CASECXLVI.

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

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

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

Nov.13th. Mrs. A—— of W——h——, Æt. 68. One of those rare cases in which no urine is secreted. It proved as refractory as usual to remedies, and not having ever succeeded in the cure of this disease, I determined to try the Digitalis. It was given in infusion, and, after a few doses, the secretion of a small quantity of urine seemed to justify the attempt. The next day, however, the secretionceased, 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.

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

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

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

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

December7th. 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.

December27th. 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. InMarchfollowing 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 narrativesee case the first, communicated by Mr. Yonge.

December31st. 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.

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 atCXLIX. 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 givenin infusion. At first it checked the vomitings, but did not occasion any secretion of urine.

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.

FOOTNOTES:[4]Then resident at Lichfield, now at Derby.[5]This disease has lately been well described by Mr. White, of Manchester.

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

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

Thefour 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.

March15th, 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.

November18th, 1780. Henry Warren, Æt. 60. This man had a general anasarca and ascites, and was moreover so asthmatic, that, neither being able to sit in a chair nor lie in bed, he was obliged constantly to walk about, or to lean forward against a window or table. You prescribed for him thus.

R. Aq. cinn. spt. ℥iv.Oxymel. scillit.Syr. scillit. aa. ℥i. m. cap. cochlear. larg. sexta quaque horâ.

R. Aq. cinn. spt. ℥iv.

Oxymel. scillit.

Syr. scillit. aa. ℥i. m. cap. cochlear. larg. sexta quaque horâ.

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

November3d, 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.

March16th, 1782. Mary Bird, Æt. 61. Great fullness about the stomach; diseased liver, and anasarcouslegs and thighs. For the first week squill was tried in more forms than one, but without advantage. On the 22d she began with the Digitalis, which presently removed all the swelling.

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

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

Shiffnall, April 26th, 1785.Dear Sir,During my residence in the Birmingham General Hospital, I had frequent opportunities of seeing the great effects of the Digitalis in dropsy. As the exhibition of it was in the following instances immediately under your own direction, I have drawn them up for your inspection, previous to your publishing upon that excellent diuretic. Of its efficacy in dropsy I have considerable evidence in my possession, but consider myself not at liberty to send you any other cases except those you had yourself the conduct of. The Digitalis is a very valuable acquisition to medicine; and, I trust, it will cease to be dreaded when it is well understood.I am, Sir, your obedient,And very humble servant,W. BAYLEY.

Shiffnall, April 26th, 1785.

Dear Sir,

During my residence in the Birmingham General Hospital, I had frequent opportunities of seeing the great effects of the Digitalis in dropsy. As the exhibition of it was in the following instances immediately under your own direction, I have drawn them up for your inspection, previous to your publishing upon that excellent diuretic. Of its efficacy in dropsy I have considerable evidence in my possession, but consider myself not at liberty to send you any other cases except those you had yourself the conduct of. The Digitalis is a very valuable acquisition to medicine; and, I trust, it will cease to be dreaded when it is well understood.

I am, Sir, your obedient,And very humble servant,W. BAYLEY.

Mary Hollis, aged 62, was admitted an out patient of the Birmingham General HospitalFebruary12th, 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 ofMaywas discharged perfectly cured. The diuretic effects of the Digitalis were in this instance immediate.

Edward James, Æt. 21. AdmittedMarch20th, 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 smalland quick, complained when he turned in bed, of something like water rolling from one side of the thorax to the other. A remarkable blueness about the mouth and eyes, and purged considerably from the pil. scill. Ordered to omit the pills and to take ℥i. of infus. Digitalis every eight hours; the proportion ʒiss. to eight ounces of water and ℥i. of aq. n. m. sp.—7th Day, The infusion had neither purged, nor vomited him: he only complained once or twice of giddiness. His belly was now very hard, rather black on the right side the navel, and his legs amazingly swelled. Ordered a bolus with rhubarb and calomel, to be taken in the morning, and ℥ii. julep salin. cum tinct. canthar. gutt. forty ter die.—12th Day, nearly in the same state, except his breathing which was somewhat more difficult, being now obliged to have his head considerably raised. Persistat—From this day to the 32d day he became hourly worse. His belly which at first was only hard, now evidently contained a large quantity of water, his legs were more swelled, and a large sphacelated sore appeared upon each outer ancle. Respiration was so much obstructed, that he was obliged to sit quite upright to prevent suffocation. He made very little water, not more than eight ounces in a day and a night, and was much emaciated. Ordered his purging bolus again, and ℥ii. of a mixture with sal diuretic, ℥ss. to ℥xii. three times in a day, and a poultice with ale grounds to his legs.

