pagenum'><a name="Page_166" id="Page_166">[166]</a></span> +and the whole may add to that weight of evidence +which long experience enables you to adduce +of the efficacy of that valuable medicine. I +have recited the only instances of its failure which +occur to me, but many other, though successful +cases, wherein its utility might seem dubious, and +also the accounts received from people whose accuracy +might be suspected, I shall not for obvious reasons +trouble you with.</p> + +<p class="right"> +<span style="padding-right: 8em">I am, dear Sir,</span><br /> +<span style="padding-right: 4em">Your obliged friend,</span><br /> +<span style="letter-spacing: 0.25ex">WILLIAM YONGE</span>.</p> + +<p>Shiffnall,<br /> +<i>May</i> 1, 1785.</p> +</div> + +<h3><a name="CASEyi" id="CASEyi"></a>CASE <span style="letter-spacing: 0ex">I.</span></h3> + +<p>A Gentleman aged 49, on the night of the +21st of August, 1784, awaked with a sense of suffocation, +which obliged him to rise up suddenly in +bed. I found him complaining of difficult respiration, +particularly on lying down; the countenance +pale, and the pulse smaller and quicker than +usual. Some brandy and water having been given, +the symptoms gradually abated, so that he slept in a +half recumbent posture. The following day he +expressed a sense of anxiety and weight in the chest, +attended by quicker breathing upon motion of the +body. That evening an emetic of ipecacoanha was +given, and afterwards a draught, with vitriolic æther<span class='pagenum'><a name="Page_167" id="Page_167">[167]</a></span> +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 <i>September</i> 15th, when upon a more +severe attack, the emetic was repeated. He now +recollected some slight pain in his arms which had +affected him previous to this last seizure, and was +disposed to consider his complaint as rheumatic. +Pills with gum ammoniac. gum guaiac. and antimonial +powder were directed, with infus. amar. simpl. +twice a day. The bowels were regulated by aperient +pills of pulv. jalap. aloes and sal. tartar. and +ʒiss balsam peruv. was given occasionally to alleviate +the paroxysms of dyspnœa.</p> + +<p>From this period until the beginning of November, +little amendment or variation happened, +except that respiration became more permanently +difficult, and particularly oppressed upon motion, +nor was it relieved by the expectoration of a mucous +discharge, which now increased considerably. +Squills, musk, ol. succini, 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.<span class='pagenum'><a name="Page_168" id="Page_168">[168]</a></span></p> + +<p>On the 15th of <i>November</i> a blister was laid over +the sternum, and ʒiss of oxymel scillitic. was given +every eight hours.</p> + +<p>On the 18th, a more copious discharge of urine +took place; the swelling of the feet soon disappeared, +and the respiration became gradually relieved.</p> + +<p>On the 30th ʒi tinct. cantharidum twice a day in +pyrmont water, with pills of ammoniac, sal tartar. +et extract. gentian. were substituted, but</p> + +<p>On the 7th of <i>December</i>, from some symptoms +of relapse, the oxymel was used as before, and continued +to be taken until the 27th, in doses as large +as could be dispensed with on account of the great +nausea which attended its exhibition: The urine +was made in the quantity of four or five pints each +day, during the whole time; the quantity then +drank being seldom more than three pints. But +now the sickness being exceedingly depressing, the +strength failing, and the diuretic effects beginning +to cease, the following prescription was directed.</p> + +<div class="recipe"><p> +R. Fol. Digitalis purpur. pulv. ℈ss.<br /> +Spec. Aromatic. ℈i. sp. lav. c. f. pilul. no. x. +capiat i. nocte maneque, et alternis diebus sensim augeatur +dosin.</p></div> + +<p>In three days the effect of this medicine became +visible, and when the dose of the Digitalis had been<span class='pagenum'><a name="Page_169" id="Page_169">[169]</a></span> +increased to six grains per day, the flow of urine +generally amounted to seven pints every twenty-four +hours. Not the least sickness, nor any other +disagreeable symptom supervened, though he persevered +in this plan until the end of <i>January</i> at +which time the dyspnœa was removed, and he has +continued gradually to regain his flesh, strength, +and appetite, without any relapse.</p> + + +<h3><a name="CASEyii" id="CASEyii"></a>CASE <span style="letter-spacing: 0ex">II.</span></h3> + +<p>About the middle of the year 1784 a lady aged 48, +returned from London, to her native air in Shropshire, +under symptoms of complicated disease. It +was your opinion that the plethoric state, consequent +to that period, when menstruation first begins +to cease, had under various appearances, laid the +foundation of that deplorable state which now presented +itself. The skin was universally of a pale, +leaden colour; her person much emaciated, and her +strength so reduced, as to disable her from walking +without support. The appetite fluctuating, the digestion +impaired so much, that solids passed the +intestines with little appearance of solution: She +had generally eight or ten alvine evacuations every +day, and without this number, febrile symptoms, +attended with severe vertiginous affection, and +vomiting regularly ensued. The stools were of a +pale ash colour. The urine generally pale, and at +first in due quantity. The region of the stomach<span class='pagenum'><a name="Page_170" id="Page_170">[170]</a></span> +had a tense feel, without soreness: the feet and +ancles 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.</p> + +<p>From the time of her arrival till the middle of +<i>August</i>, mercury had been continued in various +forms, and in doses such as the irritable state of her +stomach and bowels would admit of. Spirit. nitri +dulc.; sal. tartar, squill, and cantharides were +alternately employed as diuretics, but without success, +to retard the progress of an universal anasarca +which was then advanced to such degree and accompanied +by so great debility, and other dreadful concomitants, +as to threaten a speedy and fatal catastrophe.</p> + +<p>On the 16th of <i>August</i> you first saw her, and +directed thus.</p> + +<div class="recipe"><p> +R. Mercur. cinerei gr. ii.<br /> +Fol. Digital, purpur. pulv. ℈i. f. mass. in +pill. no. xvi. dividend.—sumat unam hora meridiana, +<span class='pagenum'><a name="Page_171" id="Page_171">[171]</a></span>iterumque hora quinta pomeridiana quotidie.</p> +</div> + +<div class="recipe"> +<p>Capiat lixivii saponac. gutt. L. in haust. juscul. +sine sale parati omni nocte.</p></div> + +<p>On the 20th the flow of urine began to increase, +and she continued the medicine in the same dose +until the 20th of <i>September</i>, discharging from six to +eight pints of water each day for the first week, and +which quantity gradually diminished as she became +empty. During this period she complained not of +any sickness, except from the lixivium, which was +after the first dose reduced to 20 drops; and her appetite +and strength increased daily, though it was +evident that no bile had yet flowed into the bowels, +nor was the digestion at all improved. The anasarcous +appearances being then removed, the Digitalis +was omitted, and pills, composed of mercur. +cinereus, aloes, and sal tartari directed twice a day, +with ʒi. of vin. chalybeat. in infus. amar. simpl.