Digoxin

“ In India the decoction is given internally, 200–250 grams, for hypertrophy of the liver, and it is considered a good diuretic and alterative. For such uses they heat the above dose in a clay vessel till the color changes from green to brown, when it is cooled and given next day. Its action is diuretic and hydragogue-cathartic. Mooden Sheriff recommends this treatment highly, and for dropsy further advises the aqueous extract, 12 grams during the day divided into 3 or 4 doses. ”

“ Digitalin and digitoxin are par excellence the poisonous principles of the plant. Toxiresin is also intensely poisonous. It may be obtained in crystals by extracting the dry exhausted leaves with alcohol of 50 per cent., precipitating with lead acetate, and washing the precipitate first with a dilute solution of sodium carbonate (to remove colouring-matter) , and then with ether, benzene, and carbon disulphide, in all of which it is insoluble; on decomposing the lead compound, digitoxin may be obtained in colourless scales or needle-shaped crystals. ”

“ There is, indeed, no difficulty in producing the characteristic effects of nicotin by administering tobacco smoke, either in man or in animals. [45]
Nicotin causes brief stimulation of brain and spinal cord, followed by depression. There is an increased flow of saliva, followed by a decrease (large doses diminish it at once) and often nausea, vomiting and diarrhea. The heart action is at first slowed and the blood pressure increased. Subsequently there is a depression of the circulation, with rapid heart action and lowered blood pressure. ”

“ When it is desired to settle the maximum safe dose for the various tinctures, extracts, and infusions of digitalis used in pharmacy, there is still greater difficulty, a difficulty not arising merely from the varying strength of the preparations, but also from the fact of the vomiting almost invariably excited by large doses. Individuals swallow quantities without death resulting, simply because the poison is rapidly expelled; whereas, if the œsophagus was ligatured (as in the experiments on the lower animals formerly favoured by the French school of toxicologists) , death must rapidly ensue. ”

“ They found, however, that it required 1000 to 2000 times the amount of antitoxin in such cases than was required when it was mixed with the toxin prior to injection. They found, moreover, that when the disease is fully developed the dose must be 150 times more than is required when the first symptoms are shown. It should be added that when the disease has developed rapidly, after a short incubation, and is well advanced the antitoxin treatment is usually of little avail. The changes in the nerve centres are already too great to allow hope of recovery. ”

“ One of the principal considerations which led the Council to accept Digalen was that it was regarded as affording a fairly constant and stable preparation of digitalis suitable for intravenous administration. If Digalen is not fairly stable and of fairly constant composition it has no obvious advantage over an active soluble digitalis preparation, such as digitalein.
The evidence now at hand seems to show: 1. Digalen is not of constant composition or activity. 2. The manufacturers, or their agents, continue to make misleading statements. ”

“ Follow with purgative of sulphate of soda and diuretics especially potassium iodide. Potassium bromide, sodium salicylate or salol may be given to calm nervous excitement and check fermentation. Degoix recommends chloral hydrate, enemata, cold to the head, and counter-irritants and in very prostrate conditions stimulants may be employed.
The most important measure, however, is the cutting off of the supply of the poison and the administration of a wholesome diet. Medicinal treatment is too often unsatisfactory and will seldom pay for the trouble ”

“ Digitalis bodies are not suited for the treatment of all cardiac disturbances, and it is, of course, self-evident that a time must come in the treatment of chronic cardiac disease when the heart is incapable of responding to any form of treatment with improvement. But, unfortunately, it never loses its response to toxic doses, and to push the administration of any drug or mixture containing any drug of the entire digitalis group—and especially those, like squill, in which the side actions are most prominent—beyond the point of tolerance is to court certain disaster. ”

“ Opium and BELLADONNA are antidotes to each other, and if a person has taken an overdose of one, the other should be given if it is at hand. Evacuate the stomach perhaps by tickling the fauces; give also strong coffee, active stimulants, witch hazel; employ friction, perhaps electro magnetism, and keep the patient moving. Morphine of course demands the same.
For NUX VOMICA and STRYCHNINE, besides giving an emetic give aromatic spirits ammonia, and also chloroform internally in 1⁄2 drachm doses diluted. Give tannin and also animal charcoal, milk and spirits camphor in large doses. ”

“ Everything tends to show that nicotine may be detected by other processes. Thus by treating the digestive canal with absolute alcohol, with the addition of a little soda, it would be dissolved, and by the reaction of the soda, a soap would be formed with the fatty matter, which would set free the nicotine; it would then only remain to distil it by heat, after having evaporated to dryness. Perhaps, also, it might be separated by acting on the tissues with pure soda or potash, then evaporating to dryness and heating it in closed vessels. ”

“ Nicotin is an alkaloid, and one of the most deadly poisons known. In distilled form, nicotin, even in minute quantities, produces death almost instantaneously. The nicotin contained in a pound of tobacco is sufficient to kill several hundred men if administered in the form of pure nicotin, but in smoking and chewing tobacco only a small amount of this poison is absorbed into the body at one time, and, owing to the gradual growth of the tobacco habit, the system has time to partly adjust itself to the use of this powerful drug, enough at least to prevent acute narcotic poisoning. ”

“ Large doses of ammonia preparations cause burning pain in the throat and abdomen, vomiting, purging, and collapse.
Antipyrin.—This drug has about the same action and uses as acetanilid, and may be given in the same dose.
Antitoxin of Diphtheria.—This is obtained from healthy horses which have been rendered artificially immune to diphtheria from having received a prolonged course of treatment with diphtheria toxin in doses gradually increased. The immunity is due to the formation in the blood of a substance which in some way counteracts the poison or toxin of the disease. ”