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

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

W. BAYLEY.

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

General Hospital, August 5, 1784.

On the 26thFebruary, 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 anda 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 ofMarch, she made rapid advances towards health, when not a symptom of disease remaining, she was discharged.

London, Norfolk-street,May 31st, 1785.Sir,I had the favour of your letter last week; and I shall be very happy if I can give you any intelligence relating to the Foxglove, that can answer the purpose in which you are so laudably engaged.It is true that my brother, the late Dr. Cawley, was greatly relieved, and his life, perhaps, prolonged for a year, by a decoction of the Foxglove root; but why it had not a more lasting effect, it is necessary I should tell you that he had all the signs of a distempered viscera, long before any watery swellings appeared; it was manifest that his dropsy was merely symptomatic, and he could therefore only from time to time have any relief from medicine. In the year 1776, he returned from London to Oxon. having consulted several physicians at the former place, and Dr. Vivian at the latter, but without any success; and he was then told of a carpenter at Oxon. that had been cured of a Hydrops pectoris by the Foxglove root, and as hewas a younger, and in other respects an healthy man, his cure, I believe, remains a perfect one.I did not attend my brother whilst he took the medicine, and therefore I cannot speak precisely to the operation of it; but I remember, by his letters, that he was dreadfully sick and ill for several days before the secretion of urine came on, but which it did do to a great degree; relieved his breath, and greatly lessened the swelling in his legs and thighs; but the two instances I have lately seen in this part of the world, are much stronger proofs of the efficacy of it than my brother's case.I am, &c.ROBERT CAWLEY.N. B. Whenever I have another opportunity of giving the Foxglove, it shall be in small doses:—In which I should hope it might succeed, although it might be more slowly. If you should try it with success, I should be glad to know what mode you made use of.

London, Norfolk-street,May 31st, 1785.

Sir,

I had the favour of your letter last week; and I shall be very happy if I can give you any intelligence relating to the Foxglove, that can answer the purpose in which you are so laudably engaged.

It is true that my brother, the late Dr. Cawley, was greatly relieved, and his life, perhaps, prolonged for a year, by a decoction of the Foxglove root; but why it had not a more lasting effect, it is necessary I should tell you that he had all the signs of a distempered viscera, long before any watery swellings appeared; it was manifest that his dropsy was merely symptomatic, and he could therefore only from time to time have any relief from medicine. In the year 1776, he returned from London to Oxon. having consulted several physicians at the former place, and Dr. Vivian at the latter, but without any success; and he was then told of a carpenter at Oxon. that had been cured of a Hydrops pectoris by the Foxglove root, and as hewas a younger, and in other respects an healthy man, his cure, I believe, remains a perfect one.

I did not attend my brother whilst he took the medicine, and therefore I cannot speak precisely to the operation of it; but I remember, by his letters, that he was dreadfully sick and ill for several days before the secretion of urine came on, but which it did do to a great degree; relieved his breath, and greatly lessened the swelling in his legs and thighs; but the two instances I have lately seen in this part of the world, are much stronger proofs of the efficacy of it than my brother's case.

I am, &c.ROBERT CAWLEY.

N. B. Whenever I have another opportunity of giving the Foxglove, it shall be in small doses:—In which I should hope it might succeed, although it might be more slowly. If you should try it with success, I should be glad to know what mode you made use of.

Dr. Cawley's prescription.

R. Rad. Digital. purpur. siccat. et contus. ℥ii.Coque ex aq. font. ℔ii. ad ℔i. colat. liquor. adde aq. junip. comp. ℥ii.Mell. anglic ʒi. m. sumat cochl. iv. omni nocte h. s. et mane.

R. Rad. Digital. purpur. siccat. et contus. ℥ii.

Coque ex aq. font. ℔ii. ad ℔i. colat. liquor. adde aq. junip. comp. ℥ii.

Mell. anglic ʒi. m. sumat cochl. iv. omni nocte h. s. et mane.

