Dr. Fortier Bernoville to-day completes a series of lectures on the drainage of the circulatory system by the study of principal tonicardiacs. The most important point to note that the remedies described are no more Homoeopathic than Allopathic. They act before all in a physiological manner. Neither they act according to the law of similars nor according to the law of contraries. They act according to the law of equilibrium, added to the law of similars. They are much more palliatives and some physiological agents than remedies proper. These medicines are used in ponderable doses. They are used in Homoeopathic doses only when the law of equilibrium becomes related to the law of similars. They are used more to give relief to the patient than to cure. But they are of such practical importance that one should know fundamentally their physiopathology and their clinical indications. All these remedies are of vegetable origin.
Digitalis purpurea. It is according to the opinions of all, the king of tonicardiacs in chronic affections of the heart in opposition to Ouabine the most important remedy of acute heart conditions. Side by side with Digitalis purpurea there are other varieties of Digitalis but Digitalis purpurea is well known and more used.
1. Physiological action of Digitalis:
Two principal actions: Tonicardiac and secondarily diuretic. (a) Tonicardiac action: Digitalis in ponderable and sufficient doses cause bradycardia, action on the bundle of intracardiac conduction of Hiss and on the pneumogastric (intra and extra cardiac action).
The second important fact. Digitalis prolongs diastole. Thus the myocardia has more time to rest between the systoles, the ventricles are filled up and are emptied completely and if there is arrhythmia, the rhythm is regularised.
The third important fact. Digitalis acts specially on the right heart.
Given by mouth its action begins after 10 to 11 hours. The action is more clear in physiological doses if the patient is asystolic.
(b) Diuretic action: It is a result of tonicardiac action of the remedy. However, it has a direct action on the kidney by slight vaso-dilatation.
2. Toxicology of Digitalis
Since longtime the heart specialists have noted that when one goes beyond the useful dose of digitalis specially in some sensitive subjects there is produced: tachycardia with tachyrhythmia. Some extra-systole with bi-or trigemination and auriculo-ventricular blockage. The patient is pale, cyanotic, has low temperature, vomiting and diarrhoea. His liver is big. He has oliguria and anuria.
3. Action and indications of digitalis in homoeopathic doses Of all the tonicardiacs, which act very often according to the law of similars, is Digitalis. We must know that in homoeopathic doses, Digitalis has four important symptoms of its action from the point of view of four clinical Homoeopathic indications of the remedy.
(a) Tendency to oedema. Almost always with oliguria. More or less marked oedema, anasarca, ascites or slight oedema of the malleoles or of the lower eye lids. It is the tendency of oedema which clearly distinguishes Digitalis from Eel Serum in which there is oliguria or anuria without oedema.
(b) Action on the liver: A big liver, accordion liver which also indicates Digitalis, China and Phosphorus.
(c) Bradyarrhythmia: With bigeminal or trigeminal pulse. In grave cases alternate pulse.
(d) A subjective symptom of great value: Sensation: The patient thinks that he must remain immobile, if not, the heart will stop by the least movement. In Digitalis arrhythmia is clearly ameliorated by immobility. These symptoms are inverse of Gelsemium in which the patient thinks that his heart will stop if he does not move. Gelsemium is a remedy of less grave state than Digitalis and it is rather a remedy of palpitations with erethism of the heart, often with erethism of the heart after the abuse of tobacco or after a stay in a hot country.
Method of application of Digitalis and clinical dose of Digitalis Digitalis is a heroic remedy of asystole in chronic cardiac patients. It is used in various doses according to the different preparations. Digitoxin 5 drops during 5 to 10 days or 15 to 20 drops for several days. In tincture homoeopathically prepared with the fresh plant growing in the mountains (plants that grow in plains are less active), finally in the form of maceration or infusion of the leaves.
We must know that a gramme of powdered leaves of Digitalis is equal to 100 drops of Homoeopathic tincture and to 50 drops of Digitalis in 1,000 th. However, the maceration of leaves contains the property of the entire plant and is more active than digitalis (one will give for example 75 centigrams of the macerated powder of the leaves to be absorbed during 48 to 72 hours).
