Diseases of Heart by Edwin M Hale.
Part I – FUNCTIONAL DISORDERS OF THE HEART
INTRODUCTORY LECTURE.
The Wonders of the Heart – Its Functions – Increased Frequency of its Diseases – Its Anatomical Peculiarities – Its Circulation – Its Innervation – Its Nervous System – When it Begins to Beat – Pathological Deductions.
GENTLEMEN : I approach the subject upon which I have been appointed to lecture with the fullest and deepest sense of its importance. Diseases of the heart, from their very nature, and the paramount importance of the organ affected, should claim the interest and profound attention of all thinking and conscientious physicians. I do not wish to exaggerate the importance of cardiac diseases, or given a false estimate of their frequency, but I have no hesitation in asserting, that my observations in a large practice of twenty years have convinced me that diseases of the heart, and especially functional disorders of that organ, have largely increased within the last decade. It may be owing to the fact that the latter half of my years of practice have been sent in a great city, that I have come to this conclusion. The intense strain upon the nervous energies incident to the business and pleasures of a city life, do certainly have much to do in the causation of certain heart diseases. In the country, life is calmer, and its tide flows slower, and the vital energies are less subjected to violent aberrations.
In view of these facts, it becomes us to study well this organ – the heart – in all its relations, not only anatomically, physiologically, but psychologically. And in order to do this, we must first inquire into the character of this organ. Is it merely an appendage to the body – an organ of elimination or secretion? Or is it the centre of the blood-system, just as the spinal cord is the grand centre of the nerve – system, and the brain the centre of the mental forces?
As the brain animates the body with intention and purpose, and the lungs give it corresponding motion, the heart, as the blood’s executive power, gives corporeal substance to the frame, inasmuch as the body itself arises from the blood. The existence of the human machine depends upon the heart, but its usage upon the lungs and brains. The heart is the source whence the finished blood descends to the organs throughout the system, and, as the life is in the blood, the heart is the agent for bestowing that life upon the organization. In a word, the heart, or blood, determines the fleshy tenement.
ITS ANATOMICAL PECULIARITIES
Anatomically the heart is a conical, hollow muscular organ, lying obliquely in the chest, between the two lungs, the base of the cone pointing upward in the direction of the right shoulder, the apex pointing to the space between the fifth and sixth ribs. It rests upon the tendinous portion of the diaphragm, which is the partition between the chest and the abdomen, and it is encased in a peculiar bag or capsule, the pericardium, which consists of two layers; the outer, fibrous, by which the pericardium is attached to the great vessels at the root of the heart; the inner, a serous layer, continuous with the serous membrane which covers the outer surface of the heart. The cavity between the heart and pericardium, thus lined by a serous covering, generally contains more or less fluid, whereby the heart is lubricated on the outside, and its local motions are rendered easy.
The heart comprises four cavities, two auricles, and two ventricles; one auricle and one ventricle being on each side, and the right pair of cavities being devoted to the circulation of the venous blood, the left pair to the of the arterial blood. the auricles are at the top, constituting the base of the heart; the ventricles form the apex; the latter are much stronger than the auricles, consisting of very thick muscular walls, the reason of which we shall see presently.
THE CIRCULATION OF THE BLOOD.
The heart is a peculiar muscle, and when any of its four cavities contract, they have the power of expelling their contents, the force of the expulsion being the prime mover of the circulation of the blood. We may begin the circle where we please and we shall find that it returns into itself. Starting, for instance, from the left ventricle, we see that the blood is driven, by the contraction of that cavity, into the aorta – the highway which leads into all the arteries of the body; through these the blood is discharged into the veins, which unite to form at last only two great trunks the venae cavae, which are again the thresholds of the heart, and debouch into the right auricle. The blood which has now passed from the left ventricle to the right auricle, has still a journey to make before it completes its course. Accordingly, from the right auricle it is forced into the right ventricle, and by the right ventricle into the pulmonary artery, which conveys it to the lungs, where it ramifies through the multiple branches of that artery, and whence it is brought back by the pulmonary veins, forming ultimately four large trunks, which empty into the heart’s left auricle, by the contraction of which the blood is next forced into the left ventricle, to the place from which we began.
Without entering into a description of the complete circulation of the blood throughout the body, with which you are all doubtless familiar, we will consider a more important and interesting subject, namely: the circulation of the blood in the heart itself.
THE CIRCULATION IN THE HEART.
That there must be a circulation in and through the heart is evident; for how else could the heart be nourished? The heart is supposed to be nourished by the coronary vessels; they are called coronary from corona, a crown, because they run in crowns or coronal circles around the heart. They arise from the aorta, close beside the semi-lunar valves, and running around the base of the heart, and sending branches down the lines of partition between the four-fold chambers, they form a kind of vascular cage-work in which it is contained. The coronary veins, said to begin from the minutest twigs of the coronary arteries, by their considerable branches for the most part accompany those of the arteries, and discharge themselves by one, two, or three orifices, into the right auricle. The interior of the four cavities of the heart is not a smooth, even surface, but is rendered extremely irregular by muscular columns, projections, and partitions; it is scooped, channelled, and caverned, besides which, on the walls of the cavities there are minute openings, the foramina of Thebesius, which are supposed to be the mouths of little veins.
It is a curious fact that nearly all the old anatomists, and some also of the moderns, have suspected a puzzle in these coronary vessels. They come from the aorta, and run backward to the heart. In a certain proportion of cases, estimated as 5 in 20, one or more of their orifices lies behind the semi-lunar valves, and such orifices, it is clear, cannot receive the streams propelled from the heart, because it lays down the valve flat upon them, and effectually closes them. As, therefore, nature’s law must be constant, it was argued that what holds of one orifice must hold of all, and that the blood runs back into the coronaries from the aorta when the heart’s contraction ceases. This was Boerhaave’s opinion.
Swedenborg, however, one of the profoundest anatomists and physiologists of any age, propounded another view. He argued that the raising up of the semilunar valves during the contraction of the heart, when the blood is expelled into the aorta, precludes its passage then into the coronaries, and that the stretching of the coronaries, and their pressure by the full aorta, contributes to the same preclusion. He held that the coronary arteries do not arise from, but terminate in the aorta; that they are veins relatively to the heart, although running into the beginning of the arteries of the body. The doctrine, in brief, is this: that the heart, as the head of the vessels and the fountain of the blood, itself requires the firstling blood for the exercise of its noble offices, and cannot hold its life by tenure from one of its own arteries, which would be to invert all ideas of the order of nature.
The heart is already full of blood, and if fluids, or fluid persons, like solid persons, move with greater velocity in proportion to their life, the best blood in this race will continually outrun the rest, and always first in the heart, will skirt along its porous walls. Now, what structure do we find upon these walls, but caverns, jagged cavities, and at the bottom of these a number of little holes, the foramina of Thebesius. Into these caverns, then, miniature ventricles in the great ventricle, hearts of the heart, the quickest blood is received, and the pores open with all their hearts to take it in. And when the heart contracts, it drives out the general blood of the body into the grand aorta, but its own particular blood, detained in the cavernous lacunae, it squeezes, slippery with spirit, through its walls, into its muscular substance, and thence onward and outward to the surface, into the coronary arteries and the coronary veins, from which there is a reflux, when necessary, into the auricles and ventricles.*
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.