whilst the muscular function is only maintained by means of hypertrophy, to which there is necessarily a limit. In these cases of strain it is impossible to reduce the original dilatation--that is permanent. But we may and ought to be able to reduce the further dilatation, if any, that has been produced in connection with recent failure of nutrition and fresh embarrassment. Therefore, whilst we promote the nutrition of the elastic and muscular structures of the myocardium on the general principles which I have just laid down, we must be distinctly sparing of our demands on them. Everything approaching effort must be forbidden at once and for a sufficient time to rest and reinvigorate the cardiac tissues; whilst the nitrites or small doses of opium will also give relief and restore confidence in attacks of palpitation and anxiety. "Exercise, but not exertion," will be the broad rule to follow, at any rate until it has been proved that greater effort can be made with safety and actual advantage. But if præcordial embarrassment be the result of the attempt, or of ordinary professional work, as occasionally happens, further rest will have to be taken, that is, rest for hours or days, according to the severity of the symptoms. I have already mentioned to you that middle-aged patients with cardiac strain, dating from their youth, occasionally break down in their work for months or even years. In such an event a thorough change of air and scene should be combined with rest as a method of treatment. A long voyage may prove invaluable, or foreign travel of an easy and interesting kind. These not only rest the heart, but they divert the mind and remove the curious nervousness or loss of courage which, as I have said, is developed occasionally in these subjects, previously so vigorous and confident.