Digitalis (U. S. P.)—Digitalis.
"The leaves of Digitalis purpurea, Linné, collected from plants of the second year's growth"—(U. S. P.). (Digitalis tomentosa, Link et Hoffmann).
COMMON NAMES: Foxglove, Purple foxglove.
ILLUSTRATIONS: Bentley and Trimen, Med. Plants, 195; Woodville, Med. Bot., Plate 24.
Botanical Source.—Foxglove is a handsome biennial plant, with a whitish root of numerous long and slender fibers. The stem is straight, wand-like, leafy, mostly simple, roundish, with several slight angles, downy, and 3 or 4 feet high. The leaves are alternate, ovate, or elliptic oblong, crenate, downy, rugged, and veiny, of a dull-green, tapering at the base into winged footstalks, the radical ones being largest. The flowers are numerous, large, pendulous, scentless, purplish-crimson, elegantly marked with eye-like spots, and hairy within, and are borne in terminal, 1-sided, erect, simple racemes. The corolla is monopetalous, campanulate, ventricose, contracted at the base, with an oblique limb; upper lip emarginate, lower trifid, with the middle lobe the largest. The calyx is composed of 5 acute sepals, permanent, and much shorter than the corolla; the uppermost are narrowest. The stamens are didynamous, and inserted into the base of the corolla; anthers large, acute, naked; style simple; stigma bilamellate. The capsule is ovate, sharp-pointed, with a septicidal dehiscence; seeds many, small, grayish-brown, pitted, and oblong (L).
History.—Foxglove is indigenous to the larger portion of Europe, and has been introduced into the United States, where it flowers in June and July. It grows in thickets, along woodland borders, and on the commons, preferring a sand-soil, not being often found where limestone abounds. Though also a mountain plant in the warmer portions of Europe, it is not found in the Swiss Alps and Jura Mountains (Pharmacographia). It has been naturalized in the Isle Chiloe of South Chili (Cunningham). The official part is the leaves, though the seeds will also be found efficient. The leaves should be collected from the second year's growth, while the plant is in bloom—Duncan says "before the inflorescence"—selecting only those which are fully developed, and separating from them the inert petioles and mid-veins; they should then be dried by exposure to a current of dry air, by being placed in a drying stove, or by being inclosed in a hot air press. Much care is necessary in preserving them for medicinal purposes. When well prepared the powder has a fine green color, and retains the intense bitterness of the fresh leaves. The leaves, when dried or in powder, should be placed in opaque, well-closed vessels, to protect them from the deleterious influence of dampness and light; and the drug should be renewed annually, as it loses its virtues by age. The seeds, though but little used, retain their properties much better than the leaves. Fresh foxglove leaves have a slight virose odor, which, by desiccation becomes feebly narcotic, with an acrid, bitter, disagreeable taste and a dark-green color. Their properties are yielded to alcohol, ether, water, or diluted acids.
Description.—The U. S. P. describes digitalis leaves as follows: "From 10 to 30 Cm. (4 to 12 inches) long; ovate or ovate-oblong; narrowed into a petiole; crenate; dull green, densely and finely pubescent; wrinkled above; paler and reticulate beneath; midrib near the base broad; odor slight, somewhat tea-like; taste bitter, nauseous. An infusion prepared with 1 part of digitalis and 10 parts of boiling water, and allowed to cool, has a peculiar odor, turns blue litmus paper red, and, upon the addition of a few drops of ferric chloride T.S., acquires a darker tint, a brown precipitate appearing after a few hours. The infusion, diluted with 3 parts of water, becomes turbid on the addition of a few drops of tannic acid T.S."—(U. S. P.).
