Digitalinum

Volume II — Main text

D. At moment of administration pulse 30, respirations 10 to II , thermometer in rectum 38.75° C. and 31.25° C. in nasal cavities ; all signs of health. I p.m. , nothing particular. 4, pulse 28 ; no change in rhythm of heart ; respirations 10 ; urine clear and in considerable quantity; temp. 36.25° C. in rectum ; a little tenderness of abdomen. 8 p.m. , appetite good; pulse 26 ; cardiac pulsations ringing ; respirations 14; urine always abundant. 9th.-Conjunctivæ pale ; pulse 24, small , hardly sensible; beats of heart enfeebled; respirations 6 ; temperature 36.25° C. 2 p.m., mucous membranes more coloured ; pulse 30 ; beats of heart more intense ; respirations 12 ; urine less abundant and less limpid ; functions now began to return little by little to their normal state. In almost every case which they experimented on the history was exactly the same. (BRUNTON, op. cit.) Digitalinum.-A glucoside obtained from Digitalis purpurea. CHO2 I. Provings.-1. a. HOMOLLE, in good health, with average pulse of 64, having on previous e. blistered a small surface on inside of 1. arm, applied, July 12th, 1841 , at 11 a.m. over this abraded spot I ctgrm. of D. 12, dazzlings, painful numbness of arms, slight headache ; pulse 64. 2.30 p.m., continued headache, yawnings,general muscular weakness ; pulse 70. 5, headache had disappeared ; dined with appetite. 7, pulse 72, regular ; bowels moved. 9, raw surface looks irritable ; another ctgrm. applied. 10, pulse 60, less regular, and now and then intermittent ; headache, dazzlings, muscular weakness. Slept well. 13th .-Abraded surface covered with a little muco-pus. Two more ctgrm. applied at 7 a.m. 8, pulse 64-68, slight headache and fleeting dazzlings. Same kind ofsymptoms continuedtill e.; urine diminished ; appetite good. At 8, pulse 68-72, soft, very irregular as to force and rhythm, intermitting once in about 20 beats, then about every 5th beat one very feeble ; slight shivering. 10, pulse 57, very irregular. Sleep very agitated and often interrupted ; painful and unusual sense of heat in hands and feet. 14th, 8 a.m., pulse 68, regular; again applied 2 ctgrm. 11 , headache, dazzlings, vision slightly disturbed, pulse 60, appetite good. 2 p.m., pulse 60, irregular and intermittent ; arm very painful. 6, after dinner, return of headache, dazzlings, great sense of fatigue. 8.30, pulse 60, unequal, irregular, intermittent ; great fatigue, with aching in loins, not to be accounted for by day's occupation ; urine scanty and bowels costive ; great feebleness, as after violent emotion orsyncope. Pain and swelling of arm obliged discontinuance of experiments. He28th. thought appetite rathertook increased during their continuance. b. July -Pulse 64-72, at 8 a.m. 5 mlgrm. No appreciable effect to 2 p.m., when 5 more were taken. 5, appetite good, slight faintness. Pulse varied from 60 to 50 and again to 56; there were frontal headache, dazzlings, loss ofappetite,sinking at epigastrium, intestinal flatulence, borborygmi, eructation, slight abdominal pains ; urine abundant ; great fatigue; painful heat ine. but no thirst. 31st. -Sleepless n.; at 6 a.m. pulse at rest 54, moving raises it at once to 66, falling immediately to 54 when at rest. Throughout this d. and next frontcal headache, yawnings, dazzling of sight, and disorder of

stomach continued. Urine was abundant and passed with heat. As pulse fell it became irregular and intermittent. For 2 d. after drug was discontinued pulse continued lowered, and then gradually regained its normal frequency and rhythm.* (From Mat. Med. Phys. and Applied, vol. i.) 2. a. BÄHR, in good health save for a chronic catarrh of nose and fauces, began May 14th, 1858, with 2x trit., taking gr.. Slight confusion and heat in head and rise in pulse (86), falling in e. (71). When playing piano felt as if heart stood still. 15th.-Same dose. Increase of nasal catarrh. 16th, 10.25 a.m.,pulse 58. Took same. An h. after, fleeting pulsating pain in region of heart's apex ; afterwards sensation as ifheart stood still, followed by much palpitation. Pulse, 10 p.m. , 80 sitting, 96 standing. 17th.-Took same. 9.30 a.m., pulse sitting 74, standing 84 ; 10.30, 69 sitting, 78 standing ; 5.30p.m., 80 sitting ; 11 , 80 sitting, pulse unequal. Frequent recurrence of pressive pain in cardiac region, lasting short time. Colicky pains as if diarrhea might come on . About an h. after dinner squeezing pains in stomach, relieved for the time by eructation and discharge of offensive flatus. 6.30 p.m., on walking slowly tightness of chest, with sensation as it heart stood still ; dull cutting pains in abdomen, feeling of flow of blood tohead. Sleep sound, seminal emission occurring without waking him . 18th.-Dose increased to gr. Pulse 70. 10.30, 72 sitting, 87 standing ; 12.10, 68 sitting ; 3.20 p.m., before eating, 86 sitting ; 11,84 sitting. In forenoon throbbing drawing pain in region of left tensor fasciæ latæ, lasting an h., increased by pressure. E., face hot and red, is usually pale. 19th.