Lauder Brunton

An Address ON BLOOD PRESSURE IN MAN: ITS ESTIMATION AND INDICATIONS FOR TREATMENT: Delivered before the Westminster Division of the British Medical Association

impaired, and if the pulse be irregular in force and rhythm the coronary arteries are much involved. In these cases the question of the free calcium ions in the blood must be considered, as you must not run any risk of sudden cardiac failare. There may be plenty of lime salts in the arteries, but the blood may be defective in free calcium ions. In such cases I find a valuable combination to be small doses of the glycerophosphats of calcium and large doses of phosphoric acid. The former drug supplies present needs, and the latter sets the lime in the vessels free. A long course of decalcifying agents has often a wonderful effect in clearing the lime out of the vessels. In these cases, especially if the pulse be infrequent, the iodine preparations are valuable, and small doses of thyroid increase metabolism and lessen the viscosity of the blood. When the 8ystolic and diastolic pressures are failing and there i8 oedema of the extremities, a temporary rest to restore the statu quo ante is highly beneficial. The diet should be dry, light, and nutritious, and nitrogenous if the kidneys be fairly healthy, sodium chloride should be eliminated, massage is useful, a course of cardiac tonics is necessary, alcohol is as a rule injurious. When the cardiac balance is restored there should be a course of graduated walking exercise, and skipping can also be commended. In many cases of myocarditis the right coronary artery i8 much more affected than the left. In such cases the hearts action may be very irregular, and during any strain there is marked dyspnoea and palpitation of the heart. There may -be no oedema of the extremities, but when theheart beains -to fail you get congestion and oedema of the lungs and portal congestion. There is often marked orthopnoea, and in such cases it is often an advantage to wear an abdominal belt so as to assist the respiratory pump in supplying the right heart with blood. A good cardiac tonic in such cases consists of glycerophosphate of calcium, strychnine, and phosphoric acid. For restlessness and insomnia the patient should get morphine and atropine. The preparations of iodine are often beneficial, and if there be much flatulence the tincture is the best. All laxatives should be gentle. The diet should be dry and largelv nitrogenous, and carbohydrates are perhaps best suppled in forms of glucose or malt. Exercise should be on the level. In many cases of myocarditis, either right or left, the irritability of the heart becomes smpaired, and in order to maintain a continuation of its contractions a certain diastolic pressure in the ventricles must be kept up. An abdominal support and an active respiratory pump assists the right heart, and for the-left heart you must not reduce the arterial pressure too low-there must be some effective resistance in the aorta in order that the contraction of the left heartbe not wasted, and that the heart itself be supplied with blood through its coronaries. If the costal cartilages are rigid a long course of phosphoric acid is useful, and for emphysema the citrate and iodide of sodium can be commended. The diet should be light and nutritious; for all forms of heart disease corpulence is a disadvantage.