I may say that after having been a very heavy drinker, he suddenly gave up alcohol in all forms seven years before this illness began. What made him give it up was that he lost nerve when at his work on roofs, and even on stepping from a curbstone into the street felt as if he would fall. Afterwards he suffered much from “indigestion,” and in the night violent palpitation and sometimes arrest of breathing, as noticed by his wife. Loss of nerve is a very common symptom in heart affections, and the probability is that the aortic disease was commencing at that time.
CASE VII.-ULCERATIVE ENDOCARDITIS ENDING FATALLY, THE AUTOPSY REVEALING A HEALED PATCH ON A SPOT WHERE INFLAMMATION HAD OCCURRED DURING AN EARLIER ATTACK OF ACUTE RHEUMATISM.
Before proceeding further I would like to refer to a case of ulcerative endocarditis following pneumonia, with delirium tremens, which I published in the November number of The Homoeopathic World for 1884 (vol. xix., p. 497). The case ended fatally, but the point I wish to refer to was made evident at the post-mortem examination. The heart weighed thirteen ounces.
On the under surface of the aortic valves (which were competent) grew abundant granulations like cauliflower excrescences, exuding purulent matter. These granulations pressed against the aortic segment of the mitral valve, constricting the orifice artificially. The mitral valve itself was healthy, except that the remains of an old deposit were found between its laminae.
Now this patient (who was a groom, and, like many of his class, addicted to spirit drinking) had been in the hospital under my care some years before with a severe attack of acute rheumatism, and during the attack there were no signs of the heart being affected. But that there had been some inflammation of the valve, and that it had healed without causing deformity, this white patch found on the mitral valve at the post-mortem examination proved. In the second attack, the aortic valve was the one which was affected by the morbid process.
Here is another case in which a murmur disappeared.
CASE VIII.-ACUTE RHEUMATISM WITH HEART INVOLVEMENT. DISAPPEARANCE OF MURMUR UNDER TREATMENT.
Walter L., aged 21, compositor, was admitted to London Homoeopathic Hospital, January 12th, 1893, having been taken ill seven days before with pains in joints of left leg.
Two days later the right leg became affected, and he took to bed. He then noticed that the slightest exertion brought on a severe pain near the upper part of the chest. He perspired a good deal. He had never had rheumatism before.
On admission, the joints of the lower limbs were painful on movement, right arm stiff, joints painful, and slightly swollen. Temperature varied from 99 degree to 100.2 degree. On the 14th when I saw him for the first time the following was the condition of the heart: Mitral bruit rather indistinct. Apex beat in fifth interspace, which is indrawn. There was a copious deposit of phosphates in the urine, but no albumen. Headache in temples; some perspiration.
There could be little doubt about the medicine in this case. All symptoms pointed to Bryonia, and I gave it in the twelfth potency, a dose every hour. For the first two days he had received Spigelia 3x, prescribed by the resident physician on account of the condition of the heart. There had been some amelioration of the chest pain, but the general condition was unchanged. Under Bryonia there was rapid subsidence of all symptoms, the chest pain more particularly. On the 25th he received Mercurius viv.12, and on February 1st Sulph. 30. He left, cured, on February 3rd. On the 28th January a careful examination of the heart failed to reveal any murmur.
I will now relate two cases in which, though the valve defect was not removed, compensation occurred and a practical cure resulted. The first was a very remarkable one, as few who saw the patient at her worst expected that she would recover.
CASE IX.-ACUTE RHEUMATIC ENDOCARDITIS. MITRAL SYSTOLIC AND PRE- SYSTOLIC BRUITS; ATTACKS OF ANGINA; CURE BY COMPENSATION; ACTION OF Crocus.
I now come to a case in which the resources of homoeopathy were markedly illustrated by the prompt effect it showed of the simillimum, given purely on symptomatic indications; the medicine, so far as I know, never having been given in a case of organic heart disease before.
