2. It Possesses A Twofold Action; The One Sedative, And The Other Diuretic

These two actions are said never to occur simultaneously; if it acts as a sedative, it produces no diuresis, and vice versa. Dr. Garrod, ¶ however, asserts that Digitalis more especially produces diuresis when the deficiency of urinary secretion depends on cardiac disease.

3. To obtain its sedative effect, the Tincture should be administered alone; but if a diuretic effect be desired, the Infusion is preferable, particularly when combined with Squills and the Sesquicarbonate of Ammonia.

4. If either of these effects be obtained in a kindly manner, the patient may be considered safe from the poisonous operation of the drug. If, on the contrary, it does not evidence its usual effects in a few days, the medicine accumulates in the system, and the patient is in danger of experiencing its poisonous influence; it should, therefore, be discontinued. On this point, Dr. Munk ¶ observes, "In no one instance have I seen a bad effect follow the use of Digitalis, where the first consequence of its exhibition was a removal or amelioration of prominent or distressing cardiac symptoms; whether this has been brought about by its operation as a sedative or as a diuretic."

5. It is chiefly applicable to diseases of an asthenic character, and in persons of shattered and debilitated constitutions.

6. Perfect rest of mind and body, and a recumbent posture, favour the development of its action. Patients should be strictly prohibited from taking any sudden or active exercise. The effect of posture on the pulse is noticed in the previous section.

7. In Old Persons, It Is Necessary Carefully To Watch The Action Of Digitalis

It has been observed by Schonlein to produce, in some instances, not only an alarming weakness, but a positive wasting and marasmus, probably by acting injuriously upon the nervous system and organs of digestion.

8. If vomiting or diarrhoea occur during the use of Digitalis, they should be checked, as either of them arrests the specific operation of the medicine.

9. It must be prescribed with caution in inflammatory or irritable states of the intestinal mucous membrane, and in plethoric states of the constitution.

Incompatible with the Infusion. The Salts of Iron and Lead; Tannin, and all vegetable solutions containing it.

* Pathology of the Saliva, Lancet, 1841-2.

Medical Notes and Reflections, p. 544.

Op. cit., vol. ii. part i. p. 530.

§ Essentials of Materia Medica and Therap., p. 264. || Op. et loc. cit. ¶ Guy's Hospital Reports, Oct. 1844.

1090. Therapeutic Uses

In Dropsy, Ascites, Anasarca, and Hydrothorax, Digitalis has been in use since its first introduction by Withering,* in 1775. Experience has proved it to be a powerful and efficacious remedy, particularly when given in combination with Mercury, Squills, &c. Dr. Withering observes, "that it seldom succeeds in persons of great natural strength, or plethoric habit, or in those with a tight and cordy pulse. If the belly in Ascites be tense, hard, and circumscribed, or the limbs in Anasarca solid and resisting, we have but little hope. On the contrary, if the pulse be feeble and intermitting, the countenance pale, the lips livid, the skin cold, the swollen belly soft and fluctuating, the anasarcous limbs pitting under pressure of the finger, we may expect the diuretic effects to follow in a kindly manner." Experience has fully proved the general justness of Withering's remarks; at the same time, it must be observed that Digitalis has failed more frequently than the eulogiums of Withering would lead us to expect. In order that it should prove effectual, it should be given in infusion, in combination with other remedies, particularly the Sesquicarbonate of Ammonia, or in the form advised by the late Dr. Baillie: -1090 Therapeutic Uses 85 Pil. Hydrarg. gr. v., Pulv. ScillAe gr. j., Pulv. Digitalis gr. 1/2, M. ft. pil. ter in die sumend. The rules given in the preceding section should be strictly observed. It is more serviceable in dropsy arising from disease of the heart, than in that arising from disease of the liver, or any other viscera. The Infusion should be freshly prepared daily, and given in doses of fl. oz. ss. - fl. oz. j. every six or eight hours. In Dropsy after Fever, Dr. Darwell speaks highly of the efficacy of Digitalis; indeed, in the dropsy after Scarlet Fever, he considers it almost a specific. He observes that the coagulability of the urine, which may have resisted blood-letting and purgatives, rapidly disappears under the use of Digitalis; and effusion disappears at the same time. Occasionally the coagulability of the urine remains, after the employment of this remedy, and then tonics become necessary.

In Chronic Dropsical Affections, in Anasarca and (Edema, attended by debility, and occurring after Scarlet Fever, Dr. Holland § strongly advises a combination of Digitalis with T. Ferri Sesquichloridi. He considers that it would be difficult to find any single combination more effectual in these cases; and adds, that he has given it for weeks together without witnessing any ill effects. When, from any cause, the internal use of Digitalis is contra-indicated, it has been advised to rub the Tincture, combined with equal parts of soap liniment, over the abdomen, twice or thrice daily. Drs. Christien, Pouchy, and Bernard, have recorded cases apparently cured by this means alone.

* On the Med. Prop. of Digitalis, 1775. Op. cit, p. 189.

Cyc. Pract. Med, vol. i. p. 164. § Med. Notes and Reflections, p. 546.

