One of the accidents of medicine is the accumulation of action of several of our most potent remedies, such as strychnine, quinine, mercury, digitalis, arsenic, iodine, phosphorus, lead, etc. In prescribing any remedies of this class for any length of time it is well to bear in mind their cumulative tendencies, for should their explosion take place, it may be with dire results. These substances are apt to be stored away in their respective places of selection, and it is their reab-sorption, either spontaneously or through medicinal influences that causes their reappearance into the circulation, and again brings into exhibition their characteristic effects. There is one feature to be noted in the treatment of a disease with some of these remedies, that is, the use of the medieine can be advantageously suspended as its power will continue to manifest itself for some time afterwards, although the patient may have ceased to take the medicine.

*Prof. J. J. Mulheron.

If the substance is a metal and has accumulated with bad effects it may be necessary to hasten its re-absorption, which is readily effected by the use of iodide of potassium. With both lead and mercury it forms double salts, which are soluble, and there is very good reason for believing that the formation of these salts takes place in the economy, and that the metal which has been lying in an insoluble condition in the various tissues is taken up and excreted." Severe salivation and ulcerative stomatitis have sometimes resulted from the use of the potassium salt in those who had previously taken large quantities of mercury.†

It is well known that iodide of potassium is indicated as a curative agent in what we might call the accumulated stage of syphilitic poisoning, and where the tissues are infiltrated with gout poison, then the addition of the iodide to the bicarbonate of potash is eminently useful.

A distinction has been made between the accumulation of action, and the accumulation of doses. Accumulation of doses signifies that there is accumulation of the substance in the digestive organs, as happens with strychnine pills which do not dissolve altogether, producing symptoms of more or less gravity. Accumulation of action, which signifies that the medicament passes into the parenchyma of the different organs, and accumulates there - and the quantity taken up by the work of absorption and eliminated, not approaching sufficiently the quantity of the substance injected, there ensues accumulation in the histological elements of the tissue.

How can this phenomenon be explained? It would seem that the process is, as if the intervals between the successive doses administered of the active substance were sufficiently short, so that there is a portion of the action of the first dose in the system at the time the following dose is administered, and so on, for the following doses. §8

To avoid accumulation of doses, the best means is not to employ medicines in a solid state; and it can be readily understood that there will be no accumulation with feeble doses, for they are destroyed and eliminated with facility, nor with substances which pass easily through the economy, and which act, for instance, solely on the globules. These substances are generally eliminated with great rapidity, as are the gases themselves; ether, chloroform, ammonia, in fine all the substances which act principally on the blood are eliminated with celerity, and accumulation is difficult. On the contrary, the substances which sojourn more or less in the system penetrate into the parenchyma, and at last are incorporated with the immediate principles, or with cellular parietas, or take part in tissue formation; such substances are the ones which show themselves particularly favorable for the production of what is called accumulation of action.*

*Prof. R. T. Edes. ‡ Fothergill

†Prof. H. C. Wood. §Prof. Adolph Gubler.