Hepatica. Liver Leaf.

Parts used - Botanical analysis - Common names - Description - Distribution by States - Description of the drug - Microscopical structure - Commercial history - Pharmacopoeial history - Constituents - Pharmaceutical preparations - Medical history - Summary - Medical properties - Homoeopathic uses - Dose - Summary - Pharmaceutical and medical references - Botanical references to Anemone acutiloba - Botanical table for Hepatica - Botanical references to Anemone hepatica

PARTS USED.—The dried plant of Anemone acutiloba Lawson, and Anemone Hepatica Linn.

Natural Order Ranunculaceae, Tribe Anemoneae.

BOTANICAL ANALYSIS.—Stem, none. Leaves radical, on petioles four to six inches long, broadly cordate, regularly three-lobed, coriaceous; margins entire. Flowers solitary, on hairy scapes about the length of the leaf-stalks. Involucre three-leaved, green, close to the flower, and resembling a calyx. Sepals six to nine, spreading, in two or three rows, resembling petals. Stamens numerous. Pistils, ten to twenty, in a head. Fruit, a sessile or short stipitate head of hairy achenes, tipped with persistent styles.

COMMON NAMES.—The plants are known as Liverwort in this country. This term properly belongs to a cryptogamic plant of the genus Marchantia, supposed to be good for diseases of the liver, and in Europe it is applied to the latter plant. We are informed by an importer who ordered "Liverwort" from Europe, that Marchantia was received. The name Liver Leaf, from the three lobes of the leaf resembling the three lobes of the liver, is a more appropriate and preferable name. It is also known as Noble Liverwort, Kidneywort, American Liver Leaf, Hepatica, Round Leaved Hepatica, Kidney Liver Leaf, Liver Weed, Trefoil, Golden Trefoil, Chrystalwort, and Herb Trinity. In some sections of the country the plants are known as May Flower.

DESCRIPTION.—Liver leaf is one of the commonest and earliest vernal flowers, especially west of New England. It is a little stemless plant, about six inches high, growing in tufts. The flowers expand in the first warm days of spring, and are found in all shades of color, from dark blue to pure white. The leaves, which are the parts used in medicine, are regularly and equally three-lobed, [Abnormal specimens with five-lobed leaves are occasionally found.] which gives them a fanciful resemblance to the shape of the liver; hence the common name. They are thick and coriaceous, smooth, of a mottled green color above, and when old, purplish underneath. They persist during the winter, apparently, however, having lost most of their vitality, and often lie procumbent on the ground; but they wither away in the spring, after the plant has flowered and the new leaves are partly unfolded. They are well represented in the accompanying plate (Plate No. V.), jagged and torn, as they usually are at flowering time. The leaf-stalks, flower-stalks, involucre and buds are covered with fine, soft hairs.

There are two species growing in this country—Anemone acutiloba Lawson, and Anemone Hepatica Linn. It is held by many good botanists that they are both varieties of the same species. Dr. Gattinger, of Nashville, Tenn., informs us that specimens with both forms of leaves from the same roots, are common in his State; and we regret very much that we have not obtained a specimen for the purpose of illustration. Prof. Babcock, in the Lens (Chicago, July, 1872), attempts to show, by a series of illustrations of leaves gathered at Mackinaw, that the two species merge into each other. We reproduce the extreme forms of each species, as shown by him. The original plate shows that the extremes of each species (a and b, c and d) are connected by all shades of intermediate forms; but the two leaves (b and c), which represent respectively the least acute of the acute-lobed species and the least blunt of the obtuse-lobed species, have, in our opinion, no connecting forms (Fig. 13).] They so closely resemble each other in everything except the shape of the leaves, that the foregoing description and botanical analysis are equally applicable to each. Anemone acutiloba has sharp leaf-lobes, and Anemone Hepatica blunt (see illustrations under the head of Commercial History of the Drug). A distinctive character between the two species has been observed by Chas. H. Peck, viz., when Anemone acutiloba is in flower, the young leaves have attained a considerable size, and are quite conspicuous; but when Anemone Hepatica is in flower, the young leaves have scarcely made their appearance, being yet closely packed away at the base of the scapes and old petioles.

That the involucre is not a calyx proper, is evident by its not being contiguous to the petals, as is shown in figure 10; and as this is the only structural character by which the sub-genus can be separated from Anemone, its botanical position, theoretically, is certainly with this genus. Yet there is such a marked difference in the general habits of the two sub-genera, and especially in the medicinal and chemical properties, Hepaticas being mild mucilaginous plants, while Anemones are acrid and irritating, that we think the Hepatica will finally be considered as entitled to a distinct generic rank. The involucral character is clearly shown in an abnormal specimen which we found in the spring of 1884 (Fig. 14). In this specimen an axillary flower was developed from each leaf of the involucre, and the involucre leaves were lobed after the manner of Anemones. A specimen in the Gray Herbarium, Cambridge, has the stem branched above the involucre, and the involucral leaves are lobed.]

The name, Hepatica, applied to this genus first by Dillenius (1718), is that by which the plant was known in old medical works. It is derived from the Greek hepar, liver, and was first applied to the cryptogamous Marchantia, but was later applied to this plant on account of its liver-shaped leaves, which, from the old doctrine of signatures, were supposed to be a remedy for liver troubles. To distinguish it from the true liverwort (Marchantia), known also as Hepatica, it was called Hepatica Nobilis.

Anemone Hepatica.—When Linnaeus published his Species Plantarum (1753), he united this plant with the genus Anemone; and recognizing its old generic and medical name, called it Anemone Hepatica. Chaix [The characters of Hepatica triloba are given on page 336, in Vol. I. of the "Histoire des Plantes du Dauphine," of Villars, in a list of plants collected in the province of Dauphiny, by Dominique Chaix, and written by Chaix for that work. The herbarium formed by Chaix was destroyed in a fire which occurred at Toulouse a few years ago, and in it, probably, the type plant of Hepatica triloba perished.] (1776) restored it to its generic rank, naming it Hepatica triloba; and this name was adopted by De Candolle and most other writers, until the appearance of Bentham and Hooker's Genera Plantarum (1862). These authors again placed it with Anemone; and their authority is now followed in the most recent American works. Salisbury (1796) applied the name Anemone praecox to the plant, without, however, any good reasons for the change, and this name is only considered a useless synonym.

