Digitalis purpurea

Volume II — Main text

DIGITALIS .

Digitalis purpurea, L. Purple foxglove. Nat. Ord., Scrophulariacea. I. Provings.-1 . HAHNEMANN, Fragmenta de Viribus. Contains 23 symptoms obtained by selfand 33 from authors . 2. IBID., Mat. Med. Pura, vol. iv of original, vol. iof translation. Contains 73 symptoms from self, 224 from ten fellow-provers, and 131 from authors . 3. IBID., Chronic Diseases, part iii oforiginal, vol. of translation . Contains 300 fresh symptoms, from 3 new observers and from Jörg (see i, 7-14 here). [The proving in the Fragmenta was made with the expressed juice of the leaves . In the Mat . Med. Pura Hahnemann directs the seeds to be used for making the tincture, in the Chronic Diseases the entire plant.] 4. To know what my pulse was in my normal state of health and manner of living, I kept a table ofthe number of pulsations, counted daily for many weeks, before breakfast and before supper. In m., before I took any exercise, pulse was uniformly 60, feeble ; and at n., after sitting for about 2 h ., it was 56, feeble. I began May 24th, 1805, to take 15 dr. of tinct. in a wineglassful of water n. and m. The first 3 d. my pulse was about 70 in m. and 66 in e., during which time I felt myself uncommonly well except that I thought I sometimes felt shifting pains in heart. On 27th I took 25 dr. 28th.-Passed restless n., being hot and feverish ; pain at heart more severe than ever this m., and from ensiform cartilage upwards chest was sore to touch. Pulse in m. 76, strong ; in e. about 70. 29th.-Harassed with tormina last n. after going to bed, which did not abate before 3 a.m. Sense of weight in head and uneasiness at heart all d. Pulse as yesterday.

30th.-Slept but little during n. and mind had somewhat of the restless activity I have experienced after taking too much wine, but particularly after laudanum ; pulse 80 in m. and go in e. During this d. took 50 dr. 31st.-Very drowsy when I wenttobed, but did not sleep soundly ; troublesome sense ofweight in head, relieved during forenoon by attack of epistaxis. Continued drowsy and incapable ofstudytille. Appetite still impaired ; pulse same. Gave up taking drug. June Ist.-Slept during n.; headache continues ; appetite, mind, and pulse the same. 2nd. Symptoms diminishing. Pulse 78 and pretty full; it was not till the 9th that it returned to its natural state. (J. SANDERS, M.D. , Treatise on Pulmonary Consumption, &c., Edin., 1808. Dr. Sanders also relates or refers to numerous experiments with single doses of 10- 30 dr., made to determine effects on pulse, which was uniformly increased in force and frequency. He prints also a communication from Mr. de Courcy Laffan, President of the Royal Philos. Soc. of Edinburgh, who obtained similar results ; but notes that the action did not increase in the direct ratio of the quantity of medicine taken, and that in many instances a sedative effect was produced, apparently greater than what could have been expected from the previous excitement.) 5. a. " On February 2nd, at 8 a.m., I took 60 dr. of the alcoholic tinct. of D., which is nearly equivalent to 5 gr. of the powder of the dried leaves. At 2 a.m. there was not any apparent effect ; I took 60 dr. more (120 dr.). At 8 p.m. I felt a slight heat of the skin and nausea. I experienced the painful feelings ofhunger, and there was an increase of the salivary and urinary secretions. The pulse was 90, strong, and full. The med. had not produced any very marked effect upon the heart. The brain did not appear affected. I took 60 dr. (180). 2 a.m.: I had experienced during the e. a considerable degree ofheat at surface of body, especially towards head,nausea and a painful feeling at stomach, analogous to hunger, although I had taken as much food as usual. My mouth was moist and pasty. The quantity ofurine excreted was much greater than the quantity of fluid drunk. The pulse was 100, strong and full ; action of heart was more violent, and was more easily felt internally and could be seen externally. There was increase of energy of intellectual faculties, imagination particularly was much more active than usual. I took 60 dr. (240) and went to bed. -3rd, 8 a.m., n. had been very restless. The light sleep which I had several times was troubled with dreams, which were remarkable for excessive imagination. I had much thirst, nausea, and uneasiness at the stomach. Urine was very abundant ; there was a slight fæcal evacuation. Tongue was covered with a white coat and slightly swollen ; pulse was 120, strong and hard. Action of heart was strong and somewhat jerky. Respirations 26, but without any difficulty. Eyes were somewhat red and more sensible than usual to the impression of light. I felt slight pain and fulness in frontal region. My intellectual faculties had undergone a slight change, I was in a state bordering on drunkenness. I took 60 dr. (300). 2 p.m.: during last 2 h. I vomited twice a large quantity of mucus. I felt much nausea, which was accompanied with painful sensation at stomach. I had several

fluid stools, and after the last vomiting I felt a chill, which was followed by considerable heat and dryness of surface of body, to which succeeded slight pain of inferior extremities, especially in calves and knees. I felt somewhat weak ; pulse was 125, strong and wiry. Contractions of heart were strong and jerky, and accompanied with palpitations when I walked in my room. I took 60dr. (360) . At 8 p.m. symptoms were almost the same as those already described ; vomiting and shivering had not reappeared. I took 60 dr. (420) .-4th, 8 p.m.: I slept during n. I again felt great uneasiness at stomach and very violent pain during vomiting, which recurred frequently and produced an evacuation of a large quantity of mucous matter. I felt besides intestinal pains, and had several mucous and bilious stools ; tongue was covered with a yellow coating and considerably swollen, mouth was full of mucus, urine was less abundant and of a deep colour ; skin was hot, dry, and a little rough ; abdomen was strongly contracted upon intestines, and was also very hot, dry, and rough to touch. I experienced in my legs a feeling of great fatigue, my intellectual faculties were in a state bordering on delirium ; my pulse was 150, small, hard, and wiry ; the action of theheart was more feeble, and constantly accompanied with palpitations. I stopped the D.-5th, noon, the last 24 h. passed amidst violent suffering, all the symptoms already mentioned were aggravated. 1 frequently felt shivering, and my strength was extremely weakened ; my pulse was 60, small and feeble, but regular ; my intellectual faculties were in a state approaching stupor and delirium ; one could observe, in a word, all the symptoms of a violent inflammation of the gastro-intestinal mucous membrane, as well as of the brain, resulting from the peculiar effects of the D. Dr. Cooper attended me on this occasion. Two weeks elapsed before it was possible for me to leave my bed, and nearly two months before my health was re-established. " b. On April 14th Dr. H- resumed the D., taking for 2 d. to dr., and for 4 d. more 15 dr., 4 times a d. 18th.-Felt slight increase of appetite, and at times flushes of heat in head ; pulse 80, after gentle exercise. From 20th-23rd increased dose to 25 dr. 21st.-At short intervals painful sense of hunger ; slight increase of heat at surface of body ; pulse 80 at rest, 85-90 after walking a few m.; urine more copious ; skin inclined to be moist ; mind a little more active. After this effects gradually diminished, and from 24th-27th he took 35 dr. doses with same results, to which were added some uneasiness after food and stronger beating of heart. On 27th slight nausea along with good appetite, bowels rather relaxed, urine much more copious ; pulse 100, full, and strong ; heart's action also stronger than usual ; moisture of skin had increased. Till 29th took 45 dr. doses. Nights sleepless, but did not feel depressed in consequence; head felt as if he had taken more wine than usual, there was dull pain in it, and he could not connect ideas ; stools copious, and seemed to contain a good deal of bilious matter ; urine more abundant and deeper in colour. He felt at times slight shiverings, followed by increase of heat ofskin. Pulse 85 at rest, but rose to 100 after gentle exercise. Action of heart irregular, increasing in force soon after taking dose, but shortly returning

towards normal state. From 29th took 55 dr. Dyspepsia and headache increased, dreamful sleep, also weak and tired state ofbody anddulness of mind, slight cough. After a d. or two of 70 dr. doses suspended medicine. May Ist.-Felt a good deal of nausea and ofuneasiness and weight at stomach ; easy stools, bilious and mucous ; no wish for food, and indigestion after taking any ; urine copious, depositing mucous sediment ; surface alternately hot and cold ; pulse 85, rather weak and irregular, especially after exercise ; systole of heart seemed rapid, but diastole slow, with uneasiness there and palpitation on movement ; at times cold sweats . Was extremely listless and weak ; but though at times in a state ofstupor could with difficulty sleep. 3rd. -Slight decrease of symptoms ; pulse 70, softer and fuller ; movements of heart a little more feeble, and it seemed to act with difficulty. 4th.-Pulse softer and fuller, 60 at rest, 75 on slight exertion. Otherwise improving ; urine less, clear and pale. Shivered readily. 5th.-Pulse 50-55 at rest. It fell no lower, and a week after had resumed natural rhythm ; but irregular action ofheart continued 10-12 d. under influence of most trifling causes, or exercise of mind or body, and it was a month ere he regained his usual health. c. July 12th, resumed experiment, taking increasing doses (12-25 dr.) 3 times a d. up to 15th. On 16th urine and saliva increased. At times heat in head ; pulse 80, full and strong. In these and other respects as in former provings. Up to 20th continued 25 dr. 3 times a d. 20th.-Pulse 60, but action of heart remarkably strong. From 21st-23rd 30 dr. doses were taken, and from 24th-26th 40 dr. On 26th, pulse strong and full,!46 beats only, their impulses rapid, separated by a considerable interval. Action ofheart very energetic, but strength somewhat diminished. d. July 26th, took 200 dr. at 2 p.m. 3 p.m., nausea, uneasiness of stomach, followed by vomiting of mucus, vertigo, headache, mental faculties disordered, heat of skin, pulse 65, hard and full ; heart's beats strong and jerky. 8 p.m., pulse 28, soft and irregular ; prostration and weakness ; heart's beats very irregular and hurried, but sometimes 10- 12 beats in succession of moderate strength. Disposition dejected ; intellectual faculties affected.-27th. Took 50 dr. every 8 h.-28th. In same state as on 26th. (W. HUTCHINSON, Jour, des prog. d. sc. et instit. méd. , 1827, vi, 218.) 6. Dr. SCHRÖN, Sept. 2nd, early in m. took I gr. of powdered D. in water. An h. after felt pressure in stomach, and p.m. pain in r. frontal region. 3rd. Early he took, fasting, 2 gr. , and soon experienced great nausea, confusion in head, and frontal headache as on 2nd ; slight pain, apparently in cardiac region, and h. after pulse is softer, smaller, yet quicker. Nausea continued several h., then came dryness ofgums and pharynx. On getting up after sitting giddiness and marked weakness of legs. Pulsation of heart softer and weaker than usual. Two hours after giddiness passed away had pressure at stomach and copious salivation. At noon saw bright sparks before r. eye. In afternoon unusual perversion of vision, with anxiety and sense as if finger pressed on eyeball. In e. took 3 gr. Same symptoms occurred, but there was now much greater dryness of mouth and pharynx, with thirst so

