CASE OF POISONING BY DIGITALIS. 99 



CASE OF POISONING BY INFUSION OF DIGITALIS 

 — EECOVERY. 



Daniel Q-., aged fifty-two. Admitted into Eoyal Infirmary, October 4, 1865. 

 The patient, who is a tall and powerful man, had an attack of pleurisy more 

 tlian three months before admission, and, after the acute symptoms were 

 relieved, he was unable to resume his occupation of using the fore-hammer on 

 account of shortness of breath, loss of appetite, and general weakness. On 

 applying to a medical man, it was discovered tliat there was effusion into the 

 left pleura, reaching up to the third rib ; and after being treated by mercu- 

 rials, &c., for some time, he was admitted into the hospital, and the effusion 

 was found to be still at the same level. On admission, tliere was dulness over 

 tlie left front from base of lung to above the level of third rib, and on left back 

 partial dulness from above the scapula to its inferior angle, and thence down- 

 wards absolute. There was frequent cough, but no expectoration. The apex 

 beat was most distinct at left side of ziphoid cartilage. Heart sounds natural ; 

 pulse 70, of moderate strength ; tongue furred ; appetite moderate ; bowels 

 regular; iirine in good quantity, natural in character. He was at first ordered 

 acetate of potash, 20 grs., three times a day; but tliis producing little benefit^ 

 he was ordered half an ounce of infusion of digitalis three times a day. 



After being ordered infusion of digitalis, he at first measured it, but soon 

 began to guess it, and had gradually increased the amount. Shortly after doing 

 this, his appetite began to fail, and, at the same time, he had a bad taste in lia 

 mouth, and his tongue felt very dry. He felt also a dull sickening pain over 

 the stomach, rising up the line of the sternum to tlie throat. Occasionally this 

 was like to make him sick. He felt weaker every day. Tlus was about the 

 middle of November, about three weeks before tlie symptoms attracted atten- 

 tion. He went on gradually increasing the dose. When he lost his appetite 

 lie also got occasional headache and, along with the pain in epigastrium, he had 

 palpitation. His bowels were costive. About the third week of November he 

 vomited once or twice after meals when seized by a severe fit of coughing. The 

 vomiting he attributes entirely to the cough. These symptoms grew worse, and 

 he felt weaker and weaker, and less able to walk. About the 1st or 2nd of 

 December he noticed his sight becoming dim, and when he looked at his own 

 hands, or another person's face, they seemed blue. The pain in the stomach 

 was now almost constant; but the headache was not much worse — it was worst 

 in the afternoon. On the morning of the 5th December he complained of weak- 

 ness and want of appetite. His pulse was found weak and very irregular. Afc 

 the visit in the middle of the day the cardiac action was found increased, and 

 the pulse distinctly dichrotic. The general rhythm was about two beats in one 

 second, and then an interval of about two seconds. The pulse was 58— some- 

 what feeble. The pupils were natural and skin moist. Urine deposits a con- 

 siderable amount of lithates, otherwise normal. He got three ounces of brandy 

 before I saw him, which I did about 5.20 p.m. At that time the cardiac 

 impulse was very abrupt and felt strong, the impression to the hand being 

 exactly what I had felt in experimenting with dogs. The pulse was 66, but 

 very irregular. I took the following tracing with the sphygmograph : — 



H 2 



