It was a circ.u.mstance 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 pract.i.tioners 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 s.p.a.ce 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 a.s.sert, 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 circ.u.mstance happened which accelerated that event. My truly valuable and respectable friend, Dr. Ash, informed me that Dr. Cawley, then princ.i.p.al 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 a.n.a.logy 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_ subst.i.tuted 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 circ.u.mstances, 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 quant.i.ty of the leaves to be dried, and as it then became possible to ascertain its doses, it was gradually adopted by the medical pract.i.tioners 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 s.p.a.ce of three, four, or five days. By this time the nausea abates, and the appet.i.te 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 quant.i.ty 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 circ.u.mstance 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 Pharmacopia, 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 ma.n.u.script 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 a.s.sures me, that the people in her country often cure themselves of dropsical complaints by drinking Foxglove tea. In confirmation of this, I recollect about two years ago being desired to visit a travelling Yorkshire tradesman. I found him incessantly vomiting, his vision indistinct, his pulse forty in a minute. Upon enquiry it came out, that his wife had stewed a large handful of green Foxglove leaves in half a pint of water, and given him the liquor, which he drank at one draught, in order to cure him of an asthmatic affection. This good woman knew the medicine of her country, but not the dose of it, for her husband narrowly escaped with his life.

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

CASES,

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

1775.

It was in the course of this year that I began to use the Digitalis in dropsical cases. The patients were such as applied at my house for advice gratis. I cannot pretend to charge my memory with particular cases, or particular effects, and I had not leisure to make notes.

Upon the whole, however, it may be concluded, that the medicine was found useful, or I should not have continued to employ it.

CASE I.

_December_ 8th. A man about fifty years of age, who had formerly been a builder, but was now much reduced in his circ.u.mstances, complained to me of an asthma which first attacked him about the latter end of autumn. His breath was very short, his countenance was sunken, his belly large; and, upon examination, a fluctuation in it was very perceptible. His urine for some time past had been small in quant.i.ty.

I directed a decoction of Fol. Digital. recent. which made him very sick, the sickness recurring at intervals for several days, during which time he made a large quant.i.ty of water. His breath gradually drew easier, his belly subsided, and in about ten days he began to eat with a keen appet.i.te. He afterwards took steel and bitters.

1776.

CASE II.

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

CASE III.

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

CASE IV.

_July_ 25th. Mrs. H----, of A----, near N----, between forty and fifty years of age, a few weeks ago, after some previous indisposition, was attacked by a severe cold shivering fit, succeeded by fever; great pain in her left side, shortness of breath, perpetual cough, and, after some days, copious expectoration. On the 4th of _June_, Dr.

Darwin,[4] was called to her. I have not heard what was then done for her, but, between the 15th of _June_, and 25th of _July_, the Doctor, at his different visits, gave her various medicines of the deobstruent, tonic, antispasmodic, diuretic, and evacuant kinds.

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

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

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

R. Fol. Digital. purp. recent. ?iv. coque ex Aq. fontan. purae ?iss ad ?i. et cola.

R. Decoct. Digital. ?iss.

Aq. Nuc. Moschat. ?ii. M. fiat. haust. 2dis horis sumend.

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

26th. Our patient being thus s.n.a.t.c.hed from impending destruction, Dr.

Darwin proposed to give her a decoction of pareira brava and guiac.u.m shavings, with pills of myrrh and white vitriol; and, if costive, a pill with calomel and aloes. To these propositions I gave a ready a.s.sent.