he is inclined to think the pressure had been higher, as it was not taken until the patient had reached the hospital and after 2 or 3 convulsions. This case might be placed with the mild ones, according to Green's classification, as there were but five convulsions in all, and a rapid recovery.

Forewarned should certainly be forearmed in eclampsia, and if this malady cannot be prevented one can be prepared for the emergency, and preparedness is both commendable and essential in the proper handling of these cases. Since by so easy a method even the approach of danger can be apprehended, no one is justified in omitting or overlooking the warning. One other point upon which authorities seem to be a unit is that the convulsions kill. This being the case, the sooner they are controlled, the better the outlook for mother and offspring.

J. C. ATTIX, M.S., M.D.

Professor of Chemistry and Toxicology

in the Medical and Pharmaceutical Departments of Temple University; Chemist, Pathologist and Bacteriologist

to the National Stomach Hospital, etc. 2355 N. 13th St., Philadelphia.

High Blood Pressure and Its Significance. EDITOR MEDICAL WORLD:-When Oliver Wendell Holmes was asked how to reach the age of seventy, he replied that a man should begin to pick out his ancestors one hundred years before he was born. More recently Osler defined longevity as a vascular question, asserting that with a majority of men death comes primarily or secondarily thru the medium of the arteries. Tho epigrammatically stated, these apparently trifling thoughts carry with them truths that are confirmed by every scientific student in the profession of medicin.

Of late much interest has attached itself to the subject of blood pressure, inasmuch as the study of abnormal pressure shows that it is either causative of or resultant from a score of major maladies too often overlooked and too little understood. The blood pressure in the systemic and pulmonary arteries varies within certain physiologic limits. Thru the invasion of pathologic processes these variations may be so markedly augmented or decreased as to point the way to a more scientific diagnosis of the affection under observation.

Thus, increased aortic resistance may be due to aortic obstruction or obstruction in the larger arterial branches or to more or less localized or generalized vascular con

tractions. Resistance will likewise be increased with aortic thrombosis, aneurism, and vascular dilatation dependent upon sclerotic changes. The reason for the permanent increase of general arterial pressure in chronic nephritis is still, to a large degree, not understood. It may be due to the action of retained urinary toxic substances upon the vascular walls, or upon the vasomotor centers, or to reflex stimulation of the cardio-vascular system. Be this as it may, the increase of arterial pressure in this class of cases has been shown to be due to increased peripheral resistance, as a result of contraction of the smaller arterioles.

Increased arterial pressure is noted in the acute infections, the exanthemata, diphtheria and syphilis. Chronic intoxications affect either the vessel wall or nerves, or the arterial effects may be due to renal changes. Intoxications may be either exogenous as alcohol, lead, ergot, nicotin, etc.; or the arterial changes may be engendered by endogenous toxins, as in the autointoxications, and in the toxins generated thru vicious metabolism, as evidenced in cases of diabetes, gout, obesity and chronic inflammations of the kidney. Violation of "the simple life" by throwing increased labor upon the circulatory apparatus, leading to early degeneration, with overfeeding, by engorging the blood stream and thru faulty metabolism, elaborating toxins, too often lead to a high blood tension and a long train of annoying and mayhap disastrous symptoms. Increased pressure in the pulmonary circuit may find expression in inflammatory conditions of the lungs and pleura, atrophy, emphysema, pleural adhesions, effusions, thoracic deformities, tumors, aneurisms, etc. The changed tension in the pulmonary system is recognized by auscultation of the pulmonic second sound, sometimes designated the "pulmonary pulse."

