The discussion that followed was to the effect that Oertel’s treatment cannot be proceeded with too carefully; it should never be used without a thorough knowledge of all the patient’s symptoms. The unanimous wish expressed was that precise indications warranting the use of the treatment should be formulated.
It is evident that this treatment should not be undertaken by any patient without the watchful care of a competent medical attendant. The altitude at which such treatment is conducted is an important factor. Hill-climbing should be commenced at a low altitude, and not until the heart has become stronger should mountain-climbing at a moderate altitude be attempted.
At the recent Congress of German Physicians in Wiesbaden considerable time was given to the discussion of Oertel’s treatment of chronic disease of the cardiac muscles. In addition to the use of diet, great stress was laid upon the employment of gymnastic measures, especially those which imply the practice of the rising from various grades of a stooping or bending posture. As a means of attaining this result, mountain-climbing has been strongly recommended, but it is needless to say that the class of cases to whom a mountain tour is practicable is very limited. As a consequence, various contrivances have been devised for replacing mountain-climbing, among the best of which is one described by Dr. von Corval in the Therapeutische Monatshefte for August, 1888. Lauder, of Stockholm, had already recommended an apparatus on the principle of a treadmill for fulfilling the indications in the treatment of various heart affections, and his apparatus, by unloading the venous circulation, through improving the general condition of the circulation, to that extent reduces the work of the heart, and consequently leads to strengthening of the heart-muscle. Von Corval points out that one of the great advantages in mountain-climbing is the simultaneous action of the arms through the use of Alpine-stocks and the legs, for by means of this the circulation in the areas of both the inferior and superior vena cava is accelerated. This object is attained by the use of a treadmill, whose steepness may be altered at will, and by the use of two vertical movable bars, which are grasped in the hand, and serve to assist the patient in ascending the inclined plane. At the commencement of this treatment the treadmill should be nearly horizontal, and the increase in steepness only gradually accomplished and with careful attention to the character of the heart’s action. Especial stress is also laid on the fact that an inspiration and expiration should accompany every two steps so that, therefore, the rapidity of the motion should not exceed sixty to seventy steps in a minute. The cases for which this mode of treatment is especially valuable are those of fatty heart, without degeneration of the heart-muscles, especially when the affection results from immoderation in eating and drinking. Dilatation of the heart from strain or valvular affections is not improved, but may be seriously damaged by this treatment. It is readily seen that, in being capable of careful regulation, this method of heart-gymnastics is preferable to mountain-climbing, while being capable of employment by many for whom a mountain tour is impossible.
CARDAESTHENIA.
I THINK this to be a better and more comprehensive name than irritable heart, for a healthy heart may be irritated by disorder of other organs, while the nervous structure of the heart may be weakened when other organs are healthy.
My observations and my studies of such authors teach me that organic diseases of the heart are more frequent in other countries, while in this country the purely functional disorders are far more frequent than abroad.
I cannot say that I believe that cardiaesthenia originates in the heart. On the contrary, it is nearly always found in those persons who have been subject to violent mental strain, or the victim of the irritating and depressing emotions. Nor do I believe it arises from any morbid condition of the brain. Its causes are psychic rather than physical.
A very suggestive paper was lately read before the New York State Society by my colleague, Dr. J. W. Dowling, whose experience as a specialist and close observer is valuable and confirms my own views as to the frequency of cardiac neuraesthenia in America. With Dr. Dowling’s consent I give his paper:
IS THE AMERICAN HEART WEARING OUT?
