Dr. Kellogg says:--

"Persons subject to attacks of _angina pectoris_ should carry with them a small bottle containing a sponge saturated with nitrite of amyl, and place it to the nose when necessary.

"Sympathetic palpitation may be relieved by bending the head downward, allowing the arms to hang down. The effect of this measure is increased by holding the breath a few seconds while bending over. Another ready means of relief is to press strongly upon the large arteries on either side of the neck.

"Palpitation of the heart is often mistaken for real organic disease of the organ. * * * * * A careful regulation of the diet is in most cases all that is necessary to effect a cure."

Dr. Edmunds, of London, was asked during a medical discussion what he thought of the use of alcohol in heart disease. His answer is embodied in the following:--

"With regard to the use of brandy in cases of heart disease, he was convinced it was a mistake to use it in such cases. There were many forms of heart disease, but the most common kind arose from the heart being too fat. Excess of fat debilitated the heart and injured its working, just as a piece of wax attached to a tuning fork would impair its usefulness. In such cases he dieted his patients in order to reduce their weight. Every dose of brandy taken for heart disease increased the evil. The moment brandy was taken for heart disease, or any other chronic complaint of a similar kind, the disease was increased. If doctors recommended alcohol to their patients, he had been asked what abstainers should do. In such cases, as had been suggested, he thought the patients might ask what the alcohol was to do for them, and if the reply was not satisfactory, they should get another doctor."

Dr. T. D. Crothers, of Hartford, Conn., has deduced some valuable facts from his experiments with the sphygmograph, upon the action of the heart. He has found by repeated experiments that while alcohol apparently increases the force and volume of the heart's action, the irregular tracings of the sphygmograph show that the real vital force is diminished, and hence its apparent stimulating power is deceptive.

Dr. C. W. Chapman, of the National Hospital for Diseases of the Heart, wrote in the _Lancet_:--

"The very thing (alcohol) which they supposed had kept their heart going was responsible for many of its difficulties."

Of cases of palpitation and irregularity caused by business anxieties or indigestion, he said:--

"To give alcohol is only to add fuel to the fire."

HEART FAILURE:--"In cases of cardiac weakness, the thing needed is not simply an increased rate of movement of the heart, or an increased volume of the pulse, but an increased movement of the blood current throughout the entire system. In the application of any agent for the purpose of affording relief in a condition of this kind, the peripheral heart as well as the central organ must be taken into consideration. In fact, the whole circulatory system must be regarded as one. The heart and the arteries are composed of essentially the same kind of tissue, and have practically the same functions. The arteries as well as the heart are capable of contracting.

"Both the heart and the arteries are controlled by excitory and inhibitory nerves. These two cla.s.ses of nerves are kindred in structure and in origin, the vagus and the vasodilators being medullated, while the accelerators of the heart and the vasoconstrictors of the arteries are non-medullated and pa.s.s through the sympathetic ganglia on the way to their distribution.

"Winternitz and other therapeutists have frequently called attention to the value of cold as a cardiac stimulant or tonic.

The tonic effect of this agent is greater than that of any medicinal agent which can be administered. The cold compress applied over the cardiac area of the chest may well replace alcohol as a heart tonic. The thing necessary to encourage the heart's action is not merely relaxation of the peripheral vessels, but, as Winternitz has shown, increased activity of the peripheral circulation in the skin, muscles and elsewhere.

Alcohol paralyzes the vasoconstrictors, and so dilates the small vessels and lessens the resistance of the heart action; but at the same time it lessens the activity of the nerve centres which control the heart, diminishes the power of the heart muscle, and lessens that rhythmical activity of the small vessels whereby the circulation is so efficiently aided at that portion of the blood circuit most remote from the heart. A continuous cold application applied to that portion of the chest overlying the heart stimulates the nerves controlling the walls of the vessels, and at the same time energizes the corresponding cardiac nerves. It is wise to remember that the vasoconstrictor nerves are one in kind with the excitor nerves of the heart, while the vasodilators are in like manner a.s.sociated with the vagus. With this in mind, it is clear that while alcohol paralyzes the vasoconstrictors, it at the same time weakens the nerves which initiate and maintain the activity of the heart; while, on the other hand, cold excites to activity those nerves which produce the opposite effect.

