hypersecretion and congestion, were associated with an excessive quantity of chloride in the urine. The former class of cases is found to be greatly benefited and even cured by subjecting the patient to a salty diet and the local application of sodium chloride. In the latter type equally good results are obtained by prohibiting the use of salty food, and thereby diminishing the excretion of salines in the urine. The author substantiates his claims for this method of treatment by a series of clinical cases in which excellent results were obtained without additional treatment. The forms of pharyngitis thus treated are very rebellious to the usual methods in use and the dietary regime should always be at least given due attention. Mention is also made of atrophic rhinitis being favorably modified by the same treatment-New Orleans Medical and Surgical Journal.

NITROGLYCERIN.

D. D. STEWART, in the Journal A. M. A., calls attention to the tolerance to nitroglycerin, which is often too readily established, so rendering the drug of but little service. He details one case, in which in less than six months after an initial dose of one drop of a one percent solution of nitroglycerin, in a case of chronic nephritis such tolerance was established that a dose of fifty minimus of a ten percent solution (five minimus of pure nitroglycerin) was taken four times daily with less effect on vascular tension than the initial dose of 1-100 grain. When it is desired to employ this drug for a considerable period for its effects on blood pressure, the best rule of administration is, in his opinion, to so proportion the dose that the intervals are comparatively short, never less than four times daily. The amount though sufficient to produce some subjective or objective effect, should never be more than just necessary to cause the slightest feeling of fullness in the head, or to slightly quicken the pulse. When a rather rapid increase seems necessary in order to maintain a constant effect, an equally important point is temporarily to discontinue the drug for two or more days, at intervals of two or three weeks. On its

resumption, a much smaller initial dose will be required to produce physiologic effects than that last taken. It must be remembered that nitroglycerin, so far as we know, has absolutely no action in cases of chronic nephritis apart from its effect on vascular tension. It is only indicated in those cases in which the blood-pressure is persistently markedly high and in which ill consequences such as cerebral hemorrhage, or valvular disease of the heart, or stretching of its cavities, are to be feared. It must not be forgotten that probably a moderate amount of tension is actually conservative, and the drug must not be prescribed merely because the case is one of chronic nephritis. He regards it as most important that other measures to lower blood-pressure be coincidently used and be tried alone. Aconite is often substituted for nitroglycerin with advantage in these cases.-The Cleveland Medical Journal.

CLINICAL EXPERIENCES WITH CERTAIN DRUGS IN HEART DISEASE.

THOMAS E. SATTERWAITE (American Medicine, November, 1905) calls attention to the fact that in the year 1900, according to the last census, as many as 70,000 persons died of heart disease in this country; also that of the nine principal causes of death, heart disease was third on the list in point of frequency, tuberculosis holding the first place, and pneumonia the second. And now that apparently successful efforts have been directed against tuberculosis, and pneumonia has been investigated by a commission, heart disease should logically be next attacked. In so far as drugs are concerned, he regards suprarenal gland as the most powerful heart stimulant known. As to the dangers from the nitrites and nitrates, about which much has been written, he finds their efforts are always evanescent. Ordinarily in angina, hypertension, and arteriosclerosis they are useful, but if they produce violent pulsation in an arteriosclerotic they should be suspended. For advanced cases of this affection the tetranitrate of erythrol is specially adapted, owing to its prolonged action. But, after all, iodine in some form or other should be the main reliance. Strych

nine is a reliable heart stimulant, but should be used with discretion and in moderate doses; larger doses produce nervousness and insomnia. It should never be continued more than a couple of weeks at a time. Cactus he finds a good heart regulator, and strophanthus is excellent if prompt action is needed. Digitalis acts best when the arteries are flaccid and just enough given to restore normal tension. If the drug produces too much tension, the work of the heart is unnecessarily increased. In acute endocarditis, the fat heart, fatty degeneration, advanced arteriosclerosis, aortic diseases, and cardiac neurosis digitalis may do serious harm. In deficient or failing compensation digitalis is useful up to the point of producing normal arterial tension, after which its action is harmful, except in so far as it may increase diuresis. Circulatory depressants, such as antimony, veratrum, pulsatilla, and hellebore, are out of date in the treatment of cardiac diseases; but aconite is useful, certainly in cardiac neurosis. There are some drugs in particular the action of which requires further investigation, because we are not sufficiently acquainted with their active principles or modes of action. These are adonis vernalis, erythrophleum, acocynin, and cratægus.-The Illinois Medical Bulletin.

