The Use of Homoeopathic Remedies in Cardiac Pain-Pain which is apparently cardiac in origin and nature, may not in reality be due to cardiac conditions alone or even in part, since cardiac pain may be simulated by other clinical states; it is not, however, within the scope of this dissertation, to trespass upon endeavor to present in a purely practical manner the homoeopathic therapy of cardiac plain; the latter will therefore, be considered in a broad rather than in a narrow technical sense.
If we consult an index of homoeopathic provings, in other worse, if we turn to a reliable repertory of the materia medica, we find some seventy-six remedies which are alleged to have produced cardiac pain: of these nine have the symptom “pain in the heart.” in the highest degree; they are as follows: ACON., APIS, CACTUS, CEREUS BON, KALMIA, LITHIUM, PULS, RHUS TOX & SPIG. Thirty-four have the symptom in a lesser degree and need not be here enumerated; the rest, thirty-three in number, are credited with the symptom, but in the lowest degree.
Even if we eliminate these thirty-three remedies from consideration altogether, we still have forty-three remedies likely to be of service in the relief of cardiac pain. The busy physician, in the active, daily routine of his work,is unlikely and perhaps can hardly be expected, to keep the indications for these forty-three remedies in mind., Neither can he draw fine differentiations by consulting his repertory, for as a rule, there is neither time nor opportunity for him to do so. He may, therefore, be perhaps excused, if he resorts to measures unhomoeopathic in character. This is in fact, just what many homoeopathic physicians do and the non-homoeopathic remedies employed, vary from those frankly physiologic in character, to the ever-alluring combination tablet of our own homoeopathic pharmacies.
We do not here presume to criticize this departure from the strict Hahnemannian path, neither do we question the justification for the use of physiologic remedies so-called, upon occasion. We realize that there are occasions when the law of similars does not apply, such for example, when a lack of reaction must be resorted to. Under such circumstances cardiac pain may and is indeed, likely to be a factor.
Nevertheless, there is an important sphere of action for the purely homoeopathic remedy, if we will only seek a closer acquaintance with the latter and study more intimately, its characteristics. Hence let us glance at the indications for the nine remedies already mentioned as prominent, in the therapy of cardiac pain.
Aconite presents the symptom, “Intense pains (cardiac) in all directions, especially down the left arm, with numbness and tingling; anxiety, fear of death, coldness, cold sweat, feeble pulse.” This complex is of course suggestive of angina pectoris. Stitches in the heart region are likewise found, but it is the typical Aconite restlessness and fear which all our attention to the remedy. The pains of endo or of pericarditis come within its range.
Under Apis mellifica we find, “Much pain about region of heart, with sense of fluctuation when turning on her side.” The symptom is credited to the clinical condition of hydrothorax. We also find “sudden attack of acute pain just below the heart, soon extending diagonally towards the right chest”; likewise “several stitch-like pains just below the heart.”
Concomitant symptoms such as, “great anguish,restlessness; feels as if each breath would be the last” are characteristic and likely to the present. But no homoeopath would think of Apis in its relation to Cardiac pain unless he had a typical Apis case in general,which means, one of nephritis, hydrothorax or of erysipelas, rheumatism or pleurisy. The general indications for Apis must be present.
Cactus was long ago thrown out of the official list of accepted remedies by our friends of the orthodox persuasion. We more simple-minded homoeopaths persist in looking favorably upon it. Bastedo. Cushny and Wilcox, do not mention the drug at all. Certain proprietary pharmaceutical firms exploit it as of great value. Homoeopathically, in the light of its provings, we find, “SENSATION OF CONSTRICTION IN THE HEART, AS IF AN IRON BAND PREVENTED ITS NORMAL MOVEMENT”.
This symptom has been variously expressed and interpreted; clinically,it is unquestionably dependable and has many times been verified. Presumably the remedy is palliative in angina and in cardio-vascular conditions in general. Severe palpitation of the heart is frequently present, occurs both day and night and is aggravated by lying on the left side. Acute stitching pains in the heart area also occur, causing the patient to cry out and obstructing respiration.
Violent irregular beating if the heart is noted, also sensations of pressure and heaviness in the cardiac region. Stauffer, in his most excellent “Homoopathische Arzneimittellehre,” speaks of its use in valvular disease of the heart, endocarditis, pericarditis, disturbances of compensation, such as dilatation and hypertrophy. Angina pectoris with dyspnoea. Basedows Disease. Certain it is, that cactus does play an important part in homoeopathic therapy and we would be badly off without it.
