Diseases of the heart may be divided into two general classes; those originating from an inflammatory process within the heart, and those originating from without. The former result from an inflammation of the lining membrane of the heart, endocarditis; the latter from (1) an extension of a chronic form of inflammation of the walls of the main artery of the body to the segments of the aortic valve, which prevents the return of the blood from this vessel into the cavity of the left ventricle; (2) from an extension of this inflammatory process to the walls of the bloody vessels which nourish the organ, the coronary arteries; (3) from the immediate contact of a toxic element in the blood with the walls of the vessels which nourish the heart, resulting in changes in those vessels which interfere with the nutrition of the organ; [*When this arterial change exists in the walls of the heart, it is never confined to this organ alone; it is a general process, and in some of the vital organs, particularly the kidneys and liver, produces serious changes by developing an adventitious tissue-growth which ultimately seriously impairs the functions of the organs, Bright’s disease of the kidneys and certain chronic liver diseases being the result. These are an accompaniment of, and go in hand with, heart disease resulting from this arterial change.] (4) from a diminished amount of the normal ingredients of the blood in the general circulation, which weakens the heart-walls from faulty nutrition, and permits them to dilate, often to such an extent as to render the valves at the various orifices incompetent to close them; and (5) from great physical strain which, by compressing the small arteries of the body, obstructs the blood-current, thus overdistending the cavities of the heart and resulting in dilatation of its walls.
Added to these may be mentioned certain nervous affections of the heart which are secondary to disturbances elsewhere, and which subside with the removal of the cause.
The first class of diseases of the heart, those originating from within, are common to all periods of life, but occur more frequently prior to manhood or womanhood, and involve almost exclusively the left side of the heart, and more frequently the mitral valve, or that which lies between the auricle and ventricle of the left side, and which, during contraction of the latter, closes and prevents the return of blood into the auricle above. They result from an inflammation of the lining membrane of the organ, the endocardium. This inflammation, endocarditis, is a complication of various acute diseases, which are characterized by the presence of certain acid poisons in the blood. Chief among these diseases is inflammatory rheumatism, or rheumatic fever of some authors. About thirty per cent. of all cases of inflammatory rheumatism are complicated by inflammation of the lining membrane of the heart. The inflammation is more intense along the edges of the valves, from the fact that the sudden closure of these valves brings the margins of their segments into forcible contact with each other; this occurring so frequently, from one hundred to one hundred and fifty times to the minute in febrile conditions, it is readily seen that on the edges of these segments the inflammation would be most intense, owing to this additional cause of irritation. The valve-tips become infiltrated and swollen, and soon develop a growth of fibrous tissue adventitious tissue. As the inflammation subsides, this newly-developed tissue contracts, changing the shape and size of the segments, with the result either of rendering the valve imperfect or of narrowing the orifice, or both. Thus is established a permanent deformity of the valve or orifice, “valvular disease of the heart,” the result being permanent obstruction at that point. If the nutrition be good, the walls of the heart, back of the deformed orifice or valve, thicken by the growth and development of new muscular fibres; the heart is strengthened, and the obstruction is, to a certain extent, overcome. This condition of the muscular walls of course causes enlargement of the heart, which, as was before stated, although the result of disease causing obstruction to the blood-current, is not in itself a disease process, but Nature’s method of overcoming obstacles to the circulation of the blood. A patient suffering from valvular disease is crippled; but, if the nutrition of the heart be good, by avoiding indiscretions and adopting an occupation that does not require great physical strain, by living on a level, as it were, life may be prolonged in comfort for many years. All are liable to the diseases producing this form of heart lesion, whether their lives are good or bad, discreet or indiscreet, but not equally liable by any means. A good and discreet life adds to the resisting power against disease-producing influences, and to the powers of endurance; while a bad and indiscreet life reduces the vitality and resisting power. Those following the latter course are much more liable to suffer by exposure to infection, to sudden change of temperature, and to other disease-producing influences.
