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As there is always more or less paresis and dilatation of the large veins of the splanchnic system, a tight bandage about the abdomen is of great advantage in raising the blood pressure to the safety mark. Strophanthin, given intravenously, is valuable as a quick restorative of the heart. Digitalis is so slow that it is of little value in an emergency. The camphor may be repeated frequently.
Strophanthin may be given intravenously. One of the greatest cares in the treatment of heart failure in pneumonia should be not to give too many drugs or to do too much.
Strophanthus is given either in the form of the tincture, or as strophanthin. It has been shown that in neither of these forms, when the drug is administered by the stomach, is the muscle of the heart or the blood vessels much acted on. Compensation could not be restored by strophanthus. In emergencies of serious cardiac failure, strophanthin intravenously has been shown apparently to save life.
"'I made a post-mortem examination of the body and found that death was due to poisoning by strophanthin, which appeared to have been injected into the thigh. The two tubes which I found on the dressing-table would each have contained, if full, twenty tabloids, each tabloid representing one five-hundredth of a grain of strophanthin.
In sudden cardiac insufficiency, provided digitalis has not been given in large doses a short time before, strophanthin may be given intravenously once or at most twice at twenty-four-hour intervals. If, in this more or less serious condition of the heart weakness, there is great sleeplessness, a hypnotic must sometimes be given, and the safest hypnotic is perhaps 3 / 10 grain of morphin.
"'On the dressing-table were two glass tubes labelled "Hypodermic Tabloids: Strophanthin 1/500 grain," and a minute glass mortar and pestle, of which the former contained a few crystals which have since been analysed by me and found to be strophanthin. "'On examining the body, I found that it had been dead about twelve hours.
It was lying on its back on the bed, which did not appear to have been slept in, and showed no sign of any struggle or disturbance. The right hand loosely grasped a hypodermic syringe containing a few drops of clear liquid which I have since analysed and found to be a concentrated solution of strophanthin.
The strenuous measures that should he used to lower a high diastolic pressure are contraindicated when the diastolic pressure is already low, even if the systolic pressure 1s high. If a high systolic pressure begins to fall more or less rapidly the heart shows fatigue, and should be stimulated by digitalis or strophanthin.
The treatment of such an undesired behavior of digitalis is, of course, to stop the drug immediately, give saline laxatives, hot sponging or hot baths, nitroglycerin and perhaps alcohol. Strophanthus: Strophanthus cannot be compared with digitalis, except when the glucosid, strophanthin, is administered subcutaneously or intravenously.
The dose of strophanthin, Merck, ranges from 1/500 to l/200 grain. The intravenous dose of strophanthin, Thoms, is about 1/130 grain. It should not be repeated within a day or two, if at all. Ampules of strophanthin in solution for intravenous use are now available.
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