</p> + +<p>Her amendment in other respects proceeded +slowly, but regularly, from that time until the 9th +of October; when the state of plethora again recurring, +with its usual attendant symptoms, ℥iv. of +blood were taken from the arm; and this was upon +the same occasion, repeated in the following month, +with manifest good consequences; though in both +instances the colour of the blood, as flowing from +the vein could hardly be called red, and the coagulum +was as weak in its cohesion as possible. The +state of the stomach and bowels was by this time +greatly improved, in common with other parts of<span class='pagenum'><a name="Page_172" id="Page_172">[172]</a></span> +the system; but no intromission of bile had yet +happened: the hardness about the hypogastric region, +though less, continued in a considerable degree, +and you ordered pills of mercury rubbed +down, and rust of iron, to be taken twice a day, +with a decoction of dandelion and sal sodæ.</p> + +<p>A cataplasm of linseed was applied every night +over the stomach and right side; and, with little +deviation from this plan, she continued to the end +of the year, improving in her general health, but +the hepatic affection yet remaining. It was then +determined to try the effects of electricity, and +gentle shocks were passed through the body daily, +and as nearly as could be through the liver, in various +directions.</p> + +<p>On the fifth day there was reason to think that +some gall had been secreted and poured out, and +this became every day more evident; but it flowed +only in small quantity, and irregularly into the +bowels, as appeared from the fæces being partially +tinged by it.</p> + +<p>In <i>February</i> the lady left this neighbourhood, and +though convalescent, yet so nearly well as to promise +us the satisfaction of seeing her perfectly restored.</p> + +<p><i>June</i> 29. The bile is now secreted in pretty good +quantity, her appetite is perfectly good, her strength +equal to almost any degree of exercise, and her<span class='pagenum'><a name="Page_173" id="Page_173">[173]</a></span> +health in general better than it has been for some +years.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">III.</span></h3> + +<p>Mr. W——, aged—. In <i>June</i>, 1782, was +affected with slight difficulty in respiration, upon taking +exercise or lying down in bed. These symptoms +increased gradually until the end of <i>July</i>, +when he complained of sense of weight and uneasiness +about the 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.</p> + +<div class="recipe"><p>R. Fol. Digital. purpur. ʒiii.<br /> +Cort. limon. ʒii. infund.<br /> +Aq. bullient. ℔i. per hor. 2 et cola. sumat +cochl. i. primo mane et repet. omni hora.</p></div> + +<p>Sometime in the night considerable nausea occurred,<span class='pagenum'><a name="Page_174" id="Page_174">[174]</a></span> +and the following day he began to make water +in great quantity, which he continued to do for +three or four days. The pulse in a few hours became +regular, slower, and stronger, and, in the +course of a week, all the symptoms entirely vanished, +and an electuary of cort. peruvian, sal martis, +and spec. aromatic. confirmed his cure.</p> + +<p>In <i>February</i>, 1784, this gentleman had a relapse +of his disease, from which he again soon recovered +by the same means, and is now perfectly well.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">IV.</span></h3> + +<p>G—— 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.</p> + +<p>After the exhibition of an emetic, six grains of +calomel were given, with a purge of jalap in the +morning, and repeated in a few days, with some appearance +of advantage. He was then directed to +take some pills of squill, soap, and rhubarb, with a +draught twice a day, consisting of infus. amar. simp. +and sal tartari. The skin soon became clearer and<span class='pagenum'><a name="Page_175" id="Page_175">[175]</a></span> +the pain in his breast considerably diminished. But +every other circumstance remaining the same, and +a fluctuation in the belly being now more evident, +the infusion of Digitalis as prescribed in case third, +was given in the dose of one ounce twice a day.</p> + +<p>On the 5th day the effects were apparent, and he +continued his medicine for a fortnight without nausea, +making four or five pints of water every night, +but little in the day, and gradually losing the symptoms +of his disease.</p> + +<p>In 1784, this person had a relapse, and was again +cured by similar treatment.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">V.</span></h3> + +<p>R—— 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.<span class='pagenum'><a name="Page_176" id="Page_176">[176]</a></span> +Repeated bleeding had no effect in diminishing +the violent action of the heart. He died in +January following, under complicated symptoms of +phthisis and ascites.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">VI.</span></h3> + +<p>A man aged 57, who had lived freely in the summer +of 1784, became affected with 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.</p> + +<p>On the 5th he was suddenly seized with faintness +and cold sweatings. I found him with a pale countenance, +complaining of weakness, and of pain, +with a sense of great heat in his stomach and +bowels. The swelling of the legs was entirely gone, +he having evacuated urine in very large quantities +for the two preceding days. He was affected with +frequent diarrhœa. The pulse was very quick and +small, and his extremities cold.</p> + +<p>A small quantity of broth was directed to be given +him every half hour, and blisters were applied +to the ancles, by which his symptoms became gradually +alleviated, and he recovered perfectly in the +space of three weeks; except a relapse of the anasarca, +for which the Digitalis was afterwards successfully +employed, in small doses, without any disagreeable +consequence.<span class='pagenum'><a name="Page_177" id="Page_177">[177]</a></span></p> + + +<h3>CASE <span style="letter-spacing: 0ex">VII.</span></h3> + +<p>S—— 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.</p> + +<p>In <i>November</i> 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.</p> + + +<h3>CASE <span style="letter-spacing: 0ex">VIII.</span></h3> + +<p>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<span class='pagenum'><a name="Page_178" id="Page_178">[178]</a></span> +pit, and from which he recovered in a few days, +except a swelling of the lower extremities, which +had appeared about that time, and gradually increased +for two or three months. The legs and +thighs were greatly enlarged and 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.<span class='pagenum'><a name="Page_179" id="Page_179">[179]</a></span></p> + +<div class="footnotes"><h3>FOOTNOTES:</h3> + +<div class="footnote"><p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> R. Rad. scil. recent. sapon. castiliens. pulv. Rhei opt. aa. ℈i. +ol. junip. gutt. xvi. syr. bals. q. s. f. mass. in pil. xxiv. divid.