The medicines indicated for hypertrophy with enlargement are best presented in four classes, arranged according to their peculiar spheres of action, thus:
I. Those medicines whose primary effect in large doses is to depress the action of the heart and weaken its muscular power, namely:
Aconite, Gelsemium, veratrum viride, veratrum album, kalmia, tartar emetic, colchicum, sanguinaria, lobelia, and tabacum.
II. Medicines whose primary effect is to increase the strength of the muscular power of the heart, by stimulating its nervous life; and whose secondary effect is to depress and paralyze the nervous and muscular power of that organ. Among the most prominent of this class are:
Digitalis, cactus, lilium, hydrocyanic acid, prunus virginiana, amygdalus, and A. amara, persica, lycopus virginica, and laurocerasus.
III. Remedies which primarily tend to increase the nervous power and nutrition of the heart; and secondarily, to weaken and paralyze the same cardiac functions, namely: Nux vomica, ignatia, hydrastis, collinsonia, cinchona, ferrum, cimicifuga, helonias, phosphorus, and sulphuric acid.
IV. Certain antipsoric or alternative remedies, whose effects cannot be classified into primary and secondary sequences, namely:
Spigelia, rhus, iodine, graphites, natrum mur., bismuth, lycopodium and sulphur.
INDICATIONS FOR THE REMEDIES IN CLASS I.
In selecting a remedy for the symptomatic or pathological results of this form of enlargement, you should first assure yourself that the force of the heart is actually increased. Remember that the heart may be in excessive action, without having increased force.
If the hypertrophy occur in robust, strong, full-blooded persons, with bright complexion, disposition to changes of color of the face, glistening eyes, injected conjunctiva, head-ache, stinging pains in the region of the heart, aconite is the remedy, and should be given in the lowest dilutions, and frequently repeated, until an amelioration occurs, when the medicine should be withdrawn. Remember that these symptoms are like the secondary effects of aconite, and this obliges us to prescribe it in more material doses. All of Class I. follow this law, and if indicated by the increased force of the heart’s action, and the general symptoms correspond, the dose should be the same as aconite.
Veratrum viride is indicated by the more forcible impulse of the heart, the stronger pulse, and the greater congestion of the heart and chest.
Gelsemium, by the same symptoms, but in a less degree, and an apparent torpor of the functions of the brain and lungs, and a less active congestion.
Veratrum album, according to Ch. Muller, causes “Extreme agony, which takes away the breath; palpitations, with anxiety, and quick audible respirations; paroxysms of agony about the heart, which beats very violently, and feels as if it were too warm; violent beating of the heart, which forces up the ribs; the heart beats up very high and forcibly, so as to force the hand away, without pain.” He remarks that “the entire absence of pain about the heart, while it beats so violently as to shake the chest, elevate the ribs, and lift the hand of the auscultator, deserves particular attention, for this almost never occurs, except in hypertrophy with dilatation.” (?) (He should have said with enlargement, for in dilatation no such forcible impulse is present.)
“Physical signs.” The percussion sound may be dull over a very large space, (the apex of the heart may beat directly beneath, outside of, or above the nipple,) bulging of the ribs over the heart; action of the heart visibly very violent; sounds of the heart very loud and clear, or else one or both sounds accompanied with abnormal murmurs.”
If veratrum alb. causes this array of symptoms – and it appears to me that the primary and secondary are mixed in the above – the increased impulse or force of the heart’s action must be a secondary effect, for the immediate effects of white hellebore are marked depression of the heart’s action, even to pulselessness. If this medicine is given for concentric hypertrophy, it must be given in the same doses as advised for aconite and others of its class.
Kalmia may be useful in certain cases, but the indications are not yet certain.
Tartar emetic should be resorted to if pulmonary engorgement is feared, and there is at the same time hepatic congestion, dyspnoea, cough, etc.
Colchicum, if the urine is scanty, red, and deposits a brick- dust sediment, and the heart’s action is excessive and strong.
Sanguinaria will prove a potent remedy if the hypertrophy is complicated with suppressed or scanty menses, congestion of the lungs, cough, dyspnoea, and sometimes congestive cephalalgia.
Lobelia should not be forgotten when there are asthmatic symptoms with the enlargement.
