Treatment of internal diseases : for physicians and students / by Norbert Ortner ; ed., with additions, by Nathaniel Bowditch Potter ; tr. by Frederic H. Bartlett.

  • Ortner, Norbert, 1865-1935.
Date:
[1913], [©1913]
Catalogue details

Licence: Public Domain Mark

Credit: Treatment of internal diseases : for physicians and students / by Norbert Ortner ; ed., with additions, by Nathaniel Bowditch Potter ; tr. by Frederic H. Bartlett. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    27/660 (page 15)
    venient administration in drop doses. The initial dose is usually 20 drops three times a day, gradually diminished. Where the internal administration of digitalis is impossible and where a rapid action is desired, it may be injected subcutaneously or intramuscularly. An ice-bag may be put over the site of injection to relieve the pain. In cases of emergency it is best injected into a vein. The technique is as follows: Circular compression is applied to the upper arm until the veins of the arm stand out prominently. The needle is then intro- duced into a large vein at the bend of the elbow and the piston drawn in slowly to make sure the needle is in the lumen of the vein. The compression band is now removed and the contents of the syringe emptied slowly in the direction of the heart. The skin and syringe should be made aseptic as in a surgical operation. The site of the puncture should be protected by collodion, or zinc oxide plaster or a sterile bandage. The dose is 1 cm. (15 drops) repeated two or three times a day. [During the past three years, I have been unable to obtain constant, prompt and lasting digitalis effect with digalen. Hale's conclusions, published in the 74th bulletin from the Hygienic Laboratory, follow: Digalen is not a uniformly stable preparation, as is shown by the gross appearance of sample 1, and by biologic tests of the five differ- ent samples. Biologic tests also indicate that digalen is relatively much less potent than corresponding amounts of crystalline digitoxin, but that it is of about the same activity as digitalein. The experiences of clinicians vary, some reporting good results from the use of digalen, but many reports indicate that it is much less effective than is claimed, and that the secondary action of the digitalis group appears equally often after its use as with the older and cheaper galenicals. Its use in cases of acute heart failure, whether by intramuscular or intravenous injection, seems to open serious objection (on account of the pain and danger of thrombosis), and it would apparently be better practice in such cases to use either an assayed strophanthin, to be given intramus- cularly or intravenously, or very small amounts of one of the prepara- tions of the suprarenal gland by intravenous injection.] Digipuratum.—Digipuratum is a greenish powder which has been used with good results, instead of the powdered digitalis leaves or of one of the glucosides. It comes in compressed tablets each of which corre- sponds to 0.1 G. (gr. iss) of the digitalis leaves. The daily dose is 3 to 4 tablets, gradually reduced. The author has seen sudden signs of intoxication (vomiting) from its use. [I have noted the same toxic symptoms, but attributed them to too large doses. In more than 180 cases of primary and secondary heart disease reported from the Massachusetts General Hospital, no toxic signs were noted, but only prompt and characteristic digitalis effect.] Greater Effect of Digitalis in Mitral as Compared with Aortic Lesions. —The valvular lesions in which, in practice, we use digitalis or its glucosides are those with broken compensation. It must be borne in mind