The American plant was not considered distinct from the European by Waiter or Michaux, who were the first to specifically describe it (1788 and 1803), although it is probable, from Michaux's description and the habitats which they cite, that they were both acquainted with the sharp-lobed form. Pursh (1814) was the first to note that there are two forms of the plant, both of which he considered varieties of the European species, calling the blunt-lobed form Hepatica triloba var. obtusa. His views were adopted by De Candolle, in his Natural System (1818). In the Botanical Register (1819) Ker figures the round-lobed form, and, considering it a distinct species, named it Hepatica americana; and De Candolle followed him in his Prodromus (1824). Although this name was adopted by but one other botanist (Miller), and has never been sanctioned by an American writer, yet it is given as the officinal name for the plant in each of the United States Pharmacopoeias, where it has been officinal from 1830 to 1870, inclusive. Most of our botanists have considered the blunt-lobed form identical with the European plant, The specimens of Hepatica from Europe, in our herbarium, and the leaves or the commercial imported drug (see Fig. 17), are intermediate in shape between the two forms of the American plant, if anything more closely approaching the sharp than the blunt-lobed form. In our opinion, the blunt-lobed American form is entitled to the rank of a variety of the European species, if indeed it is not a distinct species.] calling it Hepatica triloba, or very recently (first by Lawson, in his Ranunculaceae of Canada, 1869) Anemone Hepatica.

Anemone Acutiloba.—The sharp-lobed form was first noted as a distinct form by Pursh (1814) as Hepatica triloba var. acuta, considering it a form of the European species. Bigelow, in the year 1824, called it Anemone Hepatica var. acuta. It is, however, now classed as a distinct species, called, first by De Candolle in Prodromus (1824), and by many subsequent writers, Hepatica acutiloba, which name was changed to Anemone acutiloba by Lawson, to make it accord with late views regarding the genus; and it is so adopted in Watson's Index.

Geographical Distribution.—The two Hepaticas are distributed over about one-half of the United States, extending from Missouri and Iowa cast, but absent, as far as we can learn, west of these States.

The blunt-lobed species only is found along the Atlantic plain from Maine to the northern part of Florida, and in the Gulf States. It extends across New York, and is very abundant in the Lake Basin, and is connected by occasional stations along the Mississippi valley with its Gulf habitat. It is the lowland species, and is found in mountainous country only in the Southern States.

The sharp-lobed species is abundant in the mountainous portions of the Eastern States, and through the Allegheny ranges. It is also the exclusive species over most of Ohio, Indiana, Illinois, Iowa, and northern Missouri. In connection with the blunt form, it is common through central and lower New York, the Lake Basin, and the mountains of the Southern States.

Distribution by States.

Canada.—Both species abundant; the blunt common in Ontario and rare in western Quebec; absent from east. Canada; the sharp common throughout the dominion.

Maine.—The blunt common along the coast plain; sharp, absent; no reports from northern part of State, but only sharp probably found.

New Hampshire.—The blunt extends up the Connecticut river valley in the western part of the State, and all over the southeastern portion, but in the central, the White Mountains, and the northeastern portion, the sharp only is found.

Vermont.—The blunt form is found in the Connecticut valley on the east, and in the immediate neighborhood of Lake Champlain on the west, but in the central and greater portion of the State, the Green Mountains and the hilly elevated country on both sides, it is replaced entirely by the sharp form.

Massachusetts.—The blunt form is common all over the State; the sharp found only in the northwestern part 1 where the spur of the Green Mountains extends into the State.

Connecticut and Rhode Island.—Blunt only found, but common.

New York.—Both forms are distributed over most of the entire State; the blunt form abundant in the Hudson valley; the sharp form more common in the central, northern and western sections, and the highlands of the eastern, and only absent in the extreme southeastern.

Pennsylvania.—Reports are meager from this State. In the extreme eastern part only the blunt form is found, but throughout the State generally both forms occur.

New Jersey, Delaware, and Eastern Maryland.— Only the blunt form grows. Both are absent from the New Jersey swamp section.

West Virginia, Virginia, and Western Maryland.—Sharp form found over all three. Reports are meager, but blunt grows most common probably in southern and eastern Virginia only.

North Carolina, South Carolina, Georgia, and Alabama.—Blunt in all sections. Sharp form reported very common in the western mountainous part of North Carolina and the northern part of Georgia, and probably found in the extreme western part of South Carolina and northern part of Alabama.

Mississippi.—No reports from this State, but blunt probably found in the eastern part of the State.

Louisiana.—No report, but both probably absent.

Arkansas.— Sharp found in northeastern section; blunt not reported, but probably occurs.

Texas, Indian Territory, Kansas, and Nebraska.—Both forms absent.

Missouri.—Sharp reported from St. Louis, and probably found over most of the State; blunt reported from the Ozark Mountains.

Iowa.—Sharp form common all over the State; blunt only reported from a few localities in the immediate neighborbood of the Mississippi.

Minnesota.—Reports meager. Both probably found over the State.

Wisconsin.—Both forms found in southern and eastern section; no report from northern part of State, but both forms probably found.

Michigan.— Both forms common throughout the State.

Illinois.—Sharp common all over the State; blunt only reported from the Lake basin in the northeast and the Wabash Valley in the southeast, and from an occasional station, but rare along the Mississippi.

Indiana and Ohio.—Sharp form found all over the States; blunt only in the immediate Lake regions.

Kentucky.—Sharp form all over the State; blunt rare on the cliffs of the Kentucky River, and also probably in the southern part of the State.

Tennessee.—Both forms common throughout the State.

