Vol. 60, 1909 - University of North Carolina at Chapel Hill

22S
THE CHARI,OTTE MEDICAL JOURNAL.
ume When these physiologic conditions achievement in this affection, even to the
are accomplished the drug must be reduced point of passive congestion and dropsy.
in dosage and under such circumstances In cases of stenosis at the aortic or mitral
can be continued for a longer time, modify- orifice the use of digitalis is not indicated
ing the frequency of the dose to meet the and will do serious harm unless certain
conditions, without the fear of toxic phe- complicating factors exist that demand the
nomena. The administration of digitalis temporary use of it, such as secondary,
can be by mouth, intravenously, or by dilatation of the right ventricle and passive
rectum The usual method, unless there is eougestion of the liver and dropsy. In
decided gastrointestinal irritation from its these conditions digitalis should be used to
use should naturally be bv the mouth; restore tone to the right ventricle; when
especially so in office and general practice, this is accomplished other remedies must
The chief affections of the heart respond- be relied upon to maintain the equilibrium,
ing to the use of digitalis are those that show There is a class of cases in which the use
dilatation of the heart with comparatively of di-italis can be of advantage only in
healthy muscle. In cases with a weak and certain stages, and that is those cases withinsufficient
systole, this drug, properly used, out valvular lesion showing arterial scle-
effects most satisfactory results. In old rosis with symptoms of cardiac distress. .
rheumatic cases, with weakness of ventri- This cardiac condition, following upon the
cular action, with symptoms of failing com- obstruction to the circulation m the aorta,
pensation, with passive hypereemia of ven- kidneys, and splanchnics, due to sclerobis,
ous circuits, this remedy accomplishes bril- may show a tachy-arythmia, may show
liant results. Cloetta (cited by W. His, rapid auricular systole and slow ventricular
Therapie der Gegenwart, Berlin, XLIX, action, may give signs of dilatation of the
No. 10, p. 433) states that the administra- left ventricle, or secondary relative regurgition
of digitalis in recent valvular trouble tation of the mitral valve, and later with
will restrict the compensating hypertrophy oedema of the lungs with dilatation of right •
and dilatation to a minimum. Inthesecases ventricle and venous pulse,
its continuous use in the period of conva- In this class of cases, now so often seen,
lescence following acute endocarditis the digitalis can have no place m the therapy,
drug has been most useful in my experi- except in the most unusual syndrome, until
ence, and I believe has forestalled grave the late signs of lower blood pressure precardiac
terminations in several cases that vails in arterials and the heart labors under
showed a tendency to sudden cardiac fail- the bane of broken compensation. In these
ure. The administration of digitalis in later stiCges its careful and skilful use, in
aortic regurgitation has been a question of connection with elimination of toxic agents
dispute. In these cases effectual good can and unburdening the splanchnic and renal
be done if the case is one uncomplicated by circulation, good results can be gotten here.
great sclerosis of the arteries; with high Strophanthus, squills, apocynum, and adoniblood
pressure the administration of digi- diyi belong to this group of remedies. The
talis is not only not indicated but it is de- use of squills, apocynum and adonidin (this
cidedly harmful. But in cases of aortic last remedy is said to have a dilating effect
regurgitation, with hypertrophy and dila- upon the coronaries) areemployed very little
tation, relative mitral regurgitation, the use on account of their irritating qualities in the
of digitalis is very good in its results. gastro-intestinal tract. Slrophanthus, for-
In mitral regurgitation digitalis is most merly thought to have no constricting effect
efficacious. Especially when the disease upon the internal arteries, but latterly be- i
process begins to show or has already lieved to possess this quality, although to a
reached broken compensation. Some ob- less degree than digitalis, is much like digiservers,
as Bayet and Wood (cited, A.J. talis in action. It differs from it m being
M. Sc, Vol. CXXXVI, No. 5. p. 661) dis- less powerful as a tonic to the heart muscle
claim for it any signigcant usefulness upon but in its use the cumulative toxic elfecl
the right ventricle and therefore they claim has not been observed to any marked dein
failing compensation of mitral regurgita- gree.
tion when the right ventricle shows dilata- But the potency of cardiac tonic remedies
tion this drug could not be relied upon to depends also upon associated therapeutic
tone up the muscle of that chamber. How- measures. Digitalis alone will often fail in
ever, the clinical experience of other ob- cases that seem to be ideal for its use beservers
substantiates the view that digitalis, cause of the absence of certain co-incideiU
or some member of the group, effects both therapeutic agents directed to assist in the
ventricles, restoring tone and vigor to in- solution of the disease problem. Often the
ervated muscle and re-establishing the equi- use of spartein sulphate in large doses will
jibrium of the circulation. It is conceded effect happy results in the restoration of the
jhat this drug is capable of excellent secretion of the kidneys. In some cases
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