In touching merely upon the hem of the garment in this flighty fashion, space will just suffice to emphasize the extreme imporance of the study of blood pressure in very many pathologic processes, and three thoughts present themselves for passing notice. Ever since Robert Battey1 planned and carried into execution the unsexing of women for menstrual insanities, including such entities as hystero-epilepsy, hysteromania, convulsions, nymphomania, etc., the profession has been on the lookout for

""American Text Book of Gynecology," Battey and Coe, Vol. II.

the

a deeper understanding of these strange phenomena concurrent with each recurring menstrual period, and altho broadest hints of the existence of internal secretions and their interrelations had been curiously suspected during the 18th century,2 it was not until within quite recent years that the theory of hormones was offered for intelligent discussion. This engaging study and a clearer understanding of arterial pressure are blazing the way to a better appreciation of the etiology and the treatment of these neurologic conditions. Battey taught that with each menstrual epoch there was an increased flow of blood to the sexual organs, entirely disregarding the exalted universal arterial tension which dominates the female at these critical periods. In his quaint Georgia home this noted gynecologist with little thought of blood pressure, stumbled on the incontrovertible fact that, in some cases of intractable nerve conditions, the establishment of an artificial menopause would save many a woman the ignominy of a madhouse; but the radical innovation became a routine practise with "occasional" gynecologists. Battey was excoriated in the medical press, personal violence was even threatened, and the dictum of the famous Diffenbach, uttered a quarter of a century previously, was the slogan of the conservatives: "Ovariotomy is murder; every one who performs it should be put into the dock."

From war-distracted Europe comes a curious study of disturbed arterial circulation. Before the members of the Académie des Sciences, Dr. Moutier read a paper in which he elaborates upon the existence of radial hypotension of all soldiers that he examined who had recently returned from the battlefield. Those who exhibited general hypotension before entering upon the conflict, offered a normal tension upon their return, or even a lowering below normal. This radial hypotension, declares Moutier, is the consequence of a peripheral vasodilatation, dependent upon and compensatory to, internal vasoconstriction. By means of high-frequency currents, applied to the abdomen, the arterial tension again readjusts itself and normal radial tension is restored. In all of the battle-scarred patients he has observed changes in blood pressure when the traumatism affects the arm. Sometimes the tension is higher in the injured limb, but more usually it is lower; in some 2Science, Aug. 6, 1915.

cases the radial pulse is imperceptible. Applications of d'Arsonval high-frequency currents to the abdomen locally and at the level of the junction of the limb rapidly restores the arterial tension to normal.

Moutier further believes that these arterial changes may be instrumental in the production and course of many diseases and complications, such as frozen feet, certain atrophic conditions, delayed cicatrization and retarded bony union.

Careful investigation of increased blood tension is being thoroly carried out at present by many ophthalmologists. The tortuous arteries of arteriosclerosis and other abnormalities in blood vessels and in pressure are being more carefully investigated thru the agency of the ophthalmoscope. Thru these studies it is now largely believed that arteriosclerosis may play a major rôle in the pathogenesis of glaucoma. One fact is appreciated by many medical practicians: Often before the familiar physical signs of arteriosclerosis, with its increased tension, are recognized by the usual diagnostic appliances in the physician's armamentarium, with the subtle aid of the ophthalmoscope the delicate, thickened, tortuous arteries may be found impinging themselves upon the background of the eye.

SAMUEL LEWALD, M.D. 2226 N. 13th St., Philadelphia.

Treatment of High Blood Pressure and
Arteriosclerosis.

EDITOR MEDICAL WORLD:-I read Dr. T. J. Hickman's article in the September WORLD (page 364), concerning high blood pressure. I agree with your remark that we know "but little about its significance." If Dr. Hickman's pressure is 175, and his bodily functions are as he represents them, he need not worry much about it, if it does not continue to rise. I have made quite a study of high and low blood pressures. An examiner of one of the big life insurance companies of New York told me that he had ten applicants to examin a few years ago. He passed four and turned down six of them. The six are now living, and the four are all dead. The examiner said he turned down all whose systolic pressure was more than 150 mm.

The best remedy for high blood pressure is not to think too much about it, if the kidneys and heart are all right. Too much anxiety keeps the pressure up all the time.