Of cereus bonplandii we know comparatively little; it is a member of the Cactus family and might, therefore,be expected to produce similar symptoms. Allens Encyclopedia, volume III, gives a proving of it by Dr.John H.Fitch of New Scotland, N.Y., who in 1892 presented a proving to the International Hahnemannian Association. The I.H.A. transactions for 1892 contain the pathogenesis of this drug. In Allens presentation of the proving we find, characteristically marked, “PAIN AT HEART.” Convulsive, agonizing cardiac pains are spoken of, also a sensation as though a great stone lay upon the heart. Symptoms are worse at night and from the pressure of the clothing. Clarke, in his “Dictionary of Materia Medica,” gives the modality, “Heart symptoms worse lying on left side.” This we have more than once verified clinically and know that it is dependable.
Kalmia latifolia, finds of course, no place in Old School Medicine, but homoeopathic physicians appreciate its usefulness and think of it more particularly when rheumatism, by metastasis, affects the heart. Wandering pains are spoken of,in the cardiac area, extending down the left arm; also shooting pains, extending down the left arm; also shooting pains, extending through the body to the scapula, by the “Guiding Symptoms” of Hering; the proving as presented by Allen, says nothing at all about cardiac pain, but does not as characteristic, “PALPITATION OF THE HEART,” fluttering of the heart and slow pulse, even as slow as forty beats per minute.
Stauffer speaks of severe sharp cardiac pains, and notes and value of Kalmia in hypertrophy of the heart with disturbed compensation. He like wise mentions a rapid, weak and intermittent pulse, a system which should not be forgotten, in view of the fact that we look upon this remedy as having characteristically a slow pulse.
Lithium carbonate usually the carbonate, has produced in its proving a pain in the heart, even a violent pain in the heart and sometimes a sudden jerk or shock in the heart. The remedy is to be thought of in metastasis of gout to the heart, especially when there have been tophi and gouty pains in the small joints of the hands and feet. Farrington speaks o rheumatic soreness and valvular deposits of the heart. Certain it is, that this remedy is deserving of study and development.
Pulsatilla, that fickle, gentle, yielding little wind- flower, would scarcely be credited with the capability of producing cardiac pain; yet the proving says otherwise, for we read “Catching pain in the region of the heart, subdued for the time by pressure of the hand.” “Dull stitches and constant pressure in the praecordial region, with anxiety that impedes respiration; relieved by walking.”Palpitation, anxiety, etc. Kent gives, palpitation of the heart, worse when lying on the left side; this is of course, similar to Natrum mur, Phosphorus, Cactus and some other remedies. It takes a Pulsatilla patient to make us think of this remedy in cardiac conditions; we do know that it affects the right side of the heart and the venous system in general and that it is unlikely to be of much curative value in actual organic cardiac lesions. Anaemia is more apt to be its sphere.
We all believe and think we know, that Rhus tox. is useful in cardiac pain, more particularly in cardiac disease the result of rheumatic fever; yet the original provings give very little symptomatology with emphasis upon cardiac pain. “Palpitation so violent while sitting still, that the body moved with every pulse” is found in Allen, and “some violent, pulsating stitches above the praecordial region,” are spoken of. The latter symptom was noted by Hahnemann himself, in himself, in his “Materia Medica Pura” and is numbered symptom 540. The “Guiding Symptoms” speaks of “Stitches in the heart with painful lameness and numbness of the left arm,” likewise “ORGANIC DISEASES OF HEART, WITH STICKING PAIN AND SORENESS; NUMBNESS AND LAMENESS OF LEFT ARM,” “MYALGIA CORDIS”.
These of course, are statements resting largely upon clinical observation and we must be careful not to place too great an emphasis upon them. As with Pulsatilla, if we have a real Rhus tox. patient, the remedy will do much good in cardiac disease with pain; but not otherwise. We cannot prescribe for the pain alone, per se. Hypertrophy of the heart, the result of prolonged exertion, undoubtedly belongs to Rhus tox. and under the circumstances we would expect pain, extending down the left arm, but the condition is one, for reasons obvious,not to be found in a proving.
Spigelia is a wonderfully effective remedy in neuralgic and in cardiac disease; so far as the latter is concerned, we think of Spigelia in endocarditis,the result of rheumatism and clinically,we can all testify to its value yet the early provings say very little about cardiac pain, but do emphasize very decidedly, oppression, anxiety and palpitation of the heart. The “Materia Medica Pura” mentions many symptoms of stitches in the chest, not necessarily in the cardiac area or always in the left side; yet one striking symptom is recorded, ” WHERE THE HEARTS BEAT IS FELT, ONLY SOME WHAT MORE EXTERNALLY, OBTUSE STITCHES RECURRING SYNCHRONOUSLY WITH THE PULSE.”
This to be sure, may be indicative of an intercostal neuralgia or perhaps, of an endo or a pericarditis. Clinically, we know that this is true. Experience at the bedside, with Spigelia, has shown that its cardiac pain is aggravated by lying upon the left side and compels the patient to lie upon the right side and in the least, the semi-recumbent position. These modalities have been frequently verified. In endocarditis, especially when acute, Spigelia is a most valuable and reliable remedy.
