SEEDS.--These I believe are equally untried.
From this view of the different parts of the plant, it is sufficiently obvious why I still continue to prefer the leaves.
These should be gathered after the flowering stem has shot up, and about the time that the blossoms are coming forth.
The leaf-stalk and mid-rib of the leaves should be rejected, and the remaining part should be dried, either in the sun-shine, or on a tin pan or pewter dish before a fire.
If well dried, they readily rub down to a beautiful green powder, which weighs something less than one-fifth of the original weight of the leaves. Care must be taken that the leaves be not scorched in drying, and they should not be dried more than what is requisite to allow of their being readily reduced to powder.
I give to adults, from one to three grains of this powder twice a day.
In the reduced state in which physicians generally find dropsical patients, four grains a day are sufficient. I sometimes give the powder alone; sometimes unite it with aromatics, and sometimes form it into pills with a sufficient quant.i.ty of soap or gum ammoniac.
If a liquid medicine be preferred, I order a dram of these dried leaves to be infused for four hours in half a pint of boiling water, adding to the strained liquor an ounce of any spirituous water. One ounce of this infusion given twice a day, is a medium dose for an adult patient. If the patient be stronger than usual, or the symptoms very urgent, this dose may be given once in eight hours; and on the contrary in many instances half an ounce at a time will be quite sufficient. About thirty grains of the powder or eight ounces of the infusion, may generally be taken before the nausea commences.
The ingenuity of man has ever been fond of exerting itself to vary the forms and combinations of medicines. Hence we have spirituous, vinous, and acetous tinctures; extracts hard and soft, syrups with sugar or honey, &c. but the more we multiply the forms of any medicine, the longer we shall be in ascertaining its real dose. I have no lasting objection however to any of these formulae except the extract, which, from the nature of its preparation must ever be uncertain in its effects; and a medicine whose fullest dose in substance does not exceed three grains, cannot be supposed to stand in need of condensation.
It appears from several of the cases, that when the Digitalis is disposed to purge, opium may be joined with it advantageously; and when the bowels are too tardy, jalap may be given at the same time, without interfering with its diuretic effects; but I have not found benefit from any other adjunct.
From this view of the doses in which the Digitalis really ought to be exhibited, and from the evidence of many of the cases, in which it appears to have been given in quant.i.ties six, eight, ten or even twelve times more than necessary, we must admit as an inference either that this medicine is perfectly safe when given as I advise, or that the medicines in daily use are highly dangerous.
EFFECTS, RULES, and CAUTIONS.
The Foxglove when given in very large and quickly-repeated doses, occasions sickness, vomiting, purging, giddiness, confused vision, objects appearing green or yellow; increased secretion of urine, with frequent motions to part with it, and sometimes inability to retain it; slow pulse, even as slow as 35 in a minute, cold sweats, convulsions, syncope, death.[11]
[Footnote 11: I am doubtful whether it does not sometimes excite a copious flow of saliva.--See cases at pages 115, 154, and 155.]
When given in a less violent manner, it produces most of these effects in a lower degree; and it is curious to observe, that the sickness, with a certain dose of the medicine, does not take place for many hours after its exhibition has been discontinued; that the flow of urine will often precede, sometimes accompany, frequently follow the sickness at the distance of some days, and not unfrequently be checked by it. The sickness thus excited, is extremely different from that occasioned by any other medicine; it is peculiarly distressing to the patient; it ceases, it recurs again as violent as before; and thus it will continue to recur for three or four days, at distant and more distant intervals.
These sufferings of the patient are generally rewarded by a return of appet.i.te, much greater than what existed before the taking of the medicine.
But these sufferings are not at all necessary; they are the effects of our inexperience, and would in similar circ.u.mstances, more or less attend the exhibition of almost every active and powerful medicine we use.
Perhaps the reader will better understand how it ought to be given, from the following detail of my own improvement, than from precepts peremptorily delivered, and their source veiled in obscurity.
At first I thought it necessary _to bring on and continue the sickness, in order to ensure the diuretic effects_.
I soon learnt that the nausea being once excited, it was unnecessary to repeat the medicine, as it was certain to recur frequently, at intervals more or less distant.
Therefore my patients were ordered _to persist until the nausea came on, and then to stop_. But it soon appeared that the diuretic effects would often take place first, and sometimes be checked when the sickness or a purging supervened.
The direction was therefore enlarged thus--_Continue the medicine until the urine flows, or sickness or purging take place_.