"The apparent increase of strength which follows the administration of alcohol in cases of cardiac weakness is delusive. There is increased volume of the pulse for the reason that the small arteries and capillaries are dilated, but this apparent improvement in cardiac action is very evanescent. This is a natural result of the fact that while the heart is relieved momentarily by sudden dilation of the peripheral vessels, the acc.u.mulation of the blood in the venous system, through the loss of the normal activity of the peripheral heart, gradually raises the resistance by increasing the amount of blood which has to be pushed along in the venous system. This loss of the action of the peripheral heart more than counterbalances the temporary relief secured by the paralysis of the vasoconstrictors.

"Thermic applications, general and local, may safely be affirmed to be the true physiological heart tonic. In the employment of the cold pericardial compress as a heart tonic, the application should generally be continued not more than half an hour at a time, and its use may be alternated with general cold applications to the surface. A cold towel rub, or the cold trunk pack is the best form for application if the patient is very feeble.

"The cold towel rub is applied thus: wring a towel as dry as possible out of very cold water, and spread it quickly and evenly over the surface; rub vigorously outside until the skin begins to feel warm; then remove, dry the moistened surface, rub until it glows, and make the same application to another part; and so on until the whole surface of the body has been gone over. The procedure should be rapid and vigorous.

"If the cold trunk pack is employed, a sheet of not more than one thickness should be wrung as dry as possible out of very cold water, and wrapped quickly about the body, after first dipping the hands in water, and rubbing the trunk vigorously. In cases of extreme cardiac weakness, very cold and very hot applications may be alternately applied over the region of the heart. The duration of the hot and cold applications should be about fifteen seconds each.

"Any one who has ever witnessed the marvelous effects of applications of this sort in reviving a flagging heart will never doubt their efficacy, and will have no occasion to resort to alcohol, or any other intoxicant, to stimulate a flagging heart. The writer has employed these measures for stimulating the heart for more than twenty years, and might cite hundreds of instances in which their efficiency has been demonstrated. They are applicable not only to the cardiac depression encountered in the adynamic stage of typhoid and other fevers, but in cases of heart failure from hemorrhage, of surgical shock, collapse under chloroform or ether, opium poisoning, coal gas asphyxia, drowning, etc."--Dr. J. H. Kellogg, in _Bulletin of the A. M. T.

A._, Jan., 1899.

Dr. N. S. Davis tells of a case of threatened collapse where he was called in consultation. Patient was in a small, unventilated room.

"It was easy to see that what she needed was fresh air in her lungs. Instead of giving alcohol in any form she was moved into a large, well-ventilated room. All symptoms of 'heart failure'

disappeared. Had she begun to take whisky or brandy, physician and friends would have attributed her recovery to that, when in fact it would have r.e.t.a.r.ded recovery by hindering oxygenation of the blood."

"It would also be a very great mistake to suppose that when reaction follows collapse, in cases in which alcohol has been given, this result is always due to the alcohol. I have seen so many cases of severe collapse recover without alcohol that I cannot but be skeptical as to its necessity, and even as to its value. I was much struck many years ago by a case of post partum hemorrhage which was so severe that convulsions set in. I should then have given brandy if there had been any to give, but there was none in the house and none to be got. I administered teaspoonfuls of hot water and the patient revived and recovered; next day, except for anaemia, she was as well as ever, with no reactionary fever or other disturbance, as would almost certainly have been the case if brandy had been given.

"In collapse from hemorrhage, we have learned the value of injections of warm saline water, either into the veins, the skin or the r.e.c.t.u.m, and the same treatment is available in other cases of collapse with contracted vessels.