</p></div> + +<div class="footnote"><p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Prepared in the same manner as in the former case.</p></div> + +<div class="footnote"><p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> See this account in the <a href="#INTRODUCTION">Introduction</a>.</p></div> + +<div class="footnote"><p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> For reasons assigned at <a href="#Page_100">p. 100</a>, I did not intend to introduce +any case, occurring under my own inspection, in the course of the +present year; but it may be satisfactory to continue the history of +this disease, as Dr. Stokes's narrative would otherwise be incomplete. +</p> + +<p class="center">1785.</p> + +<p class="center">CASE.</p> + +<p><i>Jan.</i> 5th. Mrs. M——, 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. +</p><p> +Three months afterwards, a severe attack of gout in her legs +and arms, removing to her head, she died. +</p><p> +Dr. Stokes had an opportunity of examining the dead body, +and I had the satisfaction to learn from him, that there did not +appear to have been any return of the dropsy.</p></div> + +<div class="footnote"><p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> In the three last recited cases, the medicine was directed in +doses quite too strong, and repeated too frequently. If Esther +K—— 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.</p></div> +</div> + + + +<h2 style="line-height: 150%"><a name="OF_THE" id="OF_THE"></a><span style="font-size: 70%">OF THE</span><br /> +PREPARATIONS and DOSES,<br /> +<span style="font-size: 70%">OF THE</span><br /> +FOXGLOVE.</h2> + +<hr class="chapter" /> + +<p class="newchapter"><span class="firstword"><span class="dropcap">E</span>very</span> part of the plant has more or less of +the same bitter taste, varying, however, as +to strength, and changing with the age of the plant +and the season of the year.</p> + +<p><span style="letter-spacing: 0.25ex">ROOT</span>.—This varies greatly with the age of +the plant. When the stem has shot up for flowering, +which it does the second year of its growth, +the root becomes dry, nearly tasteless, and inert.</p> + +<p>Some practitioners, who have used the root, and +been so happy as to cure their patients without exciting +sickness, have been pleased to communicate +the circumstance to me as an improvement in the +use of the plant. I have no doubt of the truth of +their remarks, and I thank them. But the case of +Dr. Cawley puts this matter beyond dispute. The +fact is, they have fortunately happened to use the +root in its approach to its inert state, and consequently +have not over dosed their patients. I could,<span class='pagenum'><a name="Page_180" id="Page_180">[180]</a></span> +if necessary, bring other proof to shew that the root +is just as capable as the leaves, of exciting nausea.</p> + +<p><span style="letter-spacing: 0.25ex">STEM</span>.—The stem has more taste than the root +has, in the season the stem shoots out, and less taste +than the leaves. I do not know that it has been +particularly selected for use.</p> + +<p><span style="letter-spacing: 0.25ex">LEAVES</span>.—These vary greatly in their efficacy +at different seasons of the year, and, perhaps, +at different stages of their growth; but I am not +certain that this variation keeps pace with the greater +or lesser intensity of their bitter taste.</p> + +<p>Some who have been habituated to the use of +the recent leaves, tell me, that they answer their +purpose at every season of the year; and I believe +them, notwithstanding I myself have found very +great variations in this respect. The solution of +this difficulty is obvious. They have used the leaves +in such large proportion, that the doses have been +sufficient, or more than sufficient, even in their +most inefficacious state. <i>The Leaf-stalks</i> seem, in +their sensible properties, to partake of an intermediate +state between the leaves and the stem.</p> + +<p><span style="letter-spacing: 0.25ex">FLOWERS</span>.—The petals, the chives, and the +pointal have nearly the taste of the leaves, and it +has been suggested to me, by a very sensible and +judicious friend, that it might be well to fix on the +flower for internal use. I see no objection to the +proposition; but I have not tried it.<span class='pagenum'><a name="Page_181" id="Page_181">[181]</a></span></p> + +<p><span style="letter-spacing: 0.25ex">SEEDS</span>.—These I believe are equally untried.</p> + +<p>From this view of the different parts of the plant, +it is sufficiently obvious why I still continue to prefer +the leaves.</p> + +<p>These should be gathered after the flowering stem +has shot up, and about the time that the blossoms +are coming forth.</p> + +<p>The leaf-stalk and mid-rib of the leaves should +be rejected, and the remaining part should be dried, +either in the sun-shine, or on a tin pan or pewter +dish before a fire.</p> + +<p>If well dried, they readily rub down to a beautiful +green powder, which weighs something less than +one-fifth of the original weight of the leaves. Care +must be taken that the leaves be not scorched in +drying, and they should not be dried more than +what is requisite to allow of their being readily reduced +to powder.</p> + +<p>I give to adults, from one to three grains of this +powder twice a day. In the reduced state in which +physicians generally find dropsical patients, four +grains a day are sufficient. I sometimes give the +powder alone; sometimes unite it with aromatics, +and sometimes form it into pills with a sufficient +quantity of soap or gum ammoniac.<span class='pagenum'><a name="Page_182" id="Page_182">[182]</a></span></p> + +<p>If a liquid medicine be preferred, I order a dram +of these dried leaves to be infused for four hours +in half a pint of boiling water, adding to the strained +liquor an ounce of any spirituous water. One ounce +of this infusion given twice a day, is a medium dose +for an adult patient. If the patient be stronger than +usual, or the symptoms very urgent, this dose may +be given once in eight hours; and on the contrary +in many instances half an ounce at a time will be +quite sufficient. About thirty grains of the powder +or eight ounces of the infusion, may generally be +taken before the nausea commences.</p> + +<p>The ingenuity of man has ever been fond of exerting +itself to vary the forms and combinations of +medicines. Hence we have spirituous, vinous, and +acetous tinctures; extracts hard and soft, syrups +with sugar or honey, &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.</p> + +<p>It appears from several of the cases, that when the +Digitalis is disposed to purge, opium may be joined +with it advantageously; and when the bowels are +too tardy, jalap may be given at the same time,<span class='pagenum'><a name="Page_183" id="Page_183">[183]</a></span> +without interfering with its diuretic effects; but I +have not found benefit from any other adjunct.