DISEASES OF THE HEART.—Digitalis is, above all, a cardiac remedy; but there is as much dispute over tbe classes of cases to which it is applicable as over its physiological action.
A fact that is not only forgotten, but freqiiently ignored, is that in normal conditions the hea,rt-muscic adjusts it self to the demands made upon it. In those whose vocations force them into the extremes of bodily exertion, the heart becomes muscular in proportion to the demands. In response to temporary or protracted influences that perturb the heart and induce overexercise without diminution of tonicity of the myocar dium, as in functional or reflex disor ders, the same result follows. Digitalis is often administered under these cir cumstances to steady or quiet the car diac tumult; this is a flagrant abuse of a good medicine and an unpardonable sin against the heart, and is but an added goad to an already overworked organ. Moreover, if the stomach, whence the dis turbing impulses often proceed, is al ready irritated, the presence of digitalis will augment the difficulties in geometric ratio by increasing nausea and heighten ing the ceplialalgia and other symptoms of gastric distress. Cardiac arhythinia of myopathic origin, or reflex, toxic, or nervous in its nature, cannot present a reasonable cause for employing digi talis. If it be exhibited in palpitation due to neurotic conditions, there will be a possibility of converting the curable disorder into an incurable malady.
In aortic regurgitation it is sometimes employed in a thoughtless and careless manner. It is a dangerous medicine and often harmful in this valvular malady. If the diastole is increased and pro longed, the period of regurgitation and its force are augmented, and the difficul ties multiply.
The only excuse for prescribing it in aortic stenosis is to give vigor to the myocardium when the tendency to dilatation is pronounced. If it slows the action of the heart notably, it may add to the valvular systole or occasion tetanic contraction.
It is deplorable to employ it in con ditions of compensation. Many a case
of benign hypertrophy has thus been goaded into myocardial weariness and weakness that disabled the heart from keeping up its work. In the absence of dropsy, in all cases where the urine is voided freely, there is little, if any, call for digitalis. English (Med. and Surg. Rep., Aug. 22, '96).
In pediatric practice digitalis is indi cated in cardiac disease whenever the muscular contractions becoine of insuffi cient strength. It is especially valuable in mitral disease, but is contra-indica.ted in aortic insufficiency until the pulse be comes rapid and irregular. It Is useful for its diuretic action in respiratory dis ease, like hydrothorax and pleurisy, and for its effect upon the heart in pneu monia, severe bronchitis, and influenza. In repeated severe hannoptysis it is of value. In acute infectious diseases it is valuable if given before the myocardiutn has undergone marked degeneration. It should never be given for a longer period than 7 or 8 consecutive days, and then its use must be suspended for from to 10 days. Comby (Revue Inter. de Med., etc., vol. ix, No. 11, '99).
Digitalis is especially indicated in simple dilatation. It is not contra indicated except in the advanced stages of myocardial degeneration. Huchard (Me"d. Mod., Feb. 17, 1900).
Insufficient attention is paid to the selection of suitable patients for digitalis. When inequality, irregularity, and insuf ficiency of the pulsations are absent, or when there is no dropsy of the cellular tissues and serous cavities, contra-indica tion for digitalis exists. A permanently infrequent pulse is not a contra-indica tion. A strong contra-indication to digi talis is the presence of myocardial lesions. Thus myocarditis, senile eachexia, fatty degeneration, etc., call for the very greatest care in the use of this drug. Aortic incompetence is, generally speak ing, a contra-indication. Dyspepsia very often causes digitalis to disagree. A ca chectic condition is a contra-indication. Potain (Jour. de INT6d., Apr. 10, 1900).