Historical vignettes in heart failure. History of heart failure.

Abstract

“…We have hitherto made only a very small progress in the chemistry of animals and vegetables substances. Their virtues must therefore be learnt, either from observing their effects upon insect or quadrupeds; from analogy, deduced from the already known powers of some of their congenera, or from the empirical usages and experience of the populace. The first method has not yet been much attended to; and the second can only be perfected in proportion as we approach towards the discovery of a truly natural system; but the last, as far as it extends, lies within the reach of every one who is open to information, regardless the source from whence springs. It was a circumstance of this kind which first fixed my attention to Foxglove.”1 The discovery of the medical use of digitalis by William Withering (1741–1799) marks one of the defining moments in the treatment of patients with heart failure. Withering was born in 1741 at Wellington, Shropshire, England. In 1762 he entered the University of Edinburgh where he would receive his medical degree in 1766. The teachings and examples of William Cullen (a professor of chemistry and lecturer on material medica at the University of Edinburgh) had a profound and useful influence on Withering's career. At the end of 1766 he settled in the small town of Stafford and began his practice of medicine. Because he had a very small practice, he undertook the study of botany. His interest in this subject arose from opportunities to provide specimens for the color drawings of a patient, Helena Cook, who later became his wife. After being married, Withering moved to Birmingham and soon published his first book, A Botanical Arrangement of All the Vegetables Naturally Growing in Great Britain,2 a text with descriptions of the genera and species according to Carl Linnaeus' system of botanical nomenclature that established his reputation as one of his century's finest specialists on this subject. At age 42 he had to abandon his practice due to tuberculosis and spent much of his time writing. In 1785 he published An Account of the Foxglove, and Some of Its Medical Uses: With Practical Remarks on Dropsy, and Other Diseases.1 This very important book marked the beginning of a new era in the treatment of patients with heart failure and made Withering famous. He traveled widely as a consultant and was elected to the Fellowship of the Royal Society, honored with the diploma of the Medical Society of London, and elected a Fellow of the Linnaean Society. His health deteriorated again, and at age 55 he retired from practice. He died of pulmonary tuberculosis on October 6, 1799. He is buried at Edgbaston Old Church, Birmingham, England, where there is a monument inscribed with his name and a carving of the purple foxglove. The passage presented here demonstrates the path taken by Withering in the discovery of foxglove. In addition, it shares Withering's insightful observations on how to learn about the effects of therapeutic agents, including pharmacologic tests in animals and through the experience of laypeople. It was through the latter that he discovered digitalis. L. Fuchs originally described the plant in 1542.2 The name foxglove is derived from the plant's blossoms, which resemble the fingers of a glove. The name digitalis is derived from the Latin translation of the German word fingerhut. Fingerhut translates as “thimble,” the Latin word for which is digitalibum.2