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Digitalis has been used from early times in heart cases. It increases the activity of all forms of muscle tissue, but more especially that of the heart and arterioles, the all-important property of the drug being its action on the circulation. The first consequence of its absorption is a contraction of the heart and arteries, causing a very high rise in the blood pressure.
After the taking of a moderate dose, the pulse is markedly slowed. Digitalis also causes an irregular pulse to become regular. Added to the greater force of cardiac contraction is a permanent tonic contraction of the organ, so that its internal capacity is reduced, which is a beneficial effect in cases of cardiac dilatation, and it improves the nutrition of the heart by increasing the amount of blood.
In ordinary conditions it takes about twelve hours or more before its effects on the heart muscle is appreciated, and it must thus always be combined with other remedies to tide the patient over this period and never prescribed in large doses at first, as some patients are unable to take it, the drug being apt to cause considerable digestive disturbances, varying in different cases. This action is probably due to the Digitonin, an undesirable constituent.
The action of the drug on the kidneys is of importance only second to its action on the circulation. In small or moderate doses, it is a powerful diuretic and a valuable remedy in dropsy, especially when this is connected with affections of the heart.
It has also been employed in the treatment of internal hemorrhage, in inflammatory diseases, in delirium tremens, in epilepsy, in acute mania and various other diseases, with real or supposed benefits.
The action of Digitalis in all the forms in which it is administered should be carefully watched, and when given over a prolonged period it should be employed with caution, as it is liable to accumulate in the system and to manifest its presence all at once by its poisonous action, indicated by the pulse becoming irregular, the blood-pressure low and gastro-intestinal irritation setting in. The constant use of Digitalis, also, by increasing the activity of the heart, leads to hypertrophy of that organ.
Digitalis is an excellent antidote in Aconite poisoning, given as a hypodermic injection.
When Digitalis fails to act on the heart as desired, Lily-of-the-Valley may be substituted and will often be found of service.
In large doses, the action of Digitalis on the circulation will cause various cerebral symptoms, such as seeing all objects blue, and various other disturbances of the special senses. In cases of poisoning by Digitalis, with a very slow and irregular pulse, the administration of Atropine is generally all that is necessary. In the more severe cases, with the very rapid heart-beat, the stomach pump must be used, and drugs may be used which depress and diminish the irritability of the heart, such as chloral and chloroform.