If, however, the tendency to faint continues, and the pulse is very feeble, slow, irregular, or intermitting, digitalis is the appropriate remedy, and should be given in doses of 5 or 10 drops of the first dilution, repeated every 15 minutes. Watch the pulse, and suspend the medicine so soon as it becomes normal in force and frequency. Digitaline, 3rd trituration, may be substituted for the tincture.
If, with the general prostration, the skin becomes suddenly very cold and clammy, and cramps of the extremities set in, give veratrum album in the 6th dilution, frequently repeated.
If the pain is so severe as to predominate over all the other symptoms, and the action of the heart is not notably depressed, you may resort to the inhalation of ether. In a case which occurred in my practice several years ago, ether always gave relief in a few minutes. Chloroform may be used if more readily obtainable. It has one advantage, that it acts more quickly, but it should be used with extreme caution. If half a drachm or a drachm does not give relief it should not be tried further. The hydrate of chloral acts very quickly, and a dose of ten or fifteen grains may prove a safe and efficient palliative remedy, used for the same conditions as ether and chloroform. Never give opium, or any of its alkaloids; they do not act quickly enough to palliate, and are useless as curative agents.
It has been found that electrization of the skin in the praecordial region is remarkably effective, both in arresting the paroxysms and postponing their occurrence. It is probable that with the great advancements made in electro-therapeutics, some method of application will be discovered that will result in a more certain curative treatment than we now possess.
Swallowing pieces of ice has been found an effective measure by Romberg. The application of mustard over the region of the heart may be of benefit. Dry cupping and the hot foot-bath should not be forgotten.
You should never be at a loss for expedients in the treatment of such disorders. Anxious friends are too impatient to wait until you have tried to question the sufferer, for every moment seems an hour to both, and unless you do something very quickly, their criticisms will be anything but complimentary. Not only should you be quick to act, but you should inform the attendants just what to do if the paroxysms return, and supply them with appropriate remedy for such emergencies. It is seldom that a physician can be procured before the paroxysm has passed; for this reason it is your duty to anticipate the treatment. I will add that you will find it difficult to decide whether your treatment has really mitigated or shortened the paroxysms, for they vary so much as to intensity and duration. Finally, you must caution them against exciting causes, namely: strong mental excitement, violent muscular exercise, excesses in eating and drinking, walking against the wind, or climbing heights.
For the radical treatment of angina pectoris the best remedies are arsenicum, digitalis, lachesis, naja, rhus, aconite, spigelia, cimicifuga, and phytolacca.
Arsenicum is probably the most reliable remedy for the eradication of the disorder. Hartman says, “Not only the actual paroxysms, but the disease, generally finds in arsenicum its appropriate remedy, provided the disorder is not complicated with structural changes the heart and the large arteries, or other extensive disorganizations. It is indicated if the patient can only breathe very gently, with his chest stooping forward, and if the least motion causes a complete loss of breath; if oppression and stitches in the praecordial region are associated with anxiety and a fainting sort of weakness; if the breath gives out even while the patient is getting out of bed, and it takes him a long time to recover his breath; or if the paroxysm is excited by a simple change of position in bed.” To these indications I will add, that arsenicum is especially indicated in angina with regularly recurring paroxysms, as sometimes occurs in malarious districts. In these cases, if the 30th does not prevent the recurrence of the paroxysms, use the lower dilutions. The dose should be repeated two or three times a day.
Digitalis and digitaline come next in importance. Baehr asserts that he cured a case with digitaline, 2nd and 3rd trituration, “not very often repeated.” The symptoms and therapeutic range of the drug correspond with the disease, whether it be a pure neurosis or accompanying organic disease of the heart. In cases of angina pectoris indicating digitalis, abnormal action and a sense of oppression, with tendency of syncope, are predominant. The pulsations are irregular and feeble, or spasmodic, and cause anguish and pains under the sternum and below the ribs of the right side. The pain extends to the head and left arm. Vertigo and fainting, and feeble, irregular pulse are generally present.
I advise you to use the 1st dilution, or a few drops of the tincture of digitalis, in a half-glass of water, and repeat the dose as often as every six hours between the paroxysms. If you use Digitaline use the pure alkaloid (not Keith’s or any other inefficient article), in the 1st centesimal or the 3rd decimal trituration.
You will find lachesis and naja useful when the pain and dyspnoea are concomitants of organic disease of the heart, and are attended by irritation of the glosso-pharyngeal nerves, causing distressing sensation of choking, constriction, or “rising” in the throat, and inability to speak. Use the 200th, and repeat not oftener than every 12 hours.
Aconite will prove an excellent remedy in your hands if your cases are marked by intense anxiety, fear of death, coldness, and cold sweat, feeble pulse, and intense pain in all directions, and general or local numbness and tingling. It is indicated in pure neuralgic cases, and should be used in the lower dilutions.
Spigelia has been used with good results, when there are severe stabbing stitches in the heart at every beat; pain and palpitation, aggravated by bending forward, touching and stomach, lifting the arms, or any other motion. It is useful in the purely neuralgic, and also cases of organic disease. The 6th dilution is to be preferred.
Rhus tox. is indicated in patients of a rheumatic diathesis – when the symptoms occur with or without organic disease. The characteristic indications for its use are, stitches in the heart, with painful lameness and stiffness of the whole body and extremities, and pain extending down the left arm. A case having these symptoms, also “hypertrophy with dilatation, paleness, and weakness; pulse soft, slow – 48 per minute; coldness and numbness of left arm; pain worse every morning at 4 o’clock; a faint, fluttering sensation in stomach and left chest; gurgling in region of heart; soreness throughout left side; lying on left side brings on severe palpitation and pain in region of the heart,” is reported as cured by the 200th of this remedy.
Phytolacca will be indicated in those cases where the pain extends to the right arm.
I once cured a case with cimicifuga,* *See New Remedies, I 234. 1st dil. The pains were sharp, lancinating, and extended all over the left chest, down the left arm, and into the back, with dyspnoea, unconsciousness, etc.
If the remedies I have mentioned fail to cure, do not be discouraged, but try the valerianate of zinc, laurocerasus, cuprum, crotalus, arnica, and cactus, which last may prove to be an excellent remedy in this disorder, when its peculiar characteristic symptoms are present.* * See New Remedies.
Hale wrote Lectures On Diseases Of The Heart, Materia medica and special therapeutics of the new remedies Volume 1, Materia Medica And Special Therapeutics Of The New Remedies Volume 2, Saw Palmetto: (Sabal Serrulata. Serenoa Serrulata), The Medical, Surgical, and Hygienic Treatment of Diseases of Women, New Remedies: Their Pathogenetic Effects and Therapeutic Application, Ilex Cassine : the aboriginal North American tea, Repertory to the New Remedies with Charles Porter Hart, The Characteristics of the New Remedies, Materia Medica and Special Therapeutics of the New Remedies, The Practice of Medicine, Homoeopathic Materia Medica of the New Remedies: Their Botanical Description etc.