III. That it will often produce this effect after every other probable method has been fruitlessly tried.

IV. That if this fails, there is but little chance of any other medicine succeeding.

V. That in proper doses, and under the management now pointed out, it is mild in its operation, and gives less disturbance to the system, than squill, or almost any other active medicine.

VI. That when dropsy is attended by palsy, unsound viscera, great debility, or other complication of disease, neither the Digitalis, nor any other diuretic can do more than obtain a truce to the urgency of the symptoms; unless by gaining time, it may afford opportunity for other medicines to combat and subdue the original disease.

VII. That the Digitalis may be used with advantage in every species of dropsy, except the encysted.

VIII. That it may be made subservient to the cure of diseases, unconnected with dropsy.

IX. That it has a power over the motion of the heart, to a degree yet un.o.bserved in any other medicine, and that this power may be converted to salutary ends.

PRACTICAL REMARKS ON DROPSY, AND SOME OTHER DISEASES.

The following remarks consist partly of matter of fact, and partly of opinion. The former will be permanent; the latter must vary with the detection of error, or the improvement of knowledge. I hazard them with diffidence, and hope they will be examined with candour; not by a contrast with other opinions, but by an attentive comparison with the phnomena of disease.

ANASARCA.

-- 1. The anasarca is generally curable when seated in the sub-cutaneous cellular membrane, or in the substance of the lungs.

-- 2. When the abdominal viscera in general are greatly enlarged, which they sometimes are, without effused fluid in the cavity of the abdomen; the disease is incurable. After death, the more solid viscera are found very large and pale. If the cavity contains water, that water may be removed by diuretics.

-- 3. In swollen legs and thighs, where the resistance to pressure is considerable, the tendency to transparency in the skin not obvious, and where the alteration of posture occasions but little alteration in the state of distension, the cure cannot be effected by diuretics.

Is this difficulty of cure occasioned by sp.i.s.situde in the effused fluids, by want of proper communication from cell to cell, or is the disease rather caused by a morbid growth of the solids, than by an acc.u.mulation of fluid?

Is not this disease in the limbs similar to that of the viscera (-- 2)?

-- 4. Anasarcous swellings often take place in palsied limbs, in arms as well as legs; so that the swelling does not depend merely upon position.

-- 5. Is there not cause to suspect that many dropsies originate from paralytic affections of the lymphatic absorbents? And if so, is it not probable that the Digitalis, which is so effectual in removing dropsy, may also be used advantageously in some kinds of palsy?

ASCITES.

-- 6. If existing alone, (_i. e._) without accompanying anasarca, is in children curable; in adults generally incurable by medicines. Tapping may be used here with better chance for success than in more complicated dropsies. Sometimes cured by vomiting.

ASCITES and ANASARCA.

-- 7. Incurable if dependant upon irremediably diseased viscera, or on a gouty const.i.tution, so debilitated, that the gouty paroxysms no longer continue to be formed.

In every other situation the disease yields to diuretics and tonics.

ASCITES, ANASARCA, and HYDROTHORAX.

-- 8. Under this complication, though the symptoms admit of relief, the restoration of the const.i.tution can hardly be hoped for.

ASTHMA.

-- 9. The true spasmodic asthma, a rare disease--is not relieved by Digitalis.

-- 10. In the greater part of what are called asthmatical cases, the real disease is anasarca of the lungs, and is generally to be cured by diuretics. (See -- 1.) This is almost always combined with some swelling of the legs.

-- 11. There is another kind of asthma, in which change of posture does not much affect the patient. I believe it to be caused by an infarction of the lungs. It is incurable by diuretics; but it is often accompanied with a degree of anasarca, and so far it admits of relief.

Is not this disease similar to that in the limbs at (--3,) and also to that of the abdominal viscera at (--2.)?

ASTHMA and ANASARCA.

-- 12. If the asthma be of the kind mentioned at (---- 9 and 11,) diuretics can only remove the accompanying anasarca. But if the affection of the breath depends also upon cellular effusion, as it mostly does, the patient may be taught to expect a recovery.

ASTHMA and ASCITES.

-- 13. A rare combination, but not incurable if the abdominal viscera are sound. The asthma is here most probably of the anasarcous kind (-- 10;) and this being seldom confined to the lungs only, the disease generally appears in the following form.

ASTHMA, ASCITES, and ANASARCA.

-- 14. The curability of this combination will depend upon the circ.u.mstances mentioned in the preceding section, taking also into the account the strength or weakness of the patient.

EPILEPSY.

-- 15. In epilepsy dependant upon effusion, the Digitalis will effect a cure; and in the cases alluded to, the dropsical symptoms were unequivocal. It has not had a sufficient trial in my hands, to determine what it can do in other kinds of epilepsy.

HYDATID DROPSY.

-- 16. This may be distinguished from common ascites, by the want of evident fluctuation. It is common to both s.e.xes. It does not admit of a cure either by tapping or by medicine.

HYDROCEPHALUS.

-- 17. This disease, which has of late so much attracted the attention of the medical world, I believe, originates in inflammation; and that the water found in the ventricles of the brain after death, is the consequence, and not the cause of the illness.

It has seldom happened to me to be called upon in the earlier stages of this complaint, and the symptoms are at first so similar to those usually attendant upon dent.i.tion and worms, that it is very difficult to p.r.o.nounce decidedly upon the real nature of the disease; and it is rather from the failure of the usual modes of relief, than from any other more decided observation, that we at length dare to give it a name.

At first, the febrile symptoms are sometimes so unsteady, that I have known them mistaken for the symptoms of an intermittent, and the cure attempted by the bark.