The persistent use of potassic iodide is very effective. Ten or 15 grains may be given thrice daily before meals in half a glass of water; or 20 grains three times a day for twenty days, followed by nitro glycerin for ten days. The iodide is be lieved to dilate the arterioles and to pro mote arterial nutrition. See supposed that also by enlarging the calibre of the coronary arteries it invigorated the myo cardium.
Arsenic in small doses also tends to avert the paroxysms. In case of fatty degeneration of the heart it would be contra-indicated.
Quinine and methylene-blue have also been recommended.
The treatment by saline baths and by the Schott method of exercises has a most potent effect in improving the con dition of the cardiac muscle and vessels, and appears to have a direct effect in making the attacks less numerous and severe, and even in causing them to cease during a period of months or years. The movements must be made with es pecial care and caution in these cases, and the resistance at the onset must be at a minimum. The artificial saline baths should contain from 1 to 3 per cent. of salt, and from V, to 1 per cent. of chloride of calcium, and should grad ually be strengthened by the addition of carbonic acid. (H. N. Heineman.) Angina pectoris with pseudosteno eardia. The angina is due to probable endo-aortitis, and is relieved by an ex clusive milk diet and theobromine for two weeks. Then, one week every month, milk diet and sodium iodide. During the balance of the month, spe cial diet, with the theobromine con tinued. H. Hucbard (Jour. des Prati ciens, Feb. 23, 1901).
The writer confirms the remarkable benefit to be derived from theobromine in these conditions as announced by Askanazy in 1S95. The diuretic influ ence of this drug is familiar, but its property of promptly arresting the pains of angina pectoris, cardial asthma. and allied conditions is less generally known. and yet the writer considers it one of the most blessed facts in modern therapeutics. He describes over a dozen cases in detail, showing its rapidly beneficial influence in all pains of arte rial origin. They form a series rang ing from pure angina pectoris to attacks of pain attributed by the patients to the head, stomach, shoulder, kidney, or intestines, and apparently with no feat ures in common with angina pectoris: yet all show by the prompt response to theobromine that they have a com mon origin in the arteries and that theobromine has a specific action on the latter. Arteriosclerosis and certain other affections of the arteries are li able to cause constant pains in the ves sels which may radiate to remote re gions. The pains may be due to in creased blood-pressure and distension, hut they are also liable to be caused by spasmodic contraction of the ar teries. These contractions occur by preference in the smaller arteries and are the result of pathological or path ologically exaggerated reflexes originat ing in the diseased vascular wall. They are set in motion by various causes which raise the blood-pressure, emotions. muscular exertion, the horizontal posi tion in sleeping, etc. They are especially liable to occur in the organs which re quire the largest supply of arterial blood, such as the digestive tract, heart, and muscles. The arterial fluxion in duced by increased function starts the attack of pain. The spasmodic eontrae lion of the arteries causes symptoms of iseluemia as the arterial supply is cut off from muscular organs. In the ex tremities it becomes evident as inter mittent claudication; in the digestive tract as paresis and meteorism; in the heart_ as sudden inadequacy and paral ysis. Sensory phenomena may be super
added to these and it becomes difficult to decide whether the pains are due to the vascular spasm or to the ischa mic parenchyma. When the vessels of the heart are directly or indirectly in volved the specific angor cordis devel ops. The lesions of the heart may radiate the pain to remote region-. The spasm of the heart arteries is peculiarly intense when it is not the result of the usual causes, but is due to direct irritation of the intima by a thrombus or embolus. This explains the sudden death that may occur from a small embolus in one of the terminal ramifications of a coronary, as well a in case of obstruction of a large artery from this cause. Theobromine has evi dently some action on the spasmodic contraction of the arteries. and when this is controlled the pain ceases. It may also act by diminishing, the reflex excitability or by reducing the arterial pressure. Be this as it may. the fact is established that theobromine is a powerful and harmless remedy for pains on an arterial basis. The writer alwa‘ :rave it in the form of diuretin in doses of 0.5 gramme four or five times a day, and in the severest cases 3 to 4 grammes a day. The only ob jection to its use is the high price charged for the preparations of theo bromine. R. Breuer (Mtinchener med. Woch., Oct. 14. 1902: Jour. Amer. Med. Assoc.. Nov. 15. 1902).
The cardiac tonics—sparteine, stro phanthus, strychnine, valerian. and in suitable cases digitalis—are of the great est utility.
Digitalis is of doubt ful utility. It should not be given there is an excess of dilatation. J. If. Mussel (Amer. Jour. Med. Sciences. Sept.. '971.
The general tendency to anemia and defective oxygenation must never be lost sight of, and general tonics, including the use of oxygen-gas, will be of excellent service.
Angina pectoris is due to a simple hyperfemia of the spinal sensory centres. A spinal ice-bag from the fourth dorsal to the third lumbar vertebra, applied once or twice a day for from forty min utes to an hour. will not only relieve the attacks, but will completely eradicate t he trouble. Amyl-nitrite is useful. An other remedy recommended very highly is oxygen by inhalation. Oxygen alone will relieve an attack of angina, but in combination with cold over the spine and heat to the extremities it is the speediest method of relief at our command. Most efficient formula of oxygen for adminis tration consists of 2 parts of pure oxygen, 1 part nitrous monoxide, and 1 per cent. of ozone. B. Kinnear (Med. Record, July 16, '98).
Attacks of pseudo-angina may be treated with asafoetida, ammoniated tincture of valerian, or compound spirit of ether, and the outward employment of heat-friction and rubcfacients. Some times recourse must be had, however reluctantly, to morphine. The statement in clear and decided language of a favor able prognostic prospect is of great bene fit. Between attacks the underlying con -dition should be cared for. (Heineman.) The fact of the pain itself being capa ble of acting as a vasoconstrictor has been too much overlooked. Certainly morphine is the great remedy that we have usually to fall back upon when vasodilators have spent their powers of affording relief. Graham Steell ("The Sphygmograph in Clinical Medicine," '99; Phila. Med. Jour., Feb. 24, 1900).