DIAPHRAGMATIC HERNIA DIAGNOSED DURING LIFE

1920 Journal of the American Medical Association (JAMA)  
been observed.4 The administration of single doses equivalent to 1 minim per pound is inadvisable except in the presence of urgent heart failure, when the patient is in bed and when prompt results are demanded. It should never be attempted under any circumstances if the patient has received any preparation of digitalis or its allies within a period of two weeks. It seems plain that when we are desirous of main¬ taining a continuous effect from digitalis, it is unneces¬ sary to give it at less
more » ... o give it at less than six hour intervals, for the maximum effect of any one dose will not be reached until six hours after its administration. A twenty-four hour interval between doses would appear to be quite satisfactory for maintaining a continuous effect; in fact, I have found it so during the experience of the last two years. One dose can be given each night and will carry the patient until the next night. A dose of 20 minims daily, which is the average amount that the body can dispose of in twenty-four hours,6 will suffice in the great majority of patients to maintain the desired digitalis effect which has been produced by a series of larger doses. It is furthermore plainly inadvisable to give a sec¬ ond dose at an interval of less than six hours after a large initial dose such as has been recommended, for the full effect of the first dose will not be manifest until this time has elapsed. It would be more reasona¬ ble to wait for twelve or eighteen hours before giving the second dose, for by that time early toxic signs might make their appearance and warn us that more of the drug would have no further beneficial effect on the heart, and would only produce the undesirable phenomena of poisoning. 74 West Forty-Eighth Street.
doi:10.1001/jama.1920.02620450024010 fatcat:zbzpepoogbc43mww2pvkvdig7e