The following fortnight (September 13th) she attended again.
September 13th.-The pain is rather better and also the palpitation; but she has taken a cold and (as is usually the case with her when she takes cold) had lost her voice. Repeat.
October 4th.-Better generally, voice better. She complains, however, that the medicine (Digitalis) makes her ill; it seems to make her heart palpitate. The palpitation and pain are worse than last time; she has pain between the shoulders. She has had some annoyance during the week.
R Ignat. 1x, four times a day. Arsen. iod. as before.
October 25th.-Not nearly so much pain; less palpitation. She has a sinking sensation sometimes.
This was her last attendance. There was a great improvement in her general condition as well as in the special symptoms. I ascribe the chief share of this to the Iodide. I am inclined to believe the patient was correct in attributing the aggravation of her symptoms to the Digitalis, and certainly the substitution of Ignatia was followed by very marked improvement.
Rheumatism and Chorea are fruitful causes of heart disease. In the case next to be related there was a history of epilepsy and stammering (which is itself a choreic condition) previous to the heart attack.
CASE XVII.-MITRAL CONSTRICTION IN PATIENT PREVIOUSLY EPILEPTIC.
Chas. H. S.-, age. 14, errand boy, dark eyes, light hair. This patient was treated by me in 1882 for epilepsy. The only medicine he received was Stramonium 3. I did not see him again until January, 1884. I then learned that he had never had a fit since his previous attendance. He stammered badly. This had been the case since he was three years old. It came on during dentition.
January 25th, 1884.-He now complains of pain at the heart and of being weak and nervous. If he breathes hard it catches him an he has to fight for breath. The pain is sharp, pinching, and constant. He is short of breath on going upstairs. All this came on nine months before, the pain preceding the breathlessness. It came quite suddenly; he was running to his work and the pain stopped him. Tongue white; bowels regular; sleep sound. He always has headache over the left eye.
I found on listening over the apex beat the characteristic thump of obstructed mitral; there was a faint venous hum in the neck. The heart’s action was not regular. The pulse was very small.
Treatment Arsen. iod. night and morning, and Digit. 1, one pilule three times a day.
He came back in a fortnight feeling much better. Has only had two attacks of the heart-pain in the fortnight. His stammering was rather worse. He received another supply of medicine.
I will now relate a case of heart affection of a gouty nature.
CASE XVIII.-IRRITABLE WEAK HEART IN A GOUTY SUBJECT. HISTORY OF OVER-STRAIN; ACTION OF Arsen. iod.
The patient was a lady, age. 66, short, very stout, florid. As a child she was delicate; in middle life her health was good except that she suffered almost constantly from supraorbital neuralgia. She had lived in India some years, and had very good health except very slight attacks of fever, which seemed to relieve her of the neuralgic pains. In 1854 she had cholera in Edinburgh. Had been a great walker.
In 1884, when she consulted me, I made the following notes :-Has gouty concretions about the joints of her hands, and her feet are deformed in the same way. Her present illness dates from six years back; she was climbing a hill in Scotland, and she felt at the time she had done too much; she thought she never would have got her breath again; she has never been right in her breathing since.
After this she had a cold and cough for six weeks; it is unusual for her to take cold-she loves air and open windows. (When I saw her she had had a cold in the head; this had left the head and gone to the chest). She complains of great dyspnoea in the night, and whistling in the chest, which keeps her awake; has a sensation about the heart as if something were nipping her there- this is confined to an area about the size of a crown-piece; then she feels as if passing away, but recovers if she is quite still. At times she has a sensation of fullness, as if something in the chest would burst. Exertion or worry will bring on cough. There is no swelling of the feet. Poor appetite. I found slight wheezing here and there in the lungs.
On examining the chest I found the second sound of the heart accentuated at all areas, the first sound very faint except at the apex; there was no bruit.
I gave her Carbo vegetabilis 6, every three hours for three days, and there was considerable improvement, which, however, was not maintained. I then gave her Kali carb. 6, an hour before meals, and Arsen. iod.1, gr. 1/10, in water, immediately after food. The improvement was marked and rapid; she could move about with more comfort, and the appetite improved. Four days after this I gave her the Iodide 3x, 1 gr. three times a day after food, by itself.
She kept much better and was able to leave town soon after.
Quite recently (1894) I learned from a daughter of this patient that she died a few years ago of cancer in the left breast.
Needless to say, there are numbers of cases which are not perceptibly influenced by the Iodide. Homoeopathy has specifics for patients not for diseases, hence a strict attention to symptomatology is the only safe rule in this as in all departments of our art, as the case next to be related will exemplify.
