Digitalis purpurea

Cardiac Glycoside

"Digitalis" is without question the most valuable cardiac drug ever discovered and one of the most valuable drugs in the entire pharmacopoeia. The introduction of digitalis was on of the landmarks in the history of cardiac disease."(1)



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WILLIAM WITHERING

The man credited with the introduction of digitalis into the practice of medicine was William Withering. Withering was born in Wellington, Shropshire, England in 1741. He followed in the medical footsteps of his father who was an apothecary-surgeon. Withering received his MD degree in 1766.

As an individual, William Withering was an extremely giving person. He would personally see and treat two or three thousand poor patients a year limiting him to making about 1000 British pounds as compared to his contemporary doctors who made 5000 British pounds per year.

Withering published about 19 articles during his lifetime. After fighting a long battle with tuberculosis, William Withering, the father of digitalis medicine, died on October 6 1799, at the age of 58.

Digitalis purpurea in Witherings 18th century was a blessing for people with dropsy. At the same time, foxglove concotions began to appear in an attempt to cure, albeit unsucessfuly, illneses such as asthma, epilepsy, hydrocephalus, insanity and others. The 18th century brought foxglove into medical light, but it would take several hundred years before its true healing powers could be harnessed completely.



This picture taken from "An account of the Foxglove and its Medical Uses 1785-1985" by J.K. Aronson


EARLY HISTORY


Throughout history, man has suffered from a widespread illness that" puffed their bodies into grotesque shapes, squeezed their lungs, and finally brought slow but inexorable death. As the disease progressed, a water liquid filtered into every available space and expanded it like a balloon. Sometimes the liquid -quarts and gallons of it- made arms and legs swell so tthat they were immovable. Sometimes it poured into the abdomen to form a tremendous paunch. Sometimes it waterlogged the lung cavity and thereby made it impossible for the victim to breathe unless he sat bolt upright all day and all night."(2)

The disease,for which the afforementioned description so vividly depicts, used to be called hydrops or more commonly dropsy. Following the diseases of tuberculosis and other infectious diseases, dropsy was one of the chief causes of death. "It was so ten thousand years ago, a thousand years ago, and, but for an almost miraculous green leaf, it might be the same today."(2)

Attempts to find cures to this illnes were numerous and unsucesful. An example of the early attempts can be found in Tennants 1734 writings:

"He [Earl of Oxford] purg'd 2 or 3 Times, drank sparingly of Canary and Water, thickened with the Yolk of a new-laid Egg; and all his Victuals besides were cook'd with abundance of Garlick; and Horse-radish. This Method was pursued with great Constancy for 3 Months, and blest with intire Success."(2)
This picture taken from "Medical Botany Plants Affecting Man's Health" by Walter H. Lewis and Memory P. F. Elvin-Lewis

Nineetenth Century History


The 19th century was a slow period for Digitalis. Few papers were written. Yet these papers showed that digitalis slowed the heart by acting on the vagus nerve. Also some papers showed that there were hypertensive actions on circulation due to digitalis. The main medical use for digitalis therefore still remained for the use of curing dropsy. Due to misconceptions and misunderstandings of how digitalis worked, other uses ranging almost every letter in the alphabet were created. In a book entitled "Neale's Medical digest (1877) there were over 32 conditions for which digitalis was prescribed including adenitis, bronchitis to tuberculosis and typhoid.

There were five main physiological which digitalis possesed which explained the rational for the prescription of its use as a "cure" for all these illnesses.

1. Digitalis strengthened the pulse when it was weak and slowed it down when it was strong. This was thought to help in such cases like hemorhaging.


2. It was used in the treatment of any illness which had a fever as one of its symptoms due to the fact that:
(a) It slowed down the fast pulse (b) slowed the heart rate which would in turn decrease the amount of blood circulating and thereby decrease the amount of inflammation in tissues.
(c) It acted as a diuretic to remove the "poisons" in the blood system.

3. Dr. Erasmus Darwin, Grandfather of Charles Darwin, employed digitalis to good effect and sought to immortalize it in the following verses:




Digitalis


Bolster'd with down, amid a thousand wants,
Pale Dropsy rears his bloated form, and pants;
"Quench me ye cool pellucid rills," he cries,
Wets his parched tongue and rolls his hollow eyes.
So bends tormented Tantalus to drink
While from his lips the refluent waters shrink;
Again the rising stream his bosom laves
And thirst consumes him mid circumfluent waves.
Divine Hygeia from the bending sky
Descending, listens to his piercing cry;
Assumes bright Digitalis dress and air;
Her ruby cheeck, white neck and rraven hair;
Four youths protect her from the circling throng,
And like the Nymph the Goddess steps along,
O'er him she waves he serpent wreathed wand,
Cheers with her voicce and raises with her hand
Warms with rekindling bloom his visage wan,
And charms the shapeless monster into man.

Botanic Garden, Part 2, Canto 2