REMARKS.

DearSir,Having lately experienced the diuretic powers of the Foxglove, in a case of anasarca; I do myself the pleasure of communicating a short history of the treatment to you.I am, &c.W. JONES.Birmingham,May 17th, 1785.

DearSir,

Having lately experienced the diuretic powers of the Foxglove, in a case of anasarca; I do myself the pleasure of communicating a short history of the treatment to you.

I am, &c.W. JONES.

Birmingham,May 17th, 1785.

My patient, Mrs. C——, who is in her 51st year, had the following symptoms, viz. alternate swelling of the legs and abdomen, a little cough, shortness of breath in a morning, thirst, weak pulse, and her urine, which was so small in quantity as seldom to amount to half a pint in twenty-four hours, deposited a clay-coloured sediment.

April16th, 1785, I directed the following form:

R. Fol. Digitalis siccat. ʒii.Aq. fontanæ bullient. ℥viii. f. infus. et cola. Sumat cochl. larga iii. o. n. et mane.

On the 17th she had taken twice of the infusion, and though by mistake only two tea spoonfuls for adose, yet the quantity of urine was increased to about a pint in the twenty-four hours. She was then directed to take two table spoonfuls night and morning. And.

On the 18th, a degree of nausea was produced. A pint and half of urine was made in the last twenty-four hours. During the time above specified she had two or three stools every day. The infusion was now omitted.

On the 19th the swelling of the legs was removed. A degree of nausea took place in the morning, and increased so much during the day, that she vomited up all her food and medicine. As she was very low, and complained of want of appetite, a cordial julep was directed to be taken occasionally, as well as red port and water, mint tea, &c. She informed me that whatever she took generally staid about an hour before it came up again, and that the mint tea staid longest on the stomach. The vomiting decreased gradually, and ceased on the 22d. The discharge of urine remained considerable during the three following days, but its quantity was not measured.

22d. A dose of neutral saline julep was directed to be taken every fourth hour.

On the 23d she complained of thirst, and thought the discharge of urine not so copious as on the preceding days, therefore the saline julep was continuedevery fourth hour, with the addition of thirty drops of the following medicine:

R. Aceti scillitic. ʒvi.Tinct. aromat. ʒii.Tinct. thebaic. gutt. xx. m.

The bowels have been kept open from the 19th, by the occasional use of emollient injections.

On the 24th the legs were much swelled again; she complained of languor and a degree of nausea. The discharge of urine increased a little since the 23d. Her pulse was low and her tongue white. The urine, which had been rendered clear by the infusion of Foxglove, now deposited a whitish sediment.

On the 25th her appetite began to return, the swelling of the legs diminished, and she thought herself much relieved. The urine was considerable in quantity, and clear.

On the 26th she was thirsty and languid. The swelling was removed; the quantity of urine discharged in the last twenty-four hours was about a pint. She continued to mend from this time, and is now in good health.

A giddiness of the head, more or less remarkable at times, was observed to follow the use of the Foxglove, and it lasted nine or ten days.

This is the second time that I have relieved this patient by the infusion of Foxglove. I used the same proportion of the fresh leaves the first time as I did of the dried ones the last. The violent vomiting which followed the use of the infusion made with the dried leaves, did not take place with the fresh though she took near a pint made with the same proportion of the herb fresh gathered.

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 theinfusion of the green leaves, and it produced precisely the same effects for it increased the urinary discharge, without exciting the violent vomiting.

DearSir,The following cases are selected from many others in which I have given the Digitalis purpurea; and from repeated experience of its efficacy after other diuretics have failed. I can recommend it as an effectual, and when properly managed, a safe medicine.I am, &c.E. JOHNSTONE.Birmingham, May 26, 1785.

DearSir,

The following cases are selected from many others in which I have given the Digitalis purpurea; and from repeated experience of its efficacy after other diuretics have failed. I can recommend it as an effectual, and when properly managed, a safe medicine.

I am, &c.E. JOHNSTONE.

Birmingham, May 26, 1785.

March8th, 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 insmall quantity; body costive; pulse natural; face much emaciated, eyes yellow and depressed. He had been subject to cough and difficulty of breathing in the winter for several years; and about four years before this time, after being exposed to cold, was suddenly deprived of his speech and the use of the right side, which he recovered as the warm weather came on; but since that time had been remarkably costive, and was in every respect much debilitated. He first perceived his legs swell about a year ago; by the use of medicines and exercise, the swellings subsided during the summer, but returned on the approach of winter, and gradually increased to the state in which I found them, notwithstanding he had used different preparations of squills and a great variety of other diuretic medicines. I ordered the following mixture.

R. Foliorum Digitalis purpur. recent. ʒiii. decoque ex aq. fontan. ℥xii ad ℥vi colaturæ adde Tinctur. aromatic.Syr. zinzib. aa ℥i. m. capt. cochl. duo larga secunda quaque hora ad quartam vicem nisi prius nausea supervenerit.

