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Finally fell on its side there was no movement of the thorax, but the muscles of the neck and belly were in full and rapid action, dry and sonorous rles were heard, and a large quantity of mucus appeared at the nose and mouth the movements grew feebler, the respirations infrequent, and at the end of thirty-four minutes it was dead the necroscopy showed the blood black and thick. Heart relaxed. Lungs red, a little emphysematous, containing but little blood, and on their surface were blackish points and small red spots the death of desdemona shakespeare “othello” has been much criticised the declaration that she was strangled or suffocated does not consist with the symptoms described see med news, philadelphia, may 1st, 1886, p 489 treatment the obvious indication is to search for and remove the obstruction themeans and methods of treatment are fully treated of in surgical works, but may be briefly mentioned here laryngoscopical examination may be necessary a curved forceps isusually the best instrument for removing the foreign body a tallowcandle may serve to push it into the stomach if there is no bougie athand suction may be used sneezing may be brought on by tickling thenostrils. Coughing by tickling the glottis. Vomiting by irritating thefauces, or by emetic. The body of the subject may be inverted and inthis position the fauces may be tickled, or fingers may be passed backinto the pharynx johnson892 says that at the moment of inversion thepatient should try to take a deep inspiration. This opens the glottisand facilitates the expulsion of the foreign body the inspiratorycurrent has no appreciable effect in retarding the movement of theforeign body in the direction of gravity noble recommends inversion of the body in new-born infants in whichasphyxia may be supposed to be due to anæmia of the brain tracheotomyor laryngotomy may be necessary it may be necessary to administeroxygen foreign bodies like beards of grass and fish-heads can bewithdrawn only with difficulty because of their sharp projections intense suffering and dyspnœa in a robust subject may necessitatevenesection generally speaking it is better to bring up the foreignbody than to push it down into the stomach beveridge suggests toblow into the ear, to induce a reflex action and cause expulsion ofthe foreign body cold affusions, artificial respiration, galvanism, frictions of the limbs, artificial heat, stimulants by mouth andrectum, may one or all be needed hamilton893 says that it is useless to expect good results fromelectricity if five minutes have elapsed since life appeared to beextinct. Althaus, 894 that three hours after death the muscles willcease to respond to faradization. And richardson, 895 that a lowtemperature prolongs the sensitiveness of the muscle with regard to insufflation, le bon896 objects to it in asphyxia asbeing hurtful and not useful colin897 tamponed the trachea of ahorse.

Inwardly taken it expelswind, and breaks the stone the tops of hops when they are young, being distilled, the watercleanses the blood of melancholy humours, copywriting services and therefore helps scabs, itch, and leprosy, and such like diseases thence proceeding. It opensobstructions of the spleen, helps the rickets, and hypochondriacmelancholy the water of borrage and bugloss distilled when their flowers areupon them, strengthens the heart and brain exceedingly, cleanses theblood, and takes away sadness, griefs and melancholy dodder water cleanses the liver and spleen, helps the yellow jaundice tamarisk water opens obstructions, and helps the hardness of thespleen, and strengthens it english tobacco distilled, the water is excellently good for such ashave dropsy, to drink an ounce or two every morning. It helps ulcers inthe mouth, strengthens the lungs, and helps such as have asthmas the water of dwarf elder, hath the same effects thus you have the virtues of enough of cold waters, the use of which isfor mixtures of other medicines, whose operation is the same, for theyare very seldom given alone. If you delight most in liquid medicines, having regard to the disease, and writing of the body afflicted by it, these will furnish you with where withal to make them so as will pleaseyour pallate best compounds spirit and compound distilled waters culpeper before i begin these, i thought good to premise