97. Diseases of the Heart and its Membranes.
DISEASES of the heart command much attention in the present day, not only on account of the frequency of their occurrence, and the serious consequences they often involve, but also as the result of our more perfect acquaintance with the organ both in its healthy and morbid conditions.
CAUSES- The most common causes of Heart-disease are Rheumatic fever in the young (see Section on Rheumatic fever); over-work of mind and body, anxiety, and too little rest in middle life, are to be ranked as pre-disposing rather than immediate causes; Influenza and Kidney-disease and Atheroma in older persons. The potency and frequency of the second class of causes are obvious. The demands thus made on the over-active organ lessen its nutrition, impair its structure, and imperil its action.
Touching diseases of the heart, we may at once state that all affections so characterized are not organic, but often merely functional, and due to temporary causes, as Palpitation from debility, Indigestion, etc.
TREATMENT- Organic affections of the heart may be greatly relieved and life considerably prolonged by judicious treatment. Professional judgment and experience are, however, specially necessary. Remedies have been suggested for heart affections from Rheumatic fever. For affections of the heart consequent on over- exertion and insufficient rest, Arnica is an excellent remedy. Other remedies, for affections from other causes, are pointed out in the following Sections, which deal with prominent symptoms rather than with diseases. Expert advice is always desirable for any form of heart disease.
98. Angina Pectoris Breast Pang.
DEFINITION- Sudden, severe paroxysms of pain, or Spasm of an enfeebled or diseased heart, with a constricted, burning sensation, and intense anxiety, chiefly occurring in elderly persons, or past the middle period of life.
SYMPTOMS- The patient is seized with a sudden dreadful pain, which centres in the heart, and extends over more or less of the anterior portion of the chest, up the shoulder and down the arm. There is an agonizing sense of anxiety, faintness, fear of instant death, Palpitation and dyspnoea, so that if walking he is compelled to stop and to fix on the first object that offers support, and so remains, pale and covered with a clammy perspiration. The paroxysms may terminate in a few minutes, or last for hours, and are liable to recur with increased severity. till at length one proves fatal.
CAUSES- Diseases of the heart, or obstruction of the coronary arteries, in consequence of which the muscular fibres of the heart become impaired. Under such conditions a paroxysm may be brought on by over exertion, flatulent distention of the stomach, mental excitement, or even a terrifying dream.
EPITOME OF TREATMENT-
1. For the diseased condition- Arsenicum, Digitalis, Aurum.
2. For the Paroxysm- Inhalation of Nitrite of Amyl or administration of Trinitrin; Ac. Hydrocy., Aconite, Cact., Spigelia, Sambucus
Aconitum- Recent cases, and for plethoric patients, when there is great sense of suffocation, anxiety, and throbbing.
Digitalis- Cases in an advanced stage, the paroxysms recurring frequently and suddenly.
Veratrum- Slow, intermittent pulse, cold extremities, cold perspirations.
Arsenicum- Extreme dyspnoea, increased by the slightest movement, marked debility, pale and haggard face, feeble and irregular pulse, and dread of immediate death. Arsenicum is also valuable as an agent for warding off the paroxysms of this painful disease.
Aurum- Great mental depression; general Atheroma (also Barium).
Cactus Grand- When there is a feeling as if the heart were grasped and compressed as with an iron hand (i.e. Spasm); Rheumatism.
Sambucus- Violent dyspnoea, awaking from sleep with a suffocative sensation, and dreadful anguish about the heart.
Cuprum Acet- The late Dr. Bayes and Dr. Holland have both reported cases of Angina cured by this remedy. Although we have had no personal experience with the remedy in Angina, it is doubtless of great value in this terrible affection.
Nux Vomica- Indigestion, the attacks being attended or followed by flatulence.
Nitrite of Amyl- Useful as a palliative one or two drops on cotton wool may be inhaled. It is conveniently sold in capsules holding the exact amount required.
ACCESSORY TREATMENT- Brandy or some other diffusible stimulant, ( Dr. Anstie, in Reynold’s System of Medicine, recommends Sulphuric Ether in the purely nervous form of Angina Pectoris, and mentions a case under his care, which he is sure would have long since ended fatally in one of the agonizing attacks of spasmodic heart-pain, but for the discovery that by taking a spoonful of ether immediately on its commencement, the patient can greatly mitigate the attack, and has continued to do so with undiminished effect for some years.) in frequent small doses; a large hot bran-poultice over the region of the heart; and warmth to the extremities.
99. Syncope Fainting Fit Swooning.
DEFINITION- A loss of volition and muscular power with partial or complete loss of consciousness, due to defective nervous power, from failure of brain circulation.
