There is no attempt at anything systematic in this paper. It consists chiefly of notes and observations culled from the pages of my interleaved Repertory. These notes, many of which are not specially “Homoeopathic,” are derived from the numerous articles, papers, lectures, etc., which one reads in order to be au courant with the progress (or otherwise) of Medical and Surgical subjects in general.
The essential points are jotted down at the time and often consist of diagnostic (allopathic) tips likely to be useful in the future. I maintain that the Homoeopathic Physician must be as good at the diagnosis of the so-called “disease” as Physicians and Surgeons of the other School, as well as the more special Homoeopathic diagnosis the diagnosis of the curative medicine.
In regard to valvular diseases of the heart, the two worst forms are aortic regurgitation and mitral stenosis. Which is the worst admits of some doubt, but probably it is mitral stenosis.
In aortic regurgitation, note the pallor of the face, urgent dyspnoea, and shaking carotids. The characteristic pulse is the “water-hammer” of Corrigan: it is a low tension pulse. The rise of pressure is sudden, and the fall of pressure is also sudden, giving to the finger the impression of a very quick stroke. The expression, “water-hammer” is usually applied to the noise and jerk made by the sudden stoppage of moving water in a pipe, as when one suddenly turns off a running tap, especially if there is a certain amount of air mixed with the water.
Observe here that in children, especially, there is a similar pallor in cases of pericardial effusion. Aortic regurgitation is usually due to a primary sclerosis during, or after middle-life. The dyspnoea is less urgent when the aortic is combined with a mitral regurgitation, as then there is a kind of “safety-valve action,” on the part of the mitral valve. There is a curious mental disturbance, with all sorts of cerebral confusion, often accompanying aortic regurgitation, more especially in the form of sudden gusts of passion and great irritability.
With the low tension pulse we often see a capillary pulse on brow, red border of lips, finger nails, etc. A distinguishing characteristic of aortic regurgitation, is flatulence in the stomach (from swallowed air probably) and transverse colon, and therefore it is necessary to restrict fluids in the dietary; meals should be small and dry, with a predominance of animal food, as mutton, fish, game, poultry, but carbohydrates (except sugar, especially glucose) and fats should be cut down as far as possible.
Mitral Stenosis is a disease of early life. Pallor of face is not marked; the cheeks, indeed, are often flushed: 78 per cent. are females and 80 per cent. have suffered from cholera, “growing pains,” and other forms of “rheumatism.” For this reason it is specially incumbent on the medical attendant to look after such cases very carefully, and not to be put off with “Oh! it is only growing pains.” Such are often more disastrous, than a regular full-brown, attack of rheumatic fever. In the latter the child must be put to bed, and the heart is spared, to a certain extent, by the compulsory rest.
Mitral stenosis usually attacks the patient before puberty. In this the blood pressure is high. The ring at the mitral valve opening remains at childish size, and does not grow pari passu with the heart. The left ventricle remains small and weak, because of the lessened blood current. There is a thrill felt in mitral stenosis, ending with a short sound or snap, or some other abnormal noise, which may vary from day to day. As the heart fails this may disappear. The pulmonary second sound is accentuated or doubled. Most patients with this complaint rarely live beyond 45 or 50 years. With this lesion we often get pulmonary haemorrhage, which, if not excessive, should be left alone.
Mitral stenosis is seldom a stationary disease: it slowly but steadily increases. Compare this with mitral regurgitation which may exist for many years and never embarrass the heart muscle, nor show any signs of becoming worse. Even aortic valve damage may become stationary.
In all heart cases our first care must be to conserve the heart muscle. When I began the study of medicine, some fifty years ago, our whole attention was directed to the state of the valves. We heard but little about the cardiac muscle. Now all this is changed, and the change is mightily for the better. Now it is insisted that the essential principle of treatment is the care of the heart muscle, the condition of the valves taking quite a secondary place.
In all heart cases, apart from medicinal treatment, the great object should be to eliminate all forms of effort, except those which are essential, rather than merely necessary, for the patients occupation. For example, a farm servant has two miles to walk to and from his work: his heart shows signs of failing. But as a “bus” could be got, I advised him to cut out the walk to and fro, notwithstanding the extra expense. This made all the difference, and the man is now able to carry on his work as well as ever, though that work is rather laborious.
This is merely an example; we must look about for other forms of unnecessary effort and cut them off. If it is a harassed housewife, aim, if possible, at getting her to lie down for two hours after the mid- day meal. This will make all the difference between life and death, comfort and torture. But she must take off all her “things” and go right into bed. At the present time this does not give rise to much trouble, so that there is no excuse.
The general teaching is that, as a rule, digitalis had better be avoided in aortic regurgitation, as it may cause sudden death. But that is surely a matter of dosage. Full doses persisted with, in any form of heart disease, will cause sudden death. In mitral stenosis it is looked upon as the medicine. In all cases, the best preparation to use is the fresh infusion. With a little care and a little ingenuity the patient, especially if poor, can be shown how to make this for himself.
But in all cases where digitalis is used, Mackenzies method of administration must be rigidly followed, i.e., it must be given with a great deal of brains. Digitalis, we know, is capable of producing, extra- systoles, heart-block, the pulsus alternans, and even auricular fibrillation. To the Homoeopath these facts are very important, and justify him in using this drug, in cases other than those with a markedly slow pulse, which has hitherto been the chief homoeopathic indication for its use.
A curious kind of heart is the Tubingen Heart, the result of drinking excessive quantities of beer. Both sides are hypertrophied: the heart muscle is normal, so far as microscopic examination is concerned, and there are no valvular lesions, nevertheless the heart gradually fails a form of “alcoholic heart, ” I suppose.
