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.

    28/754 page 12
    12> THE PULSE. first occurs after middle age. It may be persistent or occasional; and when occasional only it is often due to an idiosyncrasy on the part of the patient, and is caused by some article of food, as tea, perhaps green tea, smoking, or indigestion. Certain patients are unconscious of the intermission, and as Dr. Broadbent points out, this is especially the case when the intermission is habitual. Other persons are made very uncomfortable and nervous by a sensation as if the heart stopped or rolled over. The intermission often occurs in the artery only simultaneously with a weak beat of the heart. In most cases an intermittent heart is of no significance, and does not appear in any way to imperil life, though Dr. Broadbent states that a patient so affected succumbs more readily to any ill- ness ; when, however, associated with unequivocal evidence of heart disease intermittency is of more serious import. An irregular is of far more serious significance than an inter- mittent pulse. The pulse is irregular both in force and rhythm, succeeding beats differing in length, force, and character. It is generally due to mitral and rarely occurs in other forms of heart disease, though sometimes met with in great cardiac prostration, as in an acute febrile illness a few hours before death. It occurs too in fatty degeneration of the heart and in the first and second stage of meningitis. It may be called the mitral pulse, and gener- ally indicates the need of digitalis, which in most instances lessens or removes the irregularity. This irregularity from mitral disease may exist with a weakened and degenerated left ventricle. In my experience, if the walls of the heart are degenerated, digitalis fails to influence the irregularity. Whilst an irregular pulse almost always indicates mitral disease, it must be borne in mind that a perfectly regular pulse may accom- pany extensive mitral disease; either obstructive or regurgitant, or both combined. Some hold that the occurrence of irregularity in mitral disease is a sign of defi- cient compensation, the compensation being insufficient to meet the obstruction to the circulation offered by the mitral disease. But if this view is correct, how does it happen that a few doses of digitalis will in many cases restore regularity, and that with the discontinuance of the digitalis the irregularity does not return ? The irregular pulse is very rare in children under twelve though the conditions in which it occurs in adults are well marked. If, say, between six and seven, mitral disease is established, and the child, though suffering from its effects lives till it is over twelve, the intermittency then becomes gradually developed.
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