Licence: In copyright
Credit: Angina pectoris / by G. A. Gibson. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![Erythro] tetranitrate, or tetranitrin, is often used in doses of from ^ to 2 grs., while manitol pentanitrate, or pentanitrin, and mannitol hexanitrate, or hexanitrin, have been used in recent years, in the same doses as we use in the case of nitroglycerin ; they are, however, not to be compared with it. In all cases where the heart shows any tendency to falter, or in which it is relatively weak compared with the pressure it has to overcome, the management will necessarily be to all intents and purposes that of cardiac failure ; sufficient rest with graduated exercises and such cardiac tonics as stro- phanthus with nux vomica are to be recommended. ^ In the toxic cases of cardiac pain, the elimination of the poison, the restoration of the cardiac energy and the recovery of the nervous system are the points to be borne in mind. In the case of chemical poisoning, whether due to alcohol, tobacco, or tea, further enjoyment of the poison must be prevented. In such cases a considerable lapse of time is necessary, and continued rest with massage, succeeded by respiratory exercises, and followed by graduated exertion will be necessary. Practically the same line of treatment is necessary in gouty conditions, but the specific for such states is colchicum, which, along with alkalis, will speedily bring about improvement. In instances of influenzic or diphtheritic angina, the best treatment undoubtedly is the same as has been suggested for the chemical poisons. In some cases the use of appropriate baths is indicated; along with such means the employment of strychnine promises the best results. In order to remove reflex angina pectoris, the cause of the disturbance must be ascertained, while at the same time the bromides or hydrobromic acid will lessen reflex irritation. The vasomotor type of the affection is best treated by means of the nitrites, but thyroid extract has, in my hands, produced considerable improvement in cases manifesting symptoms like those of Raynaud’s disease. Lastly, the neurasthenic and hysterical varieties must be dealt with as part of the general conditions in which the symptoms arise, and the modern treatment of such conditions produces, as a general rule, most satisfactory results. J I ii 'r re ■T :|J IJ IJ X II i f a u \ l i](https://iiif.wellcomecollection.org/image/b2168909x_0014.jp2/full/800%2C/0/default.jpg)
