Digitalinum

Volume I — Special Symptomatology

(The alkaloid of Digitalis.) Description. — Digitaline (not the spurious substance called by this name, manufactured by various firms throughout the country, which are generally inert, or less powerful than the dried leaves) is the crystallized active principle of Digitalis. It occurs in short and delicate needle-shaped crystals, and possesses an intense and persistent bitter taste; slightly soluble in water — soluble in 12 parts of cold and 6 of boiling alcohol of 90°, less soluble in absolute alcohol; nearly insoluble in ether, very soluble in chloroform.

Amorphous Digitaline is a whitish or yellowish powder, odorless, but of a very bitter taste, nearly insoluble in ether and water, readily soluble in alcohol. Crude Digitalis is said to contain 10 or 12 per cent, of crystallizable Digitaline, which is said to be somewhat more powerful than the Amorphous Digitaline.

Officinal Preparations. — Triturations of either of the above sub stances (always on the centessimal scale), up to the 3d ; afterwards, dilutions with strong alcohol.

Analogues. — Amygdala amara, Prunus, Cerasus, Hydrocyanic acid, Lycopus, Squilla, Collinsonia, Iberis, etc.

(See Therapeutics, Vol. II.)

Volume II — Special Therapeutics

I introduce this drug among the new remedies for the same reason that I introduce Atropia and Ergotin, namely, that it is not mentioned in our textbooks on Materia Medica, and that there are instances where the active principles of plants are substituted for the original drug with great benefit.

Digitalin is the active principle or alkaloid of the plant Digitalis, and possesses a large proportion of its pathogenetic effects. I assume the same ground, in treating of this substance, that I did in treating of Atropia — that while an alkaloid may represent the principal effects of the plant, it cannot represent all the symptomatic effects and nicer shades of action.

Digitalin, from the very numerous experiments recorded, made by the most eminent physiologists, seems to affect the heart in a manner nearly if not altogether identical with Digitalis.

I have written a good deal concerning the action of Digitalis, and my papers have been severely criticized by physicians so bigoted that they would not see the logical deductions which must arise in consequence of new discoveries in the action of

medicines. But time has confirmed my views and silenced my critics, and I am content.

I will state, in as brief terms as possible, the known and undisputed action of Digitalin on the heart:

(1.) Digitalin produces a condition of excitement in the controlling centres in the heart, and hence the slowing of the pulse with increased power of the heart’s impulse.

(2.) It has a peculiar specific influence on the heart’s muscle, whose contractions are strengthened in the first stage, becoming irregular in the second, and in the third a peculiar rigidity is induced.

The primary action of Digitalin and Digitalis is to cause increased power of the heart’s contractions, the pulse being first regular and slightly accelerated; next irregular and intermitting; and finally very slow, until the heart ceases to beat, and stops in systole, i. e., in rigid, tetanic, permanent contraction, which ends in death, or recovery with secondary effects.

These secondary effects are the reverse of the primary, i.e., the pulse is very slow and soft, then irregular, intermittent, and weak, and finally quick and weak ; the heart rarely completing its normal contractions, because of the feeble condition of its muscular fibres.

Now it is evident to me, as the result of twenty-five years of close observation, that Digitalis is homoeopathic to both its primary and secondary effects ; but that it has rarely been used except for the latter. Hahnemann evidently did not understand the action of Digitalis ; he as much as confesses it in several instances, as when he states that its action in certain dropsies is “ curative but nevertheless antipathic.”

Now it is a fact, that unless we understand and appreciate the secondary effects of drugs, a large proportion of our cures made with appreciable doses appear to be antipathic. This is especially the case with Digitalin, and this is the reason our school is continually losing the advantage they might gain by the rational use of Digitalis in many diseases.

Now, according to my law of dose, if we prescribe Digitalin for symptoms similar to its primary effects, we must prescribe the attenuations as high as the 6th, or we shall get unpleasant aggravations. But if we are treating conditions similar to its secondary effects, we must use the low attenuations. The question is, How long can we go with safety ?

Digitalin (and I must here warn you not to use the spurious substances called by this name, manufactured by various firms in this country, for they are generally inert, or no more powerful than the dried leaves), the erystallizable active principle (alkaloid), occurs in short and delicate needle-shaped crystals, and possesses an intense and persistent bitter taste; slightly soluble in water; soluble in twelve parts of cold and six of boiling Alcohol, of 90°; less soluble in absolute Alcohol; nearly insoluble in Ether; and very soluble in Chloroform.

Amorphous Digitalin is a whitish or yellowish powder, odorless, but of a very bitter taste, nearly insoluble in Ether and water, readily soluble in Alcohol. Crude Digitalis is said to contain ten or twelve per cent, of erystallizable Digitalin, which is said to be somewhat more powerful than the amorphous Digitalin.