CAUSES- Debility from constitutional causes, or from loss of blood or other animal fluids; emotional disturbances fright, sudden joy, grief, etc. Hysteria, etc. Many persons faint on seeing blood or a wound, or from the sight of operations, etc.
EPITOME OF TREATMENT-
1. For the fit- Camph., Mosch., Ammon-Carb., or Aconite If the patient be unable to swallow any of the above remedies in strong tincture, especially the first two, they may be administered by olfaction. At the same time, all tight clothing should be loosened, the patient exposed to cool air, and cold water dashed on the face. The invariable tendency to the horizontal posture is a conservative one, and should not, therefore, be interfered with.
2. For the debility- China, Arsenicum, Iodium, Ver-Vir.
3. Fainting from affections of the heart- Mosch., Digitalis, Ver-Vir.
4. Hysteric fainting- See Section on Hysteria.
PREVENTIVE- Reference must be had to the constitutional state which causes fainting from trifling circumstances, in order to correct the tendency.
100. Palpitation and Irregularity of the Action of the Heart.
In a healthy condition we are scarcely sensible of the heart’s beat; the perfection of action, therefore, is indicated by entire unconsciousness that such action exists at all. Palpitation is evidence of a want of balance between the blood to be driven and the power of the heart to drive it. It is not, then, evidence of excessive power, but that the muscular power has been taxed and found unequal to the demand. It is laboriousness, not excessive power, that is indicated by Palpitation (Fothergill). When, however, the pulsations of the heart become much increased in force, or frequency, or both, the unpleasant sensation known as Palpitation is experienced.
PALPITATION AND DISEASES OF THE HEART- We infer Palpitation to be the consequence of functional disorder, as of Indigestion, when it occurs only occasionally, and when the action of the heart is uniform during the intervals. In medical practice the fact is often observed that patients with serious organic disease of the heart rarely suspect anything radically wrong until the disease has made considerable advances; while patients with mere functional disorder of that organ frequently entertain the gravest apprehensions. Most cases of Palpitation are from functional disorder and not from structural disease, and are consequently quite curable. Sometimes, from nervous irritability, some of the great arteries, particularly the abdominal aorta, take on an inordinate pulsation, which might be mistaken for Aneurism.
CAUSES- Predisposing. A nervous temperament; Hysteria; a full habit and Disease of the heart. Exciting. Excessive joy, grief, fear, and other mental emotions; severe or prolonged exertions; profuse discharges; menstrual derangements; a disordered especially an overloaded stomach; flatulence, etc. Whenever the heart is acting under disadvantageous circumstances, Palpitation is never long absent. Thus any cause which, by pressure on the diaphragm, diminishes the space for the heart and impedes its beat, places the heart at a disadvantage, and Palpitation takes the place of the normal quiet contraction. The excessive use of tea is one of the common causes of irregularities of the heart’s action in weak or nervous women; in some persons Palpitation follows tobacco smoking, as it may also result from the administration of other deleterious agents. In such cases, of course, a cure can only be expected after the discontinuance of the noxious substances.
TREATMENT- The subjoined has reference to simple Palpitation, unconnected with any organic disease.
EPITOME OF TREATMENT-
1. Palpitation from Emotional Causes- Aconite (from excitement); Ignatia (from grief); Coffea (from joy, with wakefulness); Chamomilla (from passion); Opi. or Verbascum (from fright or fear).
2. From Over-exertion- Arnica
3. From Congestion- Aconite, Belladonna
4. From Indigestion- Nux V., Pulsatilla
5. Nervous Palpitation- Mosch., Spigelia, Belladonna, Aconite Cact., Arsenicum, Thyroidin (especially in those subject to enlarged thyroid glands). See Leading Indications, further on.
In the Table on opposite page, abridged from Aitken, the chief characteristics of Palpitation from structural disease of the heart are placed in contrast with those from functional disorder.
Aconitum- Palpitation from the least excitement with anxiety, chilliness, numbness of the extremities, or a sensation as if the heart ceased to beat; short, hurried breathing; hot, flushed face. It is specially adapted to plethoric patients.
Belladonna- Oppression, tremor, pain about the heart; throbbing in the neck and head; redness of the face.
Digitalis- Great irregularity, without any assignable cause, with inability to walk or lie down great distress. One to three drops of the strong tincture every two or three hours.
TABLE OF THE CHIEF DIFFERENCES BETWEEN ORGANIC AND FUNCTIONAL DISEASE OF THE HEART.
1. Palpitation usually comes on slowly and insidiously. 2. Palpitation, or distressed action, though more marked at one time than another, is constant.
3. Percussion elicits increased extent and degree of dullness in the region of the heart.
4. Lividity of the lips and cheeks, congested countenance, and Anasarca of the lower extremities, are often present. 5. The action of the heart is not necessarily quickened.