"Forget it!" Possibly Dr. Hickman may have a contracted kidney.

Autocondensation.

Now about the treatment: About three years ago I had a high pressure of 225. My heart was always a nervous animal; had been so for 50 years. My kidneys have always been all right. I first used the autocondensation treatment. Was treated by an electrotherapeutist. This would bring it down about twelve points at each treatment of twenty minutes. And by taking the treatments three times a week I could bring it to about 180; sometimes as low as 160. But if I discontinued the electricity, the pressure would go back in a week or two to 220.

I have read the note in the October MEDICAL WORLD, page 390, by Dr. J. W. Torbett, of Marlin, Texas, about the man who had a systolic pressure of 210; who, after two weeks' treatment with autocondensation had a pressure of only 125 and "is still that several weeks later." If that man's blood pressure went down to 125 and stayed there, after two weeks' treatment with electricity, it is a very remarkable case. Last winter I stayed about three months in Washington, D. C., and spent many hours with a doctor who is one of the noted electrotherapeutists and lecturers on the subject. He told me he had a case of a man who had eaten heavily at a banquet. After the affair was over the blood began to ooze from both eyes. His blood pressure was taken, and registered 230. It took two months' treatment to bring it down to 170 and keep it there for fortyeight hours; and it could only be kept at that mark by taking at least one treatment a week. Aside from the high blood pressure he was apparently a well man. What Dr. Torbett says about tobacco in high blood pressure is generally true, because most smokers and chewers of tobacco are so in

temperate in its use. Some rather immoder

ate smokers never show a pressure of over 135 or 140. However, a man with a persistently high blood pressure would better cut out tobacco, as a rule.

Aconite, Potassium Iodid and Carduus Mariana.

About six months ago I began the following treatment: 4 drops of homeopathic mother tincture of aconite in one-third tumbler of water three times in 24 hours. Iodid of potassium, 8 to 10 grains in water.

To stop hardening of the arteries, I took 5-drop doses of carduus mariana (the mother tincture) three times in 24 hours. The iodid of potassium I took morning and night. It is true that carduus mariana will soften up the arteries wonderfully. I brought a man off his bed with it who had been practically given up, whose trouble was arteriosclerosis. He is now at work, his wife informs me. I may say that Lloyd's specific aconite cannot be taken in such doses as above mentioned. It is too powerful a remedy.

Now as to results of the above treatment. In six months I have brought the pressure down as low as 158 millimeters. But it does not remain at that point. It varies from 160 to 170. A pressure of 170 does not trouble me at all. I now take the above treatment about twice a week.

Diet.

Of course, much attention must be given to diet. I use no tea or coffee. I do not eat beef or fresh pork. I cut out condiments and all spices from my food. Coffee is bad for high blood pressure; so is alcohol in all beverages.

min in the urin is at or above 170 milliIf a blood pressure with a trace of albumeters, red meats should be cut out of the diet, so should lobsters, crabs, salmon, shad, salted fish and meats. An occasional broiled lamb chop, chicken, or such fish as haddock, weakfish, halibut, smelts, butterfish, or oysters would not have a marked effect on blood pressure. A prominent physician in Washington, with a blood pressure of about 170 to 175, makes his breakfast out of a baked apple and cream and a cup of cocoa. This is a very restricted diet. Some could not live on it. Of course, the blood pressure rises some after any meal.

Tobacco Smoking.

I have smoked three cigars a day for fifty years; but there is no Havana tobacco in them. They are of the mildest brand. One cigar does not make any perceptible rise in the pressure; but two, smoked successively, will raise it about 4 points. But even after smoking two cigars the pressure returns, in about thirty minutes, to where it was before the smoking began.

Nitrite vs. Iodid.

I make daily use of my sphygmomanometer. A doctor who has not one, cannot tell how his remedies are working. Nitrite

of sodium I seldom use. I believe in the end it does harm. It is too powerful a dilator of the arteries and veins. Besides, its effects on the blood pressure cease in about an hour or so. Iodid of potassium is just as efficient and far safer to use.