CASE XIX.-IMMENSELY ENLARGED, DISPLACED HEART; VALVULAR DISEASE; INDIGESTION. GREAT RELIEF FROM VARIOUS REMEDIES.
It is notable how frequently cardiac patients complain more than anything else of indigestion. It was the principal thing the patient, James T., complained of before the attack which brought him under my care. It was the chief trouble in two of the cases still to be mentioned. In the case I am now going to relate, that of Mrs. W., an octogenarian, the strictest attention to dietetic rules was absolutely necessary in order to keep her in comfort.
This patient had survived a number of illnesses, including a right-side pleurisy many years before, which had left her with a shrunken lung and curved spine and a displacement of the heart to the right. The heart was greatly hypertrophied, and there were murmurs to be heard at every orifice, a double aortic, loud systolic at mitral and tricuspid. The heart’s action was very irregular, the arteries hard and tortuous.
I attended her through a variety of illnesses, diphtheritic sore throat, bronchitis on various occasions, influenza with bronchitis, minor urinary troubles and psoriasis. The condition of the heart dominated everything. There was great swelling of the feet, which varied in degree at different times. But her chief trouble was indigestion and flatulence; the smallest transgression was pretty sure to be visited by an “attack” in the early hours of the morning. The “attack” was a feeling of faintness, a sensation that she was “going,” violent pain at times in the region of the heart’s apex, great oppression, the symptoms being relieved after a greater or less time by a copious flow of colorless urine. Every time I was called to her in one of these attacks she thought she was dying, and was almost angry with me because I refused to confirm her prognosis and pronounce the viaticum.
Aurum metallicum in the 30th or 1m gave prompt relief to this feeling of impending death and kept her reconciled to life for long periods at a time.
Kali carb. in the same potencies gave her great help when the attacks came on between 2 and 5 A.M., and when there was a cough with aggravation at those hours. After an attack, when there was much palpitation and breathlessness with heart discomfort, Baryta carb.5 and 30, gave much relief. On occasional courses of these medicines she was kept in tolerable health for long periods. When I first began to treat her I gave the Iodide of arsenic with some benefit; but it was not nearly so marked as that from the more definitely indicated remedies in higher powers. Aurum 1m (Boericke & Tafel, or F. C.), had the most prompt action when the sensation of impending death was marked.
I will place beside this case another of extensively damaged heart in an aged patient, in which there were practically no symptoms referable to the heart itself, and consequently no call for special treatment.
CASE XX.-EXTENSIVELY DAMAGED HEART AND ARTERIES FULLY COMPENSATED AND GIVING RISE TO NO SYMPTOMS.
A stalwart octogenarian, Andrew M., came to my out-patient clinic at the Homoeopathic Hospital in the summer of 1882, complaining of rheumatic pains in various parts.
Two years before he had been laid up for five weeks with rheumatic fever, and for a short time after that he had been troubled with shortness of breath on going up stairs, but had got over that, and had not been troubled with any heart symptoms since. His irregular pulse, sharp and hard, and hard tortuous arteries at once told me that damage had been done. Here are two of his sphygmograms, pressure 4 ounces.
Examination of the heart showed the following :
There was visible pulsation in the carotids, the apex beat was in the fifth interspace, 3 1/2 inches to the left of the sternum, and the transverse dullness extended from 1/4 inch on the right of the sternum 4 inches to the left.
Vertical dullness began at the lower border of the third rib. No bruits were audible, but there was at the apex the peculiar thumping first sound which indicates mitral stenosis, this being followed by a sharp second. Over the aortic and pulmonary areas the first sound was inaudible, the second being sharply accentuated, the accentuation being most marked in the aortic area. An exaggerated second means increased backward pressure on the heart, and in the case of the aortic valve, it is generally the prelude to aortic incompetence and regurgitation. When the aorta has been affected, either by acute inflammation, as in fevers, or by chronic degeneration, it loses a certain amount of elasticity, and becomes permanently dilated under the force of the heart’s beats. When this has taken place the rebound of the column of blood after the systole is more sudden, and produces the accentuation of the second sound in the aortic area, such as was present in this case. The defect was compensated by hypertrophy.
The rheumatic symptoms gradually subsided under Bryonia and Colchicum, and, finally, Pulsatilla 3, which last did more for him than any other remedy. It removed, after the other medicines had failed, swelling, pain and numbness of the hands across the metacarpal joints, worse in the morning on rising, and left him practically well. The only symptoms he had during the course of the treatment referable to the heart were temporary giddiness and buzzing in the ears.
