ETIOLOGY AND PATHOLOGY.—The true nature of this symptom is not estab lished. Medullary disease, pressure upon the pneumogastric, or organic changes in either structure have been noted post mortem. Wood ascribes the disorder to lesions of the accelerator centres. Mar tins considered it as the manifestation of an acute cardiac dilatation.
J'hysiology can help one but little in explaining paroxysmal tachycardia, nor is one able to understand how the nor mal heart-rate can he multiplied four times for hours or days together with out apparent damage to the organ. It seems rational to believe that these at tacks are epileptiform in character; but unfortunately this loaves us about as much in the dark as we were before, ex cept as to the indications for treatment. Joseph O'Carroll (Medical Press, Jan. 7, 1903).
— Huchard advises the following: 1. During the attack physical and mental repose must be secured. The patient should be placed in bed, and lie on the right side as much as possible. The head should be low, because syn cope is always to be feared. Czermak and Quineke think that the heart may be slowed by light compression of one or the other of the carotids. In one of Nothnagel's cases the paroxysm could be arrested by deep inspiration; a spray of chloride of methyl in the pr[eeordial re crion or on the back of the neck some ,' times succeeds. Digitalis may be effect ive or not. 2. During the interval be tween the attacks, abstinence from tea, coffee, liquor, and, above all, from to bacco. Disturbances of the alimentary canal must be avoided, as well as any physical or mental excess. In cases where the arterial tension is very low, quinine and ergot in pill form have given good results. Antipyrine has been employed by Huchard without success, and veratrum viride has also failed. In several cases nothing has ended the paroxysm so quickly as an injection of morphine.
The application of the ice-bag to the prfecordial region produces an increase of the systolic force by acting directly on the myocardium, an increase of the blood pressure, diminution of the number of the cardiac pulsations, and the disappear ance of irregularities of the pulse. It also favors the pulmonary circulation and the respiration. lsnel (These de Paris, '95).
Slow Heart (Bradycardia, or Brachy cardia).
Slowness of the pulse is often observed in old people and occasionally during middle age, without evidence of im paired health. But a slow pulse does not invariably mean that the case is also one of slow heart, since every other beat of the latter may fail to be transmitted peripherally, and thus convey a wrong impression as to the rapidity of cardiac action.
-A bona-fide case of slow heart—determined by auscultation—may give rise to no subjective symptom, es pecially when permanent; in some cases it occurs in paroxysms. In such patients vertigo is first complained of, and the sufferer may become unconscious; the enforced recumbent position with the head on a level with the body usually enables the patient to quickly return to consciousness, but, on attempting to rise, he is apt to resume the syncopal state. Tinnitus, muscat volitantes, and marked prostration are complained of between the attacks. The pulse at such times may become extremely slow: below ten, in some cases. When such attacks occur in aged individuals death may occur, es pecially if the patient is allowed to as sume even the sitting position suddenly. Such cases are rare, however.
who has carefully studied this subject, states that the pulse may be greatly low ered during the puerperal state whether the labor be premature or at term and during prolonged fasting. This he terms physiological brachycardia. The patho logical variety often follows the acute fevers, especially pneumonia, typhoid fever, acute rheumatism. and diphtheria; and is the result of exhaustion (Traube). It may also be caused during gastric dis orders. ulcer, cancer, or even chronic dyspepsia (the result, probably, of in sufficient nutrition), and occasionally as the result of disorders of the respiratory tract, especially emphysema. It is not infrequently met with in connection with fibroid and fatty changes in the heart, but seldom with valvular disease. Ne phritis; uraemia; poisoning by lead, to bacco, alcohol, coffee, and digitalis; awe mia, chlorosis, and diabetes; apoplexy, epilepsy, cerebral tumors, affections of the medulla, injuries of the cervical cord; general paralysis, mania, and melan cholia; cutaneous and other affections of the genital tract, sun-stroke, and ex haustion from any cause, may, accord ing to Riegel, be associated with slow pulse.
- The recumbent posi tion, strictly enforced, is of the greatest importance until the heart has resumed its normal action. Caffeine, chloride of ammonium, strychnine, and atropine are the most effective remedies, and digitalis in small doses may be given as a cardiac stimulant. Small doses of whisky or brandy—a tablespoonful of brandy or whisky in a little hot water repeated every two hours, when the patient can drink—is a very effective means. Large doses are more hurtful than beneficial.