DESCRIPTION OF THE DRUG.—Three varieties of liver leaf are found in commerce, corresponding to the three forms of the plant described under our botanical history.

The Sharp-lobed Domestic Drug.—This is derived from the Anemone acutiloba, and forms the great bulk of liver leaf collected in this country. We obtained thirteen specimens from collectors or dealers in widely separated sections of our country, and with but one exception they were of this form. The reason is obvious, for, while the blunt-lobed form is very common in some sections of the country, it is in the extreme South and the cultivated lands of the East, where few herb-collectors reside. The sharp-lobed form grows abundantly in the highlands, and especially in the mountains of the Southern States, which supply most of our native drugs. The shape of the leaves of this drug is accurately represented, natural size, in Fig. 15. The leaves are thinner than in either of the two other forms, and in mass the drug is of a darker green.

The Blunt-lobed Domestic Drug.—This is derived from the Anemone Hepatica of American growth. It can be at once distinguished from either of the other varieties of the drug by the blunt lobes of the leaves, as shown in Fig. 16. It is very seldom seen in commerce, and we are satisfied does not form one fiftieth of the drug which is collected in this country. The only commercial specimen we could obtain during the past year came from St. Louis, and was collected in the southwestern part of Missouri. The texture of the leaves of this variety of the drug is thicker than in either of the other kinds; and in the specimen we examined the leaves were of a brownish color, though that was on account of their having been collected late in the season. This variety of the drug is the only one that has ever been officinal, for the name given by the Pharmacopoeia to the plant yielding the drug excludes both the sharp-lobed American drug and also the foreign.

The Foreign Drug.—This is derived from the Anemone Hepatica of European (mostly German) growth. In shape the leaf is intermediate between that of the two domestic drugs, but approaches much more closely the sharp-lobed form than the blunt-lobed form, as can be readily seen by the figures. The leaves and drug are of a much lighter green color than either of the domestic drugs. The foreign drug is that which is found now in most of the New York drug houses.

In commerce, all three varieties of the drug appear in masses or in fragments. Sometimes portions of the roots are attached. Owing to the fact that the plant remains green during the winter, it might be supposed that it would sometimes be gathered in the early spring. If such is the case, we failed to find specimens of it; and examinations made by us of commercial hepatica show that such would be exceptional. The leaves preserve their green color extremely well in drying. When chewed, hepatica imparts a slightly astringent, herb-like taste, but it is devoid of any peculiarities by which its sensible properties can be prominently described.

MICROSCOPICAL STRUCTURE.—(Written for this publication by Louisa Reed Stowell.)

The minute structure of hepatica leaf is exceedingly simple. The cuticle upon the upper surface of the leaf is smooth, uniform, and about 1-6,000 part of an inch in thickness. It is thicker immediately over the midribs or prominent veins, than over the fleshy part of the leaf. The epidermis on the upper side of the leaf is composed of large, open, round cells, having a uniformly thickened wall around each one. They are of a clear white appearance, containing nothing. The palisade cells found just beneath the epidermis on the upper side of the leaf, only slightly resemble the usual palisade cells of leaves. They are round or nearly square, instead of the usual shape. They have very thin walls, and are sometimes compressed into irregular shapes. In size they closely resemble the cells of the epidermis, being smaller than the cells of the rest of the leaf. Chlorophyll bodies are found in great abundance in these cells.

The loose parenchyma is found just beneath the palisade cells, and includes all the structure of the leaf between the palisade cells and the lower epidermis, excepting the veins. This structure easily divides into four or five layers of large loosely packed cells, having many open spaces between them. In these cells are scattered a few chlorophyll bodies, together with some small dried masses of protoplasm, and occasionally minute oil drops. The lower epidermis is easily separated from the loose parenchyma, and is composed of cells which are smaller, and with thinner walls, than the upper epidermis. The cuticle on the lower surface of the leaf is not so wide, and is more delicate than the cuticle on the upper surface of the leaf.

A few simple, unicellular hairs are found on the upper surface of the leaf. They are sharply pointed at one end, with a smooth wall, and are about 1-20 of an inch in length. On the lower surface of the leaf these hairs are more numerous, and are longer and more delicate. They are simple, unicellular hairs, from about 1-10 to 1-4 of an inch in length. just at the edge of the leaf the same appearing hairs are more numerous yet, but shorter, and having quite thick walls, especially at their base. The stomates are very similar to the stomates of the average leaf, much more numerous on the lower surface than on the upper surface of the leaf, and average about 23, 500 to the square inch on the lower side.

There is no marked microscopical difference between the leaves of the two species. The leaves of both are very liable to be visited by a vegetable parasite which we have observed in all the specimens we have examined.

