In Pericarditis, Niemeyer' strongly recommends digitalis in cases in which the heart's action is very rapid and feeble, and where there are cyanotic and dropsical symptoms.

In Pleurisy, with high fever, Niemeyer recommends digitalis in infusion (gr. x. ad. 3 j.). In more chronic and less febrile cases he gives the powder in one-grain doses, with equal parts of quinine. In the first stage of pericarditis and of pleurisy, my own experience leads me to prefer aconite, as it reduces the pulse and temperature more quickly than digitalis.

1 Quoted by Ringer, "Therapeutics." 3d ed p. 411. 2 The Practitioner, 1SG8, vol. i., p. 179.

In Pneumonia, Bleuler made extensive trials of digitalis, employing usually about half a drachm (in the form of infusion) daily; this was continued until a decided impression was produced on the pulse; vomiting also set in at the same time. The influence on the mortality seems to have been unfavorable, amounting to 21 per cent. under the digitalis, as against 14.5 percent. with merely expectant treatment; but Bleuler hesitates to draw a positive conclusion from this fact. In the patients who recovered he was unable to trace any distinct influence of digitalis in cutting short the inflammatory process; the defervescence occurred as early as from the fifth to the seventh day, and both Bleuler, and Nie-meyer, who comments on Bleuler's cases, regard this as being unusually early. But, according to English authorities, this is by no means an uncommon date for defervescence, especially in one-sided pneumonia; everything, therefore, depends on the question whether Bleuler's cases were of a high average severity. He records rather frequent toxic phenomena occurring after the fall of the temperature; but these disappeared as soon as the medicine was discontinued, and convalescence was never delayed. Niemeyer employs digitalis in pneumonia when the pulse ranges from 100 to 120, in combination with nitrates of potash and soda. He states that it reduces the fever, but does not alter the plastic processes.

On taking the balance of the statements which have been made by various authors as to the action of digitalis in pneumonia, it seems clear that a good case is made out for continued trials of it. The approval of so cautious an observer as Ziemssen is of much importance. He gives of an infusion (gr. v. ad. 3 j. water) a teaspoonful every two hours, or about the equivalent of 7 1/2 grains daily (for children); and though he admits that this occasionally produces intermittence, he does not think that symptom of itself dangerous. Certainly, there is no kind of justification for the statement of Stille, that the favorable opinions respecting digitalis in inflammations are totally unsupported by direct evidence. To quote one more affirmative authority, I may mention the strong testimony of M. Rory-Sancerotte,1 who, in thirty-five carefully observed cases in pneumonia, found that digitalis reduced the fever and kept down the graver symptoms, while intolerance of the drug was very rare. He remarks that the antiphlogistic operation is less rapid than that of leeches, but more durable, and nearly the same with all patients.

Digitalis has been applied, in some instances, with remarkably good effect, as a remedy for local inflammations. In orchitis, it was employed with very good results by Dr. Besnier,2 who was led to its use through having seen M. Debout apply it with success in cases of hydrocele. Besnier kept the patients at rest, and in a recumbent posture, with the scro turn conveniently raised, and constantly enveloped within compresses soaked in a very strong infusion of digitalis leaves, either warm or cold, according as the one or the other was found most comfortable. A covering of oil-silk was kept over all, to maintain continual moisture.

In concluding my remarks on digitalis in inflammation, it may be observed that one of the great questions still requiring to be answered is, whether the beneficial effects of the drug can be produced without nauseating and depressing the patient. Alison 3 asserted that the latter result could not be avoided, if the drug were given in sufficient doses to produce an impression with the rapidity which is required in oases of acute disease. Most of the recent observers insist, also, on the use of large doses; and, in their writings, nausea and vomiting are treated almost as matters of course: but, at any rate, Alison was wrong in his further opinion as to the danger implied by this state of things; for, whatever may be the worth in other respects of the German observations, they have conclusively proved that even marked intermission of the pulse is seldom followed by serious consequences, and that doses quite tenfold larger than any which Alison could have been referring to were given with impunity.

1 Practitioner, 1869, vol. ii., p. 180. 2 Bull. de Therap., Feb., 1870. 3 Outlines of Pathology, p. 243.

In Haemorrhage of various kinds, digitalis has, during the last few years, assumed an important place. In uterine haemorrhage its efficacy was, I believe, first distinctly proved by Dr. W. H. Dickinson,1 who made a remarkable communication on the subject. In doses of 1 to 1 1/2 fl. oz. of the infusion, he found that haemorrhage of this description, when unconnected with organic disease, was speedily arrested by it. Dickinson for a long time treated all his menorrhagic patients in this way, and never failed to arrest the bleeding by the second to the fourth day, according to the quantity of the drug that had been given; thus demonstrating the greatly superior action of large doses to the small quantities which had previously been held in doubtful repute for the same purpose. These statements were afterwards fully confirmed by Dr. Barclay and Dr. Tilt,2 and also by the illustrious Trousseau. It has even been shown that in organic disease of the uterus, digitalis has some power to arrest the bleedings; for M. Decaisne treated a case of haemor-hage from fungoid growths with complete success by the use of digitalis ill the daily dose of 6 granules.3