Either preparation is a very powerful poison. It is said that “ one-ninth of a grain has been taken -without toxic effect,” but I advise you not to try such a dose. One-fiftieth of a grain has caused very unpleasant if not dangerous symptoms. I should not like to give one one-hundredth of a grain frequently in repeated doses. When we wish to get prompt, decisive action, as in a case of cardiac failure, syncope, or threatened paralysis, a few doses of the one-hundredth might be given, but for general use in cardiac diseases the one-thousandth (or 2°) is as low as I advise you to use it for adults.

The action of toxic doses of Aconite, Veratrum viride, Veratrura album, and Gelseminum is just the opposite of Digitalis; for in a case of poisoning by the latter, or serious aggravation from an overdose, Aconite or Verat. vir. is the best antidote (in doses of one to three drops of the tincture, repeated frequently until the symptoms are better).

In my “ Lectures on Diseases of the Heart” I have carefully pointed out the characteristic symptoms and conditions for which Digitalis is indicated. I will therefore only briefly enumerate them.

In cardiac diseases it is primarily indicated (in high attenuations) when the heart is excited and beats with increased force and power, causing congestion of the head, ringing in the ears, flushed face, etc. Such conditions are usually caused by overexertion, overexcitement from the stimulating emotions, certain cerebral irritations, etc.

In pure hypertrophy, i. e., with enlargement of the heart-muscle, where allopaths now pronounce Digitalis unsuitable, it may be used with advantage in the 6th dilution.

But its chief value is in those conditions which simulate its secondary toxic effects, namely :

“When the muscle of the heart is for any reason unequal to the task set it, the systoles become rapid and imperfect, and by this irregular action the ventricles, neither completely filling nor emptying themselves, increase the embarrassment. Under these circumstances, Digitalis, by lengthening the diastolic pauses and increasing the force of the systolic contractions, causes the ventricles to fill themselves in the one, and to completely empty themselves in the other act. By subduing irregular action through the inhibitory nerves, by energizing the muscular power of the heart vessels, the remedy is of incalculable value, and, increasing arterial tension all over the body, causes the disappearance or lessening of symptoms due to a low pressure in the arteries.”

The Digitalin would therefore be indicated in hypertrophy with dilatation, mitral insufficiency , aortic constriction, irritable heart without enlargement, and many valvular diseases with cardiac debility.

There are many cases, and you will meet with them in practice if you watch for them, where the patient seems suffering from a condition known by the vague term “general debility.” There is an atony of all the tissues, and a poverty of all the secretions, due to lack of assimilation of the nutritive elements of food. You will observe in all these cases that the heart appears to be the weakest organ, probably because it is constantly laboring. Now, while you are building up the system with good food, fresh air, gentle stimulation, and such medicines as Nux, Phosphates, Ferrum, and the like, do not forget to give a special tonic for the heart. It will aid in a wonderful manner other remedies. Thus, if you alternate Digitalin 3X with Ferrum lx you will succeed

in curing anaemia and chlorosis in half the time you can with Ferrum alone. Digitalin 3X and Phosphate of strychnia 3X act beautifully in alternation in feeble, broken-down constitutions. You can alternate Digitalin with many other specific restorative medicines now that you understand the principle involved.

In cardiac dropsy we know that Digitalis is the chief of all remedies. When the heart has become so weakened that effusion takes place in all the cavities and the general cellular tissues (anasarca), we know of no medicine which will bear any relation to Digitalis in curative power.

It has been suggested that Digitalin might act as well as the infusion of the leaves, or the tincture, both liable to deterioration, and at times uncertain in their action.

Christison’s experiments prompted him to assert that “ Digitalin was the most powerful and certain diuretic known/’ and that “ its action on the heart, and its diuretic effect, were never coincident.” All the old authors remark that Digitalis is not diuretic until after it affects the heart and pulse.

I think there are many cases where you can substitute the alkaloid for the herb and its other preparations. It will sometimes act promptly when the tincture or trituration of the leaves will not, or have lost their virtue.

In cases of dropsy from heart disease, begin with 3X trit., in grain doses every two hours. If no action on the kidneys takes place in a few days give the 2X in the same.

In spermatorrhoea , and nocturnal emissions from erethism of the sexual organs, it often acts with surprising efficacy. But do not give it as Baehr and Burt recommend, “in grain doses,” unless you use the 3X trit. Digitalin acts on the sexual organs of men much as the Bromide of potassa, namely, it abolishes power and desire. It is therefore primarily homoeopathic to impotency with spermatorrhoea, and secondarily to emissions with overexcitement.

I would recommend, from my own experience, its use in delirium tremens, fainting attacks from sudden heart failure, nervous vertigo, collapse from uterine haemorrhage, poisoning from tobacco, Aconite, Veratrum, Mushrooms, Calabar, and other poisons which weaken and paralyze the heart.

In fact, you can use Digitalin for nearly all the conditions for

which Digitalis is indicated, and it will often act quicker, and as safely, in the proper doses.