A handbook of therapeutics / by Sydney Ringer and Harrington Sainsbury.

  • Sydney Ringer
Date:
1897
Catalogue details

Licence: Public Domain Mark

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

    25/798 page 9
    pneumonia, even when double and further complicated by extensive pericarditis, seldom destroys a patient. Again, an irregular pulse from mitral disease may be very frequent, 120, 130, or more, without indicating extreme danger. Sometimes, in acute fever, as, for instance, typhoid fever, though the temperature is high, the pulse remains normal throughout the attack; such a pulse certainly shows absence of cardiac weakness, and is of course a favourable sign. In chronic diseases a frequent pulse very generally indicates cardiac weakness. With increased frequency other signs of cardiac weakness are often associated. The weakened heart propelling the blood less energeti- cally than in health causes diminished arterial tension, and the pulse becomes soft and compressible. Relaxation of the arteries plays a part still more important in producing a compressible pulse ; this con- dition permits the blood to pass with greater readiness into the veins. This relaxed condition of the arterioles, unless the heart is very weak, causes the pulse to be large and voluminous. At first one might erroneously suppose that this pulse indicated an energetic arterial circulation and a well-beating heart, but the compressibility soon corrects this error. It is therefore highly important always to test the compressibility of the pulse. If the heart becomes still more weak, and the arterioles still more relaxed, then each beat propels little blood into the arteries, and these allowing the blood to pass readily into the veins, the pulse becomes small as well as quick, i.e: short and compressible. Smallness of the pulse, therefore, indicates still greater weakness. W hen the pulse is very small, it is said to be thread}’. When the heart is weakened, its contraction often becomes sudden and sharp, rapidly reaching a maximum and rapidly declining, giving rise to a short pulse, which thus often gives evidence of cardiac weakness, especially when combined with the other and surer indica- tions of this state. In estimating, therefore, the condition of the heart, we pay regard to the fiequency, especially with reference to the temperature, to the (impressibility, and to the size of the pulse. The more frequent, the more compressible, the smaller the pulse, the greater the cardiac weakness, and the more imminent the patient’s danger, and the greater the need for cardiac stimulants. These pulse signs, therefore, both in febrile and non-febrile disease, are indications for giving cardiac stimulants, especially alcohol.- These pulse signs, moreover, afford an accurate index of the effects of alcohol and of the amount required; for alcohol strengthens the debilitated heart, reduces the frequency of its beats, and contracts the vessels, and so heightens arterial tension and lessens the compressi- bility of the pulse.
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