great that he had frequently to drink during n. Pressive pain in eyeballs with dilatation of pupils, especially r. 4th-7th . He took daily gr. m., noon, and e. Scarcely any of the former symptoms were experienced, but he had considerable disturbance of the circulatory organs, so much so that on n. of the 3rd and 4th d. he had, on account ofpalpitation and anxiety, to get out of bed, to walk about, and open window. Pulse was 100 and strong. Head congested, with rushing and tinkling sounds in ears. Lasted several d. Palpitation less severe on the n. of 5th, but frightening him out of sleep. No action was experienced on urinary or genital organs. (WIBMER, op. cit.) 7. Dr. Jörg, æt. 45, middle sized, constitution robust, temperament sanguineous choleric, took Aug. 19th, 8 a.m., gr. of powdered D. with sugar and water. An h. after he felt his head affected, also pressure over occipital region, which continued at intervals till noon ; at same time he observed that he saw objects in a false light. From 10-11 he felt increased motion in digestive canal ; this passed into slight griping pains in bowels, extending from hypogastrium to testicles. At II a.m. the pain disappeared, but a desire to urinate, with itching excitement of glans penis, continued until afternoon. 20th.-Took at 8 a.m. gr.; soon experienced scraping in throat with hoarseness ; former soon disappeared, the latter continued all d. At 9 felt headache as on 19th, but more severe ; it disappeared at 12, but recurred several times p.m. From 10-11 borborygmi and griping pains which lasted an h.; urine passed in greater quantities than natural, without pain, but with peculiar irritation of glans penis as on 19th. This continued until noon of 21st ; appetite and pulse not affected. 22nd, 8 a.m., took & gr. of D. and 3 gr. ofmagnesia in 3ss ofwater. Experienced rawness in œsophagus and windpipe, griping pains and desire to go to stool . At 10 a.m. had a motion which contained fæcal matter. From 9 a.m. affection of head commenced, which J- compares to a spiritual intoxication, describing it as an apparent expansion of the nervous life beyond the usual limits. This state of mind passed away without leaving any headache. In afternoon flatulence, heartburn, and sensation as if throat were compressed by enlarged tonsils. Until m. of 23rd there was much and even painful excitement of genital organs ; after this excitement ceased urine flowed abundantly. 23rd.-Took I gr. in Zss of water ; experienced much the same symptoms as on 22nd, relaxation and weakness, bodily and mental. At II a.m. headache at vertex lasting anh.; 11-3 sharp burning and scratching in œsophagus. Appetite was unaffected throughout proving. On 22nd and 23rd pulse was smaller and weaker, never slower, but occasionally quicker than usual. ( Materialen , 1825, sub voce.) 8. Frau Ch-, æt. 45, short, slender frame, but healthy and of sanguineous temperament. On Aug. 18th, 8 a.m., took gr. with 4 gr. of sugar. Shortly after felt pain in hypogastrium, lasting h., followed by more or less heat in stomach, extending to œsophagus. This continued till e. 20th, 8 a.m., took gr. with 7 gr. of sugar in 3ss of water, and shortly after experienced scraping in cœsophagus . After h. felt slight cutting pains in stomach, and from 9 o'clock slight affection of head with pressive headache. At 10 desire to make

water, which was not relieved by micturition. In afternoon suffered from pressive pain over crown and back part of head ; also from sharp burning pain extending from stomach to throat ; secretion of urine increased until bedtime. 21st.-After a restless n., had headache, as on 20th, but less severe ; desire to micturate ceased at 3 p.m. , and increased secretion of urine was much diminished by e. Burning in stomach lasted until e. 22nd, 8 p.m. , repeated dose, as on 20th, with addition of It gr. of magnesia. She soon experienced slight headache, griping in abdomen, followed by increased warmth of whole body ; desire to urinate. From 10 to 11, pain in region of kidneys ; the urine increased to such a degree that she passed every 2 h. more than she usually did in 24 ; no increase of thirst. Headache disappeared on 23rd ; increased secretion of urine continued until e. of 24th, and was very troublesome, especially at n. Besides these symptoms, she felt weak and exhausted. From 22nd to 24th vision was weak and dim ; pulse kept small, weak, and a little quicker than usual. (Ibid.) 9. Отто, æt. 22, tall, slender, and of lymphatic constitution, took, Aug. 11th, gr., which caused giddiness, lasting 1 h. On 12th, took gr. , with 2 gr. of magnesia, in 3ss of water ; scraping and heat in pharynx, and longer-lasting giddiness. On 13th, took gr. It with 5 gr. of magnesia in 3ss of water. Same sensations ; p.m., copious urination. On 16th, gr. 1 at 8 a.m. At 9, pressure on head fort h., diminishing power of thinking. After dinner (eaten with great appetite) giddiness with sudden dazzling of eyes, followed by sparks as if around eyes, for h. From 3-10 p.m. passed urine copiously 6 times ; after standing it deposited thin brownish sediment. Genital organs excited ; pulse smaller and weaker. On 15th, at 11 a.m., he took 2 gr., feeling soon scratching in pharynx. Towards noon he experienced confusion in head ; this became more and more a pressive pain, which from vertex extended over whole head. As it passed away, he felt peculiar sensation in eyes he had experienced after previous doses, sight suddenly confused as when one passes from darkness into a bright light, then as if sparks were floating in air ; these symptoms and attending giddiness did not last above h. There was slight increase of urine, and forth. great excitement ofgenital organs ; pulse small and slow. Prover slept well, but woke on m. of 16th with same headache, increasing during whole d. Had not before or since suffered from a similar headache. Pulse was weak, soft, varying frequently in tension ; urine became much diminished. On n. of 17th again slept well, and headache of previous d. was nearly gone. 17th, 8 a.m., took 2 gr. in 3ss of water ; soon after felt. scratching in pharynx, lasting 4 h.; an h. later confused feeling in head, affecting thought, and passing into formerly reported pressive headache. Diminution ofpulse and excitement of kidneys and genitals as on 15th. Appetite slightly diminished. Slept well on n. of 17th and 18th, but woke with same headache as before. This headache continued throughout d. so severe that prover was unable for any work, and obliged to go early to bed. Pulse was very weak, with varying tension. (Ibid.)

1. SIEBENHAAR, æt. 22, middle sized, constitution robust, temperament melancholic, on Aug. 9th, 8 a.m., took gr. of powdered D. mixed with 3 gr. of magnesia in & oz. of water, and on 10th at same h. gr. in same mixture. He experienced burning and scraping in pharynx, followed at 8.30 by giddiness, sparkling before eyes, double vision, and acceleration ofpulse. These symptoms entirely disappeared inth. 11th.-Took I gr. with 3 gr. of magnesia. Scraping in throat was a constant symptom ; sparks before eyes and giddiness appeared about 8.30, and disappeared in h. Pulse was a little quicker than usual, but after effects of medicine had passed away it became slower and smaller. Genital organs were much excited ; no increase of urine. 13th, 8 a.m., took 1 gr. with magnesia as before. He immediately experienced scraping in œsophagus, dizziness, and sparks before eyes, which did not last long ; but irritation ofthe genital organs was so very troublesome, as to induce him to suspend med. for a few d. 17th, 8 a.m., took it gr., but without magnesia ; it tasted more bitter than before, and produced scraping and burning in pharynx ; pulse and digestive organs not affected; urine normal, genital organs much excited. 18th, 8 a.m., took 2 gr. in oz. of water. Same symptoms were experienced as on 17th ; towards afternoon secretion of urine was increased. 19th.-Took 24 gr. Same symptoms appeared as on 18th, and disappeared by afternoon. 20th, 8 a.m., took 3 gr.; symptoms as on 18th. By 10 a.m. secretion of urine was increased and forced him to pass water every 2 h., and twice during n. Genital organs were much affected ; the pulse remained undisturbed. (Ibid.) 11. GüNTZ , after I gr. of powdered leaves, felt, after h., slight frontal headache lasting 1 h. On repeating same dose, one morning, I

besides the above symptoms, had increased secretion of watery urine with frequent desire to pass during afternoon. Took 2 gr. After 10 m., slight vertigo set in and lasted 20 m. Urination became frequent, urine was watery and clear and total quantity more than he was accustomed to pass in same time. Pulse after both doses remained unaffected. ( Ibid.) 12. HEISTERBERGK, after I gr. of powdered leaves taken in & oz. of water, felt trifling pressure in vertex. Pulse was unaffected. On repeating same dose one morning at 9 a.m., in addition to above symptoms noticed at 10.30 pressing feeling in right parietal bone lasting h. After drinking 16 oz. of beer at midday passed during 12 h. about 32 oz. of dark-coloured urine. Next d. all effects had vanished. After dose of It gr. had some belching, but unaccompanied by nausea or inclination to vomit. Towards midday became ravenous. Between I and 11 p.m. bowels acted twice, fæces being thin. Pulse and urine were unaffected. Next d. bowels acted only once, but fæces were still thin. Nov. 24th, 1823, at 9 a.m., took 2 gr. and noticed following symptoms : Between 9 and 9.30, belched wind 10 or 12 times ; towards II slight headache in vertex lasting + h.; at noon ravenous hunger persisting after dinner, accompanied by much rumbling in abdomen, and at 5 p.m. evacuation of thin fæces. Urine was unaffected. Pulse between II a.m. and noon beat small and soft but not more slowly than usual. Next d. had another loose stool. Four d. later,

