Chapter IV: Part 4

--I have elsewhere remarked, that when the Digitalis has been properly given, and the diuretic effects produced, that an accidental over-dose bringing on sickness, has stopped the secretion of urine. In the present instance it likewise appears, that violent sickness may be excited, and continue for several days without being accompanied by a flow of urine; and it is probable that the latter circumstance did not take place, until the severity of the former abated. If Dr. Cawley had not had a constitution very retentive of life, I think he must have died from the enormous doses he took; and he probably would have died previous to the augmentation of the urinary discharge. For if the root from which his medicine was prepared, was gathered in its active state, he did not take at each dose less than _twelve_ times the quantity a strong man ought to have taken. Shall we wonder then that patients refuse to repeat such a medicine, and that practitioners tremble to prescribe it? Were any of the active and powerful medicines in daily use to be given in doses _twelve_ times greater than they are, and these doses to be repeated without attention to the effects, would not the patients die, and the medicines be condemned as dangerous and deleterious?--Yet such has been the fate of Foxglove!

A Letter to the Author, from Mr. BODEN, Surgeon, at Broseley,
in Shropshire.

Broseley, 25th May, 1785.
Dear SIR,

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

Thomas Cooke, AEt. 49, had been ill about two or three weeks. When I saw him he had no appetite, and a constant thirst: a fullness and load in the stomach: the thighs, legs and hands, much swell'd, and the face and throat in a morning; was costive, and made but little water, which was high coloured; the pulse very weak, and his breath exceeding bad. _June_ 17th. R. Argent, viv [Symbol: dram]i. cons. cynosbat. [Symbol: scruple]ii. fol. Digital. pulv. gr. xv. f. pil. xxiv. capt. ii. omni nocte hora decubitus. He was likewise purged by a bolus of argent. viv. jallap, Digit. elaterium and calomel, which was repeated on the fourth day, to the third time. From _June_ 17th to the 29th, the symptoms were mostly removed, making water freely, and having plenty of stools; in a week after he was perfectly well, and remains so ever since. The cure was finished by steel and bitters.

Thomas Roberts, AEt. 40, had a deformed chest, was obliged to be almost in an erect posture when in bed; the other symptoms were nearly the same as Cooke's. _August_ 3d. The pills prescribed _June_ 17th for Cooke.--17th. A purging bolus of jalap and Digitalis, once a week. He continued the medicines till the latter end of _August_, when he got very well; but the complaint returned in _Jan._ worse than before. He is now much better, but I have great reason to believe the liver to be diseased.

I am, with the greatest respect,

Your very obliged humble servant,

DANIEL BODEN.

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

CASE communicated by Mr. CAUSER, Surgeon, at Stourbridge,
Worcestershire.

Mr. P---- of H---- M----, in the parish of Kingswinford, aged about 60; had been a strong healthy, robust, corpulent man; worked hard early in life at edge-tool making, and drank freely of strong malt liquor; for many years had been subject to gout in the extremities; for a few years past had been very asthmatic, and the gout in the extremities gradually decreased. When I first saw him, which was _Sept._ 12, 1779, his legs were anasarcous, his belly much swelled, and an evident fluctuation of water. His breathing very bad, an irregular pulse, and unable to lie down. His easiest posture was standing with his body leaning over a chair, in which situation he would continue many hours together, labouring for breath, with the sweat trickling down his face very profusely; the urine in very small quantity. Diuretics of every kind I could think of were used with very little or no advantage. Blisters applied to the legs relieved very considerably for a time, but by no means could I increase the urinary discharge. Warm stomachic medicines were given, and at the same time sinapisms applied to the feet, in hopes of enticing gout to the extremities, but without any good effect.--_November_ 22d. The swelling considerably increasing, an emetic of acet. scillitic. was given, which acted very violently, and increased the urinary discharge considerably. He continued better and worse, using different kinds of diuretic and expectorating medicines until _September_ 1781, when the disease was so much worse, I did not expect he could live many days. The acet. scillitic. was repeated, a table spoonful every half hour, till it acted briskly upwards and downwards; but without increasing the urinary discharge.--On the 17th of _September_ I infused [Symbol: dram]iii. of the fol. Digitalis in [Symbol: ounce]vi. of boiling water, for four hours; then strained it, and added [Symbol: ounce]i. of tinct. aromatica.--On the 18th he began by taking one spoonful, which he was to repeat every half hour, till it made him very sick, unless giddiness, loss of sight, or any other disagreeable effect took place. I had never given the medicine before, and had prepared him to expect the operation to be very severe. I saw him again on the 21st; he had taken the medicine regularly, till the whole quantity was consumed, without perceiving the least effect of any kind from it, and continued well till the evening of the following day, when a little sickness took place, which increased, but never so as to occasion either vomiting or purging, but a surprising discharge of urine. The saliva increased so as to run out of his mouth, and a watery discharge from his eyes; these discharges continued, with a continual sickness, till the swelling was totally gone, which happened in three or four days. He afterwards took steel and bitters; and continued very comfortably, without any return of his dropsy, until the 7th of _April_ 1782, when he was seized with an epidemic cough, which was very frequent with us at that time. His swellings now returned very rapidly, with the greatest difficulty in breathing, and he died in a few days. Blisters and expectorating medicines were used on this last return.