Katie F., aged 19, was admitted to the Hospital on November 11th, 1893, having had two attacks of rheumatic fever previously, the second, three years before admission. Ever since this attack she had suffered off and on from attacks of breathlessness, lasting from a few minutes to over a week; the slightest exertion at any time gave rise to breathlessness. Four days before admission, she awoke in the night with severe pain over the right half of the liver anteriorly.
The pain spread up to the neck and seemed to cause shortness of breath. During the day the pain extended all over the chest, and the shortness of breath was worse. Motion made the pain worse, and also lying flat; she was obliged to be propped up during the greater part of her stay in the hospital. On the day following this seizure she was taken with pains in all her joints and neck simultaneously. At the same time a rash appeared on her forearms, which she described as consisting of little white bumps at first, these subsiding, and leaving small red rings. The rash was accompanied with itching, and disappeared in twenty-four hours. On admission, all the pains persisted, and the dyspnoea. The pulse was 126, and the temperature 99.2 degree. On two occasions during her stay in the hospital, the temperature went up to 102 degree. This was during extreme attacks of angina pectoris, and a low typhoid condition, which made me apprehend ulcerative endocarditis. During the attacks she was in imminent danger. With the exception of the occasions mentioned, the temperature oscillated between 97 degree and 99.6 degree. It was subnormal on admission. She received Baptisia 30 at first, and improved for some days. Spigelia, Lachesis 12, Mercurius vivus 12, Arsenicum 12, and Veratrum alb.3 during attacks of angina (collapse, pain, cold sweat on forehead) all gave considerable help.
The condition of the heart was as follows:-A thrill was felt over the region of the apex. A mitral systolic and pre-systolic bruit was heard over the apex, indicating constriction and incompetence of the mitral valve. The heart’s action was exceedingly rapid, as much as 132 per minute. The following is a sphygmogram taken on January 23rd at a pressure of three ounces.
On February 7th the only abnormal sound to be heard was a loud pre-systolic bruit, with a thump at that end of it; at that time the pain in the chest was worse than usual-an aching under the sternum with internal soreness. On other occasions the pain extended to left shoulder, but not down the arm.
On April 12th, when she was convalescent and able to walk about, this was the condition: Thrill felt over apex area, loud systolic bruit at apex prolonged into axilla, heard also in left auricular area, and faintly in aortic.
No definite pre-systolic heard. At the foot of previous page is the sphygmogram taken two days later, also at a pressure of three ounces.
On April 15th, just before she went out, I again examined the condition of the heart :- No thrill over apex. Beat rather forcible, area tender to pressure.
Loudish systolic bruit over apex, propagated into axilla. Listening near the left edge of the sternum, a very soft pre- systolic is heard as well as the systolic.
Systolic heard in left auricular area and slightly in aortic area.
Sounds in pulmonary and tricuspid areas fairly clear. She went on steadily improving, and when she left the hospital on April 22nd she could walk up and down stairs without difficulty.
It may be noted that as the regurgitation murmur (systolic) became more marked and the obstructive murmur (pre-systolic) less so, the patient’s condition improved. In some manner the constriction of the mitral valve became less during the illness, allowing freer passages of the blood stream in both directions.
I will now tell how I came to give the patient Crocus, the medicine which gave most signal help, and materially expedited her recovery. On February 24th, whilst I was in the ward seeing another patient, Katie F. was seized with a fit of uncontrollable laughter apropos of some trifle. I put on her tongue a dose of Crocus 30, which immediately quieted her. On March 29th, though much better, she still had a good deal of pain in the chest; on asking her to describe the pain, she said it was of a “jumping” character. Putting this, the internal jumping sensation as if of something alive, which is a characteristic of Crocus, with the old symptom of uncontrollable laughter, I was led to give her that medicine in the thirtieth potency three or four times a day. She immediately began to make rapid advance. The “jumping” steadily subsided. She was soon able to be up and eat ordinary food, and needed no other medicine till the end of the case.
