STRAIN AND OVER-ACTION OP THE HEART. 27 



phj, consequent to the over-action and strain, not uncommon. 

 Yet this is, on the whole, not often followed by valvular im- 

 perfection. Probably the majority of instances of valve dis- 

 ease, resulting gradually from strain or over-work, have an 

 inflammatory or other tissue change in or near the valve, pre- 

 ceding the affection. 



You must allow me, in conclusion, a few words as to the 

 management of some of the disorders of the heart we have 

 been considering, produced by strain and over-excitement of 

 the organ. Of course, I can only do so in ver}'- general terms, 

 and not with the details of a clinical discourse. It is evident 

 that the cause of the trouble must be removed if we are to 

 hoi^e for permanent improvement ; whether that cause lie in 

 derangement of the liver, stomach, or nervous system, or in 

 the nature of the patient's vocation. But besides, when a 

 heart is over-worked, or over-excited, we find certain agents to 

 produce a most salutary effect. One of these is rest in the 

 recumbent position. You know that there is a natural differ- 

 ence between the movements of the heart in the standing and 

 lying posture. But, unless you have carefully noted the mat- 

 ter, you will scarcely believe how great the difference is in an 

 excited organ. Its action may become twenty, thirty, forty beats 

 in the minute slower. If, then, your patient rest on his back 

 two or three hours a da}', he will help himself materially ; and, 

 circumstances favoring, a day or two spent in bed, will not be 

 time thrown away. Ice, applied to the prsecordial region, is 

 another agent that benefits, and will prove of service in some 

 stubborn cases. Of medicines, I have found digitalis, bella- 

 donna, and the bromides, to be the most generally available ; 

 while in cases of beginning hypertrophy, no drug, in my expe- 

 rience, compares with aconite, steadily employed. But, I 

 repeat, to endeavor, in any form of the affection, to remove 

 the cause, is a prerequisite for success. 



Yet the greatest gain from the study of the subject, its most 

 37 



