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Related post: when rapid action is necessary. When demanded,
its action is much enhanced by the subcutaneous
use of morphine. Nitroglycerin is also a Buy Microzide Online powerful
dilator and stimulant. The latter action is rather
a drawback than an advantage in a compensated
case, when its use should never be long continued,
overstimulation leading to rapid heart action, and.
finally, to irregularity. For continued use the ni-
trites Buy Microzide of sodium and potassium in small doses are
most valuable and least dangerous. I have pre-
scribed them for a month at a time without any but
beneficial results.
The therapy of the heart itself falls naturally into
two divisions. The first, and of least importance Microzide 12.5
in the stage of compensation, is drug therapy ; the
second, treatment other than drugs, especially
hydrotherapy and physical therapy. In regard to
drugs, those directed to the. heart muscle are either
stimulant or sedative. Of the former, the least said
the better. They are rarely useful and often harm-
ful. There is no more pernicious practice than that
which is still too prevalent of prescribing digitalis,
strophanthus, convallaria, or strychnine in every
case of chronic cardiac disease. Their long contin-
uance is like perpetual goading to a horse. When
the real time for their use arrives, like the blows,
they have lost their effect. The other group of
drugs, the cardiac sedatives, is of great value, and
its usefulness very wide, and, I think, in many in-
stances, somewhat neglected. The most important Order Microzide Microzide 12.5mg
is opium and its derivatives. Since Albutt's clas-
sical essay in 1869 on the hypodermatic use of mor-
phine in chronic endocarditis, the powerful stimu-
lant and sedative action of small doses of morphine
has been widely appreciated. But the great danger
of habit in its constant use has made it important
that for ordinary sedative action a less dangerous
substitute should be at our command. This v\-e
have in codeine, the most useful single drug in Generic Microzide the
treatment of heart disease in the stage of com-
pensation. It may be given for almost any length
of time in small Purchase Microzide or large doses, and yet the patient
not jjeconie addicted to it. I have given it almost
steadily for two years to a diabetic, and then stopped
suddenly without anv evil effect. In heart cases 1
have given it for months at a time without the
formation of a habit.
Lastly, we will speak of the mechanical treatment
of compensated heart disease. In this I will in-
clude all treatment other than drugs — hydro-
therapy, Nauheim baths combined with passive mo-
tion or massage, and exercises, varymg from light
calesthenics to the severer forms recommended by
Oertel, with the purpose of maintaining compensa-
tion. With regard to the .\auheim baths, whicli
are especially useful in hearts with weak muscle
and beginning dilatation, I shall not go into details,
as they have so recently been ably presented to the
New York medical piofession by the late Dr. New-
ton Heineman. llis jjapers were followed by a
lengthy discussion on the subject in all our Amer-
ican medical journals. The home methods of this
treatment were explained in a i)aper written by a
member of this society and discussed here.
The method of choice from amongst these me-
chanical means must be influenced by age. physical
condition, and social status of the patient. At both
extremes of age, naturally, the severer forms of e.K-
ercise are excluded. Before the age of puberty
there is nearly always present a strong tendency
to rapid hypertrophy, and frequently, as rapid a de-
generation of the hypertrophied muscle, making the
prognosis bad in most of these cases, so that tlie
physical activity and restlessness should be curbed
rather than added to. At the other extreme, over-
exertion, being less likely to occur, and activities
being naturally lessened, once compensation is es-
tablished, the natural hygiene of old age will be that
of the accompan}ing endocarditis, which is, as a
matter of experience, very well borne.
In between these two extremes, we have, afflicted
with chronic valvular troubles, individuals of every
variety of physical status. Up to the present time, Buy Cheap Microzide
we have had comparatively little to guide us with
regard to the variety, or, rather, the severity of ex-
ercise to which a well compensated heart muscle
should be subjected, in order to retain what has
been gained, in many instances, entirely by the ef-
forts of nature.
Modern instruments of precision, the mano-
sphygmograph, the sphygmograpli, and the orthodia-
graph combined, have placed within our hands the
means of testing the blood pressure and size of the
heart during rest, and we can test, at any rate, with
a fair degree of accuracy, the functional power of
the heart. Every heart, normal or otherwise, on
continued severe exertion, reaches a stage when
compensation fails, and even, on extreme overex-
ertion, death can take place in asystole. Func-
tional tests are not only useful in diagnosis, but I
have endeavored to use them as a means for testing
the limits of exertion to which an individual with
compensated valvular disease should be subjected.
For this purpose I have used the test proposed by
Graupner, of Nauheim, which is based upon the
following phenomena : Given a normal heart, sub-
ject it to moderate exertion for a short period of
time, and the result will be as follows : First, there
is a rise in frequency of the pulse rate ; coincident-
ly there is Microzide 25 Mg a increased force, and, when measured,
an increase of the blood pressure. If the exertion
is continued, there is a further acceleration of the
pulse rate, coincident with which there is a fall in
blood pressure. If at this stage exertion is stopped
there is a gradual retardation of the pulse rate, and
gradual increase in tlie blood pressure, which in-
crease is maintained and continues to even beyond
the normal after the pulse has returned to its nor-
mal rate. This increase Purchase Microzide Online does not ensue on ex-
treme overexertion or in functionally weak hearts,
or in any heart strained beyond its Microzide 12.5 Mg natural powers.
We know that a dilated heart muscle will respond
to physical stimulation, as in the passive motion or
massage in the Nauheim treatment, so Order Microzide Online that, if we
take a patient with cr,m]iensated heart tlisease and

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