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made by adding the white of one egg to six ounces of boiled water is given. The patient is also so- licited to drink plain water freely. If there is com- plete intolerance or aversion to milk, then butter- milk or kumyss or kefir can frequently be borne. There is no danger, in my opinion, in forcing this quantity of fluid through the cardiovascular ap- paratus and the kidneys, unless acute nephritis ex- ists as a complication. In that case it is both use- less and injurious to attempt to drive this quantity of liquid through an inflamed and partly imperme- able kidney filter. The quantity and quality of the daily urine output nuist be carefully studied, and attempts at flushing the kidneys postponed, until the mechanical obstacles to the flow of urine are re- moved. Buy Cialis Online Canada Paypal Another objection to an exclusive milk diet arises from the fact Buy Cialis Online Canada Paypal that milk is very rich in phosphates and that the urinary phosphate excretion is greatly increased on an exclusive milk diet. To convert some of these phosphates into calcium Buy Cialis Online Canada Paypal phosphate, which is absorbed with difficulty from the intestine and excreted in the fseces rather than eliminated through the kidneys, lime water is added and helps to bring about the required change (i). The acid and pepsin mixture is given after each feeding of milk and cream, because the secretion of digestive juices by the stomach is almost arrested during the fastigium of typhoid fever. This is the theory of its administration. As a clinical fact, easy of demonstration, abdominal distention and the passage of undigested curds in the stools will not be observed during its use. An able clinician of this city has raised the ob- jection that a diet of thirty-two ounces of milk and eight egg whites contains only about goo calories a day, while the average typhoid patient requires about 2,600 calorics (2). The addition of eight ounces of cream adds about 500 calories to the first mentioned figures, and when the whole egg can be taken and digested, as it usually can after the first week of rest in bed and proper general treatment, the caloric requirement can be met. In the present furore for stuffing patients, we are apt to forget that therapeutic fasting, at the beginning, may allow an uncomplicated typhoid infection to pursue a normal- ly mild course without any mixed infection, by re- ducing the bacterial content of the intestines (3). The value of the initial purge in typhoid fever prob- ably rests upon the possibility of a like bacterial reduction. After the third week, I usually allow crackers BACHMAKN: ARTERIAL PRESSURE. [New York Medical Joi-rnau with butter, well cooked rice, calves foot jelly, and broth, and other solid foods when the evening tem- perature reaches normal. Twenty-eight cases treat- ed according to this plan in St. Vincent's Hospital from June i to October i, 1910, resulted in twenty- seven recoveries, and one death from ulcerative en- docarditis; three patients recovered after severe in- testinal ha8morrhages, and in one small boy perforat- ing appendicitis developed in the fourth week, but he recovered, after surgical operation, performed within four hours after onset. References. 1. Croftan A. C. Clinical Therapeutics, second ediiiun, p. 211. Buy Cialis Online Canada Paypal 2. Manges Morris. Medical Record, April 25, 1908, p. 706. 3. Harbin R. M. New York Medical Journal, July 25. 1908, p. 1-78. 42 E.AST Twenty-ninth Street. THE .MEASUREMENT OF ARTERIAL PRESSURE IN MAN. By George Bachmann. M. D., Atlanta. {From llie laboratories of the Jefferson Hos[>ilal. Buy Cialis Online Canada Paypal Pliita- delphia.) The measurement of the blood pressure has estab- lished itself, within recent years, as one of the recog- nized procedures of clinical investigation. The pro- gressive physician does not rely entirely on his sense of touch to gauge the pressure within his patient's arteries any more than he would think of estimating the same patient's temperature by laying his hand over his forehead. It is true that the estimation of the blood pressure by the ordinary clinical instru- ments is not free from more or less serious fallacies, one Buy Cialis Online Canada Paypal of which has lately been dwelt upon by a num- ber of investigators. I refer to the resistance of the arterial wall proper as a factor apart Buy Cialis Online Canada Paypal from the pres- sure exerted by the blood against the sides of the vessels. This factor can never be expressed in math- ematical terms in any one case, but it is safe to say that it can be discarded in healthy arteries, as its value is probably within the limits of ordinary exper- imental errors. The estimation of arterial change will, therefore, continue to be obtained by the palpa- tion of accessible arteries. The resistance offered by the tissues overlying the arteries may be another dis- turbing factor, although this has been denied by some. Other and possibly more serious sources of error lie in the various methods in use for the evalu- ation of the arterial pressure. Briefly stated all in- struments are attempts to put into practice the prin- ciple, first enunciated by Marey, that the amount of pressure, applied outside an artery, just sufficient to extinguish the pulsation of the vessel at this point, is equivalent to the maximum pressure within the ves- sel under Buy Cialis Online Canada Paypal compression ; as the highest pressure is found in the arteries during the systole of the ventri- cles it is known also as .systolic pressure. The prin- ciple Buy Cialis Online Canada Paypal underlying the estimation of the minimum pres- sure may be stated as follows : — If an artery is com-