AN ACCOUNT OF THE FOXGLOVE, AND Some of its Medical Uses: WITH PRACTICAL REMARKS ON DROPSY, AND OTHER DISEASES.

BY

WILLIAM WITHERING, M. D.

Physician to the General Hospital at Birmingham.

—— nonumque prematur in annum.

HORACE.

BIRMINGHAM: PRINTED BY M. SWINNEY; FOR G. G. J. AND J. ROBINSON, PATERNOSTER-ROW, LONDON. M,DCC,LXXXV.



PREFACE.

After being frequently urged to write upon this subject, and as often declining to do it, from apprehension of my own inability, I am at length compelled to take up the pen, however unqualified I may still feel myself for the task.

The use of the Foxglove is getting abroad, and it is better the world should derive some instruction, however imperfect, from my experience, than that the lives of men should be hazarded by its unguarded exhibition, or that a medicine of so much efficacy should be condemned and rejected as dangerous and unmanageable.

It is now about ten years since I first began to use this medicine. Experience and cautious attention gradually taught me how to use it. For the last two years I have not had occasion to alter the modes of management; but I am still far from thinking them perfect.

It would have been an easy task to have given select cases, whose successful treatment would have spoken strongly in favour of the medicine, and perhaps been flattering to my own reputation. But Truth and Science would condemn the procedure. I have therefore mentioned every case in which I have prescribed the Foxglove, proper or improper, successful or otherwise. Such a conduct will lay me open to the censure of those who are disposed to censure, but it will meet the approbation of others, who are the best qualified to be judges.

To the Surgeons and Apothecaries, with whom I am connected in practice, both in this town and at a distance, I beg leave to make this public acknowledgment, for the assistance they so readily afforded me, in perfecting some of the cases, and in communicating the events of others.

The ages of the patients are not always exact, nor would the labour of making them so have been repaid by any useful consequences. In a few instances accuracy in that respect was necessary, and there it has been attempted; but in general, an approximation towards the truth, was supposed to be sufficient.

The cases related from my own experience, are generally written in the shortest form I could contrive, in order to save time and labour. Some of them are given more in detail, when particular circumstances made such detail necessary; but the cases communicated by other practitioners, are given in their own words.

I must caution the reader, who is not a practitioner in physic, that no general deductions, decisive upon the failure or success of the medicine, can be drawn from the cases I now present to him. These cases must be considered as the most hopeless and deplorable that exist; for physicians are seldom consulted in chronic diseases, till the usual remedies have failed: and, indeed, for some years, whilst I was less expert in the management of the Digitalis, I seldom prescribed it, but when the failure of every other method compelled me to do it; so that upon the whole, the instances I am going to adduce, may truly be considered as cases lost to the common run of practice, and only snatched from destruction, by the efficacy of the Digitalis; and this in so remarkable a manner, that, if the properties of that plant had not been discovered, by far the greatest part of these patients must have died.

There are men who will hardly admit of any thing which an author advances in support of a favorite medicine, and I allow they may have some cause for their hesitation; nor do I expect they will wave their usual modes of judging upon the present occasion. I could wish therefore that such readers would pass over what I have said, and attend only to the communications from correspondents, because they cannot be supposed to possess any unjust predilection in favour of the medicine: but I cannot advise them to this step, for I am certain they would then close the book, with much higher notions of the efficacy of the plant than what they would have learnt from me. Not that I want faith in the discernment or in the veracity of my correspondents, for they are men of established reputation; but the cases they have sent me are, with some exceptions, too much selected. They are not upon this account less valuable in themselves, but they are not the proper premises from which to draw permanent conclusions.

I wish the reader to keep in view, that it is not my intention merely to introduce a new diuretic to his acquaintance, but one which, though not infallible, I believe to be much more certain than any other in present use.

After all, in spite of opinion, prejudice, or error, TIME will fix the real value upon this discovery, and determine whether I have imposed upon myself and others, or contributed to the benefit of science and mankind.

Birmingham, 1st July, 1785.



INTRODUCTION.

The Foxglove is a plant sufficiently common in this island, and as we have but one species, and that so generally known, I should have thought it superfluous either to figure or describe it; had I not more than once seen the leaves of Mullein[1] gathered for those of Foxglove. On the continent of Europe too, other species are found, and I have been informed that our species is very rare in some parts of Germany, existing only by means of cultivation, in gardens.

[Footnote 1: Verbascum of Linnaeus.]

Our plant is the Digitalis purpurea[2] of Linnaeus. It belongs to the 2d order of the 14th class, or the DIDYNAMIA ANGIOSPERMIA. The essential characters of the genus are, Cup with 5 divisions. Blossom bell-shaped, bulging. Capsule egg-shaped, 2-celled.—LINN.

[Footnote 2: The trivial name purpurea is not a very happy one, for the blossoms though generally purple, are sometimes of a pure white.]

DIGITA'LIS purpu'rea. Little leaves of the empalement egg-shaped, sharp. Blossoms blunt; the upper lip entire. LINN.

REFERENCES TO FIGURES. These are disposed in the order of comparative excellence.

Rivini monopet. 104. Flora danica, 74, parts of fructification. Tournefort Institutiones. 73, A, E, L, M. Fuchsii Hist. Plant. 893, copied in Tragi stirp. histor. 889. J. Bauhini histor. Vol. ii. 812. 3, and Lonicera 74, 1. Blackwell. auct. 16. Dodonoei pempt. stirp. hist. 169, reprinted in Gerard emacul. 790, 1, and copied in Parkinson Theatr. botanic. 653, 1. Gerard, first edition, 646, 1. Histor. Oxon. Morison. V. 8, row 1. 1. Flor. danic. 74, the reduced figure.

Blossom. The bellying part on the inside sprinkled with spots like little eyes. Leaves wrinkled. LINN.

BLOSSOM. Rather tubular than bell-shaped, bulging on the under side, purple; the narrow tubular part at the base, white. Upper lip sometimes slightly cloven.

CHIVES. Threads crooked, white. Tips yellow.

POINTAL. Seed-bud greenish. Honey-cup at its base more yellow. Summit cloven.

S. VESS. Capsule not quite so long as the cup.

ROOT. Knotty and fibrous.

STEM. About 4 feet high; obscurely angular; leafy.

LEAVES. Slightly but irregularly serrated, wrinkled; dark green above, paler underneath. Lower leaves egg-shaped; upper leaves spear-shaped. Leaf-stalks fleshy; bordered.

FLOWERS. Numerous, mostly growing from one side of the stem and hanging down one over another. Floral-leaves sitting, taper-pointed. The numerous purple blossoms hanging down, mottled within; as wide and nearly half as long as the finger of a common-sized glove, are sufficient marks whereby the most ignorant may distinguish this from every other British plant; and the leaves ought not to be gathered for use but when the plant is in blossom.

PLACE. Dry, gravelly or sandy soils; particularly on sloping ground. It is a biennial, and flowers from the middle of June to the end of July.

I have not observed that any of our cattle eat it. The root, the stem, the leaves, and the flowers have a bitter herbaceous taste, but I don't perceive that nauseous bitter which has been attributed to it.

* * * * *

This plant ranks amongst the LURIDAE, one of the Linnaean orders in a natural system. It has for congenera, NICOTIANA, ATROPA, HYOSCYAMUS, DATURA, SOLANUM, &c. so that from the knowledge we possess of the virtues of those plants, and reasoning from botanical analogy, we might be led to guess at something of its properties.

I intended in this place to have traced the history of its effects in diseases from the time of Fuchsius, who first describes it, but I have been anticipated in this intention by my very valuable friend, Dr. Stokes of Stourbridge, who has lately sent me the following

HISTORICAL VIEW of the Properties of Digitalis.

FUCHSIUS in his hist. stirp. 1542, is the first author who notices it. From him it receives its name of DIGITALIS, in allusion to the German name of Fingerhut, which signifies a finger-stall, from the blossoms resembling the finger of a glove.

SENSIBLE QUALITIES. Leaves bitterish, very nauseous. LEWIS Mat. med. i. 342.

SENSIBLE EFFECTS. Some persons, soon after eating of a kind of omalade, into which the leaves of this, with those of several other plants, had entered as an ingredient, found themselves much indisposed, and were presently after attacked with vomitings. DODONAEUS pempt. 170.

It is a medicine which is proper only for strong constitutions, as it purges very violently, and excites excessive vomitings. RAY. hist. 767.

BOERHAAVE judges it to be of a poisonous nature, hist. plant. but DR. ALSTON ranks it among those indigenous vegetables, "which, though now disregarded, are medicines of great virtue, and scarcely inferior to any that the Indies afford." LEWIS Mat. med. i. p. 343.

