Disturbances of the Heart: Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood PressureOsborne, Oliver T. (Oliver Thomas)
Science
Disturbances of the Heart: Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure
Osborne, Oliver T. (Oliver Thomas)
Blood pressure; Heart -- Diseases
If the patient is sufficiently ill to require the best action of
digitalis, an active preparation should be obtained. It was long
supposed that the infusion presented activities which could not be
furnished by the tincture of digitalis. This seems not to be true.
The greater value of the infusion is generally because it is freshly
made and active; the tincture which had been used previously in a
given case was old and useless; furthermore, most physicians give a
larger dose of the infusion than they ever do of the tincture. Owing
to the uncertainty of the value of the digitalis leaves found in the
various drug shops, however, and to variations in the preparation of
the infusion, it is generally better to use a tincture of known
character. The beginning dose of such a tincture should generally
not be more than 5 drops, and it should not be repeated more
frequently than once in eight hours. It is generally advisable, in
two or three days, to increase this dose to 10 drops once in twelve
hours, later perhaps to 15 drops twice a day, and still later to 20
drops once a day. This amount may then be decreased gradually, if
the action is satisfactory. Enough should be given to procure
results, and then the dose should be brought down to what seems
sufficient and best, administered once a day. The frequence advised
in the administration of this drug is because it is eliminated
slowly. Its greatest action develops a number of hours after it has
been taken, and then the action lasts for many hours; the
administration of digitalis once in twenty-four hours is perfectly
satisfactory for many patients, and more satisfactory than any more
frequent administration. On the other hand, some patients do better
on a smaller dose once in twelve hours. This frequence is always
sufficient.
Digipuratum and digitol, a fat-free tincture, proprietary
preparations accepted by the Council on Pharmacy and Chemistry for
inclusion in N. N. R., may be employed. They are standardized
preparations and may thus be more satisfactory than some
pharmacopeial preparations of digitalis, although their claims to
lessened emetic action are not borne out by recent experiments of
Hatcher and Eggleston.
Digipuratum may be obtained in tubes of twelve tablets. The advice
has been given for patients with loss of compensation to receive
four tablets the first day, three the second, three the third, and
two the fourth day. This, however, is generally an overdosage. The
most that should generally be given is one of these tablets in
twelve hours. Digipuratum fluid is also a valuable preparation.
Digitol is a fat-free tincture of digitalis which is physiologically
standardized and which bears on each package the date of
manufacture. The close is from 0.3 to 1 c.c. (5 to 15 mimims).
Digitalinum, one of the active principles of digitalis, is not very
satisfactory. It may be given hypodermically, but often causes
irritation, and the proper dose and its value are apt to be
uncertain.
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