—I have elsewhere remarked, that when the Digitalis has been properly given, and the diuretic effects produced, that an accidental over-dose bringing on sickness, has stopped the secretion of urine. In the present instance it likewise appears, that violent sickness may be excited, and continue for several days without being accompanied by a flow of urine; and it is probable that the latter circumstance did not take place, until the severity of the former abated. If Dr. Cawley had not had a constitution very retentive of life, I think he must have died from the enormous doses he took; and he probably would have died previous to the augmentation of the urinary discharge. For if the root from which his medicine was prepared, was gathered in its active state, he did not take at each dose less thantwelvetimes 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 dosestwelvetimes 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!

Broseley, 25th May, 1785.DearSir,Have inclosed the prescriptions that contained the fol. Digital. which I gave to Thomas Cooke and Thomas Roberts.Thomas Cooke, Æt. 49, had been ill about two or three weeks. When I saw him he had no appetite, and a constant thirst: a fullness and load in the stomach: the thighs, legs and hands, much swell'd, and the face and throat in a morning; was costive, and made but little water, which was high coloured; the pulse very weak, and his breath exceeding bad.June17th. 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. FromJune17th to the 29th, the symptoms were mostly removed, making water freely, and having plenty of stools; in a week after he was perfectly well, and remains so ever since. The cure was finished by steel and bitters.Thomas Roberts, Æt. 40, had a deformed chest, was obliged to be almost in an erect posture when in bed; the other symptoms were nearly the same as Cooke's.August3d. The pills prescribedJune17th for Cooke.—17th. A purging bolus of jalap and Digitalis, once a week. He continued the medicines till the latter end ofAugust, when he got very well; but the complaint returned inJan.worse than before. He is now much better, but I have great reason to believe the liver to be diseased.I am, with the greatest respect,Your very obliged humble servant,DANIEL BODEN.P. S. The second patient, on his relapse, took Digitalis again, combined with other things.

Broseley, 25th May, 1785.

DearSir,

Have inclosed the prescriptions that contained the fol. Digital. which I gave to Thomas Cooke and Thomas Roberts.

Thomas Cooke, Æt. 49, had been ill about two or three weeks. When I saw him he had no appetite, and a constant thirst: a fullness and load in the stomach: the thighs, legs and hands, much swell'd, and the face and throat in a morning; was costive, and made but little water, which was high coloured; the pulse very weak, and his breath exceeding bad.June17th. 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. FromJune17th to the 29th, the symptoms were mostly removed, making water freely, and having plenty of stools; in a week after he was perfectly well, and remains so ever since. The cure was finished by steel and bitters.

Thomas Roberts, Æt. 40, had a deformed chest, was obliged to be almost in an erect posture when in bed; the other symptoms were nearly the same as Cooke's.August3d. The pills prescribedJune17th for Cooke.—17th. A purging bolus of jalap and Digitalis, once a week. He continued the medicines till the latter end ofAugust, when he got very well; but the complaint returned inJan.worse than before. He is now much better, but I have great reason to believe the liver to be diseased.

I am, with the greatest respect,Your very obliged humble servant,DANIEL BODEN.

P. S. The second patient, on his relapse, took Digitalis again, combined with other things.

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 wasSept.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 easiestposture 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.—November22d. 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 untilSeptember1781, 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 ofSeptemberI 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; hehad 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 ofApril1782, 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.

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

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

January2d, 1785. Mrs. S——, of W——, near Kidderminster, aged 38, has been affected with dropsical swellings of her legs and thighs, about six weeks, which have gradually grown worse; has now great difficulty in breathing, which is much increased on moving; a very irregular, intermittent pulse, urine in very small quantity, and in the seventh month of her pregnancy: a woman of very delicate constitution, with tender lungs from her infancy and very subject to long continued coughs.

R. Pulv. scillæ gr. iii.Jalap gr. x. syr. rosar. solut. tinct. senn. aa ʒii. aq. menth. v. simpl. ℥iss. m. mane sumend.

R. Pulv. scillæ gr. iii.

Jalap gr. x. syr. rosar. solut. tinct. senn. aa ʒii. aq. menth. v. simpl. ℥iss. m. mane sumend.