-After gr. at 9.40 a.m., when stooping over writing sudden oppression of breath. One gr. taken at 10.45, pulse being 70 sitting, 78 standing ; 11, pulse 64 ; 9 p.m., 78 sitting. The sleep of two previous n. disturbed by dreams, an unusual circumstance with prover. Pulse rapidly increased by movement. 20th, 21st, 22nd. -No medicine. On latter d. he experienced sudden rheumatic pains in 1. side of nape of neck and 1. arm, hindering movement (but it is doubtful if these pains can be attributed to medicine, as Bähr caught cold at this time) . b. June Ist. The nasal catarrh had much diminished when proving was resumed by taking gr. at 10.25 a.m., pulse being 60 sitting, 68 standing. It remained much the same all d. 6.30 p.m., 82 sitting. Noon, while walking, great weariness in limbs, they feel like lead. In e. in bed, lying on 1. side, 3 or 4 violent palpitations in succession, * Homolle also made experiments on the products obtained from the plant by various solvents. All actedlike digitaline save the substance taken up from the alcoholic solution by ether, consisting chiefly of a nauseous, fœtid, and acid principle, resembling the " digitalic acid " of Kosman. After taking 45 ctgrm. of this, he had no symptoms for 8 h., but was then seized with great nausea, faintness, and vomiting, which continued at 4 h . intervals for 30 h. Next d. his pulse had fallen, and on 4th d. was as low as 48. Vision was impaired, and he could not look steadily at a bright object. Urine was abundant, but bladder's contractility was impaired, and external pressure was required to expel urine. He had pulsation of abdominal aorta, anxiety, epigastric constriction, and cough with pneumonic expectoration, lasting for a week, but these, he thought, were caused by the continuous vomiting. (See Digitalis, 1 , 206.]

immediately ceasing on turning to r. side. During this time pulse was slow and full, with pulsations in head like a hammer; afterwards pulse became quicker and smaller. 2nd and 3rd.-Nothing to report. 4th, 10 a.m., took 2 gr. Pulse, sitting 65, standing 73 ; in h., while reclining 65, on standing up 97, then 89, 84, and on lying down 62. M., violent burning itching on eyelids ; rubbing does not relieve. In e. stitches in cardiac region, with palpitation. No medicine next 2 d. 7th. At 10.45 a.m. took 24 gr. Return of oppression of breathing, and after long sitting cutting pain in r. breast. Appetite very small ; tongue clean. Pulse not affected. 8th.-Took 2 gr. at 10 a.m. The rheumatic pain in both breasts more acute, with slight oppression of breathing. At 10.30 a.m. trembling of hands, then pulsating pressive pain in l. temporal and frontal regions, single stitches in cardiac region, dull pain in r. side of chest. Nasal catarrh again increased, and urine diminished. 9th.-Took 24 gr. Ten m. after felt confusion of sight and head, which increased in forehead, with throbbing pain in occiput, relieved by going into open air ; giddiness when standing; legs weak and trembling. 4 p.m., sudden throbbing tearing pain in r. elbow, extending from external condyle upwards, very violent for a time, and then decreasing ; oppression at chest ; urine diminished. An increase of nasal catarrh here occurs, so reports are omitted until 15th . 10 a.m., pulse 68 sitting, 82 standing. Took 2 gr. 10.50, pulse 72 sitting, 82 standing. After this pulse unaffected. Soon after taking dose felt weak and faint sitting or standing ; also frequent recurring attacks of pinching pains in stomach and abdomen as if diarrhea might come, but motion is natural. In h. general malaise, with trembling and weakness of legs. In afternoon throbbing pain in 1. shoulder-joint on walking ; arm feels weak. After dinner shooting in epigastrium ; at same time throbbing shooting pain in middle joint of r. index finger. Dyspnea afternoon and e. 16th.- Took 2 gr. at 10 a.m. Much the same as on 15th . In e., lying in bed on 1. side, violent shooting throbbing pain in l. side between nipple and axilla. Pulse, sitting 68, standing 90, very unequal. 18th.- Took at 10.30 2 gr. In 5 m., pulse rose from 66 sitting to 78, falling in 10 m. to 66, at which it remained. Drawing pain in r. thigh, as if radiating from sacrum . Sense of powerlessness in legs, also throbbing pain in r. side of chest. Griping pain, but no diarrhea ; in e. return of oppressed breathing ; n. quite quiet. 19th.-Took 3 gr. at 10 a.m. Soon throbbing pain in r. chest. After h. frequent stitches through cardiac region, with persistent pressive stabbing pain ; at same time feeling of looseness with pinching and digging in bowels. After 1 h . faint feeling, weakness in limbs,jerking throbbing frontal pain, throbbing in r. chest and increasing pain in limbs ; slight nausea. At noon on walking severe dull stitches in cardiac region ; great weariness, and dislike to professional visits ; irritability about trifles. In e. more severe palpitation of heart than he has yet experienced ; the r. pupil is somewhat larger than the 1. 21st, 10.10 a.m., took 3 gr. and at 10.30 p.m. I gr. No marked effect on pulse. On leaving bed griping pain in abdomen, with frequent passing of flatus; then diarrhea. Soon after first dose, while sitting, giddiness and confused vision ; it seemed

