IT, CHRONIC FIBROID YOC.1 The prognosis varies with the abruptness and the extent of thc degeneration.
AGA', ,Iim.untIon of the of a large toritti.ti ef tilt ,oronary artery. even down r.tetot.it 0,.t.itision. may sometimes be pm,111-0,1 liv the heart without very tadr11.01 t mbarras,inent. whereas the %wild...tic closure of the same vessel rittt% rts-ult in immediate death; but be tRt.. tht,e two extreme instances arc autiv de,yret_s of disturbance. Minute pAtchr, of fibroid deg,eneration hardly nen. z tlit heart's activity. More diffuse however, impair its functional senlitv. In particular. it proves unequal h., unit–tal demand upon it. Then, ticallv. even under ordinary conditions it e..r. no lonjer maintain the circulation, ••..1 the signs of cardiac failure gradu • dcvelop.
'Flit prognosis in an early stage of the rirlte,s may be said also to depend in omsiderable degree upon the intelligence of the patient. his self-control, and his • to fulfill the demands of treat ment. The hard-drinking longshoreman Leginning to break down under arterio sclerosis is sure to fail more rapidly than the fortunate individual who can with draw from business activity and enjoy years of easy travel in Europe.
Treatment. —We have no efficient trot mcnt for the acute suppurative form of n yocarditis. Prophylaxis is desirable far as it can be attained. For :trifle. the writer would advocate in ctfle unthritis the administration of salol F,rne other antiseptic which is ex ? with the urine. 'Whatever tends tr en: short the original disease will les an the chance of this secondary cardiac d'Fiturbance. It may possibly be that anti.treptoeoceie serum, if injected, m;ght aid in prophylaxis. Further than this the treatment can be merely sup 7,ortive and stimulating.. Where there is pra9cordial distress, hot applications may be made or a sinapism applied. Some aullior.s recommend ice-bags, but in view of the extreme -feebleness cf the patient it is a question whether cold might not prove depressing.
The acute parenchymatous form of inyocarditis, associated with the infective fevers, does not demand essentially differ ent treatment from that suitable for the original disease. What has already been
said about external applications will apply in these cases also, and, if signs of cardiac embarrassment develop, the diet must be restricted and simplified and stimulants and heart-tonics exhibited. The patient should not be allowed to make any unnecessary efforts so long as the pulse remains irregular and intermit tent. Death has more than once oc curred as the result of sitting up sud denly in bed after prolonged fever.
Chronic myocarditis should be treated in the first place by removing or miti gating its causes, so far as possible. The patient's activities, both physical and mental. should be carefully limited and directed. The diet is of much impor tance, overfeeding and indulgence in alcoholic beverages being harmful. An exclusive milk diet will sometimes prove of great benefit. In any case, the amount of food taken at any one time should be rather moderate and the varieties such as are of easy digestion. Iri incipient cases moderate and regular exercise is beneficial. Sudden and violent exertion is harmful and may be dangerous, but walking on level ground or playing golf, or even riding tbe bicycle, if hill climbing is avoided, are proper. In less vigorous persons massage is of great value. The .Nauheim system of medicated baths and resisted movements is excellent for prop erly-seleeted eases, and in some instances the results have been most fortunate.
With regard to drugs, iodide of potash i-n moderate doses, such as 10 grains three times a day, if long-continued, may pro mote the nourishment of the heart. Iron and arsenic are also suitable tonics. If cardiac failure begins to show itself we must have recourse to tincture of digi talis, tincture of strophanthus, and sul phate of sparteine. Strychnine long continued in moderate doses may be of marked value in strengthening and regu lating the heart. For cases where the amount of urine is very deficient diuretin sometimes works well. It may be given in divided doses to the amount of 60 to 90 grains in twenty-four hours.