Chemical Composition.—Digitalis purpurea was first investigated chemically by Destouches, in 1809, although the plant has been known in botanical literature through the writings of Leonhard Fuchs since 1542. Dulong d'Astafort (1827) appears to have been the first to recognize the bitter substance, digitalin, "as an individual body, capable of forming an insoluble compound with infusion of galls (Archiv. der Pharm., 1870, p. 28). This reaction was employed by later observers in the making of digitalin, e. g., by Homolle and Quevenne. In 1844, the Société de Pharmacie of Paris awarded a prize to these chemists for having succeeded in isolating the active principle of digitalis; yet their digitalin, though crystalline and no doubt purer than similar preparations of their predecessors, was by no means a uniform substance. Neither were the preparations obtained by later chemists, e. g., Walz (1846-58), and Kosman (1861 and later), individual substances. Nativelle (1867-74) prepared digitaline cristallisée, which at last was believed to be pure. Meanwhile a commercial distinction had been established between German digitalin (originating from Walz's preparation), an amorphous powder easily soluble in water and alcohol, less soluble in chloroform, and very little soluble in ether; and French crystalline digitalin (that of Homolle and Quevenne, and Nativelle), easily soluble in chloroform and alcohol, but hardly soluble in water and ether. In this connection it may be stated that the French Codex gives detailed directions for the preparation of both digitaline amorphe and digitaline cristallisée, the yield of the latter being 1 gram from each kilogram of leaves. To Schmiedeberg (1874) we are indebted for a critical study of the more important digitalins of commerce. He arrived at the conclusion that these preparations were composed mainly of the following principles: Digitonin, digitoxin, digitalin, and digitalein. The first is an inactive glucosid, while the three others have the property of acting upon the heart, digitoxin possessing this power in a most pronounced degree. The more recent researches of Kiliani have materially extended our knowledge of the chemical nature of these substances.
Digitonin.—This medicinally inert substance was obtained amorphous by Schmiedeberg. Kiliani found that it will easily crystallize from 85 per cent alcohol, and that by means of this solvent it may be abstracted from water-soluble commercial digitalin. When crystallized, digitonin is less soluble in water than when amorphous; its solution foams when shaken. It is little soluble in alcohol, insoluble in ether, chloroform, and benzin, and forms an insoluble tannate. Warmed with diluted hydrochloric acid, it splits into digitogenin. (observed by Schmiedeberg), galactose, and dextrose (Kiliani, Ber. d. d. Chem. Ges., 1890).
Digitoxin.—This forms the main constituent of Nativelle's digitalin. It is insoluble in water, although the presence of other digitalis glucosids or extractive matters may render it more soluble. It dissolves freely in alcohol and chloroform, slightly in ether, but is insoluble in petroleum ether (Keller, 1897). It yields a precipitate with tannic acid, but not with basic acetate of lead. Schmiedeberg could not establish the presence of sugar as a constituent of digitoxin, although he obtained toxiresin by the action of acids. Recently Kiliani succeeded in resolving digitoxin (C31H50O10), into digitoxigenin and a substance, digitoxose (C9H18O6), resembling sugar (Archiv. der Pharm., 1896, p. 481).
Digitalein.—The existence of this substance as an individual body is questioned by such authorities as Kiliani and C. C. Keller (Ber. d. d. Pharm. Ges., 1897, p. 125), who pronounce it to be most likely a mixture of digitonin with traces of digitoxin and digitalin.
Digitalin.—Schmiedeberg proved this to be a glucosid, but, excepting a resinous substance which he called digitaliresin, was unable to obtain a well defined product of hydrolysis. Homolle and Quevenne's digitalin he pronounced to be composed mainly of digitalin and digitaliresin. He also found that digitalin acts on the heart, but in a much milder form than digitoxin. It is soluble in water.
Kiliani, considering digitalin a useful therapeutic agent, made it a commercial product under the name digitalinum verum, believing it to be a uniform substance, notwithstanding its refusal to crystallize. He finally succeeded in resolving it into digitaligenin, a well-defined crystalline body, dextrose, and digitalose (Archiv. der Pharm., 1892, p. 250; also see Pharm. Jour. Trans., 1895, p. 29, for details of preparation of digitalinum verum). As regards the therapeutic use of digitalin, there has been a tendency in late years to give preference to digitoxin and the preparations containing it, although it was formerly discarded on account of its insolubility in water, as well as, the violent action it exerts when in solution. (See Amer. Jour. Pharm., 1897, p. 450, for Keller's process of preparation). Keller's test for digitoxin is as follows: Dissolve digitoxin in glacial acetic acid containing ferric chloride; float this solution upon strong sulphuric acid. At the line of contact a dark zone appears, and after a few minutes the acetic acid liquor becomes dark blue. This reaction takes place with 1/10 of a milligramme of digitoxin in 1 Cc. of acetic acid. As to the occurrence of the digitalis glucosids in leaves and seeds, Keller holds (1897) that digitoxin, digitonin, and digitalin in different proportions maybe obtained from both sources. The amount of digitoxin in the leaves was observed by him to vary from 0.26 to 0.62 percent. Kiliani, on the other hand, remarks (Pharm. Jour. Trans., 1895, p. 120, and 1896, p. 289), that digitalis seeds contained digitonin and digitogenin, and are besides the (more remote) source of his digitalinum verum, which does not occur in the leaves. The latter contain principally digitoxin, which is not to be found in the seeds. The relation of Arnaud's digitaline cristallisée (see Jour. Pharm. Chim., 1889, pp. 454 and 514) to the aforenamed principles remains yet to be established.