as if he could not fix distant objects ; weakness of legs and trembling of hands, rendering writing difficult. Urine in m. very abundant, though he had drunk very little on previous e. After e. dose return of confusion in head, with shooting frontal headache. Pains in abdomen as if diarrhea was coming on ; pains as before in chest and 1. shoulderjoint. 22nd.-No med. N. rather restless. M., great hunger ; after rising, griping in belly and discharge of fœtid flatus. Later, when walking, colicky pains in bowels with nausea as if breakfast remained in upper part of œsophagus. After h., sudden call to stool, with violent jerking pain in abdomen ; off and on same pain as yesterday in r. chest and shoulder. E., another soft stool. 23rd.-The experiment was carried on from this date until the 28th in 3 gr. doses once or twice a d. The symptoms were much the same as have been reported ; the most prominent were violent palpitations of the heart when lying on 1. side, shortness of breath, sense of oppression at chest, with increase of pain in both sides of thorax ; severe throbbing pain in r. pectoral muscle, increased by pressure ; great weakness, with ebullition of blood and vertigo. On 24th some muscæ volitantes ; and in e. upper part of visual field seemed shaded by a dark cloud. On 26th he complained of violent shootings through r. eye lasting some m.; a little later violent cramp-like drawing pains fromtoes through 1. leg,with pain in forehead, shivering and pinching pain in bowels . No more D. was taken after 26th, but after this date n. were restless and disturbed by diuresis and erections, and long-continued throbbing tearing extending upwards from inner condyle to r. thigh. On July 6th an acute smart attack of coryza, which he attributes to D., as it was different from his ordinary attacks ; he complained of dull pain in arms until 13th. (Op. cit.) 3. Mrs. BÄHR, æt. 28, sanguineous temperament.-June 16th, 10 a.m., I gr. 2x trit. Previously pulse 72 when sitting, 92 when standing. After h. cold feeling followed by rigors, and feeling of goose-skin. This is frequently repeated during following hours. Noon, menses came on a day or two too soon, and without the usual pain.- 17th . Slept ill. M., great exhaustion and very violent sacral pains ; pulse, when standing, 104. E., greater menstrual flow than usual. Sacral pains increased, and extend to anus and thighs. Belly painful as if it would be torn asunder in places. No more symptoms the following d. -June 23rd, 11 a.m., 2 gr. Pulse 72 sitting, 92 standing. No alteration in it after I h. P.m., frequent chilliness and rigor, and painful feeling as if shoulders were drawn together. All d. feeling of fulness and nausea as if contents of stomach stuck in throat. E., more severe chills. N., cannot sleep on account of drawing and uneasiness in arms . In first half-sleep nightmare, with great internal chilliness.- 24th, m., boring pain in r. side of chest from scapula to scrob. cordis , aggravated by deep breathing ; pulse,standing, 90. P.m., painin middle ofsternum, connecting itself with pain in scapula by sundry shootings. 5 p.m., 1 gr.- 25th, 10 a.m., 2 gr. Previously pulse 72 sitting, 88 standing. Pain in heart continues ; pressure in scrob. cordis increased ; great weariness all d.; frequent tasteless eructations. E., pains in scrob. cordis and chest increased, and accompanied by dyspnea both when sitting and moving. Pulse, II p.m., when sitting 72. Signs of com- VOL. II . 34

mencing catarrh.-26th, m., acute pains between scapulæ. 11.30 a.m., 3 gr. A.m., chilliness and increased chest pains, feeling of general drawing and great impatience. 2 h. after dinner hot red face, feeling as if blood rushed in behind eyes. Pulse when seated 82. The feeling of general ebullition of blood lasts all e. Pains in chest become very severe in e., and are so much increased by walking that the breathing is affected. The coryza, which had ceased in the m., returns with great anxiety, nose completely stopped up. Head confused. Pulse when seated 78, when standing 102. In afternoon transient digging toothache in r. lower molars.-27th. No med. Noon, when walking suddenly very violent pains between scapulæ, with oppression of chest like spasm, relieved by eructation. Several severe rigors. Headache, already slight in m., becomes a regular megrim in e. (Her usual headaches are always worse in m. on rising) . After eating little, nausea and full feeling.-28th, m., still headache. 10.15a.m., 2 gr. Noon, chest pains more severe, with pressive pain in r. side, which was hitherto free. These pains came in fits, and also, but independently, a desire to draw a long breath very frequently. All d. frequent rigors and general chilliness. M., severe pinching in bowels. Pulse, p.m., when sitting 92, e. 96, when standing 108. All d. nausea, with pressure in stomach, p.m.; appetite bad.-29th. No med. M., on 1. side of chest violent pressive shooting pains near axilla. Nausea, full feeling. Pulse when seated 96, when standing 116.-30th. P.m., when sitting for h. violent bearing-down pains from sacrum into bowels, as though the menses were coming on. Pains in chest gone, but shortness of breath continues. Then there came on a catarrhal affection of eyes, with soreness of both external canthi, much pain when reading and sewing, slight redness (she had the same thing 8 weeks previously) . Up to July 2nd she had occasionally a very violent stitch through chest from before backwards when walking. (BÄHR, op. cit., 195.) 