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, [375][376] 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 so 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. [376][377] 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 use 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 drugs.