The Lettsomian lectures on diseases and disorders of the heart and arteries in middle and advanced life / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1902
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Licence: In copyright

Credit: The Lettsomian lectures on diseases and disorders of the heart and arteries in middle and advanced life / by J. Mitchell Bruce. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    of the three great therapeutical indications foi- the treatment of cardiac failure: to reduce the peripheral I'esistance; to increase the vigour of ventricular contraction and i-ehal)ilitate hypei-trophy ; and to remove arrears of work in the form of residual blood in the cardiac chambers, mechanical congestion of the veins and viscera, and dropsy of the integuments and serous sacs. Bodily rest; a light, solid diet, and a definite allowance of alcohol, if required; active purgation with mercurials, salines and jalap; and the exhibi- tion of sufficiently large doses of digitalis or one of its congeners, in combination with saline and other diuretics—these are the means calculated to attain the desired objects. You will not expect me to enter into the many details of the management of cardiac failure. It is not different in any important respect in the man of middle or advanced age with cardiac degeneration from what it is in an ordinary case of chronic valvular disease. Only on a few points do I desire to dwell. First, that we must not be afraid to purge these patients, if necessary, every morning. Secondly, that when the appetite flags and flatulence occurs, instead of slops a blue pill or a dose of calomel should be given, and light solids persevered with. Third, that digitalis must be given freely, the dose of the tincture, for instance, being raised to 15 or even 20 minims every four hours, if smaller doses, such as 7|- or 10 minims, fail. Unquestionably there is a disposition on the part of some prac- titioners to pause or retrace their steps in the dosage of this invaluable drug, alarmed by the irregularity, frequency and small- ness of the pulse. All these characters of the pulse call for more digitalis, not for less. In this connection let me also say that the most ready and accurate, because measurable, evidence of the action of digitalis in cardiac failure is strangely disregarded in ordinary practice—I mean the volume of the renal secretion. We may be in difliculty, and we may diff'er with each other, as to the tension of the patient's pulse and the use of continuing or modifying the digitalis treatment, when all that we have to do is to ascertain the exact degree of diuresis. Fourth, that nocturnal restlessness and sleeplessness are to be met unhesitatingly with permission to spend the night in an easy chair by the bedside. Fifth, that, according to my experience, acupuncture and drainage succeed perfectly, in these senile cases with dropsy, as much as 10 pints or more of serum escaping in the course of 24 hours, to the complete and often lasting relief of the circulation.