THE ACTION OF DIGITALIS IN PNEUMONIA

We have shown in a series of 105 cases of pneumonia, 95 of which we have selected as available for statistical study, that digitalis given by mouth has an action on the heart. We have judged this action to be present because changes occurred in the auriculoventricular conduction time and in the form of the T wave of the electrocardiogram, just as they do in the non-febrile heart. This conclusion is strengthened by finding that the pulse rate in fibrillating and fluttering cases fell in the presence of fever, exactly as it does in non-febrile cases. The dose and the time required to produce these effects are given and are the same as in the non-febrile cases. When there was a difference in the amount necessary to produce one or the other of the changes, it was found that the T wave is more often and more readily affected than the conduction interval. We have shown that the intoxication due to pneumonia is probably not responsible for the changes found, both from a study of the statistics and because in the control cases reverse tendencies were often found (that is, decrease in conduction time and increase in the size of the T wave). We have shown that the method of selection in consequence of which we treated a large number of severe cases did not prejudice our results, because it could be demonstrated that the proximity of death, whether in control or treated cases, was not necessarily associated with the changes we are describing. We have also, by referring to the literature of the subject, brought evidence to show that heart muscle does not undergo those changes in pneumonia, as it does in other infectious diseases, which would lead one to expect changes in conduction found in other diseases. The changes in conduction which have been reported by others were almost entirely associated with the giving of digitalis.