COMMERCIAL HISTORY.—There was little demand in America for liver leaf preceding the year 1880, unless it were about 1830, during the little excitement regarding the use of this drug as a cough remedy. The records show that for a long period it burdened the pages of our pharmacopoeia, an unused member of the materia medica. One of the most extensive collectors of American drugs informs us that just preceding 1880, by an error he sent one hundred and fifty pounds of liver leaf to a dealer who purchases quantities of all the American medicinal plants in use, and it was held as an unsalable overstock. [In domestic practice it is still somewhat employed as a constituent of cough syrups, but not sufficiently to create a demand. It seems to be an herb that is used in localities where it grows, and by those who can gather it for themselves.] It is the experience of others, and ourselves, that few of the officinal drugs were in less demand than liver leaf, until about 1880. At this time a demand suddenly sprung up, and the country was afterward scoured by the consumers or their agents. Circulars were scattered over the sections of our country where the plant was collected, urging gatherers of plants to give it special attention. Contracts were made for all that could be obtained from entire sections, or even States; and we have the statistics which show that one State alone supplied, during 1883, more than 30,000 pounds. The supply from America was insufficient, even under these circumstances, and the consumers were forced to turn their attention towards the Old World. Germany naturally was their field, and by means of circulars and agents, they obtained an enormous supply. This fact was soon recognized by Gehe & Co., of Dresden, Germany, for, in their Handelsbericht (September, 1882), attention was called to the fact that the price of hepatica had advanced in consequence of the large demand from America (New Remedies, 1882, p. 337). Persons who are not aware of the extent to which a drug may be consumed when it enters into a few well advertised specialties, must be astonished when the magnitude of the liver leaf trade is laid before them. We have statistics which show that there has been a continuous increase in the consumption since 1880; and collectors inform us that the plant is now becoming scarce over some sections of our country. From the importers of New York and the collectors of America we have statistics to show that in the aggregate 425,282 pounds of liver leaf were collected and imported to supply the demand during the year 1883. It is to be expected that some escaped our notice; and we think it can be safely said that during the year 1883 an aggregate of 450,000 pounds was imported and gathered for our home market. The demand is still on the increase, and probably this year will note a greater consumption. [It will perhaps be questioned by some persons whether it is possible for such enormous amounts of a plant to be consumed, if it is inactive and of no medicinal value. We think that persons who study the history of drugs can scarcely doubt that such may be the case. This liver leaf is consumed in compounds, and even though itself inert, the associated substances may be active remedies; and certainly its presence will not interfere with their actions. If we were to venture an opinion, we would suggest that the real liverwort (Marchantia) was intended to be used, and that by a mistake liver leaf had been supplied. Marchantia has a record as a hepatic remedy, but liver leaf has none (see medical history and medical properties).]

PHARMACOPOEIAL HISTORY.—Hepatica was not recognized in the first edition of the Pharmacopoeia of the United States (1820). It was introduced in the Philadelphia edition of the second issue (1830), but was omitted from the New York edition of the same date. It occupied a position in the secondary department of each revision from 1830 to 188o, at which latter date it was discarded. Neither the Pharmacopoeia of the Massachusetts Medical Society (1808), nor Bigelow's Sequel to the Pharmacopoeia of the United States (1822), gave it a position.

The officinal name has always been "Hepatica," and the plant recognized by De Candolle's name, Hepatica americana. In connection with the Pharmacopoeial history of this plant, we note the following inconsistencies:

1st. That the plant should have been recognized by a name that was never adopted by an American botanist, as stated in our Botanical History.

2d. That the species which supplies the bulk of the American drug should never have been recognized.

CONSTITUENTS.—Hepatica contains only the ordinary constituents of herbs. The description by Rafinesque, in 1828, is about as good as any that can be given now. He described it as "scentless and nearly insipid, not bitter; but a little astringent and mucilaginous. It contains tannin, mucilage, extractive, etc." We were unable to find the record of an analysis other than the brief statement of Rafinesque, [Mr. Charles B. Smith, in a thesis presented to the New York College of Pharmacy, demonstrated the presence of a tannin in hepatica (see Druggists' Circular, 1863, p. 70).] and therefore Mr. Harter and ourselves submitted the plant to an examination, the result of which was published as a thesis by Mr. Harter, in the Pharmaceutical Record, April 1st, 1884. Nothing of interest was discovered, the summing up being as follows: "It contains none of the classes of active constituents, found in medicinal plants, but consists of the usual constituents of plants, such as a tannin, gum, sugar, chlorophyl, and small amounts of a bland oleoresin." Of the substances named, none were in amount sufficient to render them conspicuous. It may be accepted that hepatica does not contain a single prominently marked constituent, and that few herbs present less decided peculiarities.

PHARMACEUTICAL PREPARATIONS.—The Pharmacopoeia of the United States has never recognized a preparation of hepatica. [Cetraria islandica was once known as Iceland Liverwort. The Pharmacopoeia of the Royal College of Physicians (London Pharmacopoeia), 1809, 1824, and perhaps subsequent editions, recognized decoction of Cetraria islandica as "Decoction of Liverwort."]

The Pharmacopoea Homoeopathica Polyglottica prepares an "essence" as follows: "The plant, or part of it, is pounded to a fine pulp, and weighed; then take double its weight of strong alcohol, and, adding first a sixth part of it to the pulp, rub well together; then add the rest of the alcohol, work up the whole well together and put in a well-corked bottle, and leave it standing for eight days in a dark, cool place; then pour off the essence and filter."

The only unofficinal preparation of which we have a record that contains hepatica, is Beache's "Vegetable Syrup," a preparation which is nearly or quite obsolete. Infusions or decoctions of liver leaf may be made by the usual processes. Fluid extract of liver leaf may be prepared by the officinal process for making fluid extract of digitalis, employing liver leaf instead of digitalis.

MEDICAL HISTORY.—The records show that at an early day a lichen of Europe (Marchantia) was used as a remedy in liver disorders, or what were supposed to be liver disorders, and that in consequence it received the vulgar name Liverwort. The shape of the leaf of hepatica Somewhat resembled the three lobes of the liver, and hence this plant also was called Liver Leaf, or Liverwort. [The meaning of the word liverwort is liver weed.] Thus it came that two entirely distinct plants were known under the same name; and in order to distinguish them, one, a creeping plant, was called Liverwort (Marchantia), and the other, an upright plant, Noble Liverwort (hepatica). Some of the early medical works recognized both plants, but others, under the name liverwort only recognized Marchantia. As illustrations, we may refer to the New Dispensatory, 1753 (and other editions), wherein hepatica is named Noble Liverwort, a "gently restringent herb," and Marchantia is called Liverwort, and used in obstructions of the liver, in jaundice, etc." This view is also taken by Culpepper's English Physician, 1725 (which only considers Marchantia); Lewis' Materia Medica, 1761; The Pharmacopoeia Officinalis Extemporanea, or, A Complete English Dispensatory, by John Quincy, 1761; by Motherby's Medical Dictionary, 1775; and other standard European authorities which it is unnecessary to name. However, at even an earlier day some writers had included liver diseases among the many wherein "Noble Liverwort" could be used with benefit; and we may name Tournefort's Materia Medica, which was translated into English in 1708, and Salmon's English Herbal, in 1710, both of which ascribe hepatic properties to the plant. This view of the case seems, however, to have resulted from the theory of "Signatures," [Formerly a plant was supposed to be of value in the diseases of an organ of the body which it resembled. This may possibly have assisted in introducing Hepatica for liver diseases. In connection with this subject Dr. Charles Rice contributes as follows: "The Doctrine of Signatures, so broadly developed in later times, had its first beginning in certain philosophical speculations of Aristotle, who already maintained that internal qualities, character, etc., of living beings, could partly be traced or guessed by observing external signs. By a sort of peculiar metaphor, the idea became gradually developed that certain parts of plants or animals having a resemblance, or close relationship, to certain parts of the human body, exercised a peculiar influence over it, either for good or bad, when administered externally or internally. A regular system of treating diseases was gradually based on this doctrine. The chief exponent of it was Johannes Baptisia Porta (died 1615), who wrote the well-known work, Phytognomica (often edited; with curious cuts)."] and few early writers that we have consulted recognized it in this light.