The second form of cardiac diseases, or those originating from without the heart, are, save in exceptional cases, the direct result of hereditary influences, or of indiscretions in life, and, by proper knowledge and precautions, can in the majority of cases be avoided, or, if already established, checked in their progress. The portion of this article relating to the indiscretions which give rise to disease processes, which result in premature wearing out of the heart, should be carefully considered, for it is from its perusal that possible good may come, disease be warded off, and life prolonged. Of late years, physicians have paid more attention than formerly to the preventable causes of disease of the heart and of other organs of the body, and the time will come when a careful study of the etiology of the form of disease under consideration will enable the physician so to direct such of his patients as are willing to be guided for good, that these diseases will be arrested in their progress, and often, in those predisposed to them, be prevented, and later this very predisposition may be done away with.
There is a cause for every morbid condition, and the man who discovers these causes, if he have the magnetism to draw around him ardent followers, who, for the love of man, will disseminate his knowledge, will be a greater than Hippocrates, a greater than Galen; for although all concede that the calling which enables one to relieve suffering, and to cure curable diseases, is a noble one, they will concede that one which will enable man to prevent suffering and prevent incurable disease is far more noble.
A terrible bugbear to every one who is fat and short-winded, and who suffers from occasional attacks of pain in the region of the heart, or from palpitation, is fatty degeneration of the heart. It is needless to say that a person may be fat and yet enjoy good health, and that the above-mentioned symptoms associated with obesity are no evidences of this malady, which certainly does destroy many valuable lives. A distinction must be drawn between fatty degeneration of the heart and fatty heart. In the former there is a degenerative change in the muscular fibres of the heart, a greater or less number of them being converted into fat. In the latter there is a deposit of fat on the walls of the heart and between its muscular fibres. The two conditions may co-exist. The causes of fatty degeneration are faulty nutrition of the organ from a deteriorated or poisoned condition of the blood, or from improper blood supply, resulting from obstruction to the current in the bloodvessels that nourish the heart. The first cause will account for degeneration found where death has resulted from acute or chronic infectious febrile diseases, such as typhoid fever or pulmonary consumption, or from the various diseases in which there is a positive and permanent deleterious change in the constituents of the blood, as in progressive pernicious anaemia. Bright’s disease of the kidneys and certain progressive diseases of the spleen and lymphatic glands. The second cause will account for degeneration when the bloodvessels supplying the heart, as a part of a general disease process of the arteries throughout the body, have become tortuous and changed by an inflammatory or degenerative process known as atheroma, and where degeneration results from deformity of the valve at the mouth of the aorta, which prevents its proper closure.
It is generally conceded that recovery is possible from the fatty degeneration accompanying the acute fevers, new muscular fibres being formed which take the place of the old ones which have become converted into fatty debris. But a heart which has become degenerated from the second cause mentioned, arterial change resulting in permanent obstruction to the blood-current, is permanently crippled, and owing to its enfeebled condition, either venous engorgement of the various organs of the body results often to such an extent as to disturb their functions sufficiently to be incompatible with life itself or acute dropsy of the lungs, or general dropsy ensues, as a direct result of weakened heart action, and may destroy the life of the patient; or the diseased heart may suddenly fail and stop beating, owing to shock, a fit of passion, overexertion, a sudden change from the recumbent to the upright position, a chilling of the surface of the body, or the contraction of the superficial bloodvessels during the cold stage of ague; and death frequently takes place when the heart-walls are weakened, during an attack of angina pectoris. Several cases of sudden death from fatty degeneration of the heart from each of the above immediate causes have come under my personal observation. This latter disease, angina pectoris, so little understood by the laity, is not, strictly speaking, a disease of the heart, although generally so considered. A person with a perfectly sound heart may suffer from repeated attacks of angina pectoris. It is in reality a transient disease of the nervous system, an irritation of the nerve-centres from which originate the nerves which supply the walls of the small arteries containing muscular fibres. This irritation causes these vessels throughout the body to contract. The heart is overtaxed, overburdened; it struggles to empty itself; its cavities become overdistended. If its walls are strong, it can withstand many of these attacks. If it be weakened by disease, degeneration, or dilatation, it sometimes fails in its struggles, and stops with its cavities filled with blood. The reason that angina pectoris is so frequency an accompaniment of a degenerated heart and of disease of the aortic valve is that the same condition of the blood, i.e., an excess of urid acid, which it is conceded produces the one, produces the others. This condition of waste material in the blood is the result of functional disturbance of that great chemical laboratory, the liver. And this disturbances is, in the great majority of instances, the direct result of indiscretions of various kinds.
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.