I found myself safe under this regulation for two or three years; but at length cases occurred in which the pulse would be r.e.t.a.r.ded to an alarming degree, without any other preceding effect.
The directions therefore required an additional attention to the state of the pulse, and it was moreover of consequence not to repeat the doses too quickly, but to allow sufficient time for the effects of each to take place, as it was found very possible to pour in an injurious quant.i.ty of the medicine, before any of the signals for forbearance appeared.
_Let the medicine therefore be given in the doses, and at the intervals mentioned above:--let it be continued until it either acts on the kidneys, the stomach, the pulse, or the bowels; let it be stopped upon the first appearance of any one of these effects_, and I will maintain that the patient will not suffer from its exhibition, nor the pract.i.tioner be disappointed in any reasonable expectation.
If it purges, it seldom succeeds well.
The patients should be enjoined to drink very freely during its operation. I mean, they should drink whatever they prefer, and in as great quant.i.ty as their appet.i.te for drink demands. This direction is the more necessary, as they are very generally prepossessed with an idea of drying up a dropsy, by abstinence from liquids, and fear to add to the disease, by indulging their inclination to drink.
In cases of ascites and anasarca; when the patients are weak, and the evacuation of the water rapid; the use of proper bandage is indispensably necessary to their safety.
If the water should not be wholly evacuated, it is best to allow an interval of several days before the medicine be repeated, that food and tonics maybe administered; but truth compels me to say, that the usual tonic medicines have in these cases very often deceived my expectations.
From some cases which have occurred in the course of the present year, I am disposed to believe that the Digitalis may be given in small doses, viz. two or three grains a day, so as gradually to remove a dropsy, without any other than mild diuretic effects, and without any interruption to its use until the cure be compleated.
If inadvertently the doses of the Foxglove should be prescribed too largely, exhibited too rapidly, or urged to too great a length; the knowledge of a remedy to counteract its effects would be a desirable thing. Such a remedy may perhaps in time be discovered. The usual cordials and volatiles are generally rejected from the stomach; aromatics and strong bitters are longer retained; brandy will sometimes remove the sickness when only slight; I have sometimes thought small doses of opium useful, but I am more confident of the advantage from blisters. Mr. Jones (_Page_ 135) in one case, found mint tea to be retained longer than other things.
CONSt.i.tUTION of PATIENTS.
Independent of the degree of disease, or of the strength or age of the patient, I have had occasion to remark, that there are certain const.i.tutions favourable, and others unfavourable to the success of the Digitalis.
From large experience, and attentive observation, I am pretty well enabled to decide _a priori_ upon this matter, and I wish to enable others to do the same: but I feel myself hardly equal to the undertaking. The following hints, however, aiding a degree of experience in others, may lead them to accomplish what I yet can describe but imperfectly.
It seldom succeeds in men of great natural strength, of tense fibre, of warm skin, of florid complexion, or in those with a tight and cordy pulse.
If the belly in ascites be tense, hard, and circ.u.mscribed, or the limbs in anasarca solid and resisting, we have but little to hope.
On the contrary, if the pulse be feeble or intermitting, the countenance pale, the lips livid, the skin cold, the swollen belly soft and fluctuating, or the anasarcous limbs readily pitting under the pressure of the finger, we may expect the diuretic effects to follow in a kindly manner.
In cases which foil every attempt at relief, I have been aiming, for some time past, to make such a change in the const.i.tution of the patient, as might give a chance of success to the Digitalis.
By blood-letting, by neutral salts, by chrystals of tartar, squills, and occasional purging, I have succeeded, though imperfectly. Next to the use of the lancet, I think nothing lowers the tone of the system more effectually than the squill, and consequently it will always be proper, in such cases, to use the squill; for if that fail in its desired effect, it is one of the best preparatives to the adoption of the Digitalis.
A tendency to paralytic affections, or a stroke of the palsy having actually taken place, is no objection to the use of the Digitalis; neither does a stone existing in the bladder forbid its use.
Theoretical ideas of sedative effects in the former, and apprehensions of its excitement of the urinary organs in the latter case, might operate so as to make us with-hold relief from the patient; but experience tells me, that such apprehensions are groundless.
INFERENCES.
To prevent any improper influence, which the above recitals of the efficacy of the medicine, aided by the novelty of the subject, may have upon the minds of the younger part of my readers, in raising their expectations to too high a pitch, I beg leave to deduce a few inferences, which I apprehend the facts will fairly support.
I. That the Digitalis will not universally act as a diuretic.
II. That it does do so more generally than any other medicine.