II. The second object is to increase permanently the muscular power of the heart. This is to be accomplished by the judicious administration of those remedies belonging to Class III. mentioned under “Dilatation,” namely: Ferrum and its various preparations (the Iodide is the best in this disease), nux vomica, ignatia, hydrastis, manganese, aletris, helonias, china, ptelea, cuprum, platinum, plumbum, the hypo-phosphites, and the mineral acids.
The anti-psorics may be useful to combat the various dyscrasia, and may be advantageously alternated with the remedies just mentioned.
You will find that the lowest attenuation of Class III. will bring about the best results, while the high dilutions of the anti-psorics are most appropriate.
The diet of the patient is of great importance. You should aim to produce a healthy nutrition of the affected organ by rendering the blood rich in nutritive materials. All articles of diet allowed should be highly nutritious and easily assimilable. As large a portion of animal food as the digestive powers will permit should be advised. The meat should, however, be lean, tender, and properly cooked. The quantity of fluids should be restricted, in order not to make the quantity of water in the blood excessive. Warm clothing, especially about the extremities, should be insisted on. Excess of all kinds, in eating, drinking, venery, mental occupation or excitement, late hours, etc., should be prohibited. As physical indolence predisposes to this affection, a judicious course of exercise in the open air should be advised. But while exercise is advised, it should not go to the point of causing dyspnoea or palpitation. In order to have exercise do good there must be an interesting object. For this reason, hunting, fishing, botanizing, horseback riding, etc., are the best methods.
III. It is important that you should try to arrest or limit the accumulation of fat in or upon the heart. Although the pathological condition in the two forms differ, we do not know that the dietetic treatment should differ. All fatty and saccharine substances should be avoided. Starchy food is also inadmissible except in small quantity. The diet should consist of lean meat, bread, non-farinaceous vegetables, and certain kinds of fruit, principally the acid fruits.
Of medicinal remedies, those which act chemically cannot be used with safety and they have been abandoned. The bromide of ammonium, in doses of 5 or 10 grains, three times a day, seems to have the power of diminishing adiposis without injuring the health. I have found that graphites, 6th and 30th, used for a month or more, has the same effect. Phytolacca appears to have the power of diminishing the amount of fat in the system, when given in the lowest dilutions. It is claimed that the iodide of potassa has the same effect. But these remedies should always be alternated with the ferrum group.
Baehr says, after recommending iodine and calcarea, “We have two other remedies which we cannot recommend with sufficient emphasis in heart-disease generally, and more especially in fatty degeneration, we mean cuprum and plumbum. Both remedies act similarly, except that the action of plumbum is more persistent and penetrating.” He gives the following indications taken from cases of poisoning:
“Cuprum: pulse irregular, small, easily compressible, intermitting, accompanied by excessive muscular debility; the beats of the heart are scarcely, or not at all, perceptible; the sounds of the heart are indistinct; dyspnoea; feeling of anxiety; disposition to faint.
“Plumbum: the impulse of the heart is very feeble, or even imperceptible; sounds of the heart indistinct; palpitations, attended with excessive dyspnoea; pulse very soft, easily compressible, intermitting, irregular, 50 to 60 in a minute, less frequently over a hundred, after which it is scarcely perceptible; heart flabby; sudden paralysis of the heart; fainting fits during every exertion, also, attended with slight convulsions, extreme muscular debility, and oppression from the least motion; despondency and dread of death; night mare; oedema of the skin.”
The iodide of lead ought to prove more valuable than the pure lead of fatty degeneration of the heart.
Baehr thinks aurum will prove a good remedy.
Phosphorus and arsenicum are the two medicines which correspond pathologically to fatty degeneration. Both cause fatty heart, as well as fatty degeneration of the liver and kidneys. The pathogenetic symptoms also correspond, and theoretically they ought to cure this malady, but we have no clinical testimony to substantiate it. I would advise you to try them when indicated, in the 3rd or 6th attenuation, for a sufficient length of time to test their curative powers.
I have sent a few patients, whose adipose growth in general was immense, to a most rigid hydropathic establishment, where a few months’ residence removed a large quantity of the abnormal deposit.
SOFTENING OF THE HEART.