March9th. He took four doses of the mixture without being in the least sick, and made, during the night upwards of two quarts of natural coloured water.

10th. Took the remainder of the mixture yesterday afternoon and evening, and was sick for a short time, but made nearly the same quantity of water as before, the swellings are considerably diminished, his appetite increased, but he is still costive.

R. Argent, viv. balsam peruv. aa ʒss tere ad extinctionem merc. et adde gum. ammon. ℈iii aloes socotorin. ʒss rad. scil. recent. ℈ss syr. simpl. q. s. f. mass. in pil. xxxii divid. cap. iii. bis in die.

14th. Continues to make water freely. The swellings of his legs have gradually decreased; soreness and tension of the abdomen considerably less.

Omittant. pil. cap. mistur. c. decoct. Digitalis. &c. 3tia quaque hora ad 3tiam vicem.

15th. Made a pint and a half of water last night, without being in the least sick, and is in every respect considerably better. Repet. Pillul. ut antea.

21st. Makes water as usual when in health, and the swellings are entirely gone.

R. Infus. amar. ℥v. tinctur. Rhei spirit. ℥ii. spirit vitriol. dulc. ʒii. syr. zinzib. ʒvi. m. cap. cochl. iii. larg. ter in die.

He soon gained sufficient strength to enable him to go a journey, and returned home in much betterhealth 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.

R—— Howgate, a man much addicted to intemperance, particularly in the use of spirituous liquors, Æt. 60, was admitted into the Hospital near Birmingham,May17, 1783. He complained of difficulty of breathing, attended with cough, particularly troublesome on lying down; drowsiness and frequent dozing, from which he was roused by startings, accompanied with great anxiety and oppression about the breast; œdematous swellings of the legs; constant desire to make water, which he passed with difficulty, and only by drops; pulse weak and irregular; body rather costive; face much emaciated; no appetite for food.—Cap. pil. scil. iii. ter in die.[6]

May20th. The pills have had no effect.—Cap. mistur. c.[7]Decoct. Digital. &c. cochl. ii. larg. 3tia quaque hora, ad 3tiam vicem.

May21st. Made near two quarts of water in the night, without being in the least sick. He continuedthe 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.

—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 thencollected, 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 ofSeptemberfollowing, which was about two years and two months after he first begun the Digitalis.

I have had several dropsical patients relieved, and some perfectly recovered by the Digitalis, since you attended Mr. Moggs, but as I did not take any notes or make any memorandums of them, cannot give you any of them.

