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]
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.
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![be given as a diagnostic experiment. If in 4 or 5 days it produces no effect (increased strength of pulse, diminution of peripheral arterial tension and of the height of the pulse wave, fewer symptoms of conges- tion, increased diuresis), the heart muscle may be considered to be degenerated. All further administration of digitalis is then not only useless but directly dangerous. [In many cases of quite advanced fibrous and fatty myocarditis, I have obtained at least a temporary benefit from carefully administered doses of digitalis. Where such cases can be care- fully watched, the drug, in my opinion, is often worth trying.—Ed.] In addition to fatty degeneration and chronic myocarditis, which are often accompanied by an abnormally weak pulse not to be explained by the lesion itself, especially aortic insufficiency, a further contraindica- tion to digitalis therapy is an abnormal slowness of the cardiac contrac- tions. The heart itself need not be slow, for in uncompensated lesions extra contractions which do not reach the periphery often occur and sim- ulate true bradycardia, thus sometimes keeping us from the use of digitalis just where it would be most useful. If there is a true slowing of the pulse, atropine should be added to the digitalis so as to obtain all the effects of digitalis except the slowing of the pulse. We may pre- scribe it as follows: B Atropin. sulphat 0.001-0.002 gr. y»-Vso Syr. rubi idsei 15.00 3iv Inf. digitalis 180.00 gvi M. fiat solut. Sig.—1 tablespoonful every 2 hours. [Cushny does not countenance this combination. On account of its very slight inhibitive action, he tried helleborein in a few cases, but with no success, because its local irritant action produced nausea and diarrhoea. ] If a heart lesion, generally an aortic insufficiency, has developed by the extension of an atheromatous process to the aortic valves, ergotin (as Rosenbach has recommended) may be added to the digitalis, especially if the heart action is not conspicuously quickened (see p. 57). The author considers digitalis alone dangerous in the case of very rigid vessels, although uncomplicated arteriosclerosis is not a contraindication. Marked arteriosclerosis, when repeated rupture of the vessels has occurred, is. One practical point, commented on especially by Eichhorst, is that very much run down individuals are often not affected by digitalis unless it has been preceded by large doses of alcohol. If digitalis, administered for a stated number of days, or until the first appearance of symptoms of intoxication, has a plainly good effect upon the symptoms of broken compensation without wholly removing them, its use should be suspended for from 10 to 15 days, and then tried a second and a third time. Meanwhile some of its familiar substitutes may be employed, although they are not so efficacious in their tonic effect upon the heart and peripheral vessels. 2](https://iiif.wellcomecollection.org/image/b21169901_0029.jp2/full/800%2C/0/default.jpg)
