(1) The medicine chosen must be one which is capable of causing in the healthy a condition and symptoms similar to each special case.
(2) The origin and direction of the medicinal force must be similar to the origin and direction of the original morbific force. This latter rule I consider of the utmost importance. Allow me to explain: In a case of irritable heart, when you have traced the cause to be excessive, unexpected joy, the emotion first affected the brain through the soul. This shock was transmitted by the pneumogastric nerve to the heart, which it caused to palpitate violently, with increased force, as well as increased frequency. An irritation of the cardiac ganglia was set up, rendering that organ more susceptible to any and all emotions. This irritability may become permanent and possibly end in structural disease, unless it is arrested. In selecting the medicinal remedy we must select one whose pathogenetic action begins in the brain, and in that portion of the encephalon which presides over the transmission of joyous and all other exhilarating emotions. The medicinal or drug force, starting from that locality, when transmitted to the heart, must be capable of causing the peculiar kind of irritability which we find in the patient we are treating. Hahnemann and all his most scientific followers have recognized this rule, and when strictly followed it has resulted in some brilliant cures. Those who restrict themselves to covering the totality of existing symptoms will find the cure of their patients tedious and unsatisfactory.
Another rule I would add, of equal importance with the above, namely: When the primary symptoms of the case resemble the primary symptoms of the medicine selected, prescribe that medicine in the high attenuations. When the secondary symptoms of both the medicine and the disorder are coincidently present, the dose should consist of appreciable, or material, quantities.
THE MEDICINES.
We will now enumerate the medicines which will be found useful in cardiac affections from emotional causes, but in order to have a clear understanding of their action we shall compare the pathology of the emotions with the pathology of the medicines, namely:
The emotions of joy, rapture, ecstasy, hope, pride, courage, anger, rage, wrath, love, adoration, wonder, and astonishment, all stimulate and irritate the retardator nerve and increase the force of the heart’s action. Excessive and sudden joy, anger, and rage over-stimulate the retardator nerve and cause sudden death by cardiac spasms. Of medicines, Ammonia, Agaricus, Cinchona, Coffea, Crocus, Cactus, Camphor, Belladonna, Digitalis, Hydrocyanic acid, Lycopus, Laurocerasus, Ignatia, Nux vomica, and Cannabis indica, all stimulate the pneumogastric or retardator nerve and augment the force of the heart’s contractions. Of these, Cinchona (and Quinine), Camphor, Belladonna, Digitalis, Hydrocyanic acid, Nux vomica, and Ignatia, if taken in massive doses, are capable of over-stimulating these nerves to such a degree as to cause sudden death by cardiac spasm.
It follows, then, that among these medicines you will find the remedies for the cardiac disorders consequent on the morbific effect of those emotions which irritate and over-stimulate the retardator nerve. In our old repertories you will find many of these mentioned as having been recommended by Hahnemann and others.
AN ILLUSTRATIVE CASE.
As an illustration of the proper method of treating a case of prolonged cardiac hyperaesthesia from the combined effects of excessive joy and anxiety, I will narrate one that came under my care a few months ago.
A young married woman applied to me for the relief of an unpleasant nervous feeling in the chest, not amounting to pain, but an “uncertain, weak, weary sensation,” as she expressed it. She was subject to alternate feelings of depression and exhilaration; a strange sensation of sinking, and emptiness in the pit of the stomach; the heart’s impulse was feeble, its rhythm not disturbed, but the pulse-beats were small, soft, and averaged 100 to 110 per minute, even when lying down. Here were symptoms which appeared to call for Collinsonia, Lycopus, Prunus, and some others, but the history of the case revealed the true similimum. She had always been strong and healthy, but, during the civil war, her affianced was in the army during its most perilous campaigns. On several occasions rumors of his death reached her; on one occasion she did not hear from him for several months. Meanwhile it was supposed he was starving in the prison-pen of Andersonville. All this time her heart was being irritated and weakened by the emotions of anxiety, grief, and despondency. How true the ancient adage, “Hope deferred maketh the heart sick.” At last, when she had nearly given him up for dead, he suddenly appeared before her; but wan, and thin, and pale a mere shadow of his former self. The shock was sudden and overwhelming, not of joy alone, but mixed with astonishment, pain, and sorrow.
