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Introductory Chapters

heart, digitalis, action, days, body, doses and result

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INTRODUCTORY CHAPTERS (pp. 145-154 DIGITALIS.—The dried leaves of foxglove (Digitalis purpurea), a widely cultivated European plant. It is extensively grown in the United States, but more for ornament than for commercial purposes. The active principles in the leaves are glycosides, four of which are described at the present time. The details of their composition, however, can be best consulted in technical works. The action of digitalis is very complex. It is extremely bitter and irritating to the stomach, and some persons with delicate stomachs are unable to take it. It is absorbed very slowly from the stomach, and has a very pronounced action on the heart and its nervous mechanism. The principal effect of digitalis is to strengthen the contrac tions of the heart-muscle as yell as to increase the contractions of the muscles of the blood-vessels. This would tend to make the heart beat stronger and somewhat faster ; but soon after the absorption of the drug the heart regulating centre in the medulla is implicated, and as a result of the irritation in this centre the heart beats slower.

Under the full physiological action of digitalis the heart beats slowly (say 5o per minute), but stronger ; and the output of blood is increased, and the blood-tension raised throughout the body. This action, whereby all the organs of the body are better supplied with blood, may be continued for a long time under careful medical supervision, and digitalis is, therefore, one of the most reliable of all the heart-tonics. When given in large doses, or if accumulation of its effects takes place, the heart commences to beat more rapidly and irregularly, the blood-tension falls, and the patient appears to be seriously poisoned, with signs of cardiac distress and irregularity. This result often happens when the medication is prolonged, and it is usual to intermit when giving digitalis. The chief indications for its use are the various heart-disorders in which disturbance of compensation shows itself. The heart that is acting normally and is able to keep up compensation should not receive digitalis. Digitalis, moreover, is of practically little service where a quickly diffusible heart-tonic is required. It is often given

also in kidney-diseases, but in these cases it is combined with other remedies in order to overcome its blood-raising effects. It is usually prepared either as an infusion given in half-teaspoonful doses or as a tincture in doses of five drops.

DIPHTHERIA.—One of the most dreaded of the diseases which affect children. It is due to the diphtheria bacillus discovered by I.Offier, which attaches itself principally to the mucous membrane of the throat and nose, where it grows in enormous numbers. Its extremely toxic products are a source of danger to either child or adult. The most frequent site of the disease is the pharynx. It develops in from two to seven days after infection has taken place, and is ushered in by chills, fever, vomiting, malaise, loss of appetite, and headache, followed by hoarseness (croup), difficulty in swallowing, and pains in the throat. Greyish-white patches, tightly adherent to the underlying tissues, are found on the red and swollen tonsils, palatal arches, and uvula. These gradually extend to the surrounding areas, and may spread down into the larynx and bronchi. This condition is accompanied by a painful swelling of the neighbouring lymphatic glands in the neck. These appearances are developed in two to three days, and in the milder cases recede within three to five days. In the more virulent types of the disease, the symp toms are all increased in severity and are accompanied by high fever and general exhaustion. The poison developed in the body by the bacteria may also bring about severe damage to the heart, the pericardium, the lungs, the kidneys, and the nervous system ; and the disease may result fatally from interference with respiration, from pneumonia, cardiac weakness, or from paralysis. Even if this unfavourable course is avoided, the recovery, of the patient may be complicated by various sequeli which involve the heart, the lungs, or the kidneys. Or there may be paralyses of various kinds, affecting the muscles of the eyes, palate, larynx, chest, bladder, or rectum, including perhaps the entire arm or leg ; or there may be long-continued hoarseness, loss of voice, disturbances of speech, squinting, etc.

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