PRACTICAL SUGGESTIONS
The time spent in obtaining a careful history of a case is time well
spent. Often the diagnosis can be made from the history alone, the
physical examination merely adding confirmation to the data already
obtained.
The younger the patient who has arteriosclerosis, the more probable is
it that syphilis is the etiologic factor. A denial of infection should
have little weight if the history of possible exposure is present.
Miscarriages in a woman should arouse the suspicion of lues in her
husband. The complement-fixation reaction will often clear up an
apparently obscure diagnosis.
There are various ways of examining a patient but there is only one
right way; the examination should be made on the bare skin. However
skillful one may be in the art of physical diagnosis, he can gather few
accurate data by examining over the clothes even if he use a
phonendoscope.
The immoderate eater is laying up for himself a wealth of trouble at the
time when he can least afford to bear it. The ounce of advice in time is
worth more to him than the pounds of medicine later.
It is a wise maxim never to drive a horse too far. Apply that to the
human being and the rule holds equally well.
There may be no symptoms in a case of advanced arteriosclerosis. Do not
on that account neglect to advise a patient in whom the disease is
accidentally discovered.
Many a man owes a debt of gratitude to the life insurance examiner. He
rarely feels grateful.
When a competent ophthalmologist refers a case to a general practitioner
with the statement that he believes from the appearance of the fundus of
the eye that arteriosclerotic changes are present over the body, the
case should be most carefully examined. The earliest diagnoses are not
infrequently made by the ophthalmologist.
It is the part of wisdom never to have such a firmly preconceived idea
of the diagnosis that facts observed are perverted in order to fit into
the diagnosis. Let the facts speak for themselves.
Beware of the snap diagnosis. Even in a case of well-marked
arteriosclerosis when the diagnosis seems to be written in large letters
all over the patient, go through the routine. Nine times out of ten this
may seem needless. The tenth time it saves your conscience and
reputation. Always consider that you are examining a tenth case.
Gradual loss of weight in a person over fifty years old should arouse
the suspicion of arteriosclerosis.
Do not call the nervous symptoms displayed by a middle-aged man or woman
neurasthenia until you have ruled out all organic causes, particularly
arteriosclerosis.
When palpating the radial artery, always use both hands according to the
method already described. Pay attention to the superficial or deep
situation of the artery.
The examination of one specimen of urine does not give much information,
especially if it should be found to contain no abnormal elements. Fairly
accurate data may be gathered from the mixed night and morning urine;
most accurate data from the twenty-four hour specimen. To be of any real
value there should be frequent examinations of the day's excretion.
In measuring the day's output a good rule is as follows: begin to
collect urine after the first morning's micturition and collect all
including the first quantity passed the next morning. It is best to
examine the centrifugated urine for casts even though no albumin be
present. It is useless to look for casts in an alkaline urine.
Casts are not infrequently found in chemically normal urine from a
middle-aged patient. Other things being normal, the finding has no
significance. The kidneys must be carefully tested functionally.
Blood pressure readings should always be taken with the patient in the
same posture at every estimation. At the first examination it is
advisable to take readings from both brachial arteries. Let the patient
sit comfortably and relax all muscles.
Differentiate as soon as possible between the uncompensated heart caused
by valvular disease and that caused by arteriosclerosis. There is a
difference in prognosis. Both give the same symptoms, and are treated
similarly until compensation returns; thereafter the management of the
two forms is different.
Aortic incompetence that comes on late in life is generally the result
of curling of the free margins of the valves caused by syphilitic
arteriosclerosis. Prognosis is grave because of the fact that the heart
muscle also is the seat of degenerative changes and compensatory
hypertrophy is established with difficulty.
When laying down a regime for a patient, consider his disposition, and
individualize the treatment. Remember that exercise is an essential
feature of the hygiene of the patient's life but do not forget to be
explicit about the amount and character of the permissible exercise.
In the prophylaxis of arteriosclerosis, a rational mode of living is the
all-important factor. As a rule, the less meat one eats, the less is the
liability of arterial degeneration as age advances. The exceptions to
this rule are many, and probably depend upon the character of the "vital
rubber" with which the individual begins life.
The diet in well-marked cases of arteriosclerosis should be carefully
selected with regard to its nutritive and non-irritating character.
Animal proteins should be sparingly used. Milk should have an important
place in the dietary.
No drug relieves the pain of uncomplicated aneurysm as surely as iodide
of potassium.
Iodides frequently upset the stomach. Be cautious in the use of them.
The irritable stomach may turn the scales against your patient.
Use cardiac stimulants with care and judgment. If all the valuable
ammunition is used up at first, the fight will be lost.
