As heart stimulants, one may use strychnine, spartein, caffein, or camphor. In desperate cases, where a rapidly diffusible stimulant is needed, a hypodermic syringeful of ether may be given, and repeated in a short while.
Several years ago a so-called serum was brought out by Trunecek which was said to have a favorable effect on the metabolism of the vessel walls. It was given at first hypodermatically or intravenously but the former method was painful. It was later stated that given by mouth it acted just as well. The results with the Trunecek serum have not come up to the expectations that the early favorable reports promised. The original serum was composed as follows: NaCl, 4.92 gm.; Na2SO4, 0.44 gm.; Na2CO3, 0.21 gm.; K2SO4, 0.40 gm.; aqua destil. q. s. ad. 100.0 c.c. Later this was modified for internal use to the following prescription:
℞ Natrii chlor. 10. gm.
Natrii sulphat. 1. gm.
Natrii carbonat. 0.40 gm.
Natrii phosphat. 0.30 gm.
Calcii phosphat.
Magnesii phosphat. aa. 0.75 gm.
M. Ft. cachets No. XIII.
The contents of every cachet corresponds to 15 c.c. of the fluid serum or to 150 c.c. of blood serum. The preparation called antisclerosin consists of the salts contained in the serum. As to its efficacy, I can not judge, as I have never felt that it was worth while to use it. Reports of cases in which it has been tried do not speak very highly of it.
In the general treatment of arteriosclerosis, there is no one factor of more importance than the regular daily bowel movement. Attention to this may save the patient much discomfort and even acute attacks of cardiac embarrassment. The choice of the purgative is immaterial, with this reservation only, that the mild ones, such as cascara, rhubarb, licorice powder and the mineral waters, should be thoroughly tried before we resort to the more drastic purgatives. Plenolphthalein in 3 to 5 grain doses acts remarkably well in some people as a pleasant laxative. Agar-agar with or without cascara may be useful.
Liquid paraffin under a variety of names is a most useful and efficacious laxative. As its action is purely mechanical it may be taken indefinitely without doing harm to the intestinal musculature.
The old Lady Webster dinner pill is an excellent tonic aperient. When the heart is embarrassed and edema of the legs and effusion into the serous cavities have taken place, then it becomes necessary to use the drastic purgatives that cause a number of watery movements. Epsom salts given in concentrated form, elaterin gr. 1-12, the compound cathartic pill, blue mass and scammony, or even croton oil may be used. Since the observation of a greatly congested intestine from a patient who had been given croton oil, I have ceased to use this purgative, and I doubt much whether its use is ever justifiable in these cases.
The management of the ordinary case of arteriosclerosis resolves itself into a careful hygienic and dietetic regime with the addition of the iodides, aconite, or the nitrites. A diet consisting of very little meat, alcohol in moderation or even absolutely prohibited, and not too much fluid should be prescribed. Condiments and spices should also be used sparingly. Cold baths, shower baths, cold and hot sheets alternating, are of great benefit in assisting the heart to do its best work by making the large capillary area of the skin more permeable. It is not true that such baths raise the blood pressure so markedly. Certain acts, as sneezing, violent coughing, etc., increase the blood pressure much more than judicious bathing.
Symptomatic Treatment
The fact that arteriosclerosis really loses much of its own identity and, in later stages, becomes merged with the symptomatology of the diseases of various organs, as the kidney, brain, heart, compels us, for completeness' sake, to say a few words about the treatment of these complications.