I have already called your attention to this condition, when speaking of inflammation of the heart. It has also been considered as incident to fatty degeneration. It occurs during the course of essential fevers, especially typhoid fever and typhus. Sometimes the softening is limited to the left ventricle, and sometimes it extends all through the heart-substance.
When softening has taken place the walls are relaxed and feeble; the structure easily torn with the finger; the organ is flaccid and collapse with its own weight, not preserving its natural form, bur retaining, like a wet cloth, any shape in which it is placed. When incised, the cut surfaces are dry and unpolished, and the color of the cut surface is purplish and livid.
Symptoms and physical signs. These are the same as in fatty degeneration. They proceed from weakness of the organ, and loss of muscular power. Stokes gives the best indications for the diagnosis of this affection, especially when it occurs during fever.
Treatment. The sole indication for the treatment of softening from any cause, is to sustain the falling power of the heart by stimulants, ailments, and restorative remedies. The use of wine, brandy, egg-nogg, beef-tea, wine-whey, aided by china, hydrastis, ferrum, phosphorus, and the mineral acids, should be freely used, until the action of the heart denotes such an amount of force as to free the patient from danger. In severe cases the patient must not be allowed to sit up, or make any sudden movements while the heart is very weak. Fatal syncope has been known to occur from such imprudence.
INDURATION OF THE HEART.
This lesion is so rare, and so difficult to diagnosis, that I will not speak of it at length, nor shall I treat at length of
CARDIAC ANEURISM,
a condition rarely met with, but which the older pathologists confounded with hypertrophy with dilatation. Although a rare lesion, Thierman has collected seventy-four cases on record. The aneurismal dilatation forms a tumor, varying in size, in different cases, from that of a small nut to a sac as large as, or even larger than, the heart itself. It contains layers of condensed fibrin, and various forms of coagula like arterial aneurisms. It is sometimes lined or studded with calcareous matter. For a fuller consideration of this subject, I refer you to works on morbid anatomy.
Flint gives five interesting cases which came under this personal observation.
Treatment. No cure can be affected; but the same treatment recommended for dilatation of the heart would be appropriate, and perhaps palliate suffering and prolong life. Some of the early homoeopathic writers recommended lachesis and lycopodium, but we are in doubt whether they referred to hypertrophy with dilatation or true aneurism.
RUPTURE OF THE HEART.
It is believed that spontaneous rupture of the heart is of rare occurrence; and Flint doubts if it has ever occurred as a result purely of muscular activity of the organ. He believes it is always dependent on some prior morbid condition of the cardiac parieties. I believe, however, that cases are on record where rupture of the heart has occurred from violent mental emotion, independent of cardiac disease. A singular book has lately been published in England, treating of the diagnosis of the crucifixion of Christ. The authors are the eminent London surgeons, William Stroud and Sir J.Y. Simpson. Dr. Stroud, after citing and commenting on a long series of instances of bloody sweat, feels warranted in the conclusion that, “owing to the natural constitution of the human frame, the exciting passions, when violent, and especially when accompanied with agony or conflict, are capable of producing bloody sweat, and when still more intense, rupture of the heart.” Among other medical authorities he quotes the younger Gruener, to the effect that it is common for a person whose heart is oppressed by excessive congestion of blood, and who is threatened with suffocation, to “cry out with a loud voice;” and also Dr. Walshe, Professor of Medicine in University College, London, who says, that in cases of rupture of the heart, the hand is suddenly carried to the front of the chest and a piercing shriek uttered. Sir James Y. Simpson, whose high ranks in the profession has won for him the title of Baronet, adds an appendix to Dr. Stroud’s treatise, in which he says, in substance, that usually death very rapidly ensues, in consequence of the blood escaping from the interior of the heart into the cavity of the large surrounding heart-sac or pericardium, and that in such cases the sac will be found, on dissection, to contain two, three, four, or more pounds of blood accumulated within it, and separated into red clot and limpid serum, or “blood and water.” As dissection was not practiced in ancient times, the nature of this rare disease was not understood, if indeed its existence was even suspected. These surgeons agree, therefore, that death was occasioned, not by pain and physical exhaustion, which, in a person in the prime of life, would require two or three days, but by a literally broken heart
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.