In this case I did not think it necessary to alarm the patient by explaining to him the condition of his heart, as I believed it would last him as long as the rest of his body.
I will now give the particulars of a case which first came under my care as one of “indigestion.”
CASE XXI.-MITRAL DISEASE WITH ATTACKS OF SYNCOPE. ACTION OF Ignatia.
Mr. J. W., a tradesman, who had done work about my house, consulted me occasionally for an “indigestion” he was troubled with from time to time. The first time was in February, 1888, he being then 38 years old. The symptoms of his indigestion were weight at the epigastrium after food, tenderness to pressure, and drowsiness after meals. These symptoms were quickly removed by Bryonia. He also suffered frequently from headache, tightness at the chest, pain between the shoulders, and at times a cough. His pulse was somewhat frequent, but there was nothing sufficiently remarkable about it to make me suspect anything wrong with his heart.
On April 13th, 1889, I was summoned to see him in the greatest urgency. After a good deal of worry he had been suddenly seized with violent palpitation and faintness, and when I saw him he was in a death- like faint, pallid, with purple lips, and icy cold; in fact he was in a very grave condition of cardiac syncope; the pulse was weak and slow. On examining his chest, I found the heart enlarged, and a mitral systolic bruit present. I put on his tongue a dose of Ignatia 1m (Boericke and Tafel) and repeated it frequently, and he soon revived sufficiently to enable me to take him home in a cab (for he was at his place of business at the time of the seizure). On examining him more at leisure, I found the systolic bruit (which was soft) was audible over the apex, and also over the left auricle. The condition was one of mitral incompetence with hypertrophy.
I now learned that for some time past he had noticed a shortness of breath on going up stairs, and three months before he had turned faint suddenly, and was compelled to sit down. I continued the Ignatia, and I may say that ever since that time it has been a very good friend to my patient. He never goes anywhere without a bottle of pilules of the medicine in the same strength, and whenever he has any sensation of weakness about the heart, whether induced by worry, or by over-exertion, a few doses soon put him right. He has never had a fully developed attack again. He is fair, and of a very sensitive temperament, and easily affected by worry, but active and muscularly strong.
To return now to my journal :-
April 14th.-Had a slight attack in the evening after talking. Dreamed much in the night; short breath on going up stairs; head feels rather light; feet rather colder. Continue Ignatia.
April 16th.-Headache in occiput; fluttering sensation in left chest; faint trembling after waking; a little fever; much flatus downwards; thirst; lips dry. Arsenicum 1m every two hours. Ignatia if required.
April 17th.- Went for a walk yesterday, but could not go far. Dreamed much all night- muddled dreams. Tongue white; still thirsty; bowels rather confined; occipital headache on waking; tremor at heart. Repeat.
I need not follow out the case from day to day. There was another slight attack on the 20th, but by the end of the month the patient was able to return to his work. He had occasionally drawing or digging pain in his left side, and at times a sharp pain, and headache remained troublesome. At one time he described it as a “floating weight” at the vertex. This was relieved by Actea rac. 1. On May 8th he complained of feeling a weight at epigastrium after food, sinking sensation coming on after dinner, and constipation. He received Sulph. 30, one pilule three times a day. After this he was practically well, Sulphur and Ignatia being the chief remedies he required.
Early in the following year he had influenza very badly, with pneumonia and pleurisy of the left side. The heart was not directly involved. The bruit was heard, though faintly. Sulphur was his chief remedy on this occasion. At present he is in very good health. If he over-exerts himself, especially when at work on great heights, as the roofs of London houses, he is reminded that he has a heart. I examined his chest quite recently, and found this condition :-
Apex beat not felt. Area of cardiac dullness extends 2 1/2 inches to left of sternal edge. In pulmonary and aortic areas the first sound is soft; at the mitral area no bruit is heard, but the first sound is impure. This shows that the mitral valve has been restored to competence, though not to its normal state. The sharp, clear sound of the closing of healthy valves is wanting.
This patient has never had rheumatic fever, or any illness to which the state of his heart could be traced. He has always been temperate. Eleven years ago he was very nearly killed by a brick falling on his head from a building in course of erection; but this is the only illness of consequence that he remembers.
The above sphygmogram was taken on March 21, 1893, pressure 3 1/2 ounces.
The foregoing cases, chosen out of a large number, will, I think, suffice to prove that valvular disease of the heart is often curable under Homoeopathic treatment; and when the valves are beyond repair and the balance of the organ lost, much may still be done by Homoeopathy to give power to the heart and restore its equilibrium.