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.

    29/754 page 13
    Though irregularity from mitral disease is rare in children, yet I have seen aconite, in half-drop doses repeated hourly, several times produce in them marked irregularity of the pulse. Irre- gularity of the pulse in children is common in the first and second stage of tubercular meningitis; in fact its existence is often a valu- able diagnostic guide. Hitherto I have referred to the dependence of the pulse exclu- sively or mainly on the condition of the heart. But the condition of the blood-vessels themselves also influences the pulse. Through the action of the vaso-motor nerves on the muscular coat of the arteries, the small blood-vessels undergo relaxation or contraction. When the vessels are relaxed the blood passes easily from the arteries to the veins, hence arterial tension is slight, and the pulse is soft and compressible, but owing to the relaxed state of the vessels it is also large. A relaxed condition of the arteries, therefore, produces a large, soft, compressible pulse. In most diseases, a relaxed condition of the arteries is associated with a weak heart. Sometimes, however, we have arterial relaxa- tion with a normal heart, in which case the pulse is soft and com- pressible, but large. This pulse is met with in the early stage of some fevers. * Arterial relaxation, or, in other words, diminished arterial ten- sion, produces dicrotism. In this pulse one of the normal second- ary waves of oscillation becomes greatly exaggerated, so that it can be easily felt by the finger. Indeed it may be so distinct that an inexperienced person mistaking it for the primary wave, might easily be led erroneously to think it indicated a cardiac contrac- tion. Indeed a nurse has been known to make this mistake and thus to double the number of true pulsations. Dicrotism always indicates marked arterial relaxation, and often coincides with car- diac weakness. Some writers insist that this pulse indicates the use of alcohol, which should be pushed till the dicrotism ceases. Now, in this opinion I cannot concur, feeling convinced that in many cases with marked dicrotism no alcohol is needed. We must look rather to the frequency of the pulse, and if this shows the need for stimulation, then no doubt dicrotism affords additional evidence in favour of giving alcohol. A pulse not very frequent, but dicrotous and compressible, occurring at the commencement of a fever, does not necessarily indicate the need for alcohol: but this state leads us to expect that stimulation may be shortly required, and warns us to watch our patient carefully, so as to anticipate and to prevent the oncom-
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