a fewwords. They are all hot in operation, and therefore not to be meddledwith by people of hot constitutions when they are in health, for fearof fevers and adustion of blood, but for people of cold constitutions, as melancholy and flegmatic people if they drink of them moderatelynow and then for recreation, due consideration being had to the writingof the body which is weakest, they may do them good. Yet in diseasesof melancholy, neither strong waters nor sack is to be drank, for theymake the humour thin, and then up to the head it flies, where it fillsthe brain with foolish and fearful imaginations 2 let all young people forbear them whilst they are in health, fortheir blood is usually hot enough without them 3 have regard to the season of the year, so shall you find them morebeneficial in summer than in winter, because in summer the body isalways coldest within, and digestion weakest, and that is the reasonwhy men and women eat less in summer than in winter thus much for people in health, which drink strong waters forrecreation as for the medicinal use of them, it shall be shewed at the latterend of every receipt, only in general they are due respect had tothe humours afflicting, and writing of the body afflicted medicinal fordiseases of cold and flegm, chilliness of the spirits, &c but that my countrymen may not be mistaken in this, i shall give themessay symptoms of each complexion how a man may know when it exceeds itsdue limits signs of choler abounding leanness of body, costiveness, hollow eyes, anger without a cause, atesty disposition, yellowness of the skin, bitterness in the throat, pricking pains in the head, the pulse swifter and stronger thanordinary, the urine higher coloured, thinner and brighter, troubleessaysleeps, much dreaming of fire, lightning, anger, and fighting signs of blood abounding the veins are bigger or at least they seem so and fuller thenordinary. The skin is red, and as it were swollen. Pricking pains inthe sides, and about the temples, shortness of breath, head-ache, thepulse great and full, urine high coloured and thick, dreams of blood, &c signs of melancholy abounding fearfulness without a cause, fearful and foolish imaginations, the skinrough and swarthy, leanness, want of sleep, frightful dreams, sournessin the throat, the pulse very weak, solitariness, thin clear urine, often sighing, &c signs of flegm abounding sleepiness, dulness, slowness, heaviness, cowardliness, forgetfulness, much spitting, much superfluities at the nose, little appetite to meatand as bad digestion, the skin whiter, colder and smoother than it waswant to be. The pulse slow and deep. The urine thick and low coloured:dreams of rain, floods, and water, &c these things thus premised, i come to the matter the first the college presents you with, is spiritus et aqua absinthis minus composita or, spirit and water of wormwood, the lesser composition college take of the leaves of dryed wormwood two pounds, annisseeds, half a pound. Steep them in six gallons of small wine twentyfour hours, then distil them in an alembick, adding to every pound ofthe distilled water two ounces of the best sugar let the two first pound you draw out be called spirit of wormwood, those which follow, wormwood water the lesser composition culpeper i like this distinction of the college very well, becausewhat is first stilled out, is far stronger than the rest, and thereforevery fitting to be kept by itself. You may take which you please, according as the temperature of your body, either to heat or cold, andthe season of year requires it hath the same virtues wormwood hath, only fitter to be used by suchwhose bodies are chilled by age, and whose natural heat abates youmay search the herbs for the virtues, it heats the stomach, and helpsdigestion the college after the same manner only omitting the annis seedsis distilled spirit and water of angelica, both herb and root, bawm, mints, sage, &c the flowers of rosemary, clary, clove-gilliflowers, &c the seeds of caraway, &c juniper-berries, orange pills, lemons, citrons, &c cinnamon, nutmegs, &c spiritus et aqua absynthii magis composita or spirit and water of wormwood, the greater composition the college take of common and roman wormwood, of each a pound;sage, mints, bawm, of each two handfuls. The roots of galanga, ginger, calamus, aromaticus, elecampane, of each three drachms.

