SUMMARY OF THE PHYSICAL SIGNS DISTINCTIVE OF ENLARGEMENT BY DILATATION.
“1. Percussion. – The transverse dimensions of the space occupied by the heart greatly exceeding the vertical, the form of this space corresponding to the wedge-like or square form of the organ when the dilatation is excessive.
“2. Palpation. – The apex-beat devoid of abnormal force, and in some instances suppressed. Absence of heaving movement of the ribs and praecordia.
“3. Auscultation. – The element of impulsion of the first sound deficient or absent, and the sound short and valvular; in these respects resembling the second sound.”
TREATMENT OF DILATATION.
The indications for the treatment of enlargement by dilatation in some respects does not differ from the treatment of predominant hypertrophy. In other and important respects, however, the treatment materially differs.
You cannot remove the impediment to the circulation which co- exists in the great majority of cases, but the effects may be mitigated, if you have your patients avoid the extrinsic causes which excite unduly the action of the heart.
In the dark days of the history of medicine, incalculable evil was done, under the impression that the mass of blood must be diminished. Bloodletting was resorted to, giving temporary relief, but ending most disastrously, by causing anaemia and muscular atony, accompanied with excessive cardiac irritability. The same effect was produced by drenching patients with saline drugs, or the use of exhausting cathartics. When these were abandoned, the allopathic school resorted to large doses of aconite, antimony, and similar exhausting remedies, which only made the disease worse, by weakening the nervous and muscular power of the heart.
Before speaking of medicinal agents, I will give you the general rules which you should try to make your patients adopt. Excessive muscular exercise, mental excitement, or anything calculated to excite unduly the action of the heart, should be avoided.
The great end of the treatment, remember, is to increase the muscular power of the heart. The diet, therefore, should be as highly nutritious as possible, and the quantity of liquid ingesta as small as is compatible with comfort. A diet of solid, easily- digestible, animal food, with a careful admixture of nutritious vegetables, should be advised. At the same time advise the patient to avoid any articles that appear to digest with difficulty.
Indigestion, constipation, hepatic torpor, or inactivity of the lungs, must be removed as soon as discovered, and carefully guarded against. The mental condition of your patient will have much to do with his condition. Depression of spirits tend to aggravate the disease. You must encourage as much as possible; in order to prevent the gloomy forebodings which annoy and depress. You can do this conscientiously, for in the majority of cases under your care, you can safely encourage hope, not of a complete cure, perhaps, but of tolerable health for an indefinite period. The common notion that disease of the heart ends in sudden death is erroneous, and you should strive by the most positive assurances to remove this idea from the minds of your patients.
The medicines most useful in the treatment of dilatation have already been enumerated under the head of Enlargement by Hypertrophy. This, at first thought, may seem strange; but when you remember that all medicines have a double pathogenetic action, you can readily see that they will prove curative in opposite pathological conditions. You will observe this in the provings of all medicines, and also from the fact that a medicine is recommended for constipation and diarrhoea, spasm and paralysis, irritation and torpor.
I will, therefore, recapitulate the same classes I gave you in the previous lecture, but with the appropriate indications:
Class I. Includes medicines whose primary effect is to depress and weaken the muscular and nervous power of the heart, and give rise to conditions which would tend to cause dilatation; but whose secondary effects are similar to those conditions described in the last lecture.
All the truly representative men of the allopathic and eclectic schools now recognize the fact, that small doses of depressing medicines act as tonics to the tissues they primarily depress. In proof of this I refer you to the recent writings of Dr. J.R. Reynolds, handfield Jones, Trousseau, Brown Sequard, Flint, Scudder, King, and others. This is an affirmation of the theory promulgated by Hahnemann, and which forms the basis on which rests our important and universal Law of Cure. The Law of Dose, which I have taught you in my lectures when occupying the chair of Materia Medica, is, however, equally important, for without it, the selection of the dose is a matter of great uncertainty.
The medicines of this class, then, which primarily depress the heart’s vitality, are especially indicated in the treatment of dilatation, and its co-existing debility of the structure of the heart. They are:
Aconite, veratrum album, veratrum viride, gelsemium, tartar emetic, colchicum, lobelia, and tabacum.
While I advised you to use these remedies in the lowest attenuations or mother tincture, in concentric hypertrophy when there is an abnormal increase of power, I now advise you to use these medicines in high attenuations, for the reason heretofore given, that the smallest possible doses should be given when we are treating symptoms similar to the primary effects of medicines.
The two most prominent physicians* *J. Russell Reynolds and Scudder. of the opposite schools almost recognize this rule, for they prescribe the above medicines in the following manner, namely, ten or twenty drops of the tincture in four or eight ounces of water; a teaspoonful every three or four hours.
Leaving you to select each medicine in accordance with its characteristic symptoms, I advise you to give the attenuations from the 3rd to the 3000th. After you have chosen the appropriate remedy, do not change too soon, but continue its use until you are satisfied with the improvement, or are sure it is not causing the wished for amendment.
I am not favorable to the alternation of remedies, as a general practice, but I have so often seen beneficial results follow the alternation of remedies belonging to Class I. with those belonging to Class III., that I have no hesitation in advising the practice.
I will only give a few of the most characteristic symptoms of these medicines: Aconite: pulse irregular, quick, weak, thready, and small; feeble and incomplete action of the heart; the pulse and heart- beats do not agree; coldness of the extremities, numbness and tingling of the cold extremities; great anxiety and fear of death accompany the attacks of palpitation (dilatation of left ventricle.)
Veratrum album: pulse very small, almost imperceptible; intermittent; heart’s action feeble, irritable; palpitations, with distressing dyspnoea; cold face, with cold sweat on the face and forehead; cold and livid hands and feet, with tendency to cramps in extremities. No fear of death, or great anxiety, as from aconite, although the patient may think death is near (dilatation of right ventricle.)
Veratrum viride: pulse soft, feeble, but very slow, hesitating, or intermittent; excessive irritability of the heart, so that the slightest motion in bed, or sitting up, causes faintness, vertigo, and blindness; pale face, but not the excessive coldness of verat. alb.; indifference, no fear of death.
Gelsemium: pulse soft, slow, almost absent: heart’s action very feeble, slow, almost imperceptible; fear of any movement, lest the heart should stop beating;* *A very characteristic symptom, just the opposite of all other medicines.
veins of the neck distended; extremities not cold, but apparently swollen from venous turgescence, slightly livid; indifference; obtuseness; difficulty of lifting the upper eyelids, dimness of sight; heaviness and weariness of the limbs; palpitations feeble, (dilatation of left ventricle.)
Tartar emetic: pulse small, thready, irregular, feeble; heart’s action feeble and irregular; dyspnoea of a very severe character, with cough and frothy expectoration; congestion of the lungs; cannot lie down; enlargement of the liver; jaundice; attacks of vomiting; (dilatation of right ventricle, with cardiac asthma.)
Sanguinaria: for nearly the same symptoms, except that the expectoration is bloody.
Colchicum: pulse and heart’s action feeble; urine scanty and albuminous; tendency to dropsy, beginning with oedema of the feet, then extending upward.
Lobelia: pulse small, feeble, and irregular; heart’s action irregular and weak, aggravated by slightest exertion; distressing sinking sensation at pit of stomach, attended with agonizing attacks of dyspnoea; anxiety, and fear of death; cold face and extremities; cough, with serous expectoration; (dilatation of right ventricle.)
Tabacum: for nearly the same symptoms as lobelia, but with vertigo, and sensation of shocks in the heart, with feeble distressing palpitations.
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.