December 3d. – Patient still finds no relief whatever, although he has taken the medicine in exact accordance with my instructions. He has limited himself to three chews of tobacco daily, but cannot stop its use altogether. Physical examination shows the heart to be beating at the rate of 94 per minute. Ordered Nitro-glycerine increased to three drops three times per day. Even this amount has failed to improve the excitable and irritable condition, and it has been discontinued and replaced by compound spirits of ether. The latter drug has also failed to produce any relief so far. It is possible that no improvement will occur in the case until the complete discontinuance of tobacco.
CASE III. – Double Aortic Lesions complicated by Intense Paroxysms of Angina Pectoris. – J.M., aet. 40. This patient was first seen February 22d, 1887. He was found to be suffering from double lesions of the aortic valves, with advanced cardiac hypertrophy and dilatation. The case was marked by most distressing spells of angina, which frequently came on several times a day. The patient was afraid to go to bed, as the seizures were especially severe at night, and frequently rendered sleep impossible. These attacks presented the principal indication for treatment, as the disease had evidently progressed too far to admit of any hope of re-establishing cardiac compensation. As the patient was under my constant observation until his death, on the 20th of September, ample opportunity was given for comparing the effects of different remedies for angina pectoris. Among the medicaments prescribed for this complication were several preparations of opium, the iodide of potassium, the bromides, Hoffman’s anodyne, valerian, asafoetida and finally Nitro- glycerine. All these remedies were eventually abandoned except the latter. It was found to be the only agent which would arrest or ameliorate the paroxysms with any degree of certainty. It was first prescribed in drop doses of the one per cent. solution, three times a day, and one drop every fifteen minutes at the supervention of a paroxysm. In this manner the attacks were rendered far less frequent, and their severity greatly diminished. Before the patient’s death, however, it was found necessary to greatly increase the dose. Sometimes as much as fifteen or twenty drops of the usual solution would be required to tide him over a paroxysm. It is my belief that the patient’s life was considerably prolonged by the use of Nitro-glycerine. His last days were certainly rendered far more comfortable.
CASE IV. – Aortic Stenosis with Weak Heart and Severe Breast- pang. – J.M., aet. 54, applied for treatment March 31st, 1887. This case presents no features of special interest beyond the fact that Nitro-glycerine was found very efficient in relieving palpitation and sensations of impeding death with which the patient was frequently troubled. Its effects were not permanent, however, as the patient, when last seen (in September), still had occasionally very severe visitations of the attacks of cardiac pain and dyspnoea.
CASE V. – Simple Cardiac Palpitation of Neurotic Origin. – J.S., aet. 25, came under observation May, 1887. This was a case of ordinary nervous cardiac irritability due to mental anxiety and a somewhat hypochondriacal disposition. A physical examination showed the heart to be quick, sudden and overforcible in its action, but there was no evidence of organic disease. This patient is still under my observation. He has taken various remedies for the palpitation, but none has produced good results as Glonoin, given in the usual dose and manner. He claims to have practically recovered, but at long intervals he begins to feel a return of the trouble, when he immediately applies at the clinic for a renewal of the remedy.
CASE VI. – Chlorotic Anaemia, with Intense Seizures of Thoracic Angina. – Cora F., aet. 19. This patient has been attending the clinics at the Post-Graduate School since the summer of 1885. She has had chlorosis of a most obstinate type for several years. Her disease is characterized by extremely violent attacks of cardiac distress, which sometimes approach very nearly to true angina in severity. She will attend the clinics with great regularity for a few weeks, become somewhat improved, and then disappear, not to return again, until the symptoms are as severe as ever. This has been her history for the past two years. Various sedatives, antispasmodics and diffusible stimulants have been prescribed, but with only temporary relief. I finally resorted to Nitro- glycerine, and with such success that I have so far found no occasion to prescribe any other remedy for the cardiac symptoms since the beginning of its exhibition. It has seemed to me to act more efficiently and speedily than any other agent which I have used for the case. Taken at the beginning, it will almost surely abort an attack, or greatly ameliorate its violence. These spells have ceased altogether for ten days or two weeks at a time while the patient was under close observation. It is my belief that the vigorous exhibition of some reliable preparation of iron, such as the Blaud pill, together with Nitro-glycerine, for a few months, would go far towards effecting a permanent cure in this case.