In 1817, Hooper's Medical Dictionary said of Marchantia, "so-called because it was thought to be useful in diseases of the liver," but to liver leaf the same work ascribed no hepatic value. There is no doubt, however, but that at that period both plants were used in domestic practice and with some members of the medical profession as hepatic remedies.

The earliest mention in American history that we can find of hepatica, occurs in Carver's Travels, 1778, but the plant was simply spoken of as Noble Liverwort, and no medicinal value was ascribed to it. David Schoepf, in his Materia Medica Americana, 1787, briefly mentions the plant as "inodorous, insipid." Barton omitted it in his "Collections for a Vegetable Materia Medica," 1798, 1801, and 1804, which is good evidence that at his day the plant was not valued, for Barton's tendency was to recommend all plants that were in the least medicinal, rather than to omit anything. Hand (1820) gave hepatica a passing notice in his "House Surgeon and Physician," but Rafinesque, in the first volume of his Medical Flora of the United States (1828), devoted considerable space to its consideration, and figured the plant.

In 1831, Geo. W. Carpenter, of Philadelphia, issued a work, [This work was dedicated to the medical class of the University of Pennsylvania, and it will be observed as a coincidence in our Pharmacopoeial history (P. 46), that hepatica was admitted to the Philadelphia edition of the U. S. P., 1830 (issued 1831), but was not recognized by the New York edition of the same date. The testimony at our command shows that the advertisements of Mr. Carpenter's "Cough Syrup" produced a demand, and that "imitations" of his syrup resulted, as we find him cautioning the "Faculty" against these imitations. Prominent physicians of that city, and throughout Virginia, used and recommended it, but others opposed it. Thus in Dr. Coxe's American Dispensatory (1831), we find that the only recognition of the plant is a sharp criticism, and we reproduce it as follows: "If half of what was said of liverwort be true, it ought never to have left the lists of the materia medica; but if the far greater portion of it be false, or founded in error, it ought never again to have been introduced among the already too crowded lists of remedies." Dr. W. P. C. Barton, in his "Prodome of a Work to Aid in Teaching the Vegetable Materia Medica" (1833), remarks: "Hepatica triloba has reputation, but I think undeservedly, in consumption."] "Essays on Some of the Most Important Articles of the Materia Medica," in which a compound syrup of Liverwort, or Hepatica, was highly extolled.

The United States Dispensatory, 1833, 1st edition, introduced hepatica in the primary section of that work, owing to its being officinal in the Philadelphia edition of the Pharmacopoeia, but the editors spoke lightly of it, saying: "It will probably ere long be forgotten." This paper, excepting the quotation we have made, was carried to the fifteenth edition (1883) Of that work, at which time (the plant having been omitted from the U. S. P.) the paper on hepatica was transferred to the appendix.

Dunglison referred briefly to hepatica in the second (1843) edition of his Materia Medica; and in the third edition he added a copy of Rafinesque's figure of the plant, which, with the paper, was carried through the subsequent editions without further change.

Beach's American Practice (1847), Griffith's Medical Botany (1847), and Christison & Griffith's Dispensatory (1848), barely recognized hepatica, but the last named works reproduced Rafinesque's rude figure of the plant. King, in his Dispensatory (1852), gave it a short notice; Bartholow and Scudder ignored it; Stillé and Maisch placed no value on it.

SUMMARY.—In reviewing the medical history of Hepatica, we find that at an early day it reached an acknowledged but unearned position in medicine. It was introduced, through ignorance, for another plant, or in accordance with the illogical doctrine of signatures. Its worthlessness in the cure of diseases where it had stumbled into use, finally became apparent, and in the latter part of the 18th century it fell into disuse. Between the years 1825 and 1830 it was revived, by means of the advertisements of manufacturers of semiproprietary preparations, and became somewhat prominent in the cure of a class of diseases in which it had scarcely been used previously. Hepatica now became officinal (1830), (see Pharmacopoeial History, p. 46) remaining officinal until 1880, when it was discarded from the Pharmacopoeia. However, very soon after the year 1830, it was again found to be unworthy, and was relegated into comparative obscurity, remaining in a nearly obsolete condition until about 1880. At this time a demand was created for it by manufacturers of prominent proprietary medicines; others imitated them; the demand increased immediately, and at the present day the consumption of liver leaf in North America is enormous. (See Commercial History, p. 46).

MEDICAL PROPERTIES.—"While the term 'hepatica,' or 'hepaticum,' belonged formerly to two different plants, one a cryptogam and the other a flowering herb, and much confusion arose from this afterwards, nevertheless liver leaf was used medicinally for a long time back. No mention appears to be made of it by any classical writers.

J. Bauhin states that it is chiefly used by recent surgeons (viz., living about the middle of the 16th century) for healing wounds, it being used both externally and internally; also, in decoction, as a gargle in inflamed throat; 'refrigerat enim, siccat et roborat.' He adds that the surgeons living at his time use it but rarely, and Parkinson says it has been found inert."—CHARLES RICE.

