If the cause of angina is due to changes in the arteries which supply the heart with blood, and if, as outlined in the preceding article, these arteries tend to become fewer and to narrow with age, much of the treatment of angina is self-evident. It consists in putting as little strain as possible upon a heart which can no longer rapidly supply itself with nourishment.
The patient who has had one attack of angina, in the words of a well-known American clinician, “Must ever after shape his life in accordance with his narrowed limitations. He should not exert himself unduly and should cease playing golf, tennis or similar active sports. Short business hours and a long post-prandial siesta are very desirable, and a five-day week is an excellent thing for such an individual. If economic conditions permit, the patient should take a winter as well as a summer vacation. Many spend their vacations unwisely. In-stead of resting, they work just as hard only in a different way.”
The use of tobacco the patient himself usually learns to give up. Almost invariably tobacco, especially in the form of a cigar or pipe, induces an attack. It is surprising how easy it is in most cases to give up this life-long habit. I remember condoling with a professional colleague of mine, who, like myself, had been a heavy cigar smoker, on the fact that he had to do without his comfort. His reply was, “Glen, if you had the kind of pain I have when I smoke a cigar, you would give it up with praise and thanksgiving.”
This does not signify by any means that it is tobacco which origin-ally causes angina, but after the anatomical changes have occurred in the heart and an attack has been precipitated, tobacco frequently induces an attack.
The use of other habitual stimulants, on the other hand, is on an entirely different basis. Coffee for these people I believe to be not only harmless, but absolutely beneficial. Coffee increases circulation through the heart muscle, and for that reason is a good thing. In fact, several of the drugs, such as theobromine and metaphyllin, which are used in this condition, are for all practical purposes chemically similar to coffee and similar in their action.
Whiskey and brandy also are actual medicines, beneficial in this disease. Among the first accounts that we have of it, the treatment which is recommended is brandy, and I know at least one patient who has had angina attacks, to my positive knowledge, for over 12 years, whose life, I believe, has been preserved for that time by a fairly regular and liberal use of highballs. It is, in fact, a justice to people of this kind that repeal of the Eighteenth amendment allowed them to obtain medicine in quantity which would be sufficient for their needs.