How did we learn how to use digitalis?

By Chelsie Vandaveer

November 5, 2002

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The discovery of the cardioactive properties of the foxglove (Digitalis purpurea Linnaeus) was perhaps one of the most important steps toward modern medicine. In the 1780s, William Withering came to understand the correlation between heart function and health. Withering did not know why foxglove worked, but he knew when the heart beat stronger, the edema (dropsy) decreased, and the patients got better.

Foxglove, which yields digitalis, is vital
in the treatment of heart disease
Sam Abell/National Geographic Image Collection
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Withering attended the poor and frequently had more patients than he could handle. Mark S. Lesney wrote of Withering's errors, "In almost diary fashion, he confessed to years of overmedicating patients to dangerous levels with a host of painful side effects, sometimes leading to more rapid death, in his efforts to get things right in the ad hoc, patient-by-patient 'clinical trials' of the day." ("Flowers for the Heart", Modern Drug Discovery, ACS Publications, 2002)

Withering almost killed a patient with Digitalis leaf and he was getting a bad reputation from its side-effects. Finally, he began the experimentation anew. Ola Blomqvist wrote, "To start with, he gave his patients small doses which he gradually increased until the vomiting and diarrhea started. Then he knew that the boundary had been reached and he reduced the dose a little, which meant that the serious side-effects disappeared, while the beneficial effect on the heart remained...." ("In Time with the Heart", PrimaVi USA, Medical Link, 2002)

Withering had another consideration—the leaves of Digitalis. The cardioactive properties varied from plant to plant, even the stage of the plant's life made a difference in the quantity of the drug present. Dosages were an educated guess.

Not until the mid-1800s would chemists begin extracting and separating the cardioactive glycosides. Almost another hundred years would pass before all the compounds were elucidated, dosages computed, and pure, standardized digitalis-extracts saved more people than it killed.

Modern Drug Discovery (American Chemical Society Publications) has published online Mark S. Lesney's essay, Flowers for the Heart. To read this essay, click on the link:

http://pubs.acs.org/subscribe/journals/mdd/v05/i03/html/03timeline.html

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