"Another measure which has proved most efficacious is the _inhalation of oxygen_ gas. This is especially useful in cases in which alcohol is decidedly injurious, namely, those in which there is increasing congestion of the lungs, which the heart, though doing its utmost, is unable to overcome. Alcohol only increases the congestion, and the heart is already over-exerted and nearly exhausted. The effect of the oxygen is apparent in a few seconds, and cases have been rescued in which death appeared to be inevitable and imminent."--DR. RIDGE.

HEART STIMULANTS:--"The advantage of beef extract over alcohol as a stimulant was demonstrated on a large scale in the Ashantee war."--DR. RIDGE, London.

For those who must have a drug: aqua ammonia, 8 drops to 1/2 cup of hot water, or 20 grains carbonate ammonia to 1/2 cup water. Hot water alone is a useful stimulant; also water, hot or cold, with a few grains of Cayenne pepper added. The latter is good, not only to start the heart's action in collapse, but also to relieve violent pain. Hot milk is a most valuable stimulant. Many persons to whom hot milk has been given during the extreme weakness of acute disease have testified afterward to its good effects in comparison with the wine formerly administered. The wine caused an after-feeling of chilliness and weakness, while the milk gave warmth and added strength.

INSOMNIA OR SLEEPLESSNESS:--"A person who suffers from sleeplessness should avoid the use of tea and coffee, tobacco, alcoholic liquors and all other disturbers of the nervous system. Eating immediately before retiring has been recommended, but the ultimate result may be an aggravation of the difficulty instead of relief. If a person suffers from 'all gone feelings'

so that he cannot sleep, he should take a few sips of cold water or a gla.s.s of lemonade. As complete relief will generally be obtained as from eating, and the stomach will be saved work when it should be resting. A warm bath just before retiring, a wet-hand rub, a cool sponge bath, gentle rubbing of the body with the dry hand, a moist bandage worn about the abdomen during the night, are all useful measures. When the feet are cold, they should be thoroughly warmed by a hot foot or leg bath, and thorough rubbing. When the head is congested, these measures should be supplemented by the application of cold to the head, as the cold compress or the ice-cap."

A walk in the evening, or gentle calisthenics, may help those of sedentary habits. Bicycle riding and horse-back riding in the evening have helped many.

The practice of long deep breathing will often put persons to sleep when all other devices fail. The lungs should be filled to their utmost capacity, and then emptied with equal slowness, repeating the respiration about ten times a minute, instead of eighteen or twenty, the natural rate. Those who fall asleep upon first going to bed, and after a few hours awake, and are unable to sleep again, may find relief by getting out of bed, and rubbing the surface of the body with the dry hand. Or walk about the room a few minutes, exposing the skin to the air, go back to bed and try the deep breathing.

"The use of drugs for the purpose of inducing sleep should be avoided as much as possible. Opium is especially harmful. Sleep obtained by the use of opiates is not a subst.i.tute for natural sleep. The condition is one of insensibility, but not of natural refreshing recuperation. Three or four hours of natural sleep will be more than equivalent to double that amount of sleep obtained by the use of narcotics. When a person once becomes dependent upon drugs of any kind for producing sleep, it is almost impossible for him to dispense with them. It is often dangerous to resort to their temporary use, on account of the great tendency to the formation of the habit of continuous use.

The use of opiates for securing sleep is one of the most prolific means by which the great army of opium-eaters is annually recruited. Chloral, bromide of potash, whisky and other drugs are to be condemned almost as strongly as opium."--DR.

KELLOGG.

Dr. Furer, of Heidelberg, Germany, in a paper before the International Congress against alcohol, held in Basle, Switzerland, in Sept., 1895, said:--

"The sleep from alcohol does not act as a mental tonic, but leaves the mind weaker next day."

Some n.o.ble specimens of manhood have become wrecks through accepting the advice to try "whisky night-caps." Edison recommends manual labor, instead of going to rest, for aggravated insomnia. He says sleep will soon come naturally.

