E. A. Farrington was born in Williamsburg, NY, on January 1, 1847. In 1866 he graduated from the Homeopathic Medical College of Pennsylvania. In 1867 he entered the Hahnemann Medical College, graduating in 1868. He entered practice immediately after his graduation, establishing himself on Mount Vernon Street.
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DIGITALIS contains among other ingredients two substances, one known as DIGITALIN, the other as DIGITOXIN. The latter is found in larger quantity than the former. DIGITALIN has been proved separately from the Digitalis. Its symptomatology, however, is, like all other alkaloids, very nearly identical with that of the original drug.
Digitalis produces among other symptoms, very early in the proving or in poisoning cases, the most distressing nausea and vomiting. This emesis is often accompanied by a deathly faint, sinking sensation at the pit of the stomach. The surface of the body is often cold, and sometimes covered more or less with cold sweat. The pulse is irregular. These early symptoms of Digitalis remind you of several other drugs, notably, ANTIMONIUM TARTARICUM, TABACUM and LOBELIA. It is quite likely that both the latter drugs and Digitalis cause this nausea and vomiting by affecting the base of the brain, acting there upon the pneumogastric nerves as they Leave their origin. Such symptoms as this deathly nausea and vomiting might suggest Digitalis in the vomiting attendant upon cerebral disease, with meningitis, for instance, whether the meninges of the cerebrum alone, or of the cerebrum and cord combined, are involved in the inflammation.
It may even be used in the nausea and vomiting of pregnancy, and in the incipiency of abortion. One of the provers, a pregnant woman, took an overdose of Digitalis and in consequence was seized with this same deathly nausea and a flow of blood from the vagina.
We may also study Digitalis in its action on the heart. Through irritation of the pneumogastric nerves, we have inhibition of the heart’s action. As a consequence of this effect of the drug, the pulse becomes slow. Arterial tension is greatly increased, probably owing to the action of the drug on the vaso-motor centre, which is supposed to be at the base of the brain ; the pulse is therefore primarily strong. In addition to the effect of the drug on nervous structure, we must remember it also affects muscular tissue, both of the striated and non-striated varieties. Thus it causes weakness of the cardiac tissues. This weakness varies all the way in intensity from a simple weakness to a complete paralysis of the muscular fibre. Consequently, we may very soon have added to these other symptoms, weakness of the pulse. Every little extra exertion, such as that incurred while rising from a sitting to a standing posture, increases the rapidity of the pulse, but the force of the beat is diminished. This quick pulse may become irregular, and even intermittent. With this view, then, of the physiological action of the drug, you may understand the following symptoms of the heart and respiration connected therewith.
But first let me here give you a word of caution respecting the use of Digitalis in heart affections. The tendency of this drug, like that of Lachesis and Arsenicum, is downwards. You must not use it, therefore, indiscriminately or carelessly, but only when you are guided to its selection by the symptoms of the case, or you will certainly make your patient worse. In organic diseases of the heart, Digitalis must be used with extreme caution, because it may hasten the period when nature is no longer able to compensate for the interference in the circulation by hypertrophy of the heart muscle. Nature thus may be compelled to give out. Then the heart yields to the pressure of the blood within its cavities and begins to dilate; and then we will have the train of symptoms which I will shortly give you as belonging to Digitalis. This warning is particularly applicable to the use of the drug in large doses. Given thus it may relieve for a time, but it only hastens the fatal end. With this word of warning I now proceed to give you in detail the heart symptoms of Digitalis.
The heart feels as though it stood still, and this sensation is attended with great anxiety. There is a sort of indescribable uneasiness in the cardiac region which may be expressed as a sense of oppression or as tightness about the heart, or only as an uneasy feeling with weakness and numbness in the left arm. There is a feeling of goneness or sinking at the epigastrium. This is sometimes relieved by eating, but often comes on worse after eating, particularly after breakfast. There are sharp sticking pains in the region of the heart. Sometimes there is choking when trying to swallow, from reflex spasm of the glottis. The pulse is slow, often slower than the beating of the heart. In these cases, the heart beats so imperfectly that some of its pulse waves are not transmitted appreciably to the radial artery at the wrist. Any movement, such as rising from a chair, getting out of bed, or increasing the speed in walking, increases the rapidity of the pulse but causes no increase in the force of its beat. The irregular distribution of the blood owing to these alterations in the heart’s functions is exhibited in quite a variety of symptoms. In extreme cases, for instance, we find even cyanosis, which suggests Digitalis as a possible remedy for cyanosis neonatorum. The child turns blue and falls into a syncope on the slightest motion, or else it becomes deathly sick, as you see from the expression of the face and from the involuntary gagging. If you can feel the pulse, you will find it irregular both in rhythm and volume; the surface of the body is cool. The borders of the lips are blue or purple. The child is blue around the eyes. The veins wherever they show through the skin are seen to be dark.
