Renon reports benefit from Fibrolysin injections, which sometimes reduce headache and diminish the blood-pressure. Cardiac tonics are only admissible when the heart muscle has already shown signs of failure, and even then their administration must be carried out with much cir cumspection. As a rule Digitalis should be avoided owing to its action on the peripheral vessels, and the practice of minimising this by combining Trinitrin or Nitrite of Sodium with it in a mixture is based upon ignorance of the pharmacology of these drugs, the nitrites expending themselves upon a vaso-dilating influence which passes off rapidly, leaving the digi talis to produce a prolonged and continuous action upon the high pressure which may seriously embarrass the already over-burdened ventricle. Moreover, as a general rule when digitalis is indicated the vasodilators are not required.
Diuretics are indicated when the urine is scanty and of high density, a condition usually met with when the arterial tension is not abnormally great; here, as in the stage of presclerosis, Theobromine (5 grs.) or Diuretm (io grs.) may be safely administered for considerable periods.
The practice of decalcifying the blood by the administration of Lactate of Soda and Lactic Acid, with the view of preventing atheromatous deposits in the vascular walls, is of doubtful utility, as is also the plan of prescribing Citrates or Lemon Juice.
As little can be said for Ilarr's plan of adding lime salts to the blood. Enough calcium is obviously supplied in the milk administered.
Though I I vdropathv and Baths of all kinds have been vaunted as curative, little benefit is to be expected from them, but unquestionably excellent results are often obtained by a sojourn at an alkaline spa, where a course of the mineral waters may be associated with bathing and the Aix douche. Brunton strongly recommended the diuretic waters at Evian, near to Geneva, and prescribed for home treatment the follow ing powder, to be taken every morning in a large tumblerful of water: Sudii Xifrills gr. ss.—gr. ij. Polassii .Aritralis gr. xx.
Pulassii Ric«rbonalis gr. xxx.
The High-frequency Current as a means of relieving the increased arterial tension has of late years found many supporters, and excellent reports are published. In one case under the writer's care marked tem porary benefit was obtained, hut unexpected failure of compensation set in soon afterwards which, however, may not have been due to the treat ment. The Electric Cabinet, Are Light and Nanheim baths have their strong supporters; when with these are judiciously employed massage and graduated relaxation exercises much benefit has been obtained.
The third type of arterio-sclerosis,as defined by Allbutt,is the decrescent or invairtionary. This degenerative type does not correspond with any of the clinical stages of the disease as described by I Inchard, but it may at any time become accentuated by the supervention of the toxic or of the hyperpietic. As its probably lies in far-off hereditary influence or congenital dystrophy, little can be expected from the administration of drugs, especially as in these cases the tension is but slightly if at all increased. That the condition is not incompatible with long life may be vividly realised by the interesting research made upon the arteries of some of the Pharaohs, including Afeneplitah and others, who had lived to very advanced ages, the bloodvessels in the mummies of these veterans being found by Prolessor Elliot Smith in the condition of rigid calcareous tubes.
When the condition is duly recognised from its family and individual history and from the absence of the causal factors usually found to be present in the ordinary high-pressure type of sclerosis, the only treatment to be adopted is the one of so regulating the life of the patient as to shield him from those influences which tend to increase arterial tension, as in the management, of angina pectoris. It is obviously irrational to depress the action of an already unsound heart by reducing the dietary below that which is necessary to sustain life, especially when the victim, as is often the case, has always been a spare eater or frugal liver. At times it may be necessary to strengthen the enfeebled ventricle by Strychnine, or in the presence of accidental high tension to administer cautiously a vasodilator or strong saline purgative.
The treatment of any underlying condition must not be lost sight of in the general management of all cases of arterio-sclerosis. Thus Bright's Disease will give indications for eliminatory measures, and obesity, dia betes, or glycosuria for dietetic correction.
In the arterio-sclerosis of syphilis much good may be expected if the case be met in the earlier stages by the vigorous use of Iodides in large and long-continued closes, and always when the renal organs are sound the treatment should be commenced with Mercurial inunctions, which may be cautiously repeated during the intervals when the iodides are necessarily suspended from time to time. Sal•arsan is an agent of doubtful utility.