As we rarely find among the sick an affection of one organ and tissue alone, so do we rarely find cases where one emotion, unmixed with others, exercises its specific, uncomplicated influence. In this case, however, joy was the one predominant emotion. Her heart, already weakened and irritated by grief and anxiety, succumbed to the excessive stimulation of joy, and cerebral congestion, throbbing temples, loud hysterical laughter, followed by spasmodic weeping, and a sensation “as if the heart was trying to beat painfully in a cage,” as she expressed it, ended in a nervous erethism which had never left her, although she was happily married and situated pleasantly in life.
The remedy in this case proved to be Ignatia. It covers all the symptoms and conditions, and also stimulants the history of the disorder. One dose of a high potency was given and allowed to act a week. This was followed by doses of the lower attenuations, three times a day, and she was cured in a mouth.
IN ANOTHER INSTANCE,
occurring in a healthy woman, where no previous anxiety had weakened the heart, the unexpected news of great good fortune caused a condition of extreme nervousness, with strong, quick palpitation of the heart, sleeplessness, and cerebral erethism. Here the remedy was Coffea; a few doses of a lower attenuation promptly arrested the cardiac excitation after it had continued a week, notwithstanding the use of morphine and other anodynes.
The emotions of grief, sorrow, anxiety, expectation, discontent, melancholy, despair, remorse, fear, fright, horror, and astonishment, all stimulate chiefly the accelerator nerve and quicken the heart’s action, while they decrease the force of its contractions. Of these, grief, fright, terror, expectation, anxiety, and fear have caused death, from cardiac paralysis. The heart in such cases is found relaxed, flaccid, and its cavities uncontracted. Of medicines, Aconite, Arsenic, Calabor, Chloral, Cimicifuga, Crot., Gelsemium, Iberis, Lachesis, Phosphoric acid, Platina, Veratrum album, and Veratrum viride irritate the accelerator nerve, and weaken the heart. Of these, Aconite, Calabor, Chloral, Lachesis, and Crot., are capable of causing sudden death from cardiac paralysis.
It would not be proper in a paper of this scope to give the special indications for each remedy. Such indications are to be found in our textbooks on materia medica. I will, however, give
TWO TYPICAL CASES
as illustrative of the effect of medicines in the treatment of cardiac weakness.
A weakly young man, at the time of the great fire, awoke suddenly to find his room in flames, and no apparent means of escape. He was seized with an overwhelming terror, which caused profound syncope, and he was taken from the floor of his room apparently more dead than alive. It was many hours before he rallied from the shock, and then his mind and body both appeared hopelessly enfeebled. When I first saw him, it was several weaks after that fearful night, but his face still wore a look of settled fright, mingled with terror. His skin was cold and clammy. Any reference to the fire caused a cold sweat to break out on his forehead and hands. His pulse was small, weak, and quick, the heart’s action feeble, quick, and incomplete. His appetite was quite good, and there was no particular abnormal condition of the digestive system. Here was a case that called for Aconite, and a few small doses restored him to health in a very short time.
A young and blooming farmer’s daughter met with a severe disappointment in her affections. Her lover left for parts unknown. Weeks and months passed and no tidings. She did not weep, or make any outward demonstrations of grief, but her color faded, her plumpness disappeared, the extremities became cold, a dry, hacking cough set in, her breathing became shallow, dyspnoea occurred on the slightest exercise, and her mind became obtuse. She seemed all the time brooding over her sorrow, but no sighs or tears escaped her. She ate when food was set before her, but expressed no desire for anything but to be allowed to be alone. The heart beat feebly and quick, and the pulse was almost imperceptible.
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.