Six or seven spoonfuls of the decoction produce nausea and vomiting, and purge; not without some marks of a deleterious quality. HALLER hist. n. 330 from Aerial Infl. p. 49, 50.

The following is an abridged ACCOUNT of its EFFECTS upon TURKEYS.

M. SALERNE, a physician at Orleans, having heard that several turkey pouts had been killed by being fed with Foxglove leaves, instead of mullein, he gave some of the same leaves to a large vigorous turkey. The bird was so much affected that he could not stand upon his legs, he appeared drunk, and his excrements became reddish. Good nourishment restored him to health in eight days.

Being then determined to push the experiment further, he chopped some more leaves, mixed them with bran, and gave them to a vigorous turkey cock which weighed seven pounds. This bird soon appeared drooping and melancholy; his feathers stared, his neck became pale and retracted. The leaves were given him for four days, during which time he took about half a handful. These leaves had been gathered about eight days, and the winter was far advanced. The excrements, which are naturally green and well formed, became, from the first, liquid and reddish, like those of a dysenteric patient.

The animal refusing to eat any more of this mixture which had done him so much mischief, I was obliged to feed him with bran and water only; but notwithstanding this, he continued drooping, and without appetite. At times he was seized with convulsions, so strong as to throw him down; in the intervals he walked as if drunk; he did not attempt to perch, he uttered plaintive cries. At length he refused all nourishment. On the fifth or sixth day the excrements became as white as chalk; afterwards yellow, greenish, and black. On the eighteenth day he died, greatly reduced in flesh, for he now weighed only three pounds.

On opening him we found the heart, the lungs, the liver, and gall-bladder shrunk and dried up; the stomach was quite empty, but not deprived of its villous coat. Hist. de l'Academ. 1748. p. 84.

EPILEPSY.—"It hath beene of later experience found also to be effectual against the falling sicknesse, that divers have been cured thereby; for after the taking of the Decoct. manipulor. ii. c. polypod. quercin. contus. [Symbol: ounce]iv. in cerevisia, they that have been troubled with it twenty-six years, and have fallen once in a weeke, or two or three times in a moneth, have not fallen once in fourteen or fifteen moneths, that is until the writing hereof."

Parkinson, p. 654.

SCROPHULA.—"The herb bruised, or the juice made up into an ointment, and applied to the place, hath been found by late experience to be availeable for the King's Evill." PARK. p. 654.

Several hereditary instances of this disease said to have been cured by it. AEREAL INFLUENCES, p. 49, 50, quoted by HALLER, hist. n. 330.

A man with scrophulous ulcers in various parts of the body, and which in the right leg were so virulent that its amputation was proposed, cured by succ. express. cochl. i. bis intra xiv. dies, in 1/2 pintae cerevisiae calidae.

The leaves remaining after the pressing out of the juice, were applied every day to the ulcers. Pract. ess. p. 40. quoted by MURRAY apparat. medicam. i. p. 491.

A young woman with a scrophulous tumour of the eye, a remarkable swelling of the upper lip, and painful tumours of the joints of the fingers, much relieved; but the medicine was left off, on account of its violent effects on the constitution. Ib. p. 42 quoted as above.

A man with scrophulous tumour of the right elbow, attended for three years with excruciating pains, was nearly cured by four doses of the juice taken once a month. Ib. p. 43. as above.

The physicians and surgeons of the Worcester Infirmary have employed it in ointments and poultices with remarkable efficacy. Ib. p. 44. It was recommended to them by Dr. Baylies of Evesham, now of Berlin, as a remedy for this disease. Dr. Wall gave it a tryal, as well externally as internally, but their experiments did not lead them to observe any other properties in it, than those of a highly nauseating medicine and drastic purgative.

WOUNDS. In considerable estimation for the healing all kinds of wounds, Lobel. adv. 245.

Principally of use in ulcers, which discharge considerably, being of little advantage in such as are dry. HULSE, in R. hist. 768.

DOCTOR BAYLIES, physician to his Prussian Majesty, informed me, when at Berlin, that he employed it with great success in caries, and obstinate sore legs.

DYSPNOEA Pituitosa Sauvages i. 657.—"Boiled in water, or wine, and drunken doth cut and consume the thicke toughnesse of grosse, and slimie flegme, and naughtie humours. The same, or boiled with honied water or sugar, doth scoure and clense the brest, ripeneth and bringeth foorth tough and clammie flegme. It openeth also the stoppage of the liver spleene and milt, and of the inwarde parts." GERARDE hist. ed. I p. 647.

"Whensoever there is need of a rarefying or extenuating of tough flegme or viscous humours troubling the chest,—the decoction or juice hereof made up with sugar or honey is availeable, as also to clense and purge the body both upwards and downwards sometimes, of tough flegme, and clammy humours, notwithstanding that these qualities are found to bee in it, there are but few physitions in our times that put it to these uses, but it is in a manner wholly neglected."

PARKINSON, p. 654.

Previous to the year 1777, you informed me of the great success you had met with in curing dropsies by means of the fol. Digitalis, which you then considered as a more certain diuretic than any you had ever tried. Some time afterwards, Mr. Russel, surgeon, of Worcester, having heard of the success which had attended some cases in which you had given it, requested me to obtain for him any information you might be inclined to communicate respecting its use. In consequence of this application, you wrote to me in the following terms.[3]

[Footnote 3: See the extract from this letter at page 5.]

In a letter which I received from you in London, dated September 29, 1778, you write as follows:—"I wish it was as easy to write upon the Digitalis—I despair of pleasing myself or instructing others, in a subject so difficult. It is much easier to write upon a disease than upon a remedy. The former is in the hands of nature, and a faithful observer, with an eye of tolerable judgment, cannot fail to delineate a likeness. The latter will ever be subject to the whims, the inaccuracies, and the blunders of mankind."—

In my notes I find the following memorandum—"February 20th, 1779, gave an account of Doctor Withering's practice, with the precautions necessary to its success, to the Medical Society at Edinburgh."—In the course of that year, the Digitalis was prescribed in the Edinburgh Infirmary, by Dr. Hope, and in the following year, whilst I was Clerk to Dr. Home, as Clinical Professor, I had a favourable opportunity of observing its sensible effects.

In one case in which it was given properly at first, the urine began to flow freely on the second day. On the third, the swellings began to subside. The dose was then increased more than quadruple in the twenty-four hours. On the fifth day sickness came on, and much purging, but the urine still increased though the pulse sunk to 50. On the 7th day, a quadruple dose of the infusion was ordered to be taken every third hour, so as to bring on nausea again. The pulse fell to forty-four, and at length to thirty-five in a minute. The patient gradually sunk and died on the sixteenth day; but previous to her death, for two or three days, her pulse rose to near one hundred.—It is needless to observe to you, how widely the treatment of this case differed from the method which you have found so successful.



OF THE PLATE.

The figure of the Foxglove, facing the Title Page, is copied by the permission and under the inspection of Mr. Curtis, from his admirable work, entitled FLORA LONDINENSIS. The accuracy of the drawings, the beauty of the colouring, the full descriptions, the accurate specific distinctions, and the uses of the different plants, cannot fail to recommend that work to the patronage of all who are interested in the encouragement of genius, or the promotion of useful knowledge.

* * * * *

EXPLANATION.

Fig. 1. The Empalement.

Fig. 2, 3, 4. Four CHIVES two long and two short. TIPS at first large, turgid, oval, touching at bottom, of a yellowish colour, and often spotted; lastly changing both their form and situation in a singular manner.

Fig. 5, 6, 7. SEED-BUD rather conical, of a yellow green colour. Shaft simple. Summit cloven.

Fig. 8. Honey-cup a gland, surrounding the bottom of the Seed-bud.

Fig. 9. SEED-VESSEL, a pointed oval Capsule, of two cells and two valves, the lowermost valve splitting in two.

Fig. 10. SEEDS numerous, blackish, small, lopped at each end.



AN ACCOUNT OF THE INTRODUCTION of FOXGLOVE INTO MODERN PRACTICE.

As the more obvious and sensible properties of plants, such as colour, taste, and smell, have but little connexion with the diseases they are adapted to cure; so their peculiar qualities have no certain dependence upon their external configuration. Their chemical examination by fire, after an immense waste of time and labour, having been found useless, is now abandoned by general consent. Possibly other modes of analysis will be found out, which may turn to better account; but we have hitherto made only a very small progress in the chemistry of animal and vegetable substances. Their virtues must therefore be learnt, either from observing their effects upon insects and quadrupeds; from analogy, deduced from the already known powers of some of their congenera, or from the empirical usages and experience of the populace.

The first method has not yet been much attended to; and the second can only be perfected in proportion as we approach towards the discovery of a truly natural system; but the last, as far as it extends, lies within the reach of every one who is open to information, regardless of the source from whence it springs.

