Digitalis poisoning: Historical and forensic aspects

Abstract

Since the introduction of digitalis into therapy approximately 200 years ago, there have been continuing admonitions concerning its toxicity. Over 400 years ago, herbalists listed the plant as being poisonous. In fiction, the homicidal use of digitalis has appeared in the writings of Mary Webb, Dorothy Sayers and Agatha Christie. Ten instances in real life of alleged homicide by digitalis and trials of the accused are listed. The drug has been used with suicidal intent rather infrequently, compared with other medications. Possibly, it is more commonly used for such a purpose in France than in England or the United States. The fraudulent use of digitalis in the support of claims for disability because of heart disease has occurred, and one large conspiracy of physicians and lawyers in the swindle of insurance companies during the 1930s is a shameful episode in the record of these professions. Although innocent, one professor of medicine who was involved committed suicide. Two pharmaceutical (manufacturing) blunders that occurred in Belgium and Holland with mislabeling are mentioned. These resulted in numerous deaths and the profession seemed rather slow to recognize the nature of these small epidemics of poisoning. Instances of psychiatric illness with digitalis seem well documented. The story of digitalis toxicity continues into the present and physicians should be vigilant regarding the drug's potential for poisoning that can result from prescribing digitalis with ignorance of proper dosage, pharmacodynamics or drug interactions, as well as from accidental overdose as in children and use with self-destructive or homicidal intent.

Digitalis toxicity in infants and children

“…Two children died in 1886 after taking a cough medicine containing syrup of squills, a plant containing a cardioactive glycoside [9]. More recently, McNamara et al reported serious nonfatal toxicity in a child who ingested the leaves of a day lily plant [41].…”

“…Though there are several reports of homicidal administration of digitalis preparations in adults, no such reports among children have appeared in the medical literature [9].…”

Sensational site: the sodium pump ouabain-binding site and its ligands

“…Upon learning about the natives’ use of Strophanthus kombé seeds for poison arrows to kill animals as large as a buffalo, Kirk, himself, collected kombé seeds ( 70 ) and put them in his shirt pocket where he also kept his toothbrush. After brushing his teeth, he recognized that his pulse rate soon slowed and that this effect of kombé seeds seemed very similar to that of digitalis ( 136 ). In what is surely a remarkable example of independent, parallel discovery, native South American tribes also use extracts of plants from the genus Naucleopsis , that contain Strophanthus steroids, in poison blow darts ( 137 ).…”

Pharmacological aspects of acute treatment glycoside intoxication

“…сотрудник домов престарелых в американских штатах Нью-Джерси и Пенсильвания Чарльз Каллен отравил дигоксином 40 человек. Наперстянку использовали в мошеннических целях в 1930-х гг., когда врачи и юристы договорились применять это растение, чтобы спровоцировать на короткое время симптомы заболевания сердца и затем потребовать возмещение от страховых компаний [10].…”