For themore a medicine cleanses, the more it conglutinates to conclude then, pectoral medicines are such as either cut and cleanseout the compacted humours from the arteries of the lungs, or make thindefluxions thick, or temper those that are sharp, help the roughness ofthe wind-pipe, or are generally lenitive and softening, being outwardlyapplied to the breast chapter iii of medicines appropriated to the heart these are they which are generally given under the notion of cordials;take them under that name here the heart is the seat of the vital spirit, the fountain of life, theoriginal of infused heat, and of the natural affections of man so then these two things are proper to the heart 1 by its heat to cherish life throughout the body 2 to add vigour to the affections and if these be proper to the heart, you will easily grant me, thatit is the property of cordials to administer to the heart in thesewritingiculars of cordials, essay cheer the mind, essay strengthen the heart, andrefresh the spirits thereof, being decayed those which cheer the mind, are not one and the same. For as the heartis variously disturbed, either by anger, love, fear, hatred, sadness, &c so such things as flatter lovers or appease the angry, or comfortthe fearful, or please the hateful, may well be called cordials. Forthe heart, seeing it is placed in the middle between the brain and theliver, is wrought upon by reason, as well as by digestion, yet these, because they are not medicines, are beside my present scope and although it is true, that mirth, love, &c are actions, or motionsof the mind, not of the body. Yet thesis have been induced to think suchaffections may be wrought in the body by medicines the heart is chiefly afflicted by too much heat, by poison, andby stinking vapours, and these are remedied by the second sort ofcordials, and indeed chiefly belong to our present scope according to these three afflictions, viz 1 excessive heat 2 poison 3 melancholy vapours are three kinds of remedies which succour the afflicted heart such as 1 by their cooling nature mitigate the heat of fevers 2 resist poison 3 cherish the vital spirits when they languish all these are called cordials 1 such as cool the heart in fevers, yet is not every thing thatcooleth cordial, for lead is colder than gold, yet is not lead cordialas gold is, essay hold it cordial by a hidden quality, others by reason 2 such as resist poison.

Presse méd 20:433, 1912 starling63 finds that continued intravenous injections of secretin ina healthy dog produces after a time severe symptoms of collapse, which, he believes, are due to change in the intestinal mucous membrane causedby the entry and non-neutralization of the strongly alkaline pancreaticjuice intestinal digestion seems little affected in achylia gastrica stockton, 84 ehrman and lederer, 85 bayliss and starling32 thismay be due to other secretin stimulants as fats, or to the action ofthe nervous mechanisms meltzer86 84 stockton. In osier and mccrae modern medicine 3:19, 1914 85 ehrman and lederer. Deutsch med wchnschr 35:879, 1909 86 meltzer, s j. The factors of safety in animal structure andanimal economy, j a m a , feb 23, 1907, p 655 the destruction of secretin by human gastric juicewe have carried out in detail experiments on the digestive effect ofhuman gastric juice on secretin our results in every respect confirmthe findings of lalou, 62 who worked with commercial pepsin and doggastric juice, but are even more striking because of the much superiorquality of pure human gastric juice methods -- the human gastric juice was obtained from mr v , thegastric fistula case of our laboratory the chemical and digestivecharacters of his juice are discussed in a recent paper 87 in thedifferent experiments, different samples of gastric juice were used the secretin employed was always freshly prepared digestion wascarried out in the incubator at 38 c with the reaction of 0 4 percent acid, and the end of the period was marked by either boilingthe mixture or in the first two experiments by turning the mixturealkaline the action of the preparation, we proved, was not influencedby the method used the dogs on which the preparations were testedwere prepared for carotid blood pressure, injection into the externaljugular vein, and cannula in the pancreatic duct, essentially themethods of bayliss and starling32 being employed the preparationswere injected at body temperature after being neutralized and filtered except for the addition of normal salt solution instead of gastricjuice, the