Extract of a Letter from Mr. CAUSER.

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

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

CASE.

_January_ 2d, 1785. Mrs. S----, of W----, near Kidderminster, aged 38, has been affected with dropsical swellings of her legs and thighs, about six weeks, which have gradually grown worse; has now great difficulty in breathing, which is much increased on moving; a very irregular, intermittent pulse, urine in very small quantity, and in the seventh month of her pregnancy: a woman of very delicate constitution, with tender lungs from her infancy and very subject to long continued coughs.

R. Pulv. scillae gr. iii.
Jalap gr. x. syr. rosar. solut. tinct. senn. aa [Symbol:
dram]ii. aq. menth. v. simpl. [Symbol: ounce]iss. m. mane
sumend.

R. pulv. scillae [Symbol: scruple]i. G. ammoniac, sapon.
venet. aa [Symbol: dram]iss. syr. q. s. f. pilul. 42 cap.
iii. nocte maneque.

On the 7th found her worse, and the swelling increased; the urine about [Symbol: ounce]x in the twenty-four hours.

R. Fol. siccat. Digital. [Symbol: dram]iii. coque in. aq.
fontan. [Symbol: ounce]xii. ad [Symbol: ounce]vi. cola et
adde. aq. juniper. comp. [Symbol: ounce]ii. sacchar. alb.
[Symbol: ounce]ss. m. cap. cochlear. i. larg. 4tis horis.

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

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

R. Fol. sicc. Digital. G. assafetid. aa [Symbol: dram]i.
calomel. pp. gr. x. sp. lavand. comp. q. s. fiat pilul.
xxxii. cap. ii. omni nocte hora somni.

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

_March_ 15th she was delivered: had a good labour, was treated as is usual, except in not having her breasts drawn, not intending see should suckle her child, being in so reduced a state. Continued going on well till the 18th, when she was seized with very violent pains across her loins, at times so violent as to make her cry out as much as labour pains. Enema cathartic. Fot. papav. applied to the part.

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

R. Julep, e camphor, sp. minder. aa [Symbol: ounce]ii. capt.
cochlear, i. larg. post singul. pilul.

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

R. Gum ammoniac, assafetid. aa [Symbol: dram]i. camphor. gr. xii. fiat
pilul. 24. capt. ii. 3tia quaque hora in cochlear. ii.
mixtur. seq.

R. Balsam. peruv. [Symbol: dram]iii. mucilag. G. arab. q. s.
flor. zinci g. vi. aq. menth. simp. [Symbol: pound]ss. m.

Applic. Emp. vesicat. femorib. internis.

R. Sp. vol. foetid. elixir. paregor. balsam. Traumatic. aa
[Symbol: dram]iii. capt. cochlear. parv. urgente languore.

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

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

R. Infus. baccar. juniper, [Symbol: ounce]vi. tinct. amar. tinct.
stomachic. aa [Symbol: ounce]i. m.

25th. Much the same.

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

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

Applic. Emp. vesicat. stomacho et sterno.

