48 ox DIGITALIS, WITH SOME OBSERVATIONS ON THE URINE. 



occasionally found my pulse increased after taking digitaline, 

 but sometimes not ; and even had the acceleration been fre- 

 quent, I would not have been able to conclude very much from 

 it, as the pulse varies not only with position but with mental 

 states, and that to a considerable extent in a person of nervous 

 temperament. As to the secondary acceleration, it is perfectly 

 true that you often find, on looking over a table of the pulse, a 

 seeming acceleration of the pulse on the second or third day 

 after beginning to take digitalis, yet it is to no great extent and 

 not greater than we find in health. 



I'hough the primitive acceleration be denied by almost all 

 authorities, few doubt that digitalis causes retardation of the 

 pulse either immediately or in the course of a few days. I have 

 found that my pulse was sometimes quicker, sometimes slower, 

 while I took small doses of digitaline, but that under larger 

 doses there was marked lowering of the pulsations. 



This lessening of the number of beats may have two causes : — 

 1st, it may be central, from the heart being primarily affected 

 by the drug, and contracting more slowly ; 2nd, it may be 

 from contraction of the capillaries opposing greater resistance 

 to the passage of blood, and by thus requiring greater propul- 

 sive force, slowing the heart's action according to the physical 

 law, that what is gained in power is lost in speed. If the latter 

 were the case, the blood flowing slowly through the capillaries 

 would cause the arteries to become full and tense, the heart 

 would be able only slowly to distend their resisting parietes, 

 and that only to a small extent; so that if we applied a 

 sphygmograph to the artery, we should find the line of ascent 

 very oblique, the height of the curve small, and the line of 

 descent also very oblique. But this is not the case, for if we 

 examine the tracing taken on March 15, we observe that wliile 

 the pulse is slow and the duration of each beat long, it presents 

 the very opposite characters of those vfe have mentioned, the 

 line of ascent being sudden and abrupt, the lever rising so 

 rapidly that its vis viva carries it too far, so that in its descent it 

 makes a point ; the height of the curve is great, and the line of 

 descent is sudden and dichrotic. We see that the pulse in 

 Daniel G. presents the same characters. From these facts I 



