REMEDIAL POWER OF HOMOEOPATHY IN CASES OF CHRONIC HEART DISEASE.
WHEN once the muscular fibres of the heart have become weakened, so that the organ is no longer able to discharge its functions without effort, no matter what the cause of the weakening may have been, the symptoms are very similar-breathlessness and palpitation on the slightest exertion, inability to lie down flat, or to lie on the left side, pains in the heart of many kinds, and varying in intensity from very slight to the agonies of angina pectoris. These symptoms occur in chronic cases of valve disease, in cases of fatty degeneration of the muscular fibres of the heart, in accumulation of fat about the heart when it is an accompaniment of general obesity.
I will now relate a number of cases, all more or less chronic, in which chronic affections of the heart were materially and permanently relieved by homoeopathic treatment. I will first give some of the earlier ones from the series treated with Iodide of arsenic. Some of these cases are defective as therapeutic observations in that more than one medicine was given on the same day, but in spite of this I think it is possible to determine the action of the medicines given.
CASE XI.-MITRAL STENOSIS AND INCOMPETENCE WITH ANGINA. CO- EXISTENCE OF NASAL POLYPUS. PRACTICAL CURE WITH Iodide of arsenic AND OTHER REMEDIES.
Mrs. McC, age 52, rather above medium size, grey eyes, dark hair, thin, rather pale, consulted me April 22nd, 1882. She was taken ill in Scotland the previous July. She went to bed one night quite well, and woke up with a feeling as if the ribs were being pressed into the heart; for thirty-six hours was in agony. It was a month before she was well enough to travel to London. She still has the same sensation (of pressing-in of the ribs) and palpitation at the same time. Has had two or three attacks since that in July, but not so severe or long-lasting. Has frequent severe palpitation and rush of blood; is faint after the attack. In the night she wakes with a feeling of going over a precipice. If the feeling comes on when she goes to bed she cannot sleep at all and has to be propped up. She cannot go upstairs or exert herself, as it brings on pain in the side-not the pain at the heart; that comes on when she is quite calm and still.
She has a cough night and morning and raises much phlegm. Has to be very careful with her diet. Never was strong; for ten years attended the Victoria Park Hospital for Consumption. Had her right arm broken twice, at six and at sixteen.
Since the second break has had rheumatism in the arm, but never had rheumatic fever. On this day I had not time to examine the chest thoroughly, but I took the following sphygmogram, and told her to return in a week.
The sphygmogram taken on this day is of great interest, the beat being apparently triple. The beat, however, is not really triple. The first figure represents a natural beat. This is followed by a double beat, the secondary pulsation being so slight as not to be perceptible to the finger on the pulse. The second and subsequent sphygmograms show only double beats until, under treatment, the beats become quite normal and regular.
April 29th.-She reported that she had a very bad cold, and was coughing much; the cough being in fits. She raised a good deal of phlegm at night. Pulse 46.
I was now able to make a complete examination of the chest, with the result that the heart was found much enlarged and the valve action defective. Subsequent examination showed that it was the mitral valve which was at fault, being narrowed and incompetent. There was some anaemia, and some consolidation of the apex of the right lung. Here are the particulars of the examination on that date :-
Vertical dullness begins at lower border of third costal cartilage. Transverse dullness at level of fourth costal cartilage extends two and a half inches to the left of the sternum. This part is bulged forwards. The apex beat is felt, but very faintly; the impulse is felt near the sternum.
Sounds : regularly irregular. One strong beat is felt, followed by two smaller ones which make no impression on the pulse at the wrist. Sometimes there is a soft systolic bruit, and at the tricuspid area a rough bruit apparently diastolic. The heart-sounds are clear at pulmonary and aortic areas. Bruit de diable in neck.
Lungs : dullness and slight flattening with increased vocal resonance and fremitus at right apex exaggerated expiration.
Treatment Arsen. iod., gr. ij, night and morning after food; Digitalis I, one drop in water three times a day.
May 6th.-First part of week worse; twice she fainted right away, but last part of week much better, less fluttering, less flushing; cough looser.
Examination.-The secondary beat is felt like a thump at the apex, where a soft systolic bruit is heard with the primary beat; it is heard nowhere else. The region of the apex is very sensitive. Repeat medicines.
May 20th.-She is very much better; has not had the heart so quiet for months, only has palpitation now when called suddenly, and that only slight. Appetite good, but she cannot take meat.
Examination.-Action of the heart quiet and regular, but instead of the two sounds three are heard; after the systolic comes the diastolic and then a sort of rebound. With the systolic sound, in the mitral area and over the third left costal cartilage a soft systolic bruit is heard.