I may add that the effects of nitro-glycerin and amyl nitrite on blood pressure are short-lived. They are all right in an emergency case of angina pectoris.

There is much to be learned about the effect of the nervous system on blood pressure. I have taken a pressure at 4 o'clock p. m. that marked 200. Thirty minutes after a 6-o'clock supper, it stood at 145. It was due to the state of the nerves at two periods of time. It is safe to say that it is not wise to operate on the eye, especially for cataract, if the blood pressure is above 165. It is often done at a higher pressure; but there is a risk of an unmanageable hemorrhage.

Gastric Hemorrhage.

In the October issue of Ellingwood's Therapeutist I read the editorial on "Hemorrhage from High Tension," in which the editor writes on an article that appeared in the Lancet for August 14th, by Haviland Hall, of London, on increased arterial tension as a cause of pulmonary hemorrhage. Dr. Hall says:

I have been struck by the occurrence of a series of cases of hemoptysis in middle-aged or elderly people with high arterial pressure.

I

Let me cite what happened in my own experience. About six years ago, one evening, after spending a day in Boston, I was taken sick without any apparent cause. went to the closet, and had a movement of the bowels. Very soon I became nauseated, and vomited into my hands and a cuspidor masses of coagulated blood. In the feces also was found black blood, which was scooped out of the closet and weighed. All told, I lost 56 ounces of blood. My wife called the nearest physician, who, in turn, called from Boston two surgeons, who came out prepared to operate, if necessary. said to the doctor who was attending me: "All I ask is that you give me a bowl of cracked ice, and let me swallow the pieces at will. Also put cracked ice on my stomach." This was done.

I

When the surgeons arrived they diagnosed it as ulcer of the stomach. I stoutly denied it, saying I never had the slightest symptom of ulcer. I called it congestion of the liver. Well, I was given adrenalin, salt

solution, and a hypodermic of morphin in my arm. I was fed per rectum for several days; and to please my physicians, I remained in bed for four weeks; but I was as well as ever in five days after the attack. I still maintained that it was not ulcer; but I could not change the minds of the doctors. My stomach was as well as ever in three days after the vomiting, altho I felt weak. In about ten days I was eating quite solid food, and could have gotten up, only I did not, as I agreed to keep in bed for four weeks.

When the time was up, I was out of bed in short order, and have never had the slightest trouble with my stomach since. Dr. Hall did not know anything, at that time, about high blood pressure, as we now understand it. But what he called "arterial tension," is exactly what I had, in my opinion. I believe I was carrying a high blood pressure, and that it, and it alone, was the cause of the blood filling up my stomach; evidently a small artery in the stomach had ruptured, and the blood had been oozing out slowly for some time. Probably for days I had passed some blood with my feces, but did not know it.

The coagulated blood was sent to the Harvard Medical School to an expert. He later reported, "Nothing but pure, coagulated blood." Some may think my diagnosis was wrong; but I have not any doubt about it. I did things that I could not have done, possibly, had it been ulcer of the stomach.

Incidentally, let me add, that about sixteen years before this happened, while I was located in Brooklyn, N. Y., I had the grip. I vomited for three months. I lived on cracked ice, milk and a little champagne, with each feeding. I went to the Brooklyn Hospital, where the trouble was diagnosed as possible cancer, gastritis, dilation of the stomach, etc., etc. One night, while vomiting in an earthen bowl, I threw up a gallstone about three-quarters of an inch long and one-half inch wide. The doctor who saw it said: "I have practised medicin in Brooklyn for twenty-five years, and I never

(Continued beyond Yearly Index. Raise staples with a pocket knife, lift Yearly Index out, and bind in front or back of volume, as desired. We omit the title page and blank page on opposite side of same leaf. As practically all who bind WORLD use the WORLD Binder (only 35 cents each, or three for $1), a separate title page is not needed, and is seldom used. However, if as many as 100 of our subscribers request a separate title page, we will supply it without extra cost.)

saw that done before, altho I think I once read of such a case in a medical journal." Perhaps many of the readers of THE WORLD can say the same.