6. Palpitation often not much complained of by the patient, but occasionally attended with severe pain extending to the left shoulder and arm. (See Angina Pectoris).
7. Palpitation is increased by exercise, stimulants, and tonics, but is relieved by rest.
8. Is more common in the male than the female.
1. Palpitation generally sets in suddenly.
2. Palpitation is not constant, having perfect intermissions.
3. dullness in the region of the heart is not extended beyond the natural limits.
4. There is no lividity of the lips and cheeks, countenance often chlorotic, and, except in extreme cases, there is no Anasarca.
5. The action of the heart is generally quickened.
6. Palpitation much complained of by the patient, often with pain in the left side.
7. Palpitation is increased by sedentary occupations, but relieved by moderate exercise.
8. Is more common in the female than the male.
Pulsatilla- Hysterical symptoms and in females suffering from deranged period.
Administration- During a sudden attack, a dose should be administered immediately, and repeated every thirty to sixty minutes; afterwards, twice daily for a few days.
ACCESSORY MEASURES- The patient must avoid mental excitement, stimulants, coffee, sleeping-draughts, indigestible food, etc. Pure air; cold water, used internally and externally; regular, moderate exercise in the open air, short of inducing fatigue; a contented and tranquil disposition, with light and nourishing diet, are excellent auxiliaries in the treatment of this affection.
101. Intermittent Pulse.
This variety of irregularity of the heart’s action requires a distinctive notice. By the term intermittency is meant an absolute loss of the normal beats of the pulse, covering the time of a natural stroke, or in extreme instances, of two, three, or even more pulsations. The impulse of the ventricle to contract is derived from the auricle and transmitted by a special muscular structure. When this structure is affected by disease contractile impulses are not transmitted regularly. Sometimes the auricle will contract three or four times while the ventricle only contracts once, and various irregularities of rhythm may be set up. Intermittency is not always a sign of gross organic disease however, though probably it always denotes a fault in this mechanism of conduction.
The pulsation following the intermission is heavier and fuller, showing that the ventricle is contracting on an extra volume of blood after the momentary pause, like a smith, who, striking at the forge a number of strokes in regular succession, until tired of the action, changes it for a moment to give a more deliberate blow, and then rings on again in regular time.
CAUSE- Emotional and nervous states are very liable to act as determining causes. D. W. B. Richardson says- Grief from the death of friends; shock from failures of business; disappointments; violent outbursts of passion; remorse, degradation; and, most fruitful cause of all in this madly striving age, overwork of brain these are the outside influences leading to the changes on which the phenomenon of intermittency of the pulse most frequently depends.
TREATMENT- We fully concur in Dr. Richardson’s recommendation of change, sufficient rest and sleep. and the avoidance of excitement and stimulants; but our Materia Medica supplies us with remedies such as Digitalis, Phosphorus, Nux V., Ac-Phosphorus, Aconite, Belladonna, Spigelia which are greatly superior to his depletive measures, purgatives and opiates.
DEFINITION- A Tumour formed by the dilatation of an artery, or communicating with an artery, and containing blood. In its first stage the Tumour contains fluid blood and pulsates; in its second stage, it contains coagulated blood, deposited in numerous thin layers like the leaves of a book.
Aneurism may be idiopathic or traumatic the latter is caused by an injury to the artery. The disease is more common in men than in women, and causes several hundred deaths in England annually.
VARIETIES- The fusiform (spindle-shaped), sometimes called true Aneurism, consists of an unnatural dilatation of an artery; sacculated Aneurism is a partial dilatation of all the coats of an artery; and diffused implies a sac formed by the surrounding tissues. The last variety has been mistaken for a purulent sac, and opened accordingly, to the imminent peril of the patient.
TREATMENT- An Aneurism often requires surgical measures. Cases beyond the province of surgery are generally much benefited by Aconite, or Ver-Vir. They prevent arterial excitement, and remove all excuse for abstraction of blood. The disease is dependent on weakening of the arterial wall as a result of degeneration of the tissues. The drugs that tend to produce a similar arterial condition are Baryta, Lead, Adrenalin, and probably Lycopodium. Consequently one or other of them may be useful in treating Aneurism.
Arnica- This remedy may be alternated with Aconite in traumatic Aneurism.
Phosphorus- Is useful in idiopathic cases to prevent further arterial degeneration.
ACCESSORY MEANS- Rest in a recumbent posture, and a light unstimulating diet, are favourable adjuncts to the treatment; indeed, the beneficial results of recumbency are most remarkable.
103. Phlebitis Inflammation of the Veins.
Two varieties exist of this not very common disease
(a) Adhesive, generally arising from exposure to wet and cold, and affecting one of the large veins of the lower extremities.