Of all the tonicardiacs it is Digitalis which in homoeopathic doses is interesting. Among the Homoeopathic doses one should distinguish between 3x and 6x for example where the action of Digitalis is very similar to that of gross doses and the centesimal 6,30,200 which are used according to special clinical indications which we have already described. The 3x or 6x will be given as palliative in chronic cardiac patients whose hearts are somewhat decompensed or in persons having myocardia due to fatigue of old age or senility. These dilutions may be continued for a longtime. The patient does not become habituated to these dilutions and at the same time one may get favourable action while at the same time the ground remedies are used: Phosphorus, Psorinum, Carbo vegetabilis, Lachesis, Naja, etc… On the contrary one must know how to use Digitalis 30 or 200 in Cardiac liver, portal congestion, prostatic congestion.
Let us finally note that the ground remedy of Digitalis is Phosphorous.
Strophanthus and Ouabain. The Strophanthus differ from Digitalis in the following manners
1. Predominance of asystole on the left heart which explains that its ground remedy is Sulphur (Strophanthus would be an old Sulphur who had at first hypertrophied heart, then the heart has become dilated specially on the surface of the left cavitus).
2. By the predominance of tachycardia instead of bradyarrhythmia of Digitalis.
3. By its systolic action and not diastolic (Strophanthus slows down the pulse less than Digitalis)
4. By its less toxic effect, it produces less easily extrasystole and blockage.
5. Its more rapid and ephemeral action. Strophanthus has also a diuretic action.
Strophanthus gives good services in hyposystole of the left heart with hypertension in cardiac asthma, and cardio-vascular insufficiency. It is used in Homoeopathic tincture or in official tincture or in 1x to 3x dilutions.
Ouabain has such an importance here that the alkaloid become more important and goes much further than the plant itself. In cardiology Ouabain is more used than Strophanthus.
The important indication of Ouabain is the acute asystole and the insufficiency of the entire heart, right or left. It is to be applied intravenously in classic doses: 1/4 ml. and sometimes 1 mlg in 24 hours. Its action is almost immediate and becomes apparent within a few minutes by an amelioration of the dyspnoea and oedema of the lungs. When Ouabain does not act the prognosis is grave. Secondarily Ouabain may have other indications: Progressive insufficiency of the right heart after mitral lesion. Generally let us keep in mind that when it is necessary to act soon use first Ouabain and then Digitalis. Let us also keep in mind that hypertension is not a counter- indication. Let us also know that Ouabain is not used when the patient is saturated with digitalis. Some time must elapse. In the case of embolism one must be prudent to use Ouabain or digitalis.
The tonicardiacs will have their full effect if the patient is not kept immobile and kept on a strict vegetarian and fruit diet, diminishing the mechanical action of the heart.
Let us now consider three more remedies of less importance which are successors of Digitalis:
Crataegus: The indications of Crataegus are very different from those of Digitalis. It is a mild tonicardiac, having slow but sure action and it is non-diuretic. It acts more on the left heart and is indicated in tachycardia and in tachycardia and in tachyarrhythmia. It is at the sametime an interesting nerve sedative having a marked action on the extra-cardiac nervous system acting well on cardiac erethism and extrasystolic palpitations of the nervous persons. It is an excellent remedy of arterial hypertension and arteriosclerosis. It is to be used in 1x to 3x where it seems to act better in high dilutions. A curious fact is that it acts as well in hypotension and increases the blood pressure as in hypertension and decreases the blood pressure. With Hamamelis it acts favourably as a drainer of aerocyanosis. In hypertension it may be associated with Passiflora or Valeriana.
Adonis vernalis. It is more related to Digitalis. It has a weak tonicardiac and diuretic action. Like digitalis, it acts rather on the right heart. Adonis is less toxic and is easily tolerated. It is used in physiological doses or homoeopathically in lower dilutions 1x or 3x in persons suffering from mitrals and in whom Digitalis is stopped from time to time or in persons having hypertrophied heart losing tonus.