DearSir,I accept with pleasure your invitation to communicate what I know respecting the properties ofDigitalis; and if an account of what others had discovered before you,[8]with a detailof 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 theopprobriaof medicine.CASEI.Mrs. M——. Orthopnea, pain, and excessive oppression at the bottom of the sternum. Pulse irregular, with frequent intermissions. Appetite very much impaired. Legs anasarcous.Empl. vesicator. pectori dolent.Infus. Digital. e ʒiii. ad. aq. &c. ℥viii. cochl. j. o. h. donec nausea excitetur vel diuresis satis copiosa proveniat.I ordered it of the above strength, and to be repeated often, on account of the great emergency of the case, but the nausea excited by the first dose prevented its being given at such short intervals. A 3d dose I found had been given, which was followed by vomitings. All her complaints gradually abated,but in about a fortnight recurred, notwithstanding the use of infus. amar. &c.Dec. 2. Infus. Digit. e. ʒiss ad aq. &c. ℥viii. cochl. ii. horis &c. u. a.Complaints gradually abated, swellings of the legs nearly gone down.About a month afterwards you was desired to visit this patient.[9]On the examination of the body I noticed, among others, the following appearances.About ¾ oz. of bloody water flowed out, on elevating the upper half of the scull, and a small quantity also was found at the base.Brain.Blood-vessels turgid with blood, and many of those of considerable size distended with air.A very slight watery effusion between thePia MaterandTunica arachnoidea. About ¾ oz. of watery fluid in thelateral ventricles.Thorax.In the left cavity about 4 oz. of bloody serum; in the right but little. Lungs, the hinder parts loaded with blood. Adhesions of each lobe to the pleura.Pericardiumcontaining but a very small quantity of fluid.Heartcontaining no coagula of blood.Valves of the Aortaof a cartilaginous texture, as if beginning to ossify.Abdominal Visceranatural, and a profusion ofFatunder the integuments of the abdomen and thorax, in the former to the thickness of an inch and upwards, and in very considerable quantity on the mesentery, omentum, kidneys, &c.Obs.The intermitting pulse should seem to have been owing to effusions of water in some of the cavities of the breast, as it disappeared on the removal of the waters.CASEII.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 takensal. diuret. c. ol. junip.—Calom. c. jalap, et gambog.—Et ol. junip. c. ol. Terebinth.without effect.Feb.7.Infus. Digital. e. ʒiii. ad aq. &c. ℥viii. cochl. ii. 4tis horis.Ordered to drink largely ofinfus. baccar. junip.The third dose produced great nausea which continued ten hours, during which time the urine made was about a quart. The next day her apothecary directed her to begin again with it. The second dose produced vomiting. During the next twenty hours she made two quarts of water, about four times as much as she drank.From this time she took no more of theinfus. Digital.but continued theinf. bacc. junip.until aboutMarch2d, 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.CASEIII.Mrs. M—— G——, Æt. 64. Has had sore legs for these thirty-four years past. Orthopnœa. Sense of oppression at the prœcordia. Pulse intermitting. Legs anasarcous. Urine scanty, high-coloured.Infus. Digital. c. ʒiss ad aq. bull. ℥viii. cochl. ii. 4tis horis.Took six doses, when nausea was excited. Urine a quart during the course of the night. The flow of urine continued, and complaints relieved. Sal. Mart. c. extr. gent. and afterwards with the addition of extr. cort. for which last ingredient she had a predilection, confirmed the cure.On the same day the next year I was called in to her for a similar train of symptoms, excepting that the pulse was but just perceptibly irregular.Infus. Digital. u. a. præscript.The directions on the phial not being attended to,two doses of it were given after a nausea had been excited, which, with occasional vomitings, became exceedingly oppressive. A saline draught, given in Dr. Hulme's method, a draughtsal. c. c. gr. xii. c. conf. card. gr. x.produced no immediate effect, but the nausea gradually abating, inf. bacc. junip. was ordered; but this appeared to augment it,and a great propensity to sleep coming on, I directedsal. c. c. conf. card, aa gr. viii. 4tis horis, which removed the unpleasant symptoms andmyrrh. c. sal. mart.completed the cure. During the use of the above medicines, the urine was augmented, and the pulmonary complaints removed, even before the nausea left her; and the sores of her legs which were much inflamed before she began with the infus. Digital. in a day's time assumed a much healthier appearance, and on her other complaints going off, they shewed a greater tendency to heal than she had ever observed in them for twenty years before. This instance is a very pleasing confirmation of the experience of Hulse and Dr. Baylies, and of the advantage to be derived from a medicine, which, while it helps to heal the ulcers, removes that from the constitution which often renders the healing of them improper.In one case in which I ordered it, the infusion, instead of digesting three hours as I had directed, was suffered to stand upon the leaves all night. The consequence was that the first dose produced considerable nausea.The two following cases, with which I have been favoured by a physician very justly eminent, convince me of the necessity there is that every one who discovers a new medicine, or new virtues in an old one, should, in announcing such discoveries, publish to the world the exact manner in which he exhibitssuch medicines, with all the precautions necessary to obtain the promised success.In these (says my correspondent) "the infusion was given in small doses, repeated every hour or two, till a nausea was raised, when it was omitted for a day or perhaps two, and then repeated in the same manner."AnAscitesemptied by it, but filled again very speedily, thoughits use was never discontinued, and who afterwards found no salutary effects from it. Ended fatally."In anAnasarcait sometimes increased the quantity of urine, and abated the swelling, but which as often returned in as great a degree as before, thoughthe medicine was still given, and always increased in quantity so as to excite nausea. Ended fatally."I have tried it in many other cases, but found very little difference in the success attending it."May we not be allowed to conjecture that the inefficacy ofits continued useis 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 leastagainst its continued use, even in small doses, in other diseases of diminished energy, as continued fever, palsy, &c.I remain with the greatest truth,Your obliged and affectionate friend,JONATHAN STOKES.Stourbridge,May 17, 1785.

DearSir,

I accept with pleasure your invitation to communicate what I know respecting the properties ofDigitalis; and if an account of what others had discovered before you,[8]with a detailof 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 theopprobriaof medicine.

Mrs. M——. Orthopnea, pain, and excessive oppression at the bottom of the sternum. Pulse irregular, with frequent intermissions. Appetite very much impaired. Legs anasarcous.

Empl. vesicator. pectori dolent.Infus. Digital. e ʒiii. ad. aq. &c. ℥viii. cochl. j. o. h. donec nausea excitetur vel diuresis satis copiosa proveniat.

I ordered it of the above strength, and to be repeated often, on account of the great emergency of the case, but the nausea excited by the first dose prevented its being given at such short intervals. A 3d dose I found had been given, which was followed by vomitings. All her complaints gradually abated,but in about a fortnight recurred, notwithstanding the use of infus. amar. &c.

Dec. 2. Infus. Digit. e. ʒiss ad aq. &c. ℥viii. cochl. ii. horis &c. u. a.

Complaints gradually abated, swellings of the legs nearly gone down.

