372 DISEASES OF THE HEART. 



prolonged (Traube) that a pause intervenes between the murmur and 

 the next systolic sound, so that it can no longer be called praesystolic. 

 A marked improvement often accompanies such a result ; the breath- 

 ing grows more free, the swelling of the liver subsides, and the cyano- 

 sis and dropsy abate. Latterly, since I have grown bolder in the 

 use of digitalis, and rid myself of the theory of Traube, even in 

 cases of insufficience of the mitral, particularly if the heart's action be 

 much accelerated, I have seen the dropsy, cyanosis, and tumefaction 

 of the liver diminish or disappear, while the urine became more copious 

 after the use of an infusion of digitalis. I have come to the conclusion 

 that, by proper administration of this drug, compensation, which is be- 

 ginning to fail, may, for a time, be reestablished. Arsenic and anti 

 rnony, likewise, may be employed in valvular disease of the heart. 



The action of diuretics upon dropsy, resulting from heart-disease, is. 

 at least, a doubtful matter. If digitalis act here as a diuretic, it is 

 probably because it readjusts the circulatory derangement, and thus 

 permits more blood to fill the arteries, thereby affecting the glomeruli 

 of the Malpighian capsules. An agent, intended to relieve sup- 

 pression of urine, caused by disease of the heart, must either have a 

 special action upon the circulation like digitalis, or it must cause dila- 

 tation of the arterioles of the kidney, so that more blood may enter 

 :hem from the scantily-filled aorta ; or else it must so alter the struc- 

 ture of the walls of the renal vessels, as to facilitate the transfusion of 

 -iquids through them. True, as long as the class of diuretics has any 

 reputation left, it will be difficult to refrain from prescribing cream of 

 tartar, the alkaline carbonates, squills, etc., when we see the urine 

 daily diminishing, while the serous effusion augments ; but, at all 

 events, their action upon the diuresis and dropsy of cardiac disease is 

 inexplicable and remarkably small. 



Preparations of iron, on the other hand, are of signal efficacy in 

 dropsy, as is also a nourishment rich in albumen and other protein 

 substances. As already observed, we are totally unable to explain the 

 effect of iron upon the composition of the blood, which consists in an 

 increase in the number of its red corpuscles and of the amount of albu- 

 men. However, just as bleeding, by thinning the blood, favors drop- 

 sy, so iron and a nitrogenous diet, by rendering the serum more con- 

 centrated, have an antihydropic action, and deserve the utmost reliance 

 in treatment of both mitral and aortic disease. 



We may afford great assistance, by the institution of a treatment 

 of the symptoms adapted to tne phase of the disease, while all exclu- 

 sive treatment will do harm. 