Convallaria. It is a palliative, weaker than Adonis. It acts rather on the right heart. It is strongly diuretic, sedative and anti-spasmodic. An important subjective symptom is that the patient has the sensation that the heart stops suddenly and suddenly starts again. The classic dose is 20, 30, 40 drops or in Homoeopathic doses of 1x or 3x.
Let us now study a group of remedies that may be called remedies of collapse. They are Camphor, Adrenalin, Ammonia acetate and Veratrine. They are heterogenous but all of them are remedies of acute cardiac weakness, therefore, related to Ouabain.
Camphor is the most important of this group. It is a stimulant of the heart and of the nervous system and a pulmonary vaso-dilator. Its action is rapid but short lasting. In physiological doses it acts on the weakness of myocardia specially in infectious diseases. It is admitted that Camphor antidotes many Homoeopathic remedies. Besides its action in physiological doses we must also know its action in Homoeopathic doses: 3,6,30 and even in 200. It is a remedy of Collapse with sensation of coldness, in a word an acute Carbo vegetabilis. The patient is suddenly taken by an intense coldness of the whole body-external or internal. The whole body is cold to touch. It is possible that the oil of camphor is more important when there is the sensation of coldness.
Adrenalin is less used in Homoeopathic doses in heart conditions. It causes intoxication very rapidly. It is a sympathetic stimulant which causes a peripheric constriction with increase of arterial tension but is action is short lasting. It is interesting to use it in small doses in slight cardio-vascular weakness in course of an infectious disease.
Let us finally note that Adrenalin used intravenously and intracardiaclly and is sometimes a heroic remedy of grave cardiac collapse.
Acetate of ammonia. A classic remedy in Allopathy in course of broncho-pulmonary affections. But it is not of very great importance. In Homoeopathic doses, it has on the contrary, an unquestionable action in persons who have lipothymias and who are at the same time some renal patients proceeding towards uremia.
Veratrine. Experimentally studied by Jarricot has given in Homoeopathic doses some interesting results to Dr. Bernoville in cases of arrhythmia (Veratrine 200 or M, alternated with Phosphorus).
Veratrum album and Veratrum viride will be equally interesting in the cases of collapse.
Now we arrive at a group composed of three medicines: Glonoin or Trinitrine, Cafein and Spartein.
Glonoin. It is not a tonicardiac, but it is a remedy to be indicated here. It has two important actions: A physiological action in ponderable doses in the case of anger (it is a terrible vaso-dilator, having immediate effect but the effect is ephemeral).
An action according to the law of similars in Homoeopathic doses. Glonoin is the most important remedy of congestive headaches in persons suffering from hypertension, specially in women of Lachesis type and of sulphur type during menopause.
Occipital headache with throbbing sensation in the whole body, having a sensation that the blood is draining into the head. Aggravation of headache while lying down.
Amyl nitrosum in 3x is besides an excellent drainer and circulatory regulator in women who have arrived at their menopausal age of the type of Lachesis, Sulphur and Glonoin, Cimicifuga and Sanguinaria form with the preceding remedies a group of principal remedies of menopause.
Cafein. It is not used by some practitioners. But in reality here it would be considered as an interesting remedy. In physiological doses it has a tonicardiac action; it is also a vaso-dilator of the coronaries according to some authors, and has also a diuretic action. In fact, it would be useful in the degeneration of the myocardia. In Homoeopathic doses it is a remedy of insomnia hyperideation and euphoria.
Spartein. Its action is inconstant. It is used conjointly with other tonicardiacs. Its physiological action is seen in the slight increase of the intensity of the cardiac contractions, a regulation of the rhythm without the increase of tension or diuresis.
Clinical indications. Slight insufficiency of the myocardia in old and obese persons.
Two Homoeopathic remedies studied in the last lecture.
