A patient who has developed decompensation has always imperfect
elimination. The skin, bowels and kidneys do not act sufficiently or
well. The circulation in the skin is sluggish. The bowels are
generally constipated, or there is diarrhea of the fermentative
type. The amount of urine excreted is generally insufficient and
likely to be concentrated and show various signs of imperfect kidney
elimination. Therefore hot sponge baths, with perhaps warm alcohol
rubs, are daily necessary. Gentle massage, generally in the
direction to aid the circulation, will benefit the skin. If the skin
is dry or in places scaly, oil rubs are of great benefit.
The bowels must be moved daily and sufficiently, but there should be
no watery purging allowed or caused. If it seems advisable in the
beginning of the treatment to give a calomel purge, it should be
done, but such purging should ordinarily not be repeated, although
occasionally a grain or two of calomel, combined with the vegetable
laxatives needed, may act perfectly and without causing depression.
Saline purgatives, or even laxatives, are generally not good
treatment when there is cardiac weakness. The bowels should be moved
by vegetable laxatives, as aloin, cascara sagrada, or some simple
combination of either or both of these drugs.
Diuretics are often not satisfactory in cardiac insufficiency. The
cardiac tonics which are given the patient, and the improvement of
the heart from the rest in bed generally start the kidneys to
secreting properly. A diuretic administered when the kidneys are
suffering passive congestion from cardiac insufficiency does not
generally act, and is therefore useless. If digitalis is
administered, it will act as a diuretic; if caffein is deemed
advisable, that will act as a diuretic. Squills may be administered,
if it seems best. If for any reason the kidneys secrete less urine
and become insufficient, the diet should quickly be reduced to a
small amount of milk, cereal and water, and hot baths and local heat
to the back should be inaugurated.