I have written now all that I know from personal experience about the treatment of this complicated condition we call arterio-sclerosis; and many of the symptoms and much of the treatment I have been able to watch and verify for myself by almost hourly contact with it. Nevertheless, this treatment will have to stand the racket and assaults of both friendly and hostile critics, and so it should be. In the practice of medicine we must be prepared to maintain our position and to give a reason for the faith that is in us, for the issues are so great and affect others rather than ourselves.
I have said that this is somewhat of an occupation disease: it is a vicious circle, not originating necessarily in any vice, but in the pressure of life and the stress of circumstances. The causes often we cannot remove entirely, but only modify, and so we are compelled to treat symptoms only; our ambition and longing will be to do much more than this—to bring about a perfect reform; but in the management of this, as in most morbid conditions, compromise, with as much true wisdom as we can squeeze into it, is the only practical policy. Our endeavour must be to break the vicious circle whenever and wherever we can. The lowering of pressure does not sound a great thing in itself, but it immediately lessens the work of the heart, sets more free the circulation of blood in the brain, often restores the power of sleep and so ensures comparative rest all round. It thus gives us a breathing space in which we can consider and attack the origins of evil.
In conclusion I ask my readers to consider well Sir Clifford Allbutt’s most wise words on this question: “In entering upon the discussion of vaso-dilatation, as contrasted with agents which bring about this change indirectly by modifying the causes of morbid constriction, we have to consider how far mere dilatation—brought about, that is to say, immediately and singly—serves any good purpose.
“We are told that to act thus directly upon the vessels is but to treat a symptom, and is therefore absurd. But whatsoever be our judgment on this or any such particular effect, the common denunciation of treating symptoms, which sounds very philosophical, is surely but a parrot phrase. Why should we not treat a symptom? If in granular kidney by mere pressure reduction the grievous headache be abated, or in angina pectoris the pain be thus charmed away, we have so far at any rate a substantial gain.
“In renal diseases it is generally agreed that, on the whole, with due caution, to lower pressure is helpful. Moreover, if by mitigation of his suffering the patient gets a chance of picking up in many other ways, are we not more than justified in our interference, narrow as it may seem? We never know what interference may cut a link in a vicious circle. If we cannot stop the crack in the water-pipe, we need not throw away the mop.
“The warning should run not against the treatment of a ‘mere symptom,’ but lest, while giving our attention to the symptom and snatching at an immediate advantage, we lose our grip of the case as a whole.”
In whatever treatment we adopt for sclerosis, we must bear in mind that, under the raised pressure, the heart is very apt to dilate. To lower pressure alone in this condition often ends in failure. We must brace up the heart at the same time as we lower resistance. For the purpose strophanthus in large doses and strychnia are the best drugs. Digitalis is occasionally necessary, but more often does harm than good. Given, however, in this well-tried old form it contracts the ventricle without raising pressure:
| ℞ | Pulv. Digitalis | gr. 1–2 |
| Pil. Hydrarg. | gr. 1 | |
| Pil. Scillæ Co. | gr. 11/2 | |
| Ft. pil. to be taken twice a day. | ||
The compound gland tablet that I chiefly use has this formula:
| ℞ | Thyroid Extract dried | gr. 1/2 |
| Orchitic Extract dried | gr. 1/2 | |
| Ovarian Extract dried | gr. 1/2 | |
| Anterior Pituitary dried | gr. 1/2 | |
Ft. tab. 1. | ||