Turning to mitral incompetence and want of compensa-
tion, I will begin with short notes of a case, which on
admission to the hospital seemed almost hopeless, bat left
with compensation w-ell established.
A. L.9 aged 26, female, admitted to the hospital June 5, 1896.
Discharged August 1, 1896.
History, — Had rheumatic fever at the age of 12 and a second
attack when 20. Was married at 21, when she was apparently
in good health, but at the birth of her only boy two years after-
wards became very weak and has not been well since. Suffers
from palpitation and dyspnoea, with swelling of the feet and legs.
During the last few days the abdomen has begun to swell, and
her general state was so much worse that she sought admission
to the hospital.
Condition on admission. — Was suffering from marked dyspnoea.
Mucous membranes were pale. Conjunctivae tinged yellow.
Complains of severe pain in left side of chest and behind shoulder
blade, there is also palpitation and orthopnoea on the slightest
exertion. Pulse rapid; very irregular both in time and force.
The praecordia is distinctly bulged. Apex beat is felt as low down
as the eighth left interspace and as far out as the mid-axillary
line. The whole praecordia is seen to heave with the pulsations,
and there is also pulsation in the epigastrium and vessels of the
neck. Auscultation reveals a blowing systolic murmur in the
mitral area well conducted round to axilla and the angle of the
left scapula. It is less marked towards the tricuspid area. No
murminrs at the base. The heart’s action is very rapid and
Respiratory system, — There is dulness on percussion at both *
bases posteriorly with diminished breath sounds, and vocal reson-
ance is also diminished. Moist crepitus can be heard at the
right base. Alimentary system, — Appetite is very bad and patient
suffers from constant vomiting. Abdomen, — There is marked
abdominal distension (measurement 39j inches) with prominence
of the umbilicus. The walls of the abdomen pit on deep pressure.
Dulness to percussion in both flanks, which shifts in position on
lateral decubitus. Well-marked fluctuation thrill. The edge of
the liver can be felt about two inches from the umbilicus; it
is tender to pressure but quite smooth. There is general anasarca
194 ON HEART DISEASE
of the loins, abdomen and lower extremities. Urine scanty in
quantity ; copious deposit of urates with trace of albumen.
Infusion of apocynum 5 i. every three hours was ordered.
The urine passed in the first twenty-four hours was 10
ounces, the next day 24, then 32. It fell again to 8 ounces,
and infusion of digitalis 5 i. every three hours was ordered.
With this it rose again to 32 ounces, but fell again to 14
ounces. So on June 15 strophanthus nt v. was given, and
under this steady improvement took place. The quantity
passed rose to 70 ounces and the dropsy passed gradually
away, and she was able to leave the hospital with compen-
sation well established.
The tracings will show the improvement in the pulse,
and the abdomen, which on admission measured 39 J inches,
was reduced to 29^ inches.
Action of Medicines in Deopsy.
It is now generally allowed by homoeopathists that to
obtain good results in cardiac dropsy, tangible doses of the
medicines have to be used. At a meeting of the British
Homoeopathic Society in July, 1896, there was an interesting
discussion on the question whether medicines like digitalis
and strophanthus given in large doses could be considered
to be homoeopathic in their action when used in cases of
Drs. Hughes, Dudgeon and others considered their action
was antipathic, while Dr. Dyce Brown was very strong on
the opposite side and quoted Professor Hale, of Chicago, in
support of his views. Dr. Hale appeals for the following
law of dose, viz. : ” That opposite pathological conditions
are caused by the primary and secondary effects of medi-
cines, that their effects may alternate, and that a strict
adherence to the law of similars should oblige us to take
cognizance of this dual action and select the dose in accord-
ance with such action. ‘
The essential question in homoeopathy is, I maintain.
ON HEART DISEASE 195
not the actual amouut of medicine given, but that the action
of the medicine should be similar and the amount given not
sufficient to aggravate.
In the provings of digitalis the action of small doses is cUoiMZ^
seen to cause at first increased frequency of the pulse, which
afterwards becomes feeble and irregular, while in poisonous
doses the heart’s action is at once slowed and soon paralysed.
No medicine is more used in heart disease than digitalis,
and in properly selected cases no remedy could act better.
There can be no question, however, that the use of the drug
is abused. To quote from an allopathic source : ” There is
probably no one drug in the Pharmacopoeia the promiscuous
use of which has done so much harm to the human race.”
The indications for its use are therefore of the greatest im-
portance. The cardinal symptom indicating it is irregularity
of the heart and pulse with low tension. A condition like
the case I have read you, hypertrophy and dilatation of the
ventricles with mitral regurgitant murmur and quick, feeble,
irregular pulse, is one typical of the class where digitalis acts
most beneficially, but in that patient, for some reason which
I cannot explain, it did not act so well as strophanthus. In
a similar condition, where there may be also aortic disease,
digitalis maybe of great service, but must be used with more
caution ; the reason for this I will refer to later.