Other Constituents of Digitalis.—Morin (1845) isolated an acid substance which he called digitalic acid, which Flückiger believed to have been malic acid merely; and volatile antirrhinic acid which resembles valerianic acid. Digitalosmin was an odoriferous substance having a nauseous taste, obtained by Walz in 1852. The sugar inosit, was discovered in the leaves by Marmé, in 1864. The ash in the leaves was found by Flückiger to be 10.56 per cent. Infusions of digitalis sometimes gelatinize, owing to the precipitation of modified pectin matter, the result of the influence of micro-organisms. This change is facilitated (Dr. Forcke, Amer. Jour. Pharm., 1890), by the employment of the petioles in making the infusion, as they are richer in pectin matter than the leaf itself. The U. S. P., and other pharmacopoeias as well, direct that leaves of the second year's growth be employed, as the infusion from leaves collected in the first year are believed to be prone to gelatinize.
Action and Toxicology.—In single large doses, digitalis is an irritant-narcotic poison, producing gastro-intestinal irritation, nausea, vomiting, and very abundant alvine evacuations. Its action is afterward spent upon the nervous system, causing vertigo, dimness of sight, delirium, convulsions, or a general debility, and finally death (E. & V.). A slow, feeble, irregular pulse and suppression of urine are generally present. When given in medicinal doses, too long continued, or in quantities to exert an immediate action on the system, it causes an increased discharge of urine, reduces the pulse from 70 beats in a minute to 30, with languor, nausea, occasionally anxiety and salivation, a sense of weight, or constriction, obtuse pain in the head, giddiness, disordered vision, mental disturbance, and rarely spectral illusions; not unfrequently a huskiness of the voice is present, the result of irritation of the fauces, trachea, etc. The nausea produced by digitalis, and more quickly by digitalin and digitoxin, is preceded by malaise, faintness, and depression, and is exceedingly distressing. Vomiting temporarily relieves it, the vomited material being first dark-green, afterward yellow. Prostration becomes so great that the individual can not stand without help, and an intense disgust for food is experienced. Familiar objects are unrecognizable—a disturbed vision with yellowness or blueness supervening. Persons are recognized only by their voices. These effects, if not fatal, may last several days, the sleep being disturbed by nightmare and general unrest. Finally sound sleep and a voracious appetite quickly restore the individual to normal health. If the use of the remedy be persisted in, these effects will continue to increase until the poisonous symptoms, first referred to, become developed. Dr. Fuller states that digitalis stimulates the muscular fibers of the heart, and augments the contractility of the capillaries; when it kills it does so not by producing paralysis of the heart, but by giving rise to tonic contraction and spasm of that organ.
Primarily, digitalis acts upon the heart as a stimulant, increasing the tension and pulse rate; larger doses, acting as a sedative, reduce the pulse, but the tension remains unaffected. The diastole is prolonged while the systole is increased in vigor. A lethal dose produces a tetanic contraction of the heart muscle, particularly of the left ventricle, the heart being arrested in systole. The effect of the stronger systole and the prolonged diastole is a reduction of the number of pulsations. Not only does a contraction of the heart muscle take place, but a marked contraction of the arterioles also results, so that the blood current is reduced in size and the amount of blood sent through the arteries to the different parts of the system is decreased. A rise of blood pressure then ensues from the resistance of the narrowed arterial calibre and increased systolic action. From the fact that, after the administration of full medicinal doses, a change of posture, as from the recumbent to upright position, occasions a greatly increased number of pulsations and a marked diminution of cardiac force, it has been assumed that no real power is imparted to the heart by digitalis. This has been explained by others as an occurrence only met with when the tonic action is about to verge into that of exhaustion from overstimulation. Lethal doses cause the tetanic contraction above mentioned, obstructing the passage of blood through the organ and death takes place from spasm, resulting in syncope. In woman, digitalis, like ergot, causes contraction of the uterine fibers of an enlarged or gravid uterus, thereby arresting hemorrhage; in man it primarily lessens the supply of blood to the erectile tissues of the penis, preventing or enfeebling erections and consequently diminishing the venereal desires.