Cereus bonaplandii. In 3x it is a drainage remedy of hypertension.
Pencedanum 3x or 30. It is used by Dr. Nebel in some cases where there are at the sametime cardiac troubles, aerophagia, duodenal troubles and functional troubles of the kidneys.
We have already studied the action of Quinine and Quinidin. In physiological does one is well aware of their actions since the age of electrocardiogram: Auricular fibrillation and complete arrhythmia. There are cases where Quinine and Quinidin act when the other tonicardiacs are counter indicated by E.C.G. When using in Homoeopathic doses one should remember their most important indications: It is in hyperthyroidism and Basedow’s disease. In these cases this remedy is used in 3x, 6x, or 30 and 200. Sometimes mixing the dilutions and preferably applied in the morning before taking and food. It has a marvellous action in tachycardia and tachyarrhythmia.
Let us now speak something about the actions of gland extracts in cardiology and let us conclude by saying a few words about the important ground remedies in cardio-vascular pathology.
The gland extracts are: extract of Myocardia and of Kidney are of the Kidney are of the first importance and Liver extract and Thyroid extract and Thyroid extract are of the second importance.
Extract of myocardia. It may be used in physiological or Homoeopathic doses. In physiological doses its action is controversial. Dr. Bernoville uses it in hot injectable doses with good results. He has seen in a patient suffering from anuria due to cardio-renal trouble, the urine increases from 200 to 800 to 1000 grams within 24 hours. The great inconveniency is that the patient becomes agitated and goes towards Arsenic and Ignatia.
In Homoeopathic doses Dr. Bernoville and Barishac have got good results by a mixture of dilutions 3x (trit) or 6x (trit) and 200.
Same experience with Renal extract.
These two extracts in Homoeopathic doses are very good adjuvants. But one curious fact is that their actions are sometimes quite the opposite in the sense that the extract of Myocardia acts better on the diuresis and Renal extract on the heart. Dr. Bernoville generally prescribes 3x/200 a pinch while waking up in the morning and Kidney 3x/200 while going to sleep.
Liver extract. Sometimes it acts on the whole circulatory apparatus and on the diuresis. The injectable extract may be used in 3x/200.
Thyroid. Perhaps it may be used in cardiac erethism and in certain tachycardias every time when there is hyperthyroidism. Here again the mixture of dilutions 6x or M acts better.
Two essential notions are to be followed when using glandular extracts homoeopathically.
The importance and value of the stock and the preparation.
The possibility and even the interest of repeating high dilutions every day (which should not be done as regards ground remedies). Here it is a question of a remedy midway between actions according to the law of similars and physiological action.
The important ground remedies to be used in cardiopathy may be schematised in the following manner.
Digitalis is, we have seen related to Phosphorus (Asystole of the right heart).
Strophanthus and Crataegus are rather related to Sulphur (Weakness of the left ‘heart); Kali carb and Apis are remedies of oedema, Baryta carbonicum, Aurum and Plumbum are remedies of sclerosis and pre-asystolic patients.
In asystole of the right heart, it is not so much the question of a person having Oedema, as of a patient having dyspnoea and a big liver with congestion of the bases. In such a case we must know how to distinguish between Phosphorous and Arsenic. Phosphorous is more frequently indicated. One is often led to prescribe Phosphorous 200 one dose, Antim tart 6, Arsenicum 6 alternated every one or two hours with digitalis (maceration); on cardiac liver one should consider the action of digitalis in 30 and 200.
In grave failing of the heart besides Ouabain one should think of Carbo vegetabilis 30, 200, M. This remedy is to be used in high dilutions. We must also think of Cuprum, Veratrum album, Ammonium carbonicum, Camphor, Oil of camphor (cyanosis) as well as of Opium, (evolution towards uremia.)