4. Aman (no description given) took, July 6th, 9 a.m., gr. 2x trit. Pulse, which was ordinarily 60 when seated, rose in 3 m. to 64. The pulse-beats were unequal in force; heart's beats unaltered. Noon, feeling in forehead and upper part of nose as ifcoryza were coming on. -8th. The pulse, which was 60 at 9 a.m., rises to 625 m. after I gr. 2x trit., and remains at that till noon.- Ioth. It gr. causes an increase of 3 to 4 beats in pulse. After all 3 doses has for a whole d. pressure in supra-orbital region towards frontal sinus and when walking a feeling as if the ground gave way under his feet. (BÄHR, op. cit., 197.) 5. STADION, after a series of observations to determine the effects of a uniformly weighed quantity of milk, eggs, bread and butter on his urine, commenced experiments with D., following the same diet. He commenced by taking 2 mlgrm. Next d. dose was increased to 3, and so on to 18th d., increasing dose for 18 d. daily by I mlgrm. On Ist d. he experienced dull indistinct transient cutting pain in cardiac region and in l. hip-joint. By 6th d. nausea was added ; up to 12th nausea, anorexia, and muscular debility steadily increased ; he felt severe articular pains like rheumatism, and finally coryza. From

14th rapidly increasing emaciation, dirty greyish colour of face and suffering features. On 15th flickering before eyes came on, and on 18th vertigo,headache, and extreme muscular debility-this debility attended by severe pains in joints. Respiration unchanged. Pulse during first 8d. showed constant increase in frequency by several beats ; from 9th d. constant decided decrease in frequency by 6 to 7 beats ; at same time pulse was very excitable, so that least motion increased in an extraordinary wayits frequency from 12 to 20 beats. S- notes that digitaline produces violent catarrhal affection of nose, but affects intestinal canal less than digitalis. Sexual power diminished or quite abolished, temporarily. He found diminution of water, urea, chloride of sodium, phosphates, and sulphates ofurine. Amount of uric acid increased, sp. gr. falls, degree of acidity remains unchanged. He considers the most important action of digitaline to be its power to cause rapid wasting of the body,and depression of the exchange of material. (NoTHNAGEL and ROSSBACH, op. cit.) 6. Dr. LAUDER BRUNTON's very accurate experiments on himself with digitaline, continued through several months, are given in his work in fragments, so that it is difficult to present them as a continuous report. The following, however, fairly represent his results. a. March 5th, 1865.-" After taking 12 mlgrm . of Morson's digitaline, I experienced a remarkable sleepiness at night, which continued till 12th, when symptoms of abdominal irritation began to manifest themselves, and these increased till vomiting occurred. On 14th I felt great languor and prostration, and either on this d. or at least while languor continued mental faculties seemed enfeebled; while reading for an examination eye glanced over words, but mind refused to receive or retain their import. The derangement of sight which I noticed was of two kinds : Ist, a general mistiness of objects, such as is seen before fainting ; and, 2nd, a large bright spot advancing before me, and sometimes resembling a ring showing prismatic colours faintly, and similar in character to, though less distinct than, that seen round a light when digitaline has been introduced into the eye.* I found that for some days before vomiting came on, clear drops of water were always gathering at my nose. 17th.- Took 30 mlgrm. at two different times. At 4 a.m. I awoke, and vomited at intervals for about 4 h.; vomited matter yellow and liquid, somewhat like yolk of egg ; vomiting violent and painful. Vomited again on rising at 9 a.m.; again at 9.30. Frequent epigastric uneasiness and pain. In forenoon my sight occasionally not quite clear (just as one sees when about to faint, but somewhat slighter), and a large bright spot occasionally seen, such as is seen after looking at the sun, and then looking away at a dark object. Languor and discomfort all d. Occasional nausea. No more vomiting. * When digitaline is introduced into the eye it causes smarting and profuselachrymation,which passes off in a short time, and nothing more is felt except perhaps an occasional rough feeling of the conjunctiva till 4 or 5 h. after, when on looking at a light you see it surronuded by a halo presenting the prismatic colours, and not quite close roundthe light but with a dark space between. This halo increases in diameter the fartheryoumove from the light, and becomes smaller and narrower as you approach. I have noticed an appearance exactly similar when light cirrhi were crossing the moon. Idid not notice any particular difference in the pupil, and the appearance is not due to its dilatation, for I found it quite distinct on looking through a pin-hole in a card