R. pulv. scillæ ℈i. G. ammoniac, sapon. venet. aa ʒiss. syr. q. s. f. pilul. 42 cap. iii. nocte maneque.

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

R. Fol. siccat. Digital. ʒiii. coque in. aq. fontan. ℥xii. ad ℥vi. cola et adde. aq. juniper. comp. ℥ii. sacchar. alb. ℥ss. m. cap. cochlear. i. larg. 4tis horis.

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

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

R. Fol. sicc. Digital. G. assafetid. aa ʒi. calomel. pp. gr. x. sp. lavand. comp. q. s. fiat pilul. xxxii. cap. ii. omni nocte horâ somni.

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

March15th she was delivered: had a good labour, was treated as is usual, except in not having her breasts drawn, not intending see should suckle her child, being in so reduced a state. Continued going on well till the 18th, when she was seized with very violent pains across her loins, at times so violent as to make her cry out as much as labour pains. Enema cathartic. Fot. papav. applied to the part.

R. Pulv. ipecacoan. gr. vi. opii. gr. iv. syr. q. s. fiat pilul. vi. capt. i. 2da quaque horâ durante dolore.

R. Julep, e camphor, sp. minder. aa ℥ii. capt. cochlear, i. larg. post singul. pilul.

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

R. Gum ammoniac, assafetid. aa ʒi. camphor. gr. xii. fiat pilul. 24. capt. ii. 3tia quaque horâ in cochlear. ii. mixtur. seq.

R. Balsam. peruv. ʒiii. mucilag. G. arab. q. s. flor. zinci g. vi. aq. menth. simp. ℔ss. m.

Applic. Emp. vesicat. femorib. internis.

R. Sp. vol. fœtid. elixir. paregor. balsam.Traumatic. aa ʒiii. capt. cochlear. parv. urgente languore.

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

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

R. Infus. baccar. juniper, ℥vi. tinct. amar. tinct. stomachic. aa ℥i. m.

25th. Much the same.

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

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

Applic. Emp. vesicat. stomacho et sterno.

R. G. assafetid. ℈ii. pulv. jacob. ℈i. rad. scill. recent. gr. xii. extract. thebaic. gr. iv. f. pilul. xvi. cap. iv. omni nocte.

R. Sal. nitr. sal. diuretic. aa ʒii. pulv. e contrayerv. comp. ʒi. sacchar. ℥i. emuls. commun. ℔i. aq. cinnam. simpl. ℥i. m. capt. cochlear. iv. ter die.

April2d. Much the same, no increase of urine.

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

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

R. Fol. siccat. Digital. G. assafetid. aa ʒi. sp. lavand. comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node cap. pilul. e styrace gr. vi.

17th. Considerable increase of urine.

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

Applic. Emp. vesicat. femoribus internis.

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

25th. Swelling much diminished, makes plenty of water, appetite much mended, cough and breathing better. She omitted the medicine for three days; the urine began to diminish, the swelling and shortness of breathing worse. On repeating it for two days, the discharge was again augmented, and a diminution of the swelling succeeded. She has continued the pills ever since till the 14th ofMay; 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.

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,particularlythevital? 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 theneglectof adhereing to acertainandregularpreparation of the nicotiana, and thewant(of what youemphaticallycall) apracticabledose, have been the chief causes of the once rising reputation ofthat 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 yourprecepts,guards, andcautionstowards the safe and successful use of such a powerful sedative diuretic; and I have no doubt of your minute attention to those particulars, from a regard to the good and welfare of mankind, as well as to your own reputation with respect to that medicine.

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

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

December, 1782. A poor woman, who had been afflicted with an ague during the whole of her pregnancy, and for two months with dropsical swellings of the feet, legs, thighs, abdomen, and labia pudenda; was at the expiration of the seventh monthtaken 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.

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 specifyingthe nature of the disease, and when the dropsy is attended with any other affection shall notice it.

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

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 ofJuneshe 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.

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.

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

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

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

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.

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

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.

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

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.

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.

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.

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.

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

—— 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.

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.

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 inthe abdomen, and a very great œdema of the legs and thighs. His breathing was very short, and rather laborious, appetite bad, and thirst considerable. His belly was bound, and he passed very small quantities of high-coloured urine, that deposited a reddish matter. He had taken medicines some time, and, I believe, the Digitalis; and had been better.

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

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

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.

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.

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.

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.

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

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.

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.

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.

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

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

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

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

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