The indications for the use of digitalis are the insufficiency of the heart-muscle and the incompetency of the mitral valve. Chronic myoearditis is no con tra-indication. Large doses may over exert the inflamed muscle; that is why digitalis in large doses is very badly borne in acute myocarditis; small doses are often serviceable when the first onset is passed. Aortic insufficiency has been deelared contra-indieation to cligiialis by some, a.n indication by oth ers. It is certain that these observers had different eases to deal with. Aortic insufficiency, when incipient or moderate, is easily compensated, gives no uneasi ness to the patient, is not complained of, and is seldom observed when recent. This is the time when such doses of digitalis continued a long time prove of permanent service. Only those, how ever, can be thus benefited whose cases are reeognized early, either accidentally or through careful self-observation by the patient. When, however, the ease is old and compensation greatly dis tnrbed, with considerable peripheral venous obstrnetion, even digitalis will not suffice to restore the equilibrium bet»-een the action of the heart and the capillary cireulation of distant organs.
A. Jae°hi (Medical News. Jan. 11, 1902).
The legs in some instances are im mensely distended with fluid. Bullm aro apt to form, which burst spontane ously and exude dropsical fluid. Large amounts of water may sometimes be drawn from the lower extremities through Southey's capillary trocars or by means of longitudinal scarifications. A practical objection to the latter method is the great danger of erysipelas attacking the scarified tissues. Apart from that, the constant dripping day and night torments the patient and soon causes more or less eczema of the skin. But the relief to the circulation is, in some instances, worth even the immense amount of trouble and the considerable risk thus entailed.
For the attacks of syncope to which those patients are liable, the subcutane ous injection of digitalis, nitroglycerin, ether, alcohol, or strychnine is neces sary. Marked relief and apparently val uable stimulation are sometimes ob tained by the inhalation of oxygen-gas, which has once or twice seemed to the writer actually life-saving in its efficacy. In such cases, however, a fatal termina tion is merely delayed, not absolutely prevented.