We find that in early English medicine "Noble Liverwort" was used as a "corroborant and restringent." [This word seems to have been used by some of the writers upon English medicine of the last century, with a secondary meaning, somewhat as we use the word tonic. Regarding this subject, Dr. Charles Rice makes the following statement: "So far as I can ascertain, the term 'restringent' (which is never used by classic writers) was first employed by Harvey, and afterwards by a small number of English writers. It was not used on the Continent. Astringents (or restringents) were, to my knowledge, always understood to be remedies that 'contracted,' 'puckered' (the mouth, etc.), and the meaning tonic is only secondary, since many tonics are actually astringents.] Thus, in the "New Dispensatory," 1753, (Quincy), the statement was made that "It is a cooling, gently restringent herb; and hence recommended in a lax state of the fibers as a corroborant." Lewis' Materia Medica 0761), and Motherby's Dictionary (1795), make, in substance, the same statement; and we find that during those times hepatica was scarcely recognized as a hepatic remedy. Meyrick (1790), in his New Family Herbal, stated that Noble Liverwort "is a good medicine in obstructions of the liver and other viscera," and that "if administered early in the disorder, it will frequently cure the jaundice." This was not accepted by others; and such an authority as Quincy, 1817 (Lexicon-Medicum), attributed to hepatica only the properties ascribed by the former works. Passing to 1820, we find in Hand's House Surgeon both views of the subject condensed into one, and the plant is said to be "moderately astringent and strengthening, and to have been supposed to be suited to cases of disordered stomach and liver;" but he added, "This article is, in reality, worth little." In summing up the attributed uses of liver leaf at that time, we can not do better than to quote from the supplement to the London Pharmacopoeia (1821), as follows: "Aperitive, vulnery, useful in diabetes and dysentery; detergent in diseases of the skin, or in gargles."

We now come to the third period of unwarranted persecution that this innocent little herb has received at the hands of the medical profession. In our Medical History (p. 48) we stated that between the years 1825 and 1830 it was revived; and we find it then introduced as a remedy in bleeding of the lungs, coughs, and pulmonary affections generally. Rafinesque (1828), in his Medical Flora of the United States, called attention to this phase of the subject; but he added, "It has no effect upon the lungs beyond that of a mild demulcent astringent." Notwithstanding its worthlessness in these affections, advertisements from interested manufacturers of "Compound Liverwort Syrup," etc., which ascribed to it wonderful virtues, were thrust upon the medical profession of this country, and it came into a spasmodic demand. Like other substances, however, introduced in this manner, it naturally passed into oblivion as a cough remedy when the artificial support was withdrawn. [It was recommended and used mainly in the form of semi-proprietary syrups, which were accompanied by certificates from "reputable physicians." In a book before us (1830), dedicated to the medical class of the University of Pennsylvania, Compound Syrup of Liverwort is brought before the medical profession as a wonderful remedy, and the "faculty" are informed that each bottle of the writer's preparation will have his written signature, "without which none will be genuine."]

From that time until 1880, hepatica was almost lost as a member of the materia medica, and it is not recognized by the medical profession of the present day. In making this statement, we must admit that authors sometimes briefly refer to hepatica; however, they find little, if anything, to say in its favor.

In connection with the medical history of liver leaf, we find that Homoeopathic physicians scarcely use it. Prof. E. M. Hale has written the following for our publication, but he considers the plant unimportant:

HOMOEOPATHIC USES OF HEPATICA.—"This plant has been used by a few of our school in cough with bloody, sweet expectoration. Owing to the fact that we have only a fragmentary proving, we have but little clinical experience. My personal experience leads me to recommend it in catarrhal pharyngitis, laryngitis, or bronchitis, when sub-acute or chronic. It seems to be faintly analagous to Pulsatilla."

DOSE.—There is no dose. Infusions or decoctions may be given freely. If they are administered hot for coughs or colds, some beneficial effect may follow, for hot drinks are sometimes useful. If a compound syrup of liver leaf is employed, the dose will be in accordance with the dose of the associated ingredients.

SUMMARY.—We may compare the medical history of hepatica with the botanical, for in each instance much confusion has prevailed regarding it. We may say, to the credit of physicians, that it has never received the support of prominent men of the profession. The terms used by Quincy, Motherby, Dunglison, Wood, Bache, Stillé, King, Scudder, and others, are sarcastic or slighting. Barton, Pereira and Bartholow neglect to mention it. Every evidence points to the fact that hepatica is as inefficient a plant as we can find, and that the grass of the fields would prove as beneficial in the diseases to which it has been applied. [It may be argued that syrups containing hepatica, or infusions of liver leaf, have given relief in pulmonary affections; and that certain mixtures containing liver leaf have appeared to relieve diseases supposed to arise from disordered conditions of the liver. This we do not dispute, for sugar will often relieve a cough; and we have known simple syrup to prove valuable in colds. Besides, the substances with which the liver leaf is associated may he active remedies; and the maker of the once famous "Compound Syrup of Liverwort" called attention to the fact that where simple syrups of liver leaf failed to relieve, the Compound Syrup afterward effected a speedy cure. He neglected, however, to give the names of the other constituents of his syrup.] Distressed by the differences of botanists, who refuse even now to give it a clear title to a botanical home; persecuted by the medical world as it has been for some centuries, let us hope that when the present artificial demand has ceased, it may remain undisturbed our modest and charming early wild flower.

Pharmaceutical and Medical References.

1708.—Materia Medica; or a description of simple Medicines Generally used in Physick, Tournefort (translated into English 1708), p. 334.

1720.—The English Herbal, or History of Plants, Salmon, p. 648, (Rough illustrations.)

1753.—The New Dispensatory, London, Quincy, p. 138 (and other editions).

1761.—An Experimental History of the Materia Medica, London, Lewis, p. 304.

1762.—Histoire des Plantes, de L'Europe, Vol. II., p. 626, author's name not given. (Rough illustration.)

1778.—Carver's Travels through North America (Philadelphia reprint), 1796, p. 343.

