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.