An Account of the Foxglove and some of its Medical Uses. William Withering
consequence of this application, you wrote to me in the following terms.[3]
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.
FOOTNOTES:
[1] Verbascum of Linnæus.
[2] The trivial name purpurea is not a very happy one, for the blossoms though generally purple, are sometimes of a pure white.
[3] See the extract from this letter at page 5.
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,