</p> + +<p>From this view of the doses in which the Digitalis +really ought to be exhibited, and from the evidence +of many of the cases, in which it appears to +have been given in quantities six, eight, ten or even +twelve times more than necessary, we must admit +as an inference either that this medicine is perfectly +safe when given as I advise, or that the medicines +in daily use are highly dangerous.<span class='pagenum'><a name="Page_184" id="Page_184">[184]</a></span></p> + + + +<h2><a name="EFFECTS_RULES_and_CAUTIONS" id="EFFECTS_RULES_and_CAUTIONS"></a>EFFECTS, RULES, <span style="letter-spacing: 0ex">and</span> CAUTIONS.</h2> + +<hr class="chapter" /> + +<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> Foxglove when given in very large and quickly-repeated +doses, occasions sickness, vomiting, +purging, giddiness, confused vision, objects appearing +green or yellow; increased secretion of urine, +with frequent motions to part with it, and sometimes +inability to retain it; slow pulse, even as slow as 35 +in a minute, cold sweats, convulsions, syncope, +death.<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a></p> + +<p>When given in a less violent manner, it produces +most of these effects in a lower degree; and +it is curious to observe, that the sickness, with a certain +dose of the medicine, does not take place for many +hours after its exhibition has been discontinued; +that the flow of urine will often precede, sometimes +accompany, frequently follow the sickness at the +distance of some days, and not unfrequently be +checked by it. The sickness thus excited, is extremely +different from that occasioned by any other +medicine; it is peculiarly distressing to the patient; +it ceases, it recurs again as violent as before; and +thus it will continue to recur for three or four days, +at distant and more distant intervals.</p> +<p><span class='pagenum'><a name="Page_185" id="Page_185">[185]</a></span></p> +<p>These sufferings of the patient are generally rewarded +by a return of appetite, much greater than +what existed before the taking of the medicine.</p> + +<p>But these sufferings are not at all necessary; +they are the effects of our inexperience, and would +in similar circumstances, more or less attend the exhibition +of almost every active and powerful medicine +we use.</p> + +<p>Perhaps the reader will better understand how it +ought to be given, from the following detail of my +own improvement, than from precepts peremptorily +delivered, and their source veiled in obscurity.</p> + +<p>At first I thought it necessary <i>to bring on and +continue the sickness, in order to ensure the diuretic +effects</i>.</p> + +<p>I soon learnt that the nausea being once excited, +it was unnecessary to repeat the medicine, as it was +certain to recur frequently, at intervals more or less +distant.</p> + +<p>Therefore my patients were ordered <i>to persist +until the nausea came on, and then to stop</i>. But it +soon appeared that the diuretic effects would often +take place first, and sometimes be checked when the +sickness or a purging supervened.<span class='pagenum'><a name="Page_186" id="Page_186">[186]</a></span></p> + +<p>The direction was therefore enlarged thus—<i>Continue +the medicine until the urine flows, or sickness or +purging take place</i>.</p> + +<p>I found myself safe under this regulation for two +or three years; but at length cases occurred in +which the pulse would be retarded to an alarming +degree, without any other preceding effect.</p> + +<p>The directions therefore required an additional +attention to the state of the pulse, and it was moreover +of consequence not to repeat the doses too +quickly, but to allow sufficient time for the effects +of each to take place, as it was found very possible +to pour in an injurious quantity of the medicine, +before any of the signals for forbearance appeared.</p> + +<p><i>Let the medicine therefore be given in the doses, and +at the intervals mentioned above:—let it be continued +until it either acts on the kidneys, the stomach, the pulse, +or the bowels; let it be stopped upon the first appearance +of any one of these effects</i>, and I will maintain that +the patient will not suffer from its exhibition, nor +the practitioner be disappointed in any reasonable +expectation.</p> + +<p>If it purges, it seldom succeeds well.</p> + +<p>The patients should be enjoined to drink very +freely during its operation. I mean, they should +drink whatever they prefer, and in as great quantity<span class='pagenum'><a name="Page_187" id="Page_187">[187]</a></span> +as their appetite for drink demands. This direction +is the more necessary, as they are very generally +prepossessed with an idea of drying up a +dropsy, by abstinence from liquids, and fear to add +to the disease, by indulging their inclination to +drink.</p> + +<p>In cases of ascites and anasarca; when the patients +are weak, and the evacuation of the water +rapid; the use of proper bandage is indispensably +necessary to their safety.</p> + +<p>If the water should not be wholly evacuated, +it is best to allow an interval of several days before +the medicine be repeated, that food and tonics maybe +administered; but truth compels me to say, that +the usual tonic medicines have in these cases very +often deceived my expectations.</p> + +<p>From some cases which have occurred in the +course of the present year, I am disposed to believe +that the Digitalis may be given in small doses, viz. +two or three grains a day, so as gradually to remove +a dropsy, without any other than mild diuretic effects, +and without any interruption to its use until +the cure be compleated.</p> + +<p>If inadvertently the doses of the Foxglove should +be prescribed too largely, exhibited too rapidly, or +urged to too great a length; the knowledge of a +remedy to counteract its effects would be a desirable<span class='pagenum'><a name="Page_188" id="Page_188">[188]</a></span> +thing. Such a remedy may perhaps in time be +discovered. The usual cordials and volatiles are +generally rejected from the stomach; aromatics and +strong bitters are longer retained; brandy will sometimes +remove the sickness when only slight; I have +sometimes thought small doses of opium useful, but I +am more confident of the advantage from blisters. +Mr. Jones (<a href="#Page_135"><i>Page</i> 135</a>) in one case, found mint tea to +be retained longer than other things.</p> + +<div class="footnotes"><h3>FOOTNOTES:</h3> + +<div class="footnote"><p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> I am doubtful whether it does not sometimes excite a copious +flow of saliva.—See cases at pages <a href="#Page_115">115</a>, <a href="#Page_154">154</a>, and <a href="#Page_155">155</a>.</p></div> +</div> + + +<h2><a name="CONSTITUTION_of_PATIENTS" id="CONSTITUTION_of_PATIENTS"></a>CONSTITUTION <span style="letter-spacing: 0ex">of</span> PATIENTS.<span class='pagenum'><a name="Page_189" id="Page_189">[189]</a></span></h2> + +<hr class="chapter" /> + +<p class="newchapter"><span class="firstword"><span class="dropcap">I</span>ndependent</span> of the degree of disease, or +of the strength or age of the patient, I have +had occasion to remark, that there are certain constitutions +favourable, and others unfavourable to +the success of the Digitalis.