Withering and digitalis

Fold-out plate showing a common purple foxgloveThe leaves of digitalis purpurea, the common purple foxglove, contain what is now called a cardiac glycoside, an organic sugar compound which acts upon the contractile force of the cardiac muscle. Applied in the correct dosage - digitalis is also a highly toxic plant and an incorrect dosage is potentially fatal - it is an effective therapeutic treatment for congestive heart failure and is widely used for this purpose today.

The credit for the discovery of its medical properties lies with one man, the Birmingham physician and botanist, William Withering (1741-99).

The son of a Shropshire apothecary, Withering read medicine at the University of Edinburgh and established a lucrative medical practice in Birmingham, a rapidly expanding city whose place at the heart of the Industrial Revolution fostered a growing middle class willing and able to pay a physician’s fees.

Withering, however, was not just a doctor for those who could afford to pay;  he held free daily clinics for the poor, treating up to 3,000 non-paying patients a year. From his wife, an enthusiastic amateur botanical artist, he acquired an interest in botany, an interest which culminated in the publication in 1776 of what was to be for many years the standard British flora, A botanical arrangement of all the vegetables naturally growing in Great Britain.

In common with many medical discoveries, Withering’s discovery of the medical properties of the foxglove owed much to the folk medicine of the poor. In 1775 Withering heard that an old woman in Shropshire was treating dropsy (now called oedema) with a secret herbal concoction. He obtained the recipe, which contained over 20 different plants, and through study and experimentation established that the active ingredient was the leaf of the foxglove.

He also understood that the root cause of dropsy was a failure in the pumping mechanism of the heart and perceived that the foxglove had ‘a power over the motion of the heart, to a degree yet unobserved in any other medicine.’ In order to obtain a consistent level of dosage, Withering gathered the plant at a single point in its biennial cycle - just before flowering - and prepared a medicine from the dried powdered leaf.

He achieved a high rate of success with cardiac patients, and the publication of his results a decade later, in the book on display here, ensured the widespread acceptance in medical circles of digitalis as a therapeutic treatment.

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