1 Probably the earliest mention may have been that by Carrie, in his "Report on the Effects of Water, Cold, and Warm," etc.

In Erysipelas, digitalis was particularly recommended by Traube; and certainly there is not only much practical evidence in favor of its use, but a strong antecedent probability that it may do good in this complaint from its tendency to control the smaller arteries. But it is greatly inferior in this respect to belladonna, which has proved itself to be a powerful agent against erysipelas; and, on the other hand, the experience of Ferber declares it to be a dangerous remedy in this disease, because, when pushed beyond a certain point, it tends to bring out a skin exan-them, peculiar to itself, which much complicates matters. Probably, however, many of the objections to digitalis in erysipelas have been based on the use of improperly large doses.

In Rheumatic Fever, digitalis has been employed by various authorities; but the most complete account of its use in this way has been given by M. Oulmont, who was induced to try it, in consequence of the enthusiastic encomiums of Traube, and especially of Hirtz, of Strasburg,2 upon its action in fevers generally. M. Oulmont took special care to employ only the same preparation of digitalis-powder which had proved itself very efficacious in the hands of Hirtz; with this he made an infusion of 15.6 grains of digitalis to about four oz. of eau-sucree, which, in divided doses, was the allowance for twenty-four hours. The quantity was thus very considerably smaller than that employed by most of the German authorities. Twenty-four patients were taken quite indiscriminately, being the whole number that presented themselves during a certain period of time; and the results seem to have been clear and decisive. No effect was ever produced on pulse and temperature till after about thirty-six hours, but at this time, in simple and non-complicated cases,3 a sensible fall of the pulse took place, and soon afterwards a decline of the temperature; this went on very gently till the third or fourth day, when nausea and vomiting ensued; the next day the pulse invariably fell from twenty to forty beats, and the temperature from 1 3/4o to 2 1/2° (Fahr.) The use of the digitalis was then suspended; nevertheless, the lowering of the pulse and of the temperature persisted for several days, and the morbid symptoms disappeared, sometimes gradually, and sometimes with surprising rapidity. A few cases were tardy in recovering, and a few had relapses; but, on the whole, the cases of pure febrile rheumatism seem to have done remarkably well. Several patients were cured in five or six days, and left the hospital at the end of ten days. Oulmont, however, states very clearly that digitalis was only of use in the primary period of simple joint-fever. When relapses took place, the drug seemed to effect no real good, although the characteristic stomach symptoms were evoked just as before. And in cases which were already complicated with visceral inflammations, it only produced a temporary and unimportant lowering of pulse and temperature. On the other hand, Oulmont seems decidedly to think that it tends (used early enough) to avert cardiac complications. When old cardiac disease existed prior to the commencement of the rheumatic attack, the influence of digitalis seems usually to have been highly favorable in rendering the pulse regular and strong; but in one instance of extensive valvular mischief, where the febrile excitement recurred several times, at the moment of the fall of the pulse, the patient was seized with an attack of suffocation, with rapid pulsations of the heart, and precordial anxiety, and seemed in great danger; the paroxysm, however, soon passed off. Oulmont speaks of this as a reason for caution in administering digitalis in instances of old and advanced heart-disease; but he does not distinguish between different valvular affections, nor does he say whether this particular patient was the subject of excessive hypertrophy or not: a matter which we now know to be very important in reference to the effects of digitalis.

1 Medical Times and Gazette, 1862.

2 Gaz. Med de Strasbourg, 1862.

3 By this is meant, not complicated with visceral inflammations.

The general conclusion to which Oulmont comes, as to the action of digitalis in febrile rheumatism, is, that it benefits solely in so far as it relieves the febrile state. It does not touch (he says) the cases where the malady is more deeply rooted, and is either complicated with serious internal inflammation, or tends to repeated relapses of the fever and the joint-affection. On the other hand, in first attacks, and generally in cases which are of a simple type, it greatly shortens the febrile period, averts cardiac and cerebral complications, and hastens the convalescence. These conclusions are of great value, though, of course, they only apply to the use of digitalis in a certain dose and manner. Whether as good, or even better, effects might not be obtained with smaller doses, is a further question for careful consideration.

In Acute Inflammations, digitalis is reckoned by many authorities to be all but the most powerful direct remedy in existence. It is necessary, however, quite to disregard certain observations, which, though professing to refer to digitalis treatment, really have nothing to do with it. This remark applies to all cases where the alcoholic tincture has been used in very large doses; for example, Mr. King, of Saxmundham1 announced that by the use of single very large doses of the tincture - half-ounce to an ounce - with twenty-four hours' interval, it was quite possible to cut short various acute inflammations, provided the remedy were administered before the organs involved became disorganized. The influence of Traube, Thomas, Hirtz, and other physicians has, on the whole, maintained a high reputation for this drug in such affections, though individuals have not been wanting by whom its efficacy has been doubted and even denied.