SOME OBSERVATIONS OF HEART CONDITIONS. The heart is enclosed in a serous sac, the pericardium. It has four chambers, viz., a right and left ventricle and a right and left auricle. A partition of fibrous tissue, the septum, separates the right and left chambers. So well regulated is the heart that each chamber functions independently to a certain extent. Between the auricles and ventricles are valves or doors composed of strong membrane, the left side having two doors while the right has three.

What a wonderful organ is the heart! It starts to pulsate months before the child is born and continues throughout the life of the individual pausing to rest only between beats. In many individuals the heart never falters or scarcely misses a beat in the whole life span. Indeed a few persons live out their lives hardly knowing they have a heart, so well regulated are its functions.

The heart is wholly a muscular organ measuring 5 1/2 inches from base to apex, 3 1/2 inches across its broad surface, and 2 1/2 inches in thickness. In adult man it weighs about 11 ounces. It lies in the chest between the lungs and reaches up to the second rib. The upper part points upward and backward to the right; the lower part (apex) points downwards and outward to the left. About two thirds of its mass lies to the left of the median line.

The heart is enclosed in a serous sac, the pericardium. It has four chambers, viz., a right and left ventricle and a right and left auricle. A partition of fibrous tissue, the septum, separates the right and left chambers. So well regulated is the heart that each chamber functions independently to a certain extent. Between the auricles and ventricles are valves or doors composed of strong membrane, the left side having two doors while the right has three.

Openings into the arteries are also protected from return flow by half moon valves, called semilunar valves.

The heart is wholly concerned in the circulation of the blood throughout the body. Through its efforts the blood makes a circuit of the body every 23 seconds and all of the blood passes through the heart every 37 1/2 seconds. The blood leaves he left ventricle and enters the aorta by the contraction of the ventricle. It passes to all parts of the body, except the lungs, through the aortic branches. Capillaries pass the blood to return conduits, the veins, leading back to the heart. The right auricle receives the return flow. This auricle empties the blood into the right ventricle, which in turn pumps the blood to the lungs.

After the blood has exchanged its CO2 for oxygen it returns to the left auricle and thence to the left ventricle where it started from originally. The blood going through the stomach and intestines passes through the portal veins and capillaries to the hepatic veins. These veins in turn empty into the inferior vena cava, which returns the portal blood to the right auricle. Thus we have a general picture of the heart and its duties, also the many pipes it must force the blood through every second from birth to death. Some job! Is it not ridiculous to ascribe a defect in the stomach, in the liver, or even in the skin to a defect of the heart in failing to do its duty? The heart is ready and willing to furnish power but there is a break somewhere in the circuit of the systemic line, the pulmonary line, or the hepatic branches.

Right here I wish to make an observation, which I will enlarge upon later. There are chemical changes taking place at every relay station and some of them may be the cause. We have all seen cases of irregular heart following sunstroke or just from measles; not a defect of the heart at all. While in the army I once saw six hundred cases called disordered action of the heart, nearly all having very high blood pressure.

All had rapid heart action and some effort syndrome. None responded to cardiac therapy and not one was able to return to duty. My contention is that many of our heart cases where function is involved, may be due to incomplete chemical changes of the food and amino acids are absorbed before the complete split is accomplished. Also certain harmful acids are formed in the stomach or intestines producing gas and faulty heart action. To try to correct the heart in such conditions, except for emergency relief, would be bad practice.

Congenital heart defects occur occasionally. They are not amenable to medical prescription.

If the infant lives without decided improvement then X-rays should be taken and the pictures studied carefully be experts. There are in the U.S. today several surgeons who are operating these cases with complete cure and a very low percent of fatality.

Endocarditis is a germ disease of the heart, which comes on usually in the course of some systemic disease, particularly rheumatic fever or scarlet fever, as well as other germ invasions, and practically always results in damaged valves. At the present, massive doses of penicillin are very successful, greatly reducing the mortality. I have never used this method, preferring to stick to the indicated remedy and have never had a death. In scarlet fever, endocarditis usually comes on just at the close of the high fever. The pallor, the fright, and the sudden resumption of high fever again should warn you of a new serious development. In rheumatic fever endocarditis may develop at any time, often accompanied by nephritis.

For me no remedy is more often indicated in this distressing condition than Aconite. The fear, restlessness, high fever, and pallor, or nausea on sitting up clearly indicate it. Continue it for days until symptoms change. It is frequently the only therapy needed. Spigelia seldom is called for in children but in adults is sometimes needed. Bryonia in the rheumatic cases may have been indicated in the general condition but in children when endocarditis intervenes it nearly always fades out of the picture. Not so in adults, however. When Bryonia is used in heart conditions it should only be used in high potency. After the acute stage is over turn to the constitutional remedy with rest in bed.

Endocarditis in adults, of course, may be primary, accompanying such conditions as rheumatism. But I have found many cases to be a recurrence. Strange to say Aconite is seldom indicated in this condition in adults. Spigelia is often called for as is Rhus tox, the latter particularly if streptococcus germs are active or the condition has been brought on by great exertion. Bryonia will be needed in rheumatic types with sharp pains worse on motion. After acute symptoms have subsided rest is needed and often a general tonic such as Ferrum, particularly Ferrum phos.

