1. Rest, absolute if needed, and the prohibition of all physical
exercise and of all business cares.
2. Reduction in the amount of food, which should be of the simplest.
Alcohol should be stopped, and the amount of tea, coffee and tobacco
reduced.
3. If medication is needed, strychnin sulphate, 1/40, or 1/30 grain
three times a day, acid the tincture of digitalis in from 5 to 10
drop doses twice a day will aid the heart to recover its tone.
Such treatment, when soon applied to a slowly dilating and weakening
heart, will establish at least a temporary cure and will greatly-
prolong life.
If these hearts are not diagnosed and properly treated, such
patients are liable to die suddenly of "heart failure," of acute
stomach dilatation, or of angina pectoris. Furthermore, unsuspected
dilated hearts are often the cause of sudden deaths during the first
forty-eight hours of pneumonia.
Small doses of digitalis are sufficient in these early cases. If
more heart pain is caused, the dose of digitalis is too large, or it
is contraindicated. Digitalis need not be long given in this
condition, especially as Cohen, Fraser and Jamison [Footnote: Cohen,
Fraser and Jamison: Jour. Exper. Med., June, 1915.] have shown by
the electrocardiograph that its effect on the heart may last twenty-
two days, and never lasts a shorter time than five days. They also
found that when digitalis is given by the mouth, the
electrocardiograph showed that its full activity was not reached
until from thirty-six to forty-eight hours after it had been taken.
From these scientific findings it will he seen that if it is
necessary to give a second course of treatment with digitalis,
within two weeks at least from the time the last close of digitalis
was given, the dose of this drug should be much smaller than when it
was first administered.
Owing to our strenuous life, if persons over 40 would present
themselves for a heart and other physical examination once or twice
a year there would not be so many sudden deaths of those thought to
be in good health. It may be a fact as asserted by many of our best
but depressing and pessimistic clinicians, that chronic myocarditis
and fatty degeneration of the heart cannot be diagnosed by any
special set of symptoms or signs. However, it is a fact that a
tolerably accurate estimate of the heart strength can be made by a
careful physician, and if danger signals are noted and signs of
probable heart weakness are present, life may be long saved by good
treatment or management rigorously carried out. The patient must
cooperate, and to get him to do this he must be tactfully warned of
his condition. Many, such patients, noting their impaired ability,
do not seek medical advice, but think all they need is more
exercise; hence they walk, golf, and dance to excess and to their
cardiac undoing.