COMMUNICATIONS FROM CORRESPONDENTS.

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

Sir,

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

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

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

I am, &c. ROBERT CAWLEY.

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

Dr. Cawley's prescription.

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

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

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

—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, Æt. 49, had been ill about two or three weeks. When I saw him he had no appetite, and a constant thirst: a fullness and load in the stomach: the thighs, legs and hands, much swell'd, and the face and throat in a morning; was costive, and made but little water, which was high coloured; the pulse very weak, and his breath exceeding bad. June 17th. R. Argent, viv ʒi. cons. cynosbat. ℈ii. fol. Digital. pulv. gr. xv. f. pil. xxiv. capt. ii. omni nocte horâ decubitus. He was likewise purged by a bolus of argent. viv. jallap, Digit. elaterium and calomel, which was repeated on the fourth day, to the third time. From 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, Æt. 40, had a deformed chest, was obliged to be almost in an erect posture when in bed; the other symptoms were nearly the same as Cooke's. 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 ʒiii. of the fol. Digitalis in ℥vi. of boiling water, for four hours; then strained it, and added ℥i. of tinct. aromatica.—On the 18th he began by taking one spoonful, which he was to repeat every half hour, till it made him very sick, unless giddiness, loss of sight, or any other disagreeable effect took place. I had never given the medicine before, and had prepared him to expect the operation to be very severe. I saw him again on the 21st; he 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. scillæ gr. iii.

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

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

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

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

She took about three parts of the medicine 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 ʒi. calomel. pp. gr. x. sp. lavand. comp. q. s. fiat pilul. xxxii. cap. ii. omni nocte horâ somni.

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

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 horâ durante dolore.

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

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

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

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

Applic. Emp. vesicat. femorib. internis.

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

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

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

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

25th. Much the same.

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

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

Applic. Emp. vesicat. stomacho et sterno.

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

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

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 ʒi. sp. lavand. comp. q. s. f. pilul. xxxii. cap. ii. omni mane; et omni node cap. pilul. e styrace gr. vi.

17th. Considerable increase of urine.

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

Applic. Emp. vesicat. femoribus internis.

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

25th. Swelling much diminished, makes plenty of water, appetite much mended, cough and breathing better. She omitted the medicine for three days; the urine began to diminish, the swelling and shortness of breathing worse. On repeating it for two days, the discharge was again augmented, and a diminution of the swelling succeeded. She has continued the pills ever since till the 14th 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 œdematous. 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 œdematous swelling of one leg and thigh, of many weeks standing. She passed little or no urine, and had all her other complaints. She took 2 spoonfuls of an eight oz. decoction of two drams, twice a day. Her urine immediately increased; and, on the third day, the swelling had entirely subsided.

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

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

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

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.

Anasarca7 CasesCured3

Relieved1

Failed3

Ascites5 CasesCured4

Relieved1

Œdematous leg1 CaseCured1

Ascites and anasarca7 CasesCured4

Relieved2

Failed1

Asthma and dropsy1 CaseFailed1

Hydrothorax and gout1 CaseCured1

- - - - -, ascites and anasarca2 CasesCured2

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

On the 17th she had taken twice of the infusion, and though by mistake only two tea spoonfuls for 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. ʒvi. Tinct. aromat. ʒii. Tinct. thebaic. gutt. xx. m.

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

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

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

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

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

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

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, Æt. 68. He was affected with great difficulty of respiration, and cough particularly troublesome on attempting to lie down, œdematous swellings of the legs and thighs, abdomen tense and sore on being pressed, pain striking from the pit of the stomach to the back and shoulders; almost constant nausea, especially after taking food, which he frequently threw up; water thick and high-coloured, passed with difficulty and in 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. ʒiii. decoque ex aq. fontan. ℥xii ad ℥vi colaturæ adde Tinctur. aromatic. Syr. zinzib. aa ℥i. m. capt. cochl. duo larga secunda quaque hora ad quartam vicem nisi prius nausea supervenerit.

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

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

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

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

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

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

He soon gained sufficient strength to enable him to go a journey, and returned home in much 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, Æt. 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; œdematous swellings of the legs; constant desire to make water, which he passed with difficulty, and only by drops; pulse weak and irregular; body rather costive; face much emaciated; no appetite for food.—Cap. pil. scil. iii. ter in die.[6]

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

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.

