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of 12.7 per cent and the incidence of thromboembolic complica¬ tions, 5.9 per cent, compare favorably with those reported by others who used anticoagulants. The largest and only well controlled study of anticoagulant therapy in the treatment of coronary occlusion with infarction was that recently reported by the American Heart Association's committee, whose chair¬ man was Dr. Irving Wright. This comprised 432 patients who received anticoagulant therapy in addition to conventional therapy and 386 patients in the control group who received only conventional therapy. In the dicumarol®-treated series the mortality was 15 per cent and in the control group, 24 per cent. Thromboembolic complications occurred in 25 per cent of the controls and in 11 per cent of the treated patients. Evidently the mortality rate and the incidence of thromboembolic compli¬ cations were both lower in the authors' 108 uncontrolled cases than in the dicumarol®-treated patients mentioned. But .such data are not comparable and hence have no statistical signifi¬ cance.To use them as evidence that dicumarol® dilates the coronary bed in man seems to be an attempt to prove what one wants to believe. The hypothesis merits further study. Some evidence of the effectiveness of the drug as a coronary dilator in man might be obtained from its use in patients with coronary insufficiency and the anginal syndrome. I would emphasize, as the authors have, the danger of dicumarol® therapy. There probably have been many more fatalities from hemorrhage than have been reported in the literature. Valuable as the drug is in the treatment of coronary occlusion, it should never be given unless the facilities for adequate laboratory and clinical controls are available.Dr. W. M. Fowler, Iowa City : There is a tendency in the practice of medicine to overemphasize the newer methods of therapy and in the first wave of enthusiasm to allow the pendu¬ lum to swing too far. Dr. Wright and his committee for the American Heart Association have shown beyond doubt that the use of dicumarol® lowers the mortality rate and reduces throm¬ boembolic complications which follow myocardial infarct. The statistics which they have presented are impressive. Dr. Gilbert has suggested that the action of the drug may be more than that of an anticoagulant and that it may have some vasodilating action as well. This is an important observation. I do not believe that anticoagulant therapy should replace entirely the established methods of treatment for acute coronary occlusion.It has been shown experimentally in the dog that the size of the myocardial infarction following ligation of the coronary artery is definitely smaller in those animals treated with vaso¬ dilator drugs than in the untreated control animals. I believe that the use of such drugs in combination with oxygen therapy reduces the extent of myocardial injury in man following coro¬ nary occlusion and thereby reduces the mortality rate, the extent of the mural thrombus and the thromboembolic complications. I believe that these methods ...

Section of the prostate revealed nodules composed of typical glandular structures. Microscopic examination of the brain, thyroid, lung, heart, and adrenals revealed nothing of sig¬ nificance. COMMENT

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