High Pulse Rate; Causes and Remedies
The causes of high pulse should be
better known and, consequently, better managed. The case of President
McKinley gives emphasis to this. We have no disposition to criticise
that case or its management. An abdominal wound of that nature,
in our hospital service in the Civil war [sic], we regarded
as necessarily fatal and, usually, such cases lived but a short
time. A ball could not plunge through the stomach so near the median
line without injuring the cæliac plexus, or the great abdominal
brain as it has been termed. The absence of nausea and vomiting
showed that the vagus was not injured, to that degree. But there
was inaction of the inhibitors so that the heart went off at a gallop
and continued at a very high rate until the hour of collapse on
that fateful Friday. The attending family physician explained to
the alarmed nation that a high pulse rate was habitual with the
President. That may have been true, and that leads us to inquire
more earnestly as to the cause of a high pulse rate, consequently,
the very best management.
We saw today, and have seen, in the
clinic of this college and at Cook County Hospital many cases of
tachycardia dependent upon many diseased conditions. To understand
these cases the fundamental facts of cardiac anatomy and physiology
were emphasized before the pathology and therapeutics can be comprehended
and applied intelligently.
The heart, like any other muscle,
has one function and that is contraction, to be followed by relaxation.
Its twin ventricles work together, usually in a peculiar way. As
the different layers of muscles indicate, they elongate and rotate
the heart slightly; they work and rest. To control this action we
have the nerves and blood supply. If the blood is deficient, this
pump, like any other, works rapidly as in the last case before us.
The nerves are to control, retard or accelerate it. They are the
governors of this engine. All drugs that quiet the action of the
inhibitors allow the accelerators to hurry the heart. Any obstruction
acts as a stimulus to increase the cardiac action and force; so
we come to differentiate:
1—Rapid anæmic heart;
2—Stimulated pulse; and
3—Obstructed forceful pulse.
1—The anæmic pulse is small
and compressible and easily recognized. We meet it in long lasting
disease and in impoverished bodies. The principal remedies that
occur to us are Arsenicum, 
China, Phosphorus, Sulphur, etc., drugs with
a long-lasting tachycardia and systemic waste and weakness.
2—A stimulated pulse is always an
abnormal one. We look for a mental, nervous, systemic or accidental
cause. Stimulants, so called, all produce rapid heart action, usually
as a secondary effect. Alcohol, tobacco, tea, coffee are the domestic
agents that produce a very lasting tachycardia. Nervousness usually
produces paroxysmal tachycardia. Mental emotion or activity tend
to produce a longer lasting tachycardia. A small heart, as we have
seen in the clinic, gives us a rapid pulse. A small person has,
as a rule, a more rapid heart than a tall one. The child has a rapid
heart, because the circuit is short; and in the aged it tends to
rapidity because the obstructed capillaries also shorten the systemic
circuit. This very obstruction causes a rapid heart and hypertrophy
jari passu, especially in the fleshy, as was the President.
The heart, normally, begins to enlarge between the ages of 50 to
60 years. Many of the cases of rapid, stimulated heart we meet in
men are due to the action of tobacco; so we should always ascertain
the cause and attempt to antidote the bad effects.
3—We must interrogate every organ
to see if there is anywhere obstruction from habit or disease. This
form of tachycardia we have seen in goitre, in gastritis, hepatitis,
constipation, nephritis; and tachycardia is often a symptom of cerebral
lesion. A persistent rapid pulse is also a serious symptom of disease
of the chest, lungs or, sometimes, of the heart itself. It is a
pathognomonic symptom of tuberculosis when the other symptoms are
also present. It is a constant symptom of fever. So a rapid pulse
must always find a proper explanation. A traumatic pulse may be
first slow in shock but then becomes rapid, most rapid.
One of the first remedies given in
shock usually is Alcohol in some form. This is a remedy that
acts very similar, hastening the reaction of a rapid pulse. Big
doses or moderate doses of alcohol long continued tend to weaken
the heart by dilation. The action of tobacco is well known by all
who have attempted to acquire the habit. No one can forget the nausea
and faintness of its primary action. The slow pulse tells of cardiac
inhibition. Those who have attempted to break off the habit will
also remember the reproduction of the primary cardiac weakness.
So great is it that few can break off the habit without help through
this “slough of despond.” The desire of the old seductive stimulant
becomes [s]o great that few can resist, and hence they return to
its use. The speaker fought this physical depression of its primary
action for weeks. Every whiff of a cigar or pipe prolonged the agony
for months until a remedial antidote was found. Now there is a physical
repugnance to tobacco. These antidotes every physician should know,
and especially every surgeon. President McKinley should have been
allowed his tobacco, or given an antidote. Most surgeons know that
alcoholics stand operations badly, and this stimulant is often continued,
and that wisely, unless the surgeon calls into play the powerful
antidotal action of Arsenicum or Nux Vomica.
Hahnemann studied the effects of common
remedies used in his day, and so must we. Tobacco is used so extensively
and so freely that every physician should recognize its constitutional
effects as readily as he can the round red fissured tobacco tongue
we see so often in the clinic.
There are several antidotes to tobacco.
 Arsenicum antidotes
chewing tobacco. Nux antidotes some of the stomach symptoms,
while Phosphorus controls the palpitation of tobacco. For
the tobacco heart Allen says Phosphorus is the antidote.
Plantago Major has several times caused an aversion to tobacco.
One summer the writer was treating
a man for sour stomach and diarrhrea [sic], and the indicated
similar remedy was Pulsatilla. A few days after, he returned
and wanted to know what I had given him. I asked why, and he replied,
“Why, it has taken away all my appetite for my tobacco; it don’t
taste right now; I don’t want it.”
To understand the kind of palpitation
that Phos. cures we read:
“Pulse accelerated, full and hard.”
“Pulse sometimes double.”
“Pulse small, weak and frequent.”
This, doubtless, was the kind of pulse
President McKinley had.
Phosphorus also has “dilation
of the heart from fatty degeneration.” That again corresponded to
the reported condition of the dead President’s heart.
Digitalis also causes rapid
heart, but it does not antidote tobacco. Woodward says that Tabacum
affects the sensory organs first, then the circulatory, spinal,
digestive and the genito-urinary system. While Digitalis
is not similar, it affects, first, the sensory organs, then the
circulatory, next the digestive, then the genito-urinary and after
that the spinal centers. Not following the same course through the
organs they cannot be antidotes, strictly speaking. They differ
also in the emphasis made upon the organs. Digitalis
produces greater tension upon the arterial system, and, if relief
is not afforded by way of the kidneys, venous stasis results giving
its characteristic slow, intermittent pulse and blue extremities.
Tabacum has a soporific or soothing effect upon the nervous
system, causing mental languor. They therefore differ in their method
of relief. According to Woodward’s grouping of sequences, alcohol
stands nearest to Tabacum in the order of effects among the
organs. Then comes Cannabis, Cocaine and Amyl nitr.
When I read that the attending staff
of surgeons were giving Digitalis to bring down the pulse
of President McKinley I was surprised and pained at this old and
mistaken use of this powerful drug. I was sorry to see that some
of our best surgeons were not up on modern therapeutic methods.
Now the better informed give not Digitalis to “bring down
the pulse,” but when slow and intermitting from venous stasis, then
they give it to “bring up the pulse.” This proper [u]se of Digitalis
should be proclaimed far and near, so that no surgeon will hereafter
lessen the vitality of his patient by a wrong use of Digitalis.
A rapid pulse tells of some grave or dangerous condition and this,
certainly, should not be augmented by the wrong use of powerful