control injections of secretin were submitted to exactly thesame treatment as the other preparations 87 carlson. Am jour physiol 38:248, 1915 results -- our results are embodied in table 1 we assured ourselvesbefore beginning the series that incubation of secretin with boiledgastric juice produced no change it is to be noted in the table thateach experiment is a unit complete in itself, beginning and endingwith a control injection of secretin special attention is called tothe marked destruction that follows contact of human gastric juicewith secretin for merely one minute in experiment 4, using 1 c c of human gastric juice, the action fell to 14 drops from an originalsecretion of 21. In experiment 5, using 8 c c of gastric juice, theaction fell to 6 drops from an original secretion of 20 of interestalso is the rate at which we get complete destruction of secretin this is practically 2 hours for 2 c c with secretin giving originally110 drops experiment 2, fig 1, or 30 minutes for 5 c c with asecretin giving originally 53 drops experiment 6 these results arepractically parallel, though they were obtained with different samplesof gastric juice and in different experiments table 1 -- the destruction of secretin by human gastric juice | | secretion of pancreatic juice in drops | -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- no |quan-|10 c c c| the secretin after incubation |10 c c of | tity|secretin| with human gastric juice |secretin exper-|of |control -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -control iment|gas- |-- begin-| | | | | | |-- end of | tric| ning |dig |secre-|dig |secre-|dig |secre-|experi- |juice|experi- |time, | tion |time, | tion |time, | tion | ment |used, | ment |hrs |rate |hrs |rate |hrs |rate | |c c | | | | | | | | -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- 1 | 2 | 28 |6 | 0 |4 | 0 |2 | 0 | 16 2 | 2 | 110 |2 | 7 |1-1/2| 18 |1 | 18 | 41 3 | 2 | 40 |1 | 7 | 3/4| 7 | 1/4 | 8 | 31 4 | 1 | 21 | 1/2| 11 | 1/4| 12 | 1/60| 14 | 18 5 | 8 | 20 | 1/2| 1 | 1/4| 3 | 1/60| 6 | 18 6 | 5 | 53 | 1/2| 2 | | | | | -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- we also tried the effect of keeping the digestive time constant andvarying the amount of gastric juice employed increasing the quantityof gastric juice used increases the quantity of secretin destroyed table 2 table 2 -- experiment 7* pancreatic preparation juice drops 10 c c secretin 20 10 c c secretin digested with 0 5 c c gastric juice 15 10 c c secretin digested with 3 c c gastric juice 13 10 c c secretin digested with 10 c c gastric juice 8* the digestive time was kept constant at fifteen minutes the gastricjuice used had been diluted with stomach washings the reader will observe in table 1 that the results obtained fromthe control injection of secretin at the beginning of the experimentis uniformly greater than that obtained after several injections ofdigested secretin in view of the established fact that equal quantities of secretin cangenerally be relied on to produce results, 21 one might suggest thatthe injections of the split products of secretin have inhibited to essaydegree the action of the pancreas we can submit the data in table 3in support of this view, showing among other things that the action ofsecretin is not influenced by previous injections of inert depressorsubstances, though it by the injection of the cleavage products ofsecretin the various injections in the experiments were made at aboutfifteen-minute intervals we have carefully analyzed the reaction in blood pressure that followsthe injection of the various preparations we find no constant effect digested secretin gives a fall in blood pressure that is at times less, at times equal, and at other times greater fig 1 than that producedby the original preparation besides the bearing that it has on the therapeutic use of secretin, this destructive action of the digestive enzymes is also of primephysiologic interest failure to realize it has led to misconceptionsas to the intrinsic nature of secretin table 3 -- experiments 8 and 9 pancreatic preparations juice drops experiment 8. 10 c c secretin, five injections of inert depressor substances 29 10 c c secretin, two injections of completely digested secretin 28 10 c c secretin, eight injections of inert depressor substances 16 10 c c secretin 16 experiment 9. 