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
Catalogue details

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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    impulse and first sound ; the ventricle bangs, as it were, against the chest wall and the stethoscope. The acceleration and irregularity of the heart which characterise the toxic degree of digitalis action of the textbooks are not met with clinically. I herefore, my rule, and the rule I would recommend you to follow, in cardiac failure is not to be deterred by a small irregular pulse from pushing your remedy, and, instead of cutting off the digitalis, to give more. When digitalis does not produce diuresis in cardiac failure, do not discard it lightly : continue it in in- creased doses. But there is a limit to the usefulness and safety of the most valuable of therapeutic measures, and I thought so in this patient’s case when I had reached the fourteenth day of treatment, when the diuresis was profuse, and the pulse had fallen to 50. My house physician, Dr. C. F. Day, my students and myself were impressed all the more strongly with the convic- tion that we had o-one far enough in this direction O C? when we tested the condition of the heart with the stethoscope. You remember that the patient had aortic regurgitation (with other lesions) ; and now that the heart was so infrequent, we heard the period of normal diastolic silence filled by an extremely pro- longed blowing murmur, which brought home to us not only that digitalis “slows” the heart by lengthening diastole, but that in doing so it increases the duration (and therefore the amount) of diastolic reflux if the aortic valves be incompetent. The demonstration in our patient was extraordinarily complete. Although I
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