Pain in chest on drawing breath, from soreness of diaphragm from vomiting. Bowels open in m.; stool copious, quite loose ; in e. very scanty. A good deal of flatus. 18th.-Appetite improved, though not very good. Sight somewhat dim, especially after rising up or walking, and bright spots occasionally seen, chiefly after rising or walking. Bowels open. 19th.-Appetite better to-day. Sight dim, and I see a large bright spot, especially after exertion. This not so bad in afternoon. Slight pain in epigastrium occasionally, lasting some time when it occurs. After dinner constant pain in 1. side, apparently in descending colon. Much latus at n . Bowels open once; stool copious, somewhat soft. 20th.-Sight clear. After looking at a bright sky and on looking away I see a spot as if I had been looking at the sun. Appetite much better to-day. Pain in l. side still there on rising, and continued for some hours. Bowels open once, stool extremely scanty. Pain in side again to-night. A slight threatening of headache before going to bed. 21st.-Appetite good. Still occasionally see a bright spot like a large bright soap-bubble, or like the halo that is seen round a light when digitaline is put into the eye (without the central light, which is the cause of the halo in the latter case). It seems to come more after exertion, or after long writing, as in taking notes. I am not sure whether it is the attention, or looking at the white paper, or the stooping, that causes it. Bowels open once, stool scanty; partly from large, partly from small intestines. 22nd.- Still see a bright spot occasionally. Bowels open once, stool copious, well formed." b. Second set of experiments commence Dec. 13th, 1865, and extend to March 25th, 1866. They are presented very accurately in a tabular form, so as to show the effects, especially on the urine ; a record is also given ofthe pulse. Remarking on the pulse, he says :-" I have occasionally found my pulse increased (in frequency) after taking digitaline, but sometimes not." He places little value on this, and adds- " I have found that my pulse was sometimes quicker, sometimes slower, while I took small doses of digitaline ; butthat under larger doses there was marked lowering of the pulsations." Again, remarking on the urine, he says :-" In my own case I found that with small doses the urine varied just as my pulse had done, being generally increased to a slight extent while I took the digitaline, but sometimes not ; while with large doses the diuretic effect was marked. The urinary constituents also vary considerably with small doses ; but when dose was large, sp. gr. was diminished, urea increased, and phosphoric acid and chlorine diminished." (Op. cit., 1868.) 7. LEMBKE, August 17th, 1859, 9.30 a.m.-Took gr. He experienced drawing pain in l. wrist and fingers, often severe ; in 1. foot similar pain as if numb, especially when at rest ; same drawing pain in toes of 1. foot, relieved by walking ; soon a similar pain in fingers. Sharp pain in r. knee. Behind upper cartilages of r. ribs cutting pain affecting breathing ; some h. after similar pain in l. ribs. Confusion in occiput ; heat over whole body, especially back ; pulse normal, quickened easily by walking. 21st.-Took same dose, with return of same symptoms, drawing pains extending to occiput and vertex. 23rd.-Took same, and experienced similar pains. Had also

quickened pulse, heat of skin, muscæ volitantes, circles floating before the eyes, pupils contracted. The pains shift their position, and are worse when at rest than in motion. Sept. 7th.-Took gr. Similar pains, only more severe and lasting longer ; heavy headache, and constant jerking of upper lip. On 8th, he felt on waking great vertigo, objects seem to turn horizontally, lessened on closing eyes, increased by stooping or movement ; nausea, with coldness down back, cold hands, yawning, occasional short dry cough. These symptoms continued for an h., when violent vomiting of whitish sour mucus, with much retching, occurred, partially relieving head. Vertigo continued, with great sensitiveness of eyes to light and nose to smell ; again vomiting ; still great weight in head, confusion, coldness ; nausea abated in 4 h., so that food could be taken, but headache continued severe all next d. (N. Zeit. für hom. Kl., iv, 177.) 8. Dr. KOPFE took at 10a.m. 2 mlgr. of digitoxine, the crystallised digitaline of Nativelle.* Afrer an h. it caused sensation of faintness, nausea, discomfort, and slight vertigo. Pulse remained as usual 80- 84, and was regular. " Notwithstanding the unpleasant sensations I continued my work in the laboratory till 1, after which I took a walk instead of going to dinner, for I had an aversion to every kind of food. The sensation of nausea 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 ; the 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. Pulse at this time (2 p.m.) was 58, and intermitted once in 30-50 beats ; in other respects it was regular. After an h. passed in bed, with constantly increasing discomfort, I vomited a large quantity of dark greenish masses of mucus. Immediately after I experienced decided relief, which, however, lasted only + h., and gave place to the