In regard to the dosage of the Golaz dialyzed digitalis, it should be noted that one gram of the dialyzed digitalis (25 drops) corresponds to one gram of the digitalis leaves. In children of the first and second years, six to ten drops of this preparation are given daily; in older children a daily dose of 30 to 40 drops must be given for several days, to get the full effect of digitalis in a short time. For chronic treatment with digitalis, two or three drops daily are given to small children and ten to fifteen drops daily to larger children.
The dose of digalen (digitorinuto solubile Cloetta) is in childhood 0.1 to 0.3 c.c. of the liquid preparation three or four times a day, either by the mouth, by enema or as a subcutaneous injection. When the last named mode of administration is employed, a spot covered by skin which moves easily is to be chosen, such as the back or the thigh.
Marfan's recommendation of the macerated infusion of digitalis leaves for children, 20-40 cg. (3-6 gr.) to 60-100 Gm. (2-31 oz.) water for children under five years, is no longer so valuable since it is easier to use both of the preparations. just mentioned.
Besides, digitalis is employed in childhood as powder, infusion and tincture. Powdered digitalis is given in daily doses of 1 dg. gr.) for each year of life. as powder, decoction or maceration. Tincture of digitalis, a very unreliable preparation (as many drops as the child is years old, given three times a day) is now superfluous, as the Golaz dialyzed digitalis is so much better.
The effect of dig,italis preparations, especially of dialyzed digitalis and digalen, is as constant in childhood as in adults. Under exact medical control the administration of digitalis in childhood is just as free from danger as in adults.
Troitzky's opinions upon the dosage of digitalis in childhood de serve mention, as they depend, not upon the body weight, but upon the size of the heart, the blood pressure and the length of the body, with the following rules for dosage as the result: At the age of one month to the end of the first half year of lactation -1-; at the end of the last half of lactation (12 months) of the average adult dose should be ordered.
In the second year four times as much; in the third year six times as much as at the beginning of the second month, i.e., *, A of the adult dose are given. Single doses are the same for the fourth, fifth, tenth, twelfth, thirteenth and fourteenth years, ti.e., T'-a- of the adult (lose.
The doses for the eighth and fifteenth years, and also for the six teenth and seventeenth years are the same, in the former Po-, in the latter I's of the average adult dose.
There are surrogates for digitalis in children, but no true substi tute for it. Here belong adonis vernalis, caffeine, strophanthus, con vallaria, sparteine and the theobromin preparations. All these drugs are indicated in childhood in the same conditions as in adults. They may serve to support and prolong the action of digitalis without taking its place. In children with chronic heart disease, with symptoms of niyasthenia, these drugs are of value to fill in the unavoidable pauses between the cycles of digitalis.
Should digitalis be administered permanently in the chronic heart affections of children, in small doses, or not? The chronic administra tion of digitalis as employed in later life in recent years does not meet with approval in childhood. It is much more judicious to give larger
doses through several days from time to time, to its full action; then the drug is omitted until the effect of the digitalis has disappeared. How ever it is very good to fill in these pauses by giving other heart stimu lants, such as adonis vernalis or caffeine in suitable doses, of which drugs more is to be said soon.
The preparations of caffeine, caffeine sodiobenzoate, sodiosalicy late and citrate, are well borne by the stomach of children even of the tenderest age, but as a rule produce disturbing insomnia in children with heart disease. They do particularly good work in cardiac weakness and tachycardia in the acute infectious diseases. The dose is from. 3 to 6 cg. (1-1 grain) daily- for each year of life. The double salts of caffeine above mentioned may also be given subcutaneously, at the same time that digitalis is used internally.
Much recommended to fill in the pauses in the administration of digitalis are Golaz' dialyzed adonis (given in the same doses as dialyzed digitalis) and Golaz' dialyzed convallaria (3 to 6 drops daily for each year of life). Less effective are the strophanthus preparations (given 3 or 4 times a day, one to five drops for each year of life). Biedert also recommends sparteine sulphate, 2 to 5 cg. (1-i grain) several times a day.
The theobromin preparations, theocin, theophyllin, agurin, uro citral, and diuretic', act chiefly as diuretics and assist the treatment with digitalis in children with dropsy. They are given in daily doses of Gm. for each year of life and are best given in enema on account of their bad taste.
flochsinger advises the following drug treatment in chronic cardiac myasthenia: 1. In cases without dropsy alternate the administration of dialyzed digitalis (five drops for each year of life) for 4 or 5 clays with that of dialyzed adonis or convallaria, in doses given above, for 4 or 5 days. For several days now and then digalen (4 to 4 c.c. of the finished preparation three times a day) instead of the dialyzed digitalis.
2. In cases with dropsy, besides the drugs just mentioned, inter nally a theobromin preparation, preferably diuretin or agurin, should also be given by enema. If /IS a result of long continued drug treatment symptoms of gastric or rectal irritation appear, Cloetta's digalen should be used by subcutaneous injection exclusively, which, while it causes slight infiltrations, never produces abscesses when the injection is given aseptically.
Obstinate ascites will sometimes make abdominal paracentesis necessary in children also. As a rule digitalis will act better after punc ture than before. Marian recommends, besides, the adnlinistration of fractional doses of calomel [5 cg. (4 grain) in five doses at half hour intervals once in two weeks] to prevent cirrhotic changes in the con gested liver.
Massage may assist the cardiac tonic and drug treatments when there is (edema of the extremities. Gymnastics are injudicious in chil dren with insufficiency of the heart muscle, though massage of the cardiac region sometimes has a favorable effect upon the subjective symptoms. Venesection is of no value in the treatment of the symptoms due to cardiac congestion in children.