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 ʒiii. ad. aq. &c. ℥viii. cochl. j. o. h. donec nausea excitetur vel diuresis satis copiosa proveniat.

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

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

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

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

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

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

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

A very slight watery effusion between the Pia Mater and Tunica arachnoidea. About ¾ 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——, Æt. 80. Orthopnœa, with sense of oppression about the prœcordia. Unable to lie down in bed for some nights past. Anasarca of the lower extremities. Urine very scanty. Complaints of six weeks standing. Had taken sal. diuret. c. ol. junip.—Calom. c. jalap, et gambog.—Et ol. junip. c. ol. Terebinth. without effect.

Feb. 7. Infus. Digital. e. ʒiii. ad aq. &c. ℥viii. cochl. ii. 4tis horis. Ordered to drink largely 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 œdematous, which will I trust soon yield to strengthening medicines.

CASE III.

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

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

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

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

Infus. Digital. u. a. præscript.

The directions on the phial not being attended to, two doses of it were given after a nausea had been excited, which, with occasional vomitings, became exceedingly oppressive. A saline draught, given in Dr. Hulme's method, a 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——, Æt. 33. General anasarca, ascites, and dyspnœa, of seven months duration.

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

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

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

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

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

2d. Vomiting after the second dose.

10th. Urine increased to ℔vi.

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

12th. Abdomen not diminished.

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

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

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

32d. Urine exceedingly scanty.

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

44th. Tapped. Terminated fatally.

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

CASE III.

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

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

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

A CASE from Mr. Shaw, Surgeon, at Stourbridge.—Communicated by Doctor Stokes.

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

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

A Letter from Mr. Vaux, Surgeon, in Birmingham.

Dear Sir,

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

CASE I.

Mrs. O—— of L—— street, in this town, aged 28, naturally of a thin, spare habit, and her family inclinable to phthisis, sent for me on the 11th of June, 1779, at which time she complained of great pain in her side, a constant cough, expectorated much, which sunk in water; had colliquative sweats and frequent purging stools; the lower extremities and belly full of water, and from the great difficulty she had in breathing, I concluded there was water in the chest also. The quantity of water made at a time for three weeks before I saw her, never amounted to more than a tea-cup full, frequently not so much. Finding her in so alarming a situation, I gave it as my opinion she could receive no benefit from medicine, and requested her not to take any; but she being very desirous of my ordering her something, I complied, and sent her a box of gum pills with squills, and a mixture with salt of tartar: these medicines she took until the sixteenth, without any good effects: the water in her legs now began to exsude through the skin, and a small blister on one of her legs broke. Believing she could not exist much longer, unless an evacuation of the water could be procured; after fully informing her of her situation, and the uncertainty of her surviving the use of the medicine, I ventured to propose her taking the Digitalis, which she chearfully agreed to. I accordingly sent her a pint mixture, made as under, of the fresh leaves of the Digitalis. Three drams infused in one pint of boiling water, when cold strained off, without pressing the leaves, and two ounces of the strong juniper water added to it: of this mixture she was ordered four table spoonfuls every third hour, till it either made her sick, purged her, or had a sensible effect on the kidneys. This mixture was sent on the seventeenth, and she began taking it at noon on the eighteenth. At one o'clock the following morning I was called up, and informed she was dying. I immediately attended her, and was agreeably surprised to find their fright arose from her having fainted, in consequence of the sudden loss of twelve quarts of water she had made in about two hours. I immediately applied a roller round her belly, and, as soon as they could be made, 2 others, which were carried from the toes quite up the thighs. The relief afforded by these was immediate; but the medicine now began to affect her stomach so much, that she kept nothing on it many minutes together. I ordered her to drink freely of beef tea, which she did, but kept it on her stomach but a very short time. A neutral draught in a state of effervescence was taken to no good purpose: She therefore continued the beef tea, and took no other medicine for five days, when her sickness went off: her cough abated, but the pain in her side still continuing, I applied a blister which had the desired effect: her urine after the first day flowed naturally. Her cure was compleated by the gum pills with steel and the bitter infusion. It must be observed she never had any collection of water afterwards.

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

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

CASE II.

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

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

I am, &c. JER. VAUX

Moor-Street, 8th May, 1785.

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

A Letter from Mr. Wainwright, Surgeon, in Dudley.