About a month afterwards you was desired to visit this patient.[9]

On the examination of the body I noticed, among others, the following appearances.

About ¾ oz. of bloody water flowed out, on elevating the upper half of the scull, and a small quantity also was found at the base.

Brain.Blood-vessels turgid with blood, and many of those of considerable size distended with air.

A very slight watery effusion between thePia MaterandTunica arachnoidea. About ¾ oz. of watery fluid in thelateral ventricles.

Thorax.In the left cavity about 4 oz. of bloody serum; in the right but little. Lungs, the hinder parts loaded with blood. Adhesions of each lobe to the pleura.Pericardiumcontaining but a very small quantity of fluid.Heartcontaining no coagula of blood.Valves of the Aortaof a cartilaginous texture, as if beginning to ossify.

Abdominal Visceranatural, and a profusion ofFatunder the integuments of the abdomen and thorax, in the former to the thickness of an inch and upwards, and in very considerable quantity on the mesentery, omentum, kidneys, &c.

Obs.The intermitting pulse should seem to have been owing to effusions of water in some of the cavities of the breast, as it disappeared on the removal of the waters.

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 takensal. diuret. c. ol. junip.—Calom. c. jalap, et gambog.—Et ol. junip. c. ol. Terebinth.without effect.

Feb.7.Infus. Digital. e. ʒiii. ad aq. &c. ℥viii. cochl. ii. 4tis horis.Ordered to drink largely ofinfus. baccar. junip.The third dose produced great nausea which continued ten hours, during which time the urine made was about a quart. The next day her apothecary directed her to begin again with it. The second dose produced vomiting. During the next twenty hours she made two quarts of water, about four times as much as she drank.

From this time she took no more of theinfus. Digital.but continued theinf. bacc. junip.until aboutMarch2d, 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.

Mrs. M—— G——, Æt. 64. Has had sore legs for these thirty-four years past. Orthopnœa. Sense of oppression at the prœcordia. Pulse intermitting. Legs anasarcous. Urine scanty, high-coloured.

Infus. Digital. c. ʒiss ad aq. bull. ℥viii. cochl. ii. 4tis horis.

Took six doses, when nausea was excited. Urine a quart during the course of the night. The flow of urine continued, and complaints relieved. Sal. Mart. c. extr. gent. and afterwards with the addition of extr. cort. for which last ingredient she had a predilection, confirmed the cure.

On the same day the next year I was called in to her for a similar train of symptoms, excepting that the pulse was but just perceptibly irregular.

Infus. Digital. u. a. præscript.

The directions on the phial not being attended to,two doses of it were given after a nausea had been excited, which, with occasional vomitings, became exceedingly oppressive. A saline draught, given in Dr. Hulme's method, a draughtsal. c. c. gr. xii. c. conf. card. gr. x.produced no immediate effect, but the nausea gradually abating, inf. bacc. junip. was ordered; but this appeared to augment it,and a great propensity to sleep coming on, I directedsal. c. c. conf. card, aa gr. viii. 4tis horis, which removed the unpleasant symptoms andmyrrh. c. sal. mart.completed the cure. During the use of the above medicines, the urine was augmented, and the pulmonary complaints removed, even before the nausea left her; and the sores of her legs which were much inflamed before she began with the infus. Digital. in a day's time assumed a much healthier appearance, and on her other complaints going off, they shewed a greater tendency to heal than she had ever observed in them for twenty years before. This instance is a very pleasing confirmation of the experience of Hulse and Dr. Baylies, and of the advantage to be derived from a medicine, which, while it helps to heal the ulcers, removes that from the constitution which often renders the healing of them improper.

In one case in which I ordered it, the infusion, instead of digesting three hours as I had directed, was suffered to stand upon the leaves all night. The consequence was that the first dose produced considerable nausea.

The two following cases, with which I have been favoured by a physician very justly eminent, convince me of the necessity there is that every one who discovers a new medicine, or new virtues in an old one, should, in announcing such discoveries, publish to the world the exact manner in which he exhibitssuch medicines, with all the precautions necessary to obtain the promised success.

In these (says my correspondent) "the infusion was given in small doses, repeated every hour or two, till a nausea was raised, when it was omitted for a day or perhaps two, and then repeated in the same manner.

"AnAscitesemptied by it, but filled again very speedily, thoughits use was never discontinued, and who afterwards found no salutary effects from it. Ended fatally.

"In anAnasarcait sometimes increased the quantity of urine, and abated the swelling, but which as often returned in as great a degree as before, thoughthe medicine was still given, and always increased in quantity so as to excite nausea. Ended fatally.

"I have tried it in many other cases, but found very little difference in the success attending it."

May we not be allowed to conjecture that the inefficacy ofits continued useis 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 leastagainst its continued use, even in small doses, in other diseases of diminished energy, as continued fever, palsy, &c.