It was a circumstance of this kind which first fixed my attention on the Foxglove.

In the year 1775, my opinion was asked concerning a family receipt for the cure of the dropsy. I was told that it had long been kept a secret by an old woman in Shropshire, who had sometimes made cures after the more regular practitioners had failed. I was informed also, that the effects produced were violent vomiting and purging; for the diuretic effects seemed to have been overlooked. This medicine was composed of twenty or more different herbs; but it was not very difficult for one conversant in these subjects, to perceive, that the active herb could be no other than the Foxglove.

My worthy predecessor in this place, the very humane and ingenious Dr. Small, had made it a practice to give his advice to the poor during one hour in a day. This practice, which I continued until we had an Hospital opened for the reception of the sick poor, gave me an opportunity of putting my ideas into execution in a variety of cases; for the number of poor who thus applied for advice, amounted to between two and three thousand annually. I soon found the Foxglove to be a very powerful diuretic; but then, and for a considerable time afterwards, I gave it in doses very much too large, and urged its continuance too long; for misled by reasoning from the effects of the squill, which generally acts best upon the kidneys when it excites nausea, I wished to produce the same effect by the Foxglove. In this mode of prescribing, when I had so many patients to attend to in the space of one, or at most of two hours, it will not be expected that I could be very particular, much less could I take notes of all the cases which occurred. Two or three of them only, in which the medicine succeeded, I find mentioned amongst my papers. It was from this kind of experience that I ventured to assert, in the Botanical Arrangement published in the course of the following spring, that the Digitalis purpurea "merited more attention than modern practice bestowed upon it."

I had not, however, yet introduced it into the more regular mode of prescription; but a circumstance happened which accelerated that event. My truly valuable and respectable friend, Dr. Ash, informed me that Dr. Cawley, then principal of Brazen Nose College, Oxford, had been cured of a Hydrops Pectoris, by an empirical exhibition of the root of the Foxglove, after some of the first physicians of the age had declared they could do no more for him. I was now determined to pursue my former ideas more vigorously than before, but was too well aware of the uncertainty which must attend on the exhibition of the root of a biennial plant, and therefore continued to use the leaves. These I had found to vary much as to dose, at different seasons of the year; but I expected, if gathered always in one condition of the plant, viz. when it was in its flowering state, and carefully dried, that the dose might be ascertained as exactly as that of any other medicine; nor have I been disappointed in this expectation. The more I saw of the great powers of this plant, the more it seemed necessary to bring the doses of it to the greatest possible accuracy. I suspected that this degree of accuracy was not reconcileable with the use of a decoction, as it depended not only upon the care of those who had the preparation of it, but it was easy to conceive from the analogy of another plant of the same natural order, the tobacco, that its active properties might be impaired by long boiling. The decoction was therefore discarded, and the infusion substituted in its place. After this I began to use the leaves in powder, but I still very often prescribe the infusion.

Further experience convinced me, that the diuretic effects of this medicine do not at all depend upon its exciting a nausea or vomiting; but, on the contrary, that though the increased secretion of urine will frequently succeed to, or exist along with these circumstances, yet they are so far from being friendly or necessary, that I have often known the discharge of urine checked, when the doses have been imprudently urged so as to occasion sickness.

If the medicine purges, it is almost certain to fail in its desired effect; but this having been the case, I have seen it afterwards succeed when joined with small doses of opium, so as to restrain its action on the bowels.

In the summer of the year 1776, I ordered a quantity of the leaves to be dried, and as it then became possible to ascertain its doses, it was gradually adopted by the medical practitioners in the circle of my acquaintance.

In the month of November 1777, in consequence of an application from that very celebrated surgeon, Mr. Russel, of Worcester, I sent him the following account, which I choose to introduce here, as shewing the ideas I then entertained of the medicine, and how much I was mistaken as to its real dose.—"I generally order it in decoction. Three drams of the dried leaves, collected at the time of the blossoms expanding, boiled in twelve to eight ounces of water. Two spoonfuls of this medicine, given every two hours, will sooner or later excite a nausea. I have sometimes used the green leaves gathered in winter, but then I order three times the weight; and in one instance I used three ounces to a pint decoction, before the desired effect took place. I consider the Foxglove thus given, as the most certain diuretic I know, nor do its diuretic effects depend merely upon the nausea it produces, for in cases where squill and ipecac. have been so given as to keep up a nausea several days together, and the flow of urine not taken place, I have found the Foxglove to succeed; and I have, in more than one instance, given the Foxglove in smaller and more distant doses, so that the flow of urine has taken place without any sensible affection of the stomach; but in general I give it in the manner first mentioned, and order one dose to be taken after the sickness commences. I then omit all medicines, except those of the cordial kind are wanted, during the space of three, four, or five days. By this time the nausea abates, and the appetite becomes better than it was before. Sometimes the brain is considerably affected by the medicine, and indistinct vision ensues; but I have never yet found any permanent bad effects from it."—

"I use it in the Ascites, Anasarca, and Hydrops Pectoris; and so far as the removal of the water will contribute to cure the patient, so far may be expected from this medicine: but I wish it not to be tried in ascites of female patients, believing that many of these cases are dropsies of the ovaria; and no sensible man will ever expect to see these encysted fluids removed by any medicine."

"I have often been obliged to evacuate the water repeatedly in the same patient, by repeating the decoction; but then this has been at such distances of time as to allow of the interference of other medicines and a proper regimen, so that the patient obtains in the end a perfect cure. In these cases the decoction becomes at length so very disagreeable, that a much smaller quantity will produce the effect, and I often find it necessary to alter its taste by the addition of Aq. Cinnam. sp. or Aq. Juniper. composita."

"I allow, and indeed enjoin my patients to drink very plentifully of small liquors through the whole course of the cure; and sometimes, where the evacuations have been very sudden, I have found a bandage as necessary as in the use of the trochar."—

Early in the year 1779, a number of dropsical cases offered themselves to my attention, the consequences of the scarlet fever and sore throat which had raged so very generally amongst us in the preceding year. Some of these had been cured by squills or other diuretics, and relapsed; in others, the dropsy did not appear for several weeks after the original disease had ceased: but I am not able to mention many particulars, having omitted to make notes. This, however, is the less to be regretted, as the symptoms in all were very much alike, and they were all without an exception cured by the Foxglove.

This last circumstance encouraged me to use the medicine more frequently than I had done heretofore, and the increase of practice had taught me to improve the management of it.

In February 1779, my friend, Dr. Stokes, communicated to the Medical Society at Edinburgh the result of my experience of the Foxglove; and, in a letter addressed to me in November following, he says, "Dr. Hope, in consequence of my mentioning its use to my friend, Dr. Broughton, has tried the Foxglove in the Infirmary with success." Dr. Stokes also tells me that Dr. Hamilton cured Dropsies with it in the year 1781.

I am informed by my very worthy friend Dr. Duncan, that Dr. Hamilton, who learnt its use from Dr. Hope, has employed it very frequently in the Hospital at Edinburgh. Dr. Duncan also tells me, that the late very ingenious and accomplished Mr. Charles Darwin, informed him of its being used by his father and myself, in cases of Hydrothorax, and that he has ever since mentioned it in his lectures, and sometimes employed it in his practice.

At length, in the year 1783, it appeared in the new edition of the Edinburgh Pharmacopoeia, into which, I am told, it was received in consequence of the recommendation of Dr. Hope. But from which, I am satisfied, it will be again very soon rejected, if it should continue to be exhibited in the unrestrained manner in which it has heretofore been used at Edinburgh, and in the enormous doses in which it is now directed in London.

In the following cases the reader will find other diseases besides dropsies; particularly several cases of consumption. I was induced to try it in these, from being told, that it was much used in the West of England, in the Phthisis Pulmonalis, by the common people. In this disease, however, in my hands, it has done but little service, and yet I am disposed to wish it a further trial, for in a copy of Parkinson's Herbal, which I saw about two years ago, I found the following manuscript note at the article Digitalis, written, I believe, by a Mr. Saunders, who practised for many years with great reputation as a surgeon and apothecary at Stourbridge, in Worcestershire.

"Consumptions are cured infallibly by weak decoction of Foxglove leaves in water, or wine and water, and drank for constant drink. Or take of the juice of the herb and flowers, clarify it, and make a fine syrup with honey, of which take three spoonfuls thrice in a day, at physical hours. The use of these two things of late has done, in consumptive cases, great wonders. But be cautious of its use, for it is of a vomiting nature. In these things begin sparingly, and increase the dose as the patient's strength will bear, least, instead of a sovereign medicine, you do real damage by this infusion or syrup."

The precautions annexed to his encomiums of this medicine, lead one to think that he has spoken from his own proper experience.

