Pericarditis And Endocarditis in a man of 17

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Dr. Edward C. Chepmell permits us to follow his reasoning as he treats a man of 17 for pericarditis and endocarditis

Feb., 1846 –   Mr. Henry C , aged seventeen, of sanguine temperament, was laid up about two years ago, when at school in the country, with a very serious attack of rheumatic fever, in the course of which a metastasis took place, and inflammation of the heart and its membranes (pericarditis and endocarditis) supervened. The usual depletory measures of those days, bleeding, blistering, and leeching, together with the exhibition of sudorifics and mercurials, were prescribed by his medical attendants and, as it not unfrequently happens in such cases, recovery took place at the expense of an organic affection of the heart.*

Ever since that period, he has been affected with dyspnea and distressing palpitation of the heart, when walking fast or ascending a height. The heart’s action becomes tumultuous upon the slightest excitement, whether moral or physical, attended with violent throbbing of the carotids and determination of blood to the head, and at times also with severe darting and aching pains in the left infra-mammary region. These symptoms occasionally come on when lying in bed at night. In the daytime, he is subject to insuperable drowsiness, especially after meals or during the hours of study, so that often he cannot read for half an hour at a time without falling asleep. Frequently he complains of severe frontal and temporal headache of a congestive character, with cerebral confusion and marked disinclination for either mental or physical exertion. His face is very red and puffed  lips tumid ; there is also a general flabbiness and puffiness of the whole frame, which is accompanied with coldness of the extremities, especially of the lower, arising from the unequal distribution of the circulation; digestive functions weak, epigastric soreness and aching, alternations of constipation and diarrhoea. Pulse 90, variable in strength. He is very soon fatigued, and his spirits, in general, are very much depressed.

Thoracic examination. — Heart’s impulse strong and tumultuous: a loud bellows’ murmur accompanies the first heart-sound, which is heard loudest intermediately between the middle and upper third of the sternum, and also in the carotids. Percussion is dull over too great a space, so as to convey the idea of hypertrophy, in addition to that of obstruction of the aortic semi-lunar valves, which the stethoscopic signs would seem to indicate.

His diet is simple, and he takes no stimulants. Latterly he has abstained, in a great measure from animal food, by the advice of an eminent physician, to whose care he had been transferred, as soon as he was sufficiently recovered from his acute attack to return to town, where he has since continued to reside. He has lately taken a great quantity of mercury, from which he seems to have derived no benefit, but rather the contrary.

PrescriptionBryonia alba, three globules, twelfth dilution and, after an interval of four days, Lycopodium., three globules, thirtieth dilution.

Diet : Light animal food (such as game, chicken, and mutton), in moderation, three or four times a week ; with fish, macaroni, and other farinaceous food on the intermediate days.

Regular exercise, short of fatigue

Clinical CommentsBryonia was prescribed with a view to the origin of the disease, on account of its action upon the digestive organs, the cerebral circulation, and more especially upon the heart. Among its pathogenetic effects will be noticed a similar congestion of the head and face, with puffiness of the face, and darting pains in the left sub-mammary region, with increased action and impulse of the heart during motion, not to mention the moral and other symptoms. It is much indicated as a remedy in those constitutions which are subject to membranous inflammation.

Lycopodium is one of the best antipsorics in such a case. It was indicated by the moral symptoms, the state of the brain and digestive organs, but especially on account of its action upon the heart, and as being antidotic to mercury. One of its pathogenetic effects is to cause a violent disturbance in the heart’s action when lying in bed at night, which was also a characteristic feature of this case.

March 6.  Is better, and complains of less palpitation. Breathing freer and headaches less troublesome. The shooting pains in the region of the heart are also less urgent, spirits improved, and the general strength has increased. He mentions that Bryonia caused much aggravation, which continued for two days and that since he took Lycopodium he has felt such an increase of the drowsiness that he could sleep all day long.

His bowels had acted more regularly but, within the last few days, he has suffered from diarrhoea, brought on by exposure to sudden changes of temperature. At present the evacuations occur five or six times in the course of the day, consisting of loose, liquid, light coloured slimy stools, and are voided without pain. Tongue white coated; appetite indifferent, absence of thirst, fluent coryza, with fullness in the frontal sinuses. Pulse 88.