Its diuretic action is hardly to be relied upon apart from
heart disease, but when heart disease is present its diuretic
effect as a rule is beneficial. I have said ” as a rule,” for
in certain cases digitalis gives no relief and is apt to be a
great danger.’ At first, perhaps, you get a diuretic effect
but very soon the opposite result takes place and the urine
is diminished. This is probably due to the action digitalis
has in causing contraction of the arterio-capillaries and
great tension, and a feeble heart is then being whipped up
against greater obstruction than it can overcome, and fatal
syncope is very often the result. It has often been noticed
that digitalis does no t act u ntil the patient has been well
purged, a good purge being a most effectual way of lowering
the general tension of the circulatory system.
In the discussion which I have referred to before on the
ON HEABT DISEASE
heart remedies, Dr. Neild, of Tunbridge Wells, was most
emphatic on the brilliant results he had obtained by pre-
scribing nitro-glycerine in alternation with digitalis. Nitro-
glycerine was in his opinion the complement of digitalis.
It acted antipathically, and corrected the main difficulty
with digitalis, viz., extreme tension and contraction of the
By preventing tension with these two remedies we
obtain a diuretic e£fect, and thus have all the good of digi-
talis without its evil results.
Dr. Neild believed with Dr. Dyce Brown that the action
of digitalis was frequently homoeopathic. In one of his
cases the patient had a rapid, irregular and very feeble pulse,
symptoms like a typical case of poisoning by digitalis as
shown in the ** Cyclopaedia.” There was a certain amount of
tension, the kidneys were scarcely acting, and there was
albumen in the urine.
He gave Burggraeve’s granules of digitalin, eight or ten
daily. The curious thing was that he had to give very
minute doses of nitro-glycerine. He usually began with
one drop of one in a hundred, but in that case he had
to halve and halve again and again this dose on account
of its physiological action, headache and flushing being
so extreme. The sixteenth of one drop of one in a hundred
was the antipathic dose that allowed the digitalis to act
homceopathically and cured the patient when apparently
The preparations of digitalis used are of great impor-
tance. For myself I prefer the fresh infusion to the
tincture, giving a drachm every three or four hours, but
directly the pulse becomes regular and the flow of urine is
established, the frequency of the dose is to be much
Strophanthus acts in heart disease by increasing the
force of the systole, at the same time that it diminishes the
rapidity of the heart’s action.
It has little or no effect upon the blood-vessels and
therefore causes less tension than digitalis, it also causes
less gastro-intestinal disturbance. It is not cumulative in
ON HEABT DISEASE 197
its effect and can be used in smaller doses than digitalis.
It is indicated in all cases of valvular disease where com-
pensation has broken down. In mitral regurgitation where
cedema and dropsy have supervened, its action is often most
marked, the heart being strengthened and slowed, the
respiration relieved and free diuresis set up. In the case
I have narrated the quantity of urine secreted rose from
10 to 70 ounces, but in some cases the flow may be as much
as 150 ounces in the twenty-four hours. In aortic stenosis
and incompetence where there is want of compensation, and
where, as is often the case, there is marked atheroma of the
vessels, strophanthus is much preferable to digitalis. In
chronic conditions hke the irregular heart of old people and
where, a rapid action is not necessary, one or two drops
three times a day continued steadily give the best results ;
but in more acute cases five or ten drops are necessary.
Apocynum Cannabinum — This drug was first brought
to our notice in ** Hale’s New Remedies,” where it is
mentioned that in America it has received the title of
a “veritable vegetable trocar.” About its powerful diuretic
effect there can be no doubt, but precise indications are
still wanting as to the exact conditions in which it proves
useful. It belongs to the same class as strophanthus, and
its diuretic action appears to be similar, viz., through the
heart and not as a local renal diuretic. I have found it
a very disappointing remedy, although sometimes it gives
splendid results. Failures are probably due to a want of
knowledge of the precise indications for its use.
Strychnine is of great value in cases where there is a
slow, feeble, and irregular pulse. In cases of sudden failure
where there is not time to obtain the action of a medicine
by absorption from the stomach, strychnine given hypoder-
mically may generally be relied upon.
With the benefit to be derived from arsenic in relieving
pain, palpitation, and dyspncea, as well as its marked influ-
ence over anasarca, we are all well acquainted.
The homoeopathic use of drags is steadily and quietly
permeating the old school, without acknowledgment though
it may be. I must say that I am glad to see such a careful
198 ON HEART DISEASE
observer as Prof. George Balfour, of Edinburgh, in speaking
of arsenic saj’, in his book on ” The Senile Heart ” : —
*^ Most excellent results indeed occasionally follow the pro-
longed use of almost infinitesimal doses. I well remember one
old gentleman, exceedingly sensitive to the action of drugs, to
whom the ^ grain of arsenious acid was quite poisonous, but
who could tolerate the ^^^ of a grain without difficulty. After
taking this minute dose daily for two or three weeks, and
nothing else, for a dilated and hypertrophied heart beginning to
fail, he said to me, ‘ I don’t know what benefit you expected from
the treatment, but I know what I have received. I can go up-
stairs much easier than I used to do.’ ”
‘* Arsenic,” he also says, ” may be given alone, and in
anaemic and very sensitive persons who can only tolerate
a very minute dose, this is often the best way of employing
We find here, in Balfour’s recommendation, the similar
relations, the small dose and one medicine at a time.
