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.
CASE VII.-A stalwart octogenarian, Andrew M., came to my out-patient clinic at the Homoeopathic hospital in the summer of 1882, complaining of rheumatic pains in various parts of him. Two years before he had been laid up for five weeks with rheumatic fever, and for a short time after that he had been troubled with shortness of breath on going up stairs, but had got over that, and had not been troubled with any heart symptoms since. His irregular pulse, sharp and hard, and hard tortuous arteries at once told me that damage had been done. Here are two of his sphygmograms:.
Examination of the heart showed the following:.
There was visible pulsation in the carotids, the apex beat was in the fifth interspace, 3 1/2 inches to the left of the sternum, and the transverse dulness extended from 1/4 inch on the right of the sternum 4 inches to the left. Vertical dulness began at the lower border of the third rib. No bruits were audible, but there was at the apex the peculiar thumping first sound which indicates mitral stenosis, this being followed by a sharp second. Over the aortic and pulmonary areas the first sound was inaudible, the second being sharply accentuated, the accentuation being most marked in the aortic area.
An exaggerated second means increased backward pressure on the heart, and in the case of the aortic valve, it is generally the prelude to aortic incompetence and regurgitation. When the aorta has been affected, either by acute inflammation, as in fevers, or by chronic degeneration, it loses a certain amount of elasticity, and becomes permanently dilated under the force of the heart’s beats. When this has taken place the rebound of the column of blood after the systole is more sudden, and produces the accentuation of the second sound in the aortic area, such as was present in this case. The defect was compensated by hypertrophy.
The rheumatic symptoms gradually subsided under Bryonia and Colchicum, and, finally, Pulsatilla 3, which last did more for him than any other remedy. It removed, after the other medicines had failed, swelling, pain, and numbness of the hands across the metacarpal joints, worse in the morning on rising, leaving him practically well. The only symptoms he had during the course of the treatment referable to the heart were temporary giddiness and buzzing in the ears. In this case I did not think it necessary to alarm the patient by explaining to him the condition of his heart, as I believed it would last him as long as the rest of his body.
I will now give particulars of a case which first came under my care as one of “indigestion”.
CASE VIII.-Mr. J.W., a tradesman, who had done work about my house, such as gas-fitting and the like, consulted me occasionally for an “indigestion” he was troubled with from time to time. The first time was in February, 1888, he being then 38 years old. The symptoms of his indigestion were weight at the epigastrium after food, tenderness to pressure, and drowsiness after meals. These symptoms were quickly removed by Bryonia. He also suffered frequently from headache, tightness at the chest, pain between the shoulders, and at times a cough. His pulse was somewhat frequent, but there was nothing sufficiently remarkable about it to make me suspect anything wrong with his heart.
On April 13, 1889, I was summoned to see him in the greatest urgency. After a good deal of worry he had been suddenly seized with violent palpitation and faintness, and when I saw him he was in a death-like faint, pallid, with purple lips, and icy cold; in fact, he was in a very grave condition of cardiac syncope; the pulse was weak and slow. On examining his chest, I found the heart enlarged and a mitral systolic bruit present. I put on his tongue a dose of Ignatia 1m (Boericke & Tafel) and repeated it frequently, and he soon revived sufficiently to enable me to take him home in a cab (for he was at his place of business at the time of the seizure). On examining him more at leisure, I found the systolic bruit (which was soft) was audible over the apex and also over the left auricle. The condition was one of mitral incompetence with hypertrophy.
I now learned that for some time past he had noticed a shortness of breath or going up stairs, and three months before he had turned faint suddenly and been compelled to sit down. I continued the Ignatia, and I may say that ever since it has been a very good friend to my patient. He never goes anywhere without a bottle of pilules of the medicine in the same strength, and whenever he has any sensation of weakness about the heart, whether induced by worry or by over-exertion, a few doses soon put him right. He has never had a fully developed attack again.
He is fair, and of a very sensitive temperament, and easily affected by worry, but active and muscularly strong. To return now to my journal:.
April 14th.-Had a slight attack in the evening after talking. Dreamed much in the night; short breath on gong up stairs; head feels rather light; feet rather colder. Continue Ignatia.
April 16th.-Headache in occiput; fluttering sensation in left chest; faint trembling after walking; a little fever; much flatus downwards; thirst; lips dry. Arsenicum 1m every two hours. Ignatia if required.
April 17th.-Went for a walk yesterday, but could not go far. Dreamed much all night-muddled dreams. Tongue white; still thirsty. Bowels rather confined. Occipital headache on waking Tremor at heart. Repeat.
I need not follow out the case from day to day. There was another slight attack on the 20th, but by the end of the month the patient was able to return to his work. He had occasionally drawing or digging pain in his left side and at times a sharp pain, and headache remained troublesome. At one time he described it as a “floating weight” at the vertex. This was relieved by Act. rac. 1. On May 8th he complained of feeling a weight at epigastrium after food; sinking sensation comes after dinner and constipation. He received Sulph. 30, one pilule three times a day. After this he was practically well, Sulphur and Ignatia being the chief remedies he required.
Early in the following year he had influenza very badly, with pneumonia and pleurisy of the left side. The heart was not directly involved. The bruit was heard, though faintly. Sulphur was his chief remedy on this occasion. At present he is in very good health. If he over-exerts himself, especially when at work on great heights, as the roofs of London houses, he is reminded that he has a heart. I examined his chest quite recently, and fund this condition:.
Apex beat not felt. Area of cardiac dulness extends 2 1/2 inches to left of sternal edge. In pulmonary and aortic areas the first sound is soft; at the mitral area no bruit is heard, but the first sound is improve. This shows that the mitral valve has been restored to competence, though not to its normal state. The sharp, clear sound of the closing of healthy valves is wanting.
This patient has never had rheumatic fever or any illness to which the state of his heart could be traced. He has always been temperate. Eleven years ago he was very nearly killed by a brick falling on his head fro a building in course of erection; but this is the only illness of consequence that he remembers. I append his syphygmograph taken while sitting, March 21, 1893.
