IV. MEDICAL AND SOCIAL TREATMENT 



The treatment for cardiac trouble, like the treatment for 

 many other diseases, has undergone a marked change within the 

 past few years. Long ago doctors were taught to treat symptoms 

 rather than to probe deeper for causes. They could rely upon 

 little, therefore, in the way of treatment. The drug most used 

 then for cardiac disease, as today, was digitalis. When a patient 

 entered a doctor's office and it was found that his heart was not 

 doing all the work required of it, this drug or one with similar 

 action was given at once. Often the heart was having to supply 

 blood under very adverse circumstances. After the drug was 

 given the heart would start anew to pound away and try to per- 

 form its illegitimate work. In case this was not successful or 

 the case presented a need for other treatment, such as an over- 

 supply of blood, bleeding was resorted to. This was considered 

 very effective by some because of the quick relief given to the 

 patient. This is used now to meet emergencies. To be sure, 

 there was usually, if not always, a reaction, but this was not 

 always taken into account. The patient, after the loss of a large 

 or small amount of blood, was left in a weakened condition so 

 that cessation from his normal life was imperative. It is known 

 now that the rest thus obtained was probably the true cause of 

 improvement. 



Since the advent of preventive medicine, there has been a 

 marked change in thought concerning the cardiac case. The 

 present applied treatment is divided into three main groups: 

 (Ij treatment of cardiac children; (2) treatment of adults; 

 (3) convalescent care. 



The first type of treatment has been taken up in more detail 

 perhaps by the Massachusetts General Hospital in Boston than 

 by any other institution. The children with heart disease who 

 came to the clinic at this hospital presented such a great field 

 that the time of one medical social service worker has been mostly 

 taken up by their care. The doctor attempts to find the condition 

 of the heart and the cause of the trouble. He then asks for after- 

 care. This task is usually turned over to the social service 

 worker. This is provided for as far as possible with the patient's 

 family within the home. AVhen the parents of the child, however, 



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