This is not heard with the third sound, and it is not heard to the right of the sternum. In the aortic area the first is very feeble and the second stronger. In the pulmonary area all three sounds are heard, but not the bruit. Repeat.
June 3rd.-Keeping very much better. Phlegm hard to raise.
Examination.-Lungs: prolonged expiration both apices and increased vocal resonance, the latter most marked on right side, with increased vocal fremitus. Heart-sounds much steadier, there is a thump with the first sound; a presystolic bruit can now be distinctly made out in mitral area; no apex beat is felt; cardiac dullness extends from half an inch to right of sternum five inches across.
Treatment Kali bich., 3; one drop to be taken occasionally when expectoration was difficult. Otherwise the same medicines to be continued.
After this I did not see the patient again for over a year. She returned on August 25th, 1883. Her condition on this date was as follows: Pulse82, has no pain at heart now, though she feels it weak and is faint; there is a presystolic thrill.
She came now to consult me on account of blocking of the nose and loss of taste and smell. I discovered a polypus in each nostril, the right the larger. Eighteen years before she had had polypus, which she said was burnt.
Arsen. iod. 3x was given night and morning; Thuja 3x, one drop in water four times a day; Thuja 0 to be applied with brush three times a day.
September 8th.-Heart better, pulse 76. Not so faint and low. Tastes better, can smell sometimes. Sleep poor. Repeat.
September 19th.-Unable to sleep since 15th; has the “falling” sensation; continual fidgeting with the limbs. Pulse regular.
Treatment Actea r. I, one drop four times a day; Coffea 3, one drop every hour if sleepless; Thuja 0 to be applied.
October 3rd.-Very much better. Sleep good after three days; fidgetiness better; nose better-less stopped. Repeat.
October 24th.-Very much better generally, can smell now and then.
November 14th.-Very much better; smells quite well, tastes better, sleeps well. Repeat.
December 5th.-Very much better as regards the polypus, it gives no inconvenience now. Heart troublesome again; sleep not so good. Has pressure on the back of the head. The application of Thuja now causes pain.
December 29th.-In the early part of this year she had a great shock-the news of the wreck of a ship on board of which she had a son. She was for many days in suspense as to his fate, but learned at last that he was among the saved. She does not think she has been well since the shock. She has nausea after all food. Tongue white; bowels confined. Has pain in the side. Nose fairly clear. Presystolic still heard, only faintly, at apex. Pulse a little irregular; cough in fits; sleep bad till she used Coffea. Thuja still causes pain.
Treatment Arsen. iod. 3x, a grain night and morning; Ignatia I, one drop four times a day; Thuja application.
January 12th, 1884.-Very much better. Had a faint on December 31st, but much better on the 2nd and has continued so. Bowels rather difficult Nose a little stopped; has flushes. Repeat.
February 23rd.-Says she is “pretty well,” the polypus is the worst of her troubles. Is losing taste and smell; has rheumatism in left foot and arm.
Treatment Thuja 3x, one drop three times a day; repeat Thuja locally, and Arsen, iod. night and morning.
March 12th.-Better; nose better, tastes better, has little pain. Repeat.
April 12th.-Has neuralgia; nose pretty well, has been able to smell for the last fortnight.
Treatment Spigelia I, one drop four times a day.
This case was two years under observation. The patient came originally for an opinion merely, not expecting to receive much benefit, as she knew she had heart-disease and considered it hopeless. She was restored under treatment to activity and comfort, and I ascribe the chief share of the credit to the Iodide of arsenic.
In the case I shall now relate there will be less room for doubt as to the drug which worked the cure as the treatment was less complicated.
By a curious coincidence this patient also came to be treated for polypus.
CASE XII.-EXTENSIVE VALVULAR DISEASE. PRACTICAL CURE WITH Arsen. iod. POLYPUS OF THE NOSE.
Wm. B-, age.26, cabinet maker, rather below middle size, but well made and well nourished, pale, came under my care May 26th, 1883, for polypus of the nose. He was treated with Thuja internally and locally, and received much benefit, the polypus diminishing much in size and ceasing to give him trouble. He continued to attend at long intervals.
May 5th, 1884.-He complained that he felt ill in himself and was low-spirited, and suffered from giddiness. He attributed it to having three stumps taken out under gas about Christmas time.
no proper sounds, all being replaced by bruits, the heart itself being much hypertrophied. I gave him Arsenicum iod. 3x, two grains night and morning after food, and continued the application of Thuja.
