PAPERS ON SUBJECTS RELATING TO DISORDERS OF THE HEART



Next in order are the functional disorders of the heart, in which it does not seem possible, nor is it probable, that sudden death could occur through any fault of that organ. Even in angina pectoris, not due to organic disease, when the agony is fearful and the collapse great, sudden dissolution is the rarest of incidents.

Even granting that death may sometimes occur from the shock, as it is termed for it is well known that in certain debilitated constitutions pain alone, by its intensity and severity, may destroy vitality very rapidly how are we to know absolutely that the pain in the heart caused death? There are other thoracic pains which are fully equal in intensity to cardiac neuralgia. It has been supposed that there are such conditions of functional disorder of the heart as choreic convulsion, tetanic spasm, irregular contraction, and the like, which might cause rapid dissolution. But this is not fully proven. The heart is often found rigidly contracted after death, but this is generally rigor mortis, and not a true pathological state, occurring previous to death.

Right here I would like to demolish one of the most common of the popular fallacies relating to the heart, namely, that it is a delicate organ whose vitality is easily destroyed. On the contrary the heart is more tenacious of life than any organ in the body. It will go on with its work when all other organs have lost their integrity, or when its own integrity is impaired to a degree that seems wholly incompatible with its own vitality. It will even go on beating when taken out of the body, and after it has ceased to beat for hours, it may be irritated by electricity or galvanism, and commence beating again, from a strange latent vitality. The wonderful tenacity of life possessed by the heart is best seen in those organic or structural diseases in which great and important changes have taken place in its walls or valves.

The walls of the heart may become so thick that the organ becomes monstrous in weight, or so thin that they are attenuated to the last degree. In the former (hypertrophy from enlargement), death rarely occurs suddenly from the immediate consequences of the enlargement. If the patient should be of apoplectic habit, the enlargement might aid in bringing about an attack, but the resulting death could not properly be said to be due to the cardiac disease.

In the latter (hypertrophy by dilatation) death does sometimes occur suddenly, not unexpectedly by any means, but from sudden paralysis or rupture of the attenuated muscles. But nothing more astonishes the physician who sees much of cardiac disease than the length of time patients live with attenuated hearts, and the exertions they will undergo, necessary and unnecessary, without suddenly destroying the motive power of this wonderful organ.

It would seem that so long as there exists sufficient muscular fibre to force the blood out of the ventricles, the heart will go on beating inspite of all our predictions to the contrary.

Valvular diseases of the heart are rarely the immediate cause of death, and still more rarely do they cause sudden death. Prof. Tully likens the heart to a force pump, and observes that “it may be a very poor heart, but a pretty good pump.” In other words, it will keep up the circulation of the blood long after its machinery is greatly deranged. Death from valvular diseases occurs from the arrest of function in other organs, namely, the kidneys, lungs, or brain, or from the deposit of emboli in important arterial trunks. In only one or two instances can sudden death result. An embolus may plug a cerebral artery, thus cutting off the supply of blood to the brain and cause sudden and fatal coma and paralysis, or it may obstruct one of the great arteries leading from the heart. What are sometimes called polypi of the heart are of this nature, large fibrinous masses, which sometimes completely fill one of the heart’s cavities, causing sudden arrest of its contractions.

Prof. Meigs, in his treatise on obstetrics, mentions this liability to the formation of fibrinous clots within the heart, especially during the puerperal state, when from loss of blood the circulation becomes so enfeebled that the blood accumulates and stagnates in the cavities. This author accounts in this way for the cases of sudden death after childbirth, and during syncope induced by assuming suddenly the erect posture after profuse hemorrhages.

One of the most common causes of sudden death is rupture of the heart, but this accident is of very rare occurrence. It usually occurs from softening, or fatty degeneration; from abscesses or ulcerative perforation, or from aneurism or attenuation of the walls of the heart. The immediate cause in such cases has been usually ascribed to great mental excitement, anger, grief, or to sudden physical exertion, but Dr. Hallowell has collected thirty- four cases of sudden death from rupture of the heart, and it is a singular fact that in the large proportion of cases the patients were in a state of repose when it took place.

