Acute Mania. - In various forms of this disease digitalis has been strongly recommended by Homolle and Quevenne,3 Lockhart, Robertson.4 Maudsley,5 Blandford,6 Van der Kolk,7 and others; and in a considerable proportion of cases bids fair to supersede the old and dangerous routine administration of opium. It is tolerably certain that the chief proximate cause of the excitement and the sleeplessness in affections of this kind is the existence of a very irregular and ill-balanced state of brain circulation; and for this digitalis can supply a remedial influence which opium cannot afford. It would, also, be a great mistake to suppose, as was thought formerly, that digitalis is a remedy too depressing to be employed in any cases of acute mania which occur in persons of generally feeble health. This is far from being the fact; some remarkable instances have been observed, in which the maniacal patients. were the subjects of certainly weak and probably fatty heart, and yet the use of digitalis in tolerably full doses was followed by a simultaneous strengthening of the pulse, which became regular, and by a subsidence of the maniacal symptoms. In fact, one cannot but remark, that with digitalis, just as with opium, the old theoretical notions of the action of the two drugs led to conclusions directly opposed to fact, and practically very mischievous. This is particularly the case in regard to the views which prevailed during the first half of the present century, as to their employ-ment or non-employment in the treatment of acute insanity.

Neuralgia. - As a direct remedy in this disorder, notwithstanding the evidence of Fuller, above quoted, respecting sciatica, and the more dubious observations of Debout and Serre, respecting migraine, digitalis is probably not at all effective or to be relied on. According to my own experience, it succeeds only casually and rarely - if, indeed, we can suppose it to succeed at all; and certainly it is not worth naming in comparison with the powerful agents with which we are now in the habit of controlling the disease. In those forms of migraine in which there is much reason to suppose that there is great vaso-motor disturbance at the time of the attacks, and especially in those cases where there is a very evident connection between the attacks and a difficulty at the commencement of each menstrual flow, it would probably be worth while, nevertheless, to make careful and systematic trial of digitalis, pushing the doses to a rather high mark. Experience has shown that this form of migraine is not without its serious dangers, one or two recorded cases having terminated in fatal cerebral haemorrhage: and it would therefore be very desirable, upon the appearance of any threatening symptoms, to try the effects of tolerably full doses of digitalis, as a means of regulating the brain circulation.

1 Ibid, 1861, vol ii.

2 Art. "Alcoholism." Reynold's Syst., vol. ii.

3 Gaz. des Hop.. 1850. No. 53. Union Med., 1851, Nob. 69, 70.

4 Journal Mental Science.

5 Ibid., Jan., 1869.

6 Practitioner, Feb., 1869.

7 Pathol, and Therap. of Mental Diseases. English Translation.

Preparations and Dose. - Digitalis, gr. j - v. (.06 - .30); Extr. Digitalis, gr. 1/6 - j. (.01 - .06); Extr. Digitalis Fluidum, m j. - x. (.06 - .60); Tinct. Digitalis, m v. - xxx. (.30 - 2.); Infusum Digitalis,

Scrophulariaceae Foxglove Digitalis Purpurea Part  18

(15.-

30.); Digitahnum, gr. 1/65 - 1/12 (.001 - .005). there is little doubt that the watery and alcoholic preparations of digitalis differ greatly in their physiological and therapeutic effects. Since it has become the fashion to use the infusion in preference to the tincture, in order to obtain a diuretic effect, or to exert a "tonic" influence on the heart, the drug is frequently given for several days or weeks in succession. The ordinary infusion is inconvenient for this purpose, as it must be freshly made every day or two. To obtain from digitalis the active principles that are soluble in water, and to preserve them unimpaired for an indefinite period, is a problem that awaits a satisfactory solution. Dr. E. M. Hale, of Chicago, suggests that an infusion be made with boiling water, and when cold strain, and to twelve ounces add two ounces each of alcohol and glycerine. Some pharmacists have the reprehensible habit of simply dispensing the fluid extract diluted with water when a prescription calls for the infusion.