Class II. contains medicines which act in a manner directly the reverse of Class I., i.e., their primary action is similar to (not identical with) the secondary effects of the latter. I have explained to you this primary action of digitalis and its analogues, and described the condition of the heart from their ultimate primary action. Their secondary effects on the heart are weakness, irritability, and even paralysis. I believe their long- continued pathogenetic effects would result in dilatation of the heart. They are among our very best remedies in that condition; but in order to get prompt, palliative, and curative effects, you will have to give appreciable doses, not going higher than the third decimal dilutions, even for infants. You will often get the best effects from the mother tinctures, or the aqueous infusions. These medicines, you will remember, are: digitalis, cactus, hydrocyanic acid, prunus vir., prunus laurocerasus, amygdalus persica, and lycopus.
Digitalis. In the spring of 1867, I read a paper on the action of digitalis before the Illinois State Hom. Medorrhinum Society, which paper was afterwards published in the third volume of the United States Medical and Surg. Journal. To this paper I would refer you if you wish all the necessary proofs as to the tonic effects of digitalis in cardiac debility. The primary action of digitalis is quite transient. For this reason you will find its sphere of action in sthenic diseases much more limited than in the asthenic; in a weak condition of the heart oftener than in inflammations or concentric hypertrophy. It is indicated in all the varieties of hypertrophy with dilatation, whatever the cause may be, or any condition of the heart where its muscular power is especially deficient. This is directly contrary to the teachings of nearly all authorities up to a few years ago. Prof. Tully, however, was notable exception. He boldly placed it among his “antisbestic,” or exhaustion-opposing medicines, and asserts that he has given it for years to the same patient without any other than excellent effects. He used it freely in cases of hypertrophy, but it is evident, from his description, that they were cases of dilatation. Of late years, the best practitioners of the allopathic school use it without fear in cases of dilatation, even in large doses. I will quote to you from Flint, who is evidently an unbiassed witness. He says, “As a remedy, with reference to irregularity of the heart’s action incident to dilatation, digitalis often manifests a truly remarkable efficacy. Of the different preparations the tincture is to be preferred, on account of its being more reliable as regards strength. Digitaline, however, has still more this advantage, and is perhaps entitled to preference.” Alluding to the conflicting opinions relative to its action, he says, “Without discussing these different opinions, it may be assumed that, given in small or moderate doses, for example, from ten to thirty drops of the tincture, it cannot, under any circumstances, have much potency to do harm, and it cannot prove a dangerous remedy. That it renders the action of the heart slower and more regular is undeniable. With reference to these effects, Bouillard calls it “the opium of the heart. That it produces these effects without weakening the heart may be assumed; and clinical observation appears to show that, under its use, the heart, already weakened by dilatation, acts with increased strength. With these views, it is a remedy useful in cases both of hypertrophy and of dilatation.” Flint does not say how often his thirty-drop doses should be repeated, but I assure you that if they were repeated every two or three hours in a case of hypertrophy with enlargement, they would cause dangerous cardiac spasms, while in dilatation no such dangerous results would follow, although no such large doses are admissible, except in sudden cardiac syncope, and similar emergencies. I have found that doses of one, two, or five drops of the first dilution, repeated every two or three hours, acted well in children or sensitive adults, but the mother tincture in similar doses may be required. In cases of dilatation, give the digitalis until it causes the requisite slowness, strength, and regularity, even if you have to increase the dose to Flint’s standard to bring about that result.
I do not speak from mere theory in this matter, but from much practical experience, which experience I have found to substantiate my theory of dose.
There is another fact relating to the use of digitalis in dilatation. This condition will, as you are aware cause various pathological conditions in other important organs – the brain, lungs, liver and kidneys. Dilatation causes passive congestion, with consequent torpor of function in all these and other organs. Therefore, in cerebral, pulmonary, hepatic, and renal troubles; in vertigo, apoplexy, cough, haemoptysis, jaundice, enlargement of the liver, dropsy, etc., you should always ascertain if cardiac debility is not at the bottom of the trouble. If you find this to be the case, digitalis is the chief remedy always. As for characteristic symptoms whereby to select this remedy, I must say that they appear to me of less value than a knowledge of the pathological condition of the heart and its consequences I have just delineated. If you consult any work for symptoms go to the Symptomen Codex, but even there you will find the indications unsatisfactory. Neither Lippe nor Gross give any indications of value for digitalis in cardiac disease. If I were to name any group of symptoms indicating its use in dilatation, these would have the preference: quick, weak, irregular, or intermittent pulse; increased or deficient action of the heart, with deficient force or impulse; cough, haemoptysis, jaundice, alternate scanty and profuse urine, sometimes albuminous; oedema of the feet, legs, face, and scrotum, ending in general anasarca; sighing respiration, with sinking, weak feeling at pit of stomach; and sometimes vertigo and amaurosis.
I shall allude to digitalis again in the treatment of valvular diseases.
Digitalin is sometimes more efficacious in dilatation than the tincture. I allude to the digitalin of Quevenne, the only preparation of any value. It occurs in pale straw-colored scales, or a white powder, and is inodorous and extremely bitter. The triturations should always be made on the centesimal scale. You will get the best effects from the 1st to 3rd triturations, of which a grain may be given every three hours.
Hydrocyanic acid is the nearest analogue of digitalis, but it acts with greater intensity and rapidity. The primary action of this poison I have already given you. Its secondary action does not materially differ from that of digitalis. After the primary effects have passed away, the heart becomes weak, flaccid, and subject to irregular action and severe pains, which I think are myalgic. These symptoms make it indicated in dilatation with asthmatic troubles, and attacks of angina pectoris. The provings have “tightness of the chest; feeling of suffocation, with torturing pains in the chest; sticking in left side of chest, and pain and pressure in the region of the heart; irregularity, with feeble beating of the heart.” You must be exceedingly cautious in prescribing the dilutions. The 1st decimal dilution cannot be taken in doses of one drop frequently repeated, without causing, in sensitive persons, unpleasant symptoms; but you can put 10 or 15 drops in half a glass of water, of which a teaspoonful may be taken every two or three hours. Its use should be suspended, or the doses given at longer intervals, as soon as the action of the heart becomes stronger and more regular. The 3rd dilution may be given in drop doses. But when this acid is indicated, there are agents which contain it and other additional medicinal constituents, making them of greater value in the treatment of cardiac affections. The best of these is the:
Prunus virginiana (wild cherry) which contains a principle which possesses tonic properties, similar to china and hydrastis. This property is also possessed, in a greater degree, by the cerasus serotina (choke cherry).
We have no provings of these remedies, but their successful use for nearly a century, has given us clinical experience sufficient to give us reliable data.
I can give you no better indications than those of digitalis, to which can be added “weakness, loss of appetite, slow digestion, cough, tightness and constriction of the chest, and a fulness and pressure in the head.” The symptoms in italics I have often observed to arise from large doses of the infusion of the bark of these trees. You can use a hydro-alcoholic tincture of the fresh bark in drop doses, or the lowest dilutions, or the syrup, or the cold infusion, made by digesting or percolating one ounces of the fresh, or dry inner bark in a quart of water, until it assumes a dark red color. This may be given in table-spoonful or wine- glassful doses, repeated every three or six hours. Those who are sticklers for the high dilutions may object to this method of prescribing a medicine, but I cannot see the necessity of adhering to any one method of preparing our remedies. If a medicine is homoeopathic to the disease, it matters not in what form we give it, if the doses are not large enough to cause pathogenetic symptoms. Your object should be to cure your patient in the quickest manner, regardless of peculiar notions relating to arbitrary pharmaceutical preparations.
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.