Death generally follows the rupture almost instantaneously. It is rare that any struggle follows the breakage of the walls.

The common phrase, “died of a broken heart,” is not a mere myth, as some have asserted, for rupture of the heart-walls, from sudden and overwhelming grief, has been known to occur.

In fatty degenerations, sudden death oftener occurs from cardiac paralysis than from rupture. The muscular fibres are so far replaced by fat that not enough are left to propel the blood out of and contract the cavities.

The fallacy of referring all cases of sudden death to disease of the heart is well shown, if we consult any standard work on pathology, where it will be found that it may be brought about by very many other conditions, namely, diseases of the brain of an apoplectic character; spinal and cerebral-spinal congestion and extravasation; the bursting of internal abscesses and aneurisms; internal hemorrhages, and even severe mental shocks. It may also be caused by the lightening-stroke, excessive heat (sun-stroke), various injuries of an unknown nature, the action of poisons like prussic acid, and the venom of serpents.

I will venture to assert that if we could get trustworthy statistics, the ratio of sudden deaths from heart disease, compared with those arising from other causes, would not be greater than three to ten!

Now, to briefly recapitulate. The causes of sudden death from heart affections may be divided into three classes:

I. From paralysis of its muscular structure.

II. From rupture of its walls.

III. From mechanical arrest of its movements by clots, polypi, etc.

The instances of sudden and fatal cerebral or pulmonary apoplexy from heart disease are so rare that we may waive their consideration. Sudden paralysis can only occur from excessive attenuation of its walls, in debility from excessive loss of blood, during convalescence from typhus or other enfeebling diseases, from softening or fatty degeneration, or during acute pericarditis.

TREATMENT.

It comes properly within the scope of this paper to suggest the treatment of those cases where the appearances indicate that sudden death will occur during the progress of cardiac disease. In cases of threatened paralysis, from whatever cause, the assistance must be prompt and energetic. First of all the patient must be placed in the recumbent position, upon a level bed or floor (the head not elevated), and on the right side, if on either. Then we must immediately give the most rapidly acting cardiac stimulant we possess. Alcoholic spirits will do, but I prefer the volatile Ammonia to all others. The aromatic spirits should be administered in suitable doses until the pulse and heart-beats show that the patient is out of danger. Next to Ammonia, and more efficacious as a true remedial agent, is Digitalis, in material doses. If possible I generally give both remedies in rapid alternation.

In such cases do not be afraid of Digitalis. It is not the depressing agent it was decreed to be by our predecessors but a true cardiac tonic, capable of saving life when all other medicines are useless. Cases may occur, however, where Camphor, Veratrum album, Veratrine, Gelsemium or Arsenicum are the appropriate remedies.

In rupture of the heart there is no time to use medicinal agents even if they could be of value, for the death is as sudden as it is inevitable. The same may be said of those mechanical impediments called polypi, heart-clots, and fibrinous concretions. The moment they form of sufficient size to block up the great arteries, or arrest the cardiac contractions, no human interference can save the victim.

In conclusion I feel called upon to declare that it is a duty which physicians owe to themselves, to the profession, and to the public that they decline to give an opinion as to the cause of sudden death, unless their previous knowledge of the pathological condition of the deceased, or an actual post-mortem examination of the body enables them to give a positive opinion as to the cause of death.

Edwin Hale
Edwin Moses Hale 1829 – 1899 was an orthodox doctor who converted to homeopathy graduated at the Cleveland Homoeopathic Medical College to become Professor Emeritus of Materia Medica and Therapeutics at Hahnemann Medical College, editor of the North American Journal of Homeopathy and The American Homeopathic Observer and a member of the American Institute of Homeopathy. Hale was also a member of The Chicago Literary Club.

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.