(b) Suppurative, which is a more serious form, frequently an aggravation of the adhesive variety, and sometimes caused by a wound or abscess.
Phlegmasia dolens (Milk-leg or White-leg) is an Inflammation of the veins and lymphatics, peculiar to nursing women, presenting symptoms and requiring treatment similar to Phlebitis.
SYMPTOMS- If the affected vein is near the surface, it appears reddish-purple; it is hard, swollen, and knobbed; severe pains may dart through the limb, especially on movement, and there is stiffness, with more or less oedema of the part. If Suppuration occur, it may be by means of an Abscess; or it may remain under the surface, producing purulent infection. Professional treatment is absolutely necessary for this form of the disease.
EPITOME OF TREATMENT- Aconite (febrile disturbance); Hamamelis (with varices); Pulsatilla (with disordered menstruation), Phosphorus, Lachesis
ACCESSORY MEASURES- Rest fomentations of warm water; Aconite lotion if there be much pain; Hamamelis lotion (see next Section) if the veins are varicose. In acute cases the diet should be light and limited.
104. Varicose Veins (Varices).
DEFINITION- A condition in which the veins are dilated, so that their valves, which cannot undergo a corresponding enlargement, cease to be efficient.
This disease occurs most frequently in the superficial veins of the lower extremities, and not usually in the deep-seated ones, because they are supported by the muscles and fasciae. When the veins of the spermatic cord are involved, the disease is called Varicocele; when those of the anus it constitutes a form of Haemorrhoids.
SYMPTOMS- The affected veins are dilated, tortuous, knotted, of a dull leaden or purplish-blue colour, with much discoloration of the parts, and some oedema of the limb. If a great many small cutaneous veins are alone affected, they present the appearance of a close network. The enlarged veins and local swellings diminish after taking the horizontal posture.
CAUSES- Generally, conditions which induce more or less permanent distention of the veins. Strains, or over-exertions of a part, may cause an afflux of blood into them and lead to their distension; standing occupations favour the gravitation of blood to the lower extremities; and further, the length of a vein, such as the internal saphena, may lead to its undue distension in consequence of the long column of blood it contains. Obstacles to the return of venous blood, such as tight garters or strays, a Tumour, the pregnant uterus, or even impacted faeces, by pressing upon one of the large venous trunks, may occasion its permanent distention as well as that of its branches. In other instances, Varices seem to be due to an hereditary predisposition, altered condition of the blood, or deficiency of tone in the active organs of circulation, leading to an enfeebled and relaxed condition of the walls of the veins.
CONSEQUENCES- (1) Severe aching pain, with a sense of weight and fatigue, especially after long walking, or remaining for some time standing in one posture. (2) The vein may burst by injury, and occasion severe and dangerous Haemorrhage. (3) Ulcers may arise from the imperfect circulation and nutrition of the skin, usually on the lower part of the outside of the leg. (4) They incapacitate for hard or long-continued work, being usually associated with constitutional debility.
EPITOME OF TREATMENT-
1. Simple Varices- Hamamelis, Pulsatilla, Silicea, Ac-Fluor.
2. Associated with other disorders- Nux V. and Sulph. in alternation (Constipation, Piles etc.); Arsenicum, (debility, burning pains, varicose Ulcers of the legs, etc.); Ac-Nit. (weekly and tubercular patients); Aconite or Belladonna (painful inflammatory symptoms); Apis (oedema, and erysipelatoid redness).
Hamamelis Virg., administered internally, and applied as a lotion externally a compress covered with oil silk, and a well applied bandage is often specific. Lotion. One part of the strong tincture to six parts of water. A lotion of Clematis tincture of the same strength is often even more useful.
ACCESSORY MEANS- Moderate compression by accurately fitted bandages or laced stockings, so as to afford that support to the blood which the valves can no longer give, and to prevent increased distension. The pressure should be very gentle and uniform, and be applied in the morning, before the patient puts his feet to the floor, and maintained until he retires to bed. Should only a small portion of a vein be enlarged, a piece of strapping-plaster may afford the requisite support. Prolonged exercise or standing should be abstained from, and, after taking moderate exercise, the limb should be raised, and maintained in a horizontal posture. Standing is more favourable than walking. The leg should be well washed, and rubbed quite dry, every morning.
Varicose Ulcers- Their treatment is the same as that of ulcers generally, with the exception of the following directions Should a Varix burst, excessive Haemorrhage may suddenly take place, inducing fainting, or even death.
18 The patient should be immediately placed flat on the floor and the leg raised, when the Haemorrhage generally ceases. A compress and bandage should then be applied to prevent subsequent bleeding. Excoriations or tender spots about varicose veins should have early attention, to obviate the formation of ulcers. See Section on Ulcers.