CAUSES AND CLASSIFICATION.
THERE are three main divisions into which organic affections of the heart and vessels may be classed: (I,) Acute inflammatory diseases; (2,) Chronic consequences of acute inflammations; and (3,) Affections which are chronic from the beginning. To these must be added : The effects of sudden heart strain, or sudden emotions; effects of prolonged muscular over-exertion, as in athletes; faulty dress; drugging (including the effects of alcohol and tobacco); chronic kidney disease; debilitating habits; residences at high altitudes; and surgical interference with constitutional diseases.
Of all the causes which give rise to acute diseases of the heart, rheumatic fever is the most common; whooping cough, and the specific fevers (scarlatina, measles, typhoid, typhus, diphtheria, etc.), coming next in frequency. And it must not be forgotten that the heart may become the seat of inflammation primarily, from a chill, independently of any others disease, just as there may be inflammation of the lungs or any other organ from the same cause.
The serous membrane which covers the heart (pericardium), and that which lines it (endocardium) are peculiarly liable to become inflamed when the blood is charged with irritating poisons. These inflammations, as I shall show, are capable of subsiding without leaving behind any discoverable trace of their ever having occurred. Very frequently, however, permanent changes remain, which give rise to the class of heart affections which I have put second in the list.
The consequences of acute affections which remain behind are of various kinds, according to the part which was originally affected. If it was the outer covering, the result will be adherent pericardium, adhesion, that is, of the outer covering of the heart to the wall of the sac in which it moves. Strange to say this adhesion may exist to an extreme degree without giving rise to any symptoms whatever, as has been proved by post-mortem examination; the pericardium has been found to be completely adherent in patients who have not manifested the slightest sign of it during life.
The inner lining of the heart (endocardium) is a much more complicated affair than the outer covering, and consequently is much more liable to be injured by disease, and when injured to leave permanent consequences. The valves of the heart are composed of folds of the endocardium, which open and close with the heart’s beat, to admit the blood to the various cavities and prevent its return.
When these valves are inflamed they do not perform their functions properly; they open too little, and so obstruct the blood’s passage, or they do not close perfectly and allow the blood to escape backwards, or they do both. When inflammation subsides, the obstruction may be removed and the blood-current go on perfectly as before; or, it may not. Then, in listening over the heart, the murmuring or blowing sounds which are heard replacing some part of the normal “lupp-dupp” of the heart’s beat, during the acute attack, persist afterwards. The patient finds himself short of breath on very slight exertion, and liable to palpitation of the heart and attacks of pain and faintness.
If there were not some power of compensating the disadvantage, the patient would have a miserable existence, which would soon end in death. But happily the heart is capable of a large development of strength to meet the needs of the case, “compensatory hypertrophy” occurs, and the balance is more or less completely restored; in many cases so complete is the recovery that life is not shortened, nor is its usefulness impaired.
These same membranous structures are frequently the seat of degenerative changes, independently of any permanent inflammation. The result is the same in both instances-crippling of the valves, obstruction to the blood flow, and if recovery takes place, increase in the size and strength of the heart to restore the balance.
But not only may the valves and membranes of the heart become inflamed, the muscular tissue of the heart itself may be weakened and degenerated, and also the vessels which supply it with blood. In all these cases there is present some chronic poison in the organism-most probably one or other (or a combination) of the three chronic “miasms” of Hahnemann-Psora, syphilis, or sycosis.
In this connection I may refer to one of the other causes which I have mentioned as being responsible for many cases of heart disease, namely, surgical interference with constitutional affections. In my work on “Non-Surgical Treatment of Diseases of the Glands and Bones,” I have instanced a case in which the removal of diseased glands was followed by the onset of disease of the aortic valve of the heart. Another fruitful cause of it is to be found in operations for piles. A painful instance of this came under my own notice, which I will now relate.
CASE I.-AORTIC VALVULAR DISEASE CONSEQUENT ON OPERATION FOR PILES. FATAL ENDING.
Sir S.E., a prominent Indian civilian, consulted me some years ago about a persistent cold in the head.
Enquiring into its origin I found it had continued for about two years, dating from a time a little subsequent to an operation he had undergone for piles. The piles gave him but little inconvenience, but he was persuaded to have them “cured” by operation. Of course an operation never did, and never could “cure” piles : it can only remove the haemorrhoidal swellings, without touching the constitutional condition on which they depend. The constitutional disease from which Sir S.E. suffered would be called “Psora” by Hahnemann, and “Gout” by other pathologists. The basis of gout (as I hope at some future time to show) is the psoric miasm of Hahnemann. Be that as it may, the operation was performed; the cold in the head came on-and something much worse than that. Noticing a peculiar quality in the patient’s pulse, I made a cursory examination of his heart, and there found extensive degeneration of the aortic valve. On my putting one or two questions, but in such a way as not to excite any alarm, my patient said he knew his heart was all right, “The doctors examined me carefully and said it was quite sound before I was put under the anesthetic.” Beyond giving general directions I said no more about it, as it could not have helped matters to have done so; but the sequence of events was quite clear to me. Before the operation he had no heart disease.
The operation disturbed the morbid constitutional element, which at that time had a practically safe and innocent expression in the piles, and sent it in upon more vital parts of the organism. The chronic nasal catarrh and the diseased heart were the consequences. Sir S.E. only called upon me twice. A few months later I read in The Times that he had been found dead in his bed at an hotel in Edinburgh. I have no hesitation in saying that to operate for piles is as dangerous as it is unnecessary. Piles are not by any means difficult to cure by constitutional means, and when cured thus the patient is cured, and no dangerous after- effects are to be feared.
Among other causes of heart disease I have mentioned sudden emotions. The popular expression “Died of a broken heart” is not altogether figurative. It is possible for the heart to rupture from great emotion, but I am inclined to think the heart that does rupture under these conditions could not have been thoroughly sound to begin with. The majority of cases of “broken heart” are due to aneurism within the pericardium. But short of rupture, cases of dilatation of the heart do occur from strong emotion. Here is a case in point, which exemplifies the action of Iodide of arsenic.
CASE II.-DILATATION OF THE RIGHT SIDE OF THE HEART AND THINNING OF ALL ITS WALLS, DUE TO SUPPRESSED EMOTION. RELIEF FROM Iodide of Arsenic AND OTHER REMEDIES.
The patient was a lady age. 68, who came under my care in July, 1881. Her illness dated from five years before. She has lived in the West Indies and has had much trouble. The first indication of heart disease she traced to suppressed emotion; she felt as if her heart would burst, but endured it and said nothing; she had frequent fits of dyspnoea on exertion and fits of “asthma,” which were relieved if she took wine. Afterwards she had frequent attacks of bronchitis, which made matters worse. When I saw her first she complained of breathlessness on the least exertion, a stoppage when she lay on the left side, but no pain. The feet were cold but did not swell. As long as she kept quite quiet and warm she was fairly comfortable. I found evidence of slight chronic bronchial irritation, and the examination of the heart showed the following condition :-Area of dullness increased. Apex beat not felt. No tenderness. No bruit. No reduplication. Second sound slightly accentuated in pulmonary area. The sounds are weak but regular for some time; then they become irregular and fluttering for a few beats. Sometimes there was a flutter and a stop. I never could detect anything wrong with the valves.