Prognosis.—As just stated, the condi tion must terminate unfavorably. So long, however, as the hypertrophy com pensates for the obstacle which rises to it, or grows proportionally with any aug mentation of that obstacle, the patient may feel perfectly well. Even during this time of perfect compensation he may, however, suffer from cerebral hmmor rhage or (if the hypertrophy affects the right ventricle) pulmonary haamorrhage. Escaping these dangers, he may do well for years, but finally dies, either from dilatation or fatty degeneration or the failure of innervation already mentioned.
Treatment.—The care of a patient with hypertrophy demands that we should allow nothing to aggravate the condition, and should in every way pos sible promote the nutrition of the myo cardium. The etiology must be con sidered. Tobacco and alcohol must be forbidden and excitement and worry averted. Simple, nutritious food should be taken regularly in moderate quantity. It would be better to permit lunches than the ingestion of a large amount at one time. Moderate and habitual exer cise is beneficial. The exact amount and character may be determined partly by the experience of the patient: dyspncea and palpitation are not to be caused by it. If there is discomfort and throbbing in the left chest, bromides may he useful, or a drop or two of tincture of aconite, or veratrum viride, thrice daily. In a stout patient an occasional saline purge may be useful.
Treatment for hypertrophy itself is out of place, and the restriction to low diet or the use of aconite is sometimes danger ous. We have really to consider not the treatment of hypertrophy, but the treat ment suggested by the hypertrophy. It may be necessary to diminish the volume and improve the quality of the blood by appropriate diet, hygiene, and tonics. it may be desirable, also, to diminish the resistance of the arterio-capillary net work by aperients, eliminants of various kinds, and by relaxants of the arterioles and capillaries, such as nitroglycerin and the nitrites. By these means the work thrown upon the heart is reduced, and, if necessary, the heart may also be strengthened by strychnine and digitalis. Broadbent (Lancet, Mar. 21, '91).
Blood-letting at times, of life-saving usefulness, when the right side of the heart becomes engorged and overdis tended by increased obstruction to the flow of blood through the lungs or left side of the heart,—a condition not rarely observed' in intense bronchitis, especially when complicating emphysema, pulmo nary cedema, and incompetence or steno sis of the mitral orifice are present. J. E. Atkinson (Maryland Med. Jour., Dec. 29, .94).
The treatment of cardiac hypertrophy is much the same in all cases, regardless of cause. Walsh and Page are in accord as to the great value of aconite-1 drop every two hours until its effects are manifest. Page deprecates digitalis,
recommended by Walsh and Osier as a cardiac stimulant, when valvular trouble is present, broken compensation being the signal for its use. The latter authors are also in accord regarding the value of blood-letting, Osier emphasizing the fact that with signs of dilatation—as indi cated by gallop-rhythm, urgent dyspncea, and slight lividity—venesection is, in many cases, the only means by which the life of the patient may be saved; 20 to 30 ounces of blood should be ab stracted without delay. Striimpell prac tically advises the same remedies as Osier. When compensation has been es tablished, Striimpell recommends baths ranging from 90° to 93° F., which are well borne by the patients and exercise a peculiarly beneficial and invigorating influence upon the heart. F. AV. Camp bell (Montreal Med. Jour., June, '95).
Engorgement of the portal system is almost always present in heart disease. Mercurial purges given in long-continued small doses are of the greatest impor tance in these cases: grain or even V,,,„ grain of corrosive sublimate with tincture of the chloride of iron will effect revolution by aiding true heart-tonics. Adonidin, cactus, convallaria, or others of newer remedies are of no real value. Satisfaction in real heart trouble is only obtained with nitroglycerin, strophan thus, and digitalis. Horatio C. Wood (Cleveland Med. Gaz., Aug., '95).
In arterial tension, opium and iodides are followed by a rebound when taken for weeks or months. This can be pre vented by giving short courses of sodium salieylate to carry off accumulated uric acid, the cause of increased arterial ten sion. A. Haig (Therap. (Jaz., Sept. Id, '95).
Mercury is valuable far beyond its sup- I posed alterative action. Its special bene fit is exercised in dilated and hyper trophied heart. To give digitalis a fair chance, preliminary doses of mercury are I absolutely necessary. William Murray (Lancet, Sept. 25, '95).
The following method of treating cases of dilatation and hypertrophy resulting from overexertion advised: In marked cases rest in bed. Stimulants, such as brandy, wine, ether, etc., tend to irritate the organ. Digitalis is very useful in many cases. The use of strophanthus preparations and the ordinary medical cardiac stimulants in addition to digi talis may he employed. Calomel affords great service after the other cardiac remedies fail. Narcotics and hypnotics are to be used with great care. Ice-bags are of doubtful value. Blood-letting is to be recommended. The use of aerated beverages is to be avoided. Hermann Rieder (Deutsche Arehiv f. klin. Med., B. 55, p. 8, '05).
A daily cool bath, with rubbing, is a good tonic. Hot baths and Turkish baths are unfavorable or dangerous.