Dear Sir,

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

Several years are now elapsed since you communicated to me the high opinion you entertained of the diuretic qualities of this noble plant. To ensure success, due attention was recommended to its preparation, its dose, and its effects upon the system.

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

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

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

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

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

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

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

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

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

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

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

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

Dudley, April 26th, 1785.

CASE of Mr. Ward, Surgeon, in Birmingham.—Related by himself.

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

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

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

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

Birmingham, 1st July, 1785.

Communications from Mr. Yonge, Surgeon, in Shiffnall, Shropshire.

Dear Sir,

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

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

Shiffnall, May 1, 1785.

CASE I.

A Gentleman aged 49, on the night of the 21st of August, 1784, awaked with a sense of suffocation, which obliged him to rise up suddenly in bed. I found him complaining of difficult respiration, particularly on lying down; the countenance pale, and the pulse smaller and quicker than usual. Some brandy and water having been given, the symptoms gradually abated, so that he slept in a half recumbent posture. The following day he expressed a sense of anxiety and weight in the chest, attended by quicker breathing upon motion of the body. That evening an emetic of ipecacoanha was given, and afterwards a draught, with vitriolic æther and confect. card. aa ʒi to be repeated as the symptoms should require it. He continued to be affected with slighter returns of the dyspnœa at irregular intervals, until September 15th, when upon a more severe attack, the emetic was repeated. He now recollected some slight pain in his arms which had affected him previous to this last seizure, and was disposed to consider his complaint as rheumatic. Pills with gum ammoniac. gum guaiac. and antimonial powder were directed, with infus. amar. simpl. twice a day. The bowels were regulated by aperient pills of pulv. jalap. aloes and sal. tartar. and ʒiss balsam peruv. was given occasionally to alleviate the paroxysms of dyspnœa.

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

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

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

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

On the 7th of December, from some symptoms of relapse, the oxymel was used as before, and continued to be taken until the 27th, in doses as large as could be dispensed with on account of the great nausea which attended its exhibition: The urine was made in the quantity of four or five pints each day, during the whole time; the quantity then drank being seldom more than three pints. But now the sickness being exceedingly depressing, the strength failing, and the diuretic effects beginning to cease, the following prescription was directed.

R. Fol. Digitalis purpur. pulv. ℈ss. Spec. Aromatic. ℈i. sp. lav. c. f. pilul. no. x. capiat i. nocte maneque, et alternis diebus sensim augeatur dosin.

In three days the effect of this medicine became visible, and when the dose of the Digitalis had been increased to six grains per day, the flow of urine generally amounted to seven pints every twenty-four hours. Not the least sickness, nor any other disagreeable symptom supervened, though he persevered in this plan until the end of January at which time the dyspnœa was removed, and he has continued gradually to regain his flesh, strength, and appetite, without any relapse.

CASE II.

About the middle of the year 1784 a lady aged 48, returned from London, to her native air in Shropshire, under symptoms of complicated disease. It was your opinion that the plethoric state, consequent to that period, when menstruation first begins to cease, had under various appearances, laid the foundation of that deplorable state which now presented itself. The skin was universally of a pale, leaden colour; her person much emaciated, and her strength so reduced, as to disable her from walking without support. The appetite fluctuating, the digestion impaired so much, that solids passed the intestines with little appearance of solution: She had generally eight or ten alvine evacuations every day, and without this number, febrile symptoms, attended with severe vertiginous affection, and vomiting regularly ensued. The stools were of a pale ash colour. The urine generally pale, and at first in due quantity. The region of the stomach had a tense feel, without soreness: the feet and ancles œdematous, her sleep was uncertain: the pulse varying between 94 and 100, and feeble, except upon the approach of the menstrual periods, which were now only marked by its increased strength, and exacerbation of other febrile symptoms. Emetics, saline medicines, and gentle aperients were necessary to alleviate these. Six grains of ipecac, operated with sufficient power, and half a grain of calomel would have purged with great violence.

From the time of her arrival till the middle of August, mercury had been continued in various forms, and in doses such as the irritable state of her stomach and bowels would admit of. Spirit. nitri dulc.; sal. tartar, squill, and cantharides were alternately employed as diuretics, but without success, to retard the progress of an universal anasarca which was then advanced to such degree and accompanied by so great debility, and other dreadful concomitants, as to threaten a speedy and fatal catastrophe.