R. G. assafetid. [Symbol: scruple]ii. pulv. jacob. [Symbol:
scruple]i. rad. scill. recent. gr. xii. extract. thebaic. gr.
iv. f. pilul. xvi. cap. iv. omni nocte.

R. Sal. nitr. sal. diuretic. aa [Symbol: dram]ii. pulv. e
contrayerv. comp. [Symbol: dram]i. sacchar. [Symbol: ounce]i.
emuls. commun. [Symbol: pound]i. aq. cinnam. simpl. [Symbol: ounce]i.
m. capt. cochlear. iv. ter die.

_April_ 2d. Much the same, no increase of urine.

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

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

R. Fol. siccat. Digital. G. assafetid. aa [Symbol: dram]i. sp. lavand.
comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node
cap. pilul. e styrace gr. vi.

17th. Considerable increase of urine.

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

Applic. Emp. vesicat. femoribus internis.

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

25th. Swelling much diminished, makes plenty of water, appetite much mended, cough and breathing better. She omitted the medicine for three days; the urine began to diminish, the swelling and shortness of breathing worse. On repeating it for two days, the discharge was again augmented, and a diminution of the swelling succeeded. She has continued the pills ever since till the 14th of _May_; the dropsical symptoms and cough are entirely gone, the water is in sufficient quantity, her strength is recovered, and she has a good appetite. All she now complains of is a weight across her stomach, which is worse at times, and she thinks, unless it can be removed, she shall have a return of her dropsy.

Extract of a Letter from Doctor FOWLER,
Physician, at Stafford.

I understand you are going to publish on the Digitalis, which I am glad to hear, for I have long wished to see your ideas in print about it, and I know of no one (from the great attention you have paid to the subject) qualified to treat on it but yourself. There are gentlemen of the faculty who give verbal directions to poor patients, for the preparing and taking of an infusion or decoction of the green plant. Would one suppose that such gentlemen had ever attended to the nature and operation of a sedative power on the functions, _particularly_ the _vital_? Is not such a vague and unscientific mode of proceeding putting a two edged sword into the the hands of the ignorant, and the most likely method to damn the reputation of any very active and powerful medicine? And is it not more than probable that the _neglect_ of adhereing to a _certain_ and _regular_ preparation of the nicotiana, and the _want_ (of what you _emphatically_ call) a _practicable_ dose, have been the chief causes of the once rising reputation of that noted plant being damned above a century ago? In short, the Digitalis is beginning to be used in dropsies, (although some patients are said to go off suddenly under its administration) somewhat in the style of broom ashes; and, in my humble opinion, the public, at this very instant, stand in great need of your _precepts_, _guards_, and _cautions_ towards the safe and successful use of such a powerful sedative diuretic; and I have no doubt of your minute attention to those particulars, from a regard to the good and welfare of mankind, as well as to your own reputation with respect to that medicine.

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

CASES communicated by Mr. J. FREER,
jun. Surgeon, in Birmingham.

CASE I.

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

CASE II.

_December_, 1782. A poor woman, who had been afflicted with an ague during the whole of her pregnancy, and for two months with dropsical swellings of the feet, legs, thighs, abdomen, and labia pudenda; was at the expiration of the seventh month taken in labour. On the day after her delivery the ague returned, with so much violence as to endanger her life. As soon as the fit left her, I began to give her the red bark in substance, which had the desired effect of preventing another paroxysm. She continued to recover her health for a fortnight, but did not find any diminution in the swellings; her legs were now so large as to oblige her to keep constantly on the bed, and she made very little water. I ordered her the infusion of Foxglove three times a day, which, on the third day, produced a very copious discharge of urine, without any sickness; she continued the use of it for ten days, and was then able to walk. Having lost all her swellings, and no complaint remaining but weakness, the bark and steel compleated the cure.

Extract of a Letter from Doctor JONES,
Physician, in Lichfield.

Anxious to procure authentic accounts from the patients, to whom I gave the Foxglove, I have unavoidably been delayed in answering your last favour. However, I hope the delay will be made up by the efficacy of the plant being confirmed by the enquiry. Long cases are tedious, and seldom read, and as seldom is it necessary to describe every symptom; for every case would be a history of dropsy. I shall therefore content myself with specifying the nature of the disease, and when the dropsy is attended with any other affection shall notice it.

