The altered circulation in the gastro-intestinal canal frequently causes troublesome dyspepsia, and sometimes hemorrhage from the bowels; while the obstruction in the -cerebral circulation may produce serious insomnia, and sometimes delirium.

Or a fibrinous embolus from the left auricle blocks one of the cerebral arteries, and may produce limited or widespread softening. In such cases of general dropsy it now and then occurs that some large vein, as the axillary or femoral artery of one side becomes obstructed by a local thrombus, and then the swelling, pain, and tension in the corresponding limb are much greater than elsewhere. A patient too, who can only lie on one side, may thus get an unsymmetrical dropsy owing to gravitation.

Certain physical signs may occur in connection with the heart when the stage of failure sets in, which are often of importance in estimating the degree of failure which has occurred, or in foreshadowing its occurrence. Thus, the presystolic murmur may disappear owing to the complete or partial failure of the contraction of the left auricle, and a sign of similar import is the diminishing intensity of the second sound on the pulmonary side. The more complete the stasis in the pulmonary circulation and left auricle the less the quantity of blood which flows through the pulmonary orifice at each contraction of the right ventricle.

The semilunar valves therefore undergo less movement, less sudden change from flaccidity to tension, and the sound they produce diminishes in intensity. In the stage of failing compensation the left ventricle may gradually hypertrophy, as the tension of the arteries, which it has to overcome, increases owing to backward pressure. The appearance of a tricuspid murmur, and pulsation in the jugular vein, or even in the liver, may testify to a dilated tricuspid orifice allowing of regurgitation.

The patient, whose distress increases from so many causes, may gradually die in spite of every effort we may make to save him.

On the other hand the treatment of such cases is, as a rule, very hopeful, and although the actual narrowing of the mitral orifice must still remain and may even increase, death may be averted and years of fairly comfortable and useful, though quiet, life be secured. Under favorable circumstances, the dropsy gradually disappears, the urine increases in quantity, and albumen and casts disappear, the liver becomes smaller and less tender. Respiration becomes easier, the pulse slower, more regular, and fuller, the presystolic murmur reappears, and the second pulmonary sound becomes louder. The patient sleeps better, eats and digests his food better, and gradually returns to a condition of comfort.

Treatment. The first and most essential point in the treatment of heart-failure in cases of valvular disease is rest; the patient should be put to bed. This measure of itself sometimes gives wonderful results. If the venous congestion is very great, bleeding should be resorted to in mitral stenosis.

As regards drugs, digitalis still holds the foremost place where the pulse, is rapid, feeble, and irregular, and in many cases its effects are very striking. But I believe it is useless to give digitalis with a slow pulse, that is, where the pulse is beating at a rate which is normal to the individual in question, or below normal. We cannot hope to increase the force of the circulation as a whole, if, while we add to the power of each contraction of the heart, we diminish the number of beats per minute; unless, indeed, when we begin to give digitalis the heart's beats are abnormally hurried as well as feeble.

Under such circumstances digitalis sometimes fails. Strophanthus may then be tried; but the latter drug is far less frequently effectual than digitalis. Combined with digitalis we may give strychnine, which I believe is one of, if not the best, cardiac tonics we possess if given subcutaneously.

It may be given when the heart's action is slow, and it may be sometimes after digitalis has reduced the frequency of the pulse. Another very favorite drug with me, especially if the urine is scanty, is citrate of caffeine. I believe alcohol should be given in moderate quantities.

The bowels should be kept well open, but in my experience, purging is not advisable. Dyspepsia generally depends on the congestion of the liver and gastro-intestinal mucous membrane, and is relieved by the remedies which improve the heart's action; in this condition I have used bicarbonate of soda with some bitter infusion with fairly good results.

Abundant simple food in small quantities, often repeated, is most essential in the successful treatment of this condition.

I have found that one of the most difficult complications to manage is insomnia. Morphia by the mouth or in small quantities subcutaneously often acts well. Small doses of chlorai can be given with caution, and are best given with alcohol. In my hands sulphonal, and many others of the much-lauded new narcotics have failed.

THE THERAPEUTIC VALUE OF HYPNOTISM.

BY JNO. R. ROSE. M.D., EASTMAN, GA.

In presenting to your consideration a subject that has only lately been reclaimed from the misty borderland of mysticism and the tenacious grasp of the ecclesiastic to be admitted into the brighter zone of scientific investigation and approval, in speaking to you of a means and a method that, so far, is fully understood by none, practiced by only a few, that is disbelieved in and doubted by many, I must of necessity be hampered by the inherent weakness of a subject still in the experimental stage. Hypnotism to-day holds a position in medicine similar to that of electricity before the days of Tripier and Apostoli, before the days of the meter and rheostat, for while the force and its therapeutic applicability are known and can be proven, yet all means of exact dosage are wanting, and therapeutic success or failure seem to be in the majority of cases the result of personal experience and individual adaptability, which state of things would go far to explain the different results obtained by different men.

When deciding to write this paper I at first intended to just gather together as much material from the literature. on this subject as was within my reach, add to this the mite of my own experience and experimentation, subject the whole to a critical discussion and allow my hearers to form their own opinions, but I believe for the better understanding of the subject it will be best to begin with a short his

torical sketch and to mention at least some of the theories that have been advanced for the explanation of these phe

nomena.

The knowledge of hypnotism seems to date back to the very cradle of mankind, for Egyptian and Greek priests practiced it under the name of temple sleep, while in the sacred books of Persia and India we frequently find it referred to in the form of autohypnosis, as the following extract from the Persian Oupneksat will prove, where it says:

"To arrive at the bright contemplation one must, like the turtle, draw all the senses within, close eye, ear, mouth and nose; then Brahm appears with his Atma and like the rivers with the sea we are at one with the world-light." Evidently an autohypnosis similar to the plan followed by the Hesychasts of Mount Athos during the thirteenth and fourteenth centuries. In the Upanishads, the philosophical commentary on the Vedas, we read of a deep magic sleep in which the manifold makes room for the unity of things, the Nirvana. But even verbal suggestion was known in the Orient, and among the Hebrews one healing by words was called a Shem, the psalms of David and proverbs of Solomon alluding to it in several places, while its existence among the Hindoos and Persians is proven by the following passage in the Zend-Avesta.

"Many cures are made through herbs and trees, others through water and yet others through words; but the safest cures are through words." Regarding the temple sleep practiced by the ancient priests of Esculapius at his temples in Pergamos and Epidaurus since long before his time Hippocrates says: "After the soul has been loosened by this sleep, not especially from the body but from the gross service of its component parts, it withdraws within itself as within a haven to guard against storms. It sees and knows then everything happening on the inside and pic