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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    dulness may be broadened during attack, in the intervals the dimensions and sounds of the heart may in the earher stages be perfectly normal. 4. In the earlier stages and in the most characteristic cases the heart hurry has been observed to begin and to finish quite abruptly. This was so in Dr. R. P. Cotton's* case and in Sir T. Watson's, in the latter the pulse suddenly changing from 216 to 72 with subsi- dence of all symptoms whilst that physician was still in the room. 5. So far as any exciting cause can be stated it has been for the most part mental shock, mental or physical overstrain. The above characteristics are sufficient to show, were demonstration needed, that the condition is a pure neurosis and that the neurosis must be either of the vagus or sympathetic cardiac centre seems fairly cer- tain. It is inconceivable that a paralytic affection of the pneumo-gastric centre should be so persistent, should be attended with a regularity of rhythm so generally notable, and should be capable of such abrupt termina- tion as is observed in some cases. The view of sympathetic excitement is perhaps better supported by other phenomena of sympathetic irritation, such as sweatings and flushings of the face. No auto-intoxicant can be recognised in most cases. It is worthy of remark, on the one hand, that many people, especially women, suffer from persistent hurry * R. P. Cotton, British Medical jfournal, 1867, vol. i , p. 629. D