THE common notion that disease of the heart is incurable should be in every way discountenanced by Homoeopathists. Many forms of heart disease are completely curable, and the sooner the popular ideas on the subject are corrected, the better it will be for those who suffer fro any kind of heart affection. It is true that old-established valvular disease cannot be altered, destroyed valves cannot be restored, but even in these cases much maybe done by remedies to restore the power of the heart when it is defective, and to bring about proper compensation, which is practically a cure.
In recent cases of valve affection it has frequently been my lot to observe the disappearance of all signs of disease under treatment. In my book on Rheumatism I have mentioned, among others, a case of this kind which particularly struck me when I was resident medical officer at the London Homoeopathic Hospital. It was that of a young girl who had a severe attack of acute rheumatism, with both pericarditis and endocarditis. Under treatment, the friction sounds of the pericardial inflammation quite disappeared, and when these had gone the bruits indicating endocardial mischief also subsided.
One of the chief difficulties in the treatment of endocarditis occurring in connection with rheumatic fever lies in the fact that there are so few symptoms indicating the mischief. Pericarditis has generally abundance of symptoms, hence it is a much easier matter to cure cases of this. On the other hand, there may be very extensive endocarditis and so sing be given except on physical examination. In such cases the only thing to be done is to take the totality of the symptoms and to prescribe accordingly.
If there are no symptoms elsewhere to guide, such medicines as have been found in practice or in provings to have an affinity for the lining membrane of the heart and arteries should be thought of, when the constitution of the patient and his previous medical history, with any former symptoms may have had, will severe to distinguish the most similar.
CASE I.-Quite recently a little girl, aged 5, came under my care in the Homoeopathic Hospital suffering from rheumatic fever, affecting a number of joints, and complaining of pain in her chest. I found extensive effusion into the pericardium, and a marked mitral systolic bruit as well. She had received Chelidonium and afterwards Aconite before I saw her, but without benefit. There was great irritability of temper, white tongue, heavy perspirations, and marked nightly aggravation of the symptoms, causing her to scream the greater part of the night. I prescribed Merc. viv. 12, and the symptoms at once abated.
The temperature fell to normal, the effusion disappeared, and in a few days the patient was convalescent. However, the bruit persisted. But there were no symptoms whatever. The child was, in all other respects, perfectly well. As her feet were somewhat cold and clammy, I prescribed Calc. c., but I could not trace any effect on the valve to this; and as the patient had no leave the hospital I was unable to follow the case further. Compensation, however, was fully established before the left.
During last summer a number of cases of endocarditis came under my observation in connection with acute fevers. There was at the time an extensive epidemic of German measles, and the first case I shall describe is that of a young lady aged nineteen who was one of its victims.
CASE II.-On June 15, I called to see Miss L., who had been somewhat ill for four days. I found the rash of German measles, sore throat, the right tonsil being enlarged. There was a cough, and she raised a good deal of phlegm. There was some fever. The monthly period was on at the time. The pulse was 72. On listening to the heart I found a systolic mitral bruit. She had cold, clammy feet. Under Belladonna 30 the symptoms of the fever left her, but the bruit remained. On the 22d June the bruit was audible in the mitral, tricuspid and left auricular areas when she was lying down, but disappeared when she sat up.
I gave her Spigelia 30, and in a few days the bruit became less distinct. She afterwards received Nat. mur. and then Arsen. for other indications; but on June 29th, after a restless night, hot and perspiring, the pulse was 84, the mitral bruit was very distinct, and heard in all the areas of the heart, and the patient felt “queer,” so I again gave Spigelia 30. Two days after this I found her feeling much better, and I could not hear the bruit. A few days later I listened again, but could hear nothing of it, so I let her leave town for the seaside.
CASE III.-About the same time i was attending another German measles patient, also a young lady, who developed in the course of it a similar affection of the mitral valve. Eventually this also disappeared, but as this case was more complicated, the attack having supervened on a long period of over-work and mental strain, much longer time was required. The medicine which had most effect on the heart symptoms in this case, was Baryta carb., which was given in two-grain doses of the 3x. The sensations she complained of were a strained feeling referred to the base of the heart and a sharp pain about the apex. The 3x appeared to have more decided action in this case than the 30th which was given first.