May 17th.-He expressed himself as much better generally, and gave a like report on the 31st.
On the 28th of June the improvement was still maintained, though he had not had medicine all the time. Repeat.
On July 28th he was quite free from any symptoms relating to the heart.
The first (left) sphygmographic tracing shows the aortic collapse and rebound. The other tracings, taken the same day on the right side, show this peculiarity less marked. A further sphygmogram was taken on July 26th, and the tracing was much more like a normal one. The heart sounds remained the same.
In this case the steady improvement in the heart’s condition can only be attributed to the Iodide, as this was the only new element introduced into the treatment.
On the 26th of July the above tracing was taken.
CASE XIII.-DISEASE OF THE MITRAL VALVE. GREAT DEBILITY, EDEMA OF FEET. ACTION OF Iodide of arsenic.
A lady, age 58, tall, very dark, blue lips, nervous, consulted me in September, 1883. From six months old had been subject to ague. She had married rather late in life, had had no children, and had been a widow some years when she consulted me. Had never had rheumatic fever. Fifteen years before had had scarlet fever and inflammation of the lungs. Her breathing had never been quite as good since, but she only noticed distinct difficulty for six years. This had been much worse for two years. A few days before consulting me (September 17th, 1883) she had an attack of diarrhoea. This was stopped by brandy, and immediately a “cold” in the chest came on, cough hard and dry, unable to raise anything. She feels as if the windpipe were twisted and knotted, and crows with the difficulty she experiences as if she had whooping-cough. She feels very weak; is unable to walk more than a short distance, and not at all if there is a wind. The heart seems to stop and flutter. Sometimes she goes off into a kind of faint, but recovers very quickly. The feet swell about the ankles. Appetite poor; bowels confined. There is no tenderness about the larynx or trachea. The lung-sounds are feebler at left apex than right. There is a presystolic bruit.
She can sleep lying quite flat. Sleeps badly the fore part of the night, but well towards morning.
Treatment Digit. 0, one drop an hour before each meal and Arsen. iod. 1, gr. 1-20th, after food.
Three days after, she was very much better, lips less blue, expectoration easier. Much better generally. No alteration was made in the treatment. Her appetite improved, her walking powers returned, and on the 8th of October she considered herself quite well.
I will now give another case of Mitral Disease.
CASE XIV.-CONTRACTED MITRAL VALVE CLIMACTERIC SUFFERINGS. ACTION OF Arsen. iod. WITH OTHER REMEDIES.
Emma F-,age. 41, needlewoman, dark, sallow, nervous, consulted me on May 5th, 1883. She then complained of numbness and tingling in her right leg, and cramp in the right foot; numbness in arm. There was spasmodic action of the lower jaw, it closed with a jerk; (she never had had anything like this before). Had great pain in the right side of the head and burning at the vertex; the face flushed; she has pain in the back on waking. She had been ailing since the previous summer, when she had erysipelas and chronic rheumatism. The numbness had troubled her a fortnight.
The tongue was clean, bowels regular, appetite poor, sleep poor, catamenia not more than twice in the last twelve months. Pulse 102, small. She complained of her heart and breath.
On examination I found a thumping first sound, indicative of mitral stenosis, at apex. Lungs: right apex, exaggerated expiration; left apex, breathing feeble.
Treatment Arsen. iod. 3x, two grains night and morning; Ignatia3, one drop three times a day.
May 19th.-Her condition has varied; has now pains all about her, pressure at the top of the head; palpitation.
Treatment Arsen. iod., night and morning; Digitalis 1, one drop three times a day.
June 20th.-Better; no pain in left arm; has sparks before the eyes. Rheumatism; pain in the back. Tongue white, bowels much confined.
The eye symptom-“Sparks before the eyes”-is a strong indication for Spigelia. I have seen similar effects occur in patients taking Spigelia in a high potency.
Treatment Spigelia 3, one drop three times a day. Arsen. iod. as before.
July 4th.- Better. Bowels regular (I have again and again noticed this effect of Spigelia in relieving constipation in cardiac patients to whom I have been giving it). She has now no sparks before the eyes, but there is much numbness in right foot and leg. Repeat.
July 21st.-Yesterday had a bad attack; has felt giddy; breathing is difficult. Has much flatulence coming upwards, bowels confined.
Treatment Lycopod. 6, vice Spigelia.
September 25th.-Very giddy at times; flatulence very troublesome; catamenia have returned. Repeat. The following month she returned, complaining of pain through the left chest, for which she received Bryonia 3, one drop in water four times a day without any other medicine. The next fortnight this pain was better, but she complained of a choking cough rising in the throat, making her sick at times; the cough came suddenly whilst talking. She had numbness down the leg, and the bowels were rather confined.
