CASE XXXIV. Mr. S., aet. 31, merchant, was referred to me April 3d 1874, by Dr. KREHBIEL. In January, 1874, Mr. S., until then in the enjoyment of good health, woke up one morning to find, as he expressed it, “everything dark before his eyes.” He groped his way to the window, in order to open the blinds. When at the window, he felt as though about to fall out—probably vertigo. He soon returned to an apparently normal condition, and went about his business as usual. A week after, he had a much more serious attack, which he describes as follows: “I had been playing whist during the evening (several hours), when suddenly, without premonition, I felt as though a champagne cork popped against the top of my head, inside. Accompanying this was an indefinable sensation about the heart as though the blood all rushed thence down to the feet. I did not lose consciousness; did not fall. I trembled all over, and a great fear came over me. Felt very weak all night; my pulse was very slow.” About two months subsequently, patient was referred to me, as above stated. He then had an uneasy look; an indefinable continual sense of fear; was excessively nervous in the forepart of the day; had brief attacks of tremor—usually every alternate morning, but not typical as to time of occurrence. The history exhibited neither syphilis, malaria nor intemperance. Had never had headache. Sleep good; appetite likewise. The most pathognomonic symptom, however, related to his pulse. This was abnormally slow, ranging from 44 to 54 (the latter only when standing or after walking) per minute. It was full and regular. There was no organic heart trouble. In the absence of any other symptom whatsoever pointing to irritation of the pneumogastric or spinal accessory, I was justified in excluding this as the possible cause of the cardiac infrequency. On the other hand, the pathogenetic manifestations appeared all to point to “asthenia of the sympathetic”—at any rate the portion of this whence the cardiac nerves take their origin, and I formed my diagnosis accordingly. In the beginning, the treatment consisted of bilateral ascending (from cilio-spinal centre to both mastoid fossæ) galvanizations of the sympathetic, and galvanic baths (head electrode negative, surface board positive, to epigastrium) on alternate days. Improvement in every respect was steady, though not rapid. At the end of three weeks, I supplemented this treatment by the administration of ergotin and nux vomica. At the expiration of two more weeks, the patient being nearly recovered, I discontinued these medicaments, substituting the valerianates of zinc and iron, and steadily maintaining meanwhile the electrical treatment as above indicated. After a short time recovery appeared complete, and patient was discharged from treatment.