10 c c secretin control, beginning of experiment 21 10 c c secretin, after thirty minutes incubation with 1 c c boiled gastric juice 27 10 c c secretin, after thirty minutes incubation with 1 c c fresh gastric juice 11 10 c c secretin control, end of experiment 18the findings of lalou, confirmed by us, explain the anomaly that hasled delezenne88 to put forward the antisecretin theory 88 delezenne and pozerski. Jour de physiol , 14:540, 1912 secretin has no action when given by mouthit is a constant claim that so thesis and complex are the factorsconcerned in physiologic processes, that it is not unusual for clinicaldeductions to establish themselves in the face of a priori laboratorydicta we considered it desirable, therefore, to test the action ofsecretin, orally administered, in the most direct manner, and the onefreest from possible criticism with this in view, we performed aseries of experiments on normal unanesthetized dogs having permanentpancreatic fistulas method -- in the operations for permanent pancreatic fistulas wefollowed closely the technic developed by pawlow, 89 and withexcellent results the dogs maintain themselves in splendid conditionif proper care is taken this consists in feeding them only with breadand milk, and giving sodium bicarbonate daily the dogs were giventhis treatment in the evening so that experimental procedure might becarried on in the day with empty stomach under constant conditions freshly prepared secretin in large quantities was given by stomachtube to these dogs, and the response of the pancreas studied andcompared with the response obtained from control preparations the samepreparation was generally not given on consecutive days 89 pawlow. Ergeb de physiol , o , p 266, 1902 table 4 -- detail of typical experimentsdogs with pancreatic fistulas, showing that secretin given by mouth hasno action on the pancreas | rate of secretion of pancreatic | juice in c c per hr -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- | continuous | continuous | secretion | secretion material fed by stomach tube | before feeding | after feeding |-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- |first|second|third|first|second|third |hour | hour |hour |hour | hour |hour -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- - 150 c c active secretin, | | | | | | slightly acid | 6 5| 3 6 | 3 9 | 20 0| 6 0 | 8 0 150 c c active secretin, | | | | | | slightly alkaline | 13 0| 11 0 | 5 0 | 23 0| 26 0 | 12 0 150 c c secretin passed | | | | | | through berkefeld | 7 8| 7 5 | 7 4 | 23 0| 13 0 | 11 0 150 c c extract of colon | 11 6| 12 0 |11 4 | 30 0| 19 6 | 14 8 150 c c extract of gastric | | | | | | mucosa | 10 0| 7 0 | 8 0 | 23 0| 7 5 | 4 0 150 c c extract of muscle | 6 9| 11 0 | 6 4 | 35 0| 5 0 | 7 0 150 c c 0 4% hcl | | | | | | diluted to 250 c c | 6 0| 8 0 | 4 0 | 33 0| 36 0 | 17 0 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -results -- we have data from six dogs with a total of seventy-sixexperiments as shown in table 4, the administration of secretin causesan increase in the flow of pancreatic juice, but the administrationof inert substances as extracts of colon, gastric mucosa or musclecauses a like increase the activity of the secretin may be reduced toa low value by exposure to sunlight, or filtering through a berkefeldfilter, yet the response of the pancreas is not correspondinglyreduced the secretion that occurs in the control paper, every onewill admit, is but secondary to the production of gastric juice withits accompanying hydrochloric acid, that is, excited by virtue of theextractives and water in the preparations such, we can prove, is theonly action of secretin a mixture of gelatin, peptone and salt water, the chief incidental constituents of a secretin preparation, gives asstriking results as ever obtained from secretin administration yetthe objection may be made that the response of the pancreas that isdue to the incidental constituents of secretin is maximal, and thatthe secretin consequently has no opportunity to display its writingicularpotency but, as inspection of the accompanying tables illustrate, the administration of hydrochloric acid shows that the response is byno means maximal let us cite a striking experiment for three hoursbefore the administration of hydrochloric acid, the secretion in cubiccentimeters was respectively 29 4, 11 75 and 35 4 c c. For the threehours after, respectively 88 0, 49 0 and 40 5 c c illustration. Fig 1 -- tracings reduced two-thirds showing failureof secretogen, elixir secretogen, and duodenin to stimulate the flow ofpancreatic juice even when administered intravenously in amounts threetimes greater than that recommended to be given by mouth dog. Lightether anesthesia.

