Using Digitalis to the Best Advantage

Using Digitalis to the Best Advantage. Digitalis is, without doubt, the most useful remedy in the treatment of heart failure. It is almost a specific in some forms of cardiac disease. Now, even more than ever before, digitalis is the one physiopathologic drug in all cases of cardiac derangement in which failure is the predominant note. For the greatest measures of success digitalis must be given in appropriate cases and in proper doses. Otherwise, one cannot expect the full benefit of its use.

DIGITALIS has, fro the past 170 years, been the most popular and the most valuable single remedy for the treatment of heart disease. It is without a doubt one of the really great drugs in possession of the human race. Yet no one can state with certainly who discovered digitalis or when it was discovered. As a matter of fact, when it was first used as a remedy it was for other than it cardiotonic properties. Its use in medicine goes back to the Anglo-Saxon period when it was mentioned in the”Leechdoms” of the twelfth century.

In those days it was called foxglove, which is derived from the Anglo-Saxon foxesglew, i.e. for music, an allusion to the ancient musical instrument consisting of bells hung on an arched support. It was mentioned in the “Liber Medicinalis” of Apuleus, and in the “Vocabulary of the Names of Plants” of the eleventh century, as foxes glofa, while in a later vocabulary it was called foxesglove.

The ancient Welsh “physicians of Myddvai” made frequent use of foxglove. It appears as an external remedy in a treatise in the year 1250. Fuchius described it in his “Plantarium Omnium Nomenclaturae” in 1541, and gave it is present name of digitalis, in allusion to the German fingerhut (finger-stall). He also gave it its present botanical description. He described its flowers as ranging from white to purple and gave it the name of digitalis purpurea, which it still retains in spite of the fact that it is not a very accurate designation.

In the sixteenth century digitalis passed into the “Herbals” and was mentioned by Turner, and by Gerarde in 1597, who stated: “It doth cut and consume the thicke toughenesse of grosse and slimie flegme and naughty humours” in 1640, Parkinson observed its value in “extenuating tough flegme or viscous humours troubling the chest,” and remarked further that “there are few physicians who use it and it is in a manner wholly neglected.”

Ten years later, however, it was included in the London Pharmacopoeia, which shows it had found a place in the materia medica of the physicians of that period. Previous to its first inclusion Lobel mentioned that “the country people of Somersetshire employ a decoction for the cure of fever, but its operation is exceedingly violent”.

It was chiefly in the treatment of epilepsy and as an external application for scrofula or the Kings Evil, as well as for wounds and ulcers of the legs, that digitalis was employed in those days. In a manuscript book of medical recipes written in 1644 the following formula is given for “an Ointment for Kings Evil”: “Stamp a peck of Fox gloves in a stone mortar and add to it a pound of fresh butter and set them on a soft fire for four hours to make the ointment.”

Another: “Against ye falling sickness take purple foxgloves 2 handfuls of the leaves with 4 ounces of polipodium of the oak. Boil them in beer or ale and drink ye concoction. One that had the disease 26 years so that he fell with it 2 or 3 times in every month, was so cured by ye use of this decoction that he had not a fit for 16 months after”.

In the eighteenth century, the great Boerhaave considered foxglove to be of a “poisonous nature,” and Haller observed that “6 or 7 spoonfuls of the decoction produced nausea and vomiting”.

During the year 1775, in the county of Shropshire, England, an old woman was making a wonderful reputation with a mixture which was remarkably effective in curing dropsy. Her fame had spread far and wide, for her concoction had attracted acclaim over the country side. In the same year a practicing physician in the Midlands, William Withering by name, was impressed by the fact that this old woman “had sometimes made cures of cases of dropsy after the more regular practitioners had failed”.

Dr. Withering made a thorough investigation of the old womans potent herb brew and at length was successful in ascertaining that “The medicine was composed of twenty or more different herbs but it was not very difficult for one conversant in these subjects to perceive that the active herb could be no other than the Foxglove.” That very same year Withering began his study of this remarkable plant.

“I soon found,” he wrote, “the Foxglove to be a very powerful diuretic, and so in the Botanical Arrangements, published in the following spring (1776), I ventured to assert that the Digitalis purpurea merited more attention than modern practice bestowed upon it…..The more I saw of the great powers of this plant the more it seemed necessary to bring the doses of it to the greatest possible accuracy….In the spring of 1776 I ordered a quantity of the leaves to be dried and as it became possible to ascertain its does it was gradually adopted by the medical practitioners in the circle of my acquaintance.

Edward Podolski