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nn attack yesterday and another today. Thinks it is due to the zwieback and the hard boiled eggs. Leave off both and continue with the milk alone as first directed. Sodii iodide, five grains thrice daily. May 2Slh. He is worse than before. Has three or four attacks a day whether he eats or not. Attacks last for twenty minutes. Continue the sodium iodide. A tablet Cialis Da 60 Mg of nitroglycerine, i/ioo as re(|uired. He has a tic about the left eyelid (which I had not Cialis Da 60 Mg noticed before). He still smokes. Told him again to abstain. May 31st. The nitroglycerine relieves the .severity of the attacks somewhat, l)ut they recur with L'rcater frequency. He had five attacks today. Continue the nitroglycerine. Codeine as before directed. June 2(1. In .f/ into his mouth. Has a pa-n over his heart, a burning feeling, with pain in right arm, and wrist and hand. Directions: A tablcspoonful of milk of magnesia in half a cup of milk. Repeat in two or three hours as necessary. For the pain, a suppository of morphia, one third of a grain. For the burning over the praecordium, apply an ice bag. June sth. At noon his daughter called at the office and reported patient could not sleep last night, so they gave him a suppository per os, and he (naturally) felt quite nauseated after it. In the early morning he had had hot water come up into his mouth. At 6 a. m. they gave him a dose of Rochelle salts, but these had not worked as yet. 1 ordered a dose of milk of magnesia at about 2 p. m. (he was just having his noon meal, soft lK)ilcd eggs), to be repeated in one hour if necessary. If preferable, give enema. I Cialis Da 60 Mg saw him at 5 p. m. He said he was feeling bet- ter. He could not stand the ice bag over the prarcordium. Pulse 92, regular. ' Heart's action regular ; slight sensitive- ness over the praecordium and pectoral muscle. Continue the salol. Give the suppository tonight. June 6th. Getting along much better. Salol every five hours now. Tired of milk; try cocoa. June 9th. This morning his daughter re- ported he had had pain all night. Did not have any sup- pository on hand. Directed : Morphia sulphate, quarter of a grain every two or three hours as Cialis Da 60 Mg needed. 6 p. m. Daughter reported it required two powders (the second forty minutes after the first) to relieve him. He still has fome pain. Leave off the salol, and take sodii salicylate, fifteen grains every four hours. Tune 26th. I saw him no more after the 9th, but today read a notice of his death. He had passed away the day before. The only regret th.it I liave in this case is that I did not carry out the treatment as first initiated with alkalies and with larger and more massive doses if it became necessary. But it is a very difficult matter to control an ainbulant patient whom you see only occasionally and his family whom you mostly do not see at all, who all have their own ideas, especially in matters of diet. The salol and later, the sodium salicylate, were given u()on the presumption of a possible rheumatic basis, as musculaf rheumatism is quite a common complaint in this locality about this period of the year. Certainly this case can not be classed with the Dseudo anginas. The severity of the spasms, their recurrence at a later period at such brief intervals as to seem ahnost continuous and above all the lethal exitus make it more than certain that here we have, as must be admitted by all, Cialis Da 60 Mg a genuine case of the malady and here also we Cialis Da 60 Mg have this Cialis Da 60 Mg special feature common to the cases ]>reviously recorded, to wit. hyperacidity of the gastric secretion. Up to the present time the pathologA- of angina pectoris, or rather the direct cause of the spasm, is clouded in absolute darkness (4). Because of this we have the subilivision of pseudoangina (or mock angina") which is in no way distinguishable from the form hitherto regarded as the genuine. We have the anachronism of an epigastric, an abdominal angina Cialis Da 60 Mg pectoris (5), both an impossibility (6). It is very readily understood how these latter subdi- visions came to be made. The diagnosis of angina pectoris once establisheil in a case, spasmodic seiz- ures in the epigastrium, in the abdomen for which no speci.il factor was discoverable were naturally at- tributed to the anginal status and called angina pectoris Cialis Da 60 Mg of the epigastrium or the abdomen. How- ever, with the light thrown out by the cases here re- ported, the whole subject becomes clearly and dis- tinctly iliuiuitiated. It was I.atham (7) who said that angina pectoris q6S EMERSON: STANDARD METHODS IN VENEREAL DISEASE. [New York DjcAL Journal. is a spasm, a Cialis Da 60 Mg cramp, of the heart muscle. This spasm is excited by the liyperacid gastric juice through the filaments of the vagus (8). To Cialis Da 60 Mg him who is familiar with the violent spasms that can be excited by this hyperacid secretion as in spasmodic closure of the pylorus (gastralgia, spasmus ventric- uli) and even elsewhere (as I shall show in a later