328 DISEASES OF THE HEART. 



the heart. With the transition from genuine to spurious hypertrophy, 

 the picture changes, and many dangers arise. 



TREATMENT. It is certainly out of our power to cure a hypertro- 

 phied heart by any mode of treatment, although we do not deny that 

 such a heart may undergo atrophy quite as well as a normal one. 

 Much, however, may be accomplished in the way of checking the ad- 

 vance of the disease, and in moderating the dangers to which it gives 

 rise. We are not now referring, of course, to the cases in which hyper- 

 trophy is a complication of another malady of the heart or lungs, but 

 to that form of the disease which exists in a certain degree indepen- 

 dently, such as we see in drunkards, gluttons, etc. Here the disease 

 generally remains unrecognized, until the enlargement of the heart 

 begins to encroach upon the lungs, or until dizzinessj muscae volitantes. 

 or other symptoms of fluxion to the brain, arise, or, what is still more 

 common, until an apoplectic attack calls attention to the state of the 

 organ. If we now give our orders with decision, we may reckon upon 

 punctual obedience upon the part of the patient, who previously would 

 scarcely have paid them any attention, but to whom the inconven- 

 iences just alluded to become a source of the greatest solicitude. Patho- 

 geny makes the treatment clear. Such patients must beware of im- 

 moderate eating and drinking, in order to avoid the plethora which, 

 although but transient, always follows upon a free use of food or drink. 

 How often does the long-threatening apoplexy set in hi the midst of 

 the plethora which has developed after a long and hearty meal ! Here 

 too, we must insist upon the rule of issuing the most precise orders, 

 and of exactly regulating the quantity and quality of the meals of 

 which the patient is to partake in future. In this connection I may 

 mention an act of folly which I have often seen practised by tavern- 

 keepers and itinerant wine-dealers. The latter often suppose that, by 

 a free use of water, they can counteract the pernicious influences to 

 which they expose themselves, although it is evident that the pleth- 

 ora arising after a full meal would only be increased by an immod- 

 erate addition of liquid. Besides this, however, the patient must 

 avoid all the causes which, independently of plethora, stimulate the 

 action of the heart, and further distend the already overcharged 

 arteries. Under this head come the use of stimulating drinks, mental 

 excitement, and immoderate bodily exertion. Hot water must be in- 

 cluded in this class, and there is no wonder that the use of the Karls- 

 bad Sprudel should make victims every year who die of apoplexy. 



Besides these dietetic measures, we should see that there be no ob- 

 stacle to the current of blood in thg abdominal aorta, and thus remove 

 pressure from the endangered vessels of the brain and bronchi. Be- 

 sides forbidding all food that can cause flatulence, take care that the 



