Sparteine sulphate successfully used in cases of passive dilatation of the heart, especially without marked valvular le sion. It is often necessary to perma nently continue the drug, but no increase of dose is necessary. The dose i-s '/, to 1 grain every four hours. P.M. Chap man (Birmingham Med. Rev., May, '99).
ln subacute dilatation of neurotic or amemic young people, where baths and exercises are not available, nutrients like malt, iron, quinine, and the alka loids of nux vomica may check the dila tation and restore the heart's tone. In general, strychnine or brucine, in 1/,„- to 7,0-grain doses are good nerve-tonics, but, as they contract both heart and arterioles, are undesirable for contin uous use. T. E. Satterthwaite (Aledical News, Dec. 2S. 1901).
Strychnine is often of great value and may be combined with any of these or given independently. Iron is useful for its beneficial effect upon the nutrition of the heart-wall. Quinine and arsenic are advised in certain cases. It is hardly safe to give the latter to subjects in whom fatty degeneration is suspected. On the other hand, arsenic sometimes ap pears particularly efficient in cases where there is cardiac pain.
Minor forms of cardiac dilatation found in amemic girls just past the age of puberty. They suffer from menor rhagia, constipation, and flatulence. In these cases the action is, as a rule, rapid, and the first sound is exaggerated and seemingly irritable. Best results come from strychnine and digitalis in moder ate doses for a week or two, to be fol lowed by a prolonged course of iron. Beverly Robinson (Amer. Jour. Med. Sci., Aug., 1900).
'Massage may do good in two ways, both by promoting general nutrition and by assisting in the propulsion of the blood. The Schott method of treat ment may be of advantage in less-alarm ing cases where there y-et remains some muscular integrity in the heart. Oertel's method of treatment is suitable in so far as the amount of liquid ingested may often be limited to advantage, but un suitable with regard to the forced mus cular effort he advised. Climbing is more useful for obesity with fatty over growth of the heart than for conditions of cardiac dilatation. Accumulations of fluid in the abdominal or thoracic cavi ties should be withdrawn. It is some times surprising how much benefit will follow the removal of twelve or sixteen ounces of water from the chest or a few quarts from the abdomen.
In well-marked cyanosis with consid erable enlargement of the liver half a dozen leeches may give relief. They may be applied directly over the liver and the subsequent bleeding should be encouraged by warm, wet compresses.
Blood-letting is a very important remedy when the heart is dilated and there are passive eongestions and dropsy. It is espeeially valuable ill dilatation of the right heart when there is still considerable tension. Venesee Don is not to be performed in the very young or old. Leeches to the epigas trium may be employed when venesec tion would be too great a shock. The amount of blood to be withdrawn de pends upon the plethora of the patient and the effect noticed. Allyn (Univer sity ii\Tedical 'Magazine, Dee., '99).
In many bad eases of dilatation of the right heart, with cyanosis and orthop no=a, when nothing but a. large vene seetion appears to hold out ft promise, one, two, or three doses each of 10 or 12 grains of digitalis, given at intervals of three or five hours, will eontraet the heart and restore pulmonary and gen eral circulation; on the other hand, in chronic. conditions of weak heart, of either muscular or nervous origin, or of insufficient action caused by pulmonary obstruction.— as in ehronie broncho pneumonia or in tiffierculous infiltra tion,—small doses of digitalis, that is, from 4 to 6 grains daily, or its equiv alent, may be given for weeks and months and even years without any hesitation. Snell doses may be ordered while the patient is not expected to be seen for weeks or months. In most per sonal cases prescribed either from four to six doses daily of Squibb's or any other good fluid extract or the solid extract of the "Pharmacopoeia" in the shape of pills, 17, grains (0.1 gramme) daily, usually 1-/2 grain (0.03 gramme) three times a day, almost always in pills, rarely by itself, often in combina tion with sparteine, or stryehnine, or arsenic or other drugs, as the ease may require. Patients who take digitalis in this way do not show a cumulative ef fect, nor are they getting accustomed to it to such an extent as to lose the benefit of its action.