1790.—The New Family Herbal, Birmingham, Meyrick, p. 289.

1795.—New Medical Dictionary London, Motherby.

1802.—Quincy's Medical Dictionary, p. 322.

1827.—Lexicon-Medicum. A New Medical Dictionary, Quincy (Hooper's Philadelphia revision), p. 367.

1820.—Lexicon-Medicum, or Medical Dictionary, London, Hooper, p. 54.

1820.—The House Surgeon and Physician, New Haven, Wm. M. Hand, p. 226.

1821.—Supplement to the Pharmacopoeia, London, p. 150.

1825.—Medical Dictionary, London, Hooper, p. 87.

1828.—Medical Flora of the United States, Rafinesque, Vol. I.. p. 238.

1830.—Pharmacopoeia of the United States (1st revision), Philadelphia, p. 34.

1830.—Medical Flora of the United States, Rafinesque, Vol. II., p. 227.

1830.—Introduction to the Natural System of Botany, Lindley, p. 7.

1830.—Botanic Physician, New York, Smith, p. 475.

1831.—Essays on some of the most Important Articles of the Materia Medica, Carpenter, p. 190.

1831.—American Dispensatory, Philadelphia, Coxe, p. 85.

1833.—American Practice of Medicine (with copy of Rafinesque's figure), Beach, p. 105.

1833.—Prodrome of a Work to Aid in Teaching the Vegetable Materia Medica, W. P. C. Batten, p, 74.

1833.—United States Dispensatory (and subsequent editions), p. 334.

1835.—Medical Botany, Sanborn, p. 64.

1840.—Pharmacopoeia of the United States (2d revision), p. 45

1840.—Pharmacopée Universelle, Jourdan, Vol. I., p. 733,

1843.—General Therapeutics and Materia Medica, Dunglison (2d edition), Vol. II., p. 48 (subsequent editions illustrated with copy of Rafinesque's figure).

1844.—The Sick Man's Friend, Boston, Sanborn, p. 60.

1847.—Medical Botany, Griffith (with copy of Rafinesque's figure), p. 81.

1847.—American Practice, Beach, p. 658.

1848.—Christison's Dispensatory (Griffith), p. 535.

1848.—Catalogue of Medicinal Plants of New York, Lee, p. 4.

1849.—Medicinal Plants of South Carolina, Porcher (Trans. Am. Med. Assoc., p. 684).

1850.—Pharmacopoeia of the United States (3d revision), p. 51.

1850.—Catalogue of the Medicinal Plants of the United States, Clapp (Trans. Am. Med. Assoc., p. 717).

1852.—Eclectic Dispensatory of the United States of America, King and Newton, p. 206 (and subsequent editions of the American Dispensatory).

1852.—Dictionary of Medical Science, Dunglison, p. 436 (and other editions).

1858.—Catalogue of the Medicinal Plants of Michigan, Stearns (Am. Pharm. Assoc. Proc., p. 263).

1860.—Pharmacopoeia of the United States (4th revision), p. 59.

1861.—Book of Formulas, Tilden & Co., p. 55.

1865.—American Eclectic Materia Medica, Hollemback, p. 194 (poor illustration).

1866.—Materia Medica and Therapeutics, Jones and Scudder, p. 408, 537.

1870.—Pharmacopoeia of the United States (6th revision), p. 58.

1870.—Eclectic Medical journal, Cincinnati, p. 154.

1871.—The Journal of Materia Medica, Rates and Tilden, p. 143; 1873, p. 321.

1872.—Pharmacopoea Homoeopathica Polyglotta, p. 181.

1872.—Supplement to the journal of Materia Medica, Tilden & Co., New Lebanon, New York, p. 49.

1873.—Dictionary of Pharmaceutical Science, Sweringen, p. 212.

1875.—Hale's New Remedies, Vol. I., p. 354.

1876.—Encyclopedia of Pure Materia Medica, Allen, Vol. IV., p. 588.

1878.—Dispensatory and Pharmacopoeia of North America and Great Britain, Buchanan and Siggins, p. 173.

1878.—The United States Homoeopathic Pharmacopoeia, p. 149.

1879.—National Dispensatory, p. 695 (and subsequent editions).

1882.—New Remedies, Wm. Wood & Co., p. 337.

1884.—Companion to the Pharmacopoeia, Oldberg and Wall, p. 554.

1884.—Pharmaceutical Record, p. 145.

1884.—Canadian Pharmaceutical journal, p. 143.

1884.—New Remedies, Wm. Wood & Co., p. 112, 118.

Botanical references to Anemone acutiloba Lawson.

1803.—Anemone Hepatica Linn.—Michaux, Flora Boreali-Americana, Vol. I., p. 319.

1814.—Hepatica triloba var. (β) acuta—Pursh., Flora Americae Septentrionalis, Vol. II., p. 391.

1816.—Hepatica triloba — var. acuta—.—Eaton, Manual of Botany of Northern and Middle States, 1st edition, p.—; 2d edition, p. 270; 3d edition, p.—; 4th edition, p. 319.

1824.—Hepatica triloba Willd. [Should be Chaix.] var. (β).—Bigelow, Florula Bostoniensis, 2d edition, p. 222.

1824.—Hepatica acutiloba—De Candolle, Prodromus Systematis Naturalis, Vol. I., p. 22.

1829.—Hepatica acutiloba DC.—Eaton, Manual of Botany of Northern and Middle States, 5th edition, p. 241; 6th edition, 1833, Part II., p. 271; 7th edition, 1836, p.

1831.—Hepatica acutiloba DC.—Don, Dichlamydeous Plants, Vol. I., p. 22.

1838.—Hepatica triloba Chaix var. (β) acuta Pursh.—Torrey & Gray, Flora of North America, Vol. I., p. 15.

1840.—Hepatica acutiloba DC.—Eaton and Wright, North American Botany, p. 367.

