A text-book of medical treatment : diseases and symptons / by Nestor Tirard.

  • Tirard, Nestor Isidore Charles, Sir, 1853-1928.
Date:
1900
Catalogue details

Licence: In copyright

Credit: A text-book of medical treatment : diseases and symptons / by Nestor Tirard. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    28/728 (page 12)
    aortic valves, or at all events from the failure of compen- sation of the amount of obstruction or of leakage at the aortic valves. Thus patients constantly suffer from transient attacks of giddiness, especially after undergoing extra exer- tion or on assuming the erect posture suddenly. The degree of discomfort in aortic cases essentially depends upon the nutrition of the hypertrophied left ven- tricle. Very commonly, as age advances, the hypertrophied muscle undergoes gradual degeneration and becomes unable to cope with the increased aortic incompetency. Measures must therefore be adopted to retard the degenerative changes so far as possible, and to maintain the nutrition of the ven- tricle ; while, if we have good grounds for believing that degeneration has already taken place, additional warnings must be given of the risks incurred with any sudden over- strain. When patients complain of symptoms referable to the heart—that is, of sense of fulness within the thorax, or of pain in the cardiac region, or of increasing dyspnoea— relief may frequently be afforded by the employment of stimulant remedies : graduated doses of compound spirits of ether and of compound spirits of ammonia, together with avoidance of overstrain, and in some cases with actual rest in bed, will often afford temporary relief. In such cases, also, digitalis may be beneficial, though it is often urged on the other hand that by causing prolongation of diastole this drug gives more time for the blood to regurgitate into the dilating ventricle. Still, it must be regarded as a clinical fact that in a large proportion of cases of aortic disease benefit results from the use of digitalis. The cardiac contractions become more regular and more efficient, and the sense of discomfort is diminished. It has also been m'ged against the employ- ment of digitalis in aortic regurgitation, that by causing contraction of the arterioles it increases the blood pressure and so further embarrasses the action of the heart. It must be admitted that in certain cases little relief is afforded by the use of this drug; while greater help can be obtained from remedies which diminish the blood pressure—that is, by vaso-dilators. Speaking generally, the degree of benefit likely to result from the use of digitalis is to be measured by the extent of failure of compensation ; in other words, there