While death often comes quickly, in the majority of instances the end is reached in a gradual manner, the signs and symptoms of advanced dilatation closing the scene. The frequent recur rence of syncopal, pseudo-apoplectic, epileptiform, and anginal attacks herald an early fatal termination. All known remedies are without avail in restoring the integrity of the degenerated muscle tissue.
cause in each indi vidual case should be determined with precision if possible, and, if detectable, a bold attempt should be made to remove or moderate it. This course embraces in different cases many hygienic and dietetic considerations that assist in im proving the nutrition of the cardiac tis sue: one of the cardinal aims of a proper system of treatment.
Anaemia in one form or other often plays an important etiological role, and the particular variety present in each case must decide the character of the special remedies to be employed. Thus, pernicious anmmia would call for the ex hibition of arsenic in gradually-ascend ing doses to the limit of gastric toler ance; chlorosis would demand, in addi tion to an appropriate hygienic regimen, the use of iron (e.g., Blaud's pills). In that large category of cases occurring in certain each exias (cancerous or tuber culous) the following formula has. in my hands, given gratifying results:— 11; Acidi arsenosi, 1 grain.
Ferri sulph., 30 grains.
Strychnine sulph., 1 grain. Quinine sulph., 1 drachm.
Papoid, 30 grains.
M. et ft. capsule No. xxx.
Sig.: One after meal-time.
When the signs of cardiac dilatation become well established, rest, in the re cumbent posture, should be strictly en joined, owing to the danger of a sudden fatal rupture of the heart, and cardiac stimulants should be administered. Digitalis and strophanthus may be se lected, but should be given with extreme caution, the commencing dose being small, and increased according to the effect in the individual case. In the form of a powder or an aqueous extract it may be conveniently combined with the prescription appended above.
For sudden heart-failure the diffusible stimulants (ether, ammonia, and alcohol) are to be resorted to. If marked arterio sclerosis be associated, then nitroglycerin and the nitrites are to be employed.
In cases of average severity I believe that gentle indulgence in physical exer cise and light gymnastics is beneficial, since it tends to invigorate the heart muscle; it is to be increased in propor tion to the improvement manifested in the patient's condition. Walking up as
cents, however slight, is not to be ad vised for some time after the other, gentler methodic exercise has been com menced. It sometimes happens, how ever, that even slight. exertion is badly borne, and it should then be promptly discontinued. In the latter class of cases I have been in the habit of advis ing daily inhalations of oxygen-gas, com bined with complete rest and recum bency, with excellent results. Recourse to massage is also in the line of sound practice, but the sitting should not ex ceed half an hour in duration to begin with.
The more prominent symptoms may require special medication. Attacks of syncope are most successfully controlled by the hypodermic use of the diffusible stimulants (ammonia or ether), at the same time enjoining absolute rest, with the head lowered. For the angina pec toris, the combined use, hypodermically,. of morphine (in small doses) and atro pine is to be preferred, except in cases in which the apoplectiform seizures, with a comatose tendency, are of frequent oc currence. Again, when the anginoid paroxysms are dependent upon coronary disease, recourse should be had to nitro glycerin and the nitrites. For the apo plectic attacks rest in the recumbent posture, with the head slightly elevated, is useful. Among therapeutic agents, digitalis, ammonia, and ether may be used hypodermically to stimulate the heart; it is also good practice to with draw from 12 to 24 ounces of blood di rectly from a vein.
The life of the sufferer may be pro longed by giving him an abundance of sunshine and fresh air in favorable. weather, but exposure to severe cold must be scrupulously avoided.
The diet should be simple, easily as similable, though highly nutritious. I believe it to be an excellent rule to allow small meals at strictly regular, brief in tervals. A light wine may be taken at dinner as an aid to digestion and nutri tion. The bowels should be made to move rather freely and easily by means of properly-selected articles of food, and,. these failing, mild laxatives.