author's views. 73 



the fibres connecting the different ganglia of the heart, and 

 which by keeping up a perfect correspondence between the 

 different ganglia, enable the heart to contract rhythmically, now 

 convey impressions slowly and imperfectly ; the different parts 

 of the heart no longer work in unison, and the contractions 

 become irregular and peristaltic ; by-and-by the fibres do not 

 transmit impressions at all, and the ganglia working in inde- 

 pendence of each other, we see some continuing to make the 

 little area tliey supply pulsate when the rest has stopped, and 

 finally the ganglia themselves become paralysed, and the heart 

 remains motionless and contracted. But it is probable this 

 stimulating influence is not exerted on the heart and capillaries 

 alone, but on involuntary muscular fibre throughout the body, 

 or on the sympathetic nerves which supply it, since we find it 

 causing contraction of the stomach, intestines, and uterus, and 

 in those organs also, its stimulating effect would probably be 

 followed by paralysis. Not only the nerves are affected, but 

 the power of the muscular tissues themselves is impaired, as 

 shown by Dybkowsky and Pelikan, who found that when two 

 muscles were taken from a frog, one having been taken from a 

 leg which the poison was prevented from reaching by a ligature 

 applied previous to its administration, and the other being 

 taken from the poisoned animal, the curve described by the 

 former in the myographion was much higher than of the latter, 

 showing its greater power. 



The cause of death from digitalis seems to be stoppage of the 

 heart's action, and defective supply of blood to the nerve cen- 

 tres. When death occurs from not very large doses, it seems 

 often to be caused by some slight exertion at the time. As in 

 the case of Daniel G., the pulse was of low tension and irregular, 

 and when we know that any exertion still further lessens the 

 tension, we can easily imagine how in such a case there might 

 be syncope ending in death. This seems all the more probable, 

 as I noticed on the 17th of March, besides bright spots, a kind 

 of haziness such as one sees before fainting, though not of so 

 marked a character. 



There are several points which I have not yet made up my 

 mind about, such as the remarkable intermissions observed in 



