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.
