XVIII NORTH AMERICAN JOURNAL OF HOMEOPATHY. Original Articles in Medicine. THERAPEUTICS OF HEART AFFECTIONS.* Des Moines, Iowa; Dean and Professor of Materia Medica in Iowa University Homeopathic Department. YOUR Professor of Theory and Practice has very clearly taught YOUR you by lectures, both didactic and clinical, the etiology, symptomatology, diagnosis and prognosis of the different affections of the heart. From what I have seen and heard, as I have attended your clinics and observed the result of his teaching, I feel you have mastered the first part of one of the most difficult subjects we have to teach. As I come before you to-day to present the therapeutics of the same subject I want to repeat at the outset what I have so often told you, viz.: get clearly in mind what you want to do. Your knowledge of the diagnosis and prognosis of these affections must make evident the following facts: First, that you must sometimes give something to assist a weak heart in doing its normal amount of work. Second, that you must give something to keep the heart going until some acute affection like pneumonia or typhoid fever has run its course. At another time you will want to give something to prevent sudden death during an exacerbation or complication of some chronic curable or incurable heart disease, and, finally, you will give a remedy with the expectation of effecting a complete and permanent cure. To put it in other words, you will want : First, to sustain a weak heart while it is performing its usual labor. *Written expressly for the NORTH AMERICAN. Second, to sustain a weak heart while it is obliged to perform extra or unusual labor. Third, to energize a heart which has suddenly weakened or failed to perform its usual or unusual amount of labor. Fourth, to arrest the progress of disease of the heart. Fifth, to cure any disease of the heart. As heart affections were divided into two general classes, functional and organic, so their treatment should be divided into two general divisions, palliative and curative, using the two words in the sense I have so often defined. When, after carefully examining the patient, you decide the case to be curable the treatment should be strictly in line with our law-similia. Should you decide the case to be incurable and the treatment palliative, your case may or may not be in line with our law. In my own experience in only about three cases out of five has our law been followed. I will not say should have been followed. I want you to get a clear conception of the aim and scope of these two metheds of treatment in order to prevent you from making unnecessary and often injurious changes of remedies which I have so often observed made in these cases. Under the palliative treatment changes are often necessary. Under the curative treatment changes are rarely necessary. Because my time is limited I shall use many pathological and physiological terms, asking you, as you have so recently studied the subject, to substitute for each term its proper group of symptoms. I shall take the remedies as they come to mind rather than classify them, as many of them may be used to secure any of the five objects stated above. DIGITALIS. The most frequently used as well as abused drug for heart affections is digitalis. Let me therefore get its picture clearly fixed in your mind. The cardiac muscle is completely relaxed. There is distention and dilatation, the result of a want of compensation. The beat is intermittent, not only that, but it is irregularly intermittent; it may be slow and intermittent, or rapid and intermittent. The veins are full, the arteries partially empty. The urine is scanty and you have edema of the lower extremity. There is dyspnoea and some anxiety. It may be used for any of the five objects mentioned. Now, a word as to the preparation to be used. If you simply want to affect the heart and do not care for its diuretic properties, give a drop of the tincture or five drops of the IX made from the same every two hours. But if you want the diuretic effect of the drug, give teaspoonful doses of a freshly prepared infusion every four hours. Student-Professor, how do you make an infusion? And what is the difference between an infusion and a decoction? Answer-You know the active principal of digitalis is obtained from the leaves. To make an infusion, take of the powdered leaves one drachm and add to it one-half pint of boiling water; let it stand till cool and to this add a teaspoonful of tincture of cinnamon. Infusion means the obtaining of the active principal by adding water; it may be either hot or cold. Decoction means to boil down in water. CONVALLARIA. A good second to digitalis is convallaria. The right heart is the one most affected. You have valvular stenosis. The ventricles are over-distended. Dilatation is imminent if not already begun and there is absence of compensation. As a result you have pulmonary congestion. The dyspnoea is marked; the patient is irritable, nervous, even to hysteria. The heart's action is feeble; the pulse soft and irregular; there is palpitation;the urine is scanty or suppressed; there is edema; the patient cannot lie down. Ten drop doses of the IX every halfhour until there is some relief, then every two hours. AGARCIN. Agarcin, though not extensively proven, has been used very successfully by prominent men of our school as a cardiac stimulant. Should you have the symptoms which I have given you as indicating digitalis and that remedy fails, give agarcin, 2 grains of the IX every two hours. Or should you have dilatation of the right heart or emphysema or congestion of the lungs due to mitral insufficiency and accompanied by profuse sweating, or in cases of threatening paralysis due to pneumonia, or typhoid fever, give agaracin for the above symptoms in lieu of either digitalis or strychnia. SULPHATE OF SPARTEINE. This remedy I find most useful for functional troubles. It has been of little help to me in cases where there is any organic lesion. It is more frequently indicated for women than for men. Take those cases of what may be called hysteria, when the patient complains of sudden sharp pain about the heart; when the pulse becomes small and feeble and the patient becomes unconscious or feigns unconsciousness. These cases seem alarming to the friends who demanded immediate relief. In some of these cases you have marked insomnia due to disturbed circulation. Professor William Boericke says: "In cases of albuminuria where digitalis fails or is contraindicated." Professor Cowperthwaite says: "Is especially useful in cases complicated with nephritis and where dropsy is an important feature." I have not confirmed either of these statements, but, on the other hand, have confirmed the statement of my friend, J. P. Rand, who says: "It has a pleasant effect upon the circulation and I have observed a slight hypnotic effect upon the nervous system." Also the statement of Professor Cowperthwaite when he says: "In those cases of nervous origin often hysterical when the general conditions simulate cardiac failure." Dr. Rand administers it in bread in ore-tenth of a grain dose. I have used it in the IX, giving two tablets or two grains every two, four or six hours according to the urgency of the case. CACTUS. I told you that if you were giving remedies for the purpose of palliation you might or might not be in line with our law. Let me warn you never to give cactus even as a heart stimulant unless the symptoms developed in the provings are present. The condition calling for cactus are the opposite of those calling for sparteine; i.e., it is useful for organic affections rather than functional. I have found, in two well marked cases at least, that it was useful when the symptoms calling for it had been produced by over dosing a heart already affected. Patient on whom I was operating behaved badly under the anesthetic and was given strychnia and whisky hypodermically. Frequently as she was recovering from the anesthetic she complained of constriction of the chest; that she could not get her breath; that the left side was being squeezed too hard. Shortly after I had left the hospital she "fainted" and the house surgeon-an old school physician-gave her a second dose of strychnia and whisky. Soon after, the third dose was given so that in all she had had one-eighth of a grain of strychnia besides the whisky. When I arrived the house surgeon told me it was "too late." The nurse, however, told me she was till alive and repeated the symptoms which I have related above. The only cactus I had in my case was the 3X. Of this I injected one dose of five drops in hot water, and every ten minutes thereafter put three drops upon her tongue. The result was a complete restoration to her former condition. This was two years ago and she has remained the same ever since. In all cases requiring cactus I have found that characteristic "symptom constriction as by an iron band," among such symptoms as cold sweat, violent palpitation, attacks of suffocation and inability to lie down. STRYCHNIA. Strychnia comes nearer being a pure and simple heart stimulant |