CASE VII. – Simple Nervous Palpitation Arhythmia. – T.K., aet. 27, applied for treatment November 12th, 1887. This patient has suffered from cardiac palpitation and praecordial distress for more than a year past. He finds it impossible to sleep on his left side. Various remedies have been prescribed, but with very little benefit. He is familiar with most of the ordinary remedies for cardiac palpitation. The patient is a man of good habits, and uses very little tobacco or alcoholic stimulants. On examination the heart was found to be quick and nervous in its action and very intermittent, dropping from five to seven beats per minute. The pulsation would be very rapid for ten or twelve beats, and then become slow and apparently labored. There was no murmur, nor any enlargement or other evidences of valvular lesions. Ordered Nitro-glycerine in the usual commencing doses.
November 15th. – The medicine has been taken according to directions. It has caused more headache than usual, but the palpitation has been greatly benefited. Patient says he could sleep on his left side last night, for the first time in months. Ordered Nitro-glycerine to be continued, together with a laxative for the bowels. Heart not examined.
November 22d. – Patient has become very enthusiastic with reference to the virtues of Nitro-glycerine. It has relieved him more than any remedy he has ever taken. An examination of the heart sustained this favorable account of the drug. It was found to be more regular in its action and less intermittent, losing but four beats per minute. The head symptoms produced by the medicine have become scarcely perceptible. Ordered Glonoin continued in double doses.
November 26th. – The improvement has continued. The palpitation is greatly abated, and the heart loses but two beats per minute.
This patient has been twice seen subsequently. Early in the present month he stopped the Nitro-glycerine for a few days, when there was, almost at once, an exacerbation of the symptoms. He is at this time (December 17th) taking the remedy in two-drops doses four times a day, and is apparently steadily improving.
The foregoing cases, seven in number, sufficiently illustrate the action of Nitro-glycerine in the ordinary forms of heart disease met with in practice. I have observed the effects of the drug in twenty-eight different cases, and in only four has it absolutely failed. In all the others more or less relief was obtained, and in some the effects were most gratifying. As far as I have been able to judge, however, its effects are only temporary, even in cases independent of organic lesions. It may be regarded simply as a symptom-medicine, and one which probably exerts little, if any, permanent effect on the course of diseases of the heart. It undoubtedly has its sphere in the treatment of painful and irritable conditions of this organ, however, and for the temporary relief of these conditions it has seemed to me to be rather more reliable than any other single remedy.
GLONOIN AND DIGITALIS.
A new and interesting use of Glonoin has lately been suggested and tested by Professor W.H. Thomson, of New York. In a recent paper (Medical Record, May 19th, 1888) he says of Digitalis: “We all know, now, that one of the commonest causes of cardiac dilatation is not to be found in the heart at all, but in an obstructed arterial circulation. It is probable that arteries narrowed in their calibre are the cause of cardiac hypertrophy and subsequent dilatation three times in adults to valvular disease of the heart once; and just here it is that the employment of Digitalis in heart-failure so often disappoints us most signally, for, unfortunately, while it increases the contractile power of the heart, it also contracts the arteries, and thus often adds as much obstruction to the circulation in that way as it aids the circulation by its increase of the heart’s propulsion – a fact often illustrated in cases of dropsy from Bright’s disease, where the condition of the systemic arteries is the primary cause of the anasarca. It is in just such cases that Nitro-glycerine can help us to administer the Digitalis with more than double the beneficial effects of the administration of Digitalis singly. Nitro-glycerine, by its universal and prompt relaxation of the whole arterial system, makes every stroke of the ventricles stimulated by Digitalis not only more powerful, but also far more effective, in completing the systole with a short and heart-emptying contraction. Meantime, by its action in paralyzing the inhibitory action of the vagus, it insures a more rapid diastole, and in many instances I have found the intermittency caused by Digitalis to disappear as soon as the effects of the Nitro-glycerine are felt. The effect of this upon the anasarca in these cases is about as complete and gratifying as any remedial operation with which I am acquainted. But, on the other hand, the influence of Nitro- glycerine alone, as I have noted in a number of instances, is almost nil on the dropsy, however much it often seems to have a beneficial influence on the secretory action of the kidneys by increasing the specific gravity of the urine.”
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.