PNEUMONIA. pneumonia, how ever, digitalis is often distinctively of the utmost value, particularly in main taining the heart's action where there is adynamia, and for the promotion of the excretion of waste through the kidneys.
Another fact not generally noted is that many cases of pneumonia result fatally, not from the pulmonary con gestion, but from urxmic poisoning; this fact is entirely lost sight of because the attention of the practitioner is gen erally absorbed by the primary lesion. (Sajous.) Series of eight hundred and twenty-five eases of pneumonia treated with infusion of digitalis:— R Digitalis-leaves, 60 to 90 grains. Water, 52 drachms.
Simple syrup, 12 drachms.-111.
A tablespoonful every half-hour. This continued for two or three days aborts the disease and reduces the mortality to 2.06 per cent. Petreseo (Trans. XI In ternat. Med. Cong., '94).
[Huchard states that Roumanian digi talis may possess properties varying greatly from that of other countries. ED.] The effect on the pulse and tempera ture is slight, and, in view of the danger ous nature of the remedy, it is not worth the risk. Lowenthal (Centralb. f. d. Gesam. Therap., '94).
The remedy par excellence. Recoveries will and do occur in greater numbers when treated by large and persistent doses of digitalis. Paulison (Med. Age, Sept. 10, '94).
Seventy-four cases of croupous and thirty-four of lobar pneumonia treated with large doses of digitalis most sat isfactorily. Only one death: that from lobar pneumonia. Fickl (Wiener med. Woch.; Med. Age, Oct. 10, '94).
Twenty-one adults and thirteen chil dren suffering from catarrhal pneumonia treated with large doses of strong in fusion of digitalis. The adults bore the doses well, but the children frequently exhibited evidence of gastro-intestinal disturbance. Favorable results in eighteen cases. Ordinary or small doses of digitalis have no influence upon the pulse or upon the progress of acute pulmonary disease. Strong infusions are harmless, and have very favorable influence upon the process of the disease, and may even cut it short if adminis tered at the onset. Contra-indicated in children of one year and under, and in old people. Bloch (Wratsch, Nos. 15, 16,
'94).
Often of great value in various acute diseases, such as adynamic pneuinonia and adynamic fevers, by maintaining the heart's action. It can have no effect upon the diseases themselves, but may help most opportunely to sustain the heart during a crisis or a period of strain upon it. H. C. Wood ("Princ. and Prac. of Therap.," '94).
In congestion of the lungs with high fever it is often a. valuable remedy in relieving venous stasis. In the second stage of pneumonia it is of the greatest importance, being of use here to stimu late the contractile force of the cardiac muscle when the intraventricular press ure becomes stronger than the unaided muscle can resist, and dilatation is im minent, if not already begun. The main indication for the drug is the increase in intensity of the second pulmonic sound. Butler ("Text-book of Mat. Med., Therap., and Phann.," if the patient is strong, under 40, with no concomitant organic disease, prefer ence must be given to the treatment by baths; under opposite conditions, espe cially when the heart is feeble, digitalis should be given in doses of 45 and 35 grains of the powdered leaves a day, ex hibiting it every two hours infused in water with the addition of rum and syrup of orange-peel. Slight vomiting and vertigo are not contra-indications, but the treatment must be continued till the pulse becomes abnormally slow or irregular. It is doubtful whether the enormous doses given by Petrescu are free from risk, and whether the artificial lowering of temperature by them is of real value. The maximum dose should not exceed 45 grains daily of the powdered leaves. Barth (La Sem. M6d., July 22, '96).
PLEURISY.—That digitalis may be a remedy of value in pleurisy where there is effusion, goes without saying, but some believe it is indicated at even au earlier period, on the theory that it 2ombats hypermia. This, after all, is Duly an indorsement of the practices of Sir Thomas 'Watson, Aitken, and Nie meyer, who all held that the drug was especially adapted to the pre-exudative stage; and, even a quarter of a century back-, the view that the drug is anti phlogistic and adenagic had by no means become obsolete.