I have lately been told, that a person in the neighbourhood of Warwick, possesses a famous family receipt for the dropsy, in which the Foxglove is the active medicine; and a lady from the western part of Yorkshire assures me, that the people in her country often cure themselves of dropsical complaints by drinking Foxglove tea. In confirmation of this, I recollect about two years ago being desired to visit a travelling Yorkshire tradesman. I found him incessantly vomiting, his vision indistinct, his pulse forty in a minute. Upon enquiry it came out, that his wife had stewed a large handful of green Foxglove leaves in half a pint of water, and given him the liquor, which he drank at one draught, in order to cure him of an asthmatic affection. This good woman knew the medicine of her country, but not the dose of it, for her husband narrowly escaped with his life.

It is probable that this rude mode of exhibiting the Foxglove has been more general than I am at present aware of; but it is wonderful that no author seems to have been acquainted with its effects as a diuretic.



CASES,

In which the Digitalis was given by the Direction of the Author.

1775.

It was in the course of this year that I began to use the Digitalis in dropsical cases. The patients were such as applied at my house for advice gratis. I cannot pretend to charge my memory with particular cases, or particular effects, and I had not leisure to make notes. Upon the whole, however, it may be concluded, that the medicine was found useful, or I should not have continued to employ it.

CASE I.

December 8th. A man about fifty years of age, who had formerly been a builder, but was now much reduced in his circumstances, complained to me of an asthma which first attacked him about the latter end of autumn. His breath was very short, his countenance was sunken, his belly large; and, upon examination, a fluctuation in it was very perceptible. His urine for some time past had been small in quantity. I directed a decoction of Fol. Digital. recent. which made him very sick, the sickness recurring at intervals for several days, during which time he made a large quantity of water. His breath gradually drew easier, his belly subsided, and in about ten days he began to eat with a keen appetite. He afterwards took steel and bitters.

1776.

CASE II.

January 14th. A poor man labouring under an ascites and anasarca, was directed to take a decoction of Digitalis every four hours. It purged him smartly, but did not relieve him. An opiate was now ordered with each dose of the medicine, which then acted upon the kidneys very freely, and he soon lost all his complaints.

CASE III.

March 15th. A poor boy, about nine years of age, was brought for my advice. His countenance was pale, his pulse quick and feeble, his body greatly emaciated, except his belly, which was very large, and, upon examination, contained a fluid. The case had been considered as arising from worms. He was directed to take the decoction of Digitalis night and morning. It operated as a diuretic, never made him sick, and he got well without any other medicine.

CASE IV.

July 25th. Mrs. H——, of A——, near N——, between forty and fifty years of age, a few weeks ago, after some previous indisposition, was attacked by a severe cold shivering fit, succeeded by fever; great pain in her left side, shortness of breath, perpetual cough, and, after some days, copious expectoration. On the 4th of June, Dr. Darwin,[4] was called to her. I have not heard what was then done for her, but, between the 15th of June, and 25th of July, the Doctor, at his different visits, gave her various medicines of the deobstruent, tonic, antispasmodic, diuretic, and evacuant kinds.

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

On the 25th of July I was desired to meet Dr. Darwin at the lady's house. I found her nearly in a state of suffocation; her pulse extremely weak and irregular, her breath very short and laborious, her countenance sunk, her arms of a leaden colour, clammy and cold. She could not lye down in bed, and had neither strength nor appetite, but was extremely thirsty. Her stomach, legs, and thighs were greatly swollen; her urine very small in quantity, not more than a spoonful at a time, and that very seldom. It had been proposed to scarify her legs, but the proposition was not acceded to.

She had experienced no relief from any means that had been used, except from ipecacoanha vomits; the dose of which had been gradually increased from 15 to 40 grains, but such was the insensible state of her stomach for the last few days, that even those very large doses failed to make her sick, and consequently purged her. In this situation of things I knew of nothing likely to avail us, except the Digitalis: but this I hesitated to propose, from an apprehension that little could be expected from any thing; that an unfavourable termination would tend to discredit a medicine which promised to be of great benefit to mankind, and I might be censured for a prescription which could not be countenanced by the experience of any other regular practitioner. But these considerations soon gave way to the desire of preserving the life of this valuable woman, and accordingly I proposed the Digitalis to be tried; adding, that I sometimes had found it to succeed when other, even the most judicious methods, had failed. Dr. Darwin very politely, acceded immediately to my proposition, and, as he had never seen it given, left the preparation and the dose to my direction. We therefore prescribed as follows:

R. Fol. Digital. purp. recent. [Symbol: ounce]iv. coque ex Aq. fontan. purae [Symbol: pound]iss ad [Symbol: pound]i. et cola. R. Decoct. Digital. [Symbol: ounce]iss. Aq. Nuc. Moschat. [Symbol: dram]ii. M. fiat. haust. 2dis horis sumend.

The patient took five of these draughts, which made her very sick, and acted very powerfully upon the kidneys, for within the first twenty-four hours she made upwards of eight quarts of water. The sense of fulness and oppression across her stomach was greatly diminished, her breath was eased, her pulse became more full and more regular, and the swellings of her legs subsided.

26th. Our patient being thus snatched from impending destruction, Dr. Darwin proposed to give her a decoction of pareira brava and guiacum shavings, with pills of myrrh and white vitriol; and, if costive, a pill with calomel and aloes. To these propositions I gave a ready assent.

30th. This day Dr. Darwin saw her, and directed a continuation of the medicines last prescribed.

August 1st. I found the patient perfectly free from every appearance of dropsy, her breath quite easy, her appetite much improved, but still very weak. Having some suspicion of a diseased liver, I directed pills of soap, rhubarb, tartar of vitriol, and calomel to be taken twice a day, with a neutral saline draught.

9th. We visited our patient together, and repeated the draughts directed on the 26th of June, with the addition of tincture of bark, and also ordered pills of aloes, guiacum, and sal martis to be taken if costive.

September 10th. From this time the management of the case fell entirely under my direction, and perceiving symptoms of effusion going forwards, I desired that a solution of merc. subl. corr. might be given twice a day.

19th. The increase of the dropsical symptoms now made it necessary to repeat the Digitalis. The dried leaves were used in infusion, and the water was presently evacuated, as before.

It is now almost nine years since the Digitalis was first prescribed for this lady, and notwithstanding I have tried every preventive method I could devise, the dropsy still continues to recur at times; but is never allowed to increase so as to cause much distress, for she occasionally takes the infusion and relieves herself whenever she chooses. Since the first exhibition of that medicine, very small doses have been always found sufficient to promote the flow of urine.

I have been more particular in the narrative of this case, partly because Dr. Darwin has related it rather imperfectly in the notes to his son's posthumous publication, trusting, I imagine, to memory, and partly because it was a case which gave rise to a very general use of the medicine in that part of Shropshire.

CASE V.

December 10th. Mr. L——, AEt. 35. Ascites and anasarca, the consequence of very intemperate living. After trying squill and other medicines to no purpose, I directed a decoction of the Fol. Digital. recent. six drams to a pint; an eighth part to be taken every fourth hour. This made him sick, and produced a copious flow of urine, but not enough to remove all the dropsical symptoms. After a fortnight a stronger decoction was ordered, and, upon a third trial, as the winter advanced, it became necessary to use four ounces to the pint decoction; and thus he got free from all his complaints.

In October 1777, in consequence of having pursued his intemperate mode of living, his dropsy returned, accompanied by evident marks of diseased viscera. A decoction of two drams of Fol. Digital. siccat. to a pint, once more removed the dropsy. He took a wine glass full thrice a day.

In January 1778, I was desired to visit him again. I found he had gone on in his usual intemperate life, his countenance jaundiced, and the dropsy coming on apace. After giving some deobstruent medicines, I again directed the Digitalis, which again emptied the water; but he did not survive many weeks.

1777.

CASE VI.

February—. Mrs. M——, AEt. 45. Ascites and anasarca, but not much otherwise diseased, and well enough to walk about the house, and see after her family affairs. I thought this a fair case for a trial of the Digitalis, and therefore directed a decoction of the fresh leaves, the stock of dried ones being exhausted. About a week afterwards, calling to see my patient, I was informed that she was dead; that the third day after my first visit she suddenly fell down, and expired. Upon enquiry I found she had not taken any of the medicine; for the snow had lain so deep upon the ground, that the apothecary had not been able to procure it. Had the medicine been given in a case seemingly so favourable as this, and had the patient died under its use, is it not probable that the death would have been attributed to it?

CASE VII.

