The amount of digitalis that is advisable has been frequently discussed. It should be given in the best preparation obtainable, and should be pushed gradually (not suddenly) to the point of full physiologic activity. While it may be given at first three times a day in smaller doses, it later should be given but twice a day, and still later once a day, in a dose sufficient to cause the results. As soon as the full activity has been reached it may be intermitted for a short time; or it may be given a longer time in smaller dosage. In renal insufficiency associated with cardiac insufficiency, its action is subject to careful watching. If there is marked advanced interstitial nephritis, digitalis may not work satisfactorily and must be used with caution. If, on the other hand, a large part of the kidney trouble is due to the passive congestion caused by circulatory weakness, digitalis will be valuable. In sudden cardiac insufficiency, provided digitalis has not been given in large doses a short time before, strophanthin may be given intravenously once or at most twice at twenty-four-hour intervals. If, in this more or less serious condition of the heart weakness, there is great sleeplessness, a hypnotic must sometimes be given, and the safest hypnotic is perhaps 3 / 10 grain of morphin. One of the synthetic hypnotics, where the dose required is small, may be used a few times and even a small dose of chloral should not be feared when sleep is a necessity and large doses of synthetics are inadvisable on account of the condition of the kidneys. The value of the Nauheim baths with sodium chlorid and carbonic acid gas still depends on the individual and the way that they are applied. If the blood pressure is low and the circulation at the periphery is poor, they bring the blood to the surface, dilating the peripheral vessels, and relieving the congestion of the inner organs and abdominal vessels, and they often will slow the pulse and the patient feels improved. If they are used warm, a high blood pressure may not be raised; if the baths are cool, the blood pressure will ordinarily be raised. Provided the patient is not greatly disturbed or exhausted by getting into and out of the bath, even a patient with cardiac dilatation may get some benefit f rom such a bath, as there is no question, in such a condition, that anything which brings the blood to the muscles and skin relieves the passive internal congestion. Sometimes these baths increase the kidney excretion. At other times these, or any tub baths, are contraindicated by the exertion and exhaustion they cause the patient; and cool Nauheim baths, or any other kind of baths, are inadvisable with high blood pressure. DISTURBANCES OF THE HEART RATE ARRHYTHMIA