most excessive sensation of nausea. Pulse at this time was very intermittent, and only 40 ; an intermission occurred after every 2 or rarely 3 beats. About 5.15 there were several very violent attacks of vomiting, with much distressing retching, great paleness, and collapsed appearance of the face. About 6 the pulse showed a frequency of40 to 42, and a tracing in marked contrast to the normal. In the latter, which shows the usual tricrotic pulse, 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 ; and every second elevation of a couple is noticeably smaller than the first, and makes a gradation to the following intermission. Pulse continued of same frequency and ofsame character into the n. The beat was felt by me in the chest, so that I could readily count it. Every intermission was recognised 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 e. that I was not able to leave the bed without the support of another person. With these * This is not quite correct, in the light of recent research; but it is equally clear that three of the alkaloids of digitalis-those called by Schmiedeberg " digitalin," " digitalein," and " digitoxin"-are practically identical in action.-EDs.

symptoms remarkable weakness of sight developed, so that the features of my friends seemed to swim and become indistinct, and I could only recognise them by their voices. All the objects in the room seemed to run together without any outlines, so that I could only distinguish some verydark, or bright, or large,or small images in the field ofvision. Therewith all objects, especially all bright ones, seemed in a slightly yellow light. Above all, the constant and excessive nausea made my condition exceedinglydistressing. This continued the wholen. with equal intensity, and allowed me not a moment's rest. By m. there had been four attacks of vomiting, about 11, 1 , 5, and 8, associated with persistent efforts to vomit and evacuation of mucus coloured with bile. Immediately after an attack of vomiting there was always relative relief for a short time. The same condition continued the whole of next d. 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 it was 54, and intermitted every few beats. Second n. was very restless, with partial sleep, which was interrupted 4 times in one h. by confused anxious dreams and frightful fantasies. The 3rd d., 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 nowise diminished. Pulse continued through whole d. about 60, still very irregular, and intermitted every 40 to 50 beats. On the 4th d. pulse had regained its rhythm, was weak and soft, and very seldom intermitted. After a sound sleep that n. I began, on the 5th d., 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 d." (Arch. für Exp. Path. und Pharm. , iii , 275.) 9. SCHROFF made numerous experiments with D. and digitalin. In all preparations taste was intensely bitter, most so in alcoholic extract, so that it caused nausea and shuddering. Larger doses always caused nausea, and largest doses violent vomiting. When taken for a long time it caused lasting indigestion, pains in stomach, frequent eructations, anorexia, white furred tongue. Large doses caused dryness of fauces, rumbling in bowels, colic, and sometimes diarrhea. Diminished activity of heart, usually after several h., attained its maximum after 12-16 h., rarely preceded by increased frequency of heart's beats and pulse. The diminution ofthe pulse was always proportionate to the size of the dose. In one person who took 0.2 gram. of alcoholic extract of seeds there was great dilatation of pupils, confusion ofhead, drowsiness, retardation of pulse after 2 h. by 20 beats, and after 2 h. sleep the retardation amounted to 30 beats ; he woke with violent pains in head and face, great heat of head, rigor over the rest of body, great prostration, weakness, and drowsiness. A second prover woke after 2 h. from a dream, put his hand involuntarily to his cardiac region, as he felt as if the heart and arteries would burst. His pulse was only 38. In

large doses the pulse was small, weak, intermittent, always irregular, sometimes full and apparently strong. Temperature of skin lowered, only forehead felt hot, alternations of rigor and heat. Urine never increased, in some cases diminished, though there was always urging to urinate. Large doses caused prostration, weariness, weakness, and drowsiness ; but sleep in first n. was oftendisturbed and restless ; the following nights it was very profound. Confusion of head occurred after small doses, larger doses caused headache and feeling of weight, as though there was not room for bones in skull, feeling of pressure on eyelids, in eyeball, and above eye, vertigo, noise in ears, indistinct vision with very dilated pupils, inability to fix attention, increased irritability, sometimes dejection, sometimes hilariousness. (Pharmakologie, 601 .)* II. Poisonings.