Treatment Spigelia 3, three times a day.
March 13th.-Decidedly better. Has slept well, no perspirations. Appetite better; spirits better. Repeat.
March 20th.-Faintness came on on the 18th. Since then he has felt ill; has slept badly; perspired much. Has had no pain in the side. Repeat.
March 24th.-Has felt worse. The pain has been bad, leaving him faint and ill. Retches with breakfast and tea. Sleep good; has perspired slightly.
I now for the first time discovered the real cause of his illness. Patients have a way of telling their doctors all kinds of causes for their diseases except the right one, which in most cases is perfectly well known to them all the time. In many cases it is difficult, sometimes all but impossible, for them to disclose it. Sometimes it becomes possible after a time, when the confidence of the patient has been completely won by the medical attendant. In many cases, as in the one before us, the patient, partly ashamed to confess some indulgence, and partly desirous of having his sufferings relieved without being compelled to exercise self-denial, purposely keeps his medical adviser in the dark.
It is always necessary to bear this in mind, or we shall often be wasting our time and energies in fighting shadows, when with a little trouble we might find the substance and at once put an end to our difficulties.
This patient had told me of his bicycling, of his close office, of his cold, and of the history of heart-disease in his family, and this he considered enough for me to work on. It was only when the partial success of the remedies I administered suggested to me that there was some other cause at work that I inquired more closely, and found out what it was.
The patient was a smoker, and when he smoked he could not smoke moderately. At times he abstained from it altogether- generally in the summer time. From October, 1879, to January, 1880, he had indulged to excess; but had been more moderate since then. For a week previous to my finding it out he had again been smoking, and this coincided with the return of many of his symptoms, in spite of his endeavour to counteract the effects of the tobacco with stout and port wine!
In repeating his medicine I told him that what benefit he had received from medicines was as much as he might expect until he abandoned the habit entirely.
If he did that he might hope to get perfectly well, and need not let the fact of there being heart-disease in the family cause him any concern.
He returned three days later, saying he had been very much better till the day before his visit, when he nearly fainted in the evening. I gave him Cactus I. He did not return again, so whether he made up his mind to abandon his habit or not I cannot say.
I am inclined to call these three cases instances of semi- functional disease of the heart. In all of them the heart was the seat and centre of the suffering. In none of them was any heart- lesion detected by physical examination, unless the slight muffling of the first sound in Case XXIX. may be counted such. And yet they were not purely functional cases. They differed from the cases of palpitation and breathlessness met with in hypochondriacal, hysterical and anaemic subjects, where the symptoms arise from no discoverable cause beyond the general condition of the patient. In each of them the heart-weakness was traced to the operation of a drug on the cardiac nerves or tissues or both.
Case XXVIII. and XXIX. present a striking likeness to each other. The same gnawing pain at the heart was complained of, the same kind of nervousness, the same giddiness and noises in the head, the same sleeplessness and constipation.
The same agent, alcohol, was at the root of each, and the same medicine-Spigelia-was in both strikingly beneficial. Case XXVIII. may be considered as an early stage of Case XXIX. S.P. was a younger man, and his indulgence had not lasted so long, consequently he was more speedily restored to health. J.B. was an older man, and an older toper, and his symptoms were, though the same in kind as S.P.’s, much more severe and long lasting. Palpitation, scarcely complained of by the one, was a very distressing feature in the case of the other. I am inclined to regard this, combined with the muffling of the first cardiac sound, as an indication that the structure of the heart had become somewhat degenerated in J.B.’s case. In Case XXVIII., if the disorder had passed beyond the limits of purely functional disease, the organic lesion was not so severe as to be beyond repair. In case XXIX. the tissue of the heart and probably the nerves as well, were degenerated, but the tissue that remained was still susceptible of being strengthened by proper remedies.
In the latter case I at first suspected an aneurism, and my failure to find any definite physical indication of one did not altogether allay my suspicions. I do not now, however, think that there was one present. The absence of any signs of hypertrophy or dilatation of the heart militates against the idea.
It is more than probable that the arteries were affected with atheroma in the early stage, but that cannot with certainty be diagnosed.
Case XXX., though closely resembling the other two cases, presented points of difference, as we should naturally except, arising as the disorder did from a different cause. All three patients, it is true, were addicted to the use both of alcohol and tobacco, but in two of them the former greatly preponderated, and in Case XXX. the latter. The characteristic features of this case were the continual faintness, sickness, and the dull pressure on the left side as if a substance were there-well known symptoms of tobacco poisoning.
When we meet with cases of this kind in young subjects without any history of previous carditis, we may be sure there is some cause at work. Simple fatty degeneration of the heart does not come on in early life without some definite cause. When we meet with symptoms that suggest it, as in the three cases related above, and find no traces of valvular mischief, or previous disease of the organ, we may at once set to work to find out the origin of the suffering. In the majority of cases we shall find it in the abuse of alcohol, or tobacco, or both. Sexual abuses of all kinds may cause it.
Occasionally I have seen it induced by Arsenic.
With regard to treatment, the first indication is, of course, to get rid of the cause. When this can be accomplished in time, a complete cure may be looked for. And even when the injurious habit has gone on for many years, much benefit may be hoped for from its discontinuance, and the administration of homoeopathically indicated remedies. It may be urged that the discontinuance of the habit alone would be sufficient for the cure. Such objection may be brought plausibly enough against the part played by medicine in Case XXVIII., but Case XXIX. effectually answers its general applicability. Here the habit had long been given up, and various remedies tried, none of which was of any service until the specific one had been found. And as regards Case XXVIII., I do not at all believe that the recovery would have been anything like so rapid without the aid of specific medication. The chronically induced effects of continued over-use of alcohol are not wont to disappear so rapidly of themselves. We should naturally have looked for a period of great depression following the giving up of the stimulant had nothing been given to counteract it, but under the use of Spigelia no such depression occurred. For this reason I assign to Spigelia the lion’s share of the cure in that case.
Case XXX. was not so satisfactory in the matter of treatment from the fact that the use of the toxic agent was not given up. But in spite of this, benefit was received from Actaea racemosa, and marked benefit from Spigelia. It is a remarkable fact, which I have repeatedly observed, that when two drugs are capable of producing a very similar effect on the body, that is to say, are homoeopathic to each other, the one will often in infinitesimal doses hold in check the action of the other when it is still present, and has been taken in injurious quantities for a long time. I can give no explanation of the fact, but the beneficial action of Spigelia in this case is an instance of it. The patient was still smoking, though not to such an extensive degree as he had done formerly. Here, as in the majority of cases, the antagonistic action of the remedy failed, after a time, to counterbalance the action of the poison.
Spigelia is the remedy I have found most useful in cases of the kind, though the serpent poisons also correspond closely to a considerable number of them. Cactus would be called for should its characteristic constricting pain be present.
The homoeopathicity of Spigelia to the condition it removed is evident from a glance at its pathogenesis. The following are some of the symptoms from Allen :-“Anxiety and apprehensive solicitude for the future;” “great weakness of the body after walking;” “when walking he becomes dizzy;” “sleeplessness;” “tearing constriction in the lower part of the chest, above the pit of the stomach, with oppression; afterwards, also, beneath the pit of the throat, with palpitation;” “palpitation and anxious oppression of the chest.
