Strophanthus will undoubtedly be welcomed by the profession as a capital remedy in the treatment of cardiac affections. Without clinical observations it would be difficult to point out all the cases in which it might be used to advantage, but there are some conditions in which Strophanthus is decidedly to be preferred, and in these instances it should invariably have a trial. Professor Fraser regards mitral disease as the most likely to fall within the scope of its action, and the cases he has presented seem to warrant that conclusion.
Dr. Collins, on the other hand, has remarked that all aortic troubles are more amenable to Strophanthus treatment than mitral affections.
My own observations have been uniformly satisfactory in the treatment of both aortic and mitral affections, as well as in cases of incomplete closure of the heart due to atheromatous conditions.
Exophthalmus would be a suitable condition for the use of Strophanthus as respects the heart, but it should be supplemented by Ergot.
In the case of fatty degeneration of the heart, Strophanthus, it seems, is clearly entitled to supersede Strychnine and Nux vomica, and the same may be said of the later months of pregnancy, when the cardiac muscle has become flabby and there is persistent oedema. Its applicability in the later stages of pneumonia, when the nutritive processes are at a low ebb and the heart demands a tonic, it seems is clearly indicated.
Frequently it will be far safer to depend upon than Alcohol, ad need not interfere with the administration of special stimulants, such as Ammonia, Typhoid fever, when the first sound of the heart becomes weak, will demand Strophanthus, and especially should this suggestion be acted upon when it is deemed advisable to administer Antifebrin during its course. As a means of counteracting the tendency to heart-failure in the administration of ether and chloroform, it will eventually outrank Morphine and Atropine, and as an antidote to the baneful effects of Chloral its value cannot be overestimated.
ZINCUM.
(The Cyanides in Cardiac Disorders, especially the Cyanide of Zincum met.)
I have often asked myself why the cyanides are not more used in diseases of the heart. Hydrocyanic acid is one of the most potent and deadly of all the heart-poisons. It kills by causing paralysis of the cardiac nerve-supply, probably by acting on the origin or roots of the nerves in the medulla. it is not probable that it will cause or be useful in structural disorders of the heart, for its action is too transient (like Glonoin or Amyl). But when this acid is combined with alkaloids or minerals, we ought to get medicines which profoundly affect both the nerves and muscular tissues of the heart.
The most important of the cyanides are Cyanide of gold,
” ” silver,
” ” mercury,
” ” potassium,
” ” zinc.
Of the cyanide of gold we have no provings or chemical experience, but it ought to prove a powerful and unique remedy in functional heart troubles, especially in young men and women at the age of puberty, and in women at the change of life.
We have a few symptoms of the cyanide of silver. The “violent pain in the region of the sternum” (heart), the “incessant cough and feeling of suffocation,” point to cardiac oppression.
Cyanide of potassium (kali cyanatum) is better known. There is an excellent pathogenesis in Allen’s Encyc. Mat. Medorrhinum Its paralyzing effect on the cardiac and respiratory nerves is rapid and fatal. The chief indication for its use is in neuroses of the heart, angina pectoris, etc., when the “terrible sense of suffocation” is the most prominent symptom. The breathing is sometimes very slow, stertorous – as in opium – and irregular. The pulse is also slow, irregular, scarcely perceptible, and there is always cyanosis. The spasm and tetanic conditions closely resemble Strychnia.
Cyanide of mercury is one of the most virulent of this class. It unites the neurotic effects of Hydrocyanic acid with the destructive effects of Mercury. It is the most dangerous of malignant diphtheria known. It kills as diphtheria sometimes kills, namely, by profound and rapid poisoning of the nerve- centres, without showing throat-lesions. It is capable of causing diphtheritic, ulcerative endocarditis, and its early and timely administration in diphtheria will prevent the cardiac paralysis or endocarditis which renders that disease so dangerous. In syphilitic heart-lesions it ought to prove one of our best remedies.
Cyanide of Zinc, from its composition, bids fair to prove a great addition to cardiac therapeutics. A study of the symptoms of the acid, and of zinc, will show its importance. We have only a few symptoms of the Cyanide, but even those are suggestive:
“Bad temper. Very subject to anger. Very great sensitiveness. Congestion to the head. The face suddenly changes color. Great physical agitation. General trembling from time to time.”
Few as they are, they present a picture of the mental and physical condition of persons who are the victims of cardiac neuroses, especially when it occurs in hysterical women or neurasthenic men.
I have for many years used the Valerianate of Zinc in cardiac nervous affections and found in efficacious. The Picrate of Zinc is an excellent remedy in neurasthenic persons. In some special cases, when acid hydrocyanic was indicated, as well as Zincum, I have found the Cyanide to have happy effects.
Prof. Laskevitch highly praises the Cyanide in cardiac neuroses, in which he says he gets more satisfactory results than from any other drug. It acts quickly and certainly. Palpitation, want of rhythm and pain in the region of the heart are quickly affected, sometimes, indeed, cured by this drug. Similar good effects are produced when there is organic cardiac disease.
The regulating action of Cyanide of Zinc in valvular insufficiency is less marked than its effect in cardiac neurosis; nevertheless, there were cases in the wards where it acted better than Digitalis, Convallaria, Adonis, etc. In this respect it acted particularly satisfactorily in cases where other remedies could not be given without producing gastric derangement. Here it improved the action of the heart, increasing the secretion of urine, moderating the pulse, and diminishing the dropsy. In a case of nervous palpitation, with hysterical suppression of urine, Cyanide of Zinc diminished the palpitation and restored the urinary secretion.
Dr. L. prescribes 1/10 grain three times a day. Two or three grains of the 2x trituration acts better.
In some cardiac disease, functional and organic, gastric irritation and pain are common. Spasmodic retching and gastralgia seem to be sympathetic. In such cases the Zinc Cyan. will be particularly applicable, for Henning, a German physician, has used it with extraordinary success in cramps of the stomach. It formed the chief ingredient, in combination with magnesia and cinnamon, of his famous “antigastralgic powders.” He recommends it in worm affections of children, chorea and other spasmodic diseases.
Ferrocyanide of Zinc has an action on the system similar to the cyanide, with the addition of the ferric influence. In cases where the blood was impoverished, where the cardiac disease was complicated with or due to anaemia, this preparation would be better than the cyanide. Dose, a grain of the 1x trit., three or four times a day.
In my “therapeutics of New Remedies,” I called attention to the Ferrocyanide of Potassium. The chemical experience then recorded is very valuable. It is especially valuable in cardiac disease in chlorosis, neuralgia, hemicrania, feeble digestion, feeble and irritable heart, palpitation, weak, irregular pulse, cold feet and hands. etc.
All the cyanides and ferrocyanides should be more extensive used.
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.