In December, 1893, a mental shock-the sudden death of her mother from heart disease-again brought on an attack of pain and palpitation, this was followed by another acute attack of influenza, with pains all over the body, especially the feet and ankles. At times the attacks of palpitation would come on in the middle of the night, compelling her to jump out of bed.
Examination of the heart showed that it was greatly enlarged. The area of dullness was much increased; the apex beat was far to the left of its normal position. There was tenderness over the apex beat, and this was the seat of the pain. No evidence of any valve involvement. Thyroid gland distinctly enlarged; eyes not particularly prominent. When the rheumatic symptoms of the influenza had subsided, inflammation of the ear supervened. The patient suffered excessive pain which the usual remedies did not relieve very much; the pain coming in paroxysms, and lasting some hours, being worse from 1 to 5 a.m.
The ear had begun to discharge freely.
Taking into account her general state, the thyroid enlargement, heart pain, palpitation, and flushes of heat from which the patient suffered, I prescribed on February 17th Thyroidin 30, a few globules dissolved in water; a teaspoonful every two hours.
After five doses she lost the pain completely, and for the first time slept a night through. The following night she had some pain, but it did not commence till 7 a.m. Pulse much quieter.
February 21st.-Very bad earache last night.
Treatment Pulsatilla 30 every two hours.
February 22nd.-No pain in night, had some during the day. Repeat.
February 23nd.-Earache all night; some discharge; worse in warm room.
I now returned to Thyroidin, which I gave every hour.
February 25th.-Ear better; had three hours pain on night of 23rd, but none since.
On the 27th the heart was very troublesome again. The monthly period was due but had not come on; she had a sensation as if the heart stopped. I gave Pulsatilla again, and afterwards, Psorinum, but without much relief; and on March 3rd I returned to Thyroidin, which relieved the heart at once.
The period came on the same day. Since then the heart has given the patient very little trouble, and when she has felt it a few doses of Thyroidin have sufficed to put it right again.
Here is an acute case to which I have already alluded in Chapter II.
CASE XXIV.- ACUTE VALVULAR AFFECTION OF THE HEART WITH SEVERE HEART PAIN. CURATIVE ACTION OF Thyroidin.
Sydney C., 24 porter, fair, sanguine temperament, robust- looking, was admitted to the the hospital November 15th, 1893. Three or four years before he had had pleurisy. He is subject to attacks of pleurisy whenever he takes cold. Three months ago he was taken ill with pains all over, chiefly in his joints; since then he had been unable to work. On admission he complained of pains in the region of the heart, as if the heart were being squeezed; severe headaches, shooting pains in forehead and vertex chiefly, sometimes also in occiput. Burning pain round left costal margin, worse after drinking; also about half an hour after eating, pain in epigastrium to the left side, as if the food stuck there. Shooting pain across cardiac region and under left shoulder. On stooping and lifting, pain across lumbar region.
Appetite good; has much flatulence upward; waterbrash, very sour, comes on soon after drinking. Bowels regular as a rule.
Has palpitation, chiefly at night, caused by any slight noise. Orthopnoea: if he lies down the squeezing sensation at the heart comes on. Dyspnoea on exertion.
State of the heart.-Apex beat visible in fifth space in nipple line. Impulse weak. Systolic bruit heard in aortic area, and all along the sternum and in tricuspid region. Second sound weak. Mitral soft, blowing, systolic murmur very faint.
Eruption of acne on left side of chest. Pupils both very much dilated. Urine alkaline, no albumen, copious phosphates.
Treatment Cactus 30 every four hours.
Later examinations of the heart gave the following results:- November 22nd.-Systolic bruit not so loud in aortic area as in left auricular area.
November 27th.-No aortic bruit heard to-day, no mitral bruit, both sounds indistinct and muffled.
November 30th.-Faint systolic heard in pulmonary region; first sound very impure in mitral area, inaudible in aortic.
December 14th.-First sound very muffled; inaudible in aortic and pulmonary areas.
This was the last examination made. The attack was of a rheumatic nature, involving the heart, and complicated with flatulent indigestion.
apparently from another patient in the ward, with fever, cough, backache and headache, his other pains being intensified at the same time.
December 4th.-Flatulence very bad during the night, causing much pain in the chest.
Treatment Carbo.-veg. 12, every two hours during the night.
After this he slept better, and was free from indigestion for some days; but still there was at times a good deal of flatulence and acid risings; and palpitation waking him in the night.
On December 27th, guided largely by persistent rapidity of the pulse, and faintness of which he frequently complained on waking, I put him on Thyroidin 3x, gr. ij, three times a day.
The heart pains quickly subsided, but the flatulence continued, and I gave Carbo.-veg. when required, in addition to the Thyroidin.
December 30th.-Pulse diminished much in frequency. Is better, except for flatulence.
Treatment Carbo.-an. 12. Stop Thyroidin.
January 3rd, 1894.-Flatulence better. Pain under heart again, and round left side.
Repeat Thyroidin.
January 5th.-Better than he has been for a long time. Less flatulence. Still sour waterbrash.
January 6th.-No pains at all. Flatulence better.
January 10th.-Flatulence troublesome again. Pulse 84.
Treatment Carbo.-an. 12.
January 13th.-Flatulence better.
He was discharged practically well on January 15th. The Thyroidin had more marked effect on the cardiac distress than any other medicine given, and I have no doubt greatly expedited the patient’s recovery. He was quite well enough to return to work when he left the hospital.