February 11th. Mr. E——, of W——, AEt. 61. Hydrothorax, ascites and anasarca, consequences of hard drinking. He had been attended for some time by a physician in his neighbourhood, who had treated his case with the usual remedies, but without affording him any relief; nor could I expect to succeed better by any other medicine than the Digitalis. The dried leaves were not to be had; and the green ones at this season being very uncertain in their strength, I ordered four ounces of the roots in a pint decoction, and directed three spoonfuls to be given every fourth hour, until it either excited nausea, or a free discharge of urine; both these effects took place nearly at the same time: he made a large quantity of water, the swellings subsided very considerably, and his breath became easy. Eight days afterwards he began upon a course of bitters and deobstruents. The dropsical symptoms soon increased again, but he had suffered so much from the severity of the sickness before, that he was neither willing to take, nor I to give the same medicine again.

Perhaps this patient might have been saved, if I had been well acquainted with the management and real doses of the medicine, which was certainly in this instance made very much too strong; and notwithstanding the caution to stop the further exhibition when certain effects should take place, it seems the quantity previously swallowed was sufficient to distress him exceedingly.

CASE VIII.

March 11th. Mrs. H——, AEt. 32. A few days after a tedious labour, had her legs and thighs swelled to a very great degree; pale and semi-transparent,[5] with pain in both groins. After a purge of calomel and rhubarb, ung. merc. was ordered to be rubbed upon the groins, and the following decoction was directed:

R. Fol. Digital. purp. recent. [Symbol: ounce]ii. Aq. purae. [Symbol: pound]i. coque ad [Symbol: pound]iss et colatur. adde. Aq. cinn. sp. [Symbol: ounce]iv. M. capiat. cyath. vinos. parv. bis quotidie.

The decoction presently increased the secretion of urine, and abated the distension of the legs: in a fortnight the swelling was gone; but some days after leaving her bed, her legs swelled again about the ancles, which was removed by another bottle of the decoction on the 21st of April.

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

CASE IX.

March 29th. Mr. G——, AEt. 47. Very much deformed; asthma of several years continuance, but now dropsical to a great degree. Took several medicines without relief, and then tried the Digitalis, but with no better success.

CASE X.

April 10th. G—G——, AEt. 70. Asthma and anasarca. Took a decoction of the fresh leaves of the Digitalis, which produced violent sickness, but no immediate evacuation of water. After the sickness had ceased altogether, the urine began to flow copiously, and he was cured.

CASE XI.

July 10th. Mr. M—— of T——, AEt. 54. A very hard drinker; had been affected since November last with ascites and anasarca, for which he had taken several medicines without benefit. A decoction of the recent leaves of the Digitalis was then directed, an ounce and half to a pint, one eighth of which I ordered to be given every fourth hour. A few doses brought on great nausea, indistinct vision, and a great flow of urine, so as presently to empty him of all the dropsical water. Indeed the evacuation was so rapid and so complete, that it became necessary to apply a bandage round the belly, and to support him with cordials.

In something more than a year and a half, his dropsy returned, but the Digitalis did not then succeed to our wishes. In August, 1779, he was tapped, and lived afterwards only about five weeks.

For more particulars, see the extract of a letter from Mr. Lyon.

CASE XII.

September 12th. Miss C—— of T——, AEt 48. An ovarium dropsy, and anasarcous legs and thighs. For three months in the beginning of this year she had been under the care of Dr. Darwin, who at different times had given her blue vitriol, elaterium, and calomel; decoction of pareira brava, and guiacum wood, with tincture of cantharides; oxymel of squills, decoction of parsley roots, &c. Finding no relief, she discontinued the use of medicines, until the urgency of her symptoms induced her to ask my advice about the end of August. She was greatly emaciated, and had almost a total loss of appetite. I first tried small doses of Merc. sublim. corr. in solution, with decoction of burdock roots, and blisters to the thighs. No advantage attending the use of this plan, I directed a decoction of Fol. Digit. a dram and half to a pint; one ounce to be taken twice a day. It presently reduced the anasarcous swellings, but made no alteration in the distension of the abdomen.

CASE XIII.

October 9th. Mrs. B——, AEt. 40. An ovarium dropsy. Took a decoction of Digitalis without effect. Her life was preserved for some years by repeated tapping.

1778.

CASE XIV.

February 8th. Mr. R—— of K——. Had formerly suffered much from gout, and lived very intemperately. Jaundiced countenance; ascites; legs and thighs greatly swollen; appetite none; extremely weak; confined to his bed. Had taken many medicines from his apothecary without advantage. I ordered him decoction of Digitalis, and a cordial; but he survived only a few days.

CASE XV.

March 13th. Mr. M——, AEt. 54. A thorax greatly deformed; asthma through the winter, succeeded by dropsy in belly and legs. Pulse very small; face leaden coloured; cough almost continual. Decoction of seneka was directed, and small doses of Dover's powder at night.

17th. Gum-ammoniac and squill, with elixir paregor. at night.—26th, Squill and decoction of seneka.—30th, His complaints still increasing, decoction of Digitalis was then directed, which relieved him in a few days; but his complaints returned again, and he died in the month of June.

CASE XVI.

August 18th. Mr. B——, AEt. 33. Pulmonary consumption and dropsy. The Digitalis, and that failing, other diuretics were used, in hopes of gaining some relief from the distress occasioned by the dropsical symptoms; but none of them were effectual. He was then attended by another physician, and died in about two months.

CASE XVII.

September 21st. Mrs. M—— W—— G——, AEt. 50. An ovarium dropsy. She took half a pint of Infus. Digitalis, which made her sick, but did not increase the quantity of urine. She was afterwards relieved by tapping.

CASE XVIII.

October 28th. R—— W——, AEt. 33. Ascites and universal anasarca; countenance quite pale and bloated; appetite none, and the little food he forces down is generally rejected.

R. Fol. Digit. purp. siccat. [Symbol: dram]iii. Aq. bull. [Symbol: pound]i. digere per horas duas, et colat. adde aq. junip. comp. [Symbol: ounce]iii.

He was directed to take one ounce of this infusion every two hours until it should make him sick. This was on Wednesday. The fifth dose made him vomit. On Thursday afternoon he vomited again very freely, without having taken any more of the medicine. On Friday and Saturday he made more water than he had done for a week before, and the swellings of his face and body were considerably abated. He was directed to omit all medicine so long as the urine continued to flow freely, and also to keep an account of the quantity he made in twenty-four hours.

These were his reports:

October 31st. Saturday, 5 half pints. November 1st. Sunday, 6 2d. Monday, 8 3d. Tuesday, 8 4th. Wednesday, 7 5th. Thursday, 8

On Wednesday he began to purge, and the purging still continues, but his appetite is better than he has known it for a long time. No swelling remains but about his ancles, extending at night half way up his legs.

Omit all medicines at present.

7th. Saturday, 71/2 half pints. 8th. Sunday, 8 9th. Monday, 63/4 10th. Tuesday, 61/2 11th. Wednesday, 6 12th. Thursday, 61/4

On Tuesday the 17th, some swelling still remained about his ancles, but he was in every other respect perfectly well.

He took a few more doses of the infusion, and no other medicine.

CASE XIX.

December 8th. W—— B——, AEt. 60. A hard drinker. Diseased viscera; ascites and anasarca. An infusion of Digitalis was directed, but it had no other effect than to make him sick.

1779.

In the beginning of this year we had many dropsies in children, who had suffered from the Scarlatina Anginosa; they all yielded very readily to the Digitalis, but in some the medicine purged, and then it did not prove diuretic, nor did it remove the dropsy until opium was joined with it, so as to prevent it purging.—I did not keep notes of these cases, but I do not recollect a single instance in which the Digitalis failed to effect a cure.

CASE XX.

January 1st. Mr. H——. Hydrops Pectoris; legs and thighs prodigiously anasarcous; a very distressing sense of fulness and tightness across his stomach; urine in small quantity; pulse intermitting; breath very short.

He had taken various medicines, and been blistered, but without relief. His complaints continuing to increase, I directed an infusion of Digitalis, which made him very sick; acted powerfully as a diuretic, and removed all his symptoms.

About three months afterwards he was out upon a journey, and, after taking cold, was suddenly seized with difficulty of breathing, and violent palpitation of his heart: he sent for me, and I ordered the infusion as before, which very soon removed his complaints. He is now active and well; but, whenever he takes cold, finds some return of difficult breathing, which he soon removes by a dose or two of the infusion.

CASE XXI.

January 5th. Mrs. M——, AEt. 69. Hydrothorax, (called asthma) ascites and anasarca. I directed an infusion of Fol. Digital. siccat. three drams to a pint; a small wine glass to be taken every third or fourth hour. It made her violently sick, acted powerfully as a diuretic, set her breath perfectly at liberty, and carried off the swelling of her legs; when she was nearly emptied, she became so languid, that I thought it necessary to order cordials, and a large blister to her back. Mr. Ward, who attended as her apothecary, tells me she had some return of her asthma in June and October following, which was each time removed by the same medicine.

