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.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
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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    two days only, and then fell steadily to 26 fluid ounces—the same amount as on the day of the patient’s admission. He became ill again, and dropsy reappeared in the lower limbs. Manifestly the in- fluence of our treatment on the heart and kidneys, whilst it had been very powerful, was not maintained. It had sufficed to clear off the arrears, but it had not sufficed to establish the smallest reserve, nor indeed to supply an ordinary amount of what might be called working capital. Within a few days of its deprival of the assistance of digitalis the heart was already in fresh difficulties, although in every other respect the treatment remained unchanged ; and after eleven days it was failing rapidly. It appears from this observation that digitalis, although its action on the heart persists for days after its reduction, must be continued for a certain length of time if the benefits it has effected are to be maintained. It ought not to be suddenly with- drawn. We removed it in the present instance, as I have said, because the pulse had fallen to 48, and the diastolic pause with its striking murmur of aortic reflux somewhat alarmed us. We departed from the rule which the practitioner had learned long ago to observe, to reduce slowly the dose of digitalis after relieving with it the urgent manifestations of cardiac failure, and we believed at the time that we were right in departing from it, but now we found that we were wrong. We therefore determined to correct our error by resuming digitalis ; and accordingly, on December 25 (the thirty-third day of treatment) the