Part 1

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

BY

WILLIAM WITHERING, M. D.

Physician to the General Hospital at Birmingham.

_---- nonumque prematur in annum._

HORACE.

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

PREFACE.

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

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

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

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

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

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

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

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

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

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

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

_Birmingham, 1st July,_ 1785.

INTRODUCTION.

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

[Footnote 1: Verbascum of Linnæus.]

Our plant is the _Digitalis purpurea_[2] of Linnæus. It belongs to the 2d order of the 14th class, or the DIDYNAMIA ANGIOSPERMIA. The _essential characters_ of the genus are, _Cup with 5 divisions. Blossom bell-shaped, bulging. Capsule egg-shaped, 2-celled._--LINN.

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

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

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

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

_Blossom._ The bellying part on the inside sprinkled with spots like little eyes. _Leaves_ wrinkled. LINN.

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

CHIVES. _Threads_ crooked, white. _Tips_ yellow.

POINTAL. _Seed-bud_ greenish. _Honey-cup_ at its base more yellow. _Summit_ cloven.

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

ROOT. Knotty and fibrous.

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

LEAVES. Slightly but irregularly serrated, wrinkled; dark green above, paler underneath. _Lower leaves_ egg-shaped; upper leaves spear-shaped. _Leaf-stalks_ fleshy; bordered.

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

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

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

* * * * *

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

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

HISTORICAL VIEW of the Properties of Digitalis.

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

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

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

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

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

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

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

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

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

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

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

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

_Parkinson_, _p._ 654.

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

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

A man with _scrophulous ulcers_ in various parts of the body, and which in the right leg were so virulent that its amputation was proposed, cured by _succ. express. cochl. i. bis intra xiv. dies, in ½ pintæ cerevisiæ calidæ_.

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

A young woman with a _scrophulous tumour of the eye_, a remarkable _swelling of the upper lip, and painful tumours of the joints of the fingers_, much relieved; but the medicine was left off, on account of its violent effects on the constitution. _Ib. p._ 42 quoted as above.

A man with _scrophulous tumour of the right elbow_, attended for three years _with excruciating pains_, was nearly cured by four doses of the juice taken once a month. _Ib. p._ 43. as above.

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

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

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

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

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

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

PARKINSON, p. 654.

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

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

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

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

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

OF THE PLATE.

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

* * * * *

EXPLANATION.

Fig. 1. The Empalement.

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

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

Fig. 8. _Honey-cup_ a gland, surrounding the bottom of the Seed-bud.

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

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

AN ACCOUNT OF THE INTRODUCTION of FOXGLOVE INTO MODERN PRACTICE.

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

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

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

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

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