Save the NHS some money?

These striking flowers are foxgloves growing as (nice) weeds in our garden!

I really took this photograph in an attempt to capture a large bee that was entering the flowers. But the bee turned out to be camera-shy, and the photographs where I caught the bee are poor of the flowers. More for this photographer to learn and practice!

Foxgloves are of genus Digitalis (family Plantaginaceae). The common foxglove is Digitalis purpurea. 'Digitalis' is from 'digitus', Latin for 'finger' after the fingertip like flowers.

There are a number of explanations offered for the name 'foxglove'. It is said that it was originally named 'folk's love' meaning the fairies loved the way the flowers point downwards as it gives them a place to shelter. As home to the fairies, children were told it was bad luck to disturb the plant as this would lead to the fairies being homeless.

It is also said to come from 'fox glove' as the fairies gave the flowers to foxes to wear as gloves so as to leave no trace when raiding a hen house. This explanation was popular with people inclined to raid the rich man's hen house for themselves.

A group of medicines extracted from foxglove plants are called Digitalin. The use of D. purpurea extract containing cardiac glycosides for the treatment of heart conditions was first described in the English-speaking medical literature by William Withering, in 1785, which is considered the beginning of modern therapeutics (see later). Digitalin is used to increase cardiac contractility (it is a positive inotrope) and as an antiarrhythmic agent to control the heart rate, particularly in the irregular (and often fast) atrial fibrillation. Digitalis is an example of a drug derived from a plant that was formerly used by folklorists and herbalists; herbalists have largely abandoned its use because of its narrow therapeutic index and the difficulty of determining the amount of active drug in herbal preparations. Once the usefulness of digitalis in regulating the human pulse was understood, it was employed for a variety of purposes, including the treatment of epilepsy and other seizure disorders, which are now considered to be inappropriate treatments.

I am required to take digoxin (a component of digitalis) every day. Although not an expensive medication by modern standards (less than 4 p for a 250 microgram dose), I reflected that I could save the NHS a few pennies by stewing up foxglove leaves. But be careful... Depending on the species, the digitalis plant may contain several deadly physiological and chemically related cardiac and steroidal glycosides. Thus, the digitalis plants have earned several, more sinister, names: dead man's bells and witch's gloves. Digitalis toxicity (Digitalis intoxication) results from an overdose of digitalis and causes anorexia, nausea, vomiting and diarrhoea, as well as sometimes resulting in xanthopsia (jaundiced or yellow vision) and the appearance of blurred outlines (halos). Many children have been poisoned over the years by ingesting (and even just touching) parts of foxglove plants, and I suspect that many adults have also been poisoned!
There's a very nice website called "The Poison Garden" that describes the dangers of foxgloves! I've copied some entertaining titbits at the end of this Blipfoto submission...

Maybe it doesn't save the NHS much money if they have to treat patients suffering from digitalis poisoning resulting from uncalibrated doses of home-brewed medication. According to the latest pricing I can find, the cost of the purified and analysed drug is currently £1.01 (250 micrograms, 28-tab pack), so I currently cost the NHS 5.4 p per day (375 micrograms) for the good stuff made up into tablets. But as a professional chemist, I still sometimes hanker after stewing up plants and extracting powerful and interesting substances...

About William Withering:

In 1775, Dr. William Withering was asked to comment on a family recipe for the treatment of dropsy which had come from an old woman in a village in Shropshire. Dropsy, a condition where the soft tissue swells due to an increase in fluid retention was, at the time, treated symptomatically. That is, diuretics were used to remove the fluid. It is now known that congestive heart failure results in a build up of fluid in the lungs as well as the soft tissue. Withering's early experiments with foxglove were performed on poor patients who attended a weekly two hour free clinic which he offered and, in seeking to use the plant as a diuretic he, by his own admission, achieved little success.

He was inclined to give up his work with the foxglove when he heard from his friend, a Dr. Ash, that the principal of Brazen Nose (now called Brasenose) College, Oxford had been cured of Hydrops Pectoris, a sort of dropsy of the lungs, by means of the root of the foxglove. When Withering was able to obtain a supply of dried leaves, giving him the chance to measure dosage more accurately, he embarked on a series of trials all of which he set down in detail, even those which failed.

By 1785, when his 'An Account of the Foxglove' was published, Withering had demonstrated the benefit of using foxglove to treat dropsy even though he assumed its success to be based on its properties as a diuretic rather than having a direct cardiac effect.

Withering's place in the history of the development of medicine relies on three things; his willingness to look at a folk remedy to see if it had any merit when most of his contemporaries would have scorned such an enquiry, his lack of vanity in publishing all of his trial results even those which indicated failures in his treatment of patients, but his greatest legacy is much more general than just the use of the foxglove.


From "The Poison Garden" (linked)

In April 2010, Lisa Leigh Allen of Denver Colorado entered a plea of guilty to felony assault as part of a plea bargain agreement. She had been accused of attempted murder after a meal of spaghetti and salad, fed to her husband, was found to have foxglove leaves in the salad. She was sentenced to four and a half years in jail.

Her husband, who required hospital treatment for severe gastrointestinal upset and heart problems, apparently thought the salad tasted unusually bitter but assumed it was just one of those fashionable herb leaves which seem to appear from time to time.

n 2005, an amateur botanist committed suicide by eating foxglove leaves. Knowing of their emetic effect, he limited his consumption to two leaves. It was twenty-four hours later before he suffered a fatal heart attack.

There are a number of instances of poisoning as a result of drinking herbal tea mistakenly made with foxglove leaves. Generally, the confusion appears to arise with Symphytum leaves.

In 2006, Charles Cullen was sentenced to multiple terms of life imprisonment in the USA after confessing to 29 murders of patients at hospitals where he worked as a nurse. His preferred weapons were lethal injections of digoxin or insulin. He may have killed another 11 but, it seems, their illnesses may have killed them before the injections could have an effect.