If sudden cardiac failure develops, particularly in mitral eases, the abstrac tion of ten or twenty ounces of blood may save life. If the symptoms are less urgent, analogous relief may he obtained by a purge, in which ease calomel seems particularly efficacious.
When in mitral stenosis the symptoms are very urgent, veneseetion may be of striking service, and in certain cases there is no other treatment that will its place and avert a speedy, fatal ter mination. The contrast between the powerful right-ventricle impulse and the small, weal:, irreguhir pulse, is very striking, and is one of the most impor tant indications for venesection. section does not. however. dispense ith the necessity for relieving the portal cir eulation by purgation. Stimulants which without these measures afford no relief, and may. indeed, do harm, will then be of the greatest service, and digitalis. and like remedies, will find their opportunity. W. H. Broadbent ("Heart Ns.," HA)0; Phila. Med. Jour., July 7, 1900).
When the signs of failing compensa tion are more gradual, our best remedy is complete rest in lied. A fortnight or two thus spent may fully restore com pensation, independently of any drugs.
In cases which have advanced still farther downward, either in spite of or before our ministrations, the treatment becomes the same as that already de scribed at length in the article on DILA TATION OF THE HEART; but, for the sake of completeness, it may be said that our best cardiac stimulant is digitalis. This is indicated when the heart's action is feeble and ineffective, particularly if rapid and irregular.
If there is considerable dropsy, digi talis will work to much better advantage if preceded by free purgation with calo mel, blue mass, or a concentrated solu tion of sulphate of magnesia. The mer curials seem to possess a peculiar power of dilating the arterioles, which other purgatives do not have. Digitalis is much more effective if great bodily quiet is enforced during its administration. If given at all, its dose should be such as experience finds suitable in the par ticular case in hand. If an ordinary dose does not seem to be of much bene fit, gradually-increasing amounts should be given until either there is improve ment in the pulse or some toxic effect appears.
Nausea and diminution in the amount of urine are signs that the drug had bet ter be omitted. Some excellent observers believe that better results can be obtained from the use of the digitalis-leaves them selves, or an infusion made from them, than from the tincture. An easy way to obtain a fresh infusion for the patient is to order powders of digitalis, each one of sufficient size to make an infusion for twenty-four hours' use. No alkaloid of this drug appears to represent all its beneficent powers. In some instances, inhere there was obstinate vomiting, digi talis has been given with advantage by enema. When the heart appears to have come under its influence, we must be prepared to interrupt its administration as soon as there is any diminution in the secretion of urine or tendency to nausea or to a fresh irregularity of the pulse.
If digitalis, after a careful and per rsistent trial, proves unavailing, recourse may be had to tincture of strophanthus, caffeine, sparteine, adoniclin, or con vallaria majalis; but, unfortunately, these are seldom of great advantage. Strychnine is a valuable, general, and cardiac tonic. It may be used to sup plement other treatment, and also sub cutaneously in case of dangerous col lapse.
Nitroglycerin will often give great relief to cardiac distress and to dyspnwa, particularly where the pulse is hard or where there is cyanosis.
In case of marked dropsy diuretin sometimes prove very valuable. An other suitable remedy is a pill composed of 1 grain each of squill, digitalis, and blue mass, administered three times a day. If the kidneys are practically in tact, calomel may be administered as a diuretic in the dose of 3 grains every three hours until effect: either decided purging or marked diuresis. The like lihood of purging may be diminished by combining, with this dose of calomel, opium in the amount of to 1 grain. In case there is a considerable collection of fluid in one or more of the serous cavities of the body, aspiration may give great temporary relief and enable the heart to recover some of its lost power; and, when the legs are extremely oedema tous, the use of Southey's tubes or scari fications under strictly antiseptic precau tions may be of great advantage.