Baehr is of opinion that we have often cured cardiac inflammations with phosphorus without knowing it. In the conclusion of his observations he says, “Finally, we have to point out a symptom which most decidedly indicates phosphorus, we mean the dilatation which develops itself during endocardial inflammation with such surprising rapidity.”
I will add that phosphorus appears to be pathologically indicated in this disease. The post-mortem appearances observed after poisoning by phosphorus are: the muscular tissue is flabby and easily torn; opaque appearance and interstitial distension of the endocardium; bloody infiltration, which in certain circumscribed spots penetrates the whole thickness of the muscular tissue. If, in addition to these appearances, we consider the very feeble, small, and exceedingly frequent pulse; the frequent observation that the sounds of the heart either often disappear or are replaced by murmurs, we cannot deny that this remedy ought to be tried in severe cases, especially those of a secondary character.
Lachesis, as well as all the serpent-poisons, exerts a profound and specific action on the heart, and more upon the endocardium than the pericardium. In all cases we find an unusual increase of the frequency of the pulse, which becomes feeble and small, or intermittent; there is pain in the region of the hart, the pain being sometimes intense; palpitation of the heart; fearful anguish; bloody expectoration, with constant hacking cough; marked symptoms of cyanosis; icy coldness of the extremities, with cold perspiration; paralytic sensation in the whole left side of the body, or a violent pain in the left arm. In my opinion, lachesis (also crotalus and naja) is indicated in the second and third stages of very acute and severe cases of endocarditis, when arising from pyaemia, typhus, or during malignant eruptive fevers. It is homoeopathic to the vegetations and structural changes which occur, for post-mortem examinations after death from serpent-poisoning have always shown the heart more or less affected. The endocardium in the region of the valves is infiltrated and easily torn; ecchymoses cover its internal and external surfaces; and exudations occur in the muscular tissues of the heart. Take these indications, together with the many symptoms recorded in our materia medica, and you will have no difficulty in selecting lachesis. Dose: the dilutions from 6th to 30th.
Iodine and its combinations should not be neglected by you in endocarditis. They are indicated in sub-acute cases, and not so much for the inflammation as for the structural changes occurring on the valves.
Cuprum aceticum has been reported by a Dr. Kissell* * Marcy and Hunt’s Practice. as having cured three cases of rheumatic endocarditis, but the testimony is based on the observation that “auscultation revealed a bellows-sound at every other beat of the heart; feeble pulsation of the heart.” The symptoms of the heart were: “pressure under the lower part of the sternum, and oppression of the chest; pulse, 85; quick pulsation of the heart, and the tone feeble and dull, as if it came from great depth.”
Dose: the tincture, or 3rd to 6th triturations.
Apocynum androsemifolium. In endocarditis-rheumatica, when the rheumatic affection has been confined to the hands and feet, and there is present considerable gastric and hepatic irritation. (++) New Remedies, 2nd Ed.
Dose: the first dilution has been found most useful.
Asclepias syriaca, as you will observe from the provings, will likely prove of service in endocarditis from renal affections, or from a retention of scarlatinal poison.
Dose: the tincture, a few drops, in water.
Baptisia will prove in your hands an unrivalled remedy in endocarditis during or following typhoid or other low fevers, especially when you have present its well known characteristic symptoms.
Dose: the first decimal dilution, in drop doses.
Cactus grandiflorus will never fail you, in the severest cases of the acute form, if that peculiar symptom, “Sensation of constriction of the heart, as if from a band around it, preventing movement,” is present. No other remedy equals it in controlling the severe nervous palpitations common to the disease. I get the best effects from the 1st dil.
Cimicifuga must not be forgotten in the treatment of endocarditis rheumatica. It may be better suited to pericarditis, but if the former affection have a rheumatic origin, I seen no reason why this remedy should be neglected. If the endocardial inflammation occur in a woman from suppression of the menses, and there is also intense headache, delirium, stitching pain in the region of the heart, in the infra mammary region, and down the left arm, you can give the cimicifuga with every prospect of success.
Dose: the dilutions below the 4th.
Hamamelis. I have reason to believe that in certain cases of phlebitis, the inflammation may be transferred or extend to the heart. If such a condition does occur, this remedy will be found useful. In the provings we find it to cause pricking pain in the region of the heart, felt also in the superficial veins of both arms, continuing for ten days. By referring to the provings you will find other important symptoms of cardiac inflammation. This medicine acts best in the lowest dilutions.
Lachnanthes will have to be used if cerebral symptoms occur, which indicate its use. The cardiac symptoms of this remedy are also notable.
Lobelia inflata has been used successfully in some cases of endocarditis. The characteristic symptoms calling for its administration are very striking: excessive vomiting; an intense sensation of sinking at the stomach; sighing; great dyspnoea; deep seated pain in the region of the heart; and small, quick, and feeble pulse.
Dose: the dilutions from 1st to 6th.
Phytolacca may prove useful in sub-acute or chronic endocarditis if the patient has rheumatic symptoms, and the cardiac pain extends to the right shoulder and arm instead of the left.
Sanguinaria. The sphere of action of this medicine resembles that of phosphorus, in so far as the complication of endocarditis with pneumonia may occur. If you meet this complication in practice, do not forget to study the provings of sanguinaria, for you may find it indicated when phosphorus or sulphur have been used without the expected curative results. If the right lung is the seat of the inflammation, it is to be selected instead of phosphorus.
You will remember that in my lecture on pericarditis I mentioned the efficacy of the alkaline treatment, as a means of combating the existing pathological-chemical cause of rheumatism. The same observations will apply to that treatment in endocarditis. It may also prevent the formation of the solid products incident to the latter, by depriving the blood, to a certain extent, of its excess of fibrin. The carbonate of ammonia has been highly recommended for this purpose, as being more powerful than other alkalies, and it is affirmed that its use will prevent the formation of large fibrinous coagula.
The indications during convalescence and subsequently are: to advise against undue exercise, the abuse of stimulants, the avoidance of agitating emotions, and excesses of any kind, which might bring back the inflammation, or hasten the development of structural lesions. But you must not go so far as to alarm your patient to exceeding caution, for an extreme sedentary life should be equally avoided. An amount of physical activity necessary to vigorous health is not unfavorable as regards the liability to organic disease. You must not excite the fears of your patient, for the moral effect of looking forward to probable organic disease is not favorable to mental or bodily health.
MYOCARDITIS.
A brief allusion to myocarditis will close this lecture. This is an inflammation of the muscular structure of the heart. The muscular substance of the heart is the seat of inflammation much less frequently than the investing and lining membranes of the organ. it rarely, if ever, occurs independently of endo- and peri-carditis. Either the investing or lining membranes, or both, are implicated. The inflammation, probably, in most instances extends from these membranes to the muscular substance. Theoretically, it ought to occur more frequently as a complication of muscular than synovial rheumatism. Practically, however, we do not know that this is the case. The inflammation is usually limited to certain portions of the heart, and it occurs much oftener in the left than in the right ventricle. It may be confined to the outer or inner layers of muscular fibres; or it may extend throughout the walls and affect the columnae carnae. The septum is less likely to be affected than the ventricular walls. The results of myocarditis are suppuration, induration, and aneurismal dilatation. Rupture of the heart may also occur.
When abscesses exist, there is purulent infiltration of the surrounding parts. The formation of abscesses destroys the muscular structure to a great extent. They may discharge their contents into the pericardial sac, giving rise to acute pericarditis; or they may evacuate into the ventricular cavity, and give rise to purulent infection of the blood. In either case a fatal result is inevitable.
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.