ATROPHY OF THE HEART. 339 



or in relaxation of the cardiac muscles, such as occurs in anaemia, com- 

 bined with general loss of tone of the muscular system. 



TREATMENT. In cases of dilatation, we have to see that the 

 nutrition of the body goes on normally, this being the best preventive 

 of flaccidity of the cardiac walls, and the patient is to be protected 

 from all causes which render the action of the heart more laborious. 

 Thus, a nutritious diet is very proper ; but the meals should be light 

 though frequent. Eggs, meat, and, above all, milk, are particu- 

 larly commendable. Sometimes milk may be used exclusively for a 

 while. 



Iron should always be prescribed when any signs of anaemia or of 

 hydrsemia are shown. On the other hand, all violent muscular effort 

 should be forbidden, and the use of spirituous liquors ought to be 

 restricted, without entirely forbidding them, to patients habituated 

 to their use. When the liver swells, if the feet become cedematous, 

 or the patient become cyanotic, digitalis should be given. I formerly 

 looked upon the use of this remedy in dilatation of the heart as idle 

 and even dangerous. Of late years I am satisfied that digitalis is a 

 very efficient means of temporarily strengthening the heart's contrac- 

 tile power, and of thus allaying cyanosis and dropsy. In dilatation, 

 digitalis, combined with an exclusively milk diet, is invaluable. By 

 it I have often removed huge dropsical effusions and given great tem- 

 porary relief. I usually employ the infusion of digitalis. The effi- 

 cacy of this drug varies greatly according to the region where it has 

 grown. In Wlirtemberg, although giving smaller doses than I for- 

 merly gave elsewhere, I have seen grave signs of poisoning arise. I 

 generally prescribe ten grains of it to five ounces of water, giving 

 a tablespoonful for a dose, and do not repeat the medicine more than 

 twice. 



In desperate cases only I substitute the ethereal tincture for the 

 infusion, giving twelve or fifteen drops four times daily. Accord- 

 ing to Papittaud, arsenic and antimony have effects similar to that of 

 digitalis, and are valuable remedies for diseases which depress the 

 power of the heart. He prescribes the thirtieth of a grain of arsem- 

 ous acid daily, and recommends still more the sixtieth of a grain of 

 arsenite of antimony in pill twice a day. 



CHAPTER III. 



ATROPHY OF THE HEART. 



ETIOLOGY. Congenital, or original diminutiveness of the heart, 

 which, strictly speaking, cannot be called atrophy, occurs by preference 



