DIGITALIS. 313 



ventricle fail. In mild cases, when little more than a tonic 

 effect on the heart is desired, the tincture is prescribed. When 

 dropsy is present, and the patient confined to bed, the infusion 

 or the powdered leaf should be given, and the effect carefully 

 watched. Without nourishing, digestible, and digested food, 

 digitalis can only exhaust the heart, and attention must there- 

 fore be paid to the stomach, liver, and bowels. Iron may be 

 combined with advantage, but only after the excretory and 

 digestive functions have been restored. Let it be carefully 

 observed that digitalis is not to be given in a routine fashion 

 for valvular disease, but with reference to the state of the mus- 

 cular wall associated with the lesion. Digitalis is of great ser- 

 vice in failure of the heart from primary disease of the walls, 

 as in chronic myocarditis ; in the granular degeneration of 

 acute myocarditis, pericarditis, and endocarditis, occurring in 

 scarlet fever and acute rheumatism; and in acute alcoholism. 

 In fatty degeneration digitalis may have to be withheld, lest 

 irregular contraction and rupture occur. Digitalis restores the 

 vigour of the heart in failing hypertrophy of chronic Brighfs 

 disease, when it is breaking down against excessive peripheral 

 resistance ; until the heart begins to fail, the drug is contra- 

 indicated, but when dilatation begins it must be given. In 

 functional or nervous palpitation, pain, or irregularity, with 

 debility and dyspepsia, digitalis is often valuable; as also in 

 reflex cases, with gastric disorder, where small doses control the 

 vagus, but must be given intermittently, the dyspeptic effect of 

 the drug also being remembered. Digitalis is harmful in pure 

 hypertrophy. In disease of the right ventricle from chronic lung 

 disease digitalis is occasionally useful, but fails entirely in some 

 cases. In exophthalmic goitre it is invaluable combined with 

 quinine and iron. In cardiac dropsy digitalis is a thoroughly 

 rational and highly successful remedy. In renal dropsy it is of 

 great service, when this is acute, complicating scarlet fever, or 

 due to failure of an hypertrophied heart. In dropsy from 

 chronic tubular nephritis (large white kidney) it is rarely of 

 use, as it has no influence on the renal cells. 



Digitalis is used in haemorrhage, but therapeutics is 

 notoriously uncertain here. It will relieve haemoptysis due to 

 mitral disease, or to the congestion of incipient phthisis in 

 persons with languid circulation. For menorrhagia it may be 

 useful by stimulating the uterine wall, or in the subjects of 

 heart disease. 



In secondary bronchial catarrh and acute pneumonia it acts 

 entirely as a cardiac stimulant. Digitalis is but little used by 

 English physicians as an antipyretic in fever, as it is slow, 

 uncertain, dangerous, and unnecessary. Combined with quiuia 



