On the principles which govern treatment in diseases and disorders of the heart : the Lumleian lectures deliverd before the Royal College of Physicians, London / by Sir Richard Douglas Powell.

  • Powell, Richard Douglas, Sir.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: On the principles which govern treatment in diseases and disorders of the heart : the Lumleian lectures deliverd before the Royal College of Physicians, London / by Sir Richard Douglas Powell. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    It was curious to note the absolute extinction during the attack, of all the aortic characters in the pulse which became contracted to a small, hard, pulsating thread, whilst as the patient sat forward leaning against a chair, in great pain, the bed shook with the violence of the cardiac beats and his neck and sub- clavian vessels could be seen pulsating with responsive violence. A dose of trinitrine quickly brought back the charac- teristic aortic features of the pulse and dissolved the painful scene. One could not observe the labouring beat of the heart, the strongly pulsating large vessels contrasted with the almost effaced small vessels without appre- ciating the power of vaso-motor contraction to cause cramp or paralysis of a weak ventricle, j-et their are ph3^sicians who still doubt the efficacy of vaso-motor spasm in the mechanism of angina. The initial treatment may be started with nitrite of amyl inhalation and the patient should always have such at hand. But the attack is commonly attended with such acute heart failure that the clinical features of high pressure pulse and labouring heart may be immediately lost. Undoubtedly the subcutaneous injection of pure ether to which a minim of nitro-glycerine solution may be added if not already otherwise taken, is the best treat- ment in severe cases if caught at the right moment. The sense of prostration is greater and more defined in these cases.