Of remedies pre-eminently cardiac in character, we have said nothing. Strophanthus, so far as homoeopathic provings are concerned shows little of actual pain symptoms. Among two or three other, Matthes and Gisevius proved the drug in the tincture, Gisevius taking as high as eighty drops. Matthes proving produced, “Distinct stitching and restlessness towards apex of heart, increased impulse with peculiar pulsation and twitching throughout body.” Gisevius noted, “Intense palpitation from comparatively slight exertion.” Stauffer in his “Homoopathische Arzneimittellehre” sums up the uses of Strophanthus very well and states:
Dosage, tincture to third potency.
Strengthens cardiac contractions
Acts as a diuretic
No cumulative action
Cardiac lesions, more of a chronic nature
Valvular lesions with arrythmia
Heart insufficiency and weakness
Nervous heart complaints particularly before examinations or public appearances.
Kidney diseases, chronic, with cardiac insufficiency and dropsy. From all of this it will be seen, that our homoeopathic use of Strophanthus is based upon its physiologic action as originally learned from old school sources. The homoeopathic profession has contributed very little to this knowledge.
Digitalis has of course, received homoeopathic provings and was proved by Hahnemann, assisted by Franz, Gross, Ruckert, Stapf and others. In the Hahnemannian proving, contained in the Materia Medica Pura, very few heart symptoms are recorded and almost none concerning cardiac pains;but in the Chronic Diseases we find evidence of cardiac distress and pain, mentioned under the symptoms of the chest and in the introduction to the remedy, in which its clinical uses are recited we find “Angina pectoris- palpitation of the heart-carditis-chronic endocarditis. Chronic and organic affections of the (principally left) heart and the large vessels, especially hypertrophy with or without enlargement of the left ventricle-affection of the valves. Aneurism of the aorta.” These of course, are simply clinical statements, based upon experience, but in no sense pathogenetic.
Allen, in the Encyclopaedia,devotes several pages to heart and related symptoms, especially those concerning the effect of Digitalis upon the pulse; he speaks of pain in the heart,though pain symptoms are not at all prominent. On the other hand, the characteristic symptom, “A SUDDEN SENSATION AS THOUGH THE HEART STOOD STILL, WITH GREAT ANXIETY,” is very strongly emphasized, also “Dull uneasiness in various parts of the region of the heart, with a sensation of weakness of the forearm, etc”.
Convallaria majalis, lily of the valley and Adonis vernalis, a popular heart remedy in Russia, in their meager pathogenesis show no cardiac pain symptoms. Undoubtedly, however, both these medicines have been beneficial in some cardiac diseases, but it is a debatable question whether any good effects produced by them have been due to their purely homoeopathic or to their physiologic action, more especially since these medicines are commonly used in appreciable does of the tincture, frequently repeated.
Thus Royal, in his “Homoeopathic Theory and Practice of Medicine,”? speaking of the dosage of Convallaria, states, “Give the second or third (potency) except for the purpose of energizing the heart (Italics ours), for which purpose give ten drops of the tincture.” Of adonis he says, “Use in give-drop doses of the tincture”.
From all of which it will be seen,that although many homoeopathic remedies are credited with symptoms of cardiac pain, very few are really prominent in the production of such pain and these few are not characteristically or exclusively,heart remedies. Nevertheless, so far as heart pain is concerned, we feel that the homoeopathic materia medica is rich in possible heart remedies and that, provided we will study these remedies, homoeopathic prescribers have a real advantage in the possession of so many likely medicines, which can best be applied with the symptom totality of the patient in mind. Even sodium chloride, when indicated by its symptom totality and prescribed for the patient, rather than for the patients disease, becomes a cardiac remedy of no mean importance and value.
Insulin Disappointments and Hopes_Under this caption the London Lancet says in part:
“Those who hoped that the administration of insulin to a. diabetic might lead to the cure of the underlying disease. are apparently to be disappointed,. As a result of. observations lasting from 11 to 18 months on give selected. cases of diabetes mellitus, no evidence has been obtained by Dr.G.A.Harrison of even a partial remission of the disease. The daily intake of carbohydrate, protein, fat, and calories remained fixed throughout. The dose of insulin was adjusted to the fixed diet according to the results of estimation of the blood-sugar content. All five patients needed as much or slightly more insulin at the end of the period of observation”.
We quote this merely to emphasize the fact, that however valuable insulin may be, it is nevertheless not a cure, but is to be looked upon in the light of substitutive medicine. The diabetic patient will still need to be put upon a suitable diet and so far as we homoeopaths are concerned, will need to be prescribed for as an individual.
There are no remedies for diabetes, but there are many remedies for patients who have diabetes; quite another matter. Cure remains, as it always has, an elusive thing and difficult to achieve.
