Treatment of internal diseases : for physicians and students / by Norbert Ortner ; ed., with additions, by Nathaniel Bowditch Potter ; tr. by Frederic H. Bartlett.

  • Ortner, Norbert, 1865-1935.
Date:
[1913], [©1913]
Catalogue details

Licence: Public Domain Mark

Credit: Treatment of internal diseases : for physicians and students / by Norbert Ortner ; ed., with additions, by Nathaniel Bowditch Potter ; tr. by Frederic H. Bartlett. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    28/660 (page 16)
    that it is much less constant in its effect in aortic valvular lesions, par- ticularly aortic insufficiency, than in mitral valvular lesions. The reason for this appears to be that an aortic insufficiency reaches the stage of broken compensation only when the heart muscle has suffered, by fatty degeneration, fibrous myocarditis, or arteriosclerosis of the coronary arteries. [The use of digitalis in aortic insufficiency has been attended with anxiety upon the part of the physician since Corrigan discounte- nanced its employment in this lesion. Fothergill and Morrison, among others, agreed with him. Gibson, on the other hand, considers that digi- talis or one of its congeners is imperatively demanded when cardiac fail- ure makes its appearance. Burr and Balfour before him urged its em- ployment. The former suggested that the objections to its use depend largely upon a priori teaching in pharmacology. The latter always em- ploys digitalis for broken compensation, no matter what the lesion, and thinks that for aortic insufficiency the dose should be 3 times as large as that required for mitral lesions. He does not believe that sudden death is ever due to the digitalis where it is being employed in the former lesion. He combines it with some vasodilator. Allbutt gives digitalis in aortic regurgitation where the muscle is sound. He administers one dose of the tincture (10 min.) every second day and watches the effect upon the flow of urine and the rate and rhythm of the pulse. In a later stage, when the right side of the heart is involved, he believes the drug is rarely harmful. Babcock agrees with Broadbent and gives digitalis freely in this lesion when dropsy is present, but with great caution when the loss of compensation is shown by left ventricular feebleness rather than by oedema. I have found digitalis of much less value in the broken com- pensation of aortic insufficiency than in that of mitral lesions, perhaps partly because I have generally been afraid to employ the drug in the doses that Balfour recommends, usually because so many of my cases (New York City Hospital) have been at the end of their tether, with very little healthy muscular fibre. Broken compensation to me, however, indicates first, absolute rest; second, diet; third, drug treatment. Unless there is some contraindication, I usually begin my drug treatment with 5-15 gr. of calomel, followed by }/o-l oz. of Epsom salts or some other saline; then administer 10-15 min. of the tincture or 2-4 dr. of the in- fusion of digitalis every 3 to 6 hours until decided diuresis is estab- lished or the heart rate (at the apex) is less than 65.] Contraindications to Digitalis.—A diseased heart muscle, especially of the left ventricle, is a classical contraindication to digitalis. If the greater part of the muscular fibres have become degenerated, digitalis can do no good and not infrequently does harm. In all cases, then, of uncompensated lesions, particularly of the aortic valve, digitalis should be given Math great caution if there is any degen- eration of the heart muscle. It should be abandoned entirely if we are sure of fatty degeneration or chronic fibrous myocarditis. In all other cases, when we are not sure of the condition of the heart muscle, it may