On the 16th of August you first saw her, and directed thus.

R. Mercur. cinerei gr. ii. Fol. Digital, purpur. pulv. ℈i. f. mass. in pill. no. xvi. dividend.—sumat unam hora meridiana, iterumque hora quinta pomeridiana quotidie.

Capiat lixivii saponac. gutt. L. in haust. juscul. sine sale parati omni nocte.

On the 20th the flow of urine began to increase, and she continued the medicine in the same dose until the 20th of September, discharging from six to eight pints of water each day for the first week, and which quantity gradually diminished as she became empty. During this period she complained not of any sickness, except from the lixivium, which was after the first dose reduced to 20 drops; and her appetite and strength increased daily, though it was evident that no bile had yet flowed into the bowels, nor was the digestion at all improved. The anasarcous appearances being then removed, the Digitalis was omitted, and pills, composed of mercur. cinereus, aloes, and sal tartari directed twice a day, with ʒi. of vin. chalybeat. in infus. amar. simpl.

Her amendment in other respects proceeded slowly, but regularly, from that time until the 9th of October; when the state of plethora again recurring, with its usual attendant symptoms, ℥iv. of blood were taken from the arm; and this was upon the same occasion, repeated in the following month, with manifest good consequences; though in both instances the colour of the blood, as flowing from the vein could hardly be called red, and the coagulum was as weak in its cohesion as possible. The state of the stomach and bowels was by this time greatly improved, in common with other parts of the system; but no intromission of bile had yet happened: the hardness about the hypogastric region, though less, continued in a considerable degree, and you ordered pills of mercury rubbed down, and rust of iron, to be taken twice a day, with a decoction of dandelion and sal sodæ.

A cataplasm of linseed was applied every night over the stomach and right side; and, with little deviation from this plan, she continued to the end of the year, improving in her general health, but the hepatic affection yet remaining. It was then determined to try the effects of electricity, and gentle shocks were passed through the body daily, and as nearly as could be through the liver, in various directions.

On the fifth day there was reason to think that some gall had been secreted and poured out, and this became every day more evident; but it flowed only in small quantity, and irregularly into the bowels, as appeared from the fæces being partially tinged by it.

In February the lady left this neighbourhood, and though convalescent, yet so nearly well as to promise us the satisfaction of seeing her perfectly restored.

June 29. The bile is now secreted in pretty good quantity, her appetite is perfectly good, her strength equal to almost any degree of exercise, and her health in general better than it has been for some years.

CASE III.

Mr. W——, aged—. In June, 1782, was affected with slight difficulty in respiration, upon taking exercise or lying down in bed. These symptoms increased gradually until the end of July, when he complained of sense of weight and uneasiness about the prœcordia; loss of appetite; and costiveness. The urine was small in quantity, and high coloured; his pulse feeble, and intermitting; he breathed with difficulty when in bed, and slept little. After the exhibition of an emetic, and an opening medicine of rhubarb, sena, and sal tartari, he was directed to take half a dram of squill pill, pharm. Edinburg. night and morning, with ʒss sal. sodæ in ℥iss. infus. amar. simpl. twice a day; and these medicines were continued during ten days, without any sensible effect. A blister was then applied to the sternum, and six grains of calomel given in the evening. The symptoms were now increased very considerably, in every particular; and the following infusion was substituted for the former medicines.

R. Fol. Digital. purpur. ʒiii. Cort. limon. ʒii. infund. Aq. bullient. ℔i. per hor. 2 et cola. sumat cochl. i. primo mane et repet. omni hora.

Sometime in the night considerable nausea occurred, and the following day he began to make water in great quantity, which he continued to do for three or four days. The pulse in a few hours became regular, slower, and stronger, and, in the course of a week, all the symptoms entirely vanished, and an electuary of cort. peruvian, sal martis, and spec. aromatic. confirmed his cure.

In February, 1784, this gentleman had a relapse of his disease, from which he again soon recovered by the same means, and is now perfectly well.

CASE IV.

G—— A——, a husbandman, aged 57. Was in the year 1782 affected with a slight, but constant pain in his breast, with difficult respiration. His countenance was yellow; the abdomen swelled, and hard; his urine high coloured, and in small quantity; appetite and sleep little. Complained of frequent nausea, and of sudden profuse sweatings, which seemed for a short time to relieve the dyspnœa.