Iodin and Goitre-In the London Lancet for “February 6th, the leading article by Sir James Berry, B.S., London: F.R.C.S., Eng., is entitled, “Some Clinical Aspects of Simple Goitre, with Remarks on its Causation.” In speaking of the varieties of goitre Sir James says:
“If we leave aside malignant disease, acute inflammation,. and certain of the rare forms of thyroid enlargement, we are left with two main varieties of goitre. The first is characterized by excess of the cellular elements of the gland and by diminution or absence of colloid. This is exophthalmic goitre in its various forms. It appears to be essentially a hypertrophy of the gland, although this is probably not the whole explanation of the condition.
“The second variety is that of simple endemic goitre, and the first point that I want to emphasize is, that simple endemic goitre is not a hypertrophy of the gland. It is essentially a degeneration. The enlargement of the gland in the earliest stages in which I have been able to observe it, consists primarily epithelial elements. In this respect it differs entirely from the goitre of Graves disease, in which, as mentioned above, the enlargement is due to an increase in the cellular elements of the gland. This misuse of the term hypertrophy as applied to simple goitre, is very widely spread in literature at the present day”.
Further on, in combating the prevalent idea that a lack of iodin is the cause of goitre, the author states:
The most convincing single proof of the baselessness of the lack of Iodine theory is afforded by what occurred in connexion with goitre at Sanawar in North India, investigated by Colonel McCarrison and fully reported by him in the British Medical journal of June 7th, 1924. At a large school in an institution at the place, where a high incidence of goitre had been present for many years,he found in 1913 that over 80 percent, of the children were affected. By his advice a new and pure water-supply was introduced in 1918. In 1922 goitre was reported to have disappeared from the school. In the autumn of 1923, when he revisited the school, the incidence of goitre was only 2.2 per cent., or no greater than the incidence of thyroid enlargement among school children residing in a non-goitrous district such as Delhi.
He was assured by the principal that no changes had been made in the food. Samples of the new water-supply were analysed by the chemical examiner to the Punjab Government, who reported that it contained no iodine. Not satisfied with this, Colonel McCarrison caused 25 gallons of water to be evaporated to dryness after the addition to it of sodium carbonate. The residue thus obtained was sent to the chemical examiner for estimation of its iodine content. He reported that it contained no iodine.
It was clear, therefore, that the disappearance of goitre was not due to an increased intake of iodine either by way of the new water-supply or of food. Surely this well-attested instance of endemic goitre, ended by the introduction of a water-supply devoid of iodine, should alone by enough to demolish the lack of iodine theory altogether”. And express his belief, based upon long observation, study and experience in many continental countries, as well as in England and Scotland, that the true cause of simple goitre is to be found in the presence of calcium in potable waters. In this connection he states:
“To my mind there is abundant evidence that the cause of endemic goitre is to be found in drinking water, and though I fully admit that the actual nature of the poison is not definitely proved, I am inclined to think that in the minute particles of inorganic mineral matter (probably calcareous), suspended in the water, we find, even if not the actual poison, at any rate an essential accompanying factor. when visiting various goitrous districts I have been struck by the frequency with which the disease occurs among people who habitually drink turbid waters, and time after time I have been told the same story-that in certain districts goitre has disappeared or has greatly diminished since the introduction of a new and better water-supply.
Undoubtedly much more attention is directed nowadays to the importance of the water-supply in connexion with endemic goitre, but whether the action taken in consequence is always wise is questionable. For instance, the adoption of the lack of iodine” theory by medical officers of health has led to the practice of adding iodine to public water-supplies both in America and Switzerland and also in this country. Whether this is a good method of administering iodine for the prevention or cure of goitre had led to much controversy both here and abroad.
Some advocate the alternative method of giving it in sweets or chocolate to school-children, or adding it to salt. this practice of the indiscriminate administration of iodine, though in may be suitable to places with high endemicity like many parts of Switzerland, is hardly necessary in England.
“I may refer to an excellent paper of the subject by Dr. James Wheatley, M.O.H. for Shropshire, who gives the preference to the iodisation of salt,l and to another by Sir Alexander Houston, Director of Water Examinations, Metropolitan Water Board. It is to be regretted that both these writers appear to accept fully the lack of iodine theory. There is at least some evidence that iodine poisoning may occur from the indiscriminate administration of iodine”.
His observation that iodin poisoning may occur from the indiscriminate administration of iodin is of course, highly significant and will find a responsive echo in the minds of homoeopathic physicians, who, as a result of their knowledge of the pathogenesis of iodin, know when and when not to give it. Finally, his conclusions will be of interest to physicians:
1.Simple endemic goitre is not a hypertrophy but essentially a degeneration of the thyroid gland. The gland is not over-active, but under-active.