Enonymous, one of our best new remedies for passive congestions of the liver, jaundice, etc., contains an active principle Enonymin- which is a cardiac tonic. This accounts for its value in such disorders.
Chionanthus and Chelidonium may contain a similar principle.
Prunus virginiana, the bark of the wild black cherry, removes jaundice by virtue of its power to tone up and regulate a weak heart. Sometimes the jaundice, from suppression of bile, causes cardiac symptoms denoting debility. This is due to the toxic action of the bile floating in the blood, and is a kind of poisoning. Rohrig has shown that it is the glycocolic and taurocholic acids which slow the pulse. It acts upon the ganglia in the heart. Legg found that these acids greatly lowered the blood-pressure. Now it is evident that cardiac tonics are needed just as much where jaundice was the cause of the slow and weak heart. But in this case the cardiac remedy should be alternated with a hepatic remedy, as Digitalis with Podophyllum, or Enonymus with Chelidonium.
THE STOMACH
feels the bad influence of a weakened heart as soon as any other organ. There is a dyspepsia due to cardiac debility that is unmistakable. The symptoms are great sinking sensations and weakness in the epigastrium. The stomach will not tolerate or digest the simplest food. The extremities are cold and livid; the pulse weak, irregular or intermitting; the mind despondent and irritable.
Now all the pepsin compounds, bismuth or dieting will not cure such cases. We must energize the heart and the pneumogastric nerve. The alternate use of Digitalis and Ignatia, or Strophanthus and Strychnia, will soon remove the passive congestion of the stomach.
THE KIDNEYS.
These organs probably suffer more from heart disease than any others. Acute congestion may arise from hypertrophy, that form of enlargement in which there is a thickening of the walls of the left ventricle, causing an increased force of the blood-current. If there is at the same time an incompetency of the aortic valves, the blood-current is allowed to spend its full force on the arterioles. The result in this condition is an undue, distension of the small arteries, atheroma, aneurisms and extravasations of blood from rupture of the arterioles. In acute congestion of the kidneys these organs, when cut into, show scattered dark points, or minute ecchymoses, and there is a discharge of dark-colored, watery blood, showing an oedematous condition. Microscopically we find evidence of engorgement of the blood-vessels and an infiltration of serum into the interlobular tissue. In the troubles the epithelium is found to be granular, and the lumen is choked with coagulated fibrin.
Here we have the first stage of a form of Bright’s disease, and we can appreciate how important it is that we should control a heart which forces an abnormal amount of blood into the delicate tissue of the kidneys. It will surely cause inflammation, unless the power of the heart is lessened. Beside hygienic treatment, the prohibition of overeating, the use of Alcohol and excessive physical exertion, we must lessen the heart’s action by the use of Aconite, Veratrum viride, Cactus, Lycopus, Cyanuret of Zinc and others. It must not be forgotten that in the majority of cases cardiac hypertrophy has its origin in the kidneys, or in an excessive arterial tension in those organs. This tension or diminution in the size of the arteries, with or without atheromatous rigidity of their walls, always increases the action of the heart to overcome the resistance, and from this increased action we get either thickening or thinning of the left ventricle.
Hypertrophy with dilatation implies always a decreased force in the arterial circulation, and this decreased force always leads to that most unfortunate of all conditions of the kidneys passive or venous congestion. The results of this venous stasis are a proliferation of cells in the connective tissue of the kidneys and every organ where this condition exists; the organs become larger and denser; on section a glutinous fluid exudes, and in time a distinct cirrhosis results. Thus we get cirrhosis of the kidneys, the liver, the spleen, and even the uterus.
This interstitial nephritis may also be accompanied by metastatic nephritis from embolism. This affection of the kidneys from heart disease, especially valvular failure, but equally from any other cause leading to venous congestion, has been fully investigated by many leading pathologists.
The effect, says Fothergill, of venous stagnation on the kidneys of structural changes, induced by venous hyperaemia points out how very important it is to secure good acting power in the heart, not only for its own maintenance, but to avoid and delay as long as possible the venous congestion which inaugurates the renal changes. The importance of securing good ventricular contraction and good circulation is demonstrated unanswerably, and the therapeutic importance of that list of agents which induce increased ventricular contraction is enhanced. We have seen that heart-failure is the turning point in the progress and prognosis of chronic renal disease when a cause of heart disease; and now we see what a disaster impeded circulation from heart- failure is, in ultimately overtaxing the organ already enfeebled.
The clinical importance of avoiding venous congestion from heart-failure, of improving the action of the heart by aiding in securing compensatory hypertrophy, or delaying so long as may be the venous congestion, no longer to be averted, is demonstrated only too clearly.
In heart disease the appearance of albumen in the urine, with exudation casts, marks the inauguration of a secondary process which will work evil, and that, too, in no long time. In a little while chronic Bright’s disease is firmly established, with all its consequences, and it may not be possible always to determine which lesion came first in the order of time. It matters not which has priority, the failing heart must be treated. The condition known as dropsy, when not idiopathically renal, is always due to a weakened heart. This weakness may be due to fatty degeneration, or to dilatation from continued distension. So soon as there is failure in the heart’s power, we get deficient circulation. Limiting my remarks to the condition of the kidneys, the first effect of a deficient arterial circulation in these organs is venous congestion. In the first place, we get obstruction in the renal vein, and, from that, albumen and exudation tube-casts. But this is not all: venous congestion affects the nutrient branches of the renal arteries and impedes the flow through them, interfering with the elimination of solids. While these positive results follow from venous congestion, we get negatively diminished bulk of urine. This does not result altogether from venous congestion, for the narrow continuations of the bloodvessels from the glomeruli prevent its acting very strongly. It is chiefly the result of diminished arterial pressure. Venous congestion means diminished arterial pressure. The blood lying in excess on the venous side, the arteries are not so well filled; this tells on the arterial pressure, which results in diminished bulk of urine- thence dropsy. I have thus described the pathological condition in the kidneys that it may be clearly seen that, in order to treat dropsy successfully, we must restore the heart to its normal power. We must make it force the blood into the renal arteries, until we get normal pressure therein, before we can increase the bulk of the urine. It will do no good, but rather make matters worse, if we give medicines which have a direct action upon the kidneys.
Those are only useful in idiopathic renal disease before the heart-failure has set in. It is a notable and important fact that all those medicines which are really useful in cardiac dropsy are those which, by their physiological action, increase the working power of the heart. Another notable fact is that all these medicines were first known as diuretics, and their influence on the heart was discovered later. The following medicines I will mention in order of their value. In their early history they were classed as pure diuretics. Later investigations show that they do not affect the kidneys as diuretics until they have increased the force of the heart’s contractions and the pressure of the blood in the arteries, and removed the venous congestion. It may be asked: “Are they all strictly Homoeopathic to the conditions which result in cardiac dropsy?” I answer, “Yes.”
1. Their primary effect, when taken in pathogenetic doses, in healthy persons, causes abnormally increased action of the heart, increased blood-pressure in the arteries, congestion (arterial) in all organs, and even aneurisms and extravasations from arterial capillary vessels.
2. This condition, if long continued, can result in no other than a reaction or secondary condition, which is just as much a drug effect as the primary. While the primary condition resembles that brought about by a hypertrophied and thickened heart, the secondary state is similar to that in which the muscular fibres, unable to bear the strain, have become degenerated, and fail to contract with sufficient force to fill the arteries, resulting in venous stasis everywhere. Now, I hold, and have taught for twenty years, that this secondary state, caused by drugs, should be made the basis of drug selection, according to the homoeopathic law just as much as is the primary.
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.