Many affirm that digitalis has no direct diuretic power. In health it is known to generally lessen the secretion of both the solid and fluid constituents of the urine. Some contend that it slightly increases the flow of urine. It is more than probable that, when diuresis is the result of its administration, it is in those cases in which a diminished secretion of urine is due to debility or some other form of cardiac embarrassment. Others, however, maintain different views, and Brunton asserts that diuresis produced by it in dropsy is due to a special action of the drug upon the Malpighian bodies, and not to augmented blood pressure alone.
Poisoning by digitalis may be produced by 1/16 grain of digitalin (equal to 8 grains of good powdered digitalis leaves), and Taylor (Med. Juris., p. 229) states that doses of from 1/4 to 1/2 grain would probably produce death. Cold, belladonna, ergot, etc., increase the activity of digitalis, while aconite opposes its action. According to Bartholow, the most complete antagonist to digitalis, physiologically speaking, is saponin. Strychnine is also a physiological antagonist.
The poisonous effects of digitalis are best counteracted by first evacuating the stomach by the free use of warm liquids and mechanical emetics, if any of it is supposed to remain in the stomach, and then administering brandy, wine, opium, black coffee, ammonia, ammonium carbonate, or other stimulants, with sinapisms to the wrists and ankles. Both external and internal heat should be used. A solution of tannic acid might be of service, by forming an insoluble tannate of digitalin. Preparations containing tannin, such as tea, etc., may be given. Iron sulphate and chloride are recommended by some as chemical antagonists. Digitalin produces similar effects on the system with digitalis, but its internal administration is hazardous, and demands much care and prudence. After death from digitalis the gastric membranes were found partially inflamed and the meninges of the brain much injected (Taylor).
Action, Medical Uses, and Dosage.—In medicinal doses, foxglove is sedative and secondarily diuretic. It has been employed with asserted advantage in febrile diseases, acute inflammations, insanity, neuralgia attended with irritative fever, asthma, hemoptysis, whooping-cough, palpitation of the heart, epilepsy, and as a diuretic in dropsy, connected with diseased heart or kidneys. As a sedative in fevers and inflammations, its use is not to be commended, in view of the fact that it tends to produce unpleasant gastric disturbances and other disquieting symptoms. It has been claimed that it is of great service in scarlatina, both for the purpose of producing sedation and keeping the kidneys active, thus tending to avert post-scarlatinal dropsy and uraemia. That it will do this without some heart debility being present also, is by no means well established, while, on the contrary, its unpleasant, nausea-provoking properties make it an undesirable remedy. The same is true of it in typhoid and other febrile disorders. It should always be used with care, on account of its cumulative effect, which may otherwise occasion an unexpected fatality. Such cumulative action is not, however, likely to occur unless the dose be too large and too frequently repeated, thus overlapping the successive doses when, like any other remedy so administered, its effects will become cumulative. The old view of cumulative effects from small doses suddenly developing toxic symptoms, is not now held by many, yet it is proper to be cautious and to keep within the bounds of safety. When its constitutional effects become obvious, the exhibition of the remedy should be omitted from time to time, in order to guard against the results of this alarming accumulation. When its sedative effect is too great, it is best counteracted by the use of wine and opium conjointly.
Like ergot, by its contractile power over the capillaries, digitalis is a remedy for asthenic hemorrhage, metrorrhagia, menorrhagia, purpura hemorrhagica, epistaxis, and hemoptysis, though it is of less value in the last-named disorder than in those of uterine origin. However, as a remedy for hemorrhage it will not take an important place when other drugs are so preëminently superior for this purpose. Digitalis has not found favor with the majority of practitioners of our faith in pulmonic and bronchial inflammations (except pulmonary congestion), as it has with some of the members of the Allopathic persuasion. No materia medica is so rich in efficient broncho-pulmonary remedies as the Eclectic, and, as digitalis is too uncertain in its effects in these disorders, and so liable to occasion intestinal disturbances, it is not likely to become at all important with us in this branch of therapy. In nervous disorders it has a limited usefulness. In chronic mania, acute maniacal delirium, and in delirium tremens it has been administered with asserted success, but as the indications for its selection, given by different observers, are diametrically opposed, it is difficult to make a selection of the proper cases. It is probable, however, that it is of some value in congestive hemicrania. Functional exophthalmic goitre, in the anemic young, and associated with cardiac weakness and dilated vessels, is often benefited by digitalis combined with restoratives.
It is in heart troubles of an asthenic character, however, that digitalis shows its power as a true remedy. As a general statement it may be said that it is indicated by a weak, rapid, and irregular heart and low arterial tension—a condition of asthenia; and it is contraindicated by a strong, vigorous heart action, with high arterial tension—a sthenic state. As Prof. Locke very properly states, "digitalis is the true opium for the heart."
