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April 1959

AugmentationA Third Stage of Digitalis Therapy

Author Affiliations

Birmingham, Ala.

From the Department of Medicine, Medical College of Alabama.

AMA Arch Intern Med. 1959;103(4):543-550. doi:10.1001/archinte.1959.00270040029003

William Withering, in 1785, stated, in referring to digitalis: "Let the medicine therefore be given in the dose and at the intervals mentioned above:—let it be continued until it either acts on the kidneys, the stomach, the pulse, or the bowels; let it be stopped upon the first appearance of any of these effects."1 Since that time, however, it has become common medical practice to digitalize a patient initially and then to assume that a full effect will persist with an average maintenance dose. The purpose of this report is to call attention to a third stage of digitalization, following those of initial digitalization and maintenance: that of periodic augmentation.

Subject and Methods  Thirty-three patients were studied. Eighteen of them had been digitalized by other physicians in the conventional manner and maintained on an average maintenance dose without interruption for periods varying from 1 month to 15 years. Eleven

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