also at 9 a.m., took 24 gr. Belching was again present, but without headache. Towards 11 a.m. much rumbling in bowels, and at 11.30 feeling of ravenous hunger, both symptoms accompanied by small but not slow pulse. During next 24 h. two loose motions occurred. (Ibid.) 13. a. KNESCHKE on Nov. 12th, 1823, at 9 a.m., took gr.; a few minutes later had feeling of pressure in occiput going from right to left and spreading upwards towards vertex ; slight confusion of head and traces of vertigo were present until about I p.m. Urination during p.m. somewhat increased in frequency, especially between 3 and 6, urine being pale yellow in colour. After dose of 1 gr. experienced same effects, only that head-symptoms lasted 2 h. longer and urine remained unaffected until following d., when he was obliged to empty bladder every hour, urine being watery and copious. On repeating same dose same effects followed, but head-symptoms lasted until evening ; increased flow of urine also occurred during afternoon of same d. Pulse during afternoon was smaller than usual, but normal in frequency. On Nov. 24th, at 9 a.m., took 1 gr. of powdered herb in water. Head-symptoms came on at once, increasing at noon to acute stabbing pain, chiefly in occiput and vertex and to less degree in forehead (received a letter containing unpleasant news at midday). During p.m., especially from 2 till 7, urine was more abundant, light coloured and dilute; pulse was meanwhile smaller than usual. After dose of 2 gr. same effects followed except that headache did not reach frontal region, and no stabbing was noticed ; pulse was also unaffected. b. A 2 dr. dose of infusion (gr. xx to ziv) caused only confusion of head ; after oz. same effects ; during p.m., from 2 till 6, was obliged to pass water every hour, urine each time being copious and watery. On repeating same dose experienced same acute head-symptoms as after large doses of powder, urine being also in this case voided every h.; pulse was unaffected. After 25 drops oftincture (1 to 6) felt from I p.m. till evening severe pressure in r. half of occiput, and from 2 p.m. till evening increased secretion of urine. ( Ibid.) 14. SEYFFERT, after taking gr. fasting, felt immediately slight transient vertigo ; gr. caused, in addition, increased secretion ofurine lasting till next d. After gr. felt, soon, confusion of head, somewhat like feeling of intoxication, and soon passing off, with increased voiding ofurine lasting 24 h. Pulse during p.m. was smaller, but not slower than usual. Infusion (Dj to ziv) in dose of Zss caused only slight transient giddiness, and did not affect kidneys. Of tincture ( 1 to 6) 12 drops taken in & oz. water caused only slight transient giddiness ; 30 drops caused same symptoms, but acted more powerfully upon urinary organs, for he was obliged to pass water constantly all afternoon, quantity passed each time being small, but large in aggregate. This condition lasted, though to a less extent, during next d. (Ibid.) 15. Dr. BLACK commenced, Oct. 21st, 1845, to prove tinct. on himself, pulse averaging in forenoon when sitting 68, and in e. 75. "At 10 p.m., after sitting quietly for an h., felt my pulse, which was 68, and took 10 gtt. tinct.; continued to sit quietly reading. In h. felt dull frontal headache ; pulse 68. Headache continued to increase ; on

going to bed felt momentary nausea. 22nd.-While dressing, took to gtt., sat down shortly after, and in 20 m. (9 o'clock) felt my pulse, which was 66 ; no headache. At II pulse 76, of natural strength ; after walking slowly four or five times up and down my room, pulse 83 ; experienced uneasy sensation across chest to 1. side. 2 p.m., pulse 75; took 10 gtt.; dull, disagreeable sensation in region of heart. 2.30, pulse 80; feeling of slight confusion in head, especially on moving, with painful sensation of weakness in wrists and forearms. At 3 pulse was felt by a medical friend ; it was now 76 ; counted several times, it gave the first m. 36, the second 40, and three beats failed to be felt. II p.m. , have all e. been feeling dull, uneasiness in various parts of head , with sensation of weakness in forearms ; pulse 80 ; bowels moved naturally in m., and again at 9 p.m. 12, pulse 78, but weak, beating strong from 12 to 20 times, and then very weak for 4 to 5 times. 23rd.-Passed restless n., starting often in my sleep ; woke with feeling ofgreat lassitude and depression; pulse while lying in bed 62, small and weak ; on getting up, depression and languor increased ; occasional faintness, which, on moving, was attended with nausea ; appetite good ; pulse in e. 72 ; felt very well. 24th.-Slept well and experienced no symptoms. 11 a.m. , pulse 80 ; full and regular ; took 20 gtt. Quarter to 12, pulse 90, weak ; 3 or 4 pulsations in the m. hardly felt. Throughout d. experienced uneasiness in mammary regions, especially 1., extending to 1. shoulder and upper part of arm ; frequent griping pains in bowels ; palpitations of heart easily excited on going up even a slight ascent, which in health would produce no effect. 11 p.m., pulse 82, nearly natural strength, but not steadily so. 25th . -Slept well ; woke with dull frontal headache and nausea. 11.30 p.m., pulse 76, took 25 gtt. At noon, pulse 84 ; frequent griping pains in bowels, and uneasiness at heart. In e., pulse 76, rather weak. 26th .-With exception of slight uneasiness in region of heart, experienced no symptoms. Towards e., seized with very violent colicky pains, immediately followed by sudden evacuation of liquid stools. 27th, 10.30 a.m., pulse 72 ; took 30 dr. 11.30, pulse 88, irregular . 12.30, pulse 84, less irregular. 3, pulse 72, regular. Throughout d. experienced dull frontal headache, with frequent uneasiness in region of heart. 28th, 10.30 a.m., pulse 72, regular, have felt well all d .; towards e. experienced dull, disagreeable pressure outwards in chest and epigastrium, relieved by beating on chest. This lasted 3 h. 29th.- In m. pulse 73 ; dull frontal headache, increased much by movement. 30th, 6.33 p.m. , pulse 78. Nov. 4th.-Having been much occupied, and suffering from the D., I suspended med. until to-day. II a.m. , pulse 73, natural ; took 25 dr. 12.30, pulse 80 ; 2, pulse 76 ; 4, pulse 62. Suffered much after dinner from severe bruised pain in epigastrium and over sternum, with feeling of languor and indigestion, going off after a little weak tea. Throughout d. frequent uneasiness, amounting sometimes to pain in region of heart ; occasional nausea ; seldom free from dull frontal headache ; feeling of great fulness in ears, as if they were suddenly stopped, attended with flush of heat over face, lasting 2 or 3 m., recurring frequently, especially after excitement. Before going to bed took 15 dr. 5th.-In m. pulse 72. During early

part of e. of4th suffered from pains, now to be reported as being felt more on 5th, viz. bruised pain in nape ofneck, between shoulders, and extending forwards over anterior part of chest, where flesh was painful when pressed, especially over sternum. These were attended with dull frontal headache, bruised pain in epigastrium, with feeling of distension in stomach. Appetite good. After dinner dull pain and distension of stomach, felt as if I had eaten too much. In e. bruised feeling over sternum and epigastrium was very distressing, preventing any mental enjoyment. 6th.-Passed a wakeful night, suffering from palpitation and uneasiness, especially when lying on 1. side, together with pulsations in ear, especially 1. II a.m., after walking, pulse 75, a little irregular ; took 36 dr. At 12 pulse 84 ; at 12.30, 86, slightly irregular ; palpitation and uneasy feeling at heart, readily excited even by moderate exercise. In e. took 20 dr., shortly after suffered from frontal headache, with pressure on temples ; pulse 100, irregular, but full ; increase of bruised pain in epigastrium. Ioth.-Since the 6th I have not taken D., as I continued to suffer much from uneasiness in heart, headache, and disorder of stomach ; pulse was normal but easily excited. I still suffer from bruised feeling and weight in epigastrium with flatulence. These symptoms continued until about the 14th. During all the time of the experiment the condition of bowels, genital organs, and urine was not sensibly affected. (Brit. Fourn. of Hom., iv, 77. ) 16. Dr. K-, æt. 24, ofbilious temperament and average health, took under Dr. Black's directions tincture of D. He began by taking 10 dr. twice a d., then 15, then 20, increasing it by 10 dr. until the dose reached 60 dr. twice a d. No effect on pulse was noticed, only possible symptom being the urine assuming a brownish colour, and a heavy, disagreeable smell ; with this exception K- felt remarkably well. (Ibid. , p. 76.) 17. Dr. Q-, after ascertaining that his pulse generally averaged 48- 55, took 10-36 drops daily for 6 d., in all 172 dr. No effect whatever on pulse, only symptoms experienced being headache over vertex, with temporary giddiness, on 6th and 7th d. (Ibid.) 18. A medical friend happening to talk of D. I asked him to take a dose. He had been walking 2-3 h. After allowing him to sit down for about 5 m., I felt his pulse, which was 72. He then took 20 dr. In h., continuing to sit still, pulse was 84, and in h. more 74. (Ibid., p. 80.) 19. Dr. SHARP, Aug. 21, 1872, pulse 80, took at 7.30a.m. I dr. of Ist cent. No change for 5 m. Took another dr. Next m. pulse was 76, rising gradually till at 16th m. it had reached 80 again. A similar fall happened after 3rd dose taken at 21st m.; but after returning to 80 at 30th m., pulse rose to 85 by 36th, returning to 80 by 63rd. At this time there was " decided action on kidneys, shown by increased secretion." b. Dec. 2nd, at 12.30 p.m., pulse 64, took 2 dr. of tinct. At 5th m. pulse was 68, at 10th 72, at 15th 68, at 50th 64, at which it remained. c. June 11th, 1873, at 7.35 a.m., pulse 66, took 6 dr. of tinct.