Digitalis primarily excites the vaso-motor nerves only, those which are limited to the ventricular portion of the heart, contracting the blood vessels and heart muscle; temporarily quickens the heart's action, and secondarily, through paralysis of those nerves, dilatation of the blood vessels ensues with consequent spasm of the muscular tissues. Hence in cardiac hypertrophy, when simply compensatory, it should not be given at all; in cardiac dilatation it should be given in doses to produce its physiological action. Digitalis acts as a sedative to an over-excited and irregular heart, and as a tonic to a weak and enfeebled heart. But its principal employment should be in dilated enfeebled heart with feeble and irregular pulse. According to some writers it is contraindicated in ramollissement and fatty degeneration of the heart, and in aortic regurgitation, while it is especially beneficial in aortic obstructive disease.
That the slowing of the heart, with more powerful contractions and greater resistance to the blood current in the contracted arterioles produced by it, would render the drug inadmissible in a heart already enfeebled by fatty depositions, must be self-evident. Slight muscular degeneration is said not to contraindicate it, providing there are otherwise strong reasons for its use. But when aortic regurgitation occurs, which is due to faulty action of the valves (valvular insufficiency), the heart is but relatively weak, and a stronger contraction is needed to force the current onward, and thus prevent, as far as possible, the valvular leakage. Of course, some hypertrophy exists here, but not enough to be compensatory. Given to physiological effects, in aortic stenosis, it may produce death. M. Legroux states that, when given to persons in feeble health, it increases the contractile power of the capillaries, causing increased arterial tension, lowering the temperature of the body, diminishing the frequency of the heart beats, and relieving local congestions. It has, in this manner as before stated, been of service in pulmonic congestion, uterine and pulmonary hemorrhage, and in hemorrhoids. In cases where the circulation is generally active, with small, frequent, but regular pulse, aconite is preferable to digitalis. "Digitalis is indicated where there is a diminution of vascular tension; if the cardiac palpitations are purely nervous without any modification of arterial tension, digitalis is of no value. Another indication for the use of digitalis is oedema, which shows an abnormal disposition of the cellules to admit the fluid material of the blood into them. It should not be employed in heart diseases of aged persons, among those heart diseases that have already attained to a period of complete and continued asystole, nor in excessive dilatation of the heart, various cardiac degenerations, and other persistent conditions of a manifest (extreme) hyposthenia" (Ferrand).
To sum up, digitalis is useful in the following conditions: In structural heart lesions, as dilated heart with mitral incompetence; in mitral stenosis and regurgitation, and in dilated right heart with tricuspid incompetence, and in relative or positive debility of the cardiac muscle. The mechanical trouble is a state of ischaemia, or lack of sufficient arterial blood in the left heart, while in the right heart and the entire systemic and pulmonic circulation there is venous stasis. Digitalis increases the power of the auricles and ventricles to empty themselves; prolongs the inter-contractile intervals, thus allowing the auricles sufficient time to more perfectly send the blood current into the ventricles. It restores and regulates a mechanical compensation or balance in the circulatory organs. The general symptoms leading to its selection are a weak, rapid, and irregular pulse, low arterial tension, cough, dyspnoea, pulsation of the jugular veins, a cyanotic countenance, deficient urination, the secretion being high-colored, and oedema.
Digitalis is contraindicated in simple compensatory hypertrophy, aortic stenosis, fatty or other degenerations of the heart muscle, and atheromatous or other structural changes in the arteries. As a rule it should not be employed in the heart affections of old age, or when dilatation is excessive, and particularly when the flabby state of the heart muscle is due to degenerative changes.
It was formerly believed and still the view is held by many, that the diuretic effect of digitalis is the result of its secondary action. If, however, the views more recently advanced, that it has also a special action upon the renal glomeruli be true, the reason for its well-earned reputation as a remedy in dropsy will be more apparent. Digitalis has long been known as an efficient remedy where the dropsical condition was dependent upon cardiac irregularities and upon renal congestion. When the trouble is cardiac in origin it relieves by strengthening the heart action and producing capillary contraction. When of renal origin, obstructing the circulation, it relieves at least the tension of the renal capillaries, thus lessening engorgement and bringing about absorption and diuresis. In general dropsy it is indicated by the distressing dyspnoea, especially when in the recumbent posture, fullness and pulsation of the jugulars, pale or dusky countenance, scanty and high-colored urine, and quick, feeble, fluttering, and irregular pulse. When known to be associated with the cardiac lesions in which digitalis is indicated, it seldom fails to remove the dropsical effusion. It relieves chronic nephritis by lessening vascular tension in the renal capillaries, and in granular degeneration of the kidneys it is said to benefit by lessening the proportion of solids excreted, while the quantity of fluid is increased. While of doubtful utility in scarlatina, it is very serviceable in the anasarcous condition sometimes following that disease. Rheumatism, with threatened heart failure, is sometimes relieved by digitalis. Owing to its power of preventing erections, by limiting the supply of blood to the erectile tissues, it has proven itself of service in nocturnal seminal pollutions, particularly when the extremities are cold, the erections feeble, and the emissions oft-occurring.