THE ROLE OF SALINE SOLUTION IN THE TREATMENT OF

PNEUMONIA.

A RESUME is presented of the facts relating to the position of the normal salines of the blood plasma, and its contained autoprotective potentialities, the recognition and use of which is capable of furnishing a beneficent agency in overcoming infecttious processes. Modern physiological pathology has made good the assumption that the immunizing antibodies appear in the blood whenever an infectious disease terminates in recovery, and that, he says, is our greatest weapon in overcoming pathogenic elements. A few observers have called attention to the value of saline solution designed to supply the enormous loss in those essential constituents of the plasma which occurs during febrile

states. They have recommended the use of the measure not only late in the disease, and in desperate cases. Dr. Taylor calls attention to the extreme importance of following the recommendations of Sajous to employ these measures from the outset, as soon as the disease is recognized, in order to insure the full efficiency of the blood's antibodies, i. e., the body's autoprotective powers. Saline solution, used early, preserves the blood's normal fluidity, renders normal osmosis possible, and gives free sway to the immunizing process. He urges that to delay in the use of the salines is just as dangerous as to delay administering antitoxin in a case of diphtheria; and, moreover, that the blood in infections suffers such rapid depletion of saline elements, the effect of which is to impair the efficiency of, and finally arrest the protective functions of, the organism, that this constitutes one of the most active causes of death. The practical recommendation is to begin from the outset in pneumonia and other infectious fevers the internal use of saline solutions, especially those containing sodium chloride and the other saline constituents of the blood. The use of these salines by hypodermocylsis or enterocylsis has been recently shown by a number of observens, acting upon Sajou's advice, to be of great efficiency when used early. The use of the saline drink has been shown by Todd and the writer to be of equal efficiency, and not at all inconvenient or disagreeable.-St. Louis Medical Review.

THE CAUSE OF SUDDEN OR RAPID DEATH IN PNEUMONIA.

FERRIEN (Revue mensuelle des maladies de l'enfance) discussing the causes of sudden death in children with pneumonia summarizes as follows:

1. Extra pulmonary localizations are frequent, especially before the age of two years. Pericarditis, usually suppurative, is frequently encountered. It is often latent and may determine rapid death.

2. Sudden or rapid death may be observed at every age with or without extra pulmonary localization; it is, fortunately, not a frequent accident. This possibility, in a certain degree, allies

pneumonia of the child with other affections, such as diphtheria and typhoid fever, in which sudden death has been observed.

3. Cyanosis is often the first sign which reveals the imminence of a fatal termination and may b ean indication of a pericarditis or of a simple acute dilatation of the heart.-Charlotte Medical Journal.

TREATMENT OF ACUTE INFLAMMATIONS BY MEANS OF BIER'S

CONGESTION METHOD.

W. DANIELSON (Muench. med. Woch., No. 48, 1905) reports excellent results from the use of Bier's method of congestion in acute inflammatory conditions. His list of cases so treated embraces furuncles, phlegmons, carbuncles, and panaritia. He followed in the minutest detail the method laid down by Bier (Muench. med. Woch., Nos. 5-7, 1905) and reports that he was abode to dispense with large incisions and painful wound tamponade. In certain cases, where pus had formed, a small (2 millimetre) incision was made. The method guards against all interference with movement, such as so frequently follows phlegmons about joints or tendons; moreover, the usual disfiguring scars are avoided. Another great advantage of the method lies in the fact that the duration of treatment is shortened.-St. Louis Medical Review.

SOME POINTS IN THE TREATMENT OF HEART FAILURE IN

DIPHTHERIA.

C. Bolton lays stress on two points: (1) prevention of cardiac failure, and (2) rest, both mental and physical. The first embraces the earliest possible administration of antitoxin. It leads directly to the neutralization of the toxin. The latter becomes very speedily combined with the particular tissue affected by it and then neutralized only with great difficulty by the antitoxin. In human diphtheria the toxin is not suddenly poured into the blood as in experiment, but it is poured slowly, and it is therefore possible to neutralize it by large doses of antitoxin.