</p> + +<p>From large experience, and attentive observation, +I am pretty well enabled to decide <i>a priori</i> +upon this matter, and I wish to enable others to do +the same: but I feel myself hardly equal to the undertaking. +The following hints, however, aiding +a degree of experience in others, may lead them +to accomplish what I yet can describe but imperfectly.</p> + +<p>It seldom succeeds in men of great natural +strength, of tense fibre, of warm skin, of florid +complexion, or in those with a tight and cordy +pulse.</p> + +<p>If the belly in ascites be tense, hard, and circumscribed, +or the limbs in anasarca solid and resisting, +we have but little to hope.</p> + +<p>On the contrary, if the pulse be feeble or intermitting, +the countenance pale, the lips livid, the +skin cold, the swollen belly soft and fluctuating, or<span class='pagenum'><a name="Page_190" id="Page_190">[190]</a></span> +the anasarcous limbs readily pitting under the pressure +of the finger, we may expect the diuretic effects +to follow in a kindly manner.</p> + +<p>In cases which foil every attempt at relief, I have +been aiming, for some time past, to make such a +change in the constitution of the patient, as might +give a chance of success to the Digitalis.</p> + +<p>By blood-letting, by neutral salts, by chrystals +of tartar, squills, and occasional purging, I have +succeeded, though imperfectly. Next to the use +of the lancet, I think nothing lowers the tone of +the system more effectually than the squill, and consequently +it will always be proper, in such cases, to +use the squill; for if that fail in its desired effect, it +is one of the best preparatives to the adoption of the +Digitalis.</p> + +<p>A tendency to paralytic affections, or a stroke of +the palsy having actually taken place, is no objection +to the use of the Digitalis; neither does a +stone existing in the bladder forbid its use. Theoretical +ideas of sedative effects in the former, and +apprehensions of its excitement of the urinary organs +in the latter case, might operate so as to +make us with-hold relief from the patient; but experience +tells me, that such apprehensions are +groundless.<span class='pagenum'><a name="Page_191" id="Page_191">[191]</a></span></p> + + + +<h3><a name="INFERENCES" id="INFERENCES"></a>INFERENCES.</h3> + + +<p>To prevent any improper influence, which the +above recitals of the efficacy of the medicine, aided +by the novelty of the subject, may have upon the +minds of the younger part of my readers, in raising +their expectations to too high a pitch, I beg leave to +deduce a few inferences, which I apprehend the +facts will fairly support.</p> + +<p>I. That the Digitalis will not universally act as a +diuretic.</p> + +<p>II. That it does do so more generally than any +other medicine.</p> + +<p>III. That it will often produce this effect after +every other probable method has been fruitlessly +tried.</p> + +<p>IV. That if this fails, there is but little chance +of any other medicine succeeding.</p> + +<p>V. That in proper doses, and under the management +now pointed out, it is mild in its operation, +and gives less disturbance to the system, than squill, +or almost any other active medicine.</p> + +<p>VI. That when dropsy is attended by palsy, unsound +viscera, great debility, or other complication +of disease, neither the Digitalis, nor any other diuretic<span class='pagenum'><a name="Page_192" id="Page_192">[192]</a></span> +can do more than obtain a truce to the urgency +of the symptoms; unless by gaining time, it may +afford opportunity for other medicines to combat +and subdue the original disease.</p> + +<p>VII. That the Digitalis may be used with advantage +in every species of dropsy, except the encysted.</p> + +<p>VIII. That it may be made subservient to the +cure of diseases, unconnected with dropsy.</p> + +<p>IX. That it has a power over the motion of the +heart, to a degree yet unobserved in any other medicine, +and that this power may be converted to salutary +ends.<span class='pagenum'><a name="Page_193" id="Page_193">[193]</a></span></p> + + + +<h2 style="line-height: 150%"><a name="PRACTICAL" id="PRACTICAL"></a><span style="font-size: 70%">PRACTICAL</span><br /> +REMARKS ON DROPSY,<br /> +<span style="font-size: 80%">AND SOME OTHER DISEASES.</span></h2> + +<hr class="chapter" /> + +<p class="newchapter"><span class="firstword"><span class="dropcap">T</span>he</span> following remarks consist partly of matter +of fact, and partly of opinion. The former +will be permanent; the latter must vary with the +detection of error, or the improvement of knowledge. +I hazard them with diffidence, and hope +they will be examined with candour; not by a contrast +with other opinions, but by an attentive comparison +with the phœnomena of disease.</p> + + +<h3>ANASARCA.</h3> + +<p><a name="sect_1" id="sect_1"></a>§ 1. The anasarca is generally curable when seated +in the sub-cutaneous cellular membrane, or in +the substance of the lungs.</p> + +<p><a name="sect_2" id="sect_2"></a>§ 2. When the abdominal viscera in general are +greatly enlarged, which they sometimes are, without +effused fluid in the cavity of the abdomen; the +disease is incurable. After death, the more solid +viscera are found very large and pale. If the cavity +contains water, that water may be removed by +diuretics.<span class='pagenum'><a name="Page_194" id="Page_194">[194]</a></span></p> + +<p><a name="sect_3" id="sect_3"></a>§ 3. In swollen legs and thighs, where the resistance +to pressure is considerable, the tendency to +transparency in the skin not obvious, and where the +alteration of posture occasions but little alteration +in the state of distension, the cure cannot be effected +by diuretics.</p> + +<p>Is this difficulty of cure occasioned by spissitude +in the effused fluids, by want of proper communication +from cell to cell, or is the disease rather caused +by a morbid growth of the solids, than by an accumulation +of fluid?</p> + +<p>Is not this disease in the limbs similar to that of +the viscera (<a href="#sect_2">§ 2</a>)?</p> + +<p>§ 4. Anasarcous swellings often take place in palsied +limbs, in arms as well as legs; so that the swelling +does not depend merely upon position.</p> + +<p>§ 5. Is there not cause to suspect that many dropsies +originate from paralytic affections of the lymphatic +absorbents? And if so, is it not probable +that the Digitalis, which is so effectual in removing +dropsy, may also be used advantageously in some +kinds of palsy?</p> + + +<h3>ASCITES.</h3> + +<p>§ 6. If existing alone, (<i>i. e.</i>) without accompanying +anasarca, is in children curable; in adults +generally incurable by medicines. Tapping may be<span class='pagenum'><a name="Page_195" id="Page_195">[195]</a></span> +used here with better chance for success than in +more complicated dropsies. Sometimes cured by +vomiting.</p> + + +<h3>ASCITES <span style="letter-spacing: 0ex">and</span> ANASARCA.</h3> + +<p>§ 7. Incurable if dependant upon +irremediably diseased viscera, or on a gouty constitution, +so debilitated, that the gouty paroxysms no +longer continue to be formed.</p> + +<p>In every other situation the disease yields to diuretics +and tonics.</p> + + +<h3>ASCITES, ANASARCA, <span style="letter-spacing: 0ex">and</span> +HYDROTHORAX.