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

CASE I.

Ann Willott, 50 years of age, became a patient of the Dispensary on the 11th of April 1783. She then complained of an enlargement of the abdomen, difficulty of breathing, particularly when lying, and costiveness. She passed small quantities of high-coloured urine; and had an evident fluctuation in the belly. Her legs were oedematous. Chrystals of tartar, squills, &c. had no effect. The 13th of _June_ she took two spoonfuls of a decoction of Foxglove, containing three drams of the dry leaves, in eight ounces, three times a day. Her urine soon increased, and in a few days she passed it freely, which continued, and her breath returned.

CASE II.

Mr. ----, 45 years of age, had been long subject to dropsical swellings of the legs, and made little water. Two spoonfuls of the same decoction twice a day, soon relieved him.

CASE III.

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

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

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

CASE IV.

Mr. C----, 46 years of age, had dropsical swellings of the legs, and passed little urine. He took the decoction with three drams, and was soon relieved.

CASE V.

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

CASE VI.

Mrs. Slater, aged 36 years. For dropsy of the belly and legs, and scantiness of urine, of several weeks standing, took three grains of the powder twice a day, and was quite restored in ten days. She took many medicines without effect.

CASE VII.

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

CASE VIII.

Ann Winterleg, in her 26th year, had dropsical swellings of the legs, and passed little urine: she was relieved by two drams, in an eight ounce decoction.

CASE IX.

William Brown, aged 76. In the last stage of dropsy of the belly and legs, found a considerable increase of his urine by a decoction of Foxglove, but it was not permanent.

CASE X.

Mr. ----, -- years of age, and of very gross habit of body, became highly dropsical, and took various medicines, without effect. One ounce of the decoction, with three drams of the dry leaves in eight ounces, twice or three times a day, increased his urine prodigiously. He was evidently better, but a little attendant nausea overcame his resolution, and in the course of some weeks afterwards he fell a victim to his obstinacy.

CASE XI.

Mrs. Smith, about 50 years of age, after a tedious illness of many weeks, had a jaundice, and became dropsical in the legs. Two spoonfuls of the decoction, with three drams twice a day, increased her urine, and abated the swelling.

CASE XII.

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

CASE XIII.

---- Genders, about thirty-four years of age, was delivered of three children, and became dropsical of the abdomen. She passed little or no urine, had constant thirst, and no appetite. She took two spoonfuls of an eight ounce decoction, with three drams twice a day. By the time she had finished the bottle, (which must have been on the fourth day,) she had evacuated all her water, and could go about. Her appetite increased with every dose, and she recovered without farther help.

CASE XIV.

Miss M---- M----, in her 20th year. Had been infirm from her cradle, and, after various sufferings, had an astonishing oedematous swelling of one leg and thigh, of many weeks standing. She passed little or no urine, and had all her other complaints. She took 2 spoonfuls of an eight oz. decoction of two drams, twice a day. Her urine immediately increased; and, on the third day, the swelling had entirely subsided.

CASE XV.

Mr. P----, 65 years of age, and of a full habit of body. Had lived freely in his youth, and for many years led rather an inactive life. His health was much impaired several months, and he had a considerable distention, and evident fluctuation in the abdomen, and a very great oedema of the legs and thighs. His breathing was very short, and rather laborious, appetite bad, and thirst considerable. His belly was bound, and he passed very small quantities of high-coloured urine, that deposited a reddish matter. He had taken medicines some time, and, I believe, the Digitalis; and had been better.

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

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

CASE XVI.

Mrs. G----, aged 50 years. After being long ailing, had a large collection of water in the abdomen and lower extremities. Her urine was high-coloured, in small quantities, and had a reddish sediment. She took the decoction of Digitalis, squills, &c. without any effect. The chrystals of tartar, however, cured her speedily.

CASE XVII.

Mr. ----, about 50 years of age, complained of great tension and pain across the abdomen, and of loss of appetite; his urine, he thought, was less than usual, but the difference was so trifling he could speak with no certainty: his belly seemed to fluctuate. Among other things he tried the Foxglove leaves dried, twice a day; and, although it appeared to afford him relief, yet the effect was not permanent.

