Chilling of the surface of the body should be avoided; sudden cold or sustained severe cold, which increases the contraction of the peripheral blood vessels and puts more strain on the heart muscle, is to be avoided if possible. More hours in bed at night and lying down after the heavier meals of the day will tend to give the heart the kind of rest it needs. Also complete rest for one day a week, or a rest of several days at a time, and a rest, both mental and physical, with such walking, golfing or riding as seems advisable, for at least one month every year, will prolong the lives of these patients, and may make an imperfect heart act well for months and years. If the patient is anemic he should, of course, receive some nonastringent iron; a. tablet of saccharated ferric oxid (Eisenzucker), in small doses, 0.20 gm. (3 grains), once or twice in twenty-four hours, is sufficient. The prognosis of a case diagnosed as chronic myocarditis or chronic degeneration of the heart is doubtful, as one cannot tell until several weeks or months of observation whether this particular heart also has fatty degeneration or not. If there is fatty degeneration, the prognosis is bad. If there is no serious fatty degeneration, the patient, with the modified life outlined, may live for a long time. Acute dilatation from any serious strain on the heart may occur, and if there is fatty degeneration it is liable to occur at any time. Attacks of cardiac asthma are always serious, and always damage the heart a little more. FATTY DEGENERATION Fatty degeneration of the heart muscle may be caused by acute poisoning (as phosphorus, arsenic, etc.), by serious infections, or it may follow fibrosis of the heart or coronary artery disease. The symptoms are those of serious circulatory weaicnens, which does not seem to improve under any ordinary management. It is difficult, if the heart is enlarged, to determine whether there is more or less serious acute dilatation or whether the heart muscle has suffered fatty degenration. The treatment of such a patient requires the best of judgment as to the amount of food and liquid that should be given, the regulation of the administration of laxatives, the sponging of the body, the means of producing sleep if there is insomnia, how much reading, conversation or amusements should be allowed, how much stimulation by stryclmin or other stimulating drug should be given, and whether or not very small doses of digitalis should he tried. These are all matters for individualizing, and for the best medical judgment which we are called on to give. How much repair can take place in a heart muscle when fatty degeneration has started we do not know. Such treatment will give the heart the only chance it has to recuperate, but the prognosis is bad. FATTY HEART