A CASE OF CARDIAC FAILURE TREATED BY CANE SUGAR
BMJ (Clinical Research Edition)
drig slhoil(I not be puslhecl fartlher, b-Lt just eiougli givei to imainitain the advantage by keeping pace witlh the elilmiinationi of the drtug. 7. The heart tracings slhow tlhat a pure digitalis effect is obtained on perfusing digalen, the therapeuitic effect beilng marked, and the tonus at the end very considerable. 8. The tracings also demonstrate the muclh higher Coefficient of Distribution of the drug in saline soluition than in the blood so resemubling the chlorofornm actioni. Even at
... actioni. Even at the lowest concentration tested no therapeutic equilibriulm is established, but the lheart goes on taking up the drug from tlle saline till the deatlh poinlt is reachedl. This loes not occuir with a much heavier dosage in the intact animilal where the drug is dissolved in the blood. 9. Soluble digitoxin shows none of that haemolytic action in destroyiln red blood corpuscles whiclh is possessed by those sapo-glucosides whichl act on the lheart, as, for exam-ple, tlle digitonin present in ordinary tincture of digitalis. THE following notes of a case of cardiac failure treated by cane sugar show how remarkably an apparently hopeless case was benefited by its use. The patient, a plumber, aged 28, first consulted me on December 4tlh, 1910, complaining of great shortness of breath and swelling of his abdomen, which had commenced in July, 1910, and gradually grew worse; he had, however, continued his occupation. He had previously always been healthy and temperate. In March he was helping to pull a heavily-laden hand-cart up a stiff hill, wlhen he suddenly felt giddy and faint, great difficulty in getting his breath, and had to sit down for a time. After a short rest he was able to continue his work, and thought no more about this incident. State on. Exanmination. The patient looked ill, dusky complexion, anxious expression, marked dyspnoea, had to gasp between his sentences wlhilst talking to me. lIeart: Faint apex beat, little to left of left nipple line, diffused. No definite bruit heard at apex, l)ut a galloping, tumblinig kind of rhythm, very irregular anid intermittent. Aorta: N3 bruit heard, but second sound accentuated. Pudlse 100, feeble, small, irregular and intermittent. Lunigs niormal. Respirations 35. Abdoment much enlarged and definite slgns of dropsy. Slight oedema of skin over lower part. Girth measurement at level of umbilicus 35-in. Li,ier not enlarged to any extent. Appetite only fairly good. Tongute fairly clean.