The Antagonism of Therapeutic Agents; And What It Teaches - The Essay... (Paperback)

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1878 edition. Excerpt: ... obstruction commonly does not come under the notice of the physician unless the patient has been pulled down by some intercurrent condition or malady. In elderly persons, however, it presents itself primarily with certain objective and subjective phenomena. Here a new balance can only be effectually struck by an increase in the driving power, so that the normal amount of blood may be driven through a narrowed orifice in the normal time. According to the view that digitalis slows, or retards the systole, and so permits the blood in the ventricle to be completely passed through the narrowed orifice, the wants of the system would be no more perfectly met than before. But against this view are the facts that in unaided hypertrophic compensation in aortic stenosis there is no such elongation of the systole; and that Balthazar Foster has shown that digitalis does not slow the systole, but lengthens the diastole. In aortic stenosis digitalis is indicated in small or medium doses according as the hypertrophied ventricle can, or can not, quite successfully meet the obstruction offered. If the ventricle cannot completely empty itself, and blood is accumulating in the left ventricle, i. e., a condition of dilatation is being established, then digitalis is clearly indicated. When there is no dilatation, and the compensation is sufficient, digitalis is not required. Aortic Regurgitation.--Here a complex problem is presented to us, for the hypertrophy here, often enormous, is to antagonize the increased internal pressure upon the heart-walls during diastole; not to overcome any obstruction offered. There being a decided increase in the distcnding force, there is dilatation in spite of the massive hypertrophic growth. This enlargement of the left...