CASE XVIII.

Mr. W----, aged between 60 and 70 years; and rather corpulent: was considerably dropsical, both of the belly and legs, and his urine in small quantities. Three grains of the dry leaves, twice a day, evacuated the water in less than a fortnight.

CASE XIX.

Sarah Taylor, 40 years of age, was admitted into the Dispensary for dropsy of the abdomen and legs; and was relieved by the Decoctum digitalianum.

CASE XX.

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

CASE XXI.

John Leadbeater, aged 15 years. Had a quotidian intermittent, which was removed by the humane assistance of an amiable young lady. His intermittent was soon attended by a very considerable ascites; for which he became a patient of the Dispensary. He took a decoction of Foxglove night and morning. His urine increased immediately, and he lost all his complaints in four days.

CASE XXII.

William Millar, aged 50 years. Admitted into the Dispensary for a tertian ague, and general dropsy. The dropsy continuing after the ague was removed, and his urine being still passed in small quantities; he took the powdered leaves, and recovered his health in five days.

CASE XXIII.

Ann Wakelin, 10 years of age. Had for several weeks a dropsy of the belly after an ague. She took a decoction of Foxglove, which removed all complaint by the fourth day.

CASE XXIV.

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

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

REMARKS.

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

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

Anasarca 7 Cases Cured 3
Relieved 1
Failed 3
Ascites 5 Cases Cured 4
Relieved 1
OEdematous leg 1 Case Cured 1
Ascites and anasarca 7 Cases Cured 4
Relieved 2
Failed 1
Asthma and dropsy 1 Case Failed 1
Hydrothorax and gout 1 Case Cured 1
----, ascites and anasarca-- 2 Cases Cured 2

A CASE of Anasarca communicated by Mr.
JONES, Surgeon, in Birmingham.

Dear SIR,

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

I am, &c.
W. JONES.

Birmingham,
May 17th, 1785.

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

_April_ 16th, 1785, I directed the following form:

R. Fol. Digitalis siccat. [Symbol: dram]ii.
Aq. fontanae bullient. [Symbol: ounce]viii. f. infus. et cola.
Sumat cochl. larga iii. o. n. et mane.

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

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

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

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

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

R. Aceti scillitic. [Symbol: dram]vi.
Tinct. aromat. [Symbol: dram]ii.
Tinct. thebaic. gutt. xx. m.

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

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

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

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

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

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

REMARKS.

The above is a very instructive case, as it teaches us how small a quantity of the infusion was necessary to effect every desirable purpose. At first sight it may appear from the concluding paragraph, that the green leaves ought to be preferred to the dried ones, as being so much milder in their operation; but let it be noticed, that the same quantity of infusion was prepared from the same weight of the green as of the dried leaves, and consequently, as will appear hereafter, the infusion with the dried leaves was five times the strength of that before prepared from the green ones. We need not wonder, therefore, that the effects of the former were so disagreeable, when the dose was five times greater than it ought to have been. But what makes this matter still more obvious, is the mistake mentioned at first, of two tea spoonfuls only being given for a dose. Now a tea spoonful, containing about a fourth or a fifth part of the contents of a table spoon, the dose then given, was very nearly the same as that which had before been taken of the infusion of the green leaves, and it produced precisely the same effects for it increased the urinary discharge, without exciting the violent vomiting.

Letter from Doctor JOHNSTONE,
Physician, in Birmingham.

Dear SIR,

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

I am, &c.
E. JOHNSTONE.

Birmingham, May 26,
1785.

