The action and uses of digitalis in cardiac failure : a clinical lecture delivered at the Hospital for Consumption and Diseases of the Chest, Brompton / by J. Mitchell Bruce.

  • John Mitchell Bruce
Date:
1906
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Licence: In copyright

Credit: The action and uses of digitalis in cardiac failure : a clinical lecture delivered at the Hospital for Consumption and Diseases of the Chest, Brompton / by J. Mitchell Bruce. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    bably in larger doses. This is an extremely important conclusion, and one which in practice you may hesitate to follow. When you find your patient still very ill, the dropsy increasing, and the pulse very frequent and irregular, you may well ask yourselves the ques- tions, “ Have I given too much ? Is not this the toxic action of digitalis?” You can unhesitatingly answer “ No.” The toxic effect of digitalis clinically is an entirely different one from that.1 Another practical consideration that we reached was that digitalis which is acting or has acted as a diuretic in cardiac failure must not be suddenly re- moved, and must be slowly, not rapidly, reduced in dose before its final removal—that is, continued for some time after the disappearance of dropsy. If in our case, instead of reducing the dose, as I did, at once to 5 minims, and then removing it altogether, I had reduced it first to 12^ minims, and then to 10, and so on, the probability is that we should have had no return of the dropsy. The next point of which I would remind you is that the change in the characters of the pulse, par- ticularly the reduction of its frequency, in response to digitalis precedes the appearance of diuresis, and persists after its disappearance. We have now arrived at a subject on which there is a division of opinion. In our case I demonstrated to you that failure of the heart in association with aortic incompetence was beneficially, as well as safely, 1 Koehnhorn, Viertsschr. f. gerichtl. Med., Neue Folge, 1876, p. 278.
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