TREATMENT OF DISEASE OF THE HEART. 473 



is essential to relieve the strain from them and the frequency 

 of their movements ; and cardiac depressants, such as Potash, 

 Aconite, and Veratria, are employed to assist this effect. 



Removal of the cause is rarely practicable in heart disease. 

 The opposite is the case in cardiac disorder. Treatment here 

 consists in relieving dyspepsia, in restoring the condition of 

 the hlood, in securing mental rest, and in removing all poisons 

 from the system, such as alcohol, tea, and tobacco, by a 

 reformation of diet and personal habits. Carminatives are 

 specially valuable in dyspepsia with palpitation. 



A great part of the treatment of diseases of the heart 

 consists in counteracting the cause ; that is, in the prevention and 

 removal of dilatation. The first rational step to be taken is 

 to lighten the load upon the heart, to lower the intra- 

 ventricular pressure which it is unable to overcome. Eest, 

 bodily and mental, is the most obvious and easy means of doing 

 so, the patient being kept in bed, and every kind of exertion 

 and excitement forbidden. The pressure may be further 

 reduced by purgation, which diverts and drains the blood ; or, 

 if the condition be urgent, blood must be removed by leeching, 

 cupping, or venesection, all of which may give great relief, or 

 even preserve life when it is threatened. In another class of 

 cases, the arterial tension may be lowered by means of drugs. 

 Nitrite of Amyl acts very swiftly in this way, giving relief in 

 that terrible form of acute distension of the heart which is 

 called " angina pectoris," by instantly relaxing the vessels in 

 front, as well as by accelerating the cardiac action. The same 

 effect may be more slowly produced by the alkaline Nitrites, 

 Potash salts, and Belladonna. 



The second means of treating dilatation is by increasing the 

 cardiac power by direct cardiac stimulants, such as Digitalis, 

 Scilla, Alcohol, and Ammonia. Mustard or other rubefacients 

 applied to the praecordium are indirect cardiac stimulants of 

 great value in these cases. At the same time, the quantity 

 and quality of the blood supplied through the coronaries to the 

 cardiac walls must be sustained by nutritious food, and possibly 

 by Iron : a system which demands, in turn, the strictest attention 

 to the action of the stomach, bowels, and liver, flatulence and 

 other digestive disturbances being highly dangerous to a weak 

 heart. 



The third means of treating dilatation is by increasing the 

 ti)ne of cardiac rest. Three powerful direct cardiac stimulants, 

 Digitalis, Scilla, and Convallaria, have the additional action of 

 stimulating the inhibitory apparatus, both in the heart and 

 medulla. They increase the force of the systole, thus tho- 

 roughly emptying the chamber, and preventing over-disten- 



