Teleology and Evolution

Another application of it is very importalnt, and that is its absorption through the skin. In many instances, it is desirable to bring out the action of the digitalis when the risk of disordering the stomach may act as a check, or even wlhen there is already great gastric disturbance. Here it may be used by either poultices of the leaves, or flannels soaked in the infusion, or a muixture of the tincture and water applied to the abdomen and thiglhs. Cases are given by Christison of such use of it. Trousseau relates a very initeresting case where very decided results were thus obtained (vol. i, chap. xxxv). Some cases were recently detailed in the journals of such use of it. This manner of administering digitalis should never be lost sight of, as it may now and then enable us to do what we canniot accomplish by the mouth. Hypodermic injection is another mode of administering it which should not be overlooked. Certainly, in the experiments on frogs, this was chiefly resorted to oni account of its convenience. Bouillaud pursued an endermic treatlmienit by dusting a blister over the heart, with from six to fifteenl grai us of psowdered digitalis. These various modes of administering digitalis lhave each their advantages according to peculiar circumstaniccs. No one plan of action must bind the practitioner's mind in fetters. IIe must be ready and willing to use each in its place, or even to substitute for digitalis some drug of similar action. From the known in-toleraince of mercury in some constitutions, and niotably in those sufferin-g from cirrhosis of the kidney, which is often followed by consequent t lhcart-Lmischief, with its train of sequele, the old combination of digitalis, squill, and blue pill may have to be abandoned, and for the blue pill iodide of potassium substituted. Patients' prejudices, as wvell as their needis, must be consulted. It is much to be desired that some drug imiay be discovered with equal properties to digitalis, and about whose action no preconceived opinions, based on imperfect observationi, in.-y bias the minds of medical men. It would be easier to establisli thi use of such an agenit especially in this experimental age, than to wsar a-ainst a settled impression. And though at present the list of agents possessing an action on the heart, and through it a control over tele circulation, may be a very limited one, but at the same time very important, the day is not far distant when the importance of inquiry in this direction will make itself felt. I have not claimed for digitalis anythinifor which it cannot fairly substantiate its claim, nor lhave I accorded to it any mystical action, differing from that of any other therapeutic aget. I have striven, as far as possible, to exercise the functions of a jIl11ge, as well as of an advocate, and tried fairly to lay down wlat, in the present state of our knowledge, digitalis can do, and what it caiiiio'. d I am quite willing to labour under the disadvantagTe of being rl-arded as an enthusiast, if only the subject can get that attention iit to it that it deserves ; anid my experience tells me in languabe thV t as uarmintakeable, that the effect of agents upon the heart, of wlhich dii1a'lUs is the most powerful one with which we are yet acquainted, can Ino ln'ctr be overlooked by any one in the profession who regards citlhc i, oIii interests or those of his patients.