A Therapeutic Catastrophe, Entailing 16 Exhumations, following the Administration of Digitoxin Instead of Oestradiol Benzoate to Prostatic Cancer Patients: Identification of the Poison

Abstract

The authors relate a therapeutic catastrophe, entailing 16 exhumations, following the administration of capsules containing digitoxin instead of oestradiol benzoate to patients suffering from prostatic cancer. The exhumations were carried out from 17 to 40 months (minus 3 days) after death. In decomposed bodies digitoxin remains in skeletal muscle and it is there that one has the best chance of detecting it. The reason probably lies in the fact that putrefaction sets in more slowly in this tissue than elsewhere. Routine chemical investigations were entirely unsuccessful except in 2 cases where thin layer chromatography provided a weak positive reaction in the muscle. On the contrary, entirely convincing, positive proof of the presence of the heart glycoside was obtained by resorting to Trevan and co-workers' biological method (1928), using the isolated auricles of the rabbit. In all, 200 tracings were made, necessitating the sacrifice of some 60 rabbits. Of the 16 patients exhumed, 2, who were known for certain not to have received any digitoxin at all, were negative. Nine of the 14 others were strongly positive, 2 only probable and 1 doubtful. Out of the 14, only 2 eases remained negative although they had also undoubtedly taken large doses of digitoxin, but this was expected from the start because of the extremely advanced state of putrefaction of those bodies. A number of cases of digitalin poisoning of special interest are reviewed.