In circulatory troubles of menopause Lachesis should be placed on the top with Glonoin 6 or 30 (or the two at the same time). Amyl nitrate and Cereus bonaplandii. When Glonoin does not act one may think of Usnea barbata or Sanguinaria (gushes of heat). From Lachesis (ovarian insufficiency), the patient will pass towards Phosphorous, Cholesterinum and Lutein (hypercholesterinemia). Lachesis, Graphites and Sulphur in high dilutions followed by Graphites 30, Kali carbonicum 30 and Senecio 30 may regularise painful menstruation, with Ovarian or Folliculin extracts in ponderable doses. On the contrary in metrorrhagia one must use Folliculin in Homoeopathic doses 30, 200 with Sabina, China, Fraxinus, etc…
The scheme of Dr. Bernoville summarises clearly the fundamentals of this important and interesting lecture.
REMEDIES OF THE RESPIRATORY SYSTEM
In this first lecture on the drainage of the Respiratory system Dr. Bernoville will speak on the generalities. In the three following lectures Dr. Bernoville will study completely the remedies of drainage of the Respiratory system.
To-day Dr. Bernoville enlightens us about how to understand the drainage of the respiratory system which is quite different from the drainage of the other apparatuses of the organism.
After having recalled here the classification of human types of Sigaud and the morphologists into four basic temperaments, and physiopathological classification of Dr. Allendy based on the tonicity and the plasticity of the organism, the lecturer compares the respiratory system considered in relation to its aerian milieu, with the digestive system, which is a way to drainage, a way to quantitative drainage, with urinary apparatus which is a way to qualitative as well as quantitative drainage, the digestive system and the renal ways being the most important for elimination and finally the passage through the skin, the surface zone between man and his exterior milieu, which is an accessory way, but very interesting for derivation. The respiratory system as a way of elimination is less important than the four others, but it is more subtle. It should be considered from the energetic point of view and only secondarily as a local way of elimination by the help of expectoration. On the whole, on the respiratory system one should do drainage for derivation more than direct drainage.
Physiology teaches us that air inspirated contains Oxygen and Nitrogen, some Hydrogen, some rare gases, a small quantity of Ozone and a small quantity of Carbonic acid (4.01 Percent instead of 0.1 Percent in inspirated air) and more water vapour. In the inspirated air one should take into consideration the purity of the air or on the contrary the impurity by dust or micro-organism and in the expirated air the possibility of rejection of some chemical products in gaseous form, and caloric elimination. Thus the respiratory system is as well centripetal as centrifugal. The quality of expirated air plays an important part in the treatment of the diseases of the respiratory system and also of respiratory rhythm. The drainage of the respiratory system, therefore, aims at the establishment of the normal physiological balance. One will often use some medicines which have not so much an action on the nose, larynx, bronchuses or lungs than action on the bulbar centres, on the pneumogastric or sympathetic systems.
Let us deal schematically the states of hypersphyxia, then hyposphyxia and asphyxia in relation to our important remedies of temperament.
1. Hypersphyxia. It is the question for example to check in tubercular patient who has cavity in evolution the forge-like respiration. Practically in such a case one should take recourse to all sorts of collapsotherapy: Pneumothorax, phrenicecotomy and even thoroplasty.
In homoeopathy we have a remedy that should be indicated in hypersphyxia. If one intoxicates a subject with Phosphorous, one causes a exaggerated combustion in him, literally one “burns” him. Phosphorous, one knows, is the greatest reducer of all bodies by oxygen created by it. And it is, therefore, a fact on which there is the necessity to insist. Here the law of similars is not applicable. Phosphorous is a marvellous remedy but it should never be used in cases of tuberculosis or in laryngial tuberculosis specially in high dilutions because it may cause dangerous aggravation and to produce pulmonary incendiary transforming sclerous tuberculosis into tuberculosis with cavity. The Oxygenotherapy will cause the same thing. Asthma may be ameliorated by oxygen or by ozone manipulated carefully, because asthma is a state of hyposphyxia, but we must also know that a sclerous asthmatic patient may become tuberculous and a caseous tuberculous patient may become asthmatic after his cure.