</h3> + +<p>§ 8. Under this complication, though the +symptoms admit of relief, the restoration of the +constitution can hardly be hoped for.</p> + + +<h3>ASTHMA.</h3> + +<p><a name="sect_9" id="sect_9"></a>§ 9. The true spasmodic asthma, a rare disease—is +not relieved by Digitalis.</p> + +<p><a name="sect_10" id="sect_10"></a>§ 10. In the greater part of what are called +asthmatical cases, the real disease is anasarca of the +lungs, and is generally to be cured by diuretics. (See +<a href="#sect_1">§ 1</a>.) This is almost always combined with some +swelling of the legs.<span class='pagenum'><a name="Page_196" id="Page_196">[196]</a></span></p> + +<p><a name="sect_11" id="sect_11"></a>§ 11. There is another kind of asthma, in which +change of posture does not much affect the patient. +I believe it to be caused by an infarction of the +lungs. It is incurable by diuretics; but it is often +accompanied with a degree of anasarca, and so far +it admits of relief.</p> + +<p>Is not this disease similar to that in the limbs at +(<a href="#sect_3">§ 3</a>,) and also to that of the abdominal viscera at +(<a href="#sect_2">§ 2</a>.)?</p> + + +<h3>ASTHMA<span style="letter-spacing: 0ex"> and</span> ANASARCA.</h3> + +<p>§ 12. If the asthma be of the kind mentioned at +(§<a href="#sect_9">§ 9</a> and <a href="#sect_11">11</a>,) diuretics can only remove the accompanying +anasarca. But if the affection of the +breath depends also upon cellular effusion, as it +mostly does, the patient may be taught to expect a +recovery.</p> + + +<h3>ASTHMA <span style="letter-spacing: 0ex">and</span> ASCITES.</h3> + +<p>§ 13. A rare combination, but not incurable +if the abdominal viscera are sound. The +asthma is here most probably of the anasarcous +kind (<a href="#sect_10">§ 10</a>;) and this being seldom confined to the +lungs only, the disease generally appears in the following +form.<span class='pagenum'><a name="Page_197" id="Page_197">[197]</a></span></p> + + +<h3>ASTHMA, ASCITES, <span style="letter-spacing: 0ex">and</span> ANASARCA.</h3> + +<p>§ 14. The curability of this combination will +depend upon the circumstances mentioned in the +preceding section, taking also into the account the +strength or weakness of the patient.</p> + + +<h3>EPILEPSY.</h3> + +<p>§ 15. In epilepsy dependant upon effusion, the +Digitalis will effect a cure; and in the cases alluded +to, the dropsical symptoms were unequivocal. It +has not had a sufficient trial in my hands, to determine +what it can do in other kinds of epilepsy.</p> + + +<h3>HYDATID DROPSY.</h3> + +<p>§ 16. This may be distinguished from common +ascites, by the want of evident fluctuation. It is +common to both sexes. It does not admit of a +cure either by tapping or by medicine.</p> + + +<h3>HYDROCEPHALUS.</h3> + +<p>§ 17. This disease, which has of late so much +attracted the attention of the medical world, I believe, +originates in inflammation; and that the water +found in the ventricles of the brain after death, +is the consequence, and not the cause of the illness.</p> + +<p>It has seldom happened to me to be called upon +in the earlier stages of this complaint, and the symptoms<span class='pagenum'><a name="Page_198" id="Page_198">[198]</a></span> +are at first so similar to those usually attendant +upon dentition and worms, that it is very difficult +to pronounce decidedly upon the real nature of the +disease; and it is rather from the failure of the usual +modes of relief, than from any other more decided +observation, that we at length dare to give it a name.</p> + +<p>At first, the febrile symptoms are sometimes so +unsteady, that I have known them mistaken for the +symptoms of an intermittent, and the cure attempted +by the bark.</p> + +<p>In the more advanced stages, the diagnostics obtrude +themselves upon our notice, and put the situation +of the patient beyond a doubt. But this does +not always happen. The variations of the pulse, +so accurately described by the late Dr. Whytt, do +not always ensue. The dilatation of the pupils, +the squinting, and the aversion to light, do not +universally exist. The screaming upon raising the +head from the pillow or the lap, and the flushing of +the cheeks, I once considered as affording indubitable +marks of the disease; but in a child which I +sometime since attended with Dr. Ash, the pulse +was uniformly about 85, (except during the first +week, before we had the care of the patient.) The +child never shewed any aversion to the light; never +had dilated pupils, never squinted, never screamed +when raised from the lap or taken out of the bed, +nor did we observe any remarkable flushing of the +cheeks; and the sleep was quiet, but sometimes +moaning.<span class='pagenum'><a name="Page_199" id="Page_199">[199]</a></span></p> + +<p>Frequent vomiting existed from the first, but +ceased for several days towards the conclusion. One +or two worms came away during the illness, and it +was all along difficult to purge the child. Three +days before death, the right side became slightly +paralytic, and the pupil of that eye somewhat dilated.</p> + +<p>After death, about two ounces and a half of water +were found in the ventricles of the brain, and +the vessels of the dura mater were turgid with blood.</p> + +<p>If I am right as to the nature of hydrocephalus, +that it is at first dependant upon inflammation, or +congestion; and that the water in the ventricles is +a consequence, and not a cause of the disease; the +curative intentions ought to be extremely different +in the first and the last stages.</p> + +<p>It happens very rarely that I am called to patients +at the beginning, but in two instances wherein I was +called at first, the patients were cured by repeated +topical bleedings, vomits, and purges.</p> + +<p>Some years ago I mentioned these opinions, and +the success of the practice resulting from them, to +Dr. Quin, now physician at Dublin. That gentleman +had lately taken his degree, and had chosen +hydrocephalus for the subject of his thesis in the +year 1779. In this very ingenious essay, which he +gave me the same morning, I was much pleased to +find that the author had not only held the same<span class='pagenum'><a name="Page_200" id="Page_200">[200]</a></span> +ideas relative to the nature of the disease, but had +also confirmed them by dissections.</p> + +<p>In the year 1781, another case in the first stage +demanded my attention. The reader is referred +back to <a href="#CASElxix">Case LXIX</a> for the particulars.</p> + +<p>I have not yet been able to determine whether the +Digitalis can or cannot be used with advantage in +the second stage of the hydrocephalus. In <a href="#CASExxxiii">Case +XXXIII</a>. the symptoms of death were at hand; in +<a href="#CASElxix">Case LXIX</a>. the practice, though successful, was too +complicated, and in <a href="#CASEcli">Case CLI</a>. the medicine was +certainly stopped too soon.</p> + +<p>When we consider what enormous quantities of +mercury may be used in this complaint, without affecting +the salivary glands, it seems probable that +other parts may be equally insensible to the action +of their peculiar stimuli, and therefore that the Digitalis +ought to be given in much larger doses in this, +than in other diseases.