1091. In Hydrocephalus, Digitalis has been found serviceable by Withering, Brown, Whytt, Cheyne, and Golis. The latter, without appearing to place much faith in its efficacy, advises gr. 1/4 of the powdered leaves, with gr. 1/2 of Calomel, every second hour. He gave it, both in the inflammatory stage and in that of effusion; in the latter, chiefly as a palliative, to moderate the violence of the convulsions.* Kleber advises its external application, in combination with Squills, to the scalp. Dr. Memman relates a case successfully treated with Digitalis and Calomel, as advised by Golis. Its employment demands much circumspection.

1092. In Inflammation, Digitalis was formerly in high repute as an antiphlogistic; but experience has shown that, although it exercises a powerfully depressing action on the heart, it possesses little or no power in controlling inflammatory action. It is of more service in cardiac inflammation than in any other. Prof. Alison remarks, that the effect of Digitalis, in lowering the pulse, is seldom to be obtained without its nauseating effect, and this can hardly be produced within so short a time as the progress of an acute disease demands, without the danger of fatal syncope.

1093. In Inflammation of the Brain and its membranes, it was advised strongly by the physicians of the last century; but it is now rarely employed. "In no disease," observes Dr. Hope,§ "do the symptoms more require to be kept, as far as practicable, in a simple uncomplicated and intelligible state, and no remedy is so calculated to confuse them as Digitals. The reduction of the pulse which it occasions cannot be discriminated with any degree of certainty, from that occasioned by the supervention of pressure in the second stage; again, Digitalis is apt to produce vertigo, faintness, and nausea; and how," asks Dr. Hope, " are these symptoms, artificially excited, to be distinguished from the same results of cerebral inflammation?" For these reasons, it is an objectionable remedy in this class of diseases.

1094. In Diseases of the Heart, Digitalis is a remedy of great value, but considerable difference of opinion exists as to the class of cases in which it is of most use. Dr. Munk,|| for uniformity of action and to develop the full sedative action of the remedy, prefers the Tincture. He considers that it acts upon the heart in two ways: 1, by depressing the circulatory action; 2, as an antispasmodic. Where hypertrophy of the heart exists, whether complicated with other disease or not, Digitalis exercises a powerful and beneficial depressing action. Where there is an irritable state of the heart, attended with palpitations, irregularity, &c, it exercises its anti-spasmodic power. He advises the Tincture in doses of from ex. to xxx. every eight, ten, or twelve hours; and, when thus given, it seldom fails to produce a decided effect. He gives several valuable remarks on the use of Digitalis, from which many of the rules given in a preceding section have been drawn; and to which it is of great importance to attend, particularly in this class of diseases. It is far from being a remedy to be indiscriminately employed. Dr. Hope* considers that it is a dangerous remedy in organic disease of the heart attended with great debility of that organ, since it is apt to prove fatal, by creating polypus; and Dr. R. B. Todd says, "I would lay it down as a general rule, that in all cases where there is regurgitative valvular disease, but especially aortic, Digitalis, given in doses sufficient to depress the heart's action, is a dangerous remedy; it weakens the heart, and thereby increases the embarrassment under which it already labours." M. Boillard states that he has derived great advantage from the external employment of Digitalis in hypertrophy and other diseases of the heart. After applying a blister to the precordial region, he covers the denuded surface with the powder of the leaves, in doses graduated from gr. vj. - xv. daily. "We thus," he adds, "diminish the number and force of the heart's beats, as if by enchantment." He styles Digitalis "the true opium of the heart." The testimony of other observers, however, as to the form of heart disease in which Digitalis is most valuable, is not in exact accordance with the above. Dr. Handfield Jones§ finds that it is especially useful in cases of dilatation and en-feeblement of the heart. He considers that in such cases it acts as a cardiac tonic. Dr. Sutton || also finds that in cases of mitral regurgitation, with dilated hypertrophy and enfeebled condition of the heart, Tinct. Digitalis with Tinct. Ferri Sesquichlor. is most valuable. It must be given with great caution in cases of aortic regurgitant and obstructive disease; in these conditions it generally fails to produce benefit. Dr. Corrigan is of opinion that in aortic disease its effects are injurious. Dr. Wilks¶ finds Digitalis useful in proportion to the weakness and irritability of the heart. Dr. Fuller** states that Digitalis is a most valuable remedy in dilatation, and is dangerous only in hypertrophy. He says, " Whenever the pulse is feeble and irregular, and more especially when, from any cause, its feebleness and irritability are temporarily increased, Digitalis is of all known remedies the most useful."

* See Cyc. Pract. Med., vol. ii. p. 471.

Underwood on Dis. of Children, 9th Ed p. 307.

Outlines of Pathology, p. 243.

§ Lib. of Med., vol. ii. p. 58.

|| Guy's Hosp. Reports, Oct. 1844.

* On Diseases of the Heart, p. 478.

Med. Gaz., March 1851.

Hope, op. cit., p. 290.

§ Med. Times and Gaz., Dec. 13,

1862. || Ibid., Jan. 16, 1864. ¶ Ibid ** On Diseases of the Chest.