Other and more common illustrations of the irregular distribution of the blood may be shown in the sleep. The patient’s sleep is uncomfortable and restless. He dreams a great deal; he starts up from sleep dreaming that he is falling from a great height. Sometimes, he awakens with an anxious or distressed feeling, which he may be unable to locate, but which proceeds from the cardiac affection. Mentally, the Digitalis patient, besides being anxious, has those gloomy forebodings incident to heart disease. He has an apprehensive feeling, ill-defined it is true, yet none the less terrible. He is apt to be sad and depressed as well as anxious. The respiration is of course changed by this action of the heart. We frequently find breathing deep, sighing and slower than normal. This symptom is almost pathognomonic of heart affection. There is often a desire to take a deep breath, but an attempt to do so only seems to result in half-filling the lungs, which do not expand to their full capacity. Often this is attended with dry cough, which seems to be excited by deep inspiration. The deeper they attempt to breathe, the more likely are they to cough. This is a bronchial symptom altogether, and comes on from over-filling of the bloodvessels there. Suffocative spells with painful constriction of the chest, as if internal parts of the chest were grown together, are not uncommon. Sometimes, these force the patient to sit up in order that he may breathe. With these cardiac symptoms you will find Digitalis indicated in several varieties of diseases starting remotely from the heart, and yet depending either directly or indirectly upon the disease of that organ.
In almost all the affections in which Digitalis may be used there is present some one of these forms of pulse, either a slow pulse or a feeble pulse becoming irregular or quick.
For instance, dropsy may be developed and may call for Digitalis. This dropsy is not of renal origin. You would hardly think of Digitalis in dropsy resulting primarily from liver or kidney disease, but in that form occurring primarily from cardiac debility, it is at times an invaluable remedy.
Digitalis may be used with profit in a number of forms of dropsy. You may give it in anasarca when the surface of the body is bluish, rather than of the alabaster-like appearance characteristic of renal dropsies. Local dropsies, too, are present. Thus you find Digitalis indicated in hydropericardium, and even in hydrothorax and ascites, if they are connected with heart disease. In dropsies of the chest there is a remedy that is often forgotten, and that is the Sulphate of Mercury or MERCURIUS SULPHURICUS. Especially is this remedy useful when the chest dropsy occurs from heart or liver disease. When it acts well it produces a profuse watery diarrhoea with great relief to the patient. A very common form of dropsy calling for Digitalis, is infiltration of the tissues of the scrotum and penis. We may even use Digitalis in hydrocele when the cardiac symptoms calling for that remedy are present. The urine is often suppressed or very scanty. This deficiency in the renal secretion depends upon disordered circulation, and not upon primary disease of the kidneys. This urine may be dark red, or it may be albuminous.
Then, too, we find Digitalis causing some liver symptoms which are worthy of notice. But here, too, I hardly think that Digitalis has a direct action on the hepatic cells, affecting the secretion of bile; but in jaundice in which the primary trouble is a cardiac disease of the type already mentioned, with ashy white stools, Digitalis certainly acts admirably.
The liver is somewhat enlarged and feels sore, as if bruised. Objectively examined, it is found to be somewhat indurated. With this symptom we have jaundice. The taste is bitter, or at other times, sweetish. The tongue may be perfectly clean, or at other times may be whitish-yellow. The pulse is slow, even slower than the beating of the heart. Drowsiness may supervene and even increase to stupor. The stools are of the character above mentioned. The urine is high colored from admixture of bile pigment. This jaundice calling for Digitalis is not such as follows retention of bile or as that caused by catarrh of the duodenum or by some obstruction of the biliary ducts, but it is due to an actual functional imperfection of the liver, that organ not taking from the blood the elements which go to form the bile.
A remedy which here compares favorably with Digitalis is MYRICA CERIFERA, which has the following symptoms : First, despondency, that state of mind depending upon the disordered condition of the liver. The symptoms of Myrica are similar to those of Digitalis, because the origin of the jaundice is somewhat similar; because in each, case the jaundice is due to the imperfect formation of bile in the liver, and not to obstruction in the flow. But the two remedies are very different in their absolute effects on the system. With the Digitalis, the jaundice is traced back to the condition of the heart. With Myrica, the case seems to be functional rather than organic. For some reason the bile is not properly formed, and therefore its elements remain in the blood. The heart is affected secondarily, slowness of the pulse thus being produced. The symptoms calling for Myrica are these: Despondency, dull heavy headache, worse in the morning; the eyes and sclerotic have a dirty, dingy, yellowish hue, the lids themselves being abnormally red; the tongue is coated a dirty yellow. The patient is Weak and drowsy, and complains of muscular soreness and aching in the limbs. The pulse is slow. The urine is dark and turbid. You recognize at once the resemblance to Digitalis; but it is more superficial in its action than is that remedy, and would not be suitable for so violent a case.
In heart affections you may compare Digitalis with quite a number of remedies, notably, with KALMIA, ARSENICUM, HELLEBORUS and CONIUM.
