All excessive brain work must be abandoned, and violent muscular exertion of every kind interdicted. The pressure of life must be reduced to a minimum, as in arterio-sclerosis. Stock Exchange speculations, literary and professional ambitions, undertakings involving mental worry and prolonged anxiety or strain, must go by the board, and if life is to be prolonged, the arena of politics and controversy must be deserted, and every source of emotional excitement avoided. This should not mean the condemnation of the patient to an existence of listless inanity and s'othfulness; new channels of tranquil usefulness should he opened up and interests awakened in which the current of a well-regulated life may continue to flow as far as possible in placid domestic enjoyment and healthful, altruistic activity when his means permit of such partial retirement from the active battle of life. Regulation will probably he requisite of the hours of rest and exertion, which latter may be freely extended to liberal walking exercises on the ]eve].
The dietetic problem is sometimes a serious one; in many cases it is made a serious one by the inexperience of the physician. When the exciting cause of the attack can be traced to errors in eating improper or in assimilating unobjectionable food, prompt steps must be taken to place the dietary upon a correct basis or to aid the weakened digestion by medicinal agents.
Perhaps the most important point is to insist upon extreme regularity in the hours of eating, next is to arrange that the amount of food ingested should he as evenly spread over the day as possible. For this purpose three meals, with intervals of about 5 hours between each, is a good rule to follow. The practice of a late heavy dinner after a long fast is especially to he avoided.
As a rule farinaceous or carbohydrate food should he permitted only in small amounts, as these tend to the production of flatulent distension of the stomach and bowels, which is unquestionably an exciting cause of the seizures—a factor only second in importance to severe muscular exertion and emotional excitement. Animal food in such moderate quantities as will meet with the requirements of normal nutrition should form the staple basis of the dietary, and it will be advisable that the greater proportion or the whole of this should consist of light soups, white fish and poultry. The Karel! diet consists of r: pints of milk in the 24 hours whilst resting in bed 7 days.
Well-cooked vegetables and digestible fresh ripe fruits should have a prominent place in the dietary, especially as constipation must be care fully guarded against, the passage of difficult motions containing dry scvhala being especially liable to induce disturbances in the general blood pressure. Tea as an article of diet must he sparingly indulged in ; the
infusion should he weak and freshly prepared. Cocoa is, however, pre ferable. China leaf, prepared as Russian Tea, may be safely allowed between luncheon and dinner. Butter and fats are only to he permitted in small amount ; pastry, baked meats, stews, and recooked dishes must be strictly forbidden. Alcoholic liquors—beer and wines—are better to be avoided ; when the special requirements of the case demand alcohol, a little good whiskey in a small quantity of effervescing water may be permitted atdinner.
The patient should rest after each meal for a short time before under taking any mental or physical exercise. Tobacco should be .given up entirely, but when such a rule seriously interferes with the comfort of a patient he may be permitted under protest to indulge in an occasional cigarette.
Drug Treatment between the Attacks.—In accordance with his theory of causation, Allbutt's routine in order to protect the heart from inhibitive shock consists in the more or less continuous use of Atropine, a method of treatment difficult to carry out, especially in old patients. The best routine is Iodide of Sodium, and this is true regardless of any suspicion of syphilis being a causal factor. The drug should be administered in courses of at least a month's duration, with a break of S days at the end of each before restarting, and such treatment may be safely continued for many months, especially in those cases associated with aortic regur gitation or signs of general arterio-sclerosis.
The iodide treatment may he advantageously combined with the use of vaso-dilators, and the following is a good formula: R . Sodii lodidi gr. clxxx.
Spirit. Ammon. Aromat. Liquor. Nitroglyeerini min. xx.
Aqua' Chloroformi ad Sviij.
Capiat ;ss. ter in die post eibos ex ctua.
A half-dose of the above mixture taken at 3-hourly intervals will produce better results than a full dose every 6 hours.
Many authorities condemn dosing with nitrites unless during the attack, probably because they are ignorant of the harmlessness of nitrites. Trinitrin can be taken in enormous amounts and for long periods without injury.
Arsenic is of value in the type of case where there is evidence of a dis tinct neuralgic basis for the pain, and it may be safely combined with the other ingredients in the above mixture to the extent of 3 or 4 mins. Fowler's Solution in each dose, hut it should not be given for as long periods as the iodides.