1840.—Hepatica triloba — var. (β).—Hooker, Flora Boreali-Americana, Vol. I., p. 9,

1843.—Hepatica triloba Chaix var. (2) acuta Pursh.—Torrey, Flora of State of New York, Vol. I., p. ii.

1845.—Hepatica triloba Chaix var. (β) acuta—.—Wood, Class-Book of Botany. 1st edition, p. 21; 2d edition, 1847, p. 141; — edition, 1861, p. 204.

1848.—Hepatica acutiloba, DC.—Gray, Manual of the Botany of the Northern United States, 1st edition, p. 7; 2d edition, 1856, p. 6; same in 3d and 4th editions; 5th edition, 1867, p. 38.

1849.—Hepatica acutiloba DC.—Gray, Genera of the Plants of the United States, Vol. I., p. 22. Illustrated with a lithograph (Plate V.), showing a flowering plant (with mature leaves), and also enlarged stamens and carpels.

1860.—Hepatica acutiloba DC.—Lesquereux, Catalogue of the Plants of Arkansas, in Second Geological Report of Arkansas, by Dale, p. 346. [Name and habitat only.]

1869.—Anemone acutiloba.—Lawson, Ranunculaceae of the Dominion of Canada, p. 30.

1870.—Hepatica acutiloba DC.—Hall, in Bulletin of Torrey Botanical Club, Vol. I., p. xx.

1870.—Hepatica acutiloba DC.—Wood, The American Botanist and Florist, p. 18.

Table showing the Position of the Section Hepatica, as Classified by the Leading Systematic Botanists of the World.

Botanical References to Anemone hepatica Linnaeus.

1753.—Anemone Hepatica—Linnaeus, Species Plantarum, 1st edition, Vol. I., p. 538.

1788.—Anemone Hepatica Linn.—Walter, Flora Caroliniana, p. 157.

1803.—Anemone Hepatica Linn.—Michaux, Flora Boreali-Americana, Vol. I., p. 319.

1806.—Anemone Hepatica Linn.—Shecut, Flora Carolinaeensis, Vol. I., p. 162.

1814.—Anemone Hepatica Linn.—Bigelow, Florula Bostoniensis, 1st edition, p. 135.

1814.—Hepatica triloba — var. (α) obtusa.—Pursh, Flora Americae Septentrionalis, Vol. II., p. 391.

1816.—Hepatica triloba —.—Eaton, Manual of Botany of Northern and Middle States, 1st edition, p.—; 2d edition, p. 269; 3d edition, p.—; 4th edition, p. 319.

1818.—Hepatica triloba Chaix var. americana.—De Candolle, Systema Naturale Regni Vegetabilis, Vol. I., p. 216.

1818.—Hepatica triloba —.—Nuttall, Genera of North American Plants, Vol. II., p. 23.

1819.—Hepatica americana—Ker, Botanical Register, Vol. V., No. 387. Illustrated with a colored plate (No. 387) of a flowering plant (with mature leaves having acute sinuses).

1823.—Hepatica triloba — var. (α) obtusa.—Barton, Flora of North America, Vol. III., p. 45. Illustrated with a good colored copper-plate engraving (No. 87).

1824.—Anemone Hepatica Linn. var. (α).—Bigelow, Florula Bostoniensis, 2d edition, p. 222,

1824.—Hepatica americana Ker.—De Candolle, Prodromus Systematis Naturalis. Vol. I., p. 22.

1824.—Hepatica triloba —.—Elliott, Sketch of the Botany of South Carolina and Georgia, Vol. II., p. 55.

1826.—Hepatica triloba Ell. [Should be Chaix.]—Darlington, Flora Cestrica, 1st edition, p. 60.

1828.—Hepatica triloba—.—Rafinesque, Medical Flora of North America, Vol. I., p. 238. Illustrated with a small cut (No. 48) of the plant.

1829.—Hepatica americana DC. [Should be Ker.]—Eaton, Manual of Botany of Northern and Middle States, 5th edition, p. 241; 6th edition, 1833, Part II., p. 171; 7th edition, 1836, p.—.

1831.—Hepatica americana Ker.—Don, Dichlamydeous Plants, Vol. I., p. 22.

1837.—Hepatica triloba Vill. [Should be Chaix.] var. obtusa —.—Darlington, Flora Cestrica, 2d edition, p.—.

1838.—Hepatica triloba Chaix var. (α) obtusa Pursh.—Torrey and Gray, Flora of North America, Vol. I., p. 15.

1840.—Hepatica triloba — var. (α).—Hooker, Flora Boreali-Americana, Vol. I., p. 9.

1840.—Hepatica americana DC. [Should be Ker.]—Eaton and Wright, North American Botany, p. 267.

1843.—Hepatica triloba Chaix var. (1) obtusa Pursh.—Torrey, Flora of the State of New York, Vol. I., p. 10.

1845.—Hepatica triloba Chaix.—Wood, Class-Book of Botany, 1st edition, p. 20.

1847.—Hepatica triloba Chaix var. (α) obtusa.—Wood, Class-Book of Botany, 2d edition, p. 141; — edition, 1861, p. 204.

1848.—Hepatica triloba Chaix.—Gray, Manual of Botany of Northern United States, 1st edition, p. 7; 2d edition, 1856; same in 3d and 4th editions; 5th edition, 1867, p. 38.

1853.—Hepatica triloba Chaix.—Darlington, Flora Cestrica, 3d edition, Part II., p. 3.

1860.—Hepatica triloba Chaix.—Chapinan, Flora of the Southern United States, p.

1866.—Hepatica triloba Chaix.—Darby, Botany of the Southern States, p. 203.

1869.—Anemone Hepatica Linn.—Lawson, Ranunculaceae of the Dominion of Canada, p. 29.

1879.—Hepatica triloba Chaix.—Wood, The American Botanist and Florist, p. 17.

1882.—Anemone Hepatica Linn.— —, in Vick's Illustrated Magazine, p. 194.

Drugs and Medicines of North America, 1884-1887, was written by John Uri Lloyd and Curtis G. Lloyd.