The leaves, bruised and mixed with warm water, and applied upon the abdomen as a cataplasm, or the tincture mixed with warm flaxseed poultice, has been successful in urinary suppression. So great was the cutaneous absorption in one case that an enormous diuresis followed, producing death by exhaustion. Without doubt many of the failures from the use of digitalis in properly selected cases are due to the quality of the drug employed. A recent study of digitalin by competent observers shows, however, that it is unreliable in therapy and does not adequately represent the crude leaf. In fact, the crude drug in infusion is, without doubt, the best preparation of digitalis for use in medicine, and that no uncertainty as regards quality should exist, the best English digitalis should be employed. The dose of digitalis, in powder, is from 1/2 to 1 1/2 grains, repeated every 4 or 6 hours; of the tincture, from 3 to 20 minims; of specific digitalis, 1 to 3 minims; fluid extract, 1 to 2 minims; infusion (see Infusum Digitalis), 1/4 to 1 fluid ounce. The infusion should always be well shaken before administration, lest, in case of precipitation of digitalin, which has been thought to occur, an inordinate quantity of the latter should be contained in the last dose administered. Weaker infusions than the official may be administered, and for diuretic purposes it should be remembered that its action is slow, sometimes not apparent until several days after administration. Consequently too much should not be given until its effects are produced, lest the cumulative effect should obtain. Of digitalin, from 1/60 to 1/50 of a grain in syrup, or in pill mass, may be given for a dose, if it be found desirable to use it—cautiously increasing to an amount not to exceed the 1/16 of a grain.
Specific Indications and Uses.—Weak, rapid, irregular heart action, with low arterial tension; weak heart sounds; dusky countenance, jugular pulsation, cough, and dyspnoea; oedema; anasarca with scanty, high-colored urine; renal congestion. An antidote to aconite, but slow in its action.
Related Drugs.—Coronilla scorpioides. France. Cardot (1886) pronounces this leguminous plant an active heart poison. Its action is much like that of digitalis, both upon the heart and kidneys. its effects, however, are more transient. A glucosid, coronillin (C11H12O5), has been separated from it by Schlagdenhauffen and Reeb (1889). It is a yellowish powder, soluble in water, amyl alcohol, and acetone, slightly so in chloroform and ether. Treated with nitric acid, containing some cupric chloride, it produces a characteristic red coloration (Amer. Jour. Pharm., 1891). If heated with hydrochloric acid (diluted) an amorphous, yellow resin (coronillein) is obtained; insoluble in water, but soluble in alcohol, chloroform, and acetone. It has no perceptible physiological action (Amer. Jour. Pharm., 1889). Much uncertainty exists as to the size of the dose of this drug, one observer stating that 1 grain is poisonous, while another recommends as high as 5 grains. It is suggested as a remedy for cardiac dropsy.
MAUWIN BARK.—Mozambique. The bark of a tree employed by the natives of eastern Africa as an "ordeal" poison. It resembles sassy bark and contains an alkaloid (mauwinum), obtained by E. Merck, in 1891. Alcohol, chloroform, and ether dissolve it. Its action is considered similar to, but more transient than that of digitalin.
Urechites suberecta, Savannah flower, Yellow-flowered nightshade (Nat. Ord.—Apocynaceae). West Indies. Violent emeto-catharsis with convulsions are the symptoms attributed to this plant, which is said to be used as a poison by the negroes of Jamaica. Two glucosids of the digitalis group are found in the plant: Urechitin (C28H42O8) and urechitoxin (C13H20O5). Small doses of the plant are said to depress the heart's action, and, in larger doses, nausea, vomiting, marked general depression, increased action of the skin, and slowing of the pulse, are attributed to it. Death is produced by cardiac paralysis. The fluid extract, in doses of from 2 to 10 drops, has been used in Jamaica in the treatment of sthenic fevers.