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I believe that in the management of a case of glaucoma, whether it be chronic or chronic with sub-acute exacerbations, the greatest care with the aid of an expert clinician must be exercised to find out exactly what mean pressure of the arterial and venous system best conforms with the patient's general welfare, and I am bitterly opposed, and I think with right, to the sudden reduction of tensions, except in emergencies, without a perfect understanding of the facts I have ventured to indicate.
In Gilbert's chapter entitled "De arthretica passione et ejus speciebus," we are introduced to the earliest discussion by an English physician of that preeminently English disease gout. Indeed, it is one of the few diseases of the Compendium in which the author assumes the position of a clinician and introduces examples of the disease and its treatment taken from his own clientele.
The tracing of the carotid and radial shows the activity of the left side of the heart. After normal tracings have been carefully taken and studied by the clinician or a laboratory assistant, abnormalities in these readings are readily shown graphically. Especially characteristic are tracings of auricular fibrillation and those of heart block.
And it may be generally stated that the clinician can get very valuable points concerning the somatic interiors of his patients by reasoning back from the contents of their somatic delusions. But how far can we, as psychiatrists, reason back from the contents of environmental delusions, e. g. those of persecution, to the actual conditions of a given patient's environment?
It is one of the greatest pleasures of a the clinician to note such a previously inflamed heart gradually diminish in size and the murmurs at the valves affected gradually disappear. Although they may have disappeared while the patient is in bed, he is not safe from the occurrence of a valvular lesion for several months after he is up and about.
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