Use digitalis with especial care. Its chief usefulness is in steadying
the decompensated heart, improving the conduction of impulses, and
increasing the tone of the cardiac muscle. _It should never be given to
patients with very slow pulses, the subjects of Stokes-Adams syndrome._
Digitalis has been found to produce partial to complete heart block when
therapeutically administered.
Remember that in the uncompensated heart morphine not only eases the
oppressive dyspnea, but also steadies and stimulates the heart.
See to it that the patient has a daily movement of the bowels. In the
early stage try the effect of liquid paraffin or of the mineral waters
such as Pluto, or Hunyadi Janos, or artificial Carlsbad salts (Sprudel
salts). These last can be made as follows: Sodium chloride, ounce I;
sodium bicarbonate, ounce II; sodium sulphate, ounce IV. Take two
tablespoonsful of this in a glass of hot water before breakfast. Should
these not succeed, assist the action of the drugs by the use of enemata.
The pill of aloin, strychnine sulphate, and extract of cascara, with the
addition of a small quantity of hyoscyamus, is a mild tonic purgative.
In cases of constipation with high tension, there is no drug as valuable
as calomel or one of the other mercurials given occasionally.
Never give Epsom salts unless copious watery stools are desired to
deplete effusion into the serous cavities or into the subcutaneous
tissue.
Chronic constipation increases the gravity of the prognosis.
In case of suppression of urine and anasarca, hot air packs may be of
value. The patient may be wrapped in a hot wet sheet and covered with
blankets. I do not believe in administering pilocarpine to assist the
sweating.
Remember to treat the patient and not the disease. The careful hygienic
and dietetic treatment, combined with the least amount of drugging, is
the best and most rational method of treatment.
INDEX
A
Abdominal symptoms, 201
Aconite in treatment, 242
Acquired arteriosclerosis, 159
Adami, effect of syphilis in aorta, 45
Adventitia, 28
Age in arteriosclerosis, 161
Albuminuria, 221
Albutt's classification of arteriosclerosis, 186
Alcohol, 166, 228, 235
Anatomy, 25
Angina abdominalis, 201, 216
pectoris, 197, 216
pseudo, 216
Angiosclerosis, 26, 64
Aorta, 27
anatomical lesions in, 33
Aschoff on, 35
normal, 41
syphilis in, 44
thoracic, 29
thoracic and abdominal, arteriosclerosis of, 39
velocity of blood in, 66
Aortic incompetence, 61, 258
stenosis, 60
Aortitis, acute, 165
Arcus senilis, 191
Arrhythmia, tonal, 92, 102
Arterial pressure, 85
symptoms, 189
Arteries, 29
examination of, 172, 177
general structure of, 27
large, 30
adventitia of, 30
palpable, 189
pulmonary, arteriosclerosis of, 63
Arteriocapillary fibrosis, 26
Arteriosclerotic endocarditis, 60, 219
Artery, coronary, cross-section of, 36
pulmonary, 209
radial, 29
Aschoff on aorta, 35
Atheroma, simple, 32
Atheromatous abscess, 38
Auricular fibrillation, 133
flutter, 131
Auscultation, 176
Auscultatory blood pressure phenomenon, 90
method of taking blood pressure, 83
percussion, 175
B
Balneotherapy, 233
Basch's blood pressure instrument, 70
Blood, circulation of, 65
velocity of, 65
in animals, 66
in aorta, 66
in capillaries, 66
viscosity of, 68
Blood pressure, 68
auscultatory method of taking, 83
clinical applications of, 147
diurnal variations of, 102
drugs influencing, 120
estimation of, 179
in cancer, 118
in collapse, 118
in exercise, 105
in head injuries, 148
in hemorrhages, 105, 118, 148
in infectious diseases, 153
in kidney diseases, 155
in meningitis, 118
in obstetrics, 152
in pulmonary tuberculosis, 119
in shock, 105, 148
in surgery, 147
in typhoid fever, 118, 154
in valvular heart disease, 155
increase of, 55
instruments, 70
Brown's, 74
Cook's, 71
Erlanger's, 72
Faught's, 75, 80
Hill and Barnard's, 70
Hirschfelder's, 73
K. Vierordt's, 70
Marcy's, 70
Potain's, 70
Riva Rocci's, 70
Roger's, 77
Sanborn's, 80
Stanton's, 72
technique of, 80
"Tycos," 77
v. Basch's, 70
v. Recklinghausen's, 76
mechanism of, 55
normal variations of, 88