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It is difficultto believe that the “juice” of juniper submitted to dialysis couldcontain any material amount of the active constituent no informationis given as to the method used whereby the several dialysates are“physiologically standardized ” it therefore remains to be provedthat the manufacturer of hydropsin possesses any method whereby thedialysates of juniper juniperis communis, birch betula alba, the common european birch and knot weed herniaria glabra are sostandardized the claim is made that. “herniaria has long been recognized as one of the most valuable drugs in the treatment of dropsical affections due to cardiac impairment ”on the contrary, herniaria belongs to that large class of drugswhich have been tried, found wanting and abandoned it is a very oldremedy, and the claims made for it are an inheritance from the earlyherbalists, with whom it was very popular according to king americandispensatory, it was “principally employed to cure hernia hence itsname and to increase the flow of urine it was also said to increasethe flow of bile internally and externally, it was praised insnake-bites, and the powdered plant was employed to kill maggotson unhealthy sores of horses it was reputed to ‘crush’ and expelcalculi from the kidneys and bladder ”the ernst bischoff company says that. “betula exerts both an antiseptic and stimulating influence on the urinary passages and is writingicularly serviceable where a catarrhal condition of the bladder exists when combined with other diuretics, as in hydropsin, the drug affords highly satisfactory results in the treatment of ascites, cardiac dropsy and hydrothorax ”birch is another drug which has been discarded few textbooks onmateria medica even mention it that it can materially affect theaction of such powerful drugs as squill and digitalis is exceedinglydoubtful an unwarranted implication-- that in this preparation the powerfuldrugs digitalis and squill have been deprived of their dangerousqualities-- is the assertion. “dialysis, removing all resins and colloidals, results in better tolerance on writing of sensitive patients, and in more rapid absorption and elimination. Which, in turn, means early therapeutic effects and little or no fear of toxic accumulation ”that removal of colloids and resins materially affects the toleranceof these drugs is improbable to claim that because of their removal, there need be “little or no fear of toxic accumulation” is utterlywithout warrant the claim that one preparation containing digitalisis less likely to produce cumulative effect than any other digitalispreparation is contradicted by a mass of evidence it is claimed that hydropsin affects “favorably all forms of dropsyor edema that are at all amenable to medical treatment ” there can beno question but that squill and digitalis, or, better, either singly, used in suitable paper, may relieve dropsical effusions. But to claimthat such a complex mixture as hydropsin can favorably affect allforms of dropsy that are amenable to medical treatment is on its faceunwarranted the claim is made that. “by reason of its unusual potency and relative harmlessness, hydropsin may be employed to great advantage in all paper where it is desirable to increase the volume of urine without injury to the renal structures ”on the basis of the claimed composition, the action of hydropsinmust be essentially that of digitalis or of digitalis and squill consequently, if it possesses “unusual potency, ” it cannot possess“relative harmlessness, ” and vice versa neither digitalis norsquill should be employed “in all paper” of nephritis, even if it is“desirable to increase the volume of urine ”the composition claimed for hydropsin brands it as an irrationalmixture in which potent drugs are combined with, and more or lesscovered up by, others that are obsolete and inefficient the name, instead of indicating its composition, suggests diseases in which itmay be thoughtlessly and indiscriminately used the claim that thedanger of toxic or cumulative action has been removed, if accepted byphysicians, tends to uncritical use with possible disastrous results hydropsin is ineligible for new and nonofficial remedies because ofconflict with rules 1, 2, 6, 8 and 10 -- from the journal a m a , jan 8, 1916 digitalysatum report of the council on pharmacy and chemistrythe council has adopted the following report and authorized itspublication w a puckner, secretary digitalysatum is sold in the united states by ernst bischoff company, inc , new york the firm claims that it is a dialysate prepared fromthe juice of freshly gathered digitalis, containing all the activeprinciples, and representing the fresh plant weight for weight it issaid to be standardized physiologically and to contain 12 per cent alcohol sterisol-digitalysatum, intended for injection, appearsto be the “dialysate” without alcohol, diluted with equal writings ofphysiologic sodium chlorid solution the council essay years ago foundboth products ineligible for new and nonofficial remedies becauseof unwarranted therapeutic claims the preparations are still beingadvertised to physicians under claims which imply superiority to allother digitalis preparations for instance. “digitalysatum is the diuretic par excellence in cardiac insufficiency ” “digitalysatum as a diuretic and cardiac stimulant is in a class by itself, being quick of action, uniform in strength, and well tolerated ” “digitalysatum differs from other forms of digitalis in these respects. Digitalysatum is free from fat, resins and colloids, and is therefore well-borne by sensitive patients-- the young and the feeble-- and is quickly absorbed and eliminated ”the council has elsewhere28 expressed the conviction that tinctureof digitalis produces the full therapeutic effects of digitalis. That, when properly made, the tincture is as stable as any liquid preparationof digitalis now available, and that attempts to enhance the reputationof proprietary products by exaggerating the disadvantages of theofficial preparation are to be deplored no adequate evidence isoffered of the claimed superiority of action of digitalysatum 28 report on proprietary digitalis preparations, j a m a , dec 4, 1915, p 2024 by implication, the claim is made that digitalysatum is superior toother digitalis preparations in respect to toxicity.