I remain with the greatest truth,Your obliged and affectionate friend,JONATHAN STOKES.

Stourbridge,May 17, 1785.

Esther K——, Æt. 33. General anasarca, ascites, and dyspnœa, of seven months duration.

Decoct. c Digit. ʒiv. c. aq. ℔i. coquend. ad ℔ss. cap. ℥i. 2dis. horis.1stDay. 4th dose made her sick. 2dDay. The first dose she took to-day produced vomiting.

3dDay.Minuatur dosis ad ℥ss.This stayed upon her stomach, but produced an almost constant sickness. Stools more frequent, water scarce sensibly increased; and her swellings not at all reduced.

4thDay.Cap. Calomel. gambog. scill. &c.

Obs.Sufficient time was not allowed to observe its effects, neither was the patient enjoined the free use of diluents. The disease terminated fatally.

William T——, Æt. 42. Ascites, with cough and dyspnœa. Abdomen very much distended. The rest of his body highly emaciated. Urine thick, high coloured, and in very small quantity.

Decoct. Digit. (u. in Esther K——,) 4tis horis.

1stDayof taking it. The 4th dose produced sickness.

2d. Vomiting after the second dose.

10th. Urine increased to ℔vi.

11th. Flow of urine continues. Abdomen quite flaccid.

12th. Abdomen not diminished.

15th: A smart purging came on, and the flow of urine diminished.

23d. Belly much bound. Took a cathart. powder, which was followed by a diminution of the abdomen.

29th. To take a cathart. powder every 4th morning, continuing the decoct. Digit.

32d. Urine exceedingly scanty.

35th.Vin. scill. ℥ss. o. m. &c.This produced diuretic effects.

44th. Tapped. Terminated fatally.

Obs.Here the medicine wascontinued till it ceased to produce diuretic effects; and these effects were not aided by any strengthening remedies.

George R——, Æt. 52. Ascites, general anasarca, and dyspnœa. His legs so greatly distended that it was with great difficulty he could draw the one after the other.

Infus. Digital. ʒiiiss. ad. aq. ℔ss. cap. ℥i. altern. horis donec nauseam excitaverit.Rep. 3tiis diebus.tempore intermedio cap. sol. guaic. ℥i. ter indie ex inf. sinap.

1stDayof taking it. Became sickish towards night.

2dDay. Made a great quantity of water during the night, and spat up a great deal of watery phlegm. The first dose he took in the morning has produced a sickness which has continued all day, but he has never vomited.

3d.Day. The change in his appearance so great as to make it difficult to conceive him to be the same person. Instead of a large corpulent man, he appeared tall, thin, and rather aged. Breathes freely, and can walk up and down stairs without inconvenience.

4thDay.Decoct. bacc. junip. and cyder for common drink.

6thDay. 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.

12thDay.Pot. purgans illico.

14thDay.Pot. purg. c. jalap. ʒss. 4tis diebus.Infus. Dig. 3tiis diebus.

17thDay.R. Gamb. gr. iii. calom. gr. ii. camph. gr. i. syr. simpl. fiat pil. o. n. sum.Infus. Digit. 3tiis diebus.

21stDay. Made an out-patient. The super-abundant flow of urine continued for the first three days after his last course; but since, the flow of saliva has been nearly equal to that of urine.

The smalls of his legs not quite reduced, and are fuller at night. He has shrunk round the middle from four feet two inches to three feet six inches; and in the calves of his legs, from seventeen inches to thirteen and a half.[10]

Obs.The waters were here very successfully evacuated, but as you remarked to me, on communicating the case to you at the time, tonic medicines should have been given, to second the ground that had been gained, instead of weakening the patient by drastic purgatives.

Matth. D——, Æt. 71. Tall and thin. Disease a general anasarca, with great difficulty of breathing. The lac ammoniac. somewhat relieved his breath; but the swellings increased, and his urine was not augmented. I considered it as a lost case, but having seen the good effects of the Digitalis, as ordered by Dr. Stokes in the case of Mrs. G——, I gave him one spoonful of an infusion of ʒii to half a pint, twice a day. His breath became much easier, his urine increased considerably, and the swellings gradually disappeared; since which his health has been pretty good, except that about three weeks ago, he had a slight dyspnœa, with pain in his stomach, which were soon removed by a repetition of the same medicine.

Mr. Shaw likewise informs me, that he has removed pains in the stomach and bowels, by giving a spoonful of the infusion, ʒiss. to ℥viii. morning and night.