“CARDIO-PULMONARY MURMUR.” Due to some condition in lung-pleura, or mediastinum. It disappears when the patient takes a long breath and holds it in, or when he lies down. It is increased during expiration.
If we wish to know the condition of the left ventricle, feel the pulse.
If we want to know the condition of the right ventricle examine the veins of the neck.
HYPERTROPHY OF HEART. In young boys, from violent gymnastics, try Bromine.
In young girls from Calisthenics, try Causticum.
In metastasis of gout or rheumatism to the heart, study Kalmia and Sanguinaria.
In chronic valvular disease in children, note three things: (1) headache, (2) cough, and (3) epistaxis. Headache is not common in children, unless due to the presence of some grave trouble, and therefore special search for the cause must be made.
ULCERATIVE (MALIGNANT) ENDOCARDITIS. This may begin fairly suddenly. Note especially:-.
(1) Febrile temperature of septic type, with emboli in many organs, even though there is no direct evidence of cardiac disease present.
(2) Unexplained pyrexia, with profound anaemia. Along with this one may, or may not, recognise simple endocarditis, and there may be an entire absence of emboli.
PATENT DUCTUS ARTERIOSUS. There is a marked thrill all over the precordia, especially marked in the third left space. The thrill is of long duration, through the systole into diastole, and therefore it is not produced by valves. There is an increase in the number of red blood corpuscles.
In CYANOSIS, from patent foramen ovale, study Lachesis.
“IRRITABLE HEART.” What is this condition, or what does it mean? The chief symptoms are palpitation, with intermittent and frequent pulse on exertion; some cardiac discomfort and dyspnoea. This form of heart trouble is usually found in females. It is said to be a “neurosis” (whatever that is!) and likely to be caused by tobacco, tea, coffee and alcohol. In many cases of palpitation, especially in young men, the condition is at once relieved by exertion! A patient with extreme irregularity of the heart, may, after walking quickly 100 yards, or running upstairs, return with the pulse perfectly regular.
Medicines useful for “irritable heart.”
When from Influenza: Iberis.
From excessive tea or coffee drinking: Agaricine.
From excessive smoking: Ars., Kalm., Phos., Spigelia.
From effects of scarlet fever: Lachesis.
“AORTIC AXIS.” A line drawn from the right sternoclavicular articulation to the normally placed, apex beat, is the “aortic axis.” Along this line aortic murmurs are propagated. In the third left space, near the sternum is the best spot to listen for an aortic regurgitant murmur. At this point the left ventricle is not covered by the pulmonary artery: a little further out also is the tip of the left auricle.
ANGINA PECTORIS. This is usually divided into true and false. This division ought to be abolished, for the so-called “false” is frequently fatal.
The “false” is supposed to be distinguished by the facts that the attack supervenes spontaneously, that the pain lasts longer than in the “true,” that it is accompanied by restless movements, and that it tends to recur again and again, before finally subsiding, and there usually co-exists throbbing of the abdominal aorta, mobility of our kidneys, vaso-motor manifestations and other evidences of nerve instability. The false is said to be most often found in young women: the pain radiates centripetally, and is not specially caused by movement.
In true Angina. the pain is retro-sternal and may spread to arms, chest and neck: the pain is constrictive and is accompanied with a feeling of dread and fear of impending death. Patient will not move is “frozen.” The true form is often due to syphilis, via aortic disease. As a rule it appears first after some definite exertion. Patient should be very careful of chills from cold winds, sudden exertion, excitement, and especially overloading the stomach. The diet should be purine free, and chlorine free. In some cases the first attack may be the last.
LANCINATING PAINS ABOUT HEART. If from base to apex, at night, try Syphilinum; if from apex to base Medorrhinum. From base to clavicle or shoulder, Spigelia.
CONSTRICTING PAINS about heart region, consult Cactus, Spigelia, Carbolic acid and Sulphur.
An Old School observation. When cutaneous hyperaesthesia is marked about the precordia, especially about the apex beat, in over distension or heart failure, and where the least touch causes acute distress, paint apex-region with mother tincture of aconite. The same cutaneous hyperaesthesia is found in acute pericarditis, due to irritation of the intercostal nerves.
If palpitation is marked on first getting into bed, this is often due to nicotine poisoning from excessive smoking. If an attack comes on when lying quietly in bed, suspect Graves disease.
ADHERENT PERICARDIUM. The diaphragm seems fixed and the chest wall is sucked in during respiration, because the ribs dont move. There is an abnormal increase in size of the heart, as the amount of work it has to do is immensely increased, and there are greater signs of cardiac failure than one would expect from the amount of valvular lesion present. In acute pericarditis, there is complete absence of abdominal respiration, and one may mistake it for an abdominal inflammation.
In tubercular disease the heart is usually small: this disease is rare in cases of cardiac disease, especially in mitral stenosis, or in lateral curvature of the spine, or rickety deformities of the chest, or emphysema. Is this from increased venosity of the blood? But in mitral stenosis there is an increase of red blood corpuscles.
The heart rate is increased by inspiration, and decreased by expiration, especially in the young. This is quite normal and is not a sign of disease. Stop respiration and the irregularity disappears. The rate is slow, as compared with the temperature, in typhoid fever, and in influenza.
In “heart troubles” without special symptoms give Naja. For consciousness of a heart give pyrogen: the heart feels “tired.”.
HEART BLOCK. If complete the ventricle beats at its own intrinsic rate of about 30 per minute.
Drugs that have produced complete or partial heart block are Digitalis, Aconitine, Physostigmine, Adrenalin, Muscarin, Yohimbin, Squill and Strophanthus. Digitalis will also produce auricular fibrillation.
Heart block with occasional faints, or epileptic-like seizures, is known as the Stokes-Adams syndrome.
In failing heart, look at feet, lungs and liver. Gallop-rhythm means threatening break-down of the myocardium.