Digitalis

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Digitalis is one of the most important drugs used to treat cardiac failure. Although it is derived from the leaves of the foxglove, a plant native to much of Europe and even North Africa, it does not figure in the Greek physician and pharmacologist, Pedanius Dioscorides’ (circa 40—90 AD) famous compilation of herbal remedies written in the first century AD. Foxglove seems to have been known in European and especially English folk lore as a remedy for many ailments including dropsy.

In 1587 when the first English Herbal was compiled by English Apothecary John Gerarde (1545 –1611/12) the foxglove is included, and his entry explains the rationale for its use. The pictures were a great help in identifying plants for medicinal use.

In 1653 English physician and botanist, Nicholas Culpeper (1616 –1654) published his controversial Pharmacopoeia, intended to be used by lay people to make home remedies. Culpeper included the rationale for prescribing set out in plain English rather than the obscure Latin of the official Pharmacopoeia published by the College of Physicians.

By the second half of the eighteenth century medicine was adopting the ideas and methods of the scientists and philosophers of the Enlightenment. Two eminent doctors, who belonged to the Birmingham Scientific Society called the Lunar Club, were involved in botanical research. One, Erasmus Darwin (1731 –1802) (grandfather to Charles), wrote an influential poem The Botanic Garden in which he mentions digitalis, but more famously hints at evolutionary theory.

The other, botanist William Withering (1741 –1799), wrote a comprehensive botanical textbook in which he classified plants according to the new Linnaean system. This background explains the opening paragraph of his famous monograph which describes the benefits and risks of digitalis treatment in what amounts to the first ever clinical trial of a drug.

Digitalis dosage was hard to control because the extraction was variable and toxicity remained an obstacle to its use until chemical extraction and synthesis of the glycoside lanoxin was achieved. Digoxin remains one of the most important drugs in common use.

Contents

Discussion points

  • Culpeper and Withering both recommend digitalis to treat heart failure, but the former attributed its effects to emesis and purging and the latter to diuresis?
  • How does this reflect their understanding of the physiology of the circulation?
  • What do these examples show about the development of official regulation of drugs?

References

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Suggested Further Reading

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