DearSir,I send you the two following cases, wherein the Digitalis had very powerful and sensible effects, in the cure of the different patients.CASEI.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 exsudethrough 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 continuedthe beef tea, and took no other medicine for five days, when her sickness went off: her cough abated, but the pain in her side still continuing, I applied a blister which had the desired effect: her urine after the first day flowed naturally. Her cure was compleated by the gum pills with steel and the bitter infusion. It must be observed she never had any collection of water afterwards.It affords me great pleasure to inform you that she is now living, and has since had four children; all of whom, I think I may justly say, are indebted to the Digitalis for their existence.There appears in this case a striking proof of the utility of emetics in some kinds of consumptions, as it appears to me the dropsy was brought on by the cough, &c. and I believe these were cured by the continual vomitings, occasioned by the medicine.CASEII.Mr. H——, a publican, aged about 48 years, sent for me inMarch, 1778. He complained of a cough, shortness of breathing, which prevented him from laying down in bed; his belly, thighs and legs very much distended with water; the quantity of urine made at a time seldom exceeded a spoonful. I requested him to get some of the Digitalis, and as they had no proper weights in the house, I told them to put as much of the fresh leaves as would weigh down a guinea, into half a pint of boiling water;to let it stand till cold, then to pour off the clear liquor, and add a glass of gin to it, and to take three table spoonfuls every third hour, until it had some sensible effect upon him.Before he had taken all the infusion, the quantity of urine made increased, (he therefore left off taking it), and it continued to do so until all the water was evacuated. His breathing became much better, his cough abated, though it never quite left him; he being for some time before asthmatic. By taking some tonic pills he continued quite well until the next spring, when he had a return of his complaint, which was carried off by the same means. Two years after, he had a third attack, and this also gave way to the medicine. Last year he died of a pleurisy.I am, &c.JER. VAUXMoor-Street, 8th May,1785.P. S. You must well recollect the case of Mrs. F——.—It was "a general dropsy—every time she took the medicine its effects were similar, viz. The discharge of urine came on gradually at first, increased afterwards, and the whole of the water both in the belly, legs, &c. was perfectly evacuated. Although the effects were only temporary, they were exceedingly agreeable to the patient, making her time much more comfortable."—(See CaseXLIII.)

DearSir,

I send you the two following cases, wherein the Digitalis had very powerful and sensible effects, in the cure of the different patients.

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 exsudethrough 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 continuedthe beef tea, and took no other medicine for five days, when her sickness went off: her cough abated, but the pain in her side still continuing, I applied a blister which had the desired effect: her urine after the first day flowed naturally. Her cure was compleated by the gum pills with steel and the bitter infusion. It must be observed she never had any collection of water afterwards.

It affords me great pleasure to inform you that she is now living, and has since had four children; all of whom, I think I may justly say, are indebted to the Digitalis for their existence.

There appears in this case a striking proof of the utility of emetics in some kinds of consumptions, as it appears to me the dropsy was brought on by the cough, &c. and I believe these were cured by the continual vomitings, occasioned by the medicine.

Mr. H——, a publican, aged about 48 years, sent for me inMarch, 1778. He complained of a cough, shortness of breathing, which prevented him from laying down in bed; his belly, thighs and legs very much distended with water; the quantity of urine made at a time seldom exceeded a spoonful. I requested him to get some of the Digitalis, and as they had no proper weights in the house, I told them to put as much of the fresh leaves as would weigh down a guinea, into half a pint of boiling water;to let it stand till cold, then to pour off the clear liquor, and add a glass of gin to it, and to take three table spoonfuls every third hour, until it had some sensible effect upon him.

Before he had taken all the infusion, the quantity of urine made increased, (he therefore left off taking it), and it continued to do so until all the water was evacuated. His breathing became much better, his cough abated, though it never quite left him; he being for some time before asthmatic. By taking some tonic pills he continued quite well until the next spring, when he had a return of his complaint, which was carried off by the same means. Two years after, he had a third attack, and this also gave way to the medicine. Last year he died of a pleurisy.

I am, &c.JER. VAUX

Moor-Street, 8th May,1785.

P. S. You must well recollect the case of Mrs. F——.—It was "a general dropsy—every time she took the medicine its effects were similar, viz. The discharge of urine came on gradually at first, increased afterwards, and the whole of the water both in the belly, legs, &c. was perfectly evacuated. Although the effects were only temporary, they were exceedingly agreeable to the patient, making her time much more comfortable."—(See CaseXLIII.)

