THE ACTION OF THE DIGITALIS BODIES.

911 instance described by Captain Tresidder owed his’ Dr. Hatcher deal is that of its so-called cumurecovery. We understand that the same mode of lative effect; the production of the phenomenon, treatment has been used with success by Dr. W. commonly called " cumulation "-a term to which the authors object-depends on the relationship James in the Ancon Hospital, Panama Canal Zone. existing among a number of factors, including absorption, elimination, and persistence of action, EDUCATION. THE FUTURE OF DENTAL all of which are in need of investigation. The ELSEWHERE in our columns one of our Scottish cumulative effect of digitalis and its emetic action Special Correspondents, dealing with the recent are two unfortunate properties of a most valuable meeting of the West of Scotland Branch of the therapeutic agent, and it is satisfactory to know Incorporated Dental Society, states that in an that research workers are attacking the problems :address on "Dental Politics," in which the future which these properties raise. .extension of the insurance benefits to include dental attendance was dealt with, the suggestion ROYAL COMMISSION ON SEWAGE DISPOSAL. was made that dentistry should be freed from the semi-medical course and from the control of the THE final report of this Commission, according A more pernicious suggestion Medical Council. to a statement accompanying the Civil Service was never made. Dentistry is a specialised applica- Estimates for the ensuing financial year, will be tion of surgery, and the true course of evolution is " The Commission was appointed to free it from the semi-medical course" by sub- presented shortly. so long ago as May, 1898, and it has already prejecting it first to an entirely medical course, with sented eight reports. The first was special study subsequently, as in the case of any in July, 1901. The second (July, (preliminary) dealt with 1902) other specialised department of the art of medicine. certain chemical and bacteriological investigations Such an ideal may perhaps not yet be within reach which had been made under the direction of of attainment, but the reverse course would be a the Commission; the third (March, 1903) had to fatal retrogression. do with trade effluents and the setting up of rivers boards and a central authority for the THE ACTION OF THE DIGITALIS BODIES. purpose of settling disputes between manufacturers To the large mass of literature on the action of and local authorities, and for the better protection digitalis some useful additions have recently been of rivers and other waters ; the fourth (December, made by two American investigators-Dr. Robert A. 1903) dealt with the dissemination of disease by Hatcher and Dr. Cory Eggleston-whose work on means of contaminated shellfish, and other evils this subject was recently noticed in THE LANCET.l caused by the discharge of unpurified sewage and In a series of collected papers published in the trade effluents into tidal waters, and contained .current issue of the Cornell University Medical reports by the Commission’s own officers on Bnlletin these authors record the results of investi- bacteriological examinations of shellfish and sea gations conducted by them in the pharmacological water, on the land treatment of sewage, on methods laboratory of the University. The papers deal with of chemical analysis, &c.; the fifth (1908) reviewed digitalis research from several standpoints, those on the main question of what methods of sewage the emetic action of digitalis bodies being especially disposal may properly be adopted by local useful. The authorsshow that all the digitalis authorities; the sixth (February, 1909) treated of bodies which they have tested induce emesis in the disposal of distillery effluents; the seventh «cats more promptly and in smaller doses after intra- (February, 1911) dealt with nuisances due to venous administration than when they are given excessive growths of green sea-weeds in sewage by stomach, from which they conclude, as our polluted estuaries, with special reference to Belfast readers will recollect, that the emetic action Lough, and contained a separate report by officers of these drugs is exerted upon the vomiting of the Commission upon the preliminary treatment .Centre in the medulla. True digitalin is rela- of sewage in slate beds; and the eighth (November, tively the most actively emetic of the digitalis 1912) had reference to the standards to be applied principles, digitoxin being much less actively to sewage and sewage effluents discharging into emetic, while digitalis is intermediate in this rivers and streams, and the tests which should be respect, agreeing with the fact that it contains used in determining those standards. The Comboth those principles. Further, the authors’ results missioners have since investigated the question of lend no support to the claims made that digalen, the disposal of various polluting trade liquids, and digipuratum, digitalysatum, or the fat-free tincture are now engaged in preparing their final report. of digitalis is in any way less actively nauseant or emetic in proportion to its cardiac activity CHALAROSIS : A NEW HUMAN MYCOSIS. than any of the better known and less expensive galenical preparations of digitalis and strophanthus. IN the Presse Medicale for Feb. 21st M. Roger, Since there is at present no means of securing the M. Sartory, and M. Menard give an account of two cardiac actions of the digitalis bodies without cases of infection of the human subject with a subjecting the vomiting centre to the influence which they refer to the genus Chalara. of these agents at the same time, the authors con- fungus The first patient was a woman of 25, who had for clude that there is no advantage in substituting several years been subject to attacks of tonsillitis, one mode of administration or one member of the usually ending in suppuration. An attack beginning group for another, and they point out that the in October, 1911, proved more serious than those employment of opium to prevent the gastro- which had preceded it, and the tonsil was ultiintestinal symptoms of the digitalis bodies in removed. During this illness, in November, ordinary cases masks the appearance of toxic mately the was troubled by fleeting pains in patient symptoms which should serve as a signal for the various joints, and this was followed by the reduction of the dose. Another phase of the a number of nodules in the of digitalis question with which Dr. Eggleston and appearance subcutaneous tissue of the lower limbs. These 1 THE LANCET, Oct. 4th, 1913, p. 1013. gradually increased in size, the skin covering them

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