The community, in many instances the nation, has been so frequently shocked of late by announcements of sudden deaths of men high in public and social position, from diseases of the heart, that it seems not surprising that the question should be asked: “Is the American heart wearing out?” Why are these men thus smitten in the prime of manhood, in the prime of usefulness, in many instances without even the opportunity of giving a parting word to loved ones and friends? Certain it is that disease of the heart is more common among us than formerly, or that the physicians of the past failed to recognize this malady when it did exist. In the majority of cases of sudden death the diagnosis of disease of the heart is accepted without comment, without surprise, notwithstanding the announcement made that up to the time of his death the deceased was apparently in the best of health. It is rare that an investigation is made as to the cause of this disease of the heart, or the question asked why this cardiac disease remained undiscovered till death had placed it beyond the power of man to arrest its progress. No well- informed physician will claim that the sound heart becomes diseased suddenly, or that even the most obscure disease of that organ has not associated with it certain physical signs which will readily enable the expert diagnostician to recognize its existence. Scarcely a day passes but the morning papers contain obituary notices, of which the following extracts are samples:
“On Thursday he went to his office feeling quite well, but on getting up yesterday was so weak that he returned to bed, and died in a few minutes. The cause of death was heart disease.”
“He retired to bed at night apparently in his usual state of health, and was found dead in the morning. The verdict of the coroner’s jury was, `Death from disease of the heart.'”
“On Tuesday last he contracted a cold, but attended to his duties as usual till the last of the week, when pneumonia developed. He grew rapidly worse, and died on Monday, the immediate cause of death being failure of the heart.”
“He sailed from this country in February last in the best of health. He stood the journey well, and was apparently as well as usual till last night, when he was stricken with heart disease and died.”
“He left New York but a few days ago for a pleasure trip. As he was about retiring for the night, after a fatiguing journey, he fell suddenly to the floor from a stroke of apoplexy. He lingered till last evening, when he breathed his last. It is supposed that for some time past he had been suffering from disease of the heart.”
“Died, this morning, from a complication of maladies, including trouble with the heart and Bright’s disease of the kidneys. Although he had been confined to the house for several weeks, his death came unexpectedly to his family.”
The object of this paper is to fathom, if possible, the causes of this terrible mortality from diseases of the heart; to call attention to the indiscretions of life which give rise to certain forms of this malady; to show how patients suffering from organic disease of the heart may, by their own unaided efforts, prolong their days in comfort, in many cases even beyond the allotted life of man; to account for heart-failure as the immediate causes of death in many accidental and infectious diseases which, without this factor, would be recovered from, and to explain intelligibly some of the most common forms of diseases of the heart, and to correct certain misconceptions with regard to them; for, in the minds of the laity, the idea is firmly fixed that there is but one form of disease of the heart, and that invariably fatal. Physicians, too, until they have watched patients known to be suffering from serious valvular disease of the heart, and seen them live, perhaps for years, enjoying the ordinary good health of the average healthy individual, and until they have studied and become convinced of the compensating power of nature, untrammeled, in overcoming obstacles to the free circulation of the blood, continue to look with feelings of great anxiety on those of their patients and friends over whose hearts they have discovered a valvular murmur.
In order that those attracted by the title of this article, who believe themselves to be suffering from disease of the heart, may peruse these pages without palpitation of that vital organ, I will commence the consideration of my subject with the positive assertions, founded on an experience covering nearly a third of a century, of which many years have been largely devoted to the special study and teaching of diseases of the heart and lungs, that cardiac disease is not invariably fatal; that many apparently grave forms are entirely recovered from; that enlargement of the heart is not in itself a disease, but on the contrary is salutary, inasmuch as it is nature’s method of overcoming obstacles to the blood-current, either in the heart or elsewhere, this very enlargement, accompanied as it is by increased power owing to the development of additional muscular fibre, sometimes compensating entirely for the obstacle; that, with serious valvular disease developed in childhood, patients have been known to live to be aged men and women, the fathers and mothers of large families of children, in some instances, to the writer’s personal knowledge, supporting these families by manual labor requiring at times great physical exertion and mental strain; that with a large majority of those supposed to be suffering from heart disease, that organ is in reality perfectly sound, and, if affected at all, is suffering secondarily to functional disturbances of organs remote from the heart disturbances which are curable by proper and not too severe hygienic measures; and, lastly, that whenever the attention of the patient is called to his or her heart by symptoms which lead to the conclusion in his or her mind that he or she is suffering from organic disease of that organ, the chances are ninety-nine out of a hundred that the heart is perfectly sound. This last assertion will apply with equal force and truth to the lungs, brain and kidneys.
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.