From 2nd to 15th m. pulse varied from 66 to 68, but at 20th had fallen to 63 ; at 25th, 64. d. June 16th, at 7.50 p.m., pulse 72, took 8 dr. of tinct. Up to 6th m. pulse rose, reaching 76; thence to 8oth fell, reaching 64 ; at 100th was 72 again. ( Essays in Medicine, p. 717. ) 19. I made a series of observations on the effect produced by D. when administered to healthy persons, and to patients free from heartmischief. Giving it in moderate doses, 3j-zij of infusion three times a d., I obtained results agreeing with those of other observers. The pulse traces showed first a diminution in the frequency of the heart's beats ; second, an increase in the force of each beat ; third, an increase in cardiac tension. (B. FOSTER, B. and F. M. Ch. Rev., xlviii, 214.) 20. HOMOLLE and QUEVENNE experimented on themselves with full medicinal doses of digitalis and digitaline at different intervals during 1842, 1843, 1848, and 1850. They give as the average results on circulatoryorgans a slight retardation ofpulse, in a few experiments first acceleration then retardation, the latter more marked whenever the system is fully under the influence of the drug, and attended by irregularity and intermittence. The following experiments illustrate the general action of the drug : a. Prover's pulse for an averageof 18 d. observation is 68, maximum 73, minimum 62. Eight doses of powdered D. were taken, during the first 3 d. of 20 centigrammes, and on the following of30. During this time average pulse was 65, maximum 70, minimum 63. On the last 2 d. of taking these doses he experienced on first pain in stomach and disordered digestion, without any real nausea ; on second there was on standing up vomiting of yellow slimy mucus, great prostration which obliged him to lie down, and more vomiting. During 10 following d., though no more D. was taken, he felt considerable intoxication, sight was disordered, and pupils dilated ; no decided headache ; pulse was in average 60, maximum 72, minimum 53. For first 5 d. stomach was so irritable that all food was vomited. Urine was much diminished. For 24 d. after this sense of intoxication ceased pulse was slow, the average being 63, maximum 72, minimum 55. b. Homolle, after taking about 7 gr. of substance taken up by ether from an alcoholic solution of D., had no vomiting for 8 h.; he was then seized with great nausea, faintness, and vomiting, which continued at intervals of 15 m. for 30 h. Next d. his pulse had fallen, and on 4th d. was as low as 48. Vision was impaired, and he could not look steadily at a bright object. Urine was abundant, but bladder's contractility was impaired, and external pressure was required to expel the urine. He had pulsation of the abdominal aorta, anxiety, epigastric constriction, and cough with pneumonic expectoration lasting for a week, but these, he thought, were caused by the continuous vomiting. (Arch. Gén., July, 1861 , p. 5.) 21. Dr. BÄHR's experiments on himself lasted from Feb. 27th to May 17th, 1857. During this time weather was very changeable, in February and March unusually mild and dry, in April and to commencement of May dry and inclement, but during last days of experi- VOL. II . 33

ment fine and warm. During winter up to May he suffered from catarrh of nose and fauces, but no cough. The experiment was directed principally towards the action of D. on the heart and kidneys ; he took special care to ascertain the average action of these organs for several d. and 5 times a d. Quantity of urine was, maximum 1265 c.c., minimum 875 c.c.; average in d., 1075 c.c. Pulse is habitually regular, full and strong. Average in m. was, in bed, 56, on sitting 61 , on standing 66 ; pulsations of the heart are scarcely felt. The diet was carefully regulated, and maintained the same by weight before and during experiment. a. Feb 26th.-Took 10 dr. of tinct.; then occurrence of acute rheumatic pains in r. shoulder after exposure to cold delayed experiments until March 3rd, when he took in e. 10 dr., the pulse then being 60. 4th.-Pulse in bed 58, in e. sitting 62 ; took 10 dr. 5th.- During n. had seminal emissions,which had not occurred for a year ; pulse in bed 54. 10th, 11th, and 12th. -On each day 18 dr. were taken. On 13th and 14th no doses were taken ; urine 900 c.c., sp. gr. 1025, urine depositing a thick white sediment. b. On 19th the experiment was resumed with gr. of powdered leaves, pulse being 57. In 1 h. it was 54, and in an h. 51 ; in e. 66. Urine 1150 c.c., sp. gr. 1023 ; emissions during n. 20th, 10 a.m., pulse 59. 10.30, took gr. I p.m., sudden severe tearing cutting pain in r. frontal region from eyebrow upwards, lasting a short time, but returning quickly 3 different times. P.m., 3 h. after dinner, sensation as if food were rising up in œsophagus, but no nausea. II p.m., pulse 58, urine 870 c.c., sp. gr. 1023. 21st.-Passed restless n. 10.30 a.m., took I gr. II a.m. , pulse 58, urine 1145 c.c., sp. gr. 1017 . 22nd.-Took I gr.; urine 975 c.c., sp. gr. 1025. 23rd.-Took 1 gr.; urine 1100 c.c. , sp. gr. 1018. 24th, 10.30 a.m., I gr. After dinner sudden feeling as if heart stood still, with sense of anxiety and need to hold breath, lasting about a m. Urine 1200 c.c., sp. gr. 1024. 25th. -No dose ; 10 a.m., pulse sitting 68, standing 81 , recumbent 62 ; distinctly irregular, three to four quicker pulses, then smaller and slower, then stronger and fuller. During whole d. felt irritable and out of humour, whereas in general he was cheerful. Appetite diminished. P.m. , same pain as on 25th, but not so severe. In e., while walkingslowlyfelt quick pulsating pain in region ofr. nipple, lasting a m., attended with taking away of breath, with anxiety. Sleepless restless n.; about I a.m. severe palpitation of heart with rapid pulse ; urine 825 c.c., sp. gr. 1026. No doses after this. 26th.-Urine 1110 c.c., sp. gr. 1026. 27th.-Urine 1105 c.c., sp. gr. 1026. Towards the end of March severe nasal catarrh, and during 4 consecutive n. seminal emissions, with strong erections before rising and on getting up (a very unusual circumstance with the prover) . c. April 22nd, 10 a.m., took 1 gr. of powder ; pulse before taking, sitting 59, standing 61 ; 3 h. after dinner pulse 73 sitting, 78 standing. 11 p.m. , pulse 82 sitting, 94 standing ; took after this another gr. Wakened towards 3 a.m. with desire to pass water, which was passed in trifling quantities. 23rd.-Pulse in bed 59. Coffee and bread taste bitter. 9 a.m., pulse 72 sitting, 79 standing. Feels pulse much

quickened when he walks ; after sitting an h., pulse 66 sitting, standing 85 ; while in former position it is full and irregular, in the latter it is small, weak, and irregular. At 10.30 a.m. It gr.; in an h. slight giddiness with difficulty of fixing eyes on an object. Sense of emptiness in stomach ; noon, pulse 65 sitting, 81 standing, with the same character as in forenoon. 11 p.m., pulse 68 sitting, 84 standing, and irregular as before. Urine 1430 c.c., sp. gr. 1030. 24th, 11 a.m., pulse 60 sitting, 72 standing, very slight movement increases frequency and weakness of pulse. Urine 950 c.c., sp. gr. 1022. 25th.-Seminal emissions towards 1 a.m. On following n., unusual erections. d. May 5th, 10 a.m., resumed taking 1 gr.; previous to this pulse 61 sitting, 68 standing. II a.m., squeezing pressure on stomach ; later while visiting a patient sense of giddiness as if he might swoon away. 6 p.m., pulse 68 sitting, 85 standing ; again giddiness and faintness. 6th, 9 a.m., pulse 69 sitting, 75 standing. 7 p.m., pulse 67,75 standing; no other symptoms noticed. Urine 1460 c.c., sp. gr. 1018. 8th, 10 a.m., took 30 gtt. tinct. Little variation in pulse during d. 10 a.m. , pulse 70 sitting, 82 standing. A similar report and dose may be given to 9th. 10th.-Pulse in bed 70. After passing a much diminished quantity of water, sp. gr. 1031, felt pressure in bladder and burning in urethra, lasting h. The complexion was so bad as to attract attention. On getting up in m. continued erections, more marked than on 8th, and becoming painful and unpleasant. In e. in bed throbbing toothache in l. lower incisors, lasting h.; prover's teeth are sound, and he never suffers from toothache. Wakes at n. with painful erections like chordee ; sleep very restless, disturbed by dreams . 15th .-Took 24 gr.; n. again restless, with return of the toothache of Ioth, but not so severe. Sp. gr. of urine in m. was 1033, quantity during d. c.c. 1050, reaction neutral, average sp. gr. 1026. During all the proving there was rather a tendency to costiveness, which is unusual with the prover. On 18th motions became natural ; he complained all d. of troublesome dyspnea, which had been observed in a slighter degree on 14th and 17th, but to-day felt more urgent, increasing towards e.; sense as if clothes over chest were too tight. Pulse, 11 p.m., 82 sitting, 90 standing, small, weak, and somewhat irregular. Heart-beat is strong, and much more perceptible than usual. No observations regarding urine taken. 19th.-Erections towards the m. had ceased for some d. Pulse 58 sitting. Dyspnea shown lately in less degree, but accompanied by sense of uneasiness and exhaustion in the chest, and repeated dry cough. P.m., dyspnea increases ; not worse in e. than during previous n., worse on writing. Pulse, 7 p.m., 74 sitting, 86 standing, rising soon to 94, but without any noticeable irregularity ; it gradually became slower. 20th, 9.30 a.m., pulse 52 sitting, 60 standing, full and regular. Sense of oppressed breathing continued, slight in m., increased in afternoon and e.; some palpitation of heart. All n., deep under r. mammary region, drawing pressive pain prevented him a long time from going to sleep ; restless n. The sense of oppressed breathing continued in a less degree throughout May, and did not entirely cease until the commencement of June. (Dig. purp., Leipzig, 1859.)

1. LEMBKE.-April 11th, 9 a.m. , gr. of D. leaves. Taste acrid, bitter. 9.30 a.m. , marked heat and redness of face, lasting h. Head heavy at vertex ; pupils contracted. 10 a.m., chill over back, cold hands for some m.- 16th , 8.30 a.m. , gr. After h. heat in head and face ; pupils dilated ; pulse slow, full, and large, soon afterwards small, quicker ; pupils after 10 m. contracted, afterwards repeated alternation of dilatation and contraction of pupils. 9.30 a.m., head heavy, pressure on vertex and forehead. Pupils contracted, but sight stronger, clearer. 10 a.m. , at first heat on back, then chill over it, with cold hands, rigor over back lasting several m. Drawing in toes . The heat of head lasts till noon, heaviness and confusion with pressure on vertex some h. longer.-23rd, 7.30 a.m., gr. 7.45a.m., forehead and vertex hot and heavy, pulse 60 to 65. Pressure on vertex, pupils contracted. These symptoms lasted till 10 a.m. Pulse varies quickly from 65 to 75 or 80.-May 2nd, 8.30 a.m., gr. 9 a.m., pupils dilated, slight drawing in fingers, white spots and black rings hover before eyes for more than I h. 9.15, head heavy, confused, as if full, for some h. Painful drawing in r. lower extremity, especially thigh, when sitting, then in r. knee and ankle. Dryness and scraping in fauces, drawing in toes repeatedly. 10 a.m., pressure in r. elbow, severe boring in r. wrist towards thumb continued. Pulse between 65 and 75. Urine normal. 4 p.m., drawing in bones of head.-8th, 8.30 a.m., gr. Flickering and black rings and spots hover before eyes, pupils contracted, head confused, heavy, pressure in some parts of it ; pressure in 1. knee and bones of foot. 9 a.m., heat of head ; drawing in toes ; great general heat ; distended veins ; pulse 85. Many spots, stripes, white specks hovering before eyes ; pressure and weight in forehead. The general heat and quick pulse lasth. The other symptoms longer. Scraping in fauces. 9.45 a.m., chilliness in back, cold hands, rush of cold through limbs, pulse 60 to 65, frequent rigor, lasting nearly h. Head, especially in frontal region, very heavy, confused, painful, especiallywhen walking, stooping, getting heated ; lasts several h. -27th, 8 a.m., & gr. 8.30 a.m., drawing in elbows and knees. 8.45 a.m., scraping in fauces ; sinciput heavy, hot ; tearing in stomach ; uneasiness in lower extremities and knees ; rings, spots, flickerings before eyes ; frequent chilliness over back, cold hands. 9.30 a.m., suddenly a peculiar feeling in chest as if the heart stood still,several strong, slow heart's beats, sudden heat in occiput, and momentary loss ofconsciousness with cold sweat on forehead, all lasting but a moment. Pulse 60 to 65.- June 25th, 7 a.m., & gr. 7.30 a.m., head confused, dryness of mouth. 8 a.m. , heat all over body, especially of head ; hot skin, swollen veins ; pulse 80, small. Pressure in toes and on various parts of skull ; dryness and scraping in fauces till 3 p.m.-27th, 7 a.m., 1 gr. Continued pressure in stomach . 7.30 a.m., head confused, hot, pressure in sinciput. 8.15 a.m., extreme heat of head, pupils dilated ; bright stripes hovering before eyes ; burning heat in hands ; pulse 75, small ; single, strong, slow heart's beats when sitting. General heat of body ; pressure in bones of feet ; black rings and spots before eyes ; oppressed feeling in heart and obligation to breathe deeply, repeated at noon. 9.30 a.m., very Noon, pressure in r. severe cutting at intervals in abdomen, also later.

