DIGITALIS 79 



ministered for several days. On the other hand, the effects are very 

 lasting, the heart remaining slow for several days after the drug has 

 been discontinued, so that there is a tendency after repeated doses to 

 an increased action or cumulative action. If this important fact is 

 neglected and digitalis is pushed for more pronounced effect, the 

 cumulative action may lead to the sudden development of the toxic 

 stage of action. In this stage the heart is accelerated and may sug- 

 gest the need of more digitalis, v?hich, indeed, may temporarily slow 

 the heart but will always hasten a fatal termination. A patient re- 

 ceiving digitalis should always be closely watched for a weak, ir- 

 regular, rapid heart, and the drug withdrawn immediately. 



Elimination. Digitalis is largely excreted by the kidneys. 



Toxicology. The early symptoms of poisoning by digitalis are 

 gastro-enteritis, irregular, full, slow pulse, followed in more serious or 

 fatal cases by more pronounced symptoms of gastro-intestinal dis- 

 order, such as nausea, vomiting (in the dog and cat), diarrhea, irregu- 

 lar, rapid, weak pulse, cold extremities, salivation and finally death 

 in from several hours to several days. There are no lesions except 

 possibly some gastro-enteritis. The average toxic dose for the horse 

 is 25 grams (about 3vj) ; dog, 5 grams (about 3j). According to 

 Frohner, death takes place whether these doses are given at one time 

 or distributed over several days (3) in smaller amounts. 



Treatment of poisoning. This should be mainly prophylactic 

 or directed toward the avoidance of cumulative action. In the 

 simplest conditions of poisoning where there is excessive vagus stimu- 

 lation or irregularity of the heart, the treatment is to stop the drug, 

 and keep the patient quiet until its effects have worn off. Atropine 

 given subcutaneously will check the excessive vagus stimulation 

 (causing slowing of the heart) but its effects will not last more than 

 an hour. If there is reason to believe that some of the drug remains 

 in the stomach, this should be evacuated by the stomach tube or an 

 emetic, and tannic or gallic acid administered as an antidote. Aco- 

 nite has been recommended as an antidote by some, while others say 

 that it is not the physiological antidote. The rest of the treatment 

 is purely symptomatic, as there is no specific for the treatment of 

 poisoning by this drug. General stimulants may be given on account 

 of the action on the medullary centers, but there is little that can be 

 done to counteract its action upon the heart. The animal should be 

 kept warm and quiet. 



Action upon Different Animals. According to Trohner, the 

 crude drug or its preparations have no effect upon ruminants when 

 "•iven per os. Cows have stood without any reaction the fatal dose 

 for the horse (30 grams daily for 4 days) for several successive days. 

 It is therefore believed that the active principles are destroyed in the 

 rumen since ruminants react the same as other animals if the drug is 

 given intravenously. Horses are a little more susceptible than dogs. 