</p> + + +<h3>HYDROTHORAX.</h3> + +<p>§ 18. Under this name I also include the +dropsy of the pericardium.</p> + +<p>The intermitting pulse, and pain in the arms, sufficiently +distinguish this disease from asthma, and +from anasarcous lungs.</p> + +<p>It is very universally cured by the Digitalis.<span class='pagenum'><a name="Page_201" id="Page_201">[201]</a></span></p> + +<p>§ 19. I lately met with two cases which had been +considered and treated as angina pectoris. They +both appeared to me to be cases of hydrothorax. +One subject was a clergyman, whose strength had +been so compleatly exhausted by the continuance of +the disease, and the attempts to relieve it, that he +did not survive many days. The other was a lady, +whose time of life made me suspect effusion. I directed +her to take small doses of the pulv. Digitalis, +which in eight days removed all her complaints. +This happened six months ago, and she remains +perfectly well.</p> + + +<h3>HYDROTHORAX <span style="letter-spacing: 0ex">and</span> ANASARCA.</h3> + +<p>§ 20. This combination is very frequent, and, +I believe, may always be cured by the Digitalis.</p> + +<p>§ 21. Dropsies in the chest either with or without +anasarcous limbs, are much more curable than those +of the belly. Probably because the abdominal viscera +are more frequently diseased in the latter than +in the former cases.</p> + + +<h3>INSANITY.</h3> + +<p>§ 22. I apprehend this disease to be more +frequently connected with serous effusion than has +been commonly imagined.</p> + +<p>§ 23. Where appearances of anasarca point out the +true cause of the complaint, as in cases <a href="#CASExxiv">XXIV</a>. and<span class='pagenum'><a name="Page_202" id="Page_202">[202]</a></span> +<a href="#CASExxxiv">XXXIV</a>. the happiest effects may be expected from +the Digitalis; and men of more experience than myself +in cases of insanity, will probably employ it successfully +in other less obvious circumstances.</p> + + +<h3>NEPHRITIS CALCULOSA.</h3> + +<p>§ 24. We have had sufficient evidence of the efficacy +of the Foxglove in removing the Dysuria and +other symptoms of this disease; but probably it is +not in these cases preferable to the tobacco.<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a></p> + + +<h3>OVARIUM DROPSY.</h3> + +<p>§ 25. This species of encysted dropsy is not without +difficulty distinguishable from an ascites; and +yet it is necessary to distinguish them, because the +two diseases require different treatment and because +the probality of a cure is much greater in one than +in the other.</p> + +<p>§ 26. The ovarium dropsy is generally slow in its +progress; for a considerable time the patient though +somewhat emaciated, does not lose the appearance +of health, and the urine flows in the usual quantity. +It is seldom that the practitioner is called in early +enough to distinguish by the feel on which side the +cyst originated, and the patients do not attend to +that circumstance themselves. They generally menstruate +<span class='pagenum'><a name="Page_203" id="Page_203">[203]</a></span>regularly in the incipient state of the disease, +and it is not until the pressure from the sac becomes +very great, that the urinary secretion diminishes. +In this species of dropsy, the patients, +upon being questioned, acknowledge even from a +pretty early date, pains in the upper and inner +parts of the thighs, similar to those which women +experience in a state of pregnancy. These pains +are for a length of time greater in one thigh than in +the other, and I believe it will be found that the +disease originated on that side.</p> + +<p>§ 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<a href="#CASElxi"> LXIst +case</a> the patient was too much reduced, and the +disease too far advanced to allow of a cure by any +method; but it teaches us that a caustic may be +used with safety.</p> + +<p>§ 28. When tapping becomes necessary, I always +advise the adoption of the waistcoat bandage +or belt, invented by the late very justly celebrated +Dr. Monro, and described in the first volume of +the Medical Essays. I also enjoin my patients to +wear this bandage afterwards, from a persuasion +that it retards the return of the disease. The proper +use of bandage, when the disorder first discovers +itself, certainly contributes much to prevent its +increase.<span class='pagenum'><a name="Page_204" id="Page_204">[204]</a></span></p> + + +<h3>OVARIUM DROPSY <span style="letter-spacing: 0ex">with</span> ANASARCA.</h3> + +<p>§ 29. The anasarca does not appear until the encysted +dropsy is very far advanced. It is then probably +caused by weakness and pressure. The Digitalis +removes it for a time.</p> + + +<h3>PHTHISIS PULMONALIS.</h3> + +<p>§ 30. This is a very increasing malady in the present +day. It is no longer limited to the middle part +of life: children at five years of age die of it, and +old people at sixty or seventy. It is not confined +to the flat-chested, the fair-skinned, the blue eyed, +the light-haired, or the scrophulous: it often attacks +people with full chests, brown skins, dark hair and +eyes, and those in whose family no scrophulous taint +can be traced. It is certainly infectious. The very +strict laws still existing in Italy to prevent the infection +from consumptive patients, were probably not +enacted originally without a sufficient cause. We +seem to be approaching to that state which first +made such restrictions necessary, and in the further +course of time, the disease will probably fall off +again, both in virulency and frequency.</p> + +<p>§ 31. The younger part of the female sex are +liable to a disease very much resembling a true consumption, +and from which it is difficult to distinguish +it; but this disease is curable by steel and bitters. +A criterion of true phthisis has been sought for in the<span class='pagenum'><a name="Page_205" id="Page_205">[205]</a></span> +state of the teeth; but the exceptions to that rule +are numerous. An unusual dilatation of the pupil +of the eye, is the most certain characteristic.<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a></p> + +<p>§ 32. Sydenham asserts, that the bark did not +more certainly cure an intermittent, than riding did +a consumption. We must not deny the truth of an +assertion, from such authority, but we must conclude +that the disease was more easily curable a century +ago than it is at present.</p> + +<p>§ 33. If the Digitalis is no longer useful in consumptive +cases, it must be that I know not how to +manage it, or that the disease is more fatal than formerly; +for it would be hard to deny the testimony +cited at page 9. I wish others would undertake +the enquiry.</p> + +<p>§ 34. When phthisis is accompanied with anasarca, +or when there is reason to suspect hydrothorax, the +Digitalis will often relieve the sufferings, and prolong +the life of the patient.</p> +<p><span class='pagenum'><a name="Page_206" id="Page_206">[206]</a></span></p> +<p>§ 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.</p> + +<p>After some days a copious purulent discharge issued +from the opening, his cough became less troublesome, +his expectoration less copious, his appetite +and strength returned, he got abroad, and the wound, +which became very troublesome, was allowed to heal.