The blood pressure is generally ten degrees lower in the morning after a good night’s rest; and for this reason, in severe cases, I often advise people to take a whole day in bed once a week, so that this lower pressure may be prolonged for twenty-four hours.
The non-medicinal treatment of sclerosis, prophylactic and curative, consists then chiefly in a philosophical, calm mode of life, in a firm restraint of passions, of worry and excitements, in a wise and economic use of brain power, in great moderation in eating and drinking, in giving as much of our time as is possible to fresh air and moderate, unhurried exercise, and lastly to the avoidance of all severe strains on mind or body. Very few of us are able to accomplish all these positive and negative virtues, but as far as in us lies, they should be our rule of life.
CHAPTER IV
THE MEDICINAL TREATMENT OF SCLEROSIS
The question now arises, what can the Physician, by real therapeutics, do to help? Much, I feel sure, if he will carefully and courageously apply the knowledge that has come to us of the late years. Firstly, Lauder Brunton showed us how we can quickly reduce the blood pressure that is one of the chief symptoms in angina pectoris, the immediate effect of amyl nitrite in reducing arterial tension, and the slower but very valuable effects of nitroglycerin and the other nitrites. This has enabled us to meet many an emergency, but the effects of these are not sustained enough to become a steady daily treatment. The orthodox remedy has been for years Iodide of Potassium; this has been by the teachers of the past so driven into us that, in spite of failures that far outweigh the successes, it has become heterodox to doubt it. Yet one must confess that one has been for years prescribing it more from a sense of duty than from any confident hope of its results. In a few cases, where there is cardiac pain and symptoms of new or chronic aortitis, it certainly does good, but in the average case of hyperpiesis it is a very poor reed to trust.
How does Iodide act? Chiefly, in all probability, by stimulating the thyroid to pour more of its secretion into the blood stream. Thus is produced the absorption of gummata, of new lowly formed tissues and the thickenings of fibrositis and rheumatism. We see the same result more decidedly and more constantly in the treatment of myxœdema by thyroid feeding.
As I have shown before, senile degeneration, premature and normal, is largely due to general endocrine degeneration and deficiency, and it has many relations to myxœdema. Thyroid deficiency as a rule means raised blood pressure, and, as has been shown in young animals deprived of their thyroids, a strong tendency to get atheromatous disease of the large arteries, even in youth.
The parallels are many, and so are the lessons they convey. If one had a perfectly functioning thyroid in arterio-sclerosis, one might with some confidence treat it by Iodides; but as we know that such is not the condition in the great majority of cases, we should expect to fail. One would have to give Iodide in enormous quantities with any hope to whip up a senile thyroid into effectual activity, and then in all probability fail. (This may be the explanation of the miracles worked by big doses of Iodide in syphilitic gummata in the brain, but in these cases there is rarely evidence of thyroid deficiency.)
Why then do we take the long and disagreeable route to our object by giving Iodide? Thyroid feeding acts here just as it does in myxœdema. We have to take into consideration the comparative failure of the other endocrine glands, but that only adds to the charm and attractiveness of the problem. The suprarenal and the pituitary are the most important, but one must not neglect the sexual glands. I feel strongly that thyroid treatment alone or in combination is the rational method to adopt in sclerosis: personal experience confirms this every day. We purposely side-track the worn-out thyroid of sclerosis and senility, and, by thyroid feeding, restore to a great extent the whole endocrine harmony, thus giving a new tone and stimulus to existence. We shall have to use more or less thyroid feeding for the remainder of life, but we must show our patients that it is not a medicine but a necessary food. As in myxœdema, so in sclerosis, thyroid feeding is the only means, as yet known, of producing absorption of those thickenings that characterize both diseases.
I have had lately the opportunity of watching and treating a thorough case of myxœdema in a lady about forty years of age, a very intelligent and educated woman. She weighs her symptoms and knows exactly when she needs more or less thyroid; she judges by her head feelings, vertigo, the sense of fatigue, etc., and by her hair falling out. But thyroid in sufficient doses produces a quick, irritable heart action; this she can quiet by taking suprarenal extract. Under sufficient thyroid her blood pressure comes down to normal and the suprarenal does not raise it. With this balanced combination she can lead a useful and enjoyable life. The same thing happens more or less in later life, where there is high pressure and other signs of arterial thickening.