Prescription — Pulsatyilla three drops, third dilution, in doses of a sixth part every four hours.

Diet : light farinaceous food for a few days.

Clinical Comments: — Pulsatilla was prescribed with a view to its action upon gastro-enteric and nasal mucous membranes. The diarrhoea, which is recorded in the pathogenesis of this remedy, is characterized by absence of thirst, and is usually unattended with colic or tenesmus, as compared with that of Chamomilla, Verbascum, Arsenicum, and Mercurius Sub. Corr.  It is chiefly adapted, as an intermediate remedy, to the treatment of the affections of persons of a mild and timid disposition, and of lymphatic or nervous-lymphatic temperament, more particularly of those who are subject to mucous fluxes. As a medicine, it likewise exerts a powerful influence upon the heart’s action.

March 8.  The diarrhoea soon abated after a few doses of the Pulsatilla had been taken; it has now entirely ceased. He feels less drowsy and is free from headache. The heart is easier. Pustular eruptions have broken out upon the face.

Prescription — Arsenicum Alb., three globules, thirtieth dilution, four nights hence.

Clinical Comments: — Arsenicum Alb. exerts a powerful action upon the heart and blood-vessels (especially the veins), as well as the serous membranes.  On referring to its pathogenesis, we shall find, “violent and insupportable throbbings of the heart, especially at night when lying down;” also, “irregular beating of the heart, with anxious countenance, and irregularity of the radial pulsations.” The exhibition of this antipsoric was indicated to support the vital powers, which had been depressed for so long a period and also on account of the tendency to serous infiltrations, manifested by the chronic puffiness and flabbiness of the external cellular texture.

March 28. Has lately suffered from headache, which supervened upon an infraction of the dietetic restrictions, namely, in taking wine. General health, however, is improved ; extremities warmer, bowels regular , pulse full, face very red.

Prescription — Nux Vom., three globules, twelfth dilution and, after an interval of four or five days, Phosphorus, three globules, thirtieth dilution.

Clinical Comments:  Nux Vom. was exhibited with a view to the dynamic neutralization of the effects of the stimulant, and on account of its action upon the general circulation.

April 16. No longer suffers from headaches; the puffiness and redness of the face have in great measure subsided and palpitation is less urgent. The breathing is much more free, so that he can now go up stairs without inconvenience. The circulation appears to be more equally distributed, and a consequent increase of firmness in the fibrous tissues has taken place generally. The heart’s impulse is less strong, and the bellows’ murmur is not so loud. The bowels act once a day; stools rather loose, but normal otherwise. Pulse 84, more regular.  Upon the whole, he feels better and stronger than he has ever done since his imperfect convalescence from the rheumatic fever. Moreover, he takes regular exercise with ease and comfort to himself, and can now go on with his studies.

Prescription — Lachesis, three globules, thirtieth dilution.

Clinical Comments: — The exhibition of Lachesis was suggested by its decided action upon the heart, also on account of the tendency (manifested in this case) to chronic relaxation of the intestinal canal, very similar to that which it produces pathogenetically and as an efficacious mercurial antidote. The extensive range of action which this remedy possesses entitles it to a high place among the most energetic of the antipsorics.

May 6  –  Feels better and stronger. Heart’s impulse less, spirits good. The bowels have acted regularly and normally in every respect, with the exception of a very slight return of the relaxation a few days ago.

Prescription: Arsenicum Alb., three globules, thirtieth dilution.

May 29. Continues to improve, and takes plenty of out-door exercise. Small pustular eruptions have come out all over the body, and also upon the face. Pulse 92. Has felt rather drowsy lately.

Prescription — Sulphur., six globules, 800th dilution, in doses of a sixth part morning and night and, after an interval of two days, Sulph three globules, 800th dilution, at a single dose.

June 18. Fresh eruptions continue to come out as the old ones disappear. Within the last few days he has experienced great drowsiness and his sleep has been heavy and stupor-like. Heart much less troublesome; bellows’ murmur very much diminished. Pulse 82.

Prescription — Opium, three globules, thirtieth dilution and, after an interval of three days, Sulphur, three globules, thirtieth dilution.