KALMIA LATIFOLIA is a drug which belongs to the order ERICACEAE, along with RHODODENDRON and LEDUM PALUSTRE and other remedies. It is a valuable remedy in rheumatism when it affects the chest. The pains in the Kalmia affection of the heart are sharp, taking away the breath; the patient at most suffocates, so severe are the pains. The pains shoot down into the abdomen or stomach ; the pulse being slow, almost as slow as that calling for Digitalis. Kalmia is especially useful when gout or rheumatism shifts from the joints to the heart, especially after external applications to the joints. I refer here especially to the applications to the joints, of substances that are not homeopathic to the case. If you were giving ARNICA internally and applying it locally, and if it were the indicated remedy, there would be no danger of metastasis. But if some one apply tincture of Aconite to the affected joint there would be danger of the inflammation travelling to some more vital part. The Kalmia rheumatism, like that of Ledum, almost always travels upwards.
HELLEBORUS is similar to Digitalis in the slowness of the pulse. The respiration is also slow and the temperature of the body is greatly diminished, often being as low as 95° or 96° F. There is generally cerebral disease.
SPIGELIA also must be compared with Digitalis. It has the following symptoms: Sharp pain shooting through the heart to the back, or radiating from the heart and down the arm or over the chest and down the spine; great oppression or anxiety about the heart; palpitation of the heart worse from any movement of the arm or body; thrilling or purring sensation is felt over the cardiac region (this is just such a thrill as you feel when stroking a cat’s back when the animal is purring) ; blowing sound over the heart. You will find Spigelia indicated when these heart symptoms accompany other affections, for instance neuralgia, particularly if it affects the left side of the face, commencing in the occiput and settling over and in the left eye. That is the Spigelia headache. Its aggravation follows the course of the sun. It commences in the morning, reaches its acme at noon and diminishes towards night. You may also use it in ciliary neuralgia with these accompanying sympathetic symptoms of the heart. Sharp pain shoots through the eye-ball and radiates in all directions, almost driving the patient mad. At other times there is a sensation as. if the eye were being squeezed in a vice or as if it were enormously enlarged and was being pushed out of the head. It is one of the chief remedies to be thought of in iritis with excessive pain. I wish also to mention a symptom for Spigelia that the late Dr. Jacob Jeanes confirmed many times, and that is intermittent pulse. He prescribed this remedy as an intercurrent, in many varieties of disease, when the pulse assumed this character.
It will not be unprofitable for us next to study the action of Digitalis on the brain. It causes symptoms which are very much like those of meningitis, even meningitis with effusion, or hydrocephalus, and also in cerebro-spinal meningitis. The symptoms from which you will have to decide are these: There is throbbing headache which is referred to the forepart of the head; delirium, which may be so violent as to simulate mania; decided errors in vision: bright balls of fire appear in the field of vision, or, like SANTONINE, objects appear of various colors, as blue or green. Still later, as the trouble progresses, mental confusion increases and amaurotic congestion of the retina takes place; the pupils become dilated and fail to respond to light and finally coma appears. There is great general prostration with coldness of the body, which is covered with a cold sweat. Even in these forms of cerebral disease, when Digitalis is to be your remedy, the pulse comes in as your chief guide. If the symptom buzzing in the ears, which, by the way, I forgot to mention as belonging to Cinchona, should suggest CINCHONA, I entreat you not to give it after Digitalis, for Hahnemann tells us that, although there is a similarity in the cerebral symptoms and in the weakness, yet the drugs are inimical.
Lastly we will speak of the action of Digitalis on the urethra and genital organs. Digitalis produces an irritation of the bladder particularly about its neck, this being catarrhal in origin. The symptoms are, strangury and frequent urging to urinate while the patient is up. The patient may also have frequent urging to urinate at night. The urethra is inflamed so that we have burning in the urethra with purulent discharge, thick in character and bright yellow in color. Now if you combine these symptoms with another one, namely, that the glans penis becomes inflamed with copious secretion of thick pus over its surface, you have a perfect picture of Digitalis in gonorrhoea. This form of the trouble, Digitalis will cure whether the pulse be slow or fast, soft or weak, or what not. Often, too, when Digitalis is indicated in this trouble, you will find the prepuce puffed up and infiltrated with serum. Let me say in passing that if the prepuce becomes indurated, Digitalis will do no good, but SULPHUR will.
The nearest remedy to Digitalis in gonorrhoea is MERCURIUS. This is a good remedy for gonorrhoea associated with inflammation of the prepuce, but with less oedema and more dark purplish swelling of the parts with phimosis or paraphimosis.
MERCURIUS CORROSIVUS is good in these cases when the glans has a dark red or gangrenous appearance.
In the beginning of these cases of paraphimosis, we may give COLOCYNTH, which will sometimes relieve the spasm and enable the prepuce to be drawn forwards over the glans.
PETROSELINUM is to be thought of as an intercurrent remedy in gonorrhoeal affections when the neck of the bladder is involved and there is sudden urgent desire to urinate. It seems as if the patient could hardly retain his urine until he gets to a convenient place.
Digitalis also produces violent erections, even chordee. It is one of our best remedies for involuntary seminal emissions during sleep, without dreams even. The emissions are followed by great weakness.