</p> + +<p>He then undertook a journey to London; whilst +there he became worse: returned home, and died +consumptive some weeks afterwards.<span class='pagenum'><a name="Page_207" id="Page_207">[207]</a></span></p> + + +<h3>PUERPERAL ANASARCA.</h3> + +<p>§ 36. This disease admits of an easy and certain +cure by the Digitalis.</p> + +<p>§ 37. This species of dropsy may originate from +other causes than child birth. In the beginning of +last <i>March</i>, a gentleman at Wolverhampton desired +my advice for very large and painful swelled legs and +thighs. He was a temperate man, not of a dropsical +habit, had great pain in his groins, and attributed +his complaints to a fall from his horse. He +had taken diuretics, and the strongest drastic purgatives +with very little benefit. Considering the +anasarca as caused by the diseased inguinal glands, +I ordered common poultice and mercurial ointment +to the groins, three grains of pulv. fol. Digitalis +night and morning, and a cooling diuretic decoction +in the day-time. He soon lost his pain, and the +swellings gradually subsided.</p> + + +<p class="center" style="padding-top: 2em; letter-spacing: 0.25ex">THE END.</p> + +<div class="footnotes"><h3>FOOTNOTES:</h3> + +<div class="footnote"><p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> See an original and valuable treatise by Dr. Fowler, entitled, +<i>Medical Reports of the Effects of Tobacco</i>.</p></div> + +<div class="footnote"><p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Many years ago I communicated to my friend, Dr. Percival, +an account of some trials of breathing fixed air in consumptive +cases. The results were published by him in the second Vol. of +his very useful Essays Medical and Experimental, and have since +been copied into other publications. I take this opportunity of +acknowledging that I suspect myself to have been mistaken in the +nature of the disease there mentioned to have been cured. I believe +it was a case of <i>Vomica</i>, and not a true <i>Phthisis</i> that was cured. +The Vomica is almost always curable. The fixed air corrects the +smell of the matter, and very shortly removes the hectic fever. +My patients not only inspire it, but I keep large jars of the effervescing +mixture constantly at work in their chambers.</p></div> +</div> + + +<div class="advertisements"> + +<p><span style="font-size: 150%; letter-spacing: 0.25ex">BOOKS</span>,<br style="line-height: 3em" /> + +Printed for G. G. J. and J. <span style="letter-spacing: 0.25ex">ROBINSON</span>,<br /> +Booksellers, Paternoster-Row, London.</p> + +<p><span style="font-size: 80%">AN ACCOUNT OF THE</span><br style="line-height: 3em" /> + +<span style="font-size: 150%">Scarlet Fever and Sore Throat,</span><br /> + +Or, <big><span style="letter-spacing: 0.25ex">SCARLATINA ANGINOSA</span>;</big><br style="line-height: 3em" /> + +<span style="font-size: 90%">Particularly as it appeared at <span style="letter-spacing: 0.25ex">BIRMINGHAM</span> in</span><br /> +<span style="font-size: 90%">the Year 1778.</span></p> + +<p>By <span style="letter-spacing: 0.25ex">WILLIAM WITHERING</span>, M. D.</p> + +<p>Price 1s. 6d.</p> + +<p style="padding-top: 1em">Also, Price 2s. 6d.</p> + +<p><span style="font-size: 150%">Outlines of <span style="letter-spacing: 0.25ex">MINERALOGY</span>,</span><br style="line-height: 3em" /> + +<span style="font-size: 90%">Translated from the original of Sir <span class="smcap">Torbern +Bergman</span>; with <span style="letter-spacing: 0.25ex">NOTES</span>,</span></p> + +<p>By <span style="letter-spacing: 0.25ex">WILLIAM WITHERING</span>, M. D.</p> + +<p style="font-size: 80%">Member of the Royal Medical Society at Edinburgh.</p> + +<hr /> + +<p><span style="font-size: 90%">In the Spring of the Year 1786, will be published, by</span><br /> +<span style="font-size: 90%">the same Author, a New Edition of the</span><br /> + +<span style="font-size: 140%">BOTANICAL ARRANGEMENT.</span><br style="line-height: 3em" /> + +<span style="font-size: 80%">With very great Additions; in Three Vols.</span><br /> +<span style="font-size: 80%">large Octavo.</span></p> +</div> + +<div class="note"> + +<h3><b>Transcriber's Notes</b></h3> + +<p>Obvious printer's errors have been fixed. For the detailed list, please +see below. The frontispiece has been moved from the beginning of the book +to the section explaining it.</p> + +<h4>Errors fixed</h4> + +<ul> +<li>page <a href="#Page_xvi">xvi</a>—typo fixed: changed 'afterterwards' to 'afterwards'</li> +<li>page <a href="#Page_29">029</a>—typo fixed: changed 'apetite' to 'appetite'</li> +<li>page <a href="#Page_43">043</a>—typo fixed: removed an extra 'in' after 'and she died'</li> +<li>page <a href="#Page_62">062</a>—typo fixed: changed 'Dovers' to 'Dover's' after 'seneka'</li> +<li>page <a href="#Page_95">095</a>—typo fixed: changed 'ef' to 'of' after 'whilst the rest'</li> +<li>page <a href="#Page_98">098</a>—typo fixed: changed 'harrassed' to 'harassed'</li> +<li>page <a href="#Page_103">103</a>—typo fixed: changed 'Shiffnal' to 'Shiffnall'</li> +<li>page <a href="#Page_106">106</a>—spelling normalized: changed 'Fox-glove' to 'Foxglove'</li> +<li>page <a href="#Page_110">110</a>—typo fixed: changed 'suceed' to 'succeed' after 'hope it might'</li> +<li>page <a href="#Page_111">111</a>—typo fixed: changed 'atttention' to 'attention' after 'repeated without'</li> +<li>page <a href="#Page_114">114</a>—typo fixed: changed 'disgreeable' to 'disagreeable' after 'or any other'</li> +<li>page <a href="#Page_115">115</a>—typo fixed: removed an extra 'the' in front of '7th of April'</li> +<li>page <a href="#Page_123">123</a>—typo fixed: changed 'susspended' to 'suspended' after 'the medicine to be'</li> +<li>page <a href="#Page_135">135</a>—typo fixed: changed 'vomitted' to 'vomited' after 'that she'</li> +<li>page <a href="#Page_141">141</a>—typo fixed: changed 'contiued' to 'continued' after 'He'</li> +<li>page <a href="#Page_148">148</a>—typo fixed: changed 'praecordia' to 'prœcordia'</li> +<li>page <a href="#Page_158">158</a>—typo fixed: changed 'spoonfulls' to 'spoonfuls'</li> +<li>page <a href="#Page_163">163</a>—typo fixed: changed 'mecine' to 'medicine'</li> +<li>page <a href="#Page_164">164</a>—typo fixed: changed 'slighest' to 'slightest' after 'distressing on the'</li> +<li>page <a href="#Page_166">166</a>—typo fixed: changed 'ipecacohana' to 'ipecacoanha'</li> +<li>page <a href="#Page_170">170</a>—typo fixed: changed 'meridiaana' to 'meridiana'</li> +<li>page <a href="#Page_196">196</a>—typo fixed: removed an extra 'the' in front of 'abdominal viscera'</li> +<li>page <a href="#Page_200">200</a>—typo fixed: removed an extra 'and' after 'from asthma'</li> +</ul> + +</div> + + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of An Account of the Foxglove and some of +its Medical Uses, by William Withering + +*** END OF THIS PROJECT GUTENBERG EBOOK AN ACCOUNT OF THE FOXGLOVE *** + +***** This file should be named 24886-h.htm or 24886-h.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. 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