_March_ 8th, 1783, I was called to attend Mr. G----, a gentleman of a robust habit, who had led a regular and temperate life, AEt. 68. He was affected with great difficulty of respiration, and cough particularly troublesome on attempting to lie down, oedematous swellings of the legs and thighs, abdomen tense and sore on being pressed, pain striking from the pit of the stomach to the back and shoulders; almost constant nausea, especially after taking food, which he frequently threw up; water thick and high-coloured, passed with difficulty and in small quantity; body costive; pulse natural; face much emaciated, eyes yellow and depressed. He had been subject to cough and difficulty of breathing in the winter for several years; and about four years before this time, after being exposed to cold, was suddenly deprived of his speech and the use of the right side, which he recovered as the warm weather came on; but since that time had been remarkably costive, and was in every respect much debilitated. He first perceived his legs swell about a year ago; by the use of medicines and exercise, the swellings subsided during the summer, but returned on the approach of winter, and gradually increased to the state in which I found them, notwithstanding he had used different preparations of squills and a great variety of other diuretic medicines. I ordered the following mixture.

R. Foliorum Digitalis purpur. recent. [Symbol: dram]iii.
decoque ex aq. fontan. [Symbol: ounce]xii ad [Symbol:
ounce]vi colaturae adde Tinctur. aromatic.

Syr. zinzib. aa [Symbol: ounce]i. m. capt. cochl. duo larga
secunda quaque hora ad quartam vicem nisi prius nausea
supervenerit.

_March_ 9th. He took four doses of the mixture without being in the least sick, and made, during the night upwards of two quarts of natural coloured water.

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

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

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

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

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

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

R. Infus. amar. [Symbol: ounce]v. tinctur. Rhei spirit.
[Symbol: ounce]ii. spirit vitriol. dulc. [Symbol: dram]ii.
syr. zinzib. [Symbol: dram]vi. m. cap. cochl. iii. larg. ter
in die.

He soon gained sufficient strength to enable him to go a journey, and returned home in much better health than he had been from the time he was affected with the paralytic stroke, and excepting some return of his asthmatic complaint in the winter, hath continued so ever since.

CASE II.

R---- Howgate, a man much addicted to intemperance, particularly in the use of spirituous liquors, AEt. 60, was admitted into the Hospital near Birmingham, _May_ 17, 1783. He complained of difficulty of breathing, attended with cough, particularly troublesome on lying down; drowsiness and frequent dozing, from which he was roused by startings, accompanied with great anxiety and oppression about the breast; oedematous swellings of the legs; constant desire to make water, which he passed with difficulty, and only by drops; pulse weak and irregular; body rather costive; face much emaciated; no appetite for food.--Cap. pil. scil. iii. ter in die.[6]

[Footnote 6: R. Rad. scil. recent. sapon. castiliens. pulv.
Rhei opt. aa. [Symbol: scruple]i. ol. junip. gutt. xvi. syr.
bals. q. s. f. mass. in pil. xxiv. divid.]

_May_ 20th. The pills have had no effect.--Cap. mistur. c.[7] Decoct. Digital. &c. cochl. ii. larg. 3tia quaque hora, ad 3tiam vicem.

[Footnote 7: Prepared in the same manner as in the former
case.]

_May_ 21st. Made near two quarts of water in the night, without being in the least sick. He continued the use of the mixture three times in the day till the 30th, and made about three pints of water daily, by which means the swellings were entirely taken away; and his other complaints so much relieved, that on the 6th of June he was dismissed free from complaint, except a slight cough. But returning to his old course of life, he hath had frequent attacks of his disorder, which have been always removed by using the Digitalis.

Extract of a letter from Mr. LYON,
Surgeon, at Tamworth.

--Mr. Moggs was about 54 years of age, his disease a dropsy of the abdomen, attended with anasarcous swellings of the limbs, &c. brought on by excessive drinking. I believe the first symptoms of the disease appeared the beginning of November, 1776; the medicines he took before you saw him, were squills in different forms, sal diureticus and calomel, but without any good effect; he begun the Digitalis on the 10th of July 1777; a few doses of it caused a giddiness in the head, and almost deprived him of sight, with very great nausea, but very little vomiting, after which a considerable flow of urine ensued, and in a very short time, a very little water remained either in the cavity of the abdomen, or the membrana adiposa, but he remained excessive weak, with a fluttering pulse at the rate of 150 or frequently 160 in a minute; he kept pretty free from water for upwards of twelve months; it then collected, and neither the Digitalis nor any other medicine would carry it off. I tapped him the 2d of August 1779 in the usual place, and took some gallons of water from him, but he very soon filled again, and as he had a very large rupture, a considerable quantity of the water lodged in the scrotum, and could not be got away by tapping in the usual place. I therefore (on the 28th of the same month) made an incision into the lower part of the scrotum, and drained off all the water that way, but he was so very much reduced, that he died the 8th or 9th of _September_ following, which was about two years and two months after he first begun the Digitalis.