CASE IV.-Charlie W., aged 10, had an attack of English measles in May, 1892. I saw him on the 28th, and all the classical symptoms of the disease were present, and in addition, a mitral systolic bruit. There were no symptoms arising from the latter, and I treated the case according to the symptoms in the ordinary way. Under Bell. 30, Merc. sol. 30, and Sulph. 30, the disease ran a mild course, leaving the boy well, except for the bruit. On May 7th, as there were no symptoms, I put him on Lycopus virginicus 1 x which has a reputation in valvular disease.
I could trace no effect to this, nor to Spongia 30, with which I followed it. On 17th of May, taking into consideration that he came of a consumptive family on one side of the house, and guided by the crenated appearance of his teeth, which Dr. Burnett has shown is an indication for the medicine, I gave one dose of Tuberculinum (Heath) 200, and as he had cold, clammy feet, I followed this with Calc, carb. Under this treatment he made good progress, and on the 10th of June I ceased attending. The bruit was then inaudible when he stood up but could be heard if he lay down.
On December 14th I saw him again for something else, and had the opportunity of examining the heart. He told me he had no shortness of breath on running up stairs, and he could run as well as ever be could. The apex beat was felt in the fifth space, further to the left than normal, and the area of cardiac dulness was greater than normal. On standing, no bruit was audible; there was a little accentuation of the first second at the apex, and of the second over the pulmonary artery. On making him lie down I found that the bruit reappeared in all the areas, loudest over the apex, and the action of the heart became irregular.
I have not been able satisfactory to account to myself for this condition in which there is competence of the valve in the erect, and incompetence in the recumbent position, but it is a condition I have often observed. In one case, that of a child who bad at one time unmistakable mitral incompetence with attacks of violent palpitation and flushing of eyes and face following whooping- cough, I found, after some years, that the bruit could only be heard when she lay down; and still later it could not be heard at all. There was no anaemia in this case. Some defect of the posterior flap of the valve, or irregular action of the columnae cardiae may possible account for it.
CASE V.-On the 22d June, 1880, James T., a chimney-sweep, aged 44, came to my hospital clinic on the recommendation of a private patient of mine who had persuaded him to try Homoeopathy. When he entered my out-patient’s room it was easy to see he was exceedingly ill. Like most of his class he had led a hard, reckless life. He commenced chimney-sweeping as a tiny boy in the days when boys were sent up the flues instead of the machine- brushes now used. Naturally, he was a man of powerful physique; but now it had been with the greatest difficulty that he had succeeded in reaching the hospital.
He had the blurred, heavy look of countenance-a sort of indistinctness of features-often noticed in suffers from heart-disease. He had the blurred, heavy look of countenance-a sort of indistinctness of features-often noticed i suffers from heart-disease. He felt just as ill as he looked, for he afterwards told me that he never expected to reach home again alive.
Fourteen days before, he had taken cold form getting wet during a trip to Oxford on the river. This was followed by a cough with raising of thick phlegm, the cough being so painful that he had to hold himself, and this had continued. The chief thing he now complained of was a pain at the heart as if it were swelling up. The pain gradually moved down, and the night before his visit to me was in the left flank; then it moved up to the heart again. Sensation as if a big knife went through it, aggravated on taking for him so lie on the left side. Tongue white; appetite good, but he could not eat, because eating brought on the pain. Bowels confined, he had a choking sensation in the epigastrium, and a dizziness in the eyes. He was excitable.
On examining the heart I found there was increase in size, a pericardial rub, and bruits in aortic and mitral areas; that is to say, there was pericarditis with effusion and endocarditis as well.
The knife-like pain in the heart singled out Spigelia from all the other medicines related to his condition, so I gave it him in the 3d centesimal dilution, a dose every hour.
He slept well that night, as he was able to breathe better. The next day I called at this house, and I found a decrease in the pericardial rubbing sound, and a diminution in the area of cardiac dulness.
June 24th.-Still better; sleeps well; has no pain appetite good. On the day I made the following note of the state of the heart:.
Sight rub heard over centre of heart.
Mitral area: double bruit, the systolic portion being heard in the axilla.
