35 
But in poisoning from digitalis the contraction of the heart is so rigid that aconite 
has not the power to relax the tetanic spasm and again dilate the cavities. Ringer 
claims that, after a large dose of digitalis has been given, the pulse sometimes becomes 
very frequent and feeble while the heart is beating strongly, the weak pulse being due to 
dilatation of the arterioles whereby the blood passes readily and quickly into the veins. 
Traube holds that digitalis, in medicinal doses, stimulates the vagi nerves and thus 
slows the action of the heart* while poisonous doses paralyze these nerves, and the 
heart then beats rapidly and irregularly from want of nervous control. If this be true, 
digitalis is contra-indicated in aortic regurgitation, where a slowing of the action of 
the heart allows the blood to regurgitate into the ventricles ; while, on the other hand, 
it will be of signal service in those cases of obstruction from disease of the mitral 
valves where its stimulating effects upon the vagi nerves, with its consequent slowing of 
the pulsations, allows more time for the distended auricle to empty itself before the final 
contraction of this cavity. Ringer notes a case of dropsy where digitalis was adminis¬ 
tered in which the discharge of urine per day was increased to sixteen times the pre¬ 
vious amount and the dropsy was entirely removed. But he holds that where there is 
no dropsy in a case of heart disease, digitalis will not act as a diuretic ; yet he consid¬ 
ers it a diuretic acting directly upon the kidneys. Are we to infer from this, then, 
that diuretics have no action upon the kidneys in disease of the heart without dropsy? 
If digitalis will not stimulate the secretion of urine except in the cases he mentions— 
those accompanied with dropsy—it must be an indirect diuretic unless the heart disease 
prevents a direct diuretic action. In that functional derangement palpitation of the 
heart, or what some have been pleased to call “spasm of the diaphragm,” the pulse is 
very weak, while the action of the heart is strong and tumultuous—in some instances 
striking the side of the chest with such force that the concussion can be heard at a dis- 
o 
tance of several yards. In these cases, generally due to over-exertion, especially on hot, 
sultry days, digitalis, administered in small and oft-repeated doses, will soon reduce 
the action of the heart to its normal condition. Gamgee records cases where it required 
eight days for complete recovery to take place. I have never seen a case that did not 
recover entirely in twenty-four hours’ time. It may be that the palpitation in the cases 
mentioned by Prof. Gamgee was due to some organic disease of the heart ; for if it was 
simply due to an exhaustion of the influence exercised by the vagi nerves upon the 
heart, it would certainly yield to treatment in much less time than he mentions. I re¬ 
member a case where the heart was so tumultuous in its action that the whole body 
was shaken at every pulsation, and yet it recovered in two and a half hours from the 
administration of ounce doses of ether repeated every half hour. Digitalis is highly 
recommended in those cases of pneumonia where there is danger of death from heart 
clot. The digitalis, by strengthening the heart’s action, prevents the commencement 
of the fatal heart clot. 
I used digitalis, carbonate of ammonia, and opium combined in a case of obstinate 
diarrhoea accompanying pneumonia, but without success. The pneumonia did well but 
the diarrhoea would not yield to treatment, and the patient died of asthenia. Dr. 
Brinton highly recommends digitalis in haemoptysis, and says that hemorrhage will 
cease so soon as the frequency of the pulse is reduced. I have never seen it tried ; but 
if digitalis strengthens the action of the heart and relaxes the arterioles, why is it the 
bleeding is not increased instead of diminished? 
The sensation of hunger is increased by the administration of bitter tonics, but 
we have no evidence that strychnia increases the power of digestion in a healthy person. 