shoulder repeatedly, and in l. knee. Urine more frequently passed, and increased in quantity, also at n., colour normal.-29th, 8 a.m., I gr. 9 a.m. , black rings and spots before eyes, pressure in toes ; pulse slow, large and full ; oppressed feeling at heart, and often laboured breathing ; pressure and weight in sinciput. 9.30 a.m., scraping in throat, drawing in fingers. Noon, pressure and boring in pectoral muscles, in 1. side superiorly ; dryness and scraping in throat; urinescanty, dark. 6 p.m , stiffness and pain in r. nuchal muscles, especially on bending head, continues till he goes to sleep, and only goes off in forenoon of next d. (N. Z. f. h. Kl. , ii , 171.) 23. a. PURKINJE took daily for 4 d. 3gr. ofaqueous extr. Without any general disturbance, there occurred on 2nd d. a very slight flickering before 1. eye, but therewith he was unable to recognise a distinct conformation in the distribution of light and shade. It was as if at each glance the crystalline lens trembled, and thereby altered refraction, producing transient breaking up of lights and shadows on objects. Next d. flickering was more noticeable, and not only on winking, but as often as he looked from a light to a dark portion of the field ofvision ; this led him to suppose it not a mechanical movement, as he was at first disposed to think, but one more due to the sudden change from light to shade. He now directed his eye to the bright sky, and suddenly covered it, without closing eye or moving it in the least, with the flat hand, when flickering was noticed quite as distinctly as before. On suceeeding d. this condition also occurred in r. eye ; repeated observations sharpened the vision, and he was able to discern a definite conformation ; there seemed to be in middle of visual field an alternately disappearing and reappearing roundish spot of dim light, and about this concentrically several waves of light and shade in similar motion. This flickering continued for 7 d. after taking drug ; but at last intermitted, appearing (for short time only) when going into room from open air, after moderate exercise, or after going upstairs. b. Some weeks later P- took at 8 a.m. a decoction ofzij of leaves to Oj of water. At 10 nausea ; pulse fell from 60-70 to 50, sometimes intermittent, and with each intermission oppression of heart as if grasped by hand. No appetite at meals. At 8.30 p.m. paroxysm of the peculiar sensation in heart, with intermittent pulse and congestion of head, especially in l. occiput, with urging to vomit. This he favoured mechanically, ejecting a quantity of saliva, mucus, and acid food. Woke 3 times in n. from quiet dreamless sleep with a violent sneezing, irritation to which seemed to mount upwards from cardiac orifice of stomach. Next m., at 5, vomited spontaneously a quantity of decoction, unaltered. Now came flickering betore 1. eye ; nausea, oppression at heart, feeling of weakness and trembling in muscles lasted all d. He was disinclined to leave bed ; and took only a little soup. Towards noon flickering came on in r. eye also, the figures of which had 3 distinct outlines. Closing eye and rubbing it gently caused clouds ofphosphorescence to pass before it. Eye very sensitive to light, but pupil not dilated. Several times this d. hehad to excite vomiting, when the nausea and urging were at their worst. On 3rd d. all symptoms the same. On 4th d. he felt very unstrung ; calves especially ached ;

slight diarrhea came on ; urine was very red and burning ; on the border of the cornea of r. eye, near inner angle, after burning came a small pustule with a little inflamed areola. General symptoms did not disappear till 7th, flickering not till 15th day. c. The figures formed by the flickering in these experiments Pdescribes as " Flimmerosen," because the outline ofthe rose is their type. In place of the round spots in the middle of the field of vision observed in the first experiment there now occurred a space bounded by four deep oval circular lines, forming four large round indentations, and the waves of light and shade surrounding it show the same indented form but less pronounced. These figures, which first appeared on the 2nd d., were formed when they reached their height on the 3rd by curved (but flatter) lines having 5 indentations, and were surrounded by waves of light and shade exhibiting a similarly fivefold but not deep indentation. During the later days, when the flickering decreased, there was noticed only a lateral fragment of the rose shape, as it were a small segment of a much larger but much less deeply indented circle than that seen heretofore. (Phys. der Sinne, ii, 120 ; from Frank's Magaz., iv, 154.) 24. Man, æt. 25, in good health. For 3 d. preceding experiment average daily quantity ofurineexcreted was 1474.5 c.c., sp. gr. 1024* 30, solid matter 75.31 grm., of which 30.17 grm. were inorganic, and 45°14 organic. Tinct. was now given, 20 min. 3 times dailyfor 2 d. Urine passed on 1st d. was of pale straw colour, and feeble acid reaction ; quantity 1950 c.c., sp. gr. 1Q13.25 ; total solids 69.98 grm., 31.27 inorganic, 38.71 organic. No other effects. On 2ndd. urine presented similar physical characters ; quantity was 1873.6 c.c., sp. gr. 101432 ; total solids 63.74 grm., inorganic 30.15, organic 33.49. Pulse slower and fuller. On 3rd d. quantity was 1624.9 c.c.; sp. gr. 102004 ; solid matter 67.29 grm., 33.19 inorganic, 34.10 organic. Urine otherwise same. On this d. characteristic cardiac effects of drug were manifest. (HAMMOND, Amer. Fourn. of Med. Sciences, N. S., xxxvii, 276. ) II. Poisonings.- I. A healthy, robust young man, affected with sore-throat, was advised to take " throat-wort tea." Having filled a quart pitcher with the fresh leaves ofD., he poured upon themas much boiling water as the pitcher would hold. Of this strong infusion he took a teacupful on going to bed, which caused him to sleep soundly. In m. he took a second cupful (the infusion being much stronger), and then went to his employment. He soon felt dizzy and heavy, began to stagger, lost his consciousness, and at length fell down in a state of syncope. On being conveyed home he vomited severely, and suffered extreme pain in abdomen. When visited he was conscious, complained ofgreat pain in head ; pupils were dilated, and the surface was cold, pallid, and covered with a copious perspiration. Pulse was low, about 40, three or four feeble pulsations being succeeded by a complete intermission of several seconds ; and each stroke, though weak, was given with a peculiar explosive shock. There was still great pain in abdomen, with incessant and violent vomiting ; no diarrhea ; suppression ofurine and abundant flow of saliva. Brandy and ammonia with warmth were employed, and after reaction had commenced purgatives were admin

istered. The man slowly recovered, but the pulse presented its peculiar beat and weakness for several d., and during this time the man could not bear the upright position. (TAYLOR, Poisons, p. 747.) 2. A peasant, æt. 55, took by the advice of a neighbour half a glassful of the juice of D. for the cure of an intermittent fever. Severe pain in epigastrium soon set in, followed by constant evacuations, both by vomiting and stool, of dark yellow colour and offensive smell, confusion of ideas, giddiness, contracted pupil, cold sweat, universal and partial trembling and likewise stiffening of body, bending forward of body attended with violent tearing pain in the abdomen, sighing respiration, difficulty of swallowing, small irregular pulse, and scanty, very painful expulsion of red urine. These symptoms continued 6 d.; on 7th pain subsided, but patient was stupefied, face livid, body covered with cold sweat, respiration more rapid. He died on 8th d. On dissection stomach was found empty and inflamed at larger curvature, but more so at pylorus. Duodenum was in same state, and a gangrenous spot at its larger curvature. Whole of the intestines were inflamed, and partially gangrenous. Liver and spleen were swollen, and bladder full ofurine. (Oppenheim's Zeitschrift, 1843, May, p. 52.) 3. A man suffering from asthma took by mistake 4 grammes instead of 5 centigrammes of powdered leaves. He was soon attacked by vomiting, vertigo, and dazzling ; he could not sit up or distinguish objects. The vomiting was violent, attended by abdominal pains, and continued for 2 d.; on 3rd d. these were less, pulse remaining slow and slightly irregular. On 5th d. pulse was still slow, pains less, asthma decidedly relieved. Weakness and slowness of pulse continued during the 6th and 7th d., and these symptoms disappeared on 9th, but at this date vision was still confused, and the fire appeared to the patient of ablue colour. It was not until the 14th d. that vision became normal . (ORFILA, Toxicologie, 1845, ii, 418.) 4. Victoire Z-, servant with an apothecary, generally of good health, sent for me on March 10th, 1863, about 5 p.m. She complained of lassitude, violent headache, and pain in the pit ofthe stomach. Since the previous evening she had vomited a great deal and felt herself much worse. She attributed her malaise and the vomiting to indigestion owing toeating chestnuts. I found skin cold ; pulse 52,of fairstrength, but irregular, and with frequent intermissions ; face was pale, pupils dilated ; tongue slightly coated, thirst considerable ; epigastric pain was increased by pressure ; abdomen painless, no diarrhea. Sinapisms and infusions of lime flowers were the remedies. On the 11th, 3rd d. of her illness, she had not slept at all ; vomiting recurred as often as she took anything. Pulse 52, irregular, and intermittent ; temperature of skin subnormal ; pupils still dilated. The cause of her illness was obscure until the apothecary exclaimed, " The cause has been discovered ; the unfortunate girl has been poisoned with infusion of digitalis." She had taken it by mistake ; the infusion contained about 50 grains of the leaves. From this moment all was explained, the slowness and irregularity of pulse, the vomiting, the muscular debility. For 3 h. she had experienced no uneasiness, soon after felt desire to vomit, then vomited alimentary matters of a greeenish-yellow colour.