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

Communications from Dr. STOKES,
Physician, in Stourbridge.

Dear SIR,

I accept with pleasure your invitation to communicate what I know respecting the properties of _Digitalis_; and if an account of what others had discovered before you,[8] with a detail of my own experience, shall be allowed the merit of at least a well meant acknowledgment, for the early communication you were so kind to make me, of the valuable properties you had found in it; I shall consider my time as well employed. A knowledge of what has been already done is the best ground work of future experiment; on which account I have been the more full on this subject, in hopes that given with the cautions which you mean to lay down in the cure of dropsies, it may prove alike useful in that of other diseases, one of which stands foremost among the _opprobria_ of medicine.

[Footnote 8: See this account in the Introduction.]

CASE I.

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

_Empl. vesicator. pectori dolent._
_Infus. Digital. e [Symbol: dram]iii. ad. aq. &c. [Symbol: ounce]viii.
cochl. j. o. h. donec nausea excitetur vel diuresis satis copiosa
proveniat._

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

_Dec. 2. Infus. Digit. e. [Symbol: dram]iss ad aq. &c.
[Symbol: ounce]viii. cochl. ii. horis &c. u. a._

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

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

[Footnote 9: For reasons assigned at p. 100, I did not intend
to introduce any case, occurring under my own inspection, in
the course of the present year; but it may be satisfactory to
continue the history of this disease, as Dr. Stokes's
narrative would otherwise be incomplete.

1785.

CASE.

_Jan._ 5th. Mrs. M----, AEt. 48. Hydrothorax and anasarcous
legs, of eight months duration. She had taken jallap, squill,
salt of tartar, and various other medicines. I found her in a
very reduced state, and therefore directed only a grain and
half of the Pulv. Digital. to be given night and morning.
This in a few days encreased the secretion of urine, removed
her difficulty of breathing, and reduced the swelling of her
legs, without any disturbance to her system.

Three months afterwards, a severe attack of gout in her legs
and arms, removing to her head, she died.

Dr. Stokes had an opportunity of examining the dead body, and
I had the satisfaction to learn from him, that there did not
appear to have been any return of the dropsy.]

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

About 3/4 oz. of bloody water flowed out, on elevating the upper half of the scull, and a small quantity also was found at the base.

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

A very slight watery effusion between the _Pia Mater_ and _Tunica arachnoidea_. About 3/4 oz. of watery fluid in the _lateral ventricles_.

THORAX. In the left cavity about 4 oz. of bloody serum; in the right but little. Lungs, the hinder parts loaded with blood. Adhesions of each lobe to the pleura. _Pericardium_ containing but a very small quantity of fluid. _Heart_ containing no coagula of blood. _Valves of the Aorta_ of a cartilaginous texture, as if beginning to ossify.

_Abdominal Viscera_ natural, and a profusion of _Fat_ under the integuments of the abdomen and thorax, in the former to the thickness of an inch and upwards, and in very considerable quantity on the mesentery, omentum, kidneys, &c.

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

CASE II.

Mrs. C---- of K----, AEt. 80. Orthopnoea, with sense of oppression about the proecordia. Unable to lie down in bed for some nights past. Anasarca of the lower extremities. Urine very scanty. Complaints of six weeks standing. Had taken _sal. diuret. c. ol. junip.--Calom. c. jalap, et gambog.--Et ol. junip. c. ol. Terebinth._ without effect.

_Feb._ 7. _Infus. Digital. e. [Symbol: dram]iii. ad aq. &c. [Symbol: ounce]viii. cochl. ii. 4tis horis._ Ordered to drink largely of _infus. baccar. junip._ The third dose produced great nausea which continued ten hours, during which time the urine made was about a quart. The next day her apothecary directed her to begin again with it. The second dose produced vomiting. During the next twenty hours she made two quarts of water, about four times as much as she drank.

