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Anginous Attacks
Let
us look now at the cases with definite anginous attacks. For these cases you must give the patient relief very speedily. It
is a little difficult to pick out of the Materia Medica the most commonly indicated drug for it, but I think one can limit
the choice to about one of half a dozen — Aconite. Cactus, Arsenic, Iodine, Spongia, Spigelia and Lilium tig.The outstanding
characteristic of the majority of these cases in their first attack is an absolutely overwhelming fear. The patient is certain
he is going to die, and that very speedily, and he is terrified. He is quite unable to keep still, and yet any movement seems
to aggravate his distress. Here a dose of Aconite in high potency will give relief almost instantaneously. I have seen a case
of that sort and put a dose of Aconite on the tongue and almost before the remedy could be swallowed that patient was feeling
better. I usually carried 10m as my highest potency in general practice and I gave Aconite 10m.
The man had a similar attack
at a later date, and the anxiety, the distress, and the fear were nothing like so marked because he had come through one attack
before, and Aconite had no effect at all. That has been my experience. Where you are dealing with the first attack and the
patient is quite certain he is going to die, Aconite does relieve him right away, but does not act in a second or later attack.
So if you get a man with his first attack, give a dose of Aconite and you will probably find in no time he is feeling more
comfortable. But if he has had a previous attack Aconite will not be helpful. For the patient who is having a subsequent attack
much the most likely drug to help is Cactus. Cactus has a good deal of anxiety and fear, but it is quite different from that
of Aconite. It is not a fear that the immediate attack will be fatal, it is more a conviction that he has an absolutely incurable
condition which will eventually kill him.
That is one point about the Cactus indications. Another is the type of the actual
distress of which the patient complains. He feels as if he had a tight band round the chest which was gradually becoming tighter
and tighter and that if this constriction did not let - up soon the heart would be unable to function. It is that feeling
of increasing tension which gives you the Cactus indication. In addition you may get stabbing; radiating pains from the precordium,
but they are not so characteristic of Cactus as the intense constricting feeling, which is, of course, just exactly how the
majority of your anginous patients describe it. In these acute conditions I always give the drug in high potency because it
acts much more quickly and one wants instant relief.Then you will get an occasional patient having an anginous attack with
very similar constricting feelings, not quite so intense but a definite feeling of constriction. The patient has been ailing
for some time, is rather anxious and worried, very chilly, and accompanying this feeling of constriction there is an
acute, distressing, burning sensation in the chest. These anginous patients respond very well to a dose of Arsenic. I have
never seen Arsenic do anything in an anginous attack except in the rather broken down, ill-looking patient, who is a bit pale,
rather withered looking, very definitely anxious, fearful, with that sense of constriction accompanied by the burning discomfort
in the chest. And Arsenic does relieve these cases quickly. There is another type of case which is very similar to that; with
very much the same sensation, but the feeling of constriction, the feeling of tension, is described as being actually in the
heart itself rather than involving the whole of the side of the chest.
The patients are just about as
anxious as the Arsenicum patients — in fact all these anginous patients are anxious — but instead of the intense
chilliness of the Arsenic they are uncomfortable in heat and in a stuffy atmosphere. They are just about as restless, but
instead of the pale, drawn appearance which you get in Arsenic, they tend to be rather flushed, and as a rule they are
dark-haired, dark-complexioned people. They are rather underweight, in spite of the fact that they have always been pretty
good livers and very often have an appetite above the average although they have not been putting on weight.
These cases respond exceedingly well to Iodine. Then there is yet another type of case in which instead of the complaint being
of constriction it is of a progressive sensation of swelling in the heart region. It feels as if the heart gets bigger and
bigger until it would finally burst, and this sensation of fullness spreads up into the neck.
This sensation of fullness
and swelling is very much aggravated by lying down, when the patient feels as if he would nearly choke and it is accompanied
by very acute pain.The patients themselves are chilly and any draught of air increases their distress.
In addition
to the feeling of distension, they usually complain of more or less marked numbness, particularly of the left arm and hand,
though very frequently there is numbness of the hand only without any involvement of the arm, and not infrequently they complain
of numbness of the lower extremities too. As a rule the face and neck give you the impression of being some what congested;
they do not have the pale, drawn, wrinkled Arsenicum appearance. And these cases respond well to Spongia. Another drug which
you will find useful in a condition which is somewhat similar, though not an angina at all, but which you meet with in hysterical
women. You will fail to find any cardiac lesion, but they will produce a symptom picture difficult to distinguish from a true
anginous attack. They have the very marked stabbing, radiating pains, and often an intense hyperesthesia of the chest wall.
