Latrodectus is another remedy that comes in for equal honours in coronary disease. It attacks the entire precordial region, causing violent griping pain extending to the axilla, down left arm and often up into the neck and back of the head. Patient fearful and screams with the pain, dyspnoea severe. Patient fears he will lose his breath. Has numbness in lower limbs and a sinking sensation in epigastrium, which increases his fear of death.
Cactus.- Indicated when you have that characteristic iron-band constriction. Patient in a cold sweat, pain running down left arm and ring finger. The pains of Cactus are not usually over the whole left chest but seem to start from the apex of the heart and shoot upwards. They are aggravated by pressure and lying on left side.
Spongia is a remedy often forgotten in these cases. Patient awakened usually after midnight with a violent pain, badly frightened and thinks he will suffocate. Has violent palpitation heart feels as if it were trying to push its way up through the chest.
These are desperate cases and a doctor is anxious and worried and inclined to resort to morphine, but if you keep your head and know you materia medica you will relieve your patient and will not have to combat the damage done by morphine. Of course, you will have to treat your patient after the acute attack and here dont forget NAJA ; it is especially indicated in thrombosis, which will rapidly form an embolus if not checked. Following this probably Crataegus is one of our best remedies, but almost any remedy might be indicated, for it is the patient you are treating and not one symptoms.
Angina pectoris often is confused with coronary disease and rightly so, as sometimes it is very difficult to make a correct diagnosis. However, there are a few symptoms that will help to distinguish between them. In angina the patient will get into a certain position and will not move for fear of increasing the pain, while in coronary trouble the patient will move about trying to find some position to relieve the pain. Angina will be benefited by the nitrites, while they have little or no effect on coronary conditions.
In angina both the pulse and blood pressure will be accentuated, while in coronary trouble the pulse is apt to be irregular but the blood pressure is usually low, and a rise in same is a good symptoms. For an acute attack Amyl nitrite, Glonoin, Cactus or perhaps some of the above-mentioned remedies will usually control, but as this is purely nervous trouble the after-treatment must be directed to the constitutional nervous condition.
Mitral Cases.- Another condition that gives us a good deal of concern is the old mitral case. The heart of fifty or sixty with a history of “Flu” or pneumonia of inflammatory rheumatism, a heart that perhaps has already been weakened by heavy drinking or some other physical ailment, falls easy prey to this infection. Examination reveals dilatation, especially of the left side, marked mitral murmurs, first sound weakened or obliterated altogether, a failing compensation, oedema about the ankles, may or may not find albumin in the urine.
Anyway, it is the beginning of the end unless checked immediately. You may be called in the night and find the patient rapidly failing perhaps unconscious, with weak, rapid, irregular pulse, loud irregular breathing. Often incontinence. These are cases needing immediate stimulation to support the failing heart, so a hypodermic of Glonoin or Coramin.
The latter I always give into the blood stream ; it is about as quick in action as Glonoin and lasts much longer, and will usually stimulate the failing heart and keep the patient alive until you can substitute some of the more substantial remedies. You often will get fibrillation but don;t think you have to give Digitalis or Quinidine in large doses for Digitalis or China in potency will do the work for you.
Crataegus to follow up will do wonders in these old cases. It acts through the cardio-inhibitory vagus, strengthens and slow the hearts action. Especially indicated in high tension, this remedy alone will often keep these old cases alive and comfortable for years. It does not have an accumulative effect and can be given in substantial doses over long periods of time with no danger.
Digitalis in potency is indicated when the muscle is weak and accompanied with a good deal of dropsy. It stimulates the cardiac ganglion, it has an accumulative effect and is very slowly eliminated and must be carefully watched.
CHAMOMILLA
THE keynote of this drug is restlessness and peevishness with pain and all the symptoms are relieved by active or passive motion. The child is bad tempered with pain, asks for a toy and throws it at the head of the nurse and wants to be carried about the nursery all the time. It is excellent for severe pains in all potencies and occasionally high potencies, such as the 200th, are best.
Adonis vernalis often is an excellent remedy to follow Digitalis. It also has also good deal of dropsy, the weak slow pulse, low vitality, a fatty heart accompanied with a good deal of pain, and does not have the accumulative effect of Digitalis.
Strophanthus has much the same indications as Digitalis. Especially indicated in tobacco smokers, does not have the accumulative effect, does not affect the vasomotor nerves ; this it is much safer for the old, weak heart, especially when there is threatened oedema of the lungs.
The old cardiorenal case is like the poor : we have them with us always. And in the treatment of these cases I would like to give three of four outstanding cases and their treatment :.
Mrs. F.- The patient, a female fifty years old, was found sitting and partly lying on sofa with the limbs over the edge and and feet on floor. The limbs were burst open in many places and discharging serum which was running across the linoleum. Examination revealed a marked mitral murmur as well as an aortic regurgitation. The mitral murmur was well transmitted to all parts of the chest. Heart enlarged transversely, accentuation of the second pulmonary sound.
Failing compensation with marked hypostatic congestion through lower lobes of lungs. Dyspnoea so great that she could scarcely talk. Abdomen seemed to contain buckets of water which was causing a good deal of pressure upon the heart. The urine when examined contained large quantities of albumin and casts and some pus cells. A short history was obtained from the husband which he admitted showed a plus Wassermann.
She was given intravenous injections of a mercury preparation called Novasurol, and given Digitalis in potency, with the most marvellous action I have ever seen. Within three days the dropsy had all disappeared and the woman could lie down in comfort. She was then placed on Crataegus which carried her through for six years, and she not only did her housework but cared for a large garden.
Mr. P., captain of the Civil war, was another case given up by his physician. His examination was essentially the same as the former case except he had no aortic lesion and practically no dropsy. He was placed on Crataegus and lived for five years and enjoyed very good health, finally dying from the infirmities of age.
Mrs. A., female, age forty-eight, had been sitting in a chair for weeks unable to breathe at all lying down. Her dropsy was also extremely marked ; her limbs also had burst and were discharging serum freely. Her heart was enlarged and had all the abnormal sounds ever heard in one heart. Action was extremely weak and was accompanied by nausea and faintness. The urine was suppressed and passed only by drops. The least movements caused violent palpitation. She was given Digitalis which has removed all symptoms except the murmurs. This was ten years ago and she is able to do her own work and goes to town like any other woman. Seems perfectly well.
Mabel H.- One more case and I will stop. This was a case of a “blue-baby” in which the valve never closed, and at the age of eighteen months she became paralysed on the entire right side. At the age of four the case was turned over to me by another doctor who had failed to help her at all. She had NO use of the right leg and very little of the arm. The cyanosis was extremely marked ; her tongue was as black as that of a Chow dog.
Her heart had NO normal sounds and evidence of some degeneration of the pulmonic valve which gradually increased as she grew older. Under Gelsemium she was relieved of the paralysis and got so she could walk with the support of something to steady her. She was kept on Crataegus with now and then a dose of some other indicated remedy, and lived to be fourteen, which I understand is several years longer than any other like case on record.
Of course, in treatment of these cases as well as any case it is essential to look after the bowels, the diet, see that they have proper rest, and correct any abnormal condition that they may have ; and i believe as times goes on and we better understand the vitamins, that they will become one of the greatest adjuncts we have in medical. But dont forget that even the heart may be only one symptoms of a diseased body which must be treated as a composite whole and not as a single unit.
