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, Vol. V., No. 12. tripital massage reduces it quickly almost ventricle, accentuated second aortic sound, to fatness with slight clear urethral dis- signs of interstitial nephritis. charge. The initial rise is well marked

Treatment. In the treatment of high and sustained for two minutes, followed by a distinct fall at 5 minutes, back to blood pressure I have made use of the the lying pressure in seven 'minutes. There nitrites-nitroglycerine, Sodium and powas a corresponding rise in the pulse fol

tassium nitrite. It has been proven that lowing the manipulation. The immediate effect of prostatic massage

sodium and potassium nitrite and erythrol

tetranitrite have a more prolonged action is to cause first a rise in pressure fol

than nitroglycerine. The fall in pressure lowed by a fall which in some instances

is slower and the subsequent rise delayed. is quite remarkable, with a return to nor

For permanent lowering of pressure themal not later than ten minutes after the

oretically sodium and potassium nitrite are manipulations. Stimulation of the schneid

to be chosen. The method of treatment erian membrane with the Faradic current, and the vagina, and rectum by manual

aims at repeated periods of pressure lowerstimulation have been shown to induce

ing with the hope that sooner or later the marked lowering of pressure. Pain in- 1904 4


7 8 creases blood pressure.


9 25 7 31 28 2

Hg. The impression has gained ground that

230 arteriosclerosis is always associated with high blood pressure. As a matter of fact

220 arteriosclerosis may be about equally divided between the state of hypertonia 210 and hypotonia. I have three cases of ad

200 vanced arteriosclerosis

at the

the present time with blood pressures varying from

190 90 to 120. The disease is marked in the


GHB. peripheral arteries. The radials are round, and full, tortuous and palpable after compression. There is apparently no discover

CHART 6. CASE IV. able cardiac enlargement and no accentua

time will come when the continuous adtion of the second aortic sound. These

ministration will cause a greater delay, in are usually cases of peripheral arterio

the pressure reaching its height. I am in sclerosis with little if any involvement of

the habit of giving three and four doses the capillaries or splanchnic vessels. On

daily and continuing the remedy over conthe other hand we may have high pressure

siderable lengths of time, always controlwith soft radials due to splanchnic involve- ing my dose by blood pressure records. ment alone.

When the pressure reaches what may be Should one picture a case of typical ar- considered the low point sought the remteriosclerosis with hypertension he would edy is gradually withdrawn. group the following phenomena: high ten- The nitrites should never be continued sion pulse, beaded hard arteries, palpable for long periods without systematic conafter compression, hypertrophy of the left trol. Some individuals are quite sus

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ceptible to their action. Some very im

Some very im- ganism must bring about a tremendous portant reports have recently been pub- lowering of blood pressure. This is a lished regarding subnitrate of bismuth point which requires elucidation. poisoning in children and in patients tak- I will give a brief outline of a few cases ing large amounts for radiographic pur- and illustrate them with lantern slides. As poses. These cases have all showed a I wish to consider the condition of blood pronounced methemoglobinaemia with

pressure as influenced by the nitrites, I 1907 Sept. 1908. Oct. Sept.

Dec. M.M. 9116 18 31 2 14 21

16 21 31 Hg


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more or less cyanosis, collapse and in some shall not weary you with a detailed history cases death. It has been found that bis- substantiating the diagnosis. . muth sub-nitrate decomposes very readily

CASE 4. G. B. Aet. 67


arteriosclerosis, angina pectoris, the pain children's stools forming nitrites and

tient sought relief from dizziness, subthat X-rays decompose the nitrate setting sternal distress, shortness of breath on exfree the nitrite. The methemoglobin- ertion. He had to stop two or three times

No intermittent aemia is due to the nitrite poisoning. The going as many blocks.

claudication phenomena. He was put on elaboration of so much nitrite in the or- pil nitroglycerine 1/100 gr. afte: meals

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CHART 10. CASE VII. 1. Complained of cold extremities. 2. Complained of extremities being too hot, advised continue with glonoin. 3. Continued to complain of hot extremities, allowed to discontinue glonoin. 4. Returned to glonoin.

with Dr. Darling. He died after operation for impacted gallstone in ilium with ulceration. Autopsy was permitted on the abdomen and heart. The coronaries were calcareous and brittle, the heart was slightly enlarged. Urine and blood nega

ticularly noticeable in the morning, confusion of ideas. His pressure was 190, pulse regular, arteries palpable after compression, tortuous. He made steady improvement from his symptoms on spirits of nitroglycerine from 2 to 4 minims of the 1% solution, from May II, 1904 to


July 29. I did not see him again profes- because her feet and hands were now “so sionally until November 11, the pressure hot.” I discontinued the remedy for two was 170, he was feeling well so I did not days, then encouraged her to begin again. advise continuing the remedy.

He re

She made steady and seemingly permanturned the following June with a similar nent improvement from now on. January, group of symptoms. Pressure 165, symp- 1907, she returned with the same group of toms relieved by nitroglycerine. He took symptoms and in addition distinct urinary a lake trip the latter part of June, returned changes, albumin and large numbers of home feeling better, but was found dead in hyaline casts. The effect of the nitrite is bed one morning. No autopsy.

shown in the chart. February 7 was the CASE 6. Charts 8 and 9. D. P. Aet. 55. last time casts appeared in her urine. I Achylia Gastrica. This patient had typical have examined the case several times attacks of achylia gastrica with diarrhoeal since. There has been no return of alstools. During the period from Septem- bumin or casts. With these findings the ber 12, 1905, to January 5, 1906, the symp- diagnosis of interstitial nephritis can be toms required constant watching. The made. attack subsided and he remained to all intents and purposes perfectly well until

4 5 6 September, 1907, when he had another at

1907 3 12 26 tack but of short duration. A third attack M.M. occurred in September of the following year. The patient had been abroad and

200 had had a miserable summer. When I saw him in October the pressure was again high but gradually subsided with the

190 abatement of his symptoms. There was no attempt to reduce blood pressure in this case. He did not seem to be suffering

180 from high pressure symptoms and his pressure was never excessively high. The

170 records were kept as a routine measure and may illustrate how bodily states of various kinds may influence blood pres

160 sure. This patient now at 59 is a remarkably well preserved man with excellent arteries but with a well marked gastro- 150 intestinal neurosis.

Case 7. Chart 10. Miss H. A. Aet. 57. Arteriosclerosis mild. Interstitial nephritis mild. Complained of sleeplessness, palpitation, gas in stomach, cold hands and

CHART 11. CASE VIII. feet, throbbing in the left temple, dizziness. The radials were slightly tortuous, easily CASE 8. Chart II. A. H. Aet. 58. compressed. She had a distinct hyper- Arteriosclerosis, attacks of acute myocarchlorhydria. During the first portion of dial insufficiency valvular lesions. This the chart the urine was negative.

patient was observed at irregular intervals unable to say that her hypertension was from April, 1907 to June. He had a disentirely due to her arteries. There was no tinct hypertonia. He was put on nitroaccentuation of the aortic second sound. glycerine 1/100 gr. t. i. d. and was fairly She did not sleep largely because she felt faithful about taking it. The patient has her heart beating. I put her on spirits of now a well marked myocardial insufficiency. nitroglycerine. She returned two days While taking the glonoin the pressure relater to tell me she must stop the medicine mained down.


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