336  Tincture  of  Fat-Free  Digitalis.  {Kmi™f;m*™' 
generally  accomplished.  A  short  time  ago,  however,  an  even  more 
valuable  feature  of  the  fat-free  tincture  became  evident ;  this  was 
the  rapidity  with  which  the  preparation  was  absorbed  and  assimilated 
in  comparison  with  the  official  product.  Observations  were  then 
made  to  determine,  clinically,  the  relative  rapidity  with  which  the 
fat-free  tincture  and  the  official  tincture  were  each  absorbed,  noting 
(i)  the  time  of  primary  effect;  (2)  the  time  of  maximum  effect,  and 
(3)  the  pulse  reduction  or  work,  both  in  maLe  and  female  patients, 
and  both  hypodermically  and  by  mouth. 
Through  the  kindness  of  Dr.  F.  A.  Sherrer,  formerly  of  this  city 
(now  of  Hazleton,  Pa.),  this  work  has  been  done.  The  main  diffi- 
culty was  experienced  in  the  selection  of  bed-cases  in  which,  while 
the  use  of  digitalis  was  indicated,  the  physical  conditions  were  as 
nearly  uniform  as  possible,  so  that  comparative  results  could  be  had. 
The  cases  chosen  were  mostly  rheumatic  with  endocarditis.  In  one  or 
two  cases  there  was  arhythmia,  which  disappeared  in  fifteen  minutes 
after  the  first  dose.  Patients  were  given  the  tinctures  three  hours 
after  meals,  when  the  stomach  was  practically  empty.  The  fat-free 
tinctures  one  day,  the  official  the  next  day.  No  food  or  water  was 
taken  during  the  time  of  administration.  The  beginning  of  each 
administration  was  so  timed  that  there  was  no  serious  difference 
between  the  rate  of  pulse-beat  when  the  giving  of  each  preparation 
was  commenced.  At  most,  the  primary  difference  was  never  more 
than  six  beats.  It  is  obvious  that  if  a  heart  is  beating  almost  nor- 
mally one  day,  when  one  tincture  is  given,  and  is  beating  tumultu- 
ously  the  next  day  when  another  tincture  is  used,  that  uniform 
conditions  do  not  exist  and  comparative  results  cannot  be  had. 
The  next  essential  is  rest  in  bed,  and  perfect  quiet.  • 
Speaking  of  this  in  connection  with  digitalis  administration,  Dr. 
H.  C.  Wood  writes  (U.  S.  D.,  1898,  478) : 
"  Whilst  the  patient  is  in  a  horizontal  position  the  pulse  is  very 
slow  and  strong,  but  when  he  rises  to  his  feet  it  becomes  at  once 
rapid,  irregular,  small  and  feeble,  and  even  hobbling." 
Doubtless,  sphygmographic  tracings  would  have  determined  the 
results  of  rapidity  of  absorption  and  action  more  accurately,  but  as 
this  means  of  observation  was  not  available,  it  was  not  followed.  A 
few  preliminary  trials  made  by  the  mouth  showed  that  primary 
effects  were  had  with  the  fat-free  tincture  in  about  fifteen  minutes, 
and  primary  effects  with  the  official  tincture  in  about  thirty  minutes ; 
so  observations  of  pulse-beats  were  taken  every  fifteen  minutes. 
