Physiological principles in treatment / by W. Langdon-Brown.

Walter Langdon-Brown

Date:: 1914

Credit: Physiological principles in treatment / by W. Langdon-Brown. Source: Wellcome Collection.

326/426 page 312

$and therefore a rise of blood-pressure. Recent ob¬ servers have failed to find this vaso-constrictor action in human beings. Still, it seems to me not to give satisfactory results when the pressure is high, and, indeed, Withering, when he introduced the drug, did not advise its use in the type of case which we now know has a raised pressure. In such circumstances I prefer strophanthus, or with the digitalis a slowly acting vaso-dilator, such as erythrol tetranitrate, \ grain, or mannitol nitrate, 1 grain, every six hours. In my opinion the blood-pressure ought to be deter¬ mined in every case. Turning from the vessels to the heart, we have to distinguish between the action of the drug on con¬ ductivity, on tonicity, and on contractility. On con¬ ductivity digitalis often-has a depressing effect; Mac¬ kenzie has shown that it causes a delay, and sometimes a stoppage, in the transmission of the impulse from auricle to ventricle. Conduction is such an important function of the auriculo-ventricular bundle that, when this structure is involved, as in partial heart-block, digitalis is contra-indicated. In many cases of heart- block the blood-pressure may be quite high, although the arterial pulse is so slow. Gibson has seen three cases in which the pressure ranged from 210 to 270 millimetres. In one such case, where the radial pulse was 82, while the venous pulse was 64, I found that the blood-pressure was more than 800 milli¬ metres. Qn the other hand, when auricular fibrillation is$

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