“ Besides this, care should be taken that the germs are not carried to others by the use of eating utensils, such as cups, glasses, spoons, forks, or plates. All of these should be sterilized with boiling water after each meal.
ANTITOXIN TREATMENT.
Depending on the way it is treated, diphtheria is one of the least dangerous or one of the most dangerous diseases. It is one of the least dangerous when promptly treated with antitoxin; it is one of the most [8] dangerous when the antitoxin treatment is not given, or is delayed or insufficient. ”

“ Even were it granted that pancreas extracts are valuable in the treatment of diabetes, and that gold and arsenic also have beneficial effects, it is our opinion that Trypsogen should be considered an unscientific shotgun mixture, because fixed combinations of remedies of different potencies, such as arsenic, gold, bromid and pancreas, are therapeutically erroneous, as they do not permit of that accurate adjustment of dosage of each ingredient that is indispensable to obtain maximum benefit with minimum danger of poisoning. ”

“ This fact alone, however, would not warrant any very trustworthy conclusions as to the influence of curare upon discharging centres; for it is not improbable that the paralyzing effects may here be due to the influence of the poison on the surrounding contractile tissue.
It is interesting to observe that if the discharging lithocyst be injected with chloroform, or a not too strong solution of morphia, it recovers in the course of a night. With alcohol the first effects of the injection are considerably to accelerate the frequency and to augment the potency of the discharges ”

“ On Digitalis, with Some Observations on the Urine, Lond., 1868.
§ 543. Action of the Digitalins on the Muco-Intestinal Tract and other Organs.—In addition to that on the heart, there are other actions of the digitalins; for example, by whatever channel the poison is introduced, vomiting has been observed. Even in frogs this, in a rudimentary manner, occurs. The diuretic action which has been noticed in man is wanting in animals, nor has a lessened diminution of urea been confirmed. ”

“ Birds also show tetanic convulsions followed by paralysis and speedy death. The symptoms witnessed in mammals poisoned by nicotine are not essentially dissimilar. With large doses the effect is similar to that of prussic acid—viz., a cry, one or two shuddering convulsions, and death. If the dose is not too large, there is trembling of the limbs, excretion of fæces and urine, a peculiar condition of stupor, a staggering gait, and then the animal falls on its side. The respiration, at first quickened, is afterwards slowed, and becomes deeper than natural ”

“ On the basis of the claimed composition, the action of Hydropsin must be essentially that of digitalis or of digitalis and squill. Consequently, if it possesses “unusual potency,” it cannot possess “relative harmlessness,” and vice versa. Neither digitalis nor squill should be employed “in all cases” of nephritis, even if it is “desirable to increase the volume of urine.”
The composition claimed for Hydropsin brands it as an irrational mixture in which potent drugs are combined with, and more or less covered up by, others that are obsolete and inefficient. ”

“ The treatment of diphtheria in man by the antitoxic serum thus obtained has proved to be remarkably successful. Furthermore, if a susceptible person who has been exposed to the infection of diphtheria, is injected with a small dose of antitoxic serum, he becomes temporarily immune, and does not fall a victim to diphtheria. This is a most important point especially for young children, who may already be incubating a disease which but for this prophylactic injection might occur and prove fatal. ”

“ The leaves and seeds. These contain the digitalis glycosides, chiefly digitoxin, which is a powerful heart stimulant. Poisoning is characterized by nausea, vomiting, and dizziness and can be experienced several hours after ingesting the plant parts. The plant is severely poisonous and can cause heart failure because of its powerful action on the heart muscles.
Antidotes: Call your doctor. Have patient vomit. Physicians perform gastric lavage and treat for digitoxin and digitalis glycoside poisoning. ”

“ Omitting unnecessary details, we may describe the process of obtaining diphtheria antitoxine as follows: A certain amount of diphtheritic poison (of the bacteriological sort, prepared by cultivating the diphtheria microbe) is injected into the circulation of a horse--sufficient to make the horse sick, but not enough to endanger his life. The horse's system straightway begins to elaborate the protective antitoxine, and there results from this one injection a sufficient amount of it to save the horse, although far too little to make the serum of his blood potent enough for medicinal use. ”

“ It is certain that a mere "sore throat," not serious enough to be diagnosed as diphtheria, cannot produce paralysis or heart-failure; but we know positively that the antitoxin can do it and does do it. The cases that Dr. Osler refers to undoubtedly received the antitoxin treatment, because it is administered on the slightest suspicion of diphtheria, nay, even to perfectly healthy persons "for purposes of immunization." ”

“ It is doubtful whether the stomach pump can be ever applied with benefit in strychnine poisoning, the introduction of the tube is likely to aggravate the tetanus, but apomorphine can be injected subcutaneously. Large and frequent doses of chloral should be administered in order to lessen the frequency of convulsions, or prevent their occurrence, and it may be necessary in a few cases, where death threatens by suffocation, to perform tracheotomy, and to use artificial respiration. ”

“ On the other hand, single doses of from 1 to 4 grms. have caused serious poisonous symptoms. The extract and the tincture are seldom given in larger doses than that of a drachm as a first dose, to excite uterine contraction. In fact, the medical practitioner has in many cases to experiment on his patient with the drug, in order to discover, not only the individual susceptibility, but the activity of the particular preparation used. From the experiments of Nikitin, it is probable that the least fatal dose of sclerotic acid for an adult man is 20 mgrms. ”

“ It may be readily conceived that the research for absorbed nicotine might be fruitless in those cases where death was occasioned by only a few drops of this body; but then the presence of the alkali may be detected in the digestive canal.
Gentlemen, after results such as those obtained by M. Stas and myself, society may feel satisfied. Without doubt intelligent and skilful criminals, intent on puzzling the Chemists, will sometimes have recourse to very active poisons, but little known to the community at large, and difficult to detect; but science is on the alert to surmount all difficulties. ”