The action and uses of digitalis in cardiac failure : a clinical lecture delivered at the Hospital for Consumption and Diseases of the Chest, Brompton / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1906
Catalogue details

Licence: In copyright

Credit: The action and uses of digitalis in cardiac failure : a clinical lecture delivered at the Hospital for Consumption and Diseases of the Chest, Brompton / by J. Mitchell Bruce. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    am not one of those who dread giving: digitalis for failing heart in aortic incompetence, I felt that the time had come to reduce the dose; and I did so, giving but 5 minims instead of 15 every four hours. We now enter upon the third phase of our obser- vations, and we shall find it as instructive as the first and second phases. To begin with, the volume of urine steadily fell off to 80, 60, 50, 40, and finally to 30 fluid ounces. I questioned whether this fall could be solely referred to the reduction of the diuretic drug. The dropsy had been practically removed by this time, and since there was no effusion to remove, and as the diet remained “dry,” the urinary excretion necessarily declined. That this was the correct ex- planation appeared to be proved by the striking fact that the pulse continued to be infrequent, usually under 60, for about another week, and, indeed, at the end of that time fell to 48. The dose of digitalis, smaller though it was, appeared to maintain such an amount of the drug in the body (once it had been, as it were, saturated with it) that the heart remained under its influence. Accordingly, on the twenty- second day of our observations, trusting that we had overcome the dropsy, 1 removed digitalis entirely, nux vomica alone being given. Let us consider the phenomena of the phase which we had now reached, the fourth phase of the case. The pulse rose steadily from 48 through 54, 78, 90, and 106 to 124, and became irregular and smaller. In the same time the excretion of urine remained constant for a few days, rose to 40 fluid ounces for