ARTERIOSCLEROSIS.
Of Allbutt's three types of this condition the toxic is regarded as the product of blood changes, probably acting through the increased viscosity of the circulating fluid, due to the influence of toxins manufactured mostly within the body, as in typhoid fever, diabetes, and syphilis, or poisons, like lead and alcohol, introduced from without.
The treatment of this type of the disease must lie in measures directed to the primary malady or infection, and to agents which promote elimina tion as purgatives, diuretics, baths, massage, &c. As there is no rise in pressure, vasodilators are not indicated. Huchard maintained that the first stage of arterio-sclerosis (presclerosis) is due to intoxication, the direct result of renal and hepatic insufficiency, and is curable by suitable milk and vegetable diet, which reduces arterial tension by producing more complete elimination of the toxic substances assisted by diuretics like Theobromine, and by regulation of the habits and daily exercises.
The hyperpietic type, the effect of persistently high blood-pressure, is caused by either increased viscosity or a narrowing of the small arteries, or a combination of both these causes. The common causal factor in these cases is over-eating, though the patient may be of spare habit, and it is usually aggravated by the too free indulgence in alcohol, tea, coffee, and tobacco. The clear indication for treatment is to reduce the volume of food and drink to the requirements of the body; highly nitrogen ised diet, especially that containing purin bodies and meat extractives, should be cut down to the lowest safe amount, as in the dietetic treat ment of chronic gouty patients. Milk, koumiss, or buttermilk, moderate amounts of farinaceous foods, fish, cheese, biscuits and white bread, fresh vegetables, fruits and eggs, should constitute the staple limited diet, tea, coffee and alcohol being prohibited. The habits of the patient as regards regularity of meals, moderate and cautiously regulated muscular exercises and the curtailment of all intellectual and business pressure or worry are no less important elements in the treatment. The general management of patients suffering from this type of arterio-sclerosis has been already defined in the article under the heading of Angina Pectoris, and by following the general principles there laid down life may be prolonged, and sometimes its span lengthened into the senile period of existence.
Diet is vastly more important than drugs, and though the Nitrites are often irrationally and mischievously employed, their administration is nevertheless at some stage necessary and highly beneficial, as in exacerba tions of high pressure, but with evidence of failing pumping power their use is fraught with danger. Of these as a rule only the most slowly and continuously acting are admissible, save in the presence of acute attacks, when Amyl may be called for. There is a consensus of opinion in favour of occasional short courses of mercurials, 4 grs. Blue Pill twice a week, or gr. Calomel daily for 5 or 7 days at considerable intervals. These drugs must, however, be given with great circumspection when there is much albumin in the urine, and their effects must be carefully scrutinised. Saline purgatives are also of value.
Iodides are undoubtedly of use; their beneficial action on the circulation has already been dwelt upon in the description of the treatment of angina pectoris and aneurism. The Iodide of Sodium may be given in prolonged courses of 5-15 grs. ter die alone or combined with a vasodilator like Trinitrin (see formula on p. 44). lodipin and the newer iodine com pounds are extolled, but there is no proof that they are more efficacious than the sodium salt, though undoubtedly they can in some cases be better tolerated, and Iothion may be administered by inunction, and is very valuable in syphilitic cases.
Vasodilators may be employed to ward off a threatening attack of cardiac distress or asphyxia, and the nitroglycerin tablets divided into fragments may be continuously administered for many hours as described under Angina. Urgent dyspncea may herald a fatal attack of oedema of the lung, and the writer satisfied himself that he has saved life by promptly opening a vein in the arm; and some authorities highly recom mend periodical bleedings in the plethoric type of patient, and moderate hypodermic injections of Morphia may be safely administered to relieve severe cardiac and respiratory distress when there is no suppression of urine.