say first stage 1,500 feet, second stage from 2,500 to 3,000 feet, and third stage from 4,000 to 6,000 feet, with a stay of one or two days at the intermediate places. The stay at the health resort will be shortened, it is true, but the patient will derive more benefit. On the return journey one short stay at one intermediate place will suffice. Even a fairly strong heart will not stand an overstrain in the first days spent at a high altitude. A Dutch lady, about forty years of age, who had spent a lifetime in the lowlands, came directly up to Adelboden (altitude, 4,600 feet). After two days she went on an excursion with a party up to an Alp 7,000 feet high, making the ascent quite slowly in four hours. Sudden heart syncope ensued, which lasted the best part of an hour, though I chanced to be near and could give assistance, which was urgently needed. The patient recovered, but derived no benefit from a fortnight's stay, and had to return to the low ground the worse for her trip and her inconsiderate enterprise. Rapid ascents to a high altitude are very injurious to patients with arterio-sclerosis, and the mountain railways up to seven thousand and ten thousand feet are positively dangerous to an unsuspecting public, for many persons between the ages of fifty-five and seventy years consider themselves to be hale and healthy, and are quite unconscious of having advanced arterio-sclerosis and perchance contracted kidney. An American gentleman, aged fifty-eight years, was under my care for slight symptoms of angina pectoris, pointing to sclerosis of the coronary arteries. A two-months' course of treatment at Zurich with massage, baths, and proper exercise and diet did away with all the symptoms. I saw him by chance some months later. 'My son is going to St. Moritz (six thousand feet) for the summer,' said he; 'may I go with him?' 'Most certainly not,' was my answer. The patient then consulted a professor, who allowed him to go. Circumstances, however, took him for the summer to Sachseln, which is situated at an altitude of only two thousand feet, and he spent a good summer. But he must needs go up the Pilatus by rail (seven thousand feet), relying on the professor's permission, and the result was disastrous, for he almost died from a violent attack of angina pectoris on the night of his return from the Pilatus, and vowed on his return to Zurich to keep under three thousand feet in future. I may here mention that bad results in the shape of heart collapse, angina pectoris, cardiac asthma, and last, not least, apoplexy, often occur only on the return to the lowlands."