She felt cold all over, and had vertigo and dimness of sight to such an extent that she could not come downstairs the whole e. Since taking to bed she had not urinated ; no movement of bowels. She felt bruised all over, felt as if drunk, and vision was still indistinct ; soft blowing murmur with first sound of the heart. Thursday, 4th d. of illness, found patient had passed water during n. and also towards m.; bowels not opened. Vomiting continues, pulse 42, respiration embarrassed (16) ; still vertigo, felt as ifdrunk and much fatigued. Evening, pulse 46, stronger ; vomiting less frequent. Friday, 5th d., pulse 58, less irregular, vomiting less frequent, patient's feelings as before, menstruation has come on. In afternoon pulse 60 and quite regular. The first part of the night she passed comfortably ; at 2 a.m. she got up alone to make water ; on returning to bed she suddenly fainted, the attendant rushed to her but she was dead. No post-mortem examination was obtained. ( Gazette des Hôpitaux, June, 1864.) 5. Poisoning of two healthy recruits by long-continued use of D. taken to save them from military service ; as reported by Dr. CONRAD KÖHNHORN . a. The symptoms of one on Dec. 18th (4 d. after enrolment)were complete loss of appetite, nausea, heartburn, occasional vomiting, constipation, great tenderness over stomach, headache, and dizziness. He presented a miserable appearance, tongue was thickly coated, and breath fœtid ; temp. 98.6°, pulse 56. These symptoms continued until end of December, strength failing, and aspect becoming more pitiable. Jan. Ist. Skin pale and ashy grey, parchment-like ; lips, conjunctivæ and gums anæmic, tongue moist, with greyish-white coating, breath offensive. No disturbance of motor power, sensorium free ; temp. 97.8°, pulse 52. These symptoms remained stationary until Jan. 9th, with increase of headache and vertigo ; also noise in ears, dimness of vision and hiccough . On 9th he stood up to have his throat examined and fell down in a faint. At I a.m., wishing to go to the closet, he was helped by an assistant to dress ; scarcely had he risen when he fainted, became convulsed, and died. P. M.-All the organs were healthy ; blood nowhere coagulated, but fluid, and of dark cherry-red colour ; r. side of heart full, l. contained no blood. Brain was very anæmic ; mucous membrane of stomach and duodenum presented some isolated spots of congestion upon which the capillaries had ruptured, and ecchymoses were found. The deceased, it was calculated, had 246 gr. of powdered D. in shape of pills during a period of four to five weeks. b. The other recruit, alarmed by this result, confessed to having taken some of these pills, but for a shorter time. He complained of loss of appetite, loathing of food, nausea, vomiting, constipation for 3 or 4 d., tinnitus aurium and vertigo, and the sense of a thick cloud before his eyes. (Lancet, 1876, i, 582. ) 6. A servant-maid, æt. 22, took at 7 a.m., Feb. 4th, a tablespoonful of tinct. of D.; she took her usual meal at 8, and felt no effect until 12.30, when she had malaise, followed in an h. by vomiting. At 8 p.m. she was admitted into the Hôtel Dieu, Paris. She had had frequent and violent vomiting, first of food, then ofgreenish-brown viscid

liquid ; very violent epigastric pain, intense pain over r. orbit, disordered vision, noise in ears, and great weakness. Towards 5 p.m. there had been some spasmodic movements of thighs, then occasional shivering followed by sweats, at the same time flushings of heat towards ears, and from thence spreading all over body. Pulse was scarcely to be felt. The n. passed without sleep, frequent vomiting of greenish thick matter ; throughout the n. general numbness. 5th, m., face very pale, greenish and livid, with redness over malar bones ; look of extreme exhaustion ; more headache ; vertigo and noise in ears ; sight disordered, scarcely able to see surrounding objects, pupils dilated and inactive ; intelligence clear ; extreme malaise referred especially to epigastrium, causing frequent sighing ; continual nausea, occasional vomiting ; the tongue pale, not coated ; no appetite, great thirst, desire for cold drinks ; no action of bowels since yesterday ; she has passed no urine, bladder feels distended ; respiration deep and unequal, 3 or 4 inspirations are followed by a deep and moaning expiration ; the action of the heart most violent, affecting the head of the auscultator, no bruit, the first sound deep and dull, the second very sharp ; the pulse is irregular, intermittent, and 44. Skin cold, especially on extremities . At n. urine was drawn off by catheter. 6th.-No sleep, occasional vomiting of greenish matter, slight delirium with agitation. Face is less livid, great thirst, intense frontal headache, vision clear ; pulsations of heart still very violent, heard all over chest ; pulse hard and resistant, 48. 7th. No sleep, violent delirium during n., no vomiting, still the violent headache. This m. one vomiting ; acute pain at epigastrium and in abdomen ; pulse38. No urine passed. 8th.-Violent delirium, no sleep ; continued whining, acute epigastric and abdominal pain ; no vomiting, no action of bowels for 2 d., intense thirst. Face pale and expressing great prostration, eyes fixed, pupils less dilated. Heart-beats weaker, more frequent, and always intermittent ; the pulse easily compressed, irregular, intermittent, 48-60. She has passed urine, thick, and holding in suspension whitish matter, which was not examined. On 9th no delirium, less anxiety, abdomen painful ; she has passed urine once, pulse 52. On 10th a little sleep ; headache, and heat of the extremities ; general aching ; the pulse very unequal, 60. 11th and 12th. Continued improvement, but on the last date a soft bellows murmur is audible at base of heart, and up aorta towards carotids. 13th.-Ten loose motions. More calmness, but heart's action violent and continuance of murmur with first sound ; pulse strong, a little unequal, intermittent, 68-84. It ceased to be irregular after 21st, but preserved its strength. ( TARDIEU, de l'Empoisonnement, p. 685.) 7. A servant-maid, æt. 27, who was pregnant, took for cædema ot the legs a large quantity of the fresh juice. After taking it she frequently vomited and lost a considerable quantity of blood from the uterus, which led the attendants to suppose abortion had taken place. On the 5th d. she was seen by a medical man ; she was then in a state of complete prostration and quite comatose ; face pale; the tongue swollen, red at edges, white in centre ; pulse very slow ; epigastrium tender ; frequent hiccough and diarrhea. She grew worse, and urine and stools passed involuntarily. She died on 12th d. Autopsyshowed

partial inflammation of stomach and a little serum in pericardium. (Ibid, p. 687.) 8. I was called, Sept. 16th, 1870, to see Mrs. H-, who complained of a very distressing nausea, together with a heavy headache, and flashes of light before her eyes. There had also been great commotion of heart " a great throbbing and pounding," as she expressed it. It was found she had been drinking for a cough a tea made from foxglove instead of mullein. On leaving this off symptoms promptly subsided. (P. K. GUILD, M.D., Publ. of Mass. Hom. Soc., iv, 30.) 9. The effect of too large or long-continued doses of D. is manifested by the disordered condition of the alimentary canal, of the circulating organs, and of the cerebro-spinal system. The more ordinary symptoms are nausea and actual vomiting, slow and often irregular pulse, coldness of extremities, syncope or tendency thereto, giddiness, and confusion of vision. Sometimes the sickness is attended with purging, or even with diuresis ; at other times the patient is neither vomited nor purged, and the principal disorder of system is observed in the altered condition of the nervous and vascular organs. External objects appear ofa green or yellow colour ; the patient fancies there is a mist, or sparks before his eyes ; a sensation of weight, pain, or throbbing of the head, especially in the frontal region, is experienced ; giddiness, weakness of the limbs, loss of sleep, and occasionally stupor or delirium, or even convulsions, may also be present. The pulse becomes feeble, sometimes frequent, sometimes slow ; and there may be profuse cold sweats. Salivation is sometimes produced by poisonous doses, and has been known to last three weeks. (PEREIRA, op. cit.) 10. a. D., in common with only a small number of other drugs, possesses the peculiar faculty (which is probably due solely to an unusually slow elimination through the kidneys) ofunfolding its action in the body during a relatively long period, and therefore of developing cumulative effects when repeated doses are administered. These may, under certain circumstances, produce threatening phenomena, or even symptoms of poisoning, among which are headache, dryness of throat, nausea, sensation of choking, and in well-marked cases-buzzing in ears, disturbances of vision (manifested by appearance of sparks before eyes, amblyopia, or diplopia), also dizziness, swooning, vomiting, diarrhœa, sleeplessness, a thready, scarcely appreciable, and sometimes aryhthmical pulse, and a very great fall in the bodily temperature, a result of the slowing ofthe circulation. A headache, which appeared after even 0.03-0.09 grm., was a prominent symptom in many cases. b. Traube has observed an affection of the skin after the use of D. In a case of pleuritis and pericarditis, the patient took from 4th-6th d. of his illness 3.75 grms. in infusion. Four d. after last dose there appeared, while bodily temperature was normal, an erysipelatoid affection of the face, which resulted, 5 d. later, in an excessive ragged desquamation . In a second case, ofpleuro-pneumonia,4.08 grms. were taken in 5 d. Four d. after last dose, patient-then free from feverexperienced a rise in temperature ; and on 5th d. there appeared on body, supinator surfaces of forearms, and backs of hands, a papular exanthema, made up of quite prominent, carmine-red, rounded spots