There are many other medicines that I should like to
refer to, but time forbids. I can only mention that we have
in the Nauheim method of baths and exercise a most valu-
able adjunct in many cases of failing heart ; we frequently
make use of it in our hospital, and it can be easily carried
out in a private house.
I am afraid of wearying you, gentlemen, but there are a
few points of interest that I should like to bring before your
notice before concluding.
In the class of cases we have been so far considering,
viz., inflammation in young people, and chronic failure in
middle life, much may be done by medicines”; but in cases
where degenerative changes have proceeded to a certain
point, especially if occurring at a period which ought to be
the prime of life, little can be done by medicines, and our
efforts ought to be directed to prevention before they reach
such a stage.
By degenerative changes I mean the atheromatous and
fatty changes found in the blood-vessels as well as the heart
itself. If for a moment we look upon the heart as a pump
connected with a series of elastic tubes, we can see how
ON HEABT DISEASE 199
these changes are brought about. To represent the capil-
laries we should need a network of fine tubes to complete
the flow of fluid to and from our pump. We can easily see
then how any interference with the calibre of these fine
tubes would alter the work which falls upon the propulsive
power, the least contraction of the tubes would mean in-
creased work for the heart to overcome, and if such force
is applied, there must be increased tension in the vessels
leading to the capillary network. This is what actually
takes place. In gout, Bright’s disease and allied conditions,
we have foreign matters retained in the blood which either
by irritation cause a contraction of the capillaries and small
vessels, or by altered constitution of the blood interfere with
its free passage. In either case we have interference with
the peripheral circulation, and as a result hypertrophy of
the walls of the heart, and a general arterio-sclerosis is
developed, and from this, atheroma.
On the other hand, with a weak propulsive power and
low tension in the vessels, we get interference with the
return of the blood to the heart, and a general condition of
venous stasis ; this, from the want of proper oxidation of the
tissues, leads to fatty deposit and degeneration.
From this we can see the need of an accurate means for
measuring the blood pressure. For my own part, I find it
most difficult to decide in many cases, from the touch of the
fingers on the pulse, the exact condition with regard to
tension. The sphygmograph gives some help, which these
tracings illustrate. I have here Dr. Leonard HilFs sphyg-
mograph, and shall be glad to demonstrate its use after the
discussion. It is the best means we have at present for
determining the blood pressure, and already some good work
has been done with it, especially by Dr. Maurice Craig, of
Bethlehem Hospital, who, in a paper published recently by
him on the blood pressure in lunatics, shows clearly that
melancholia and delirium are associated with high and low
tension, and he gives the result of treatment in these
200 DISCUSSION ON HEART DISEASE
Dr. Hawkes referred more particularly to acute infective
endocarditis, and recounted two cases which had lately been
under his care. In regard to the treatment of pericarditis, a
patient at present in the wards, who at the end of a long attack of
subacute joint trouble had suddenly developed well-marked peri-
carditis, had recovered rapidly and completely under the use of
Dr. Murray Moore said he had for thirty years used cactus
grandiflorus with marked benefit. He considered that the exhi-
bition of digitalis called for very careful consideration, as it some-
times gave rise to an aggravation. In the treatment of a certain
class of heart disease, where it was required to produce more
efficient cardiac action without at the same time increasing the
peripheral resistance to be overcome, he used iberis amara.
Dr. Gordon pointed out that the ** cactina pillets ” which had
been referred to in the paper contained not only cactus, but also
small quantities of convallaria and strophanthus. In cases of
rheumatism where there were rapidly shifting pains, he con-
sidered there was greater liability to rheumatic heart trouble, and
in such cases he relied chiefly on aconite, given generally in the
Dr. Green gave particulars of a case in which two-drop doses
of digitalis <^ had produced distinct aggravation, but which was speedily reheved by cactus grand. He used apis in cases of peri- carditis with effusion, and considered that drug was of use in limiting the amount of fluid effused as well as aiding in its absorption. Dr. Ellis announced himself as sceptical of the good to be derived from the use of hotnoeopathic medicines in mitral incom- petence and allied heart diseases. He did not believe that digi- talis ever did or ever could act homceopathically. He had been accustomed to use cactus grand, in functional heart cases only. Dr. J. W. Hayward referred to the value as a prophylactic of all rheumatic afifections of correct hygiene, especially of sufficient physical exercise and bathing. As regards medicinal treatment, he advocated more thorough study of and appreciation of the salient indications of individual drugs. Dr. Meek said his chief difficulties in the management of heart cases generally, were in regard to (1) diet ; (2) action of the bowels ; and on these points he would like further information. Dr. J. D. Hayward (in the chair) tendered to Dr. Byres Moir the sincere thanks of the Society for his presence there that even- ing, as well as for the extremely interesting and instructive paper. SPECIMENS SHOWN : SESSION 1897-98 201