The points which we especially wish to emphasize in summing up are as follows:

1. The great frequency of heart murmurs and of irregularity of the pulse. The prognosis does not depend on the mere presence of these signs, but upon the severity of the infection, the length of time without treatment, the rate and degree of irregularity of the pulse and the presence of the graver signs of cardiac disturbance.

2. Moderate disturbance of the heart is very common: severe complications are infrequent.

3. Frequent examinations of the heart are necessary to really determine its condition, because of the marked changes in rhythm from one hour to the next.

4. Gallop rhythm, late vomiting, and epigastric pain and tenderness are important as danger signals of severe heart complications. The association of late vomiting with gallop rhythm renders the outlook almost hopeless.

5. Antitoxin does not affect the heart unfavorably, but on the other hand its early use prevents the appearance of grave heart complications.

6. Frequent examination of the heart and pulse in the second and third week of the illness are necessary, that being the time when severe heart complications most frequently occur.

7. Broncho-pneumonia is a more frequent fatal complication of diphtheria than heart disease; sudden death from heart disease is very rare when patients are kept in bed for a proper period.

8. Prolonged rest in bed is necessary in all severe cases ; it is not necessary to keep all patients in bed who have cardiac murmurs and a pulse which is somewhat irregular and increased in rate. One should be governed by the stage of the illness and the patient's general condition. If no serious heart trouble has developed within four weeks the patients are usually safe from this complication.

Heart murmurs and irregularity are of long duration in many cases and make it necessary to watch the condition of the heart long after convalescence in all severe cases.

We wish to acknowledge our indebtedness to Dr. McCollom, Medical Director of the South Department of the Boston City Hospital, for the opportunity to study these cases, and for his valuable suggestions and kindly interest in our work.

DISCUSSION.

Dr. N. P. WOOD, of Northfield: I would like to ask whether or not these patients were all from the city. How many came from the country?

Dr. WHITE.—I think they came mainly from the City of Boston.

Dr. J. H. McCOLLOM, of Boston: All patients in the South Department come from the City of Boston. They may not be permanent residents, but they are supposed to be in Boston 24 to 48 hours.

Dr. C. F. WITHINGTON, of Boston: I think it is a pretty difficult matter to say whether these cases are due to degeneration of the pneumogastric nerve, to granular degeneration of the heart muscle, or functional nervous causes.

Dr. McCOLLOM: I should not say that all these were cases of degeneration of the pneumogastric nerve, but a majority of them, in my opinion, were such.

ARTICLE LI.

CONCLUSIONS FROM A SERIES OF MEASUREMENTS OF BLOOD PRESSURE IN FEVERS, BEFORE, DURING AND AFTER THE ADMINISTRATION OF STRYCHNIA.

BY RICHARD C. CABOT, M.D.

OF BOSTON.

READ JUNE 7, 1904.

CONCLUSIONS FROM A SERIES OF

MEASUREMENTS OF BLOOD PRESSURE IN FEVERS, BEFORE, DURING AND AFTER THE ADMINISTRATION OF STRYCHNIA.

1. The cases included in this study were all febrile. Among them were 31 cases of typhoid fever, 4 of pneumonia, and 15 others with a variety of diagnoses.

2. In 32 cases the strychnia was given by mouth, and in 18 subcutaneously. The total daily dose was usually 1-8 grain, sometimes 1-6 grain. Except in a few instances, the diet and position of the patient remained the same throughout the experiment.

3. The records were continued for days, and occasionally for weeks, before and after the drug was given, in order that the regular range of variation in the blood pressure might be ascertained.

4. The measures were taken with Stanton's modification of the Riva-Rocci instrument. The maximum pressure was recorded as the height of the mercury column at the moment of the disappearance of the radial pulse, and the minimum as the trough of the wave of greatest oscillation of the column.

5. Measurements were taken at various intervals of time succeeding the administration of strychnia, from a few minutes to several hours. The observations extended over about eight months and included over 5000 measurements.