disappearing on pressure, the majority of which united to form large patches elevated above surface of skin. Next d. desquamation began on face in tolerably large masses, whilst new eruptions showed themselves on upper arms and neck. Four d. later still, exanthem had almost entirely disappeared ; and not until some time afterwards , during the course ofa newly-developed typhoid affection, did desquamation, in large flakes, occur on the body and extremities . A similar exanthema, spreading over the whole body, was observed by Schuchardt in the case of a young man who had taken D. for a long time for the relief of endocarditis. When same patient took D. again, one year later, same eruption appeared with equal intensity. (LEWIN, op. cit.) 11. In the case of a man, æt. 50, the tinct. taken in medicinal doses for about 20 d. produced the following symptoms :-The pulse, which during a former use of the medicine had lessened by ro or 15 beats, sank almost to halfits usual number. The patient was tormented with the most painful disquietude, so that, even in n., he left the bed every moment, could not sleep, and with his eyes open conversed with persons who were not present. At same time pupils were dilated, and conjunctiva both of eyes and lids red ; he had but little appetite, with great nausea, violent thirst and dryness of mouth ; alvine evacuations were scanty ; secretion of urine increased. These phenomena lasted 6 d., when restlessness diminished, sleep returned, and dilatation of pupils disappeared. (Med. Times, xxxi, 275. ) 12. A man, æt. 52, having pleural effusion, but otherwise (save for furred tongue) fairly well, heart and urine quite normal, pulse 70, was ordered infusion of D. 3 times a d. He at first measured dose, but soon began to guess it, and gradually increased amount. Shortly after doing this, appetite began to fail, he had bad taste in mouth, and tongue felt very dry. He felt also dull sickening pain over stomach, rising up line of sternum to throat. He felt weaker every d. This was about middle of Nov., about 3 weeks before symptoms attracted attention. He went on gradually increasing dose. When he lost his appetite he also got occasional headache ; and along with the pain in epigastrium he had palpitation. Bowels were costive. About 3rd week in Nov. he vomited once or twice after meals when seized with severe fit of coughing. Symptoms grew worse ; he felt weaker and weaker, and less able to walk. About Ist or 2nd Dec. he noticed his sight becoming dim ; and when he looked at his own hands, or another's face, they seemed blue . Pain in stomach was now almost constant, but headache was not much worse-most felt p.m. On m. of Dec. 5th he complained ofweakness and want of appetite. His pulse was found weak and very irregular. At midday visit cardiac action was found increased, and pulse distinctly dicrotic ; the general rhythm was about 2 beats in a second, and then an interval of about two seconds ; pulse was 58, and somewhat feeble. Pupils were natural and skin moist ; urine depositing lithates freely, otherwise normal. He got ziij of brandy before I saw him, which I did about 5.20 p.m. At that time cardiac impulse was very abrupt and felt strong ; pulse was 66, and very irregular. He omitted the D., and took brandy and sp. amm. arom., under which dimness of vision and pain at epigastrium gradually diminished up to

8th, when he had (p.m.) rigors, and went to bed complaining of intense frontal headache. This better next d., but continued to some extent up to 19th, when record ceases . It was over r. or 1. parietal and frontal bones, chiefly about parietal protuberances, never in vertex or occiput. Pulse was regular by 13th. (BRUNTON, On Digitalis, 1868.) III. Experiments on animals. 1. a. In 6 or 8 h. after giving a large dose of D. to horses they stand at the stretch of their halter, sad, dejected, and without appetite, and their coats lustreless and rough. Then signs ofgeneral excitement appear. Conjunctivæ are injected and of a bright red ; eyes brilliant and fixed ; face pinched ; nostrils dilated and quivering ; respiration hurried, number being 15 to 20 or 25 in m .; circulation more rapid, beats of heart being abrupt, their energy much increased, and accompanied after a certain time by a vibratory thrill, with a decided metallic tinkling, and as poisoning goes on a distinct bellows murmur becomes audible, and is rendered louder by any exertion ; beats then show decided intermittence, and pulse is small, thready, and intermittent ; heat of body is increased ; hot sweats appear on ears, nose, shoulders, and flanks ; mouth is hot and filled with saliva, which is sticky and scanty ; tongue is of purplish red at its tips and edges, and is covered on dorsum by a thick coat, which gives it a leaden hue ; fæces are of their normal form and colour. During the first 12 h. the animals often show signs oftransitory intestinal pain. b. At the end of 24 or 36 h. stage of excitement has passed and animals become comatose, their heavy heads hanging down towards litter or kept at bottom of manger, completely insensible to external noises or stimuli, their eyes fixed, without movement or expression, sometimes half covered by the fading lids, and at other times haggard and ready to start from their orbits, pupils greatly dilated, and conjunctivæ, previously of a light red, are now of a violet brown, and their secretion dried up. The previous acceleration of the respirations is now succeeded by great slowness, their number descending to 8 , 7 , or even 6 per m. , and being deep, broken, and trembling. The heat of the body is diminished, the sweats stop, and the skin becomes cold. The fæces are now of a browner character, and covered with a layer of mucus more or less thick. The urine is at first suppressed but at the end of36 or 48 h. is passed in abundance, pale, clear, and inodorous, voided very frequently, and in small quantity at a time. There is great muscular weakness, staggering gait, oscillation of posterior extremities, and a kind of paralysis which slows their movements . In some cases there are slight vertigoes, in others spasmodic fibrillary contractions of muscles of face and ofale nasi. Severity ofsymptoms rapidly increases. Muscular weakness becomes extreme, the legs are The no longer able to support the body, and the animal falls en masse. respiration becomes more disturbed, sometimes jerking, difficult, and plaintive, more frequently very slow but in some cases slightly accelerated. In some it presents remarkable intermittency, and its time ofstoppage coincides with that of heart when latter also intermits. In some cases 24 to 36 h. before death there has been noticed a paralysis of lips, chiefly upper, and a thick and stringy saliva flows from mouth. Diarrhea appears, and quantities ofa very fœtid, soft, blackish

paste are discharged, and when intestinal canal is completely emptied diarrhea becomes serous, expelled matters being liquid, blackish, and of repulsive odour. Skin becomes icy cold ; thermometer introduced into mouth, rectum, or subcutaneous cellular tissue standing in some cases at 31.5°, or even, before death, 25° C. Death generally comes on quietly but is sometimes accompanied by unconnected movements . c. When given in doses less rapidly fatal, so that each dose would only produce slight symptoms which would soon pass away if dose were not carefully repeated, influence which it exerts on circulation is by far the most prominent phenomenon. At first there is slight excitement ofheart and its pulsations are a little quickened, then later on they undergo a remarkable diminution, falling to 25 or even 20 per m. If dose be still repeated beats become quicker and more energetic, rising to 55, 60, 65, and 70. The cardiac sounds are more clearly heard, more distinct from each other than normally, and following a different rhythm, there being occasional intermittences, usually after same number ofbeats, but this number varying in different subjects, and in the same subject according to date ofpoisoning. There may be 5 or 6 pulsations between intervals in some, 15 or 16 in others, and in yet others intermissions are completely irregular. As poisoning goes on metallic ringing appears and becomes more and more distinct and sonorous. Still later a vibratory thrill appears and is followed by a bellows murmur. As death approaches beats ofheart become more and more rapid, being 92, 100, or even 114. Beats of pulse correspond in time to those of heart, but as the latter increase in energy in same ratio the former become more and more feeble, and less and less perceptible, till at last when poisoning is complete it becomes completely imperceptible. In doses so small as to have no poisonous effect its action is shown first on the urine, and secondly on circulation. To show this Messrs. Bouley and Reynal give following typical case : d. A Hungarian horse, of an excellent constitution, employed in the service of the Veterinary School of Alfort, aged 10 years. Normal state at time of experiment : Respirations 16, pulse 37, full, mucous membranes rosy, digestive functions intact ; all the signs of health . Jan. Ist, 1849, 11 a.m., 6 grm. of D. powder were given in electuary when animal was completely fasting. 2 p.m., respirations 14 ; passed water, which was clear and plentiful. 6 p.m., respirations 13, pulse 35 ; -water always passed in abundance and with same limpidity. Next d. effects had disappeared. 4th, 10 a.m., 6 grm. given as before. At time ofgiving respirations 16, pulse 37. 3 p.m. , respirations 14 ; urine clear, abundant, and odourless. 6, respiration, circulation, and urinary secretion same. 8, respirations 13 ; cardiac beats a little diminished in intensity, otherwise quite healthy. 5th .-7 a.m., conjunctivæ pale, pulse 22, small, and not well felt ; beats of heart diminished in intensity, remain quite distinct, marked intermittence after each beat ; respirations 6 to 7. Noon, same state. 2 p.m., pulse 25 ; intermittence less sensible ; respirations II ; urine always clear, less abundant. 7 p.m., lying down quietly ; litter much soaked with urine; pulse 30 ; intermittence disappeared ; respirations 15. 6, all symptoms of med. disappeared and functions return to their normal state. 8th.-Six grm . of

Volume II — Appendix

Digitalis.- P. 507, 1. 9 from bottom, for " Materialen " read " Materialien." After II. 12, insert the following : 13. A boy, æt. 10, took for anasarca after scarlatina (6 weeks after the commencement of the scarlatina) 2 gr. fol. dig. divided into 6 equal doses.-April 15th, 7 a.m., he took the first dose, which had no apparent effect; at 6 p.m. the second dose. After 10 m. complained of violent dull headache above and between eyebrows. The pain went off for a few m. and returned with equal intensity, and this went on for more than 1 h. 7 p.m., suddenly complained of loss of vision, which lasted 10 m. The vision then returned, and he was cheerful, pupils somewhat dilated, pulse rather quick, frequent yawning. 9 p.m., drowsiness passing into stupor. 11 p.m., convulsive movements of extremities and facial muscles, which increased on returning and recurred at shorter intervals. 12 p.m., general convulsions, tonic alternating with clonic convulsions, with longer and shorter intervals, heart and carotids beat violently, irregularly, pulse 130, involuntary emission of stools and urine, temperature elevated. This state lasted 2 h. Warm baths, antispasmodic enemata, and skin irritants were employed. At 2 a.m. he became quieter, the convulsions gradually subsided, the heart still beat violently, pulse 120.-16th, 6 a.m., sat up inbed with discomposed features, widely-opened eyelids, staring eyes, very dilated pupils, gives incoherent answers, speaks a great deal, mostly saying the same thing over and over again, very hurriedly and with weak voice, but does everything he is told. Tongue clean, urine pale, heart's beats more regular, only every 5 or 6m. there comes on a violent contraction of heart and simultaneously twitching movements of extremities and facial muscles, pulse softer, fuller, 100, temperature normal, skin moist. The anasarca is quite gone. 10 a.m., he fell into a quiet sleep, which lasted 3 h., from which he woke with signs of returning consciousness, buthe still speaks shortly and hurriedly but sensibly, his hands tremble, and he has some difficulty in taking hold of anything. Eyes still wide open, sight weak, circulation nearly normal, the convulsive movements have ceased, but he often starts suddenly as if in affright. 5 p.m., again fell asleep, and the n. was passed quietly.- 17th. Still vertigo and mist before eyes, eyelids open, pupils dilated, and he is very weak. In a few d. well. (SAZYMA, Med. Jahrb. d. k. k. Oest. Staates, 1829, x, pt. i, 129; in Frank's Mag., i, 732. ) 14. Atailor, æt. 24, affected with anasarca of legs, hypertrophy of heart, and insufficiency of mitral valve, came under treatment Sept. 6th, and up to Oct 19th he had taken Dig. in powder 42 gr. and Ziij gr. iv in infusion. The toxic symptoms after this quantity were but slight : confusion of head, loss of appetite, and an inclination to vomit, the pulse sank to 40 and became intermittent. These symptoms soon went off when the medicine was discontinued. On Oct. 25th violent. symptoms of poisoning presented themselves, confusion of head, anorexia, inclination to vomit, and colicky pains, vomiting of the medicine and of a greenish-bitter fluid, pulse 40. On leaving off the medicine these symptoms went off in 24 h. By the end of October the anasarca was gone, but on Jan. 12th it returned in great intensity. Dig. was again given. After taking 3j in infusion he had on 22nd confusion and heaviness and stupefaction of head, misty vision. The medicine was discontinued, but after 24 h. (Jan. 23rd) he was stupefied, answers questions at first shortly, then not at all, pupils not much dilated, breathing slow, heart's beats strong ; auscultation revealed an intense follicular noise, obscuring the heart's sounds ; the first seemed to pass into the second. Urging to stool and urine roused him for a little, but he again fell into the previous state. Pulse 50, intermittent.-24th. Lethargy, he lies unconscious, with hot head, eyes staring, immovable, glassy, all the organs of sense seemed in abeyance, sight, hearing, taste and smell were lost, skin insensible, the lower jaw could with difficulty be separated from the upper, respiration very slow, stool and urine suppressed. Tetanic stiffness of whole body and limbs, pulse 40, weak and intermitting. This state lasted 48 h. Patient slowly recovered consciousness, vision misty, confusion of head. These symptoms also went off, but he got pleurisy of 1. side, for which he had antiphlogistic treatment, and recovered in 8 d. The dropsical symptoms returned, and he died Feb. 16th. (MELION , Vierteljahrsch.f. d. prakt. Heilk., Prag., v, 88.)