From this time she took no more of the _infus. Digital._ but continued the _inf. bacc. junip._ until about _March_ 2d, when all the swellings were gone down, her respiration perfectly free, and she herself quite restored to her former state of health. On the 29th she had an attack of jaundice which was some time after removed; since which she has enjoyed a good state of health, excepting that for some little time past her ancles have been slightly oedematous, which will I trust soon yield to strengthening medicines.

CASE III.

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

_Infus. Digital. c. [Symbol: dram]iss ad aq. bull. [Symbol: ounce]viii.
cochl. ii. 4tis horis._

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

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

_Infus. Digital. u. a. praescript._

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

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

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

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

"An ASCITES emptied by it, but filled again very speedily,
though _its use was never discontinued_, and who afterwards
found no salutary effects from it. Ended fatally.

"In an ANASARCA it sometimes increased the quantity of urine,
and abated the swelling, but which as often returned in as
great a degree as before, though _the medicine was still
given_, and always increased in quantity so as to excite
nausea. Ended fatally.

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

May we not be allowed to conjecture that the inefficacy of _its continued use_ is owing to its narcotic property gradually diminishing the irritability of the muscular fibres of the absorbents, or possibly of the whole vascular system, and thus adding to that weakened action which seems to be the cause of the generality of dropsies, which leads us to caution the medical experimenter against trying it, at least _against its continued use, even in small doses_, in other diseases of diminished energy, as continued fever, palsy, &c.

I remain with the greatest truth,

Your obliged and affectionate friend,

JONATHAN STOKES.

Stourbridge,
May 17, 1785.

The three following Hospital Cases, which Dr. STOKES had an
opportunity of observing, are related as instances of bad
practice, and tend to demonstrate how necessary it is when
one physician adopts the medicine of another, that he should
also at first rigidly adopt his method.

CASE I.

Esther K----, AEt. 33. General anasarca, ascites, and dyspnoea, of seven months duration.

_Decoct. c Digit. [Symbol: dram]iv. c. aq. [Symbol: pound]i. coquend. ad [Symbol: pound]ss. cap. [Symbol: ounce]i. 2dis. horis._ 1st DAY. 4th dose made her sick. 2d DAY. The first dose she took to-day produced vomiting.

3d DAY. _Minuatur dosis ad [Symbol: ounce]ss._ This stayed upon her stomach, but produced an almost constant sickness. Stools more frequent, water scarce sensibly increased; and her swellings not at all reduced.

4th DAY. _Cap. Calomel. gambog. scill. &c._

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

CASE II.

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

_Decoct. Digit. (u. in Esther K----,) 4tis horis._

1st DAY of taking it. The 4th dose produced sickness.

2d. Vomiting after the second dose.

10th. Urine increased to [Symbol: pound]vi.

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

12th. Abdomen not diminished.

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

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

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

32d. Urine exceedingly scanty.

35th. _Vin. scill. [Symbol: ounce]ss. o. m. &c._ This produced diuretic effects.

44th. Tapped. Terminated fatally.

OBS. Here the medicine was _continued till it ceased to produce diuretic effects_; and these effects were not aided by any strengthening remedies.

CASE III.

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

_Infus. Digital. [Symbol: dram]iiiss. ad. aq. [Symbol: pound]ss.
cap. [Symbol: ounce]i. altern. horis donec nauseam
excitaverit._ _Rep. 3tiis diebus. tempore intermedio cap.
sol. guaic. [Symbol: ounce]i. ter in die ex inf. sinap._

1st DAY of taking it. Became sickish towards night.

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

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

4th DAY. _Decoct. bacc. junip. and cyder for common drink._

6th DAY. A second course of his medicine produced a flow of urine almost as plentiful as the former, though he drank little or nothing at the time. In a day or two after he walked to some distance.

12th DAY. _Pot. purgans illico._

14th DAY. _Pot. purg. c. jalap. [Symbol: dram]ss. 4tis diebus._
_Infus. Dig. 3tiis diebus._

17th DAY. _R. Gamb. gr. iii. calom. gr. ii. camph.
gr. i. syr. simpl. fiat pil. o. n. sum._
_Infus. Digit. 3tiis diebus._

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

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