Antall József szerk.: Orvostörténeti közlemények 115-116. (Budapest, 19869

KISEBB KÖZLEMÉNYEK — ELŐADÁSOK - Ringelhann, Béla: A digitalis 200 éve az orvostörténetben (angol nyelven)

an observer that of a historian, from that he should never depart, his chief merit is: correctness and fidelity. ' ' [32] The most widely used equipment of the internist, the phonendcscope, helped in the identification of heart murmurs and in the more extended use of the Digitalis. Fraser recommended Stropantin in 'k' form (the name was given bay Livingston, it means 'kombi') and the so-called "Stosstherapie" which is faster than the Digitalis. There were many scientists who tried to improve on the positive effects of the Digitalis. The most prominent among them were the German Schmiedeberg and Lange ndorf, who were able to perfuse isolated mammalian hearts, Sahli, Romberg, and last but not least the internationally acclaimed Frigyes Korányi. [33] The discovery of auricular fibrillation was announced in 1901; that is the ''flimmern'' of the atrium which contracts 350 to 400 dines during one minute. The ventricle does not keep up with this very high rate. [28] The verb "flattern" also means a very fast movement, but not as fast as fibrillation is; the ventricle contacts 2:1 or 4:1 in this case. When the atrium and ventricle are arrhythmich the stimulation diminishes and starts descending from the sinus to the atrioventricular node (Aschoff-Tawara). Studies on systole and diastole were completed around 1905. Cloetta in Zurich, Windaus in Göttingen and Jacobs in the Rockefeller Institute worked on the production of the drug later. After twenty years there were still arguments concerning the question whether the cardiac output increases or dicreases under the effect of the Digitalis. The conclusion is that the Digitalis has a positive inotrop action by enhancing contraction in the heart (systole) and the outflow of the blood. [33] The drog activates the reserve energy of the heart. Overdosing it causes the dicrease of the contraction, thus a negative inotrop effect develops. The amount of the reserved energy depends on the actual state of the heart: if it is oedemic even after hypertension if heart failure develops. Digitalis helps the recovery of the reserve energy. [4] New diuretic drugs appeared on the market in the market in the second half of the 20th century which modified the therapy. The Hypothiazid and other drugs increased the excretion of fluid and Potassium, and this decreased the effectiveness of the drug, because it increased the Potassium intake. In 1970 the beta blockers were introduced, and very soon they became widely used. Other diuretics and the so-called long acting Nitrates were used as well. Calcium chaneil blockers which inhibited the movement of Calcium from the extracellular into the intracellular space were employed. Overviewing the studies on the effects of the Digitalis. Mulrow and his co-workers came to the conclusion in 1984 that the results were contradictory 736 articles were published in English scientific literature between 1960 and 1982 which used Digitalis in the therapy of sinus rhythm and congestive heart failure. There were only two double blind experiments which reculted in useful conclusions. One stated that Digitalis can be left out of the treatment of sinus rhythm and congestive heart failure, that mostly means the omittion of the drug from the treatment of elderly peopie. Where the heart failure is more serious and the chardiac output is diminished, the Digitalis treatment is to advantage. [35] German literature came to similar conclusions. About 3 million peopie take Digitalis over the age of 65. This amounts to a high risk because about 20 % of them develop an intoxication from