In the treatment of patients suffering from " heart pang " the careful management of the diet is second in importance only to the need for rest. True angina will be treated here : anginoid attacks (or pseudo-angina) come more rightly under functional disorders, to which the reader is referred for its dietetic treatment. The frequency with which an attack of angina is caused by some dyspeptic attack or the ingestion of some indigestible food must have been the common experience of all, and it is only by the greatest attention to diet that patients who are liable to such attacks can be kept free from them. In many cases errors in diet have to be corrected and dyspepsia treated, for flatulent distension of the stomach or bowels must be carefully guarded against. All irritating food such as peppers and spices must be avoided. Strong alcoholic drinks come into this category and should not be allowed as a routine, though their efficacy in the treatment of the immediate attack must be allowed. In some cases the patients are weak and feeble and their powers of digestion much impaired; and with such cases a purely milk and soup diet is best to begin with. Indeed we shall have to peptonize even this form of nourishment in some instances. As they get stronger it is important to give flesh and fish, thoroughly minced and well cooked, rather than starchy foods. With those who are able to take, more or less, ordinary food the principles to be followed are these :
1. These patients need good nourishment.
2. They need nourishment in small bulk that will promote vigorous action of the heart.
3. The food must be most digestible, quickly digestible, and, above all, not such as will cause flatulent distension.
Of our mixed diet undoubtedly flesh in some form or other (meat, bird or fish) answers the above requirements most closely. Further, one must again urge the limitation of starchy foods, because of their slow digestibility and the flatulent distension so often caused by their use. Thus we have :
Milk, good strong soups (not spiced), meat, bird, fish (all carefully selected and well cooked). Eggs are permissible, as well as well cooked green vegetables (preferably rubbed through a wire sieve), the pulp of cooked fruit with cream, custards, junket and plain jellies. Tea and coffee are best avoided, and in any case, excess in their use must be looked for and strictly prohibited. Stimulants can only be allowed in a weak form and very small quantities. For drink water or any of its disguises, such as barley-water, toast-water, home made lemonade and so forth, with milk, is much the best, and in many cases fairly copious drinks of hot water are directly beneficial, by aiding digestion and elimination and preventing stasis, fermentation and flatulent distension.