CASE XXII.

January 11th. Mr. H——, AEt. 59. Ascites and general anasarca. A large corpulent man, and a hard drinker: he had repeatedly suffered under complaints of this kind, but had been always relieved by the judicious assistance of Dr. Ash. In the present instance, however, not finding relief as usual from the prescriptions of my worthy friend, he sent for me; after examining into his situation, and informing myself what had been done to relieve him, I was satisfied that the Digitalis was the only medicine from which I had any thing to hope. It was therefore directed; but another patient requiring my assistance at a distance from town, I desired he would not begin the medicine before I returned, which would be early on the third day; for I was well aware of the difficulties before me, and that he would inevitably sink under too rapid an evacuation of the water. On my return I was informed, that the preceding evening, as he sat on his chair, his head sunk upon his breast, and he died.

This case, as well as case VI. is mentioned with a view to demonstrate to younger practitioners, how sudden and unexpected the deaths of dropsical patients sometimes happen, and how cautious we should be in assigning causes for effects.

CASE XXIII.

August 31st. Mr. C——, AEt. 57. Diseased viscera, jaundice, ascites and anasarca. After trying calomel, saline draughts, jallap purges, chrystals of tartar, pills of gum ammoniac, squills, and soap, sal succini, eleterium, &c. infusion of Digitalis was directed, which removed all his urgent symptoms, and he recovered a pretty good state of health.

CASE XXIV.

September 11th. I was desired to visit Mr. L——, AEt. 63; a middle sized man; rather thin; not habitually intemperate; found him in bed, where he had been for three days. He was in a state of furious insanity, and had been gradually losing his reason for ten days before, but was not outrageous the first week; his apothecary had given him ten grains of emetic tartar, a dram of ipecacoanha, and an ounce of tincture of jallap, in the space of a few hours, which scarcely made him sick, and only occasioned a stool or two; upon enquiring into the usual state of his health, I was told that he had been troubled with some difficulty of breathing for thirty years past, but for the nine last years this complaint had increased, so that he was often obliged to sit up the greater part of the night; and, for the last year, the sense of suffocation was so great, when he lay down, that he often sat up for a week together. His father died of an asthma before he was fifty. A few years ago, at an election, where he drank more than usual, his head was affected as now, but in a slighter degree, and his asthmatic symptoms vanished; and now, notwithstanding he has been several days in bed, he feels not the least difficulty in breathing.

Apprehending that the insanity might be owing to the same cause which had heretofore occasioned the asthma, and that this cause was water; I ordered a decoction of the Fol. siccat Digital, three drams to half a pint; three spoonfuls to be taken every third hour: the fourth dose made him sick; the medicine was then stopped; the sickness continued at intervals, more or less, for four days, during which time he made a great quantity of water, and gradually became more rational. On the fifth day his appetite began to return, and the sickness ceased, but the flow of urine still continued.

A week afterwards I saw him again, and examined him particularly; his head was then perfectly rational, appetite very good, breath quite easy, permitting him to lie down in bed without inconvenience, makes plenty of water, coughs a little, and expectorates freely. He took no other medicine, except a little rhubarb when costive.

CASE XXV.

September 15th. Mr. J. R——, AEt. 50. Subject to an asthmatical complaint for more than twenty years, but was this year much worse than usual, and symptoms of dropsy appeared. In July he took G. ammon. squill and seneka, with infus. amarum and fossil alkaly. In August, infusum amar. with vin. chalyb. and at bed-time pil. styr. and squill. His complaints increasing, the squill was pushed as far as could be borne, but without any good effect. September 15th, an infusion of Digitalis was directed, but he died the next morning.

CASE XXVI.

September 18th. Mrs. R——, AEt. 30. After a severe child-bearing, found both her legs and thighs swelled to the utmost stretch of the skin. They looked pale, and almost transparent. The case being similar to that related at No. VIII. I determined upon a similar method of treatment; but as this patient had an inflammatory sore throat also, I wished to get that removed first, and in three or four days it was done. I then directed an infusion of Digitalis, which soon increased the urinary secretion, and reduced the swellings, without any disturbance of her stomach.

A few days after quitting her bed and coming down stairs, some degree of swelling in her legs returned, which was removed by calomel, an opening electuary, and the application of rollers.

CASE XXVII.

October 7th. Mr. F——, a little man, with a spine and thorax greatly deformed; for more than a year past had complained of difficult respiration, and a sense of fulness about his stomach; these complaints increasing, his abdomen gradually enlarged, and a fluctuation in it became perceptible. He had no anasarca, no appearance of diseased viscera, and no great paucity of urine. Purges and diuretics of different kinds affording him no relief, my assistance was desired. After trying squill medicines without effect, he was ordered to take Pulv. fol. Digital. in small doses. These producing no sensible effect, the doses were gradually increased until nausea was excited; but there was no alteration in the quantity of urine, and consequently no relief to his complaints. I then advised tapping, but he would not hear of it; however, the distress occasioned by the increasing fulness of his belly at length compelled him to submit to the operation on the 20th of November. It was necessary to draw off the water again upon the following days:

December the 8th. — — 27th. 1780. February the 4th. — — 23d. March the 9th.

During the intervals, no method I could think of was omitted to prevent the return of the disease, but nothing seemed to avail. In the operation of February 23d, his strength was so much reduced, that the water was not entirely removed; and on the 9th of March, before his belly was half emptied, notwithstanding the most judicious application of bandage, his debility was so great, that it was judged prudent to stop. After being placed in bed, the faintness and sickness continued; severe rigors ensued, and violent vomiting; these vomitings continued through the night, and in the intervals he lay in a state nearly approaching to syncope. The next day I found him with nearly the same symptoms, but remarked that the quantity of fluid he had thrown up was very much more than what he had taken, and that his abdomen was considerably fallen; in the course of two or three days more, he discharged the whole of the effused fluid; his strength and appetite gradually returned, and he was in all respects much better than he had been before the last operation.

Some time afterwards, his belly began to fill again, and he again applied to me; upon an accurate examination, I judged the quantity of fluid might then be about four or five quarts. Nature had pointed out the true method of cure in this case; I therefore ordered him to bed, and directed ipecacoanha vomits to be given night and morning: in two or three days the whole of the water was removed by vomiting, for he never purged, nor was the quantity of his urine increased; his appetite and strength gradually returned; he never had any further relapse, and is now an active healthy man. I must leave the reader to make his own reflections on this singular case.

1780.

CASE XXVIII.

January 11th. Captain V——, AEt. 42. Had suffered much from residing in hot climates, and drinking very freely, particularly rum in large quantity. He had tried many physicians before I saw him, but nothing relieved him. I found him greatly emaciated, his countenance of a brownish yellow; no appetite, extremely low, distressing fulness across his stomach; legs and thighs greatly swollen; pulse quick, and very feeble; urine in small quantity. As he had evidently only a few days to live, I ordered him nothing but a solution of sal diureticus in cinnamon water, slightly acidulated with syrup of lemons. This medicine effecting no change, and his symptoms becoming daily more distressing, I directed an infusion of Digitalis. A few doses occasioned a copious flow of urine, without sickness or any other disturbance. The medicine was discontinued; and the next day the urine continuing to be secreted very plentifully, he lost his most distressing complaints, was in great spirits, and ate a pretty good dinner. In the evening, as he was conversing chearfully with some friends, he stooped forwards, fell from his chair, and died instantly. Had he been in bed, I think there is reason to believe this fatal syncope, if such it was, would not have happened.

CASE XXIX.

February 6th. Mr. H——, AEt. 63. A corpulent man; had suffered much from gout, which for the last year or two had formed very imperfectly. He had now symptoms of water in his chest, his belly and his legs. An infusion of Digitalis removed these complaints, and after being confined for the greater part of the winter, he was well enough to get abroad again. In the course of a month the dropsical symptoms returned, and were again removed by the same medicine. Bitters and tonics were now occasionally prescribed, but his debility gradually increased, and he died some time afterwards; but the dropsy never returned.

CASE XXX.

February 17th. Mr. D——, AEt. 50. Ascites and anasarca, with symptoms of phthisis. He had been a very hard drinker. The infusum Digitalis removed his dropsical symptoms, and he was sufficiently recovered to take a journey; but as the spring advanced, the consumptive symptoms increased, and he died soon afterwards, perfectly emaciated.

CASE XXXI.

