Digitalis is now, and will probably be for centuries, the principal drug in this category. You are all familiar with its action on the heart and the general system. You know that it stimulates the cardiac muscles to unnaturally forcible contractions, and that were it not for the power it possess to contract at the same time the distal arteries, its extreme effect would be to cause active congestion, inflammation and hemorrhage in every important organ. This arterial contraction reacts upon the heart, increasing the strain on the walls of the ventricles, until they close in systole and death. But if this fatal result does not occur, the overstrained ventricles relax and dilate, their muscular tissues become thin and fail to fill the arteries. After this the result is venous congestion and effusion of serum.
Adonis has an action on the heart and circulation similar to Digitalis, and often acts in cardiac failure and its resulting dropsy better than the latter.
Convallaria resembles both, and will often remove cardiac failure when they have failed.
Strophanthus, the newest cardiac drug, has been used with very excellent success. It does not contract the arteries as much as the others, and is considered safer in many respects.
Apocynum cannabinum has been used for a century as a potent remedy in dropsy, but it is only recently that its active principle. Apocynin, has been found to be an energetic heart- tonic, acting like Digitalis.
Cactus, so favorably known to us, is a cardiac stimulant, causing veritable spasms of the spinal muscular fibres of the heart. It is largely used to combat symptoms similar to its primary and secondary effects, and in certain cases will remove cardiac dropsy with great celerity.
Helleborus niger was used among the ancients as a potent remedy in dropsy. Singularly they relied as much upon its hydragogue as its diuretic effects. It is now well known that its alkaloid, Helleborne, is a powerful cardiac stimulant in its primary action.
Iberis amara, although not much used, has a favorable influence in cardiac dilatation attended with dropsy.
Scorparius, or “Broom,” is an old and valued diuretic. It was once the chief medicine in obstinate dropsies. Within a few years its alkaloid, Sparteine, has taken a place alongside of Digitalis, and shown in many cases a powerful action on the kidneys.
Oleander with its active principle, Nerein, has been found to belong to the same class as the above, but it has not yet been used much in disease. It is predicted that it will rival Digitalis.
Caffeine is probably the most powerful heart-energizer yet discovered. In massive doses it will rapidly tetanize the healthy heart. In threatened cardiac paralysis, five grains every two hours have apparently snatched the patient from the jaws of death. In those cases of rapid heart-failure, which sometimes occur in pneumonia, typhoid fever and extreme dilatation, two grains every two or three hours have restored the force and rhythm of the heart in a very short time.
Sterculia (Kola), an African nut, which contains Caffeine and Theobromine, bids fair to rival any of the above. The time will come when the powerful alkaloids of all these cardiac medicines will be used instead of the crude drug.
THE UTERUS AND OVARIES.
It may seem strange that I should connect diseases of the uterus and its apendages with cardiac disorders. It is not so much the acute disorders as the chronic which I shall discuss. No one will deny that inflammatory affections of the heart do have some influence on uterine pathology. We often find acute arterial congestion of the uterus and ovaries, acute haemorrhage and even dysmenorrhoea aggravated by an enlargement of the heart, or even undue excitement of that organ. Witness the subsidence of these conditions when the woman is put under the influence of such cardiac sedatives as Aconite, Cactus, Gelsemium or Veratrum viride. But I will not further discuss this point, but proceed to the consideration of chronic maladies of the uterus. The scientific and talented Dr. Mary Putnam Jacobi, in a notable paper published several years ago, observed that “the first link in the chain of uterine pathology is venous stasis.” To this cause, she asserts, are due the nutritive changes, the displacements, the flexions, many amenorrhoeas, dysmenorrhoeas, and haemorrhages of various kinds which attend uterine disorders. If you will recall what I have said of the changes in the kidney caused by venous congestion, you will more readily comprehend the above statement. Now, as in the kidneys, venous stasis of the uterus is not always due to a failing heart. It may originate in some local disorder or traumatic condition.
It may originate in suppressed menses after miscarriage or post partum. It may be due to a sudden cold or powerful emotion, when the vaso-motor nerves are irritated, resulting in spasm of the arterioles. But these local states may finally result in heart- failure, just as undue tension of the renal arteries may cause such changes in the kidneys as will soon result in some form of Bright’s disease.
While we are treating these acute disorders with Aconite, Belladonna, Cactus, Veratrum viride, Aurum or Glonoinum, we should be on the watch for that weakness of the heart, more common in women than men, which so often attends the failing health, resulting in any uterine ailment, for as soon as the circulation is weakened the local disorder tends to become chronic. So soon as the heart loses its power of propelling the blood freely and forcibly into the arteries of the uterus, pathological changes are sure to be perpetuated. If a weakened heart has anticipated any uterine disorder, that organ cannot long remain free from disease. In such cases local treatment, no matter how skillfully applied, will do but little more than palliate.
If women get up from a miscarriage or confinement with a loss of the heart’s normal power, as they are sure to do if they have lost much blood or have not been properly fed or nursed, the acute congestion of the uterus will change to venous stasis, unless we tone up the heart and increase the blood by means of Iron and Digitalis, China and Nux vomica, with nutritious food, fresh air and proper exercise. If the local weakness results in retroflexion, the pessary will not cure until we restore the circulation to its normal force. That condition, called areola hyperplasia, is the same as hyperloasia of the connective tissue of the kidneys. Both are caused by venous congestion. In the former we have scanty menses and sterility; in the latter, Bright’s disease and dropsy. If there are structural changes in the heart, organic weakness, chronic venous stasis in the uterus and ovaries become fixed, rebellious to treatment, and often incurable.
There are two points I desire to emphasize relating to the treatment of chronic disorders of the uterus. 1. That, in connection with proper hygienic surroundings, good diet, a pure air and good climate, we a should always prescribe some one of the known and trustworthy cardiac tonics. Those which have an affinity for the reproductive organ, as well as the heart, should obtain a preference. Among the most important of the latter class are Nux vomica, Ignatia, and the alkaloid common to both, Strychnia. There is no drug which is a better energizer of the heart than Strychnia. Under its use the hypertrophied and dilated heart decreases in size and increases in thickness. At the same time the tonicity of the uterus and its appendages is increased and the circulation in those organs equalized.
Convallaria and Lilium tigrinum come next in order. The former, as shown by recent provings, acts upon the heart similarly to Digitalis, while it does not cause the same amount of arterial tension. It has also a specific action on the uterus and ovaries. During its primary action they are stimulated and congested. During its secondary action, when the heart has become enfeebled, those organs become engorged with venous blood, making them subject to nutritive and structural changes.
Lilium has a similar action, but differing enough to enable us to differentiate between them. Cactus has a specific affinity, which is well known to all of you.
Strophanthus will, I predict, when better known and proved on the female organism, prove to be a valuable remedy in such cases. Digitalis, especially when associated with Strychnia or Iron, is of inestimable value in chronic cases, complicated with muscular atony or blood impoverishment.
2. The above remedies, when aided by those medicines which have a specific affinity for the reproductive organs, like Sepia, Calcarea, Cimicifuga, Secale, Aletris, Hydrastis and Viburnum, enable us to treat successfully all the non-surgical diseases of the uterus.
I fear that I have not presented this subject as forcibly as I should. It demands a more facile pen and a wider experience; but If I have given you food for serious thought and a fuller appreciation of the value of restoring the normal integrity of the circulation, I shall be satisfied with my endeavor.
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.