ANGINA PECTORIS. 97 



sequence of the obstruction the blood meets with from pulmonary- 

 disease. 



Consequences of diseased heart. — From the obstruction the circu- 

 lation meets with, various organs become congested, and uhimately 

 diseased, whilst the serum is apt to be effused, constituting various 

 forms of dropsy. Great dyspnoea, with more or less bronchitis, and 

 finally hydrothorax ; congestion of the liver, and abdominal viscera, 

 or of the kidneys ; blueness of the lips, and ascites and anasarca are 

 the general precursors of death. Sometimes the heart becomes so 

 thin and soft that it bursts or ulcerates at one point, causing sudden 

 death from hemorrhage into the pericardium. 



Treatment. — The treatment of permanently diseased heart, must 

 be palliative; whatever symptoms happen to be urgent must be 

 relieved. The general rule is, that all violent exertion and mental 

 anxiety, especially running up stairs, and fits of anger ; all intempe- 

 rance and unwholesome food must be shunned. Unwholesome food 

 is very liable to cause distress, by distending the greater end of the 

 stomach, and pressing it up against the heart. 



U there is much palpitation, pain, and dyspnoea, with blood to 

 spare, leeches or a small cupping will relieve; a belladonna or opiate 

 plaster over the heart, and small doses of hydrocyanic acid, if the 

 stomach is irritable, are the remedies. But it must be borne in 

 mind, that if the aortic orifice is contracted, increased action of the 

 ventricle is beneficial, and must only be kept within reasonable 

 limits. 



If the patient's condition is feeble and bloodless, and there seems 

 evidence of dilatation, tonics, especially iron, given in very small 

 doses for a long time, and a nutritious diet, are of service. The 

 ferriirn tartar izatiini is a good form from its diuretic qualities. 



Diuretics are always of immense service in heart disease, by 

 relieving vessels loaded with the blood which cannot pass rapidly 

 enough through the heart. Digitalis in small doses, with squill 

 and mercury, may be tried, especially if there is any dropsical ten- 

 dency. 



Purgatives and tnercurials for relieving abdominal and hepatic 

 congestion are often also necessary. 



Blisters and setons to the chest may be used if there is a suspi- 

 cion of any inflammatory process about the heart, or pericard'um. 



Stimulants and antispasmodics, such as ammonia, ffither, hen- 

 bane, &c., in small doses, often give great relief where there is 

 palpitation, combined with nervous debility and a languid circulation. 



ANGINA PECTORIS. 



This dreadful complaint attacks persons who have some organic 

 alteration of the heart, and generally of an atrophic character. In 

 some cases the heart has been found excessively loaded with fat ; in 



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