March 5th. I was desired to visit Mrs. H——, a very delicate woman, who after a severe lying-in, had her legs and thighs swollen to a very great degree; pale and semi-transparent. I found her extremely faint, her pulse very small and slow; vomiting violently, and frequently purging. She was attended by a gentleman who had seen me give the Digitalis in a similar case of swelled legs after a lying-in (see Case XXVI.) about six months before. He had not considered that this patient was delicate, the other robust; nor had he attended to stop the exhibition of the medicine when its effects began to take place. The great distress of her situation was evidently owing to the imprudent and unlimited use of the Digitalis. I was very apprehensive for her safety; ordered her cordials and volatiles; a free supply of wine, chamomile tea with brandy for common drink, and blisters. The next day the situation of things was much the same, but with all this disturbance no increased secretion of urine. The same methods were continued; an opiate ordered at night, and liniment. volatile upon flannel applied to the groins, as she now complained of great pain in those parts. The third day the nausea was less urgent, the vomitings less frequent, the pulse not so slow. Camphorated spirit, with caustic volatile alkaly, was applied to the stomach, emulsion given for common drink, and the same medicines repeated. From this time, the intervals became gradually longer between the fits of vomiting, the flow of urine increased, the swellings subsided, the appetite returned, and she recovered perfectly.

CASE XXXII.

March 16th. Mr. D——, AEt. 70. A paralytic stroke had for some weeks past impaired the use of his left side, and he complained much of his breath, and of a straitness across his stomach; at length, an anasarca and ascites appearing, I had no doubt as to the cause of the former symptoms; but, upon account of his advanced age, and the paralytic affection, I hesitated to give the Digitalis, and therefore tried the other usual modes of practice, until at length his breath would not permit him to lie down in bed, and his other symptoms increased so rapidly as to threaten a speedy dissolution. In this dilemma I ventured to prescribe an infusion of the Fol. siccat. Digital. which presently excited a copious flow of urine, and made him very sick; a strong infusion of chamomile flowers, with brandy, relieved the sickness, but the diuretic effects of the Digitalis continuing, his dropsy was removed, and his breathing became easy. The palsy remained nearly in the same state. He lived until August 1782, and without any return of the dropsy.

CASE XXXIII.

March 18th. Miss S——, AEt. 5. Hydrocephalus internus. As the case did not yield to calomel, when matters were nearly advanced to extremities, it occurred to me to try the Infusum Digitalis; a few doses of which were given, but had no sensible effect.

CASE XXXIV.

March 19th. A young lady, soon after the birth of an illegitimate child, became insane. After being near a month under my care, swellings of her legs, which at first had been attributed to weakness, extended to her thighs and belly; her urine became foul, and small in quantity, and the insanity remained nearly the same. As it had been very difficult to procure evacuations by any means, I ordered half an ounce of Fol. Digital. siccat. in a pint infusion, and directed two spoonfuls to be given every two hours: this had the desired effect; the dropsy and the insanity disappeared together, and she had afterwards no other medicine but some aperient pills to take occasionally.

CASE XXXV.

April 12th. Mr. R——, AEt. 32. For the last three or four years had had more or less of what was considered as asthma;—it appeared to me Hydrothorax. I directed an infusion of Digitalis, which presently removed his complaints. In June following he had a relapse, and took two grains of the Pulv. fol. Digit. three times a day, which cured him after taking forty grains, and he has never had a return.

CASE XXXVI.

May 15th. Mrs. H——, AEt. 40. A spasmodic asthma, attended with symptoms of effusion. An infusion of Digitalis relieved her very considerably, and she lived four years afterwards without any relapse.

CASE XXXVII.

May 26th. R—— B——, AEt. 12. Scrophulous, consumptive, and at length anasarcous. Took Infus. Digital. without advantage. Died the July following.

CASE XXXVIII.

June 4th. Mrs. S——, of W——, AEt 49. Ascites and anasarca. Had taken many medicines; first from her apothecary, afterwards by the direction of a very judicious and very celebrated physician, but nothing retarded the increase of the dropsy. I first saw her along with the physician mentioned above, on the 14th of May; we directed an electuary of chrystals of tartar, and Seltzer water for common drink; this plan failing, as others had done before, we ordered the Infus. Digital. which in a few days nearly removed the dropsy. I then left her to the care of her physician; but her constitution was too much impaired to admit of restoration to health, and I understand she died a few weeks afterwards.

CASE XXXIX.

June 13th. Mr. P——, AEt. 35. A very hard drinker, was attacked with a severe haemoptoe, which was followed by ascites and anasarca. He had every appearance of diseased viscera, and his urine was small in quantity. The powder and the infusion of Digitalis were given at different times, but without the desired effect. Other medicines were tried, but in vain. Tapping prolonged his existence a few weeks, and he died early in the following autumn.

CASE XL.

June 27th. Mr. W——, AEt. 37. An apparently asthmatic affection, gradually increasing for three or four years, which not yielding to the usual remedies, he took the infusion of Digitalis. Two or three doses made him very sick; but he thought his breathing relieved. After one week he took it again, and was so much better as to want no other medicine.

In the course of the following winter he became hectic, and died consumptive about a year afterwards.

CASE XLI.

July 6th. Mr. E——, AEt. 57. Hydrothorax and anasarca; his breath so short that he could not lie down. After a trial of squill, fixed alkaly, and dulcified spirit of nitre, I directed Pulv. Digital. gr. 2, thrice a day. In four days he was able to come down stairs; in three days more no appearance of disease remained; and under the use of aromatics and small doses of opium, he soon recovered his strength.

CASE XLII.

July 7th. Miss H—— of T——, AEt. 39. In the last stage of a phthisis pulmonalis became dropsical. She took the Digitalis without being relieved.

CASE XLIII.

July 9th. Mrs. F——, AEt. 70. A chearful, strong, healthy woman; but for a few years back had experienced a degree of difficult breathing when in exercise. In the course of the last year her legs swelled, and she felt great fulness about her stomach. These symptoms continued increasing very fast, notwithstanding several attempts made by a very judicious apothecary to relieve her. The more regular practitioner failing, she had recourse to a quack, who I believe plied her very powerfully with Daphne laureola, or some drastic purge of that kind. I found her greatly reduced in strength, her belly and lower extremities swollen to an amazing size, her urine small in quantity, and her appetite greatly impaired. For the first fortnight of my attendance blisters were applied, solution of fixed alkaly, decoction of seneka with vitriolic aether, chrystals of tartar, squill and cordial medicines were successively exhibited, but with no advantage. I then directed Pulv. Fol. Digital. two grains every four hours. After taking eighteen grains, the urine began to increase. The medicine was then stopped. The discharge of urine continued to increase, and in five or six days the whole of the dropsical water passed off, without any disturbance to the stomach or bowels. As the distension of the belly had been very great, a swathe was applied, and drawn gradually tighter as the water was evacuated. As no pains were spared to prevent the return of the dropsy, and as the best means I could devise proved unequal to my wishes, both in this and in some other cases, I shall take the liberty to point out the methods I tried at different times in as concise a manner as possible, for the knowledge of what will not do, may sometimes assist us to discover what will.

1780.

July 18th. Infusum amarum, steel, Seltzer water.

September 22d. Neutral saline draughts, with tinct. canthar.

26th. Pills of soap, garlic and millepedes.

30th. The same pills, with infusum amarum.

October 11th. Pills of aloes, assafetida, and sal martis, in the day-time, and mercury rubbed down, at night.

December 21st. The accumulation of water now required a repetition of the Digitalis. It was directed in infusion, a dram and half to eight ounces, and an ounce and half given every fourth hour, until its effects began to appear. The water was soon carried off.

30th. Sal diuretic. twice a day. To eat preserved garlic frequently.

1781.

February 1st. Pills of calomel, squill and gum ammoniac.

3d. Infusion of Digitalis repeated, and after the water was carried off, Dover's powder was tried as a sudorific.

March 18th. Infus. Digital. repeated.

26th. Pills of sal martis and aromatic species, with infusum amarum.

May 5th. Being feverish; James's powder and saline draughts.

10th. Laudanum every night, and an opening tincture to obviate costiveness.

24th. Infus. Digitalis, one ounce only every fourth hour, which soon procured a perfect evacuation of the water.

August 11th. Infus. Digitalis.

October 19th. An emetic, and fol. Cicut. pulv. ten grains every six hours.

November 8th. A mercurial bolus at bed-time.

16th. Infus. Digitalis.

December 23d. An emetic—Pills of seneka and gum ammoniac—Vitriolic acid in every thing she drinks.

25th. Squill united to small doses of opium.

1782.

January 2d. A troublesome cough—Syrup of garlic and oxymel of squills. A blister to the back.

4th. Tincture of cantharides and paregoric elixir.

28th. Infus. Digitalis, half an ounce every morning, and one ounce every night, was now sufficient to empty her.

March 26th. Infus. Digitalis; and when emptied, vitriol of copper twice a day.

