Diseases of the Organs of Circulation.
Inflammation of the Membranes of the Heart.
SIMPLE endocarditis or inflammation of the lining membrane of the heart is always associated with some other affection, chiefly with rheumatism. Pain in the region of the fifth rib, sometimes extending down the left arm, a feeling as if the heart were being squeezed, oppressed breathing and palpitation are the commonest symptoms, and when the inflammation is of a malignant form they are all much more pronounced, with increase of temperature, and many symptoms like those accompanying typhoid fever. It is a difficult disease to diagnose, and a layman can only go by the general symptoms.
Pericarditis, or inflammation of the membrane covering the heart, has symptoms similar to those just given, and though the pain is very distressing in some instances, it is often felt more as a sense of uneasiness or oppression. In pericarditis, with secretion of a serous, watery fluid there may be chill, fever, pain, rapid breathing, nausea and vomiting, or sometimes in children, no early local symptoms, but, after a week or two of failing health, slight fever, shortness of breath and increasing pallor, fluid will be found to be present. There is then bulging of the chest, rapid, weak pulse; a dusky, anxious countenance; difficult breathing, and later, if pus forms, there will be erratic chills, sudden rise in temperature; cold sweating; rapid, feeble pulse; diarrhea; great prostration, and muttering delirium. The physical signs in these diseases are given on pages 314 and 315. Both endocarditis and pericarditis have a chronic, as well as an acute form. If a remedy is well selected in accordance with the majority of the symptoms present, it will act effectually whether the prescriber is able to say whether the case is one of endocarditis or pericarditis.
Aconite. Acute cases, especially when complicating acute rheumatism; there may or may not be fever; great anxiety; restlessness; pain about the heart extending into left arm, and if rheumatism is present, pain and swelling of the joints.
Spigelia. Pain and violent action of the heart are its chief characteristics; violent palpitation; severe stitching or stabbing pains; great oppression, the least motion almost producing suffocation; irregular pulse; no effusion.
Veratrum Vir. Very violent, forcible action of the heart in full blooded, non rheumatic patients, with full, bounding. but not necessarily a quick pulse.
Colchicum. Acute rheumatism where there is sudden shifting of the disease to the heart, with severe, tearing pains in the heart; threadlike pulse, small and rapid; great oppression, and difficult breathing.
Bryonia. Pericarditis complicating pleurisy or pneumonia, and in rheumatic endocarditis with inflammation of the valves causing valvular murmurs; intense headache in forehead or back of head, worse on the slightest motion.
Arsenicum. In pericarditis, with effusion of fluid; restlessness and anxiety; suffocative attacks; violent and irregular palpitation; cold surface; thirst; fear of death; also in endocarditis when the case is serious, with the above symptoms, and great prostration.
Also Digitalis in the later stages of inflammation, with feeble, irregular, fluttering, intermittent or very slow pulse, much worse on changing position; feeling as if the heart stood still; lips blue; great anxiety, but no restlessness. Belladonna in the early stage with great congestion, flushed face; bounding pulse; throbbing arteries in the neck, especially in children.
Rest and quiet in bed should be enjoined; the use of flannel blankets instead of cotton sheets; or a light cotton jacket or flannel shirt; a light, nutritious diet without tea or coffee; no stimulants unless heart's action is feeble, then whiskey, brandy or strychnine, 1100 of a grain; hot, light compresses placed above flannel over the heart, an occasional warm bath, temperature 1000; do not let the patient make any exertion.
Hypertrophy and Dilatation of the Heart.
HYPERTROPHY is an enlargement of the heart by actual increase of the muscular structure causing thickening of the walls of the heart. Dilatation consists of an increase in the size of one or more of the cavities of the heart, with either thickening or thinning of its walls. Both affections are common, and often coexist. Any condition which prevents the heart from doing its work is a cause of enlargement, as overexertion, making the heart work too hard; overexcitement; excesses in food or drink; sexual excesses; diseases of the valves; weakening of the heart by poor nutrition, infectious diseases, etc. In hypertrophy, the weight of the heart may be increased from the normal, about nine ounces in men and eight ounces in women, to even forty or fifty ounces, but rarely above twenty ounces.
The symptoms and physical signs are given in the larger section on diseases of the heart, earlier in the book. Attention is called to the fact that the following remedies should be consulted in cases where it is known that there is valvular disease of the heart, that is, where the valves do not close properly.
Aconite. Hypertrophy of the heart with acute attacks of violent palpitation, with great anxiety and restlessness; pulse hard and strong; constriction of the chest, difficult breathing.
Digitalis, I x. Heart's action weak; pulse small, weak, irregular and intermittent; feeling of anxiety about the heart; oppressed breathing as if there was a "want of air"; faint, sinking feeling in the stomach; especially valuable in bad cases where the valves are affected, and there are dropsical symptoms. Five drops several times daily. Strophanthus may be used in its place when digitalis does not give satisfactory results, or where it disturbs digestion.