Treatment Lachesis 6, Bryonia 3; every two hours alternately.
After this she continued in much better health till January of the following year.
January 16th, 1884.-For the last fortnight she has had pain round the sacrum, coming on between 4 and 5 a.m., and preventing her sleeping after that. She trembles all over, has low spirits; pain in the side of the head. Tongue white, lips parched.
Treatment Lachesis and Bryonia.
January 30th.-Pain round the back better, but the chest is giving much trouble-this comes on when she exerts herself.
She has a creeping sensation under the skin.
I now returned to the Iodide of arsenic, giving it night and morning and continuing the Lachesis three times a day. The next report was much more favourable, and the improvement was steady and rapid till she ceased to attend on the 15th of April.
There was a steady improvement both in the heart symptoms and the general condition whilst taking the Iodide of arsenic on the first occasion, though it was never given separately, and therefore the observation is not pure. On the second occasion the improvement was much more decided, and here, as the patient was already taking Lachesis when put on Iodide of arsenic, the increased rapidity of the improvement may fairly be attributed to the latter. The case was complicated by climacteric sufferings, but the signs and symptoms of heart disease were unmistakable.
CASE XV.-MITRAL CONSTRICTION WITH ANGINOUS PAIN. Arsen. iod., Naja.
Emily T,-age 43, dark, small, housewife, was first seen on May 31st, 1882, when she gave the following report. Has pain in left side and down left arm, has had it for three or four months; it came first eight years ago, then it took the whole side.
The pain is constant and does not depend on exertion. She has palpitation, but only when she exerts herself. She always has a little cough; much expectoration in the morning, none at night; coughing makes the pain worse. She cannot lift her left arm.
Her family history is as follows. Her father died of old age; her mother of consumption when the patient was born. Three of her children and her husband have died of consumption. Patient’s previous health has never been very good, but she has had no severe illnesses. A few months ago she had pain in the right side with retching, taking the strength out of her like labour pains.
The tongue was white, bowels regular, sleep restless. The catamenia had ceased three years. She suffered from flushes; had headache at vertex and across the eyes. The pain in the arms is relieved at times by motion; the arm swells at times. Examination of the heart showed the existence of stenosis of the mitral valve. Bryonia and subsequently Spigelia failed to give substantial relief.
June 28th.-Arm not any better.
I now gave her the Arsen. iod. 3x, 2 grains three times a day, and this, as generally happened, soon told beneficially on the general health, causing some improvement in the pain.
July 12th.-Feeling better generally, pain not quite so bad, breath much the same. Repeat.
Feeling better she did not return for six weeks.
August 23rd.-Arm has been better, but it is very painful again to-day. Repeat.
September 13th.-Arm better at times; for a few days it has been bad, it feels cold, aching is continuous.
Treatment Naja 6, every three hours. Arsen. iod. 3x, night and morning.
The next report was that the arm was much better. Repeat.
This was her last attendance. In this case the improvement was initiated by Arsen.iod. alone, but it did not give complete relief; this was left for Naja to accomplish.
It is remarkable how frequently disease of the heart is met with in patients with a strong consumptive history. This was exemplified in the case of Emily T-,and also in the one I will now relate. The power of Arsen.iod. to relieve many cases of phthisis may account for its wide range of action in cases of heart disease.
CASE XVI.-MITRAL INCOMPETENCE, DILATATION OF LEFT AURICLE, AND HYPERTROPHY OF RIGHT SIDE OF HEART.
Salome B,age. 38, single, housekeeper, dark, blue lips, attended at the L. H. Hospital on August 30th, 1882.
She complained that she felt ill in the morning, and could hardly raise herself from her pillow. Two years before she had “congestion of the liver” and now she feels just as she did then; she has a heavy pain in the left side, depression of spirits. She gets no rest, comes over faint, especially on walking. Has headache across the forehead and vertex on waking. Tongue clean, appetite poor, bowels regular, sleep bad, catamenia scanty, regular.
She has never been strong; her mother died of consumption; also one brother and one sister. Her father is living, but in poor health.
Examination.-Has scar of ulcerated gland on right side of root of neck. Lungs: apices clear. Heart: apex beat not visible, it is felt in the fifth space three inches to left of sternum. Vertical dullness begins in the middle of the second space. Transverse dullness at the level of the fourth costal cartilage extends one inch to the right and three inches to the left of the sternum. In the mitral area is a soft systolic bruit, heard also sometimes in the third space. The second sound is accentuated and occasionally reduplicated in the pulmonary area.
