THE PROBLEMS OF THERAPEUTICS 183 



nine, the action of which on the heart was practically unknown when 

 I was a student, and perhaps now it is hardly sufficiently recog- 

 nized. At the time of which I speak, digitalis was looked upon as 

 a cardiac depressant, and almost the only cardiac stimulant that 

 was known was alcohol. Now digitalis, strophanthus, and a num- 

 ber of others are regularly used as cardiac tonics, and their power 

 of contracting the vessels is also sometimes useful in removing 

 dropsy. When this action is likely to be harmful to a weak heart, 

 it may be lessened by the simultaneous administration of vascular 

 dilators. We still, however, want drugs which will act only on the 

 heart, or only on the vessels. We require medicines which will 

 diminish the cardiac action and dilate the vessels for use in high 

 tension, such as so often occurs in gout, and we need drugs which will 

 make the heart beat more forcibly while they cause the vessels to 

 contract and raise the tension in cases of debility. 



But prevention is better than cure, and if by modifying tissue- 

 change we can obviate the high tension and hypertrophy of the 

 heart which so frequently lead to apoplexy, or the atheromatous 

 condition of the vessels which leads to senile degeneration of the 

 brain or premature old age, we shall lessen the necessity for either 

 cardiac tonics or vascular dilators. Some authorities claim that 

 they can do this by vegetarian diet, limited in quantity as well as 

 in quality, while others would treat it by a diet almost entirely of 

 meat with liberal potations of hot water. The subject of diet is one 

 regarding which the most contradictory opinions prevail and there 

 is a sad want of precise knowledge upon which to base dietetic rules. 

 We may hope, however, that the investigation at present being con- 

 ducted by Professor At water under the United States Government, 

 combined with that which is being carried on under the auspices of 

 the Carnegie Trustees, will furnish the information we need. 



Time will not allow me to do more than mention aerotherapeu- 

 tics, balneotherapeutics, and hydrotherapeutics ; the rest-cure which 

 is associated with the name of one of America's most brilliant and 

 versatile sons, Weir Mitchell; massage and movements which Ling 

 and his pupils, both in Sweden and elsewhere, have done so much 

 to elaborate and which when rightly used may be so beneficial 

 and wrongly used so harmful. For all these branches of therapeu- 

 tics we require a more exact knowledge of their action and the 

 rules for employing them, so that even those who have made no 

 special study of them may employ them rightly in all diseases in 

 which they may be of service. 



Another method of cure consists in eliminating waste products from 

 the body by rendering them more soluble and while limiting the water 

 drunk would give lithia, piperazine, piperidine, and other substances 

 which increase the solubility of uric acid. Before therapeutics can 