Tricuspid area (right border of sternum on level of fourth rib); a double rough, grating sound.
Aortic area; a double bruit.
On the night of the 25th-26th (as his wife informed me) his breathing seemed to be arrested; it began again with a gasp.
The Spigelia 3 was continued al this time, though it was not given so frequently as at first. From the 25th it was given every two hours.
A few weeks after this he mentioned a circumstance which occurred during the time he was taking Spigelia-the loss of a pain in the right knee which had troubled him for eighteen months. if he knelt on it he was unable to get up without going down on the other knee as well, and then stretching out the right leg. The pain was as if the knee got out of joint.
He had been sometimes for hours at night before he could get is into the right position in bed. He asked me if my medicine could have had anything to do with its disappearance; for as he had not told me anything about it before, he did not see how I could have cured it. On referring to Allen, I found this in italics; Tearing pains, like a sprain, in the knee-cap, only when walking, so that at times he limped, since he could not bend the knee as usual. Other similar symptoms refer to the right knee and both knees. That the Spigelia must have the credit of this bye-cure I proved later on, for the pain in the knee returned; but a few doses of the Spigelia 1m F.C. permanently removed it.
But it go back. By July 1st he was quite free from any chest symptoms; he could lie on either side. But he has weak in the calves, had giddiness, and suffered from constipation with straining, Nux 1m relieved the latter condition.
On July 3d he was still complaining of weakness in the legs; so I put him on Baryta. c. 1m, after which there was rapid improvement. He continued on this medicine, with a rest, till August 10th. Occasionally he had palpitation on lying down at night; on the 5th there was slight pain in lower part of left chest; on the 12th numbness of left shoulder and arm. On August 1st he had an attack of coldness in the evening whilst walking in the street. He resumed work on the 9th of August.
On October 11th he declared he felt as well as ever he did in his life. Being an enthusiastic member of the volunteer force,he had been testing his powers by practicing ball-firing. The following Easter he went though the fatigues and exposure of the Easter Volunteer manoeuvres, indulging him-self even (without asking my permission, I need hardly say) in bathing in the cold spring sea.
On the 19th of March, 1893, I called upon him to make an examination of his present condition. For the last eighteen months he has been better, he says, than for years before. His pulse was 72, regular, steady and of good force. I append his sphygmogram, taken from the left radial, standing, with a pressure of 3/12 ounces. It does not differ from a normal tracing except, perhaps, in the strength and sharpness of the upstroke and sudden though quickly-arrested return.
The area of dulness is still greater than normal; the apex beat is felt in the sixth interspace and more to the left than normal. Combing to the heart sounds, I found, of course, no pericardial rub. Also the mitral bruit and the grating sound (probably pericardial) in the tricuspid area were no longer to be heard. The double aortic bruit still remains. In the tricuspid area the first sound is clear, and a soft bruit replaces the second. This is probably the aortic diastolic propagated downwards. In the mitral area the first sound is somewhat impure- not the clear, sharp click of a normal valve-but there is no bruit, showing that the valve is competent.
In this case I conclude that under the treatment-that is, under the action of Spigelia and Baryta carb, chiefly-the inflammation of the heart, which affected both the outer and inner lining, was subdued, and the affection of the mitral valve was so far remedied that it has been restored to competence. The aortic valves remain still as they were, but the softness of the systolic portion of the double bruit shows that the degree of obstruction to the blood-flow is but slight, and the softness of the diastolic part that the regurgitation is not considerable.
This shows that there has been, at any rate, an arrest of the disease process, and I am disposed to think that the aortic trouble dates from before the time when I saw him. I may say that after having been a very heavy drinker, he suddenly gave up alcohol in all forms seven years before this illness began. What made him gave it up was that he lost nerve when at his work on roofs, and even on stepping from a curbstone into the street felt as if he would fall. Afterwards he suffered much from “indigestion,” and in the night violent palpitation and sometimes arrest of breathing, as noticed by his wife. Loss of nerve is a very common symptom in heart affections, and the probability is that the aortic disease was commencing at that time.
