DISEASES OF THE HEART. 



449 



of the precordial dulness, aDd by the symptoms, which are most 

 alarming. Hydro pericarditis and myocarditis (especially chronic 

 myocarditis) are more difficult to distinguish from hypertrophy ; 

 their distinction is often impossible. The differential diagnosis 

 with valvular lesions is relatively simple ; these latter are marked 

 by characteristic bruits. 



Treatment. The principal indication of the treatment of hyper- 

 trophy and dilatation of the heart is to search for the causes of 

 these troubles and to lessen their effects. 



Let us first remark that it is always inadvisable to obstruct (by 

 digitalis, for instance) the development of a compensatory hyper- 

 trophy. The patients should be protected from the various causes 

 of excitement and fatigue ; we must avoid riding or harnessing the 

 horse or letting the dog hunt. Inactivity being necessary if we 

 wish to obtain a cure, we find that the owners decide to sacrifice 

 the animals in most cases. A nitrogenized alimentation is ad- 

 vantageous ; it furnishes the cardiac muscle, which is forced into a 

 hypertrophic condition, the necessary materials for the formation 

 of muscular substance. 



When the dilatation complicates the hypertrophy we must com- 

 bat the relaxation and weakness of the heart by cardiacs, stimu- 

 lants, and tonics. We administer digitalis leaves in small and 

 repeated doses at short intervals (horse, 2 to 5 grammes ; dog, 0.1 

 to 0.3 gramme per day, in an infusion). This agent moderates the 

 activity of the heart, increasing the duration of its resting periods, and 

 permits it to assimilate a greater proportion of nutritive elements ; 

 its prolonged use requires some precautions. In certain cases there is 

 advantage in using caffeine (horse and ox, 5 to 10 grammes; small 

 breed of dog, 0.1-0.5 gramme; large dog, 0.5 to 2 grammes), tinc- 

 ture of strophauthus (horse and ox, 10 to 25 grammes ; dog, 10 to 

 25 drops). In circulatory troubles we must resort to stimulants: 

 (wine, camphor, alcohol, ether, veratrine). In associating these 

 remedies, we may for a certain time counteract the insufficiency of 

 the cardiac muscle, but the complete cure is only possible in cases 

 where hypertrophy is idiopathic and when its causes may be com- 

 pletely suppressed. 



[Iodide of potassium is a very valuable drug in this disease, as 

 its action upon the heart is to induce rest of the organ, thus allow- 

 ing more time for the circulation of the blood in, and the nutrition 

 of its own tissues. In those asthmatic attacks which are induced 



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