LA GRIPPE:--"Alcohol has no place in the treatment of _la grippe_; on the contrary it is because of the too frequent use of this, and other narcotics, that epidemics make such fearful headway in our land, and such must be the rule until the people study the laws of health and obey them. Profuse sweating, followed by a careful bathing of the body in tepid water, gradually cooling it to a normal temperature, and avoiding unnecessary exposure, will relieve. The patient should sleep in pure air and eat as little as possible, and that only when hungry. * * * * * Quinine is essentially a nerve poison, and capable of producing a profound disturbance of the nervous centres. A drug of such potency for evil should be employed with the greatest care, and never when a milder agency will secure the result. Exceedingly pernicious is the habit of dosing children with this drug."--DR. CHARLES H. SHEPARD, Brooklyn, N.

Y.

"A late surgeon of the gold coast of Africa wrote the following to the London _Lancet_ of Jan. 2, 1890: 'Some of the worst cases of this disease, the grippe, remind me of an epidemic I saw among the natives of the swamps of the Niger. * * * * *

Irrespective of disinfectants and inhalations there is a simple, effective and ready remedy, the juice of oranges in large quant.i.ties, not of two or three, but of dozens. The first unpleasant symptoms disappear, and the acid citrate of potash of the juice, by a simple chemic action decreases the amount of fibrine in the blood to an extent which prevents the development of pneumonia.'"

The Syracuse (N. Y.) _Post-Standard_ contained the following during the epidemic of 1899:--

"Dr. George D. Whedon declared to a _Post-Standard_ reporter yesterday that there is practically no subsiding of the grippe in this city. Dr. Whedon said that the weather conditions have little, if anything, to do with the disease, and that it is impossible to define the conditions which produce it. It is some morbific agency, the influence of which, Dr. Whedon said, is exerted upon the pneumogastric nerve.

"_Dr. Whedon was emphatic in denouncing treatment by means of alcoholic stimulants, and coal tar derivatives._ In discussing the subject at some length he said:--

'I find that infants and young children are practically exempt from the disease, and the liability increases with age. In my own experience, which has since 1889 amounted to an aggregate of 3,000 cases, alcoholic stimulants have appeared to be usually of little or no value; their usual stimulating effect does not seem to be realized in this condition. Unless malarial complications exist quinine appears of no benefit, and then should not be used in larger than two grain doses. Large doses depress the weakened heart, and in all cases increase the terrible confusion and headache constantly present in severe cases.

'From the views I entertain of its pathology, and from the terrible fatality which has attended the extensive use of the coal tar derivatives in treatment of _la grippe_, I argue that the manner in which they have been prescribed in the beginning of the disease, to reduce fever, and relieve the often intense suffering, lowers the heart's action, which is already sufficiently incapacitated by the toxic agent producing the disease.

'The intention is usually to stimulate later, but later is in many cases unfortunately too late. The heart being overwhelmed by the poison, and by the added depression of all coal tar preparations, cannot keep up the pulmonary circulation. The swelling of the lungs increases, and the result is fatal.

'I am aware of the weight of authority for their administration and of the relief they afford, but am just as well a.s.sured that were their use discontinued, the greatly increased death-rate from _la grippe_ would cease to appear.

'These coal tar remedies are being used everywhere, and the medical journals recommend them despite the fatal results. They are being used every hour in the day in Syracuse, and, as a result, are knocking out good people. Among the most popular coal tar derivatives I might mention anti-kamnia, salol-phenacetine, anti-pyrine and salicylate of soda.

'Prognosis is favorable at all ages. Patients should be kept warm, and perfectly quiet in bed, and supplied with such nutritious and easily digested food, at frequent intervals, as the partially paralyzed stomach can take care of. All nourishment must be fluid and warm rather than cold.'"

The _Journal of Inebriety_ for April, 1889, says:--