DIGITALIS IN SHOCK. 409 



me not improbable that this is due to the stimulus thus given 

 to the vaso-motor nerves. At other times, however, the addi- 

 tional injury seems to produce an injurious effect either on the 

 heart or vessels, and the patient succumbs. It is possible tliat the 

 different effects of operations performed during shock may depend 

 to some extent on the greater or less amount of irritation which 

 is occasioned to the nerves of bones as compared with those of 

 the soft parts; for, as we have already mentioned, injuries to bones 

 tend to cause syncope, while irritation of other nerves, unless it 

 be excessive, tends to prevent it by raising the blood-pressure. 

 This, however, is a question wliich pertains more especially to 

 surgeons, and with them I will leave it. I must not conclude 

 without mentioning another valuable remedy in cases of shock, 

 viz., digitalis. It lias, I think, been conclusively proved by Dr. 

 Adolf B. Meyer and myself,* that this drug possesses the power 

 of contracting the arterioles, and I have showmf that it greatly 

 strengthens the pulsations of the heart. We would therefore 

 expect it to prove useful in shock, and experience does not dis- 

 appoint our anticipations. This is well shown by a case of shock 

 following parturition, in which it was employed by Dr. WilksJ 

 some years ago. My attention was drawn to this by my friend 

 Dr. Milner Fothergill, and I quote the following from his admir- 

 able essay on digitalis.§ " The patient was apparently in articulo 

 mortis', her limbs w^ere cold, her body in a state of deathly 

 clammy sweat ; the face was livid, no pulse could be felt at 

 the wrist, and a mere fluttering was heard when the ear was 

 placed over the region of the heart. Brandy and ether had 

 been tried without any good effect, and as dissolution was 

 imminent, it was determined to try digitalis. Half-drachm 

 doses were given every hour; after four doses a reaction 

 took place, and after seven doses complete recovery occurred." 

 Such a case as this needs no comment, and a consideration 

 of the encouraging results here obtained can hardly fail to 

 gain for digitalis a much more extensive application in cases of 

 shock than it has hitherto received. 



* Journal of Anatomy and Physiology, Nov., 1872, p. 134, vide antea, p. 151. 



f On Digitalis^ London, 1868, p. 28, vide anlea, p. 52, 



X Medical Times and Gazette, Jan. Ifi, 1864. 



§ Digitalis : its Mode of Action and its Use, London, 1871, p. 03. 



