ACTION ON UTERUS.—The muscular substance of the uterus is powerfully contracted by digitalis. It was long sup- ' posed that this action was the result of stimulation of uterine ganglia, but it is now believed to be due to the affinity of the drug for unstriped mus-cular fibre. In uterine limorrliage, when admin istered, the patient (usually in about ten minutes) complains of very severe pain in the region of the sacrum, which passes into the hypogastrium, and in every respect seems to resemble the pain of the first stage of labor; very shortly afterward a considerable quantity of blood, generally in part coagulated, is forced out from the womb.
As digitalis has been employed some what extensively and successfully in sim ple menorrhagia, its affinity for the re productive apparatus of the female seems well established; some authors go so far even as to accredit it with phenomenal emmenagogic properties, though the evidence adduced appears to be of rather a hazy and uncertain character; and yet digitalis is employed as an ecbolic or abortifacient in some European -coun tries.
Incompatibles. — Digitalis is incom patible in fluid preparations with salts of iron and lead; likewise with tannin and all vegetable solutions containing them. Therapeutically it is antagonized by aconite and its alkaloid, by scoparine, muscarine, saponin, staphisagria and the alkaloid of the latter, delphinine, and by drugs of the belladonna group.
Digitalis Poisoning. — Digitalis poi soning is of extremely rare occurrence: a fact that may be, oftener than not, perhaps, ascribed to the practically-inert character of most of the preparations marketed. The symptoms are, for the most part, the same as when too large or too-long-continued doses have been ex hibited, but in greatly-aggravated degree: disordered state of prima? vice; slow and irregular pulse; coldness of extremities; syncope or tendency thereto; giddiness; confusion of vision, external objects ap pearing of yellow or green hue, mist or sparks before eyes, which are prominent, with pupils fixed and perhaps dilated; weight and pain in forehead; weakness of limbs; insomnia; stupor or delirium; urine suppressed, perhaps; there may be abundant salivation. Fatality is usu
ally preceded by stupor or convulsions and a dilated, insensible pupil.
According to Tardieu, an almost diag nostic symptom of digitalis poisoning is a blue color of the sclerotic.
The minimum fatal dose of digitalis is not known, and, owing to the incon sistency of its action, probably never will be. The treatment after evacuat ing stomach and bowels should be tan nin, opium, stimulants, and recumbent posture; aconite may be employed, but it requires to be administered with cau tion.
Treatment of digitalis poisoning must be symptomatic. The administration of the drug is to be stopped; the ali mentary canal is to be cleared of any impurities it may contain; elimination must be increased by diluents; sickness allayed; arterial tension reduced when high; sleep procured if necessary, and other ,symptoms treated as they arise.
Nitroglycerin is the best remedy for the reduction of arterial tension. If the blood-pressure is low, alcohol will prove of great service. Taylor and Marshall (13rit. Med. Jour., Nov. 4, '99).
After the drug had been administered to a woman of 40 for six weeks (5 drops of the tinctnre every four hours), symp toms of profound mental disturbance appeared. At first simula,ting mere hys terical excitement, the disorder rapidly developed into a violent mania. The drug was immediately discontinued, and slie recovered promptly. A. IV. Dunning (St. Paul Med. Jour., May, 1902).
In spite of a vast amount of evidence adduced in favor of medicinal use of the glucosides of digitalis, the fact remains that all are uncertain bodies, and that no one definitely represents the thera peutic activity of the drug itself. They are practically worthless in heart dis eases. Even for hypodermic use tincture of digitalis is preferable and it is less irritating. In any event, the only glu cosides worthy of attention are the dig italeine of Nativelle, or d. crislallisee, and the digitoxin of Schmiedeberg; even these are highly irritant to the skin and likely to produce eczematous and other eruptions that are also often, as well, results of the us.e of digitalis ointments or poultices.