ADDITIONS TO THE REVISED EDITION OP 1880. 391 



patient becomes cyanotic and dropsical, the obstruction in the veins 

 of the pulmonary circulation gives rise to extreme dyspnoea, and at 

 last to osdema of the lungs. More rarely death takes place with 

 cerebral symptoms, or in consequence of intercurrent disease. An 

 improvement terminating in complete restoration is by no means an 

 uncommon occurrence. Indeed, recovery is a much more common 

 ending of the disorder than is death. 



Basedow's disease often recovers under a treatment consisting 

 in a strengthening diet and the use of iron. The secale cornutum 

 has also been prescribed as having a reputed power of causing con- 

 traction of the walls of blood-vessels, and a reduction of their cali- 

 bre. Whether the improvement be really in consequence of this 

 mode of treatment, or not, remains a matter of doubt. At all events, 

 it would be well to try this remedy, or some similar one. 



Recent observations have induced Von Dretsch to apply the con- 

 stant current of ten or twenty elements to the sympathetic of the 

 neck, with the result of considerably reducing the pulse-rate, mod- 

 erate diminution of the exophthalmos, and better and more quiet 

 sleep. Further trials by Eulenburg, Choostek, M. Meyer, and others, 

 place the efficacy of galvanism beyond a doubt. Benefit is often 

 derived after a few sittings, but it is incomplete ; the exophthalmos 

 and the thyroid tumor diminish more than does the overaction of 

 the heart.] 



ADDITIONS TO THE REVISED EDITION OF 1880. 



SECTION I. DISEASES OF THE HEART. 



1. P. 324. 



When the impulse of the heart cannot be distinctly felt, the 

 auscultation should be repeated while the patient is made to bend 

 forward. The heart then falls more forward, displacing the lungs 

 to right and left. Thus the stroke of the apex, previously imper- 

 ceptible beyond the mammillary line, may often be made out, and 

 a dubious case of enlargement of the heart made certain. 



2. P.329. 



Traube, however, points out that the action of digitalis has more 

 than one stage : 1. A stage when the frequence of the pulse dimin- 

 ishes and the tension of the aortic system augments ; 2. A stage 

 in which the pulse-rate and pressure are abnormally low ; 3. When 

 the pulse-frequence is abnormally high and the aortic pressure ab- 



