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 epidemic form. In this the spleen and liver are commonly but not always swollen, and the liver is often tender on pressure. As a large proportion of the sufferers from this disease have been butchers, and the epidemics have occurred in the hot season of the year, it probably arises from contact with decomposing animal matter. Hepatic abscess may follow on an attack of amoebic dysentery, and is produced either by infection through the portal vein, or by direct infection from the adjacent colon. In general pyaemia multiple small abscesses may occur in the liver.

The Gall-Bladder.—The formation of biliary calculi in the gall-bladder is the chief point of interest here. At least 75% of such cases occur in women, especially in those who have borne children. Tight-lacing has been stated to act as an exciting cause, owing to the consequent retardation of the flow of bile. Gall-stones may number from one to many thousands. They are largely composed of cholesterin, combined with small amounts of bile-pigments and acids, lime and magnesium salts. Their presence may give rise to no symptoms, or may cause violent biliary colic, and, if the bile-stream be obstructed, to jaundice. Inflammatory processes may be initiated in the gall-bladder or the bile-ducts, catarrhal or suppurative in character.

The Pancreas.—Haemorrhages into the body of the pancreas, acute and chronic inflammation, calculi, cysts and tumours, among which cancer is by far the most common, are recognized as occurring in this organ; the point of greatest interest regarding them lies in the relations established between pancreatic disease and diabetes mellitus, affections of the gland frequently being complicated by, and probably causing, the appearance of sugar in the urine.

The Small Intestine.—Little remains to be added to the account of inflammatory lesions in connexion with the small intestine. It offers but few conditions peculiar to itself, save in typhoid fever, and the ease with which it contrives to become kinked, or intussuscepted, producing obstruction, or to take part in hernial protrusions. The first section, the duodenum, is subject to development of ulcers very similar to those of the gastric mucous membrane. For long duodenal ulceration has been regarded as a complication of extensive burns of the skin, but the relationship between them has not yet been quite satisfactorily explained. The condition of colic in the bowel usually arises from overdistension of some part of the small gut with gas, the frequent sharp turns of the gut facilitating temporary closure of its lumen by pressure of the dilated gut near a curve against the part beyond. In the large bowel accumulations of gas seldom cause such acute symptoms, having a readier exit.

The Large Intestine.—The colon, especially the ascending portion, may become immensely dilated, usually after prolonged constipation and paralysis of the gut; occasionally the condition is congenital. Straining efforts made in defaecation may often account for prolapse of the lower end of the rectum through the anus. Haemorrhage from the bowel is usually a sign of disease situated in the large intestine: if bright in colour, the source is probably low down; if dark, from the caecum or from above the ileo-caecal valve. Blood after a short stay in any section of the alimentary canal darkens, and eventually becomes almost black in colour.

 DIGGES, WEST (1720–1786), English actor, made his first stage appearance in Dublin in 1749 as Jaffier in Venice Preserved; and both there and in Edinburgh until 1764 he acted in many tragic rôles with success. He was the original “young Norval” in Home’s Douglas (1756). His first London appearance was as Cato in the Haymarket in 1777, and he afterwards played Lear, Macbeth, Shylock and Wolsey. In 1881 he returned to Dublin and retired in 1784.

 DIGIT (Lat. digitus, finger), literally a finger or toe, and so used to mean, from counting on the fingers, a single numeral, or, from measuring, a finger’s breadth. In astronomy a digit is the twelfth part of the diameter of the sun or moon; it is used to express the magnitude of an eclipse.

 DIGITALIS. The leaves of the (q.v.), gathered from wild plants when about two-thirds of their flowers are expanded, deprived usually of the petiole and the thicker part of the midrib, bitter taste; and to preserve their properties they must be kept excluded from light in stoppered bottles. They are occasionally adulterated with the leaves of Inula Conyza, ploughman’s spikenard, which may be distinguished by their greater roughness, their less divided margins, and their odour when rubbed; also with the leaves of Symphytum officinale, comfrey, and of Verbascum Thapsus, great mullein, which unlike those of the foxglove have woolly upper and under surfaces. The earliest known descriptions of the foxglove are those given by Leonhard Fuchs and Tragus about the middle of the 16th century, but its virtues were doubtless known to herbalists at a much remoter period. J. Gerarde, in his Herbal (1597), advocates the use of foxglove for a variety of complaints; and John Parkinson, in the Theatrum Botanicum, or Theater of Plants (1640), and later W. Salmon, in The New London Dispensatory, similarly praised the remedy. Digitalis was first brought prominently under the notice of the medical profession by Dr W. Withering, who, in his Account of the Foxglove (1785), gave details of upwards of 200 cases chiefly dropsical, in which it was used.

Digitalis contains four important glucosides, of which three are cardiac stimulants. The most powerful is digitoxin C34H54O11, an extremely poisonous and cumulative drug, insoluble in water. Digitalin, C35H56O14, is crystalline and is also insoluble in water. Digitalein is amorphous but readily soluble in water. It can therefore be administered subcutaneously, in doses of about one-hundredth of a grain. Digitonin, on the other hand, is a cardiac depressant, and has been found to be identical with saponin, the chief constituent of senega root. There are numerous preparations, patent and pharmacopeial, their composition being extremely varied, so that, unless one has reason to be certain of any particular preparation, it is almost better to use only the dried leaves themselves in the form of a powder (dose -2 grains). The pharmacopeial tincture may be given in doses of five to fifteen minims, and the infusion has the unusually small dose of two to four drachms—the dose of other infusions being an ounce or more. The tincture contains a fair proportion of both digitalin and digitoxin.

Digitalis leaves have no definite external action. Taken by the mouth, the drug is apt to cause considerable digestive disturbance, varying in different cases and sometimes so severe as to cause serious difficulty. This action is probably due to the digitonin, which is thus a constituent in every way undesirable. The all-important property of the drug is its action on the circulation. Its first action on any of the body-tissues is upon unstriped muscle, so that the first consequence of its absorption is a contraction of the arteries and arterioles. No other known drug has an equally marked action in contracting the arterioles. As the vaso-motor centre in the medulla oblongata is also stimulated, as well as the contractions of the heart, there is thus trebly caused a very great rise in the blood-pressure.

The clinical influence of digitalis upon the heart is very well defined. After the taking of a moderate dose the pulse is markedly slowed. This is due to a very definite influence upon the different portions of the cardiac cycle. The systole is not altered in length, but the diastole is very much prolonged, and since this is the period not only of cardiac rest but also of cardiac “feeding”—the coronary vessels being compressed and occluded during systole—the result is greatly to benefit the nutrition of the cardiac muscle. So definite is this that, despite a great increase in the force of the contractions and despite experimental proof that the heart does more work in a given time under the influence of digitalis, the organ subsequently displays all the signs of having rested, its improved vigour being really due to its obtaining a larger supply of the nutrient blood. Almost equally striking is the fact that digitalis causes an irregular pulse to become regular. Added to the greater force of cardiac contraction is a permanent tonic contraction of the organ, so that its internal capacity is reduced. The bearing of this fact on cases of cardiac dilatation is evident. In larger doses a remarkable sequel to these actions