Before leaving the acute cases I would like to refer to a case of ulcerative endocarditis following pneumonia, with delirium tremens, which I published in the November number of The Homoeopathic World for 1884 (vol. xix., p. 497). The case ended fatally, but the point I wish to refer to was made evident at the post-mortem examination. The heart weighed thirteen ounces.
On the under surface of the aortic valves (which were competent) grew abundant granulations like cauliflower excrescences, exuding purulent matter. These granulations pressed against the aortic segment of the mitral valve, constricting the orifice artificially. The mitral valve itself was healthy, except that the appearance of an old deposit was found between its laminae. There were no signs of the heart being affected during his first rheumatic attack, but that there had been inflammation of the valve which had healed without causing deformity, the appearance of this specimen clearly showed.
I will now pass on to speak of chronic cases.
At the Annual Homoeopathic Congress, held in LOndon in September, 1884, I read a paper, which was afterwards published in a small volume, entitled Iodide of Arsenic in Organic Disease of the Heart. Iodide of arsenic is a drug that has received no extensive proving, and my prescription of it in the series of cases I narrated was, to a certain extent, based on general considerations. Since that time I have had many opportunities of repeating the observations I then made, especially in cases where pulmonary or bronchial affections complicate heart disease. In one case of chronic tobacco-heart it was the remedy that gave most relief.
It seems to act when the symptoms of either of its elements are present, but I cannot give any markedly characteristic symptoms that indicate it in preference to other drugs. The accompaniment of cough with expectoration sometimes difficult to raise, and sense of oppression at the chest complicating valvular disease, are perhaps the leading indications, but pain at the heart, breathlessness on movement, faintness, and nervousness, occurring independently of cough, are also relieved by the Iodide. In all cases of overburdened or overbalanced heart the drug should be thought of.
But, as I mentioned in my paper, there are number of cases which are not perceptibly influenced by the Iodide. Homoeopathy has no specifics for diseases, hence a strict attention to symptomatology is our only safe rule in this as in all departments of our art.
CASE VI.-It is notable how frequently cardiac patients complain more than anything else of indigestion. It was the principal thing the patient, James T., complained of before the attack which brought him under my care. It was the chief trouble in two of the cases still to be mentioned. In the case I am now going to relate, that of Mrs. W., an octogenarian, the strictest attention to dietetic rules was absolutely necessary to keep her in comfort.
This patient had survived a number of illnesses, including a right-side pleurisy many years before, which had left her with a shrunken lung and curved spine and a displacement of the heart to the right. The heart was greatly hypertrophied, and there were murmurs to be heard at every orifice, a double aortic, loud systolic at mitral and tricuspid. The heart’s action was very irregular, the arteries hard and tortuous.
I attended her through a variety of illness, diphtheritic sore throat, bronchitis on various occasion, influenza with bronchitis, minor urinary troubles and psoriasis. The condition of the heart dominated everything. There was great swelling of the feet, which varied in degree at different times. But her chief trouble was indigestion and flatulence; the smallest transgression was pretty sure to be visited by an “attack” in the early hours of the morning.
The “attack” was a feeling of faintness, a sensation that she was “going,” violent pain at times in the region of the heart’s apex, great oppression, the symptoms being relieved after a greater or less time by a copious flow of colorless urine. Every time I was called to her in one of these attacks she thought she was dying, and was almost angry with me because I refused to confirm her prognosis and pronounce the viaticum.
Aurum metallicum in the 30th or 1m gave prompt relief to this feeling of impending death and kept her reconciled to life for long periods at a time. Kali carb. in the same potencies gave her great help when the attacks came on between 2 and 5 A.M., and when there was a cough with aggravation at those hours. After an attack, when there was much palpation and breathlessness with heart discomfort, Baryt. carb. 5 and 30, gave much relief. On occasional courses of these medicines she was kept in tolerable health for long periods. When I first began to treat her I gave the Iodide of arsenic with some benefit; but it was not nearly so marked as that fro the more-definitely indicated remedies n higher powers. Aurum 1 m (Boericke & Tafel, or F.C.), had the most prompt action when the sensation of impending death was marked.
I will place beside this case another of extensive damaged heart in an aged patient, in which there were practically no symptoms referable to the heart itself, and consequently no call for special treatment.