- 1 . A married lady, æt. 34, fair complexion, nervous temperament, had been ordered 2 or 3 granules of Homolle's digitaline ( 1 mlgrm. each) for palpitation and other hysterical symptoms. On April 25th, about 3 p.m., she took 57 granules. She felt no inconvenience till 6, when at dinner she had giddiness and desire to vomit, and vomited several times. A medical friend prescribed a mixture of tartar emetic and sulphate of soda, of which she only took 2 spoonfuls. At 8 p.m. face was dusky, pupils dilated, extremities cold ; pulse 48, weak and irregular ; great præcordial oppression and increasing gastric pain ; breathing slow, inspiration deep and prolonged. Retching continued at every h. during n.; no sleep; and temperature only sustained by stimulants, hot baths, &c. Next m. very weak ; pulse 44, feeble and intermittent ; sighing respiration ; face almost livid ; pupils dilated ; mind clear. No action of bowels ; urine abundant ; great irritability of stomach ; great præcordial oppression, as though heavy stone lay on chest. At noon, symptoms same, save less vomiting ; pulse 42, intermittent. Besides other stimulants, 2 gr. of musk were now given every h. At midnight pulse rose to 60, though still intermitting once in every 4beats ; but warmth had returned, and improvement now steadily continued. ( Lancet, 1880, i, 166.) 2. ROUSS DE CORBENY, æt. 72, complained of stitch in side and cædema of lower limbs. Pulse 68-70. He was treated with granules of digitaline. On June 5th, at 6 a.m., he took a strong dose of granules. At 10a.m., beginning of headache and sickness. At 10.30, however, he took another dose of about 35 granules. At 5 p.m. he felt for or h. difficulty of seeing, rushes of blood-as he says . Præcordial anxiety extreme ; he says continually his last hour has come. Intelligence clear. On coming to him at 6 p.m., I find the above symptoms more marked, and further note : tongue rather contracted than large, with slight yellow coating on sides, dryness and redness at point. No thirst ; refusal of drinks, which bring on frequent sickness, distressing by reason of violent straining. Pain in r. epigastric region ; abdomen retracted ; urine scanty, of a red-brown colour, with much brick-dust deposit ; a little greater quickness in breathing. Limbs cool without being cold ; no sweats ; rushes of heat to face ; pulse full, throbbing under the finger, irregular, as low as * This should properly have come in under Digitalis.-EDs .

48-50 ; sounds ofheart strong and impulse lifting chest. Headache is lancinating. Swimming in head on rising, and giddiness which obliges him to lie down again ; neither buzzing in ears nor deafness. General sensibility not altered, only some cramp in legs; general weakness . Twenty-four hours after, pain in head same, but anxiety less ; pulse 54, always full and regular ; sickness less frequent ; urine less scanty, but still some cramps and convulsive movements. 7th.- Pretty good n. , headache persists ; no cramp, heart-beats irregular, first sound is dull and prolonged as a murmur, second loud. He tries to get up, but is again troubled with sickness and giddiness ; some colic, but no stools. 8th.-72 h. after taking drug. He has had relief of bowels 5 or 6 times ; headache less ; abdomen retracted, no swelling or pain on pressure ; pulse 68-70. High-coloured urine,still depositing sediment, but ofnormal quantity. No appetite ; no thirst ; sleepiness and (once) sickness continue. 9th.-Headache persistent ; a little general aching ; tongue dry, coated in centre ; pulse 60, regular. roth.-Good n., pulse 56. 11th.-Same state. 12th .- Patient feels severe pain in dorsal and epigastric regions, so violent on 13th that it makes him cry out. At 4 a.m., limbs still cool, pulse 50. Sickness again. 14th . -Head still a little heavy ; abdomen painful on pressure, and gurgling is heard in iliac fossa ; pulse 62. 15th.-Symptoms tending to disappear, and patient discharged cured on 16th. (TARDIEU, op. cit., p. 689.) 3. Madame X-, æt. 23, good constitution, sanguine temperament, wishing to kill herself, took, on June 26th, at 7 a.m., 16 granules of digitaline. Two h. later she is seized with violent shivering accompanied with trembling. Wishing to get up she feels giddy and is obliged to return to bed. During part of d. these incidents repeat themselves alternately with strange hallucinations. About 8 p.m. she conceals her indisposition and forces herself to take food which is offered to her. A few moments after, fresh shiverings, with chattering ofteeth, cold perspiration, and dyspnea. Warmth returns bydegrees , violent agitation succeeds it. Complete insomnia and persistent dyspnoea. At I a.m. patient says she cannot breathe, rises, is seized with vertigo, and drags herself to the window, where she stays till about 3. Goes back to bed and sleeps, and wakes next d. at 7 a.m. without feeling slightest indisposition. Seeing that she had failed then in her attempt at suicide, she takes 40 more granules. An h. after following symptoms occur :-patient feels hallucinations, vertigo, frequent shiverings ; a cold sweat covers her body. Nausea comes on, followed by excessive vomiting and colic without result. The patient feels herselfgrowing weaker, and tries, but in vain, to feel her pulse beat. In e. vomiting is more frequent, followed by great weakness. No urine, no stools. Patient cannot stir ; she is not able to make a sound ; feels as if her eyes were much too large and would escape from their sockets. This state lasts all n. , and all d. on 28th, until 5 p.m.; at this moment the vomiting stops ; patient can only speak in a low voice. During n. weakness increases ; shivering, hallucinations, and cold sweats continue. Impossible to make the slightest movement, every minute she feels sick ; burning thirst. She cannot pass water, or relieve bowels,

