Disturbances of the Heart   By: Oliver T. (Oliver Thomas) Osborne (1862-1940)

DISTURBANCES OF THE HEART

Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure

OLIVER T. OSBORNE, A.M., M.D. Professor of Therapeutics and formerly Professor of Clinical Medicine in Yale Medical School NEW HAVEN, CONN.

THE JOURNAL of AMERICAN MEDICAL ASSOCIATION Five Hundred Thirty Five North Dearborn Street, Chicago

PREFACE

The second edition of this book is offered with the hope that it will be as favorably received as was the former edition, The text has been carefully revised, in a few parts deleted, and extensively elaborated to bring the book up to the present knowledge concerning the scientific therapy of heart disturbances. A complete section has been added on blood pressure.

PREFACE TO THE FIRST EDITION

That marvelous organ which, moment by moment and year by year, keeps consistently sending the blood on its path through the arteriovenous system is naturally one whose structure and function need to be carefully studied if one is to guard it when threatened by disease. This series of articles deals with heart therapy, not discussing the heart structurally and anatomically, but taking up in detail the various forms of the disturbances which may affect the heart. The cordial reception given by the readers of The Journal to this series of articles has warranted its issue in book form so that it may be slipped into the pocket for review at appropriate times, or kept on the desk for convenient reference.

CONTENTS

Preface Preface to First Edition Disturbances of the Heart in General Classification of Cardiac Disturbances Blood Pressure Hypertension Hypotension Pericarditis Myocardial Disturbances Endocarditis Chronic Diseases of the Valves Acute Cardiac Symptoms: Acute Heart Attack Diet and Baths in Heart Disease Heart Disease in Children and During Pregnancy Degenerations Cardiovascular Renal Disease Disturbances of the Heart Rate Toxic Disturbances and Heart Rate Miscellaneous Disturbances

DISTURBANCES OF THE HEART IN GENERAL

Of prime importance in the treatment of diseases of the heart is a determination of the exact, or at least approximately exact, condition of its structures and a determination of its ability to work.

This is not the place to describe its anatomy or its nervous mechanism or the newer instruments of precision in estimating the heart function, but they may be briefly itemized. It has now been known for some time that the primary stimulus of cardiac contraction generally occurs at the upper part of the right auricle, near its junction with the superior vena cava, and that this region may be the "timer" of the heart.

This is called the sinus node, or the sino auricular node, and consists of a small bundle of fibers resembling muscle tissue. Lewis [Footnote: Lewis: Lecture in the Harvey Society, New York Academy of Medicine, Oct. 31, 1914.] describes this bundle as from 2 to 3 cm. in length, its upper end being continuous with the muscle fibers of the wall of the superior vena cava. Its lower end is continuous with the muscle fibers of the right auricle. From this node "the excitation wave is conducted radially along the muscular strands at a uniform rate of about a thousand millimeters per second to all portions of the auricular musculature."