Cactus. Constriction of the heart as if bound by an iron hand; palpitation of the heart day and night, worse when waking, and when lying on left side, brought on by any excitement; sometimes acute stitching or shooting pains.
Arsenicum Iod. Suffocative attacks on slight exertion; pain about the heart; weak heart action; rapid, irregular pulse; general weakness, prostration, and restlessness; nervous irritability; especially in chronic cases, with disease of the arteries.
Also Arnica in cases due to overstrain and over fatigue. Rhus tox. in hypertrophy of the heart, without valvular disease; in rheumatic subjects who have overexerted themselves. A dose of the indicated remedy every half hour to three or four hours.
The rest treatment is very desirable in these cases, and at least the avoidance of all excitement and worry; no tea, coffee or alcohol, rich or fried foods, or effervescing drinks; avoid an excess of fat, sugar or starch in the diet; eggs, milk, fish, rare beefsteak, chops, well cooked fruit and the lighter vegetables are allowable; do not make any quick movements, as to catch a train; retire early; rest before and after meals; do not overeat; quiet walking is the best exercise; no active games are permitted; fresh air is essential; keep the bowels and skin active.
The Bad Nauheim or Schott method of treatment is highly recommended.
Palpitation. Weak Heart. Anemia.
MANY times in connection with indigestion, convalescence from long sickness, working or studying too hard, and getting run down, palpitation of the heart or irritable heart will be an annoying condition when there is no change whatever in the heart's structure. At puberty, with impoverished blood, and at the change of life the same condition may be present. Tobacco, alcohol, sexual excesses, and excitement are frequent causes of palpitation. While the treatment is largely hygienic, remedies will greatly aid in restoring the normal tone of the system.
Ferrum .Bloodless subjects; palpitation, with feeling of oppression about the heart; full, soft pulse; frequent flushings of the face.
Nux Vom .Palpitation from indigestion; worse after eating; from highly seasoned foods, tea, coffee, tobacco and alcoholic liquors; sedentary habits; too much study or too close application to business. Consult the symptoms under "Dyspepsia."
Glonoine. Violent palpitation or fluttering; pulsation felt over the entire body; from working before a furnace or being out in the sun.
Also Aconite when palpitation is caused by fright or shock, with anguish and anxiety. Moschus. Hysterical palpitation. Ignatia. Palpitation from grief or suppressed emotion; melancholy; excessive tea drinking. China. After long illness, exhausting diarrhea or monthly flow; much flatulence. Spigelia. Violent, nervous palpitation, with irregular, tremulous action of the heart; oppressed breathing, and sharp, shooting pains. Coffee. After great joy or other excitement; sleeplessness. A dose of the indicated remedy every fifteen minutes to two or three hours,
Neuralgia of the Heart. Angina Pectoris.
BREAST PANG is a familiar name for this affection which is characterized by paroxysms of intense pain in the heart, under the breast bone, to the left and usually extending into the left shoulder and down the left arm. Frequently angina is associated with some organic disease of the heart or arteries, but often nothing of the kind can be found. True angina occurs more often in men than in women, and after the age of forty. The paroxysms seem to be excited by cold, violent exertion, mental excitement, indigestion, the excessive use of tobacco, and last from a few seconds to two or three minutes or even longer. The pain is excruciating, and accompanied by a horrible sense of suffocation; the face is pale, cold, and clammy, the expression one of agony and terror; the pulse varies, and may be feeble and irregular, and death may ensue or the attack pass off with belching of gas or vomiting. Attacks simulating true angina occur in hysterical persons, but the pain is less intense, more diffused, and lasts longer.
Aconite, 1 x. Attacks following exposure to cold, with intense anxiety, coldness, pain at the heart radiating in every direction, with numbness and tingling,
Arsenicum, 3 x. When the disease is of purely nervous origin, with debility and prostration, severe suffocative attacks; feeble and irregular pulse. A dose three times a day between the paroxysms.
Spigelia, 2 x. Violent palpitation; severe stabbing stitches in the region of the heart at every beat; irregular pulse; tendency to faint.
Cactus, 2 x. Sensation of great constriction, as of an iron band about the heart; irregular action of the heart; palpitation; pain in heart shooting down left arm to the finger tips.
Amyl nitrite perles, containing three to five drops each can be obtained at any large pharmacy, and one may be crushed in one's handkerchief, and the vapor inhaled to relieve the pain, etc., of a severe attack, or the inhalation of oxygen will give relief. In mild attacks frequent doses of the indicated remedy may be given, and its use continued three or four times a day for weeks at a time to improve the constitutional condition. The general health must be improved by all hygienic and dietetic measures. The spinal ice bag applied to the middle of the back for forty minutes, once a day, has proved curative; electricity is beneficial. During an attack the clothing should be loosened, and hot fomentations applied over the heart.
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