phenomenon, auscultatory, 90
precautions when estimating, 181
value of, 181
Bowman's capsules, sclerosis of, 62
Brain, changes in, 62
Brown atrophy, 60, 118, 201
C
Calcification of media, 43, 59
Cancer, blood pressure in, 118
Capillaries, anatomy of, 27, 31
Capillary pulse, 67
Cardiac dullness, 172
irregularities in arteriosclerosis, 131
symptoms, 195
Cerebral symptoms, 203
Circulation of blood, 65
physiology of, 65
Cirrhosis of liver, 64, 216
Classification of arteriosclerosis, 32, 37
Allbutt's, 186
Collapse, blood pressure in, 118
Congenital arteriosclerosis, 157
Cook's blood pressure instrument, 71
Cor bovinum, 116
Coronary artery, cross section of, 36
Corpus luteum, 241
D
Definition of arteriosclerosis, 26
Diabetes mellitus, 216
Diagnosis, 210
differential, 215
early, 210
ophthalmic examination in, 214
Diastolic pressure, 69, 83, 85, 94
importance of, 97
Dicrotic pulse, 123
Dietetic treatment, 235
Differential diagnosis, 166, 215
Diffuse arteriosclerosis, 32, 37, 38, 57
Digitalis in treatment, 246, 259
Diuretin in treatment, 246
Drug intoxications, 166
Drugs influencing blood pressure, 105, 120
Ductless glands, 171
Dullness, cardiac, 172
Dyspeptic symptoms, 184
Dyspnea, 184
treatment of, 248
E
Electrocardiogram, 126
Embolism, 59
Endarteritis deformans, 47
obliterans, 46
Endocarditis, arteriosclerotic, 60, 219
Endothelial lining, 27
tubes, 31
Epistaxis, 184, 221
Erlanger's blood pressure instrument, 72
Erythromelalgia, 192, 208
Estimation of blood pressure, 179
Etiology, 157
Examination of arteries, 172, 177
of heart, 172
of urine, 257
Exercise, blood pressure in, 105
in prophylaxis, 225
in treatment, 230
Experimental arteriosclerosis, 50
Extrasystole, 138
F
Faught's blood pressure instrument, 75, 80
Fibrillation, auricular, 133
ventricular, 138
Fibrolysin in treatment, 243
Fingernail palpation, 178
Finger tip palpation, 179
Flutter, auricular, 131
Food poisons in arteriosclerosis, 163
G
Gibson's law, 154
H
"H" wave, 126
Habits, personal, 234
Head injuries, blood pressure in, 148
Headache, 184
treatment of, 248
Heart block, 140
boundaries, 172
examination of, 172
hypertrophy of, 60
physical examination of, 172
stimulants, 243, 246, 259
symptoms, 188
Hemorrhages, blood pressure in, 118
Henle, membrane of, 29
Hill and Barnard's blood pressure instrument, 70
Hirschfelder's blood pressure instrument, 73
His, bundle of, 141, 197
Hygienic treatment, 230
Hyperpietic arteriosclerosis, 186
Hypertension, 60, 106, 169, 185, 249
cause of arteriosclerosis, 159
classification of cases, 112
Hypertrophy of left ventricle, 58
Hypotension, 117
I
Incompetence, aortic, 61, 258
Indicanuria, 167
Infants, arteriosclerosis in, 158
Infectious diseases in arteriosclerosis, 163
blood pressure in, 153
Insomnia, treatment of, 248
Intermittent claudication, 192, 208
treatment of, 247
Intoxications, chronic drug, 166
Intracranial tension, 105
Involutionary arteriosclerosis, 187
Iodides in treatment, 238, 247, 259
K
Kidney diseases, blood pressure in, 155
Kidneys, sclerosis of, 61, 170
L
Life insurance, relation to, 249
Light percussion, 174
touch palpation, 175
Liver, cirrhosis, 64, 216
Local symptoms, 207
M
Marey's blood pressure instrument, 70
Maximum pressure, 85, 94
Mean pressure, 85
Media, calcification of, 43, 59
Medicinal treatment, 238
Meningitis, blood pressure in, 118
Mental strain, 168
Mesaortitis, 45, 47, 49, 165
Mesentery, cross-section of small artery in, 56
Milk diet, 237
Minimum pressure, 86, 94
Moenckeberg type of arteriosclerosis, 43
Morphine in treatment, 243
Mosenthal test meal, 221
Muscular overwork, 169
N
Nervous symptoms, 191
Nitrites in treatment, 240
Nitroglycerin in treatment, 241
Nodular arteriosclerosis, 32, 37
Normal blood pressure variation, 88
O
Obstetrics, blood pressure in, 152
Occupation in arteriosclerosis, 162
Ocular symptoms, 190
Ophthalmic examination, importance in early diagnosis, 214, 256
Orthodiagraph, 173
Overeating, 167, 212, 225, 235
Overwork, muscular, 169
P
"P" wave, 129
"P-R" interval, 130
Palpable arteries, 189
