The leaves, pits, or inner bark of the amygdalus persica (peach) is much stronger in prussic acid, and may be used in infusion or hydro-alcoholic tincture, but in one-half or one-third the quantity recommended for prunus.
The amygdala amara (bitter almond) is still more powerful. This medicine, as well as the pit of the peach, may be prepared in triturations, and used in the 1st. In cases of hypertrophy with dilatation I have known a few bitter almonds eaten before and after meals prevent the palpitations which are apt to occur after eating.
Lycopus virginicus is likely to prove one of our best remedies in dilatation. If you will refer to the provings and clinical experience recorded in “New Remedies,” you will see that its sphere of action is evidently that of a cardiac sedative and tonic. It is useful in dilatation associated with and causing pulmonary troubles, such as congestion, haemoptysis, cough, and dyspnoea. You can prescribe it in the tincture or lowest dilutions, or an infusion of half an ounce of the leaves to eight ounces of hot water. Of this a teaspoonful may be given every two or four hours.
Ferro-cyanuret of potash has lately been introduced into practice as a remedy for hypertrophy, as well as for functional disorders of the heart. This double salt is of a yellowish, color, and quite innocuous when compared with the cyanide of potash, with which you should be careful not to confound it.
Dr. Ray, in a recent paper, speaks very highly of its use, and gives several clinical cases in which he prescribed it with excellent results. The symptoms which he removed with it were: palpitation, ringing in the ears, vertigo, intermittent pulse, waking with a sense of suffocation, palpitation disturbing sleep at night, improvement in the open air. Some of the cases were doubtless purely functional, others apparently structural.
You will doubtless find it especially useful in those cases which seem to require iron and digitalis. This meets the indication for both, and may be given in grain doses of the 1st decimal trituration, repeated every few hours. It is peculiarly suitable in those cases of dilatation aggravated by venereal excesses. In doses of 10 or 15 grains every five hours it soon destroys all sexual desire and powder, (while its use is continued) and arrests the cardiac irritation.
We next come to the remedies of Class III., namely: nux vomica, ignatia, collinsonia, cimicifuga, china, hydrastis, ferrum, cuprum, hypophosphite of potassa, phosphoric acid, sulphuric acid, muriatic acid, etc.
Nux vomica, and its alkaloid, strychnia, are the most important of this class. By referring to your notes on the treatment of hypertrophy with enlargement, you will find nux vomica recommended for its primary symptoms. Allusion was made to its secondary effects, which are very profound and important. The reaction from the intense stimulation (primary) induces a condition of nervous and muscular irritability in proportion to the weakness which obtains in the nerve-centres. To make matters worse, all the important organs of the body partake of the prostration and loss of tone. The liver, stomach, intestinal canal, renal and sexual organs, and even the brain, become the seat of morbid irritability and perverted function.
I will not attempt here to give you all the symptoms which indicate its use in hypertrophy with dilatation. They are too numerous for me to mention and for you to remember. Suffice it to say, that the general mental and physical condition, the weakness and irritability of the heart, the aggravations after meals and from emotions, and the dyspeptic symptoms, must be your guide. First be sure of your diagnosis, then consult the Symptomen Codex, or the excellent materia medica cards of Prof. Hoyne, and prescribe for the ensemble of the symptoms.
The dose of nux vomica is quite important. As a rule, the lowest dilutions or triturations will give you the best results. The 1st or 2nd decimal dilution, or trituration, one drop or one grain every three or six hours, will, in a few days or weeks, produce a notable curative result.
Strychnia will sometimes give better satisfaction than the nux vomica, especially when there is a preponderance of symptoms denoting spinal exhaustion, and a general tendency to paralysis of muscular power and torpor of function. Use the centesimal triturations, from the 1st to the 3rd.
Ignatia, while it resembles nux vomica in some respects, has important symptomatic differences. It is more suitable for women; for the hysterical condition; for irregular manifestations of a spasmodic character; and for the effects of grief. A characteristic symptom which is a valuable guide is the “sensation of great weakness and sinking in the stomach.” This feeling oftener proceeds from cardiac weakness than any other cause.
Dose: the same as nux vomica.
Collinsonia is certainly of considerable value in this disease. While it does not appear to me to act on the nerve-centres like nux vomica, it resembles that remedy closely in its action on the vegetative system, and the various organs of the body. Dr. Squire thinks (Eclectic Medical Journal Vol. 1871, page 267) we have no remedy superior to it in chronic functional or structural diseases of the heart. He asserts that he has given it in nearly one hundred cases of cardiac trouble, and that it has not failed to give relief in a single case. In one patient suffering with hypertrophy, the irregular action of the heart ceased in a few days, and in three months he was discharged cured. The doses used in these cases were 15 drops of the fluid extract three or four times a day. He remarks that “larger doses did not have the desired effect,” which shows that pathogenetic aggravations were present in some degree.
The 1st dilution, or drop doses of the tincture, may be prescribed. Consult the provings and account of its cures in “New Remedies,” for further indications.
Cimicifuga, from its well-known action on the muscular and nervous system, will doubtless often aid you in the treatment of hypertrophy with dilatation. It is the remedy, par excellence, for the palliation and cure of myalgia. It occupies a place between nux and china., partaking of the characters of both. It does not seem to affect the functions of the vegetative system so much as the nerves of motion and sensation. All weakened muscles become irritable, painful, and subject to spasmodic movements. Cimicifuga controls this condition, and restores the normal tone of the nerves which supply the muscles. Chorea is sometimes associated with cardiac debility; even the movements of the heart may partake of that character. In such cases, no remedy rivals cimicifuga. If the disease is sequel of muscular rheumatism, this medicine is especially indicated. In dilatation during pregnancy, or at the critical age, no remedy will prove more useful. If sympathetic cerebral symptoms occur, cimicifuga will be finely indicated.
Dose: the dilutions from 1st to 3rd, or the lowest triturations of cimicifugin (macrotin), its active principle. Do not leave off its use too soon, or change the remedy until you are sure it is not appropriate.
Agaricus should be consulted if cimicifuga seems indicated but does not give satisfaction.
China, or its alkaloid, quinine, has already been spoken of. While you will rarely have to use it in enlargement, you will frequently find it invaluable in dilatation. It is especially useful if the disease is associated with, or produced by malaria, loss of the vital fluids, long-continued night watching, or deficient food. The action of the heart may be very tumultuous, while the real force is weak; the blood is poor, and deficient in quantity; the countenance sallow; digestion impaired, with tendency to flatulence; there is ringing in the ears, vertigo, and night sweats.
Hydrastis, or the active principle, hydrastin, ranks next in importance. As a restorer of the tone of muscular tissue it is not surpassed. It is indicated in those cases which do not arise from malaria, but which appear to indicate china; also for those cases where the action of the heart is persistently weak and excited, and where the patient is emaciated, is troubled with indigestion, and the liver is also deranged. Its persevering use will bring about permanent good results.
Dose: the lowest dilutions of hydrastis, or triturations of hydrastin.
Ferrum. All the preparations of iron are indicated in dilatation, especially if it co-exist with anaemia. In selecting the preparation, the idiosyncrasies of your patient must be taken into account, as well as the bodily constitution. Ferrum metallicum or ferrum carb. are indicated in uncomplicated cases. If fatty degeneration of the heart is suspected, use ferrum iod. If dyspeptic symptoms predominate, try the lactate of iron, or the double salt of iron and strychnine. Certain cases will require the phosphate of iron, and others improve rapidly under the tinct. ferr. muriaticum in the low dilutions. The dose of the ferruginous preparations may range from the 1st to the 6th.
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.