Tabacum is secondarily homoeopathic to hypertrophy, and Baehr advises smoking small cigarettes for palliative relief of the excessive palpitations. If they are marked by increased impulse, tobacco may be used occasionally; if the impulse is weak it should be prohibited.
In regard to the administration of these remedies, I wish to impress upon your minds this important fact, namely, that if you wish to get permanent curative effects from any remedy in hypertrophy, you must continue its use for days and even weeks. If you have selected aconite as the appropriate medicine, do not supplant it for some other in a few days because you do not see an improvement in the action of the heart. Our doses do not rapidly depress the excessive cardiac action, therefore the physiological or normal action which we wish to induce does not come suddenly.
As a general rule, the remedies above named may be given every three or six hours, according to the severity of the case, and always in the lowest potencies, and sometimes the mother tincture.
INDICATIONS FOR THE MEDICINES IN CLASS II.
Of all the medicines in this class, the digitalis purpurea is the most important, but even to this day its true method of action is not understood by a portion of the profession, who persist in believing it to be a primarily depressing medicine. Those of you who have read my paper on digitalis, published in the United States Medical and Surgical Journal, and reprinted in pamphlet form, need not be told that many years ago I adopted the views of Prof. Tully, who was far ahead of his time in his estimate of some medicines. Within a few years, Handfield Jones, Hammond, and others have adopted the same view of its action.
Digitalis, when given in medicinal doses, causes pathogenetically a condition similar in effect to hypertrophy with enlargement of the heart. It does not cause actual enlargement, but such a hyper-stimulation of the heart that the results are similar.
When death occurs from acute poisoning by digitalis, the muscular substance is hard and firm; the heart is rigidly contracted, and no blood is found in its cavities. Now, if death should suddenly occur from concentric hypertrophy or enlargement, the heart would be found in the same condition as in digitalis- poisoning.
It is obvious that if we accept this as the true action of digitalis, namely, that it is, in large doses, a cardiac tonic, you can readily understand how injurious, and even dangerous, it would be to give large doses in hypertrophy with enlargement, i.e., when the heart has already an excess of muscular power. It is in such cases that, when given by the old school, dangerous and alarming symptoms occurred, which led to the fears of its use which we find so prevalent. It is as if an allopath were to give a massive dose of belladonna in a case of cerebritis, or nux vomica in spinal congestion, or arsenic in gastritis. In such cases, the remedy being intensely homoeopathic, a severe or fatal aggravation would occur.
The deduction I would have you draw from this is, that as digitalis is primarily and intensely homoeopathic to a condition similar to hypertrophy with enlargement, in which the contractile power and impulsive force of the heart is increased, it should be prescribed in the smallest dose consistent with reason. I will explain what I mean: the 3rd of digitalis may not be stronger in reality than the 30th of lycopodium, for while the former appears to lose its medicinal power after the 3rd, the latter seems to gain in power at every remove upwards from the 3rd trituration. This difference is due to the fact that certain medicines have different qualities of inherent power; and, in the future, it should be the aim of our school to ascertain the inherent medicinal power of each drug, instead of quarreling about the dose.
The dose of digitalis, then, in this disease, should lie in the first three dilutions of the tincture, or the triturations of digitaline from the 3rd to the 6th. With these doses, repeated every few hours, or as often as every hour, no aggravation, but much benefit, will be derived.
Cactus grandiflorus is an analogue of digitalis, and not of aconite, as some suppose. If you will look at the provings you will see that the evident primary symptoms are those of hyper- stimulation of the heart, even to spasmodic contraction of its muscular tissues. What else can that characteristic symptom, “constriction in the chest and in the heart, as if from an iron hand,” mean? The general symptoms of cactus all tend in this direction, for it causes ‘constriction’ everywhere. I have carefully analyzed the clinical cases wherein cactus has proved curative, and am convinced that in those cases where the high dilutions were beneficial, there was present a condition of increased tonicity of the heart; in other words, the palpitations and so-called congestions of the heart were due to cardiac hyper- stimulation. In cases of true hypertrophy, then, do not use cactus lower than the 6th decimal dilution. Lower than this I have found it to aggravate all cases where the impulse of the heart was too strong.
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.