68 ENDOCRINE THERAPEUTICS 



The brain begins to work again smoothly and 

 easily ; the exaggerated worries of life assume 

 their natural proportion, and quiet sleep comes 

 back again. In this early experimental stage of 

 treatment the heart needs watching closely. 

 Where, as often happens, there has been dilata- 

 tion and, perhaps, an apex-systolic murmur, 

 strophanthin in good doses should be given ; 

 strychnine also helps, but its action on the adrenals 

 raises pressure somewhat. The quickest and 

 surest plan is to give hyperdermically every day, 

 or every other day, an ampoule of Martindale's 

 strophanthin : this is extraordinarily effective. 

 Digitalis as a rule should be avoided ; whatever 

 its effect on pressure may be in health I feel 

 certain that its activity raises pressure when 

 there is hyperpiesis. There are some cases where 

 the liver and the kidneys are not doing their 

 work, and where there is some oedema of the 

 legs, in which digitalis is needed, but it should be 

 given with mercury. The old pill of digitalis, 

 blue pill and squills, is most effective. Mercury 

 is probably the best and steadiest lowerer of 

 high pressure that we have, but for obvious 

 reasons it cannot be given for any length of time. 

 A weekly dose of blue pill, or calomel, is a great 

 aid to other forms of treatment. The other heart 