Don't Worry.

The tinctures of pulsatilla and scutellaria are good in nervousness and worry in persons suffering with high blood pressure. If the blood has spells of "rushing to the head," use 8 or 10 drops of a good tincture of viscum album (mistletoe) in water as often as the occasion demands.

Final word: If you have high blood pressure, with a fairly good heart and kidneys, don't worry all the time over it. Remember that in many cases a pressure of 200 millimeters is necessary as a compensatory process.

After all, blood pressure is like electricity, what we don't know about it is more than what we know. A. W. MILLS, M.D.

Framingham Centre, Mass. [We are compelled to hold over till next month a splendid article on "The Place of Autocondensation in the Treatment of Hypertension," by Dr. A. B. Hirsh, of Philadelphia. We had intended to include it as a part of the symposium on treatment of high blood pressure and arteriosclerosis, but we have so much material on hand for our various departments that we must retain many for next issue.—ED.]

Reminiscences of a Laboratory Specialist. V. TISSUE EXAMINATIONS WORTH WHILE. EDITOR MEDICAL WORLD:-King Alcohol must go! The laboratory man may not be a prohibitionist, but if you want to hear him preach a sermon on temperance, send him a specimen of diseased tissue preserved in alcohol. In some cases it may be impossible to secure formalin, and the physician may be driven to use some of his good Bourbon, but, as a rule, all tissues should be preserved in 10% formalin solution.

Time was when we were forced to use the alcohol-celloidin methods, and it was not until three or four days after the tissue was received that we could complete the examination and venture a diagnosis. But now most men use the rapid-freezing methods. Given a warm room and a tissue soaked in alcohol, freezing is practically impossible. In such cases we are forced to turn back to the old methods or give the tissue several baths in water, and either means a delayed

report. A mere trace of alcohol delays or prevents freezing.

There are tissues and tissues. Some tissues cannot be examined because of the fact that they are no longer tissues-a tissue is made up of cells, but if the cells are dead, they will not take the stains, and a tissue. examination is impossible. A pathologist would be unwise to attempt a diagnosis in such a case. In securing tissue for histotomy it is not sufficient to take sloughs, but firm, viable tissue should be removed by knife or curet.

Quite frequently diagnoses may be ventured from curettings, but, as a rule, a bit of the suspicious tumor is best sliced off with a sharp knife. There has been some objection raised to this latter method, the contention being that if the tumor is malignant, diagnostic slicing will spur it to a more rapid growth and favor metastases. There is some theoretic ground for this belief, but I have never seen it work out in practice. It is best, however, not to extend the cut into the normal surrounding tissue, or new paths will be opened up for the growth, is the opinion of some men, and it may be that they are correct in this contention. Personally I have noted that an infiltrating tumor experiences no great difficulty in invading perfectly normal tissues, and I am inclined to believe that the physician should not hesitate to make a diagnostic section where such is the method of choice.

Tumors of the Gum.

These are not the most frequent of tumors, but to me they are the most interesting. Now and then I see a case where the dentist gets up against it. It is strange that women are affected much more frequently than men. It will be noted that some of the upper teeth are becoming loosened, and when extracted it will be seen that the roots have been destroyed. In a few days the patient will return to the dentist, complaining that the gums remain sore. On examination, small reddish masses may be seen protruding from the sockets, and they may be mistaken for granulation tissue. But at length the dentist becomes worried and finally calls in a physician. These masses may prove to be granulation tissue, but more likely it will be found that they are but parts of an antrum tumor, a sarcoma or fibrosarcoma.

I have made examinations of a large number of tumors included by the surgeon