Pericarditis starts from acute colds or exposure in most cases. The pains are those of acute pleurisy localized in the region of the heart. Here Aconite may be your first remedy in both children and adults. Spigelia will follow Aconite quite often, particularly with hypertension and very hard beating heart and often may be used for long periods of time. It is often surprising how frequently Rhus tox, is required. The effusion and pain referred to the right shoulder with great restlessness, especially at night, should point to its need.

The irregularities of the heart such as tachycardia, bradycardia, palpitation, and auricular fibrillation, as well as the intermittent types, are not primarily heart diseases, but if neglected and allowed to run untreated the heart may then become defective, involving the muscles and overstraining the controlling nerves. The causes for these functional troubles must be looked for along the systemic line, only occasionally to the respiratory.

In palpitation or auricular fibrillation we should study and often direct our treatment to the nerve control of the heart, but before doing so we must satisfy ourselves that other causes are not at the bottom of the trouble. I have seen the most violent palpitation or attacks of auricular fibrillation brought on by agitation or anger, also from prostatic irritations, or just attacks of acute indigestion. There are many other conditions, including business strains and high tension golf games, which lead to heart irregularities.

When called on to treat one of these distressing functional heart disturbances, if it is early in the case of palpitation or auricular fibrillation, try this method. Have the patient stand on the floor, then stoop over rising on his toes and bending all of his joints, including the arms, to extreme flexion. This compresses the circulation at every joint. Now have him take a deep breath and hold it until his face flushes and he feels a beating in his neck. I have found over fifty percent of the cases in the first ten or twenty minutes will be stopped with his method.

The rest of the cases will have to be put to bed. Medicine, however, will not check the heart in many of them. Occasionally one will be checked by Lachesis or, if the beating is very violent, by Spigelia. But many times the safest way is to give a hypodermic of 1/4 gr. of Morphine with 1/100 gr. of Atropine. When they wake up the heart will be back to its lower and normal speed. It is in normal intervals that the curative medicine should be given. A careful study will often give you the clue.

In stomach trouble Nux vomica 12x or Bryonia 200. may be indicated. Lachesis has a decided action on the heart as indicated by the paleness of the face, the faintness, and with all the fear and dread of the outcome, with cold sweats and tightness in the throat. I have seen a few cases stopped in just a few minutes with one or two doses of Lachesis. One other remedy often needed in functional heart trouble with enlarged or irritated prostate is Sepia.

In this condition you seldom need any active heart medicines. In fact you may be wasting valuable time in resorting to them.

A diet is very necessary as well as very helpful. Carbohydrates must be cut decidedly. Sugar can well be exchanged for comb honey, brown rice for potatoes and bread allowed only at the evening meal. Breakfast is a token meal, consisting of rye crisp, butter and honey, and good ripe apples eaten with the skins on. No tea or coffee, but hot water in abundance. The noon meal should be the heavy meal of the day. A large salad of leafy vegetables, also carrots, spinach, chives, cucumbers, and celery with a dressing of olive oil and lemon juice or just plain French dressing. Roast or broiled lean beef or lamb or fish, if not fat. Nearly all of the raw fruits can be allowed provided they are eaten without sugar.

The coronary conditions (occlusions, thrombosis) are largely due to business strains, overwork, and constant indiscretions in diet and very often come before the patient has any warning or has not heeded it. In the attack such heroic measures as are necessary must be used promptly. I have found the hypodermic very much needed here, but if your patient survives the attack Your patient has a long road, but he travels in bed and on a very limited diet, perhaps only fruit juices or a salad, gradually enlarging the diet as improvement takes place.

He must be in bed for weeks, free from business cares and agitation. Indicated medicines of course depend on the state of his blood pressure and his heart, but appropriate study must be made of the kidney function, the liver, and the entire digestive tract. The remedies mentioned in functional types may still be indicated, but in addition several others with good eliminative powers are useful.

With high blood pressure, liver involvement, headache, dry tongue, and often intestinal gas and umbilical colic, Chionanthus is ten drop doses, three times daily, will do wonders. But the dosage should be reduced as soon as the blood pressure drops to normal. Carduus marianus in tincture is another remedy which may be called for if the tongue is coated, the liver sluggish, and there is a history of alcoholic use and dietetic indiscretions. This medicine is very helpful if sugar is found in the urine.

Low blood pressure is quite a different problem in coronary cases and is much more serious. That indicates either an anemic condition with neurasthenic problems or it may mean degeneration of the heart muscles with dropsical manifestation.

Here we have one remedy which will do much, Crataegus is a bulwark in degeneration of the heart muscles in either low or high blood pressure. It is of little value in endocarditis, either acute or chronic, but cardiac muscles degeneration from arteriosclerosis very frequently calls for it. Many of these cases if not advanced in age can be salvaged, but they must understand that strenuous business must not be entered into. They must also know that heavy eating is dangerous and drinking and smoking must be given up. In addition they must visit their doctor at least once in two weeks for a check up.

You will notice I have not mentioned many of the so called heart remedies. Digitalis, which is used in most heart cases in massive doses, may produce very sudden death from cardiac syncope, unless clearly indicated by its symptoms, such as a slow and irregular heart from old mitral diseases or rapid and weak heart with muscular dilation with cyanosis on movement. The heart feels as though it would stop if he moves. In these kinds of cases Digitalis may be used, but much better results will be attained with high potencies.

I have tried to convey to you in this paper the importance of studying the general system in the heart diseases you meet with. Many of them will prove to be not heart disease primarily at all.

R C Bowie