agus and the vasodilators being
medullated, while the accelerators of the heart and the
vasoconstrictors of the arteries are non-medullated and pass
through the sympathetic ganglia on the way to their
distribution.

"Winternitz and other therapeutists have frequently called
attention to the value of cold as a cardiac stimulant or tonic.
The tonic effect of this agent is greater than that of any
medicinal agent which can be administered. The cold compress
applied over the cardiac area of the chest may well replace
alcohol as a heart tonic. The thing necessary to encourage the
heart's action is not merely relaxation of the peripheral
vessels, but, as Winternitz has shown, increased activity of the
peripheral circulation in the skin, muscles and elsewhere.
Alcohol paralyzes the vasoconstrictors, and so dilates the small
vessels and lessens the resistance of the heart action; but at
the same time it lessens the activity of the nerve centres which
control the heart, diminishes the power of the heart muscle, and
lessens that rhythmical activity of the small vessels whereby
the circulation is so efficiently aided at that portion of the
blood circuit most remote from the heart. A continuous cold
application applied to that portion of the chest overlying the
heart stimulates the nerves controlling the walls of the
vessels, and at the same time energizes the corresponding
cardiac nerves. It is wise to remember that the vasoconstrictor
nerves are one in kind with the excitor nerves of the heart,
while the vasodilators are in like manner associated with the
vagus. With this in mind, it is clear that while alcohol
paralyzes the vasoconstrictors, it at the same time weakens the
nerves which initiate and maintain the activity of the heart;
while, on the other hand, cold excites to activity those nerves
which produce the opposite effect.

"The apparent increase of strength which follows the
administration of alcohol in cases of cardiac weakness is
delusive. There is increased volume of the pulse for the reason
that the small arteries and capillaries are dilated, but this
apparent improvement in cardiac action is very evanescent. This
is a natural result of the fact that while the heart is relieved
momentarily by sudden dilation of the peripheral vessels, the
accumulation of the