April 1st. A cordial mixture for occasional use.

Two months afterwards a purging came on, which every now and then returned, inducing great weakness—her appetite failed, and she died in July.

INTERVALS.

From July 9th, 1780, to December 21st, 171 days. From December 21st to February 3d, 1781, 34 days. From February 3d to March 18th, 44 days. From March 18th to May 24th, 66 days. From May 24th to August 11th, 79 days. From August 11th to November 16th, 98 days. From November 16th to January 28th, 1782, 74 days. From January 28th to March 26th, 57 days.

None of the accumulations of water were at all equal to that which existed when I first saw her, for finding so easy a mode of relief, she became impatient under a small degree of pressure, and often insisted upon taking her medicine sooner than I thought it necessary. After the 26th of March the degree of effusion was inconsiderable, and at the time of her death very trifling, being probably carried off by the diarrhoea.

CASE XLIV.

July 12th. Mr. H——, of A——, AEt. 60. In the last stage of a life hurried to a termination by free living, dropsical symptoms became the most distressing. He wished to take the Digitalis. It was given, but afforded no relief.

CASE XLV.

July 13th. Mr. S——, AEt. 49. Asthma, or rather hydrothorax, anasarca, and symptoms of a diseased liver. He was directed to take two grains of Pulv. fol. Digital. every two hours, until it produced some effect. It soon removed the dropsical and asthmatic affections, and steel, with Seltzer water, restored him to health.

CASE XLVI.

August 6th. Mr. L——, AEt. 35. Ascites and anasarca. Pulv. Digital. grains three, repeated every fourth hour, until he had taken two scruples, removed every appearance of dropsy in a few days. He was then directed to take solution of merc. sublimat. and soon recovered his health and strength.

CASE XLVII.

August 16th. Mr. G——, of W——, AEt. 86. Asthma of many years duration, and lately an incipient anasarca, with a paucity of urine. He had never lived intemperately, was of a chearful disposition, and very sensible: for some years back had lost all relish for animal food, and his only support had been an ounce or two of bread and cheese, or a small slice of seed-cake, with three or four pints of mild ale, in the twenty-four hours. After trying chrystals of tartar, fixed alkaly, squills, &c. I directed three grains of Pulv. fol. Digital. made into pills, with G. ammoniac, to be given every six hours; this presently occasioned copious discharges of urine, removed his swellings, and restored him to his usual standard of health.

CASE XLVIII.

August 17th. T—— B——, Esq. of K——, AEt. 46. Jaundice, dropsy, and great hardness in the region of the liver. Infusion of Digitalis carried off all the effusion, and afterwards a course of deobstruent and tonic medicines removed his other complaints.

CASE XLIX.

August 23d. Mr. C——, AEt. 58. (The person mentioned at Case XXIII.) He had continued free from dropsy until within the last six weeks; his appetite was now totally gone, his strength extremely reduced, and the yellow of his jaundice changed to a blackish hue. The Digitalis was now tried in vain, and he died shortly afterwards.

CASE L.

August 24th. Mrs. W——, AEt. 39. Anasarcous legs and symptoms of hydrothorax, consequent to a tertian ague. Three grains of Pulv. Digitalis, given every fourth hour, occasioned a very copious flow of urine, and she got well without any other medicine.

CASE LI.

August 28th. Mr. J—— H——, AEt. 27. In consequence of very free living, had an ascites and swelled legs. I ordered him to take two grains of Fol. Digital. pulv. every two hours, until it produced some effect; a few doses caused a plentiful secretion of urine, but no sickness, or purging: in six days the swellings disappeared, and he has since remained in good health.

CASE LII.

September 27th. Mr. S——, AEt. 45. Had been long in an ill state of health, from what had been supposed an irregular gout, was greatly emaciated, had a sallow complexion, no appetite, costive bowels, quick and feeble pulse. The cause of his complaints was involved in obscurity; but I suspected the poison of lead, and was strengthened in this suspicion, upon finding his wife had likewise ill health, and, at times, severe attacks of colic; but the answers to my enquiries seemed to prove my suspicions fruitless, and, amongst other things, I was told the pump was of wood. He had lately suffered extremely from difficult breathing, which I thought owing to anasarcous lungs; there was also a slight degree of pale swelling in his legs. Pulv. fol. Digital. made into pills, with gum ammoniac and aromatic species, soon relieved his breathing. Attempts were then made to assist him in other respects, but with little good effect, and some months afterwards he died, with every appearance of a worn out constitution.

About two years after this gentleman's death, I was talking to a pump-maker, who, in the course of conversation, mentioned the corrosion of leaden pumps, by some of the water in this town, and instanced that at the house of Mr. S——, which he had replaced with a wooden one about three years before. The lead, he said, was eaten away, so as to be very thin in some places, and full of holes in others;—this accidental information explained the mystery.

The deleterious effects of lead seem to be considerably modified by the constitution of the patient; for in some families only one or two individuals shall suffer from it, whilst the rest receive it with impunity. In the spring of the year 1776, I was desired to visit Mrs. H——, of S—— Park, who had repeatedly been attacked with painful colics, and had suffered much from insuperable costiveness; I suspected lead to be the cause of her complaints, but was unable to trace by what means it was taken. She was relieved by the usual methods; but, a few months afterwards, I was desired to see her again: her sufferings were the same as before, and notwithstanding every precaution to guard against costiveness, she was never in perfect health, and seldom escaped severe attacks twice or thrice in a year; she had also frequent pains in her joints. I could not find any traces of similar complaints either in Mr. H——, the children, or the servants. Mrs. H——was a water drinker, and seldom tasted any fermented liquor. The pump was of wood, as I had been informed upon my first visit. Her health continued nearly in the same state for two or three years more, but she always found herself better if she left her own house for any length of time. At length it occurred to me, that though the pump was a wooden one, the piston might work in lead. I therefore ordered the pump rods to be drawn up, and upon examination with a magnifying glass, found the leather of the piston covered with an infinite number of very minute shining particles of lead. Perhaps in this instance the metal was so minutely divided by abrasion, as to be mechanically suspended in the water. The lady was directed to drink the water of a spring, and never to swallow that from the pump. The event confirmed my suspicions, for she gradually recovered a good state of health, lost the obstinate costiveness, and has never to this day had any attack of the colic.

CASE LIII.

September 28th. Mrs. J——, AEt. 70. Ascites and very thick anasarcous legs and thighs, total loss of strength and appetite. Infusion of Digitalis was given, but, as had been prognosticated, with no good effect.

CASE LIV.

September 30th. Mr. A——, AEt. 57. A strong man; hydrothorax and swelled legs; in other respects not unhealthful. He was directed to take two grains of the Pulv. fol. Digit. made into a pill with gum ammoniac. Forty grains thus taken at intervals, effected a cure by increasing the quantity of urine, and he has had no relapse.

CASE LV.

November 2d. Mr. P—— of T——, AEt. 42. A very strong man, drank a great quantity of strong ale, and was much exposed to alterations of heat and cold. About the end of summer found himself short winded, and lost his appetite. The dyspnoea gradually increased, he got a most distressing sense of tightness across his stomach, his urine was little, and high coloured, and his legs began to swell; his pulse slender and feeble. From the 20th of September I frequently saw him, and observed a gradual and regular increase of all his complaints, notwithstanding the use of the most powerful medicines I could prescribe. He took chrystals of tartar, seneka, gum ammoniac, saline draughts, emetics, tinct. of cantharides, spirits of nitre dulcified, squills in all forms, volatile alkaly, calomel, Dover's powder, &c. Blisters and drastic purgatives were tried, interposing salt of steel and gentian. I had all along felt a reluctance to prescribe the Digitalis in this case, from a persuasion that it would not succeed. At length I was compelled to it, and directed one grain to be given every two hours until it should excite nausea. This it did; but, as I expected, it did no more. The reason of this belief will be mentioned hereafter. Five days after this last trial I gave him assafetida in large quantity, flattered by a hope that his extreme sufferings from the state of his respiration, might perhaps arise in part from spasm, but my hopes were in vain. I now thought of using an infusion of tobacco, and prescribed the following:

R. Fol. Nicotian. incis. [Symbol: dram]ii. Aq. bull. [Symbol: pound]ss. Sp. Vini rectif. [Symbol: ounce]i digere per horam.

I directed a spoonful of this to be given every two hours until it should vomit. This medicine had no better effect than the former ones, and he died some days afterwards.

CASE LVI.

November 6th. Mr. H——, AEt. 47. In the last stage of a phthisis pulmonalis, suffered much from dyspnoea, and anasarca. Squill medicines gave no relief. Digitalis in pills, with gum ammon. purged him, but opium being added, that effect ceased, and he continued to be relieved by them as long as he lived.