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statement. The first sign of the coming danger from this source we would put as shortness of breath upon exertion. If the significance of this were more appre- ciated in time by many who ascribe it only to their growing fat, or to their sedentary habits, many valua- ble lives would be prolonged and years of usefulness saved. It is instructive to note also the entire differ- ence in the meaning of a rapid pulse in secondary cardiac dilatation from the rapid pulse of primary heart disease. In secondary dilatation it is not from irritation of the heart itself, but because the organ is not capable of emptying itself fully order viagra discreetly enough with each stroke to meet the needs of the circulation, and there- fore has to increase the frequency of its order viagra discreetly systole. Digi- talis, and not aconite, will lessen order viagra discreetly this symptom. This leads me, in conclusion, buy legal viagra to mention briefly the particular uses of some of our symptomatic remedies. In secondary cardiac dilatation digitalis certainly takes the lead of all other drugs, but there is not one in the list whose administration should be less a mat- ter of routine. In the first place, we have now in all cases of peripheral obstruction a coadjutor to the action of digitalis which has removed one of the chief former buy legal viagra obstacles to the remedial effect of this drug, and that is nitroglycerin, which, by dilating the arterioles, whereas digitalis contracts them, enables ns to ease the heart of the peripheral obstruction against which it had to contend before on account of the order viagra discreetly increased arterial pressure caused by the digitalis. But another serious effect of digitalis when given too continuously and in too large doses is that it causes a gastric disturbance which is very difficult to allay. In cases, therefore, of much dilatation, with cardiac arhythmia, general dropsy, and pulmonary cedema, it has been my practice to begin with free doses of an ounce of the infusion of digitalis four times a day for two or three days, and then to change its administra- tion altogether to a permanent dose of half a grain of the powder three times a day, which dose order viagra discreetly may then be kept up for a long time with great benefit. Prior, however, to these smaller buy legal viagra doses, and during the administration buy legal viagra of larger doses, we have an adju- vant to the action of digitalis which I think cannot be order viagra discreetly appreciated too highly, and that is calomel, given in closes of one-half to two-thirds of a grain three times daily, until the first slight signs of mercuralization are manifest, when its administration should be stopped. The increased beneficial effect upon the heart and cir- culation of this short course of calomel in these cases is often as striking as any effect in therapeutics. As a modification of the digitalis treatment I ofterr use a combination order viagra discreetly of the three tinctures of strophan- thus, mix vomica, and digitalis in equal parts, dose twenty to thirty drops of the mixture three times a day, particularly in aortic regurgitant and mitral stenotic rases. Of course, the commonest cause of general endar- teritis is renal disease, but the relations of this sub- ject to cardiac disease are too wide for us to enter upon now. I can only say that in chronic interstitial nephritis the high tension of the pulse and the low 7q6 MEDICAL RECORD. [June 6, 1896 specific gravity of the urine seem both to be favorably affected by the action of small doses of corrosive sub- limate. In the cerebral derangements of such pa- tients which are short of apoplexy, both the cardiac symptoms and order viagra discreetly the cerebral have often seemed to me to be improved by a pill containing two-thirds of a grain of sparteine sulphate, one-half grain of pulverized digi- talis, and one-twenty-fourth of a grain of corrosive sublimate. In all cardio-renal cases with extensive dropsy I would avoid a milk diet. Repeatedly have I seen the dropsy at once decline upon a marked restriction be- ing ordered in the amount of fluids taken and the ad- ministration of solid food. We forget often that opium is a powerful heart stimulant, as its anodyne and order viagra discreetly soporific properties are so much more familiar to us, but for severe attacks of cardiac dyspnoea we can hardly do without it as an occasional resort. I would, however, mention that in very many cases of nocturnal attacks of dyspnoea in cardio-renal patients, chloral acts to a better advantage than any other remedy for this particular complica- tion. STATISTICS OF DIPHTHERIA. By C. G. COAKLEV, M.D., CLINICAL PROFESSOR OF LARYNGOLOGY, MEDICAL DEPARTMENT, NEW YORK UNIVERSITY. The study of the statistics of the infectious diseases is exceedingly valuable to the medical profession. We find, however, that in some of the infectious dis- eases the study presents difficulties that are not to be found in others and that diphtheria probably offers us a greater degree of uncertainty than any of the others. One of the order viagra discreetly greatest difficulties lies in the uncertain- ty of the diagnosis. Physicians readily learn to accu- rately diagnose the exanthems. but with some of the in- fectious diseases, notably tuberculosis and diphtheria, we have been able only since the discovery of their pathogenic organisms to accurately differentiate these diseases from others presenting very similar subjective and objective symptoms. In order that the statistics of diphtheria may be properly appreciated, I shall divide buy legal viagra the disease into two periods, an early period and a late period. The