In considering the treatment of organic diseases of the heart it will be well to divide them into acute and chronic.

Acute endocarditis and pericarditis can conveniently be taken together. The indications for treatment are : (1) To feed without loading the excretory organs with work. (2) To give plenty of fluid in order to promote fluidity of blood and sweating. (3) To increase or alter the nourishment under certain circumstances, such as cardiac failure, etc. (4) To be careful in selecting the most appropriate nourishment during convalescence.

1. In order to give the excretory organs, and the heart, as little work to do as possible, the diet should be fluid and consist chiefly of milk. Remembering that the function of the kidneys is impaired in these febrile, often rheumatic, conditions we should refrain from using strong meat essences. Moreover they undoubtedly stimulate the heart, and, in the majority of cases, we want to rest it. On the other hand, there are certainly some cases where the patient is weakly, anaemic and delicate, or where milk causes vomiting or distension, in which we must have recourse to essences and meat broths rather than an entirely milk diet.

2. We regard the free use of alkaline drinks as an important point in the treatment of acute endocarditis. They lessen the toxaemic state of the blood and probably diminish the tendency for thrombi to form on the valves, whilst, at the same time, they promote sweating.

3. In some cases where the cardiac action is very weak, we must overlook the rheumatic element in the case and give a more liberal diet, consisting of beaten up eggs, meat juices and the lighter kinds of white fish. The greatest necessity for careful consideration of the diet occurs in those cases (mostly of pericarditis) where great cardiac depression, vomiting or a collapsed state supervenes. Here we must stop the exhibition of all drugs by the mouth, reserving the stomach for nourishment only. Digitalis is especially harmful; if necessary it (or strychnine) can be given hypodermically. The milk should be peptonized or well diluted with alkaline water, or citrate or bicarbonate of soda added in the proportion of 2 grains to the ounce. The feeds should be small and frequent, the actual amount and frequency regulated by the tolerance of the stomach. Strong meat juices and broths are often most useful to take the place of milk for a time. Stimulants may be necessary, brandy and champagne will generally be found most suitable. If there is absolute intolerance of the stomach for food, all feeding by the mouth must be discontinued for a time and recourse be had to nutrient enemata. This is most important, as vomiting throws a great strain upon the already embarrassed heart.

4. During the convalescence of acute endo and pericarditis the food must be increased cautiously. Increase of fatty food will be the first addition, such as cream, butter and fat of bacon. At the same time one may give farinaceous and milky puddings and custards. Eggs, fish and chicken may soon be added, with a little potato, well cooked green vegetables, and stewed fruit. Whilst admitting that, in exceptional cases, where the patient is very anaemic and debilitated, we do well to allow red meat rather early in the convalescence, one feels that its stimulating effect upon the heart, and its possibly acid producing properties are not usually desirable and that, in most cases (especially those of rheumatism), it should be the last item restored to the ordinary diet.

N.B. - One must emphasize the great difference between the treatment of acute and chronic heart troubles. In the chronic form so much of the treatment turns upon the judicious use of cardiac stimulants, whilst in the acute form stimulants, whether as food or drugs, except in quite rare instances, are best avoided. It has been pointed out that the food in acute endo and pericarditis should be selected for its non-stimulating characters. Further with regard to the use of alcohol, it must be laid down that, though it has been mentioned above as occasionally necessary in cases where there is imminent danger of cardiac failure, as a rule it is not advisable to use it at all; whilst the routine practice of giving it in all, or nearly all, cases of acute heart trouble is to be condemned as most harmful.