Relief by these means is often im mediate; but, if not, ether should be inhaled. Chloroform is also advised by excellent authorities. Flint thinks it not without danger, if the heart is weak; ether, on the other hand, is a stimulant.
Morphine, subcutaneously, is a valuable and sometimes an indispensable remedy. Whittaker suggests that it be given with caution in a condition which may any way terminate in sudden death. The morphine grain) may be guarded by atropine grain), and in case of alarm also by strychnine ('A, to grain). Electricity has also been recom mended.
Electricity is generally unreliable or dangerous, and faradization should be used only in threatening syncope. lluchard (Univ. Med. Mag., May, '92).
The application of the continuous electric current along the course of the vagus in the neck and clown the arm, in cases where a distinctly painful aura is experienced in the hand, has been found useful in warding off attacks. Burney Yeo (Practitioner, May, '93).
Electricity certainly seems to exercise its best effects in those cases in which the pain is of a very positive neuralgic character, with no co-existing organic disease, although the presence of struct ural changes in the heart and blood vessels does not contra-indicate the judi cious use of either form of current. Rockwell (Hare's "System of Practical Thcrap.," vol. i, p. 394).
Hot and stimulating applications over the prwcordia, such as a strong mustard poultice, are appropriate, as are also heat and friction for the extremities. Some times an ice-bag is put over the heart. Alcohol and aromatic spirit of ammonia are of benefit in case the cardiac action is feeble. Syncope demands such drugs as digitalis, digitalinc, caffeine, strych nine, and camphor, employed hypoder mically. I have known oxygen to con tribute to a favorable result in collapse due to chronic myocarditis with dilata tion of the left ventricle. and cannot see why it might not be well for a subject of angina pectoris to keep some ready in his house.
Between attacks it is of vital impor tance to avoid the predisposing and ex citing causes. Rest and moderation are demanded. As for drugs, nitroglycerin, taken after meals in doses just short of causing headache, has a distinct inhibi tory effect upon the paroxysms. In some
instances it might be better to order it every hours, as its influence is not long continued. Nitrite of sodium (2 to 5 grains) may replace nitroglycerin.
A new remedy is erythrol-tetranitrate in grain doses four times in the twenty four hours. If this drug is given in spirit and water (1 grain in 1 drachm of alcohol and 7 drachms of water) the tension begins to fall in two or three minutes; if given in a pill, the time is twenty to forty minutes; if given in tabloid form and chewed, the time lies somewhere between the two. The drug was not introduced to replace amyl nitrite and nitroglycerin in cutting short attacks, but only to replace them in pre venting the onset of the attacks. J. B. Bradbury thinks the tablet undoubtedly the best form of administration.
Severe case in a physician, in which erythrol-tetranitrate (1-grain doses) was taken steadily, at eight hours' interval, as a prophylactic. For three weeks there was immunity from attacks, al though some weariness and oppression came on after six or seven hours from taking the tablets. Now taken four times in the twenty-four hours with marked relief.
The initial fall of the pulse-tension de pends on the mode of administration. If the drug is given in spirit and water (1 grain in 1 drachm of alcohol and 7 drachms of water) the tension begins to fall in from two to three minutes; if given in a pill and swallowed, the time is from twenty to forty minutes; if taken in tablet form and masticated the time lies somewhere between the two. The best form of administration is un doubtedly the tablet. The alcoholic solu tion sometimes irritates the stomach. Bradbury (Brit. Med. Jour., Apr. 10,'97).
Erythrol-tetranitrate in angina pec toris. Case in which glycerin soon lost its effect, and its administration was attended by severe headaches. Erythrol tetranitrate was substituted in tablets of grain, each, two to three times a day. This produced a cessation of the attacks, the administration of the remedy being attended by the same vasodilator effect noted in the use of the nitrites and glonoin, but the action was much more sustained. Boughton Addy (Brit. Med. Jour., May 6, '99).