DearSir,It gives me great pleasure to find you intend to publish your observations on the Digitalis purpurea.Several years are now elapsed since you communicated to me the high opinion you entertained of the diuretic qualities of this noble plant. To ensure success, due attention was recommended to itspreparation, itsdose, and itseffectsupon the system.I always gave the infusion of the dried leaves; the dose the same as in the prescriptions returned. If the medicine operated on the stomach or bowels, it was thought prudent to forbear. When the kidneys began to perform their proper functions, and the urine to be discharged, a continuance of its farther use was unnecessary.These remarks you made in the case of the first patient for whom you prescribed the Digitalis in our neighbourhood, and I have found them all necessary at this present period. From thedecidedgood effects that followed from its use, in those cases where the most powerful remedies had failed, I was soon convinced it was a most valuable addition to the materia medica.The want of a certain diuretic, has long been one of the desiderata of medicine. The Digitalis is undoubtedly at the head of that class, and will seldom, if properly administered, disappoint the expectation. I can speak with the more confidence, having, in an extensive practice, been a happy witness to its good qualities.For several years, I have given the infusion in a variety of cases, where there was a deficiency in the secretion of the urine, with the greatest success. In recent obstructions, I do not recollect many failures. In anasarcous diseases, and in the anasarca, when combined with the ascites; in swellings of the limbs, and in diseases of the chest, when there was the greatest reason to believe an accumulation of serum, the most beneficial consequences have followed from its use.Had I been earlier acquainted with your intention to publish an account of the Digitalis, I could have transmitted some cases, which might have served to corroborate these assertions: but I am convinced the Digitalis needs not my assistance to procure a favorable reception. Its own merit will ensure success, more than a hundred recited cases.I could wish those gentlemen who intend to make use of this plant, to collect it in a hot dry day, when the petals fall, and the seed-vessels begin to swell.The leaves kept to the second year are weaker, and their diuretic qualities much diminished. It will therefore be necessary to gather the plant fresh every season.These cautions are unnecessary to the accurate botanist, who well knows, that a plant in the spring, though more succulent and full of juices, is destitute of those qualities which may be expected when that plant has attained its full vigour, and the seed-vessels begin to be manifest. But for want of attention to these particulars, its virtues may be thought exaggerated, or doubtful, if beneficial consequences do not always flow from its use. There are diseases it cannot cure; and in several of those patients in this town, who first took the Digitalis by your orders, there was the most positive proof of the viscera being unsound. In these desperate cases it often procured a plentiful flow of urine, and palliated a disease which medicine could not remove.At a remote distance, physicians are seldom applied to for advice in trifling disorders. Many remedies have been tried without relief, and the disease is generally obstinate or confirmed.—It would not be fair to try the merits of the Digitalis in this scale. It might often fail of promoting the end desired. I flatter myself the reputation of this plant will be equal to its merit, and that it will meet with a candid reception.As there is no pleasure equal to relieving the miseries and distresses of our fellow-creatures, I hope you will long enjoy that peculiar felicity.Permit me to return my thankful acknowledgments, for your free communication of a medicine, by which means, through the blessing of providence, I have been enabled to restore health and happiness to many miserable objects.I am, &c.Yours,J. WAINWRIGHT.Dudley, April 26th,1785.

DearSir,

It gives me great pleasure to find you intend to publish your observations on the Digitalis purpurea.

Several years are now elapsed since you communicated to me the high opinion you entertained of the diuretic qualities of this noble plant. To ensure success, due attention was recommended to itspreparation, itsdose, and itseffectsupon the system.

I always gave the infusion of the dried leaves; the dose the same as in the prescriptions returned. If the medicine operated on the stomach or bowels, it was thought prudent to forbear. When the kidneys began to perform their proper functions, and the urine to be discharged, a continuance of its farther use was unnecessary.

These remarks you made in the case of the first patient for whom you prescribed the Digitalis in our neighbourhood, and I have found them all necessary at this present period. From thedecidedgood effects that followed from its use, in those cases where the most powerful remedies had failed, I was soon convinced it was a most valuable addition to the materia medica.

The want of a certain diuretic, has long been one of the desiderata of medicine. The Digitalis is undoubtedly at the head of that class, and will seldom, if properly administered, disappoint the expectation. I can speak with the more confidence, having, in an extensive practice, been a happy witness to its good qualities.

For several years, I have given the infusion in a variety of cases, where there was a deficiency in the secretion of the urine, with the greatest success. In recent obstructions, I do not recollect many failures. In anasarcous diseases, and in the anasarca, when combined with the ascites; in swellings of the limbs, and in diseases of the chest, when there was the greatest reason to believe an accumulation of serum, the most beneficial consequences have followed from its use.

Had I been earlier acquainted with your intention to publish an account of the Digitalis, I could have transmitted some cases, which might have served to corroborate these assertions: but I am convinced the Digitalis needs not my assistance to procure a favorable reception. Its own merit will ensure success, more than a hundred recited cases.

I could wish those gentlemen who intend to make use of this plant, to collect it in a hot dry day, when the petals fall, and the seed-vessels begin to swell.

The leaves kept to the second year are weaker, and their diuretic qualities much diminished. It will therefore be necessary to gather the plant fresh every season.

These cautions are unnecessary to the accurate botanist, who well knows, that a plant in the spring, though more succulent and full of juices, is destitute of those qualities which may be expected when that plant has attained its full vigour, and the seed-vessels begin to be manifest. But for want of attention to these particulars, its virtues may be thought exaggerated, or doubtful, if beneficial consequences do not always flow from its use. There are diseases it cannot cure; and in several of those patients in this town, who first took the Digitalis by your orders, there was the most positive proof of the viscera being unsound. In these desperate cases it often procured a plentiful flow of urine, and palliated a disease which medicine could not remove.

