The proper treatment for these palpitations and irregularities in the pulse will be to attend to the general health, with cold bathing (when the season of the year will allow); animal food (tender); with occasional purgatives and tonics. The patient may take, according to the strength of his or her constitution, two or three of the Cathartic and Tonic pills, No. 5, every second or third night at bedtime; and may take a teaspoonful of the following mixture three times a day, in a wineglassful of water:

Citrate of Iron and Quinine.................Two Drams.

Tincture of Orange Peel.....................One Ounce.

Syrup............................................One Ounce.

Water, sufficient to make...................Three Ounces.

It may be of a little assistance in deciding between disease of the heart and mere nervous disorder to notice the position of the patient when lying down.

It is stated that when there is mere nervous palpitation, the patient lies as well, or perhaps better, on the left side than otherwise: whereas, when the heart is actually diseased, lying on the right side is more comfortable than on the left. If a person can go quickly up stairs, or up a hill, without feeling more out of breath than other and healthy people of his own age, we may comfort him with the assurance that there is not much amiss with his heart.

The circulation of the blood through the brain is liable to be much disturbed in heart diseases; and to this circumstance we must attribute the headaches and giddiness which accompany them; the dread and causeless apprehension which such patients frequently exhibit; the cowardice and irritability which disease of the heart excites in men who previously were intrepid, and of strong and firm nerves; also that propensity to dreaming, and especially to distressful and frightening dreams, so commonly observable in them; and the sudden startings from sleep in agitation and alarm.

One of the most common indirect symptoms of disease of the heart is dropsy; yet, sometimes cardiac disease may continue long, and even prove fatal, without giving rise to any dropsy.

Fatty Degeneration Of The Heart

The parts of the heart which have undergone this change are altered in colour as well as in consistence. They are pale like a faded leaf, or of a yellowish brown, or a muddy pink colour, and they commonly have a spotty or mottled appearance. The change of texture varies in degree and in extent. It may render the muscle merely soft and flabby, or it may reduce it to a state in which it feels like a wet kid glove, and can be torn as readily as wet brown paper.

Fatty degeneration of the heart may proceed from a defect of healthy nutrition throughout the body, in consequence of some general disorder, or of a natural decay in the decline of life. In such cases the same morbid change is commonly manifest in other parts also; in the arteries, in the liver, in the kidneys, and in the eye.

But fatty degeneration may be limited to the heart, and even to a small portion of the heart, and then it is owing to some local failure of nutrition; of which perhaps the most common cause is a diseased condition of the coronary arteries. Fatty degeneration of the heart is also met with after inflammation, either of the muscular tissue of the heart itself, or of its lining or its investing membrane. In every case the change seems ultimately traceable to deficient nutrition.

Under this dilapidating process the walls of the heart may become so soft and yielding as to bulge out into a pouch, or even so fragile as to crack; in which latter case the patient almost always dies suddenly. King George the Second died of rupture of the heart; and a Duchess of Brunswick, of the same family as George the Second, died of the same disease; and Dr. Abercrombie of Edinburgh died of the same disease. Among 83 fatal cases of fatty degeneration of the heart, collected by Dr. Quain, there were 28, or about one in every three, in which rupture was discovered after death.

There do not appear to be any signs by which, during life, we can decide that a person has fatty degeneration of the heart. In more than one-half of Dr. Quain's cases, the age of the patients was above sixty. In twenty-one instances out of sixty-eight, death took place in a fainting-fit. Of the whole number (83) sixty-eight died suddenly. Death is apt to occur upon some shock, or unusual effort: a hasty ascent, straining at the water-closet, or the act of vomiting. "The principal character, (writes Mr. Paget), which all these cases seem to present is, that they who labour under this disease are fit enough for all the ordinary events of calm and quiet life, but are wholly unable to resist the storm of a sickness, an accident, or an operation. Where a person over the age of 63 shows a tendency to grow fat and flabby, with a pale and sickly complexion, we may suspect the existence of the disease;

Although we can do nothing to cure this disease, we may do a great deal to alleviate the sufferings of the patient, and by strengthening his constitution, to prolong his life. Above all things he must practice temperate habits, and a life of constant quiet. He must never be tempted nor surprised into any act which implies unusual effort. He must, for instance, lose a journey rather than hurry on foot to a railway train for which he is late. He must be content to get wet through, rather than run for shelter in a sudden shower. He must never lift a burden, nor climb stairs hastily, nor strain to relieve costive bowels. Neither will it be safe for him, even on what might seem legitimate occasions, to yield to feelings of anger, or any kind of excitement. These cautions are indeed more or less applicable to all disorders of the heart.

Treatment

An occasional brisk purgative will be found of benefit, and the patient may take the Pills, No. 4 or No. 5. Dr. J. M. Fothergill strongly recommends the continued use of Digitalis in small doses, in heart diseases, and I have known the continued use of Prussic Acid (Hydrocyanic Acid) in small doses combined with an opiate afford great relief. As the active principle of the Wild Cherry Bark is Prussic Acid, an infusion of that bark is a very convenient and agreeable medium for the patient. He may take one or other of the following combinations; changing them as they appear to lose their effect, or as the system appears to get accustomed to them, and to require a change:

Tincture of Digitalis.........................Two Drams.

Tincture of Orange Peel...................One Ounce.

Infusion of Wild Cherry...................Ten Ounces.

Syrup...........................................One Ounce.

Two tablespoonfuls three times a day.

The following pills may be taken at the same time, with each dose of the mixture:

Powdered Sulphate of Iron.....................24 grains.

Powdered Gum Myrrh..........................36 grains.

Extract of Gentian sufficient to make 24 pills. Two for a dose.

Or the patient may take the following:

One tablespoonful three times a day. - The patient may take the pills above, at the same time.

If the sleep is disturbed the patient may. take ten or fifteen grains of Bromide of Ammonia, or Bromide of Potash, at bedtime.