Dr. Fortier Bernoville to-day completes a series of lectures on the drainage of the circulatory system by the study of principal tonicardiacs. The most important point to note that the remedies described are no more Homoeopathic than Allopathic. They act before all in a physiological manner. Neither they act according to the law of similars nor according to the law of contraries. They act according to the law of equilibrium, added to the law of similars. They are much more palliatives and some physiological agents than remedies proper. These medicines are used in ponderable doses. They are used in Homoeopathic doses only when the law of equilibrium becomes related to the law of similars. They are used more to give relief to the patient than to cure. But they are of such practical importance that one should know fundamentally their physiopathology and their clinical indications. All these remedies are of vegetable origin.
Digitalis purpurea. It is according to the opinions of all, the king of tonicardiacs in chronic affections of the heart in opposition to Ouabine the most important remedy of acute heart conditions. Side by side with Digitalis purpurea there are other varieties of Digitalis but Digitalis purpurea is well known and more used.
1. Physiological action of Digitalis:
Two principal actions: Tonicardiac and secondarily diuretic. (a) Tonicardiac action: Digitalis in ponderable and sufficient doses cause bradycardia, action on the bundle of intracardiac conduction of Hiss and on the pneumogastric (intra and extra cardiac action).
The second important fact. Digitalis prolongs diastole. Thus the myocardia has more time to rest between the systoles, the ventricles are filled up and are emptied completely and if there is arrhythmia, the rhythm is regularised.
The third important fact. Digitalis acts specially on the right heart.
Given by mouth its action begins after 10 to 11 hours. The action is more clear in physiological doses if the patient is asystolic.
(b) Diuretic action: It is a result of tonicardiac action of the remedy. However, it has a direct action on the kidney by slight vaso-dilatation.
2. Toxicology of Digitalis
Since longtime the heart specialists have noted that when one goes beyond the useful dose of digitalis specially in some sensitive subjects there is produced: tachycardia with tachyrhythmia. Some extra-systole with bi-or trigemination and auriculo-ventricular blockage. The patient is pale, cyanotic, has low temperature, vomiting and diarrhoea. His liver is big. He has oliguria and anuria.
3. Action and indications of digitalis in homoeopathic doses Of all the tonicardiacs, which act very often according to the law of similars, is Digitalis. We must know that in homoeopathic doses, Digitalis has four important symptoms of its action from the point of view of four clinical Homoeopathic indications of the remedy.
(a) Tendency to oedema. Almost always with oliguria. More or less marked oedema, anasarca, ascites or slight oedema of the malleoles or of the lower eye lids. It is the tendency of oedema which clearly distinguishes Digitalis from Eel Serum in which there is oliguria or anuria without oedema.
(b) Action on the liver: A big liver, accordion liver which also indicates Digitalis, China and Phosphorus.
(c) Bradyarrhythmia: With bigeminal or trigeminal pulse. In grave cases alternate pulse.
(d) A subjective symptom of great value: Sensation: The patient thinks that he must remain immobile, if not, the heart will stop by the least movement. In Digitalis arrhythmia is clearly ameliorated by immobility. These symptoms are inverse of Gelsemium in which the patient thinks that his heart will stop if he does not move. Gelsemium is a remedy of less grave state than Digitalis and it is rather a remedy of palpitations with erethism of the heart, often with erethism of the heart after the abuse of tobacco or after a stay in a hot country.
Method of application of Digitalis and clinical dose of Digitalis Digitalis is a heroic remedy of asystole in chronic cardiac patients. It is used in various doses according to the different preparations. Digitoxin 5 drops during 5 to 10 days or 15 to 20 drops for several days. In tincture homoeopathically prepared with the fresh plant growing in the mountains (plants that grow in plains are less active), finally in the form of maceration or infusion of the leaves.
We must know that a gramme of powdered leaves of Digitalis is equal to 100 drops of Homoeopathic tincture and to 50 drops of Digitalis in 1,000 th. However, the maceration of leaves contains the property of the entire plant and is more active than digitalis (one will give for example 75 centigrams of the macerated powder of the leaves to be absorbed during 48 to 72 hours).