At a remote distance, physicians are seldom applied to for advice in trifling disorders. Many remedies have been tried without relief, and the disease is generally obstinate or confirmed.—It would not be fair to try the merits of the Digitalis in this scale. It might often fail of promoting the end desired. I flatter myself the reputation of this plant will be equal to its merit, and that it will meet with a candid reception.

As there is no pleasure equal to relieving the miseries and distresses of our fellow-creatures, I hope you will long enjoy that peculiar felicity.

Permit me to return my thankful acknowledgments, for your free communication of a medicine, by which means, through the blessing of providence, I have been enabled to restore health and happiness to many miserable objects.

I am, &c.Yours,J. WAINWRIGHT.

Dudley, April 26th,1785.

InSeptember, 1782, I was seized with a difficulty of breathing, and oppression in my chest, in consequence of taking cold from being called out in the night. My tongue was foul; my urine small in quantity; my breath laborious and distressing on the slightest exercise. I tried the medicines most generally recommended, such as emetics, blisters, lac ammoniacum, oxymel of squills, &c. but finding little or no relief, I consulted Dr. Withering, who advised me to try the following prescription.

R. Fol. Digital. purp. siccat. ʒiss.Aq. bullientis ℥iv.Aq. cinn. sp. ℥ss. digere per horas quatuor, et colaturæ capiat cochlear. i. nocte maneque.

He also desired me to take fifty drops of tincture of cantharides three or four times a day.

After taking eight ounces of the infusion, and about twelve drams of the drops, I was perfectly cured, and have had no return since. The medicine did not occasion sickness or vertigo, nor had they any other sensible effect than in changing the appearance, and increasing the quantity of the urine, and rendering the tongue clean. After the last dose or two indeed, I had a little nausea, which was immediately removed by a small glass of brandy.

Birmingham, 1st July, 1785.

DearSir,I have great satisfaction in complying with your just claim, by transcribing outlines of the subsequent cases, for insertion in your long requested tract on the Digitalis purpurea. The two first of these you will easily recollect, the cures having been conducted immediately under your own management,and the whole may add to that weight of evidence which long experience enables you to adduce of the efficacy of that valuable medicine. I have recited the only instances of its failure which occur to me, but many other, though successful cases, wherein its utility might seem dubious, and also the accounts received from people whose accuracy might be suspected, I shall not for obvious reasons trouble you with.I am, dear Sir,Your obliged friend,WILLIAM YONGE.Shiffnall,May1, 1785.

DearSir,

I have great satisfaction in complying with your just claim, by transcribing outlines of the subsequent cases, for insertion in your long requested tract on the Digitalis purpurea. The two first of these you will easily recollect, the cures having been conducted immediately under your own management,and the whole may add to that weight of evidence which long experience enables you to adduce of the efficacy of that valuable medicine. I have recited the only instances of its failure which occur to me, but many other, though successful cases, wherein its utility might seem dubious, and also the accounts received from people whose accuracy might be suspected, I shall not for obvious reasons trouble you with.

I am, dear Sir,Your obliged friend,WILLIAM YONGE.

Shiffnall,May1, 1785.

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 ætherand 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, untilSeptember15th, when upon a more severe attack, the emetic was repeated. He now recollected some slight pain in his arms which had affected him previous to this last seizure, and was disposed to consider his complaint as rheumatic. Pills with gum ammoniac. gum guaiac. and antimonial powder were directed, with infus. amar. simpl. twice a day. The bowels were regulated by aperient pills of pulv. jalap. aloes and sal. tartar. and ʒiss balsam peruv. was given occasionally to alleviate the paroxysms of dyspnœa.

From this period until the beginning of November, little amendment or variation happened, except that respiration became more permanently difficult, and particularly oppressed upon motion, nor was it relieved by the expectoration of a mucous discharge, which now increased considerably. Squills, musk, ol. succini, æther, with other medicines of the same kind, were now used, but without success. The effects of opium and venæfection were tried. The appetite diminished, and his sleep became short and disturbed. He sometimes slept lying upon his back, but generally upon his left side. The urine which had hitherto been of good colour, and sufficient quantity, now became diminished, and lateritious; and the ancles œdematous.

On the 15th ofNovembera blister was laid over the sternum, and ʒiss of oxymel scillitic. was given every eight hours.

On the 18th, a more copious discharge of urine took place; the swelling of the feet soon disappeared, and the respiration became gradually relieved.

On the 30th ʒi tinct. cantharidum twice a day in pyrmont water, with pills of ammoniac, sal tartar. et extract. gentian. were substituted, but

On the 7th ofDecember, 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.

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