The author agrees in opinion with those who hold that digitalis is not a cumulative poison in the sense in which this term was formerly used. Doses of digitalis frequently repeated, so that the effect of one is added to those before given, will certainly produce toxic symptoms. In this sense opium, belladonna, strychnine, etc., are cumulative poisons. If full doses of digitalis are given at proper intervals, and the effects of one dose are permitted to cease before the next is given, no accumulation will take place. Sudden toxic symptoms are developed as follows: When, after the administration of large doses, the pulse is much reduced in the recumbent posture, on rising, the heart is suddenly found unequal to maintaining the circulation in face of the increased resistance in the arterioles and against the force of gravity. It must not be forgotten, further, that the irritability of the vaso-motor nervous system may be destroyed by over-stimulation by digitalis, and lethal effects be produced in this way.

Authorities referred to:

Ackermann, Prof. Th. Ueber die Wirkungen der Digitalis. Volkmann's Sammlung, No. 48.

Boehm, Dr. Rudolph. Ueber die physiologische Wirkung der Digitalis und des Digitalin. Schmidt's Jahrbücher, vol. cliii, 1872.

Briesemanx, Dr. C. Schmidt's Jahrbücher, vol. cliii, p. 29.

Dybkowsky, W., und Pelikau, Eug. Schmidt's Jahrbücher, vol. cxvi, p. 170.

Foster, Dr. B. Clinical Medicine: Lectures and Essays, 1874, p. 92. Digitalis in Heart Disease.

Fothergill, Dr. J. Milner. Prize Essay. British Medical Journal, July and August, 1871.

Gourvat, M. Gazette de Paris, July to December, 1871, and January to February, 1872.

Hirtz, Dr. Gazette Medicale de Strasbourg, 1862.

Holland, Sir Henry. Medical Notes and Reflections, American edition.

Homolle, M. Archives Générales, July, 1861, p. 5.

Husemann, Prof. Dr. Th. Handbuch der gesammten Arzneimittellehre, zweiter Band, p. 914, et seq.

Kohler, Dr. H. Ueber den Antagonismus der physiologischen Wirkungen der Saponin und Digitalin. Archivf. exper. Path, und Phar., 1873, p. 138.

Liebermeister, Prof. Dr. Karl. Ziemssen's Cyclopaedia of the Practice of Medicine, vol. i, p. 217.

Leyden, Prof. Dr. Deutsche med. Zeitschrift, No. 23, 1881.

Maudsley, Dr. Henry. The Practitioner, January, 1869.

Schmiedeberg, Prof. Archiv für exper. Pathol, und Pharmacol, Band iii, p. 16.

Taylor, Dr. A. S. On Poisons, third edition, London, p. 796.

Traube, Prof. Dr. L. Berliner klinische Wochenchrift, No. 17, April, 1870, and No, 18, May 2, 1870.

Weil, Dr. A. Schmidt's Jahrbücher, vol. cliv, p. 143.