A handbook of therapeutics / by Sydney Ringer.

  • Sydney Ringer
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of therapeutics / by Sydney Ringer. Source: Wellcome Collection.

    23/754 page 7
    become fibrous or calcareous. The pulse is an accurate index of the condition of the heart, and is therefore the most valuable guide in disease. The importance of the pulse is manifest when we consider that disease kills by arresting- the heart. Whilst the heart beats there is life and hope. In many instances, the pulse gives the promptest siens of dangrer and the earliest indications for treatment. To illustrate this by an example, take the case of pneumonia, in which disease so long as the pulse continues good we have fair hopes of our patient. In some patients the heart fails early and the pulse soon reveals this condition; the patient fails, we say, at the heart. In other instances, the nervous system first gives way, shown by sleeplessness and muttering delirium ; but though these symptoms cause anxiety, yet so long as the pulse remains good, we hope to save our patient. The anxiety we feel with regard to this nervous perturbation arises from its depressing effect on the heart; for if the patient does not sleep, this unrest, with the consequent delirium, rapidly depresses and weakens the patient, and at last arrests the heart. The disease, therefore, may directly tell on the heart, or it may indirectly affect this organ by its depressing effect on another system. In any case it is the ultimate effect of the disease on the heart that destroys life. It is hardly possible, therefore, to over- estimate the cardinal importance of the pulse. The pulse-beats may be frequent or infrequent; slow or quick; small or large; compressible or incompressible; regular or irre- gular; or intermittent. By the frequency of the pulse we mean the number of beats in a given time. In a quick pulse each beat occupies less than the usual time, that is, each wave is of short duration relatively to the pause be- tween the waves. When the volume of the pulse is greater than usual, it is said to be large; or the volume may be less than usual when it is said to be small. When the fingers can easily stop the pulse it is said to be com- pressible ; when, on the other hand, it can be arrested only with difficulty or not at all, the pulse is said to be incompressible. The pulse may be irregular or intermittent. In an irregular pulse, succeeding beats differ in length, force, and character. In an intermittent pulse a beat is from time to time lost. Five conditions produce a frequent pulse :* Fever, debility, ex- * The pulse is greatly accelerated in exophthalmic goitre.
    digitised image 1
    digitised image 2
    digitised image 3