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January 26, 1970

Strictum et Laxum

JAMA. 1970;211(4):654-655. doi:10.1001/jama.1970.03170040058014

The ancient methodistic doctrine of the strictum et laxum of Asclepiades attributed disease to constricted or relaxed conditions of solid particles and directed therapy to counteracting them. Under different guises this doctrine has been frequently revived through the ensuing centuries. Without accusing modern cardiologists of attempting another revival, we note that in the treatment of cardiogenic shock they tend to be preoccupied with vascular constriction and relaxation. Unlike the disciples of Asclepiades, however, the cardiologists do not agree among themselves on the correct therapeutic approach. In fact, they are divided into two main opposing camps, one espousing vasopressor drugs, the other favoring vasodilators. A recent debate between Corday and Lillehei1 succinctly presents the contrasting views.

Having championed for 20 years the cause of norepinephrine in cardiogenic shock complicating myocardial infarction, Corday has now amplified and modified the rationale for its use. Originally norepinephrine was thought to be beneficial because