The n. passes thus, but towards m. she feels awish to live and asks for a doctor. 29th.-I saw her soon after. She is stretched in her bed nearly motionless. Face very pale, and a rather curious symptom is a very considerable exophthalmos of both sides. Eyes wide open, conjunctiva of eye and lids lemon-yellow, pupils dilated. Voice inaudible, patient cannot utter a sound. Skin cold and covered with a general perspiration. Pulse small, weak, intermittent, 46-48 ; sometimes almost inappreciable. Tongue dry, white in the middle, a little red at point ; intense thirst ; nausea, not the slightest appetite. Epigastric region seat of a pretty severe pain, augmented by pressure. For 2 d. she has passed neither urine nor stools ; bladder does not appear distended. 30th.-Very disturbed n.; complete insomnia ; pulse a little better, 56-58 ; skin a little less cold ; intermittences less frequent and less marked. There is a little voice ; patient seems less feeble, but least movement causes giddiness. Burning thirst,tongue red at point, great pain in epigastric region ; 4 stools. For 3 d. no urine, and bladder not distended. July Ist.-No more shivering or perspirations ; skin less cold than on previous days. Pulse better, 60-64 ; still some intermissions, more marked than yesterday. Voice has returned ; epigastric trouble has disappeared. Patient has passed water several times, urine red and giving forth a fœtid odour. Face less pale, but exophthalmos still very pronounced ; injection and coloration of conjunctiva less marked. Three d. later patient is in her normal health, but exophthalmos still persists. Pulse regular, not intermittent, 64. (Ibid., p. 692.) III. Experiments on animals.- I. Dyblowsky and Pelikan found that in frogs which were poisoned by digitaline (or other cardiac poisons producing an identical effect), after a few m. irregularity of heart was noticeable. This was of two kinds-(1) The ventricular contractions became peristaltic, so that ventricle did not contract as a whole, but first its upper third, whence contractions gradually passed down to apex, but before this had contracted upper third was again dilated. Two or three m. before complete paralysis, contractions became still more irregular, so that upper or r. half was dilated, while lower or 1. half was contracted ; and sometimes auricles did not contract simultaneously. Finally, when ventricle completely stopped, one or more palpitating points could still be observed in it. (2) The second form, which was especially notable in poisoning by digitaline and green hellebore, consisted in a notable diminution of the number ofbeats, the heart contracting regularly, but very slowly,just as under galvanisation of the vagi. This sometimes happened before peristaltic movements occurred, or even after their disappearance. (L. BRUNTON, op. cit.) 2. The cardiac action of D. on frogs was first accurately observed in 1853, by Vulpian, and he gave his evidence afterwards in the famous trial of Dr. de la Pommerais for the murder of Mad. Pauw to this effect :-In the great majority of cases, when the heart has ceased to beat, the ventricles are pale and contracted, and the auricles dilated,this change taking place while the animal preserves the power ofmotion. (Mém. de la Soc. de Biologie., 2e série, ii, 67.) Fagge and Stephenson

confirmed Vulpian's results, showing that the " characteristic effects of these agents " (D. and similar poisons) " on frogs is the production of irregularity of the heart's action followed by complete stoppage of its pulsations, the ventricle remaining rigidly contracted and pale after it has ceased to beat, the muscular power of the animal being at the same time unimpaired. The rhythm of the heart's beats is not generally much altered, and they become peristaltic, or different parts of the muscular wall of the ventricle contract and dilate at different times, the blood forming pouches in the relaxed portion of the ventricles." (Proc. ofRoy. Soc., May, 1865.) Nunneley (Brit. and For. Med.-Chir. Rev., 1869), who has made numerous observations on the the action of D. on frogs, says the ventricular systole is lengthened, but it presents a very different appearance from the systole in health. " The ventricle seems no longer to act as a single large muscle, but as if made up of numerous small ones, which contract energetically but in an irregular and disorderly way ; hence there are projected bundles of contracted muscular fibres, which give the ventricle a rough and uneven surface and an irregular outline. During the diastole the ventricle does not everywhere assume a red colour, but one or more red spots appear, as if the ventricle was so tightly compressed that only a small quantity of blood could enter it by chance." (Mat. Med. Phys. and Applied, vol. i.)