Digitoxinum

An active principle of Digitalis (see note to

Digitalinum ).

Formula, C21H82O7.

Preparation , Triturations.

Authority.

Proving by Dr. Kopfe with one dose of 2 milligrammes at 10 A.M., Archiv f. Exp. Path. und Pharm., 3, 275.

After an hour it caused a sensation of faintness, nausea discomfort, and slight vertigo. The pulse remained as usual, 80 to 84, and was regular. Notwithstanding the unpleasant sensations, I continued with my work in the laboratory till one o'clock, after which I took a walk instead of going to dinner, for I had an aversion to every kind of food. The nauseous sensation gradually increased to such a degree that I was forced to make an effort to reach the house, in order to avoid vomiting in the street, yet I was in no condition to walk rapidly and steadily, for a decided sensation of weakness and loss of power rapidly increased, and forced me to take a carriage in order to gain my residence, some distance away. Having reached the house, I immediately went to bed. My pulse at this time (two o'clock) was 58, and intermitted once after 30 to 50 beats; in other respects it was regular. After an hour passed in bed, with constantly increasing discomfort, the tormenting nausea reached its highest point, and at half past three I vomited a large quantity of dark greenish masses of mucus. Immediately after, I experienced decided relief, which, however, lasted only a quarter of an hour, and gave place to the most excessive nauseous sensation. This continued to increase, until after an hour the vomiting was repeated violently, with the evacuation of bilious-colored masses of mucus, accompanied, preceded, and followed by retchings. The pulse at this time was very intermittent and only 40 to the minute; an intermission occurred after every two or rarely three beats. About quarter past five there were several very violent attacks of vomiting, with much distressing retching, great paleness and collapsed appearance of the face. About six the pulse showed the following tracing (No. 2), with a frequency of 40 to 42 in a minute. This tracing is in marked contrast to the normal; concerning the latter (Fig. 1), which shows the usual tricrotic pulse, attention is called to the fact that the second elevation is unusually great, and exceeds more than double the height of the first. The Digitoxin curve shows an intermission after every two beats. Every second elevation of a couple is noticeably smaller than the first, and makes a gradation to the following intermission. The pulse continued of the same frequency and of the same character into the night. The beat was felt by me in the chest, so that I could readily count it. Every intermission was recognized by the sensation of oppression and anxiety in the chest which it caused. With these symptoms the prostration and loss of power had so far progressed towards evening that I was not able to leave the bed without the support of another person. On attempting to walk or stand, my limbs refused their service. In spite of the greatest exertion of the will, the knees gave out and I was obliged to catch hold of the wall and furniture to support myself. With these symptoms, remarkable weakness of sight developed, so that the features of my friends seemed to swim and become indistinct, and I could only recognize them by their voices. All the objects in the room seemed to run together without any outlines, so that I could only distinguish some very dark, or bright, or large, or small images in the field of vision. Therewith all objects, especially all bright ones, seemed in a slightly yellow light. Above all, the constant and excessive nausea made my condition exceedingly distressing. About eight o'clock in the evening I attempted to take a glass of champagne cooled in ice, for the nausea, but after a few minutes, during which the nausea rapidly increased, I vomited a large quantity of a watery, slimy substance, slightly colored with bile, followed by much retching. On repeating the experiment after half an hour, I was obliged to set the wine aside, on account of the great retching which it caused. This distressing condition continued the whole night with equal intensity, and allowed me not a moment's rest. In the morning there had been four attack of vomiting: about eleven, one, five, and eight, which were associated with persistent efforts to vomit and evacuation of mucus colored with bile. Immediately after an attack of vomiting, there was always relative relief for a short time. The same condition continued the whole of the next day with equal intensity, only actual vomiting did not take place, although the nauseous sensation did not leave me for a moment, and there were frequent attacks of ineffectual retching. Carbonated waters of all kinds and the usual drinking-water, from which I hoped for relief of this distressing symptom, had an opposite effect; they always aggravated it for some time. In other respects, as I had said, the symptoms remained the same. The pulse, whose every beat I was still able to feel and count in my thorax, and whose every intermission I was conscious of, from the sensation of uneasiness and a kind of slight præcordial anxiety which it caused, was very easily excited by the slightest excitement or physical exertion. During complete physical and mental rest, the pulse was 54 in a minute, and intermitted every few beats. The pulse-curve of this day (Fig. 3), showed at first sight great irregularity in every particular not only in the strength of the different contractions, as exhibited by the varying heights of the waves, but also in respect to the more or less hard character of the pulse, as shown in the more or less blunted waves, and also lastly, in the irregular wave following the beat, which is seen in the varying size of the intervals between the beats. The second night was very restless, with partial sleep, which was interrupted four times in one hour by confused anxious dreams and frightful fantasies. The third day, which I still passed in bed, was much more tolerable than the preceding, since the distressing nausea had moderated and I was able to drink a little water. The weakness of vision, however, still continued; and the yellow vision was in no wise diminished. The pulse continued through the whole day about 60, still very irregular, and intermitted every 40 to 50 beats. In the evening I attempted, though against my appetite, to eat some bits of bread, and did not vomit, as I feared. The following night was similar to the preceding, though more quiet, and with longer and more sound sleep. A part of the fourth day I passed out of bed. Subjectively I experienced much relief. Though I had no longing for food, eating was not repugnant to me, and from time to time I took a small quantity of meat and drank as much water as I pleased. The pulse had regained its rhythm, was weak and soft, and very seldom intermitted. After a sound sleep that night I began, on the fifth day, to take short walks, leaning on the arm of another. My power of vision had not yet returned, and all objects seemed in a yellow light. The symptoms gradually disappeared during the three succeeding days. With sound sleep and extraordinary appetite, my physical strength and normal vision returned, and objects appeared again in their natural light.