Treatment Arsen. iod. 3x, night and morning; Digitalis 1, three times a day.
The following fortnight (September 13th) she attended again.
September 13th.-The pain is rather better and also the palpitation; but she has taken a cold and (as is usually the case with her when she takes cold) had lost her voice. Repeat.
October 4th.-Better generally, voice better. She complains, however, that the medicine (Digitalis) makes her ill; it seems to make her heart palpitate. The palpitation and pain are worse than last time; she has pain between the shoulders. She has had some annoyance during the week.
R Ignat. 1x, four times a day. Arsen. iod. as before.
October 25th.-Not nearly so much pain; less palpitation. She has a sinking sensation sometimes.
This was her last attendance. There was a great improvement in her general condition as well as in the special symptoms. I ascribe the chief share of this to the Iodide. I am inclined to believe the patient was correct in attributing the aggravation of her symptoms to the Digitalis, and certainly the substitution of Ignatia was followed by very marked improvement.
Rheumatism and Chorea are fruitful causes of heart disease. In the case next to be related there was a history of epilepsy and stammering (which is itself a choreic condition) previous to the heart attack.
CASE XVII.-MITRAL CONSTRICTION IN PATIENT PREVIOUSLY EPILEPTIC.
Chas. H. S.-,age. 14, errand boy, dark eyes, light hair. This patient was treated by me in 1882 for epilepsy. The only medicine he received was Stramonium 3. I did not see him again until January, 1884. I then learned that he had never had a fit since his previous attendance. He stammered badly. This had been the case since he was three years old. It came on during dentition.
January 25th, 1884.-He now complains of pain at the heart and of being weak and nervous. If he breathes hard it catches him an he has to fight for breath. The pain is sharp, pinching, and constant. He is short of breath on going upstairs. All this came on nine months before, the pain preceding the breathlessness. It came quite suddenly; he was running to his work and the pain stopped him. Tongue white; bowels regular; sleep sound. He always has headache over the left eye.
I found on listening over the apex beat the characteristic thump of obstructed mitral; there was a faint venous hum in the neck. The heart’s action was not regular. The pulse was very small.
Treatment Arsen. iod. night and morning, and Digit. 1, one pilule three times a day.
He came back in a fortnight feeling much better. Has only had two attacks of the heart-pain in the fortnight. His stammering was rather worse. He received another supply of medicine.
I will now relate a case of heart affection of a gouty nature.
CASE XVIII.-IRRITABLE WEAK HEART IN A GOUTY SUBJECT. HISTORY OF OVER-STRAIN; ACTION OF Arsen. iod.
The patient was a lady, age. 66, short, very stout, florid. As a child she was delicate; in middle life her health was good except that she suffered almost constantly from supraorbital neuralgia. She had lived in India some years, and had very good health except very slight attacks of fever, which seemed to relieve her of the neuralgic pains. In 1854 she had cholera in Edinburgh. Had been a great walker.
In 1884, when she consulted me, I made the following notes :-Has gouty concretions about the joints of her hands, and her feet are deformed in the same way. Her present illness dates from six years back; she was climbing a hill in Scotland, and she felt at the time she had done too much; she thought she never would have got her breath again; she has never been right in her breathing since.
After this she had a cold and cough for six weeks; it is unusual for her to take cold-she loves air and open windows. (When I saw her she had had a cold in the head; this had left the head and gone to the chest). She complains of great dyspnoea in the night, and whistling in the chest, which keeps her awake; has a sensation about the heart as if something were nipping her there- this is confined to an area about the size of a crown-piece; then she feels as if passing away, but recovers if she is quite still. At times she has a sensation of fullness, as if something in the chest would burst. Exertion or worry will bring on cough. There is no swelling of the feet. Poor appetite. I found slight wheezing here and there in the lungs.
On examining the chest I found the second sound of the heart accentuated at all areas, the first sound very faint except at the apex; there was no bruit.
I gave her Carbo vegetabilis 6, every three hours for three days, and there was considerable improvement, which, however, was not maintained. I then gave her Kali carb. 6, an hour before meals, and Arsen. iod.1, gr. 1/10,in water, immediately after food. The improvement was marked and rapid; she could move about with more comfort, and the appetite improved. Four days after this I gave her the Iodide 3x, 1 gr. three times a day after food, by itself.
She kept much better and was able to leave town soon after.
Quite recently (1894) I learned from a daughter of this patient that she died a few years ago of cancer in the left breast.