Am.  Jour.  Pharm.  "I 
January,  191 8.  -* 
Digitalis  Therapy. 
2/ 
tract.  Digitalis  tincture,  as  well  as  the  infusion  and  fluidextract,  are 
absorbed  fairly  promptly;  strophanthus  and  strophanthin,  ouabain, 
convallaria  preparations,  apocynum  preparations,  and  wahoo  are 
absorbed  very  irregularly.  This  is  of  prime  importance,  because  it 
requires  the  administration  of  large  doses  of  these  drugs  in  order 
to  insure  the  therapeutic  effects ;  but  rapid  absorption  occurs  occa- 
sionally under  conditions  that  are  not  understood,  and  severe,  or 
even  fatal,  poisoning  may  result.  The  latter  drugs  should  never  be 
used  for  oral  administration. 
There  is  no  difficulty  in  getting  standardized  digitalis  prepara- 
tions, and  these  do  not  deteriorate  rapidly.  Slight  deterioration  is 
not  important,  because  the  drug  must  always  be  given  until  a  defi- 
nite action  is  induced,  and  this  varies  with  every  patient ;  since  there 
is  no  fixed  dose  that  is  applicable  to  different  patients. 
Tincture  of  digitalis  contains  only  traces  of  fat,  and  that  is  no 
more  disturbing  to  the  stomach  than  an  equal  amount  of  other  fixed 
oils  or  fats. 
Granted  that  a  correct  diagnosis  has  been  made,  digitalis  therapy 
becomes  largely  a  matter  of  correct  dosage,  including  the  proper 
method  of  administration,  which  is  nearly  always  oral.  It  is  beyond 
the  scope  of  this  paper  to  consider  dosage  and  methods  of  adminis- 
tration in  detail,  the  present  purpose  being  to  point  out  to  the 
clinician  the  resources  that  he  has  at  his  command ;  but  he  will  find 
valuable  suggestions  in  the  following  papers : 
"A  Clinical  Study  of  Crystalline  Strophanthin,"  by  Harold  C. 
Bailey.2  In  this  paper  the  author  reports  most  careful  clinical  ob- 
servations with  crystalline  ouabain,  formerly  called  crystalline  stro- 
phanthin. 
"The  Toxic  Actions  of  Digitalis  on  the  Heart,"  by  the  same 
author.3  This  is  an  excellent  study  of  the  toxic  actions  of  digitalis 
that  frequently  escape  attention. 
"  Digitalis  Dosage,"  by  Cary  Eggleston.4  This  is  perhaps  the 
best  recent  study  of  the  method  of  administering  digitalis  whereby 
prompt  effects  are  induced  after  oral  administration. 
Fraenkel  and  others  have  published  numerous  papers  dealing 
with  the  intravenous  administration  of  strophanthin. 
1  am  well  aware  that  many  readers  will  be  inclined  to  deny  many 
2  Jour.  Pharmacol,  and  Exper.  Therap.,  1909,  1,  359. 
3  Am.  Jour.  Med.  Sc.,  1911,  p.  1. 
4  Arch.  Int.  Med.,  July,  1915,  p.  1. 