Volume IV — Appendix

DIGITALIS. (See vol. ii, pp. 503, 755.)

For several of the foreign provings of D. we used Dr. Black's translation in the Mat. Mtd.^ Phys. and Jpplitd^ vol. I. Dr. Dudgeon, however, has gone over these with their originals, and finds the following corrigenda nccessa

ry (for which we are indebted to himj ; ottom, for " In e." read " After 3 d.'

p. 506, 1. 2 from botto

p. 507, 1. 2 from top, before "4th " supply '*Oct."

„ I. 3 „ read *' None of the former symptoms were experienced save nausea and pressure in stomach. Gradually action of heart and arteries increased to such a degree, and there came on such orgasm of blood and palpitation, that on n. of 3rd and 4th d. he had," &c.

p. 507, 1. 7 from top, for " rushing and tinkling " read " roaring and tinnitus."

p. 513, 1. 23 from bottom, for "standing up" read " risine frona bed."

?• ST3> J- 19. . » after "53" add "There was consti-

pation for 4 d. ; vision was impaired, and pupils somewhat dilated."

p. 514, I. 4 from top, read, " He took care to observe condition of urine in normal stale for 8 d. before commencing experiment, and of

heart for 10 — 12 d. Before and during experiment he passed urine usually 5 times a d., rarely only 4 times. Quantity " Sec.

p. 514, 1. 6 from top, after *' 1075 c.c.''' add **Sp. gr. in normal state was 1032 — 1017, average 1025 ; reaction acid."

p. 514, 1. II from top, after ** tinct. j " read "■ while sitting quietly had sudden feeling as if heart stood still, accompanied with great anxiety, for I m. Then " &c.

p. 514, 1. 15 from top, for "seminal emissions" read **a seminal emission " (and so also on March 19th and April 25th). p. 514, 1. 16 from top, after ** in bed ", read " m."

M „ „ for statement as to loth, nth, and 12th d.

read ** loth. — 1 1.30 p.m., 15 dr. N., restless sleep with frequent waking with hot face. Urine 11 25 c.c, acid, sp. gr. 1025. nth. — 11 p.m., x8 dr. Pulse 58, unequal, sometimes slow and full, sometimes quicker and smaller. Urine 1040 c.c, acid, sp. gr. I025"25. 12th. — 11 p.m., 20 dr. Pulse, 61 ; urine 1040 cc, acid, sp. gr. 1025, soon becomes turbid."

p. 514, 1. 28 from top, after " 1025 " ^^^ ** ^> * vesicular eruption on chin."

p. 514, 1. 29 from top, for ** i or." read " i4 gr."

„ 1. 34 „ after *' ftiUer " add " A small boil on nape." „ 1.36 „ for « 25th " read « 20th." „ 1. 37 „ for ** quick " read " acute." » !• 38 )} for ** taking away " read " oppression." „ 1. 2 from bottom, for " quantities " read ** quantity." p. 515, 1. I from top, for " wallcs " read " plays the piano." „ 1. 2 „ for ** irregular " read " regular." „ 1.3 „ for " In an h." read " For some h. afterwards ", „ 1. 4 „ for " emptiness " read " fulness," and after ** stomach " add " as if food would rise up j expectoration of greyish, sweet-putrid mucus".

p. 515, 1. 6 from top, after " forenoon " add " Character of pulse is undulating, the several beats not distinctly marked, but running one into another."

p. 515, 1. 10 from top, "after " i a.m." substitute for text " On waking in m. sore pain in urethra. On following days till May 5th had continual erections m. in bed, also after rising ; increase of cough and expectoration ; and a peculiar oppression on chest, especially after sitting for any length of time."

p. 515, 1. 14 from top, instead of ** again giddiness and faintness" read " quick and weak."

p. 515, 1. 18 from top, for " a.m." read " p.m."

„ 1. 23 „ after " unpleasant " insert " 6 p.m., pulse 68, sitting. 10.30 p.m., took 30 dr. After i^ h. disagreeable pulsating pain in 1. side of chest inferiorly, as if in integuments."

p. 515, 1. 26 from top, after "chordee" insert *'with urging to urinate though there is but little urine in bladder ".

p. 515, 1. 27 from top, after «' 2j gr." add " at 10.15 ».«»." „ 1. 29 „ for " 1050 " read " 860," and for « 1026 " read " 1025."

p. 515, 1. 31 from top, after " prover " add "On 1 6th, urine, hitherto always acid, was neutral."

P- 5»5> '■ 33 fro"" *°P> ^^^ " '4th " read " i6th."

„ i. 34 „ after "e." add "felt need to take deep breath, but when he did so felt as though there was an obstacle low down in lungs which prevented their hlling with air mofc than one half."

I. 25. At Dr. Black's suggestion I made a few experiments with » view to determine the action of D. in small doses on the pulse. The subjects were two girls, M. and Z., set. 14 and 12 respectively, both in good health. I made my experiments with the sphygmograph which would detect any alteration in the quality of the pulse not ascertainable by the finger. The sphygmograms lie before me.

a, M's pulse before commencing was 84. i dr. of ist cent, was taken. 5 m., pulse 90, took another dr. 7 m., pulse 78 } 10 m., 64} 12 m., 78 ; 20 m., 75. 21 m., took another dr. 23 m., pulse 75 30 m.j 72 } 37 m.,72. For comparison's sake M.'s pulse was observec one d. when nothing had been taken. It was at first 84 ; 5 m. aftef settling down it was 78, and so remained for 20 m. more.

h. Z's pulse was 96. Two dr. of tinct. were given. In 5 m pulse was 90 ; 10 m., 84; 15 m., 78 ; 20 m., 80.

Character of pulse in both experiments remained the same, as wtt< nessed to by the sphygmograms. (Dudgeon, Brit. Joum. of Htm,. xxxix, 279.)

1. I have in some healthy persons observed, after taking a dessert* spoonful of the infusion 3 times daily for 5 — 6 d., a frequent desire w urinate, but only small quantities of high-colourcd water passed at : time ; in others the flow was copious, and the water clear. In somi instances, where the desire was frequent and the quantity small, then was pain and often emission of blood before and after micturition (Phillips, op. cit., 2nd d.)

II. 15. A man, aet. 26, for palpitation, took by mistake as much as 8 grm, of powdered leaves. He dined at 6, and vomited what h took. N. was restless, but without further vomiting. This, however, recurred in m. Seen at 5 p.m. pulse was 90 and very irregular; urin scanty, infrequently passed, high coloured. On 3rd d. he vomited onljp after certain drinks i pulse and heart irregular, but rather less so than yesterday; pain at praecordia. Urine scanty and red, with brick-dust deposit. A similar condition of urine persisted for several d. yet, pul gradually becoming quiet and regular. (Lemsurien, Jnn. ii Hjg^ puhLy 1st ser., xxxix, 452. — In an article in L'Art Al/dical for Oct

1884, from which we have taken the above, Dr. Marc Jousset has collected a number of cases of poisoning by D. and its alkaloid to illustrate their influence on the urine, which was generally as in the present case. — Eds.)

1. For a lung time the cumulative action of digitalis has been believed to be one of the possible results of its administration, and, at the present time, most physicians are on the alert to observe any evi« denceof this accumulated influence in all cases in which the drug is

einid<^ed. Recently, however, there have been those who have ex- {M%ssed unbelief in tlie possibility of the occurrence of this effect after the use of digitalis, while others pay very little heed to this part of the subject when treating of the administration of the drug. While we ouy rightly believe that the cumulative action of digitalis is not frequently met with, I think that the following brief history will demonstrate that this sequence of its administration is liable to occur.

L. Y.,aet. 6, after an attack of scarlatina occurring in March, 1877, developed albuminuria. As a part of the treatment of this pathological condition, she was ordered to receive ti^iv of tinct. digitalis every 4 h. At the time this was prescribed her pulse had not fallen below 118. She took the medicine for 5 d. with perfect regularity (except during the hours of sleep), her pulse ranging between 96 and no. During this time the renal symptoms were improving. On the 6th d. the pulse was irregular — at 70. Ordered only three doses during d. On the 7th d. pulse was 60 and irregular. Discontinued medicine. During the next 4 d. (patient taking no medicine) pulse averaged 52, was very irregular, and, at times, was as low as 46. On the 1 2th d. pulse became regulsu* at 56. From this time no irregularity was observed, the frequency of the pulse gradually becoming normal. I took the trouble to ascertain that the tincture was of the same purity when the prescription was renewed, during its use, as when originally ordered. (Edward L. Partridge, N. T. Mid. Record^ Aug. 17, 1878.)