TREATMENT - CHRONIC CONGESTION OF THE KIDNEYS.
Although we are unable to remove the mechanical interference with the circulation, yet the condition of the patients can often be very much improved. The main indications are to improve the character of the circulation and to remove the dropsy. In order to improve the circulation it is absolutely necessary to study the char acter of the heart's action, to appreciate the organic changes in the heart, and to determine whether the walls of the arteries are thickened and whether there is an increase or diminution of the arterial tension. It is unfortunate that there is no instrument to tell us certainly what the arterial tension is; we have to depend upon the sense of touch. This, however, can be educated, and a phy sician is not competent to manage cardiac cases if he cannot appre ciate changes in arterial tension.
In many patients with an irregular heart, dyspncea, and dropsy, simple rest is of the greatest service. This is especially marked in hospital patients who have tried to work up to the time of their ad mission. It is often a good rule to give no medicine to such patients until we see how much they improve with rest alone.
The regulation of the food is of importance. It is to be remem bered that, while gastric indigestion and flatulence make the heart's action worse, on the other hand meat is one of the best cardiac stim ulants. Most patients are better for meat in some form at least once a day.
Tumultuous and exaggerated heart action may be due to contrac tion of the arteries and require such drugs as nitroglycerin or chloral hydrate. It may be the expression of a heart which is really feeble and requires digitalis. It may mean a real exaggeration of the
muscular action of the heart and be benefited by aconite, belladonna, and the local action of cold. A feeble heart without contraction of the arteries calls for cardiac stimulants ; digitalis, strophanthus, and caffeine are the best. But it is to be remembered that with aortic and mitral stenosis, myocarditis, and diseased coronary arteries, there comes a time when cardiac stimulants make the heart's action worse instead of better. This is the time for the use of opium. Small doses of codeine or of morphine give the patient more relief than can be ob tained in any other way.
In many patients the condition of the heart and arteries varies from day to day so that there have to be many corresponding changes and combinations of the drugs—the cardiac stimulants, the arterial dilators, and the opium.
The dropsy is more or less favorably affected by the rest in bed and the regulation of the circulation. It can also be reduced by the hot pack and the hot-air bath.
For very extensive cardiac dropsies, with only chronic congestion of the kidney or but little nephritis, calomel is the most efficient diu retic. Three grains of calomel with of a grain of morphine, four times a clay for four days, is the dose. The mouth and gums are to be kept very clean. If the drug acts properly there is but little effect on the bowels and no salivation, but on the third day the quantity of urine increases and remains large for several clays. The dropsy diminishes and may disappear altogether.