Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL CO.MMUNICATIONS. 227
branch of medicine; and this remarkable ation of the circulation, as revealed in
fact, in which all physicians must rejoice, secretory functions, in certain viscera, notais
to he explained upon a two-fold basis: bly the kidneys, intestines, liver, lungs, and
notably, the new and clarifying additions so on.
to our knowledge of the phenomena often The potency of the therapy of serious
characterizing pathologic conditions of the cardiac conditions might be discussed in
heart and, secondly, a coincident enlighten- several ways, but I desire to present the
meut upon the value and therapeutic appli- subject from the view point of drugs comcalion
of remedies used in these conditions, monly used in heart maladies.
When we reflect upon the pictures present- Digitalis.—This is the great cardiac stiming
clinically in some cases of heart dis- ulant. It has its definite field of therapeutic
ease, as that of failing heart with dropsy, application. It has its peculiarities that
dyspucEa, insomnia, discomfort and many makes it dangerous and harmful to the
others, or of angina pectoris with its great heart under some conditions. It is toxic
pain, alarm, and so on, or some functional from cumulative effect or from over-dose,
syndrome with its tachycardia or brady- producing incoordination and disassociacardia,
and see these groups of heart mala- tion of auricular and ventricular systole.
dies yield to therapeutic agents and be He who gives digitalis to slow the heart in
removed from conditions of gravest danger paroxysmal tachycardia, in cases of fever,
I
to those of comparative comfort and security in cases of associated acute nephritis, in
against premature and sudden end, we pleural effusion, in cases of extensive and
can very readily understand the renewed late degeneration of the myocardium with
interest and enthusiasm exhibited in the arteriosclerosis, in pneumonia, in rheumatic
consideration of this subject. The former fever, will meet failure in its use. In these
conception that heart murmurs were the conditions digitalis is impotent. Not only
only diagnostic symptoms of supreme im- the nature of the heart lesion has an effect
portance; that the lesion back of such mur- upon the efficiency of its action, but also
murs, of structural origin, represented ir- the kind of preparation has a decided inremediable
conditions in which effort should fluence upon the results secured. Therebe
limited to the comfort of the case; that fore, it is important in administering this
the heart should not be considered thera- drug to know that you are working with
peutically until these murmurs were as- a physiologically standardized preparasociated
with pronounced symptoms of a tion. This subject has recently been
more or less distressing kind, is giving way thoroughly investigated by Edmunds and
to the view that heart murmurs give but Hale (Bulletin No. 48 Public Health and
little valuable information in connection Marine Hospital Service of the United
with the matters of greatest importance in States). The action of digitalis upon the
the treatment of cardiac diseases, that val- heart may be divided into three elements,
vular disease is really of far less imi^ortance It slows the pulse by prolonging the diasthan
the behavior of the myocardium and tole through stimulation of the vagus. It
that the early management of beginning effects greater tonicity in the heart muscle
derangement in cardiac action is of the and thus produces a stronger and more
greatest importance, and that upon these complete systole. It acts to produce conconditions
deoend therapeutic success. striction upon the splanchnic arterial vesf\nother
more recent consideration of this sels and dilatation of the peripheral and
subject is to take a broader range as we cerebral arterioles, due, it is thought, to the
tudy cardiac problems. No longer do increased pressure in the internal arteries,
clinicians deal with heart pevse. The vas- (. Miller, J. A. M. A., Vol. II, No. 21, citcular
system has to be considered at the ing Gottlieb and Magnus). Having the
same time. The newer views of arterio- standardized drug and administering it in
[sclerosis have added much to the success- the selected cases in which it is useful the
jlful management of cases with prominent clinician has to watch the effect of the diug
Icardiac disease. The mere fact that palp- upon the heart very carefully. Sometimes
lable arteries seem not involved in sclerosis brilliant results will be forestalled by the
does not preclude the likelihood of serious too persistent use of it; sometimes the retvascular
disease:— not infrequently a con- suits will be delayed by the insufficient
Mition in which the crux to the distressing dosage. The careful study of the pulse, an
I;ymptoms
are to l)e found. Internal and accurate observation of the daily secretion
ocal arteriosclerosis, with or without high of the urine nre essential as a guide
irterial blood pressure, often sustain a most in its use. The fir^t good effect to be
mportant relationship to the cardiac em- noted in the use of digitalis will be the in-
)arrassnient. luirther, the value of medi- crease of urine; this usually appears in
ration in cardiac diseases depends upon an about forty-eight hours. The pulse is
idequate understanding of the proper oper- slow^ed, has more precision and more vol-