Clinical Comments: — Opium was given on account of the great drowsiness and stupor and also as an intermediate remedy, with a view to awakening the sensitiveness of the organism to the action of an appropriate antipsoric.

July 4. Continues to improve in every respect. The puffiness and congestion of the face are, comparatively speaking, but very slight, and the drowsiness is no longer distressing. He very seldom experiences pain at the heart; the bellows’ murmur is now only heard when the circulation has been disturbed by over-exertion or great moral excitement, and even then only in a slight degree. He has resumed his former habits of bodily activity, and enjoys good spirits.

Prescription — Nux Vom., three globules, twelfth dilution then, after an interval of four days, Arsenicum Alb., three globules, twelfth dilution ; and, lastly, after a further interval of four days, Arsenicum Alb., three globules, 800 th dilution.

Clinical Comments — This case (or rather a portion of it) is given in order to exhibit the degree of relief which it is within the power of the physician to afford, in the treatment of these serious structural diseases, even in a very short space of time, provided only that he will condescend to be “the servant of Nature,” and take her for his guide.  It can scarcely be doubted but that the increased action of the heart (if Nature’s language admits of any interpretation), in such cases, is induced only with a view to the best distribution of the circulation which the actual state of things, under these adverse circumstances, admits of. Hence the advantage of gentle remedial stimulation in sympathy with the vital efforts.

In the treatment of these and similar cases, moderation in diet must be insisted upon to prevent local plethora, as well as abstinence from those stimulants which act upon the heart, and tend to disturb the harmony of its ordinary functions. All sources of moral or physical excitement, which are likely to cause an unequal distribution of the blood, and thereby to favour its accumulation in sensitive organs (e. g., the heart and brain), should also, and for obvious reasons, be avoided.

March 5, 1847. — The treatment has been continued since last July. The patient has, during this interval, grown very much, and his physical development has been very rapid,; notwithstanding his strength has continued to increase, and he has felt so well that he has occasionally remained a month at a time, and latterly nearly two months, without medicine. The antipsorics prescribed from time to time, generally in the highest dilutions (200ths and 800ths), have invariably produced a constant succession of numerous small pustular eruptions.

Clinical Comments  — The remarkable effects of these last remedies, with regard to the modification of that constitutional state upon which the seriousness of the original disease, and of its after consequences, in some measure depended, tend to confirm the correctness of Hahnemann’s psoric theory.

The permanency of the organic disease of the heart was, however, owing to that partial “bankruptcy” (if I may be allowed the expression) of the vital resources which had been induced by the injudicious measures of depletion and drug derivation adopted at the outset, to which allusion has already been made.  It is owing to the abuses of this kind, so commonly sanctioned and enjoined by our medical “fathers,” that not a few of the younger and better instructed physicians of the present day have become “ thorough skeptics” in medicine. Blinded by the flood of light which has recently been shed upon the malpractices of ages, they can no longer discern what always has been, and ever will be, true and valuable (although of less general application than direct dynamic medication) in the allopathic and antipathic methods.

Excerpted from: Hints for the Practical Study of the Homoeopathic Method

In The Absence of Oral Instruction: Cases for Clinical Comment, Illustrative of the Mechanism Of Disease, And Of The Treatment. – Edward C. Chepmell, M.D

About the author

Edward Charles Chepmell

Edward Charles Chepmell, M.D was physician to the Hahnemann Hospital, physician to the Islington Homoeopathic dispensary and a member of the British Homoeopathic Society. He was author of A Domestic Homoeopathy and Hints for the Practical Study of the Homoeopathic Method. Circa : 1815

3 Comments

  • Thank you Alan, again.
    Interesting series of prescriptions and excellent explanations for remedy indications.

    The observant physician following up a case as it evolves towards cure.
    A constitutional prescription along side makes a major supportive difference though …

  • Alan, is is possible to order this book?

    Excerpted from: Hints for the Practical Study of the Homoeopathic Method

    In The Absence of Oral Instruction: Cases for Clinical Comment, Illustrative of the Mechanism Of Disease, And Of The Treatment. – Edward C. Chepmell, M.D

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