Palpation, 174, 180
fingernail, 178
finger tip, 179
light touch, 175
Pathology, 32
Percussion, 174
auscultatory, 175
light, 174
Peripheral symptoms, 207
Personal habits, 234
Phlebosclerosis, 64
Phthalein test, 221
Physical signs, 183
Physiology of the circulation, 65
Potain's blood pressure instrument, 70
Practical suggestions, 256
Pressure, arterial, 85
ausculatory method of determining, 83
diastolic, 83, 94
estimation of, 179
in surgery, 147
maximum, 85, 94
normal variations, 88
pulse, 83, 85, 87, 100
systolic, 82, 85
technique, 80
venous, 120
Prognosis, 218
Prophylaxis, 224
exercise in, 225
Pseudo angina pectoris, 216
Pulmonary artery, 209
arteriosclerosis of, 63
tuberculosis, blood pressure in, 119
Pulse, 123
capillary, 67
deficit, 135
dicrotic, 123
in arteriosclerosis, 123
pressure, 69, 83, 85, 87, 100
rate, 69
venous, 123
Purgatives in treatment, 244, 259
Pyrosis, 184
Q
"Q R S" complex, 129
R
Rabbits, lesions produced experimentally in, 50
Race in arteriosclerosis, 161
Radial artery, 29
Radials, sclerosis of, 43
Raynaud's disease, 192, 207
Recklinghausen's blood pressure instrument, 76
Renal disease, 169
symptoms, 199
Rest in treatment, 242
Riva-Rocci's blood pressure instrument, 70
Rogers' blood pressure instrument, 77
S
Sanborn's blood pressure instrument, 80
Scaphoid scapula, 158
Schwellungsperkussion, 174
Sclerosis of veins, 64
Senile arteriosclerosis, 32, 37, 43, 59
Sex in arteriosclerosis, 161
Shock, blood pressure in, 105, 148
Spinal symptoms, 205
Spirochaeta pallida, 45
Stanton's blood pressure instrument, 72
Stenosis, aortic, 60
Stokes-Adams syndrome, 197
Stomach, ulcer of, 216
Strain hypertrophy, 47, 54, 55
Surgery, blood pressure in, 147
Symptomatic treatment, 245
Symptoms, 183
abdominal, 201
arterial, 189
cardiac, 195
cerebral, 203
dyspeptic, 184
dyspnea, 184
general, 183
headache, 184
heart, 188
local, 207
nervous, 191
ocular, 190
peripheral, 207
pyrosis, 184
renal, 199
special, 194
spinal, 205
vertigo, 184
visceral, 201
Syphilis, 165
in aorta, 44
Syphilitic arteriosclerosis, 37
Systolic pressure, 69, 82, 85, 94
importance of, 97
T
"T" wave, 130
Technique of blood pressure instruments, 80
Thayer and Fabyan, 34
Theocin, 247
Thoma on arteriosclerosis, 33
Thoracic aorta, 29
Thyroid extract in treatment, 239
Tobacco, 167, 212, 234
Tonal arrhythmia, 92, 102
Toxic arteriosclerosis, 186
Treatment, 229
aconite in, 242
balneotherapy in, 233
corpus luteum, 241
dietetic, 235
digitalis in, 246, 259
diuretin in, 246
exercise in, 230
fibrolysin in, 243
heart stimulants in, 243
hygienic, 230
iodides in, 238, 247, 259
medicinal, 238
morphine in, 243
nitrites in, 240
nitroglycerin in, 241
of dyspnea, 248
of headache, 248
of insomnia, 248
of intermittent claudication, 247
personal habits in, 234
purgatives in, 244, 259
rest in, 242
symptomatic, 245
theocin in, 247
thyroid extract in, 239
Trunecek's serum in, 243
venesection in, 242
veratrum viride in, 242
Trunecek's serum in treatment, 243
Tuberculosis, blood pressure in, 119
Tunica intima, 28
media, 28
"Tycos" blood pressure instrument, 77
Typhoid fever as cause of arteriosclerosis, 164
blood pressure in, 118
U
Ulcer of stomach, 216
Urine, examination of, 257
suppression of, 259
V
Valvular heart disease, blood pressure in, 155
Vasa vasorum, 29
Veins, anatomy of, 30
sclerosis of, 64
Velocity of blood in animals, 66
of blood in aorta, 66
Venesection in treatment, 242
Venous pressure, 120
pulse, 123
Ventricle, left, hypertrophy of, 58
Ventricular fibrillation, 138
Veratrum viride in treatment, 242
Vertigo, 184
* * * * *
Transcriber's Notes: Irregular hyphenation has been preserved, as in
blood pressure and blood-pressure. Both "Hg" and "Hg." appear.
Minor typographical errors and inconsistencies have been silently
normalized.
The original printed list of illustrations shows the original
locations; they have been moved closer to their discussion area
in the text to not interrupt the flow of reading.
Page 244 Prescription symbol is replaced with R_{x}
Page 259 Apothecaries ounce symbol replaced with "ounce"