388 DISEASES OF THE HEART. 



medicines, because they are superfluous and impotent ; as it is, the 

 mental preoccupation afforded by the preparation of an effervescent 

 powder, etc., is often of the greatest relief to any person afflicted with 

 palpitation, and even shortens the paroxysms. The application of cold 

 over the heart seems to be of decided efficacy in abbreviating the fits. 

 The nervines, tincture of castor, tinctura valerianae setherea, often have 

 the same effect. On the contrary, narcotics, especially digitalis, if 

 used, must always be employed with the greatest caution in cases of 

 nervous palpitation, in the narrow acceptation of the term which we 

 employ. 



It is doubtful whether it be in our power to relieve paroxysms of 

 angina pectoris by means of any medication ; but, after having once 

 witnessed the impatient and hurried clutch of the sufferer for his medi- 

 cine-glass, as the attack comes on, the physician will readily acknowl- 

 edge that the " laisser aller" mode of treatment is sheer cruelty. 

 Romberg advises the inhalation of sulphuric and acetic ether, a couple 

 of teaspoonsful of it being poured into a saucer, and its edge held to 

 the mouth of the patient while it evaporates. The inhalation of 

 four or five drops of nitrite of amyl also has been strongly recom- 

 mended. Chloroform cautiously used is equally serviceable. Hypo- 

 dermic injections of morphine are also good. I have seen the fit 

 cut short by tinctures of valerian and castor setherea. During the 

 intervals, treatment must be limited to combating all recognizable 

 predisposing causes. Fontanelles, setons, etc., should not be used. 



CHAPTER XV. 



BASEDOW'S DISEASE. 



THE term Basedow's disease is applied to a train of symptoms ol 

 tolerably frequent occurrence, consisting of a subjective sense of pal- 

 pitation, accompanied by acceleration of the action of the heart, beat- 

 ing of the veins of the neck and head, swelling of the thyroid gland, 

 and exophthalmos. This peculiar series of symptoms is sometimes 

 Been in patients with valvular disease of the heart, but is more fre- 

 quently observed in persons free from any organic cardiac disease. 

 The tumefaction of the thyroid body, which is not often very large, 

 arises partially from dilatation of its vessels, and in part from infiltra- 

 tion of its tissues with serum, and from simple hyperplasia. More 

 rarely cysts, with serous or colloid contents, are found in the gland. 

 The swelling of the intra-orbital fat, which is the cause of the ex- 

 ophthalmos, seems in most cases to be due to hyperasmia and cedema, 

 or to simple hyperplasia of the adipose tissue \ since, when recoverv 



