To obtain the best results from the administration of digitalis, it must be of good quality and the preparations made with great care. Every precaution taken, it is still difficult to manage, because so apt to disorder the stomach and derange digestion. Recent experience has appeared to show that the most powerful and effective, yet manageable, of the constituents is digitoxine. This is a white crystalline substance, insoluble in water, of which the dose is 1/125 grain to 1/150 grain, and is best administered in pill or wafer. It may be advantageously combined with adonidin and sparteine in various cardiac affections and dropsy.

Digitalis has an undoubted power to arrest haemorrhage (Leyden). The mechanism of its action is similar to that of ergot; it slows the action of the heart and contracts the arterioles. In haemoptysis it is especially useful in the following state of things: frequent expectorations of bloody mucus, with occasionally a mouthful of florid blood, accompanied by fever. This group of symptoms is dependent on transudation from a number of small vessels about the site of a pneumonia due to a tubercular or caseous deposition. The same kind of expectoration, due to pulmonary congestion from mitral regurgitation, is amenable to the same treatment. In uterine hemorrhage digitalis is also serviceable, but it is more especially indicated in menorrhagia and metrorrhagia of plethoric subjects. Like ergot, digitalis has the power to induce uterine contractions, and hence it has been used successfully to arrest post-partum hemorrhage. Cases of menorrhagia, of a peculiarly obstinate kind, are caused by mitral regurgitation or stenosis, the mechanical result being to increase the blood-pressure in the venous system of the uterus. Digitalis is the appropriate remedy in such cases. Granules of digitaline may be prescribed for some days previously to the occurrence of the menstrual molimen, but during the attack the infusion of digitalis is more serviceable. In cases of haemorrhage, generally speaking, the infusion is the most effective form in which to employ digitalis. If the symptoms are urgent, a table-spoonful of the infusion may be given every half-hour until four doses are taken. In ordinary cases a table-spoonful of the infusion twice a day is a sufficient quantity to maintain a constant physiological effect. In the treatment of haemorrhage, digitalis may be combined with other remedies which are synergistic. Rx Infus. digitalis, oz ij; tinct. krameriae, ext. ergotae fluidi, āā oz j. M. Sig.: A table spoonful pro re nata.

In purpura and the haemorrhagic diathesis, digitalis is useful when given conjointly with restorative medicines; but, as a dyscrasia exists on which the extravasations of blood depend, it is obviously necessary to correct this state of things, in order that the patient shall be benefited by a remedy which gives tone to the heart and vascular system.

The most important uses of digitalis are in cardiac diseases. In general terms it maybe said that it is indicated when the action of the heart is rapid and weak and the arterial tension low, and is contrain-dicated when the action of the heart is vigorous and the arterial tension high.

In simple hypertrophy, which is compensatory, digitalis has no utility. In stenosis of the aortic orifice, with compensatory hypertrophy, it is not only useless, but it may give rise to serious symptoms, and even cause a fatal result, if administered in doses sufficient to produce physiological effects (Fernet). When stenosis of the aortic orifice leads to incompetence and regurgitation of the mitral, then digitalis may be used with advantage. As respects the nature of the cardiac lesion merely, digitalis is useful in dilated heart with incompetence of the mitral, in disease of the mitral orifice with stenosis or regurgitation, and in dilatation of the right heart with incompetence of the tricuspid. As respects the mechanical difficulties which ensue from cardiac lesions merely, digitalis is useful, by reason of the increased power which it gives the auricles and ventricles to empty their respective cavities, and the longer intervals between the pulsations, which enable the auricles more perfectly to discharge their contents into the ventricles. The mechanical difficulty consists in a deficiency of blood (ischaemia) on the arterial side, and a stasis of blood on the venous side, of the systemic and pulmonary circulation. Digitalis, therefore, assists in the "compensation," or, in other words, by its action on the heart restores the mechanical balance of the circulation, deranged by the cardic lesions. As respects the rational symptoms of heart-disease, digitalis is useful when the action of the heart is rapid and weak, the tension of the pulse low, when there are cough, difficulty of breathing, a dusky countenance, pulsating jugulars, scanty and high-colored urine, and general dropsy. As a rule, it may be stated that the rational signs furnish more conclusive indications of the need of digitalis than the physical. If given in suitable cases, the action of digitalis in heart-diseases is most conspicuous for good; but careful consideration should be given to the conditions detailed above if the practitioner would procure thoroughly satisfactory results. The form in which digitalis is prescribed is most important. The infusion is the best form in cases of cardiac disease with dropsy. It should be given in table spoonful doses, twice a day, until some characteristic physiological effects are produced. After the subsidence of the severe symptoms, digitaline-granules may be substituted for the infusion, or the powder of the leaves may be given in pill-form. As very decided anaemia is present in these cases, the best results are obtained by a combination of digitalis with quinine and iron. Rx Pulv. digitalis,Э ij; ferri redacti, quininae sulph., āā Эj. M. Ft. pil. no. xx. Sig.: One pill two or three times a day.

The antipyretic effect of digitalis is a fact much insisted on in Germany (Traube, Wunderlich, Thomas, Liebermeister, etc.). In the recent elaborate work of Husemann digitalis is classed with the Fie-bermittel—the "antipyretica." The results which have followed its administration as an antipyretic in fevers (typhoid, typhus, etc.) do not, it appears to the author, justify its use in these maladies, notwithstanding its power to lower the temperature. Prof. Leyden regards it as unsafe as an antipyretic. The indications for its use are, according to Liebermeister, just the opposite of those which obtain in cardiac disease; that is, "digitalis is only to be used in those cases of typhoid fever in which there is no considerable degree of cardiac weakness." He usually gives from eleven to twenty-two grains, extended over a period of about thirty-six hours.