General massage is clearly indicated in patients whose embarrassed breathing prevents muscular exercise, and though Nauhcim treatment may be valuable in the early stages, it is dangerous once the breathing becomes difficult. The excessive indulgence in douches, spongings, towelling and baths which the life of leisure tends to foster in invalids and which is often urged by the physician not infrequently does more harm than good. The hot and the Turkish bath should be forbidden, and the writer considers the cold plunge bath even more objection able.
As cardiac dilatation, anginal symptoms or palpitation are liable to at any time, the patient should have a few Trinitrin tablets or Amyl capsules in his pocket, and the following carminative may be left in his hands for use in emergencies, or the mixture on p• 393 can be employed: R. Tinct. Sirophaltthi 3j.
Tinct. Zingiber. Fort. 3v. Tinct. Belladonn re 5j.
St!. Ammon. Aromat. 3iij. spt. _Etheris Nitrosi ad Ft. mist. cpt. 5j. ex S-j. aqua dyspmva urgente.
Severe attacks of syncope or dvspncea will require more active treat ment; the patient should be immediately placed in the horizontal posi tion, Ammonia or Nitrite of Amyl applied to the nostrils, and if un consciousness has occurred a dash of water may be thrown upon the face.
Strychnine hypodermically is the only available cardiac stimulant in such cases, and it should be given in full doses to To gr.). Many physicians believe in ih gr. Atropine given in the same manner; both drugs may he given together. Where dyspncea and cyanosis are pro minent Oxygen inhalations may be employed.
Cardiac tonics have a very narrow range of usefulness in fatty degenera tion; they possess no influence on the degenerated fibres, and digitalis, owing to its powerful action on the walls of the small vessels, may so increase the peripheral resistance as to rupture the left ventricle or cause a fatal dilatation of the chambers of the heart. It should, therefore, never be given in this condition unless in cases where valvular disease is also present with dropsy and much previous hypertrophic changes, and then its use must be carefully watched and corrected by vaso dilators. Strophanthus is less objectionable.
Strychnine, however, may always safely be given as a routine to assist the tone in the unaffected muscular fibres, and one of the best possible combinations is to give the drug with Iron and Quinine as in drachm doses of Easton's Syrup. Short courses of Sodium Iodide appear to be
the only method by which the degenerative process itself can he in any way checked or modified by drugs; its action is inscrutable, but its beneficial effects are unmistakable, especially in those cases of mixed fibroid and fatty degeneration which are associated with general arterial sclerosis and cardiac pain. Phosphorus and Arsenic are recommended, but since both these drugs will undoubtedly produce fatty degeneration of the cardiac muscular fibre when given for long periods or in full doses, it is therefore wiser to regard them as agents which may be productive of evil. Organic phosphorus and Glycerophosphates are less objection able.
The treatment of the attacks of paroxysmal bradycardia (Stokes Adams Syndrome) which are liable to occur in cardio-sclerosis owing to involvement of the a-v bundle causing Twirl block can only he carried out as for syncope. Digitalis is especially dangerous in this condition; Mackenzie has shown that it may bring about an attack of heart block.
Cheyne-Stokes respiration is not a rare phenomenon, and it may be associated with heart block; it is believed to be due to exhaustion of the respiratory centre. Though many agents have been suggested and tried for the removal of this symptom, none have any specific action. Morphia should be given when the apnceic stage is causing great rest lessness and air hunger; the combination of a small dose of Strychnine with the hypodermic dose of Morphia is advantageous from several points of view; a little relief may he obtained from Oxygen inhalation.
Fatty infiltration must be differentiated from fatty degeneration; its early recognition and treatment will prevent the accumulation of adipose tissue in such quantities as will cause pressure and subsequent degenera tion of the muscular fibres. The treatment is that of the obesity of which it is but a local manifestation. A carefully regulated dietary, with Oertcl's methods, open-air life, &c., and in some cases Thyroid feeding, should be prescribed (see under Obesity). At a later stage the general lines of treatment should follow those of fatty degeneration, care being always maintained that exercises should never be pushed to the extent of possibly causing acute dilatation of the heart.