This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
In Haemoptysis, digitalis has received warm praise from many writers. Dr. Brunton4 states that, as soon as the characteristic slowing of the pulse is produced, the bleeding from the lung is stopped; he even speaks of it as the most powerful remedy for haemorrhage from cavities. Dr. Fuller recommends it (in conjunction with dry-cupping, and ice to the spine) in full doses, 1 to 2 drachms of tincture, or 6 to 8 grains of the powder, daily. It may be said, perhaps, that these are scarcely what we should call "full doses" at the present day; but I may remark that, from experience with other remedies, as well as with digitalis, it would appear that smaller doses of haemostatic medicines are required to check haemorrhage from the lungs, than of those which are needed' to arrest uterine bleeding. It may be observed that, though most of the authors who have written on the subject mention that the bleeding stops when the peculiar slowing of the pulse has been produced, there is much doubt whether the mere reduction of the frequency of pulsation is the curative agent; it is much more probable that the cessation of haemorrhage is chiefly due to the contraction of the smaller arteries, and the consequent prevention or diminution of venous stagnation.
In Epistaxis, digitalis, especially in the form of infusion, appears to be quite as efficacious as in pulmonary or uterine haemorrhage. This is markedly the case in the bleeding from the nose which sometimes com plicates acute rheumatism, and is occasionally so severe, if unchecked, as to greatly confuse the patient and delay his convalescence. Indeed, in all cases of epistaxis, except those which depend upon a general hemorrhagic tendency, such as is developed in scurvy, in purpura, and in the rarer diathetic disease which is now called haemophilia, digitalis appears to be a very prompt and powerful remedy. It should be given in one 01 two large doses, 1/2 oz. of the infusion, repeated twice, if necessary, at half-hour intervals.
1 Medical Times and Gazette, Dec. 15, 1835.
2 Handbook of Uterine Therapeutics, ttd ed., p. 225.
3 The granules of Homolle and Que venue contain .0156 gr. each of digitaline. 4 Brunton on Digitalis, p. 4.
In Nervous Diseases, digitalis has probably very useful functions to fulfil; but it must be admitted that the subject has not yet been accurately inquired into. Speaking generally, it would appear that the effects, physiological and therapeutical, of digitalis upon the nervous system are, for the most part, strictly dependent on its action on the circulation. Yet there appears to be something more than this, as indicated by certain curious and, apparently, well-established instances of its acting in a localized manner, not to be easily explained as a circulation-effect. For instance, there is a considerable amount of evidence as to its favorable action on local nerve-pain. Fuller1 recommends it on this ground for sciatica of pure neuralgic type, and Lehmann2 speaks of it as an effectual local remedy in earache. There are many facts, also, which show its sedative action on the nerves of the sexual apparatus. Brug-mans3 found that it was equally applicable for this purpose to both sexes, and in a great variety of complaints. It is possible that these effects are wholly or partly due to the reduction of the quantity of blood in the organs, an idea to which some slight probability is given in Dr. E. Mackay's4 observations on the great relief to the congestion and pain of haemorrhoids which is produced by digitalis; for there is, undoubtedly, much sympathy between the disturbances of circulation in the lower bowel and in the genitalia. But there is reason to think that digitalis also acts upon the sensation of different parts through the spinal cord, possibly through the vaso-motor centre in the medulla oblongata, primarily. Its generalized action is seen in the instance of the moderately successful treatment of intermittents, which I do not include under the section of digitalis in fever, properly so called, as it stands on a very different foot-irg from the positive effects which have been obtained in typhoid, etc. Of the localized sedative action, perhaps the most useful form is the employment of digitalis in spermatorrhoea, as originally recommended by Corvisart,5 and approved by Ringer,6 who says few remedies are more successful in arresting spermatorrhoea than digitalis; he recommends 1 or 2 drachms of the infusion twice or thrice daily. In this view these writers are supported by several others.
The principal therapeutic effects of digitalis upon cerebral affections are produced, there can be little doubt, through modifications in the cerebral circulation.
In Delirium Tremens, digitalis first attracted attention as a remedy from the bold experiments of the late Mr. Jones, of Jersey.7 This gentleman was in the habit of giving 1/2-oz. doses of the tincture at first, and 2-drachm doses subsequently, till caim and sleep were produced.
1 "Rheumatism, Rheumatic Gout, and Sciatica," 3d ed., p. 426. 2 Amer. Journ. Med. Sciences, v.. p. 34. 3 Journ. de Med. de Bruxelles, Nov., 1853.
4 Brit. Med. Journ.
5 Bull, de Therap., xi. iv. 18.
6 Handbook. 3d ed., p. 412.
7 Med. Times and Gaz., 1860, vol. ii.
Mr. Jones's facts were probably correct, for they have been substantially confirmed by the careful observations of Dr. Peacock;1 though the latter considers digitalis chiefly applicable to young and robust persons. Very obviously, however, the treatment has no right to be called a digitalis-treatment; for, as Dr. Anstie2 observes, the 1/2-oz. doses of proof spirit were probably of much more consequence than the drug itself. It is otherwise, perhaps, with the tincture in 20 or 30 minim doses, more frequently repeated, as advised by some. Nothing can be reckoned satisfactory except the evidence from the use of the infusion of the powder or of digitaline, and this must at present be pronounced too scanty to admit of positive conclusions.