After the exhibition of an emetic, six grains of calomel were given, with a purge of jalap in the morning, and repeated in a few days, with some appearance of advantage. He was then directed to take some pills of squill, soap, and rhubarb, with a draught twice a day, consisting of infus. amar. simp. and sal tartari. The skin soon became clearer and the pain in his breast considerably diminished. But every other circumstance remaining the same, and a fluctuation in the belly being now more evident, the infusion of Digitalis as prescribed in case third, was given in the dose of one ounce twice a day.

On the 5th day the effects were apparent, and he continued his medicine for a fortnight without nausea, making four or five pints of water every night, but little in the day, and gradually losing the symptoms of his disease.

In 1784, this person had a relapse, and was again cured by similar treatment.

CASE V.

R—— H——, Aged 43. Towards the end of the year 1783, became affected with slight cough and expectoration of purulent matter. In December his skin became universally of a pale yellow colour. The abdomen was swelled and hard; his appetite little, and he complained of a violent and constant palpitation of the heart, which prevented him from sleeping. The urine pale, and in small quantity. The pulse exceedingly strong, and rebounding; beating 114 to 120 strokes every minute. He suffered violent pain of his head, and was very feeble and emaciated. After bleeding, and the use of gentle aperient medicines, he continued to take the infusion of Digitalis for some days, without any sensible effect. Other diuretics were tried to as little purpose. Repeated bleeding had no effect in diminishing the violent action of the heart. He died in January following, under complicated symptoms of phthisis and ascites.

CASE VI.

A man aged 57, who had lived freely in the summer of 1784, became affected with œdematous swelling of his legs, for which he was advised to drink Fox Glove Tea. He took a four ounce bason of the infusion made strong with the green leaves, every morning for four successive days.

On the 5th he was suddenly seized with faintness and cold sweatings. I found him with a pale countenance, complaining of weakness, and of pain, with a sense of great heat in his stomach and bowels. The swelling of the legs was entirely gone, he having evacuated urine in very large quantities for the two preceding days. He was affected with frequent diarrhœa. The pulse was very quick and small, and his extremities cold.

A small quantity of broth was directed to be given him every half hour, and blisters were applied to the ancles, by which his symptoms became gradually alleviated, and he recovered perfectly in the space of three weeks; except a relapse of the anasarca, for which the Digitalis was afterwards successfully employed, in small doses, without any disagreeable consequence.

CASE VII.

S—— D——, a middle aged single woman, was affected in the year eighty-one, with a painful rigidity and slight inflammation of the integuments on the left side, extending from the ear to the shoulder. In every other particular she was healthy. The use of warm fomentations, and opium, with two or three doses of mercurial physic, afforded her ease and the inflammation disappeared, but was succeeded by an œdematous swelling of the part, which very gradually extended along the arm, and downward to the breast, back, and belly. Friction, electricity and mercurial ointment were amongst the number of applications unsuccessfully employed to relieve her for the space of three months, during which time she continued in good general health.

In November she became ascitic, passing small quantities of urine, and soon afterwards a sudden dyspnœa gave occasion to suppose an effusion of water in the thorax. The Digitalis, squills, and cantharides were given in very considerable doses without effect. She died the latter end of December following.

CASE VIII.

W—— C——, a collier aged 58, was attacked in the spring of 1783 with a tertian ague, which he attributed to cold, by sleeping in a coal pit, and from which he recovered in a few days, except a swelling of the lower extremities, which had appeared about that time, and gradually increased for two or three months. The legs and thighs were greatly enlarged and œdematous. His belly was swelled, but no fluctuation perceptible. He made small quantities of high coloured water. The appetite bad, and pulse feeble. He had taken many medicines without relief, and was now so reduced in strength, as to sit up with difficulty. An infusion of the Digitalis was directed for him, in the proportion of one ounce of the fresh leaves to a pint of water, two ounces to be taken three times a day, until the stomach or bowels became affected. Upon the exhibition of the sixth dose, nausea supervened, and continued to oppress him at intervals for two or three days, during which he passed large quantities of pale urine. The swelling, assisted by moderate bandage rapidly diminished, and without any repetition of his medicine, at the expiration of sixteen days, he returned to his labour perfectly recovered.

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