They are very depressed, frightened, and intensely irritable. They are sensitive to heat, and their distress is aggravated
by any movement. In addition to the stabbing pains they have the anginous sense of constriction, tightness, of
the chest wall. These cases are usually associated with some kind of pelvic lesion, or a history of having had some gynaecological
illness.
I have seen quite a number of these cases now in which an electro-cardiogram shows no lesion at all. And all the
symptoms have cleared up entirely with Lilium tig. So you see when you are confronted with one of these very distressing conditions
where you have to make a quick decision, it is fairly easy to individualize and get something which will give almost instantaneous
relief.
- By Dr. Douglas M. Borland
DISCUSSION
Dr. McCrae thought the paper was a masterpiece. There was nothing in it to criticize,
there were details of valuable help to everybody which were like the artist sharpening his pencil to produce some line of
particular splendour which would make the picture complete. Most had pencils but they were blunt, and the homeopath would
always be grateful for these amazingly useful hints.
Dr. John Paterson said that they had listened to a real clinical paper. There was not much which one
could criticize, but one might add a little. With regard to the cardiac cases, Arsenic and Sulphur his experience was that
Arsenic was often the acute of Sulphur and on the mental side they were the exact opposite. One found that a Sulphur
patient swung in an acute condition to Arsenic and Dr. Boland had brought out that point. He was interested in the question
of Aconite acting in the first attack but not in the second. There had been many discussions about covering the totality of
the symptoms and here was evidence that the homeopathic remedy could be prescribed on the mental symptoms which worked in
the first instance but it did not cover the whole of the case. It was possible to prescribe homeopathically without covering
the whole of the case, only covering a phase because obviously on the next occasion the pain was present but not the fear,
the Aconite had removed one phase of the case — mental fear. Aconite came out very strongly in the air raids.
Another remedy was Natrum Mur.
He wondered if any orthodox practitioners were surprised that there was no mention of Digitalis
but Digitalis was quite useful in these slightly relaxing hearts in homeopathic doses, not in the massive doses given in allopathic
medicine.
Dr. Stonham said that the paper was excellent and the sort of paper which would appeal to the general
practitioner, who was always coming up against acute cases. To have such cases so plainly stated with the drug indications
for them was valuable. There were one or two points he would like to mention with regard to Aconite which, as Dr. Borland
had , was very useful in many cases. The case which he did not mention was the acute pulmonary oedema. He had
given. Aconite 30 in such cases and it quickly calmed the patient in that distressing and somewhat dangerous condition and
he had found it valuable not only in the first case but also in cases when the attack has been repeated. Dr. Borland said
he gave Laurocerasus in acute heart complaints. He had had an acute case with Cheyne-Stokes respiration, it looked as if the
patient would die, he gave Hydrocyanic Acid and he recovered very nicely. Many people would substantiate the value of Dr.
Borland's paper.
Dr. G. R. Mitchell said that a clinical paper was most useful. He wanted to criticize something Dr.
Paterson said when he took the Aconite example as not prescribing on the totality. He would have thought it was an example
of prescribing on that procedure because in the first case, on all the manifestations, Aconite was the drug, and it worked
and on the second occasion there was a different totality, and the Aconite did not work. That was the way he would have regarded
the matter.
Dr. Hardy added her grateful thanks to Dr. Borland for his paper. With regard to medicines for heart
complaints she agreed with Dr. Paterson that Digitalis 200, one dose, was very effective in the semi-chronic or chronic case
of the right sided congestion, blue face and blue nails, but not in the acute patient. She also used mother tincture Crataegus for heart patients because it was specific for the cardiac muscle. Another drug which was used in Russia was Adonis
mother tincture, five drops to a dose. ..the wonderful collection of details on which indications had been given and
which were of the greatest possible value. The paper would require a great deal of study, so that these indications could
be taken for future use. He was rather in favour of trying to keep the remedies which were very definitely specific for
particular conditions because in cases where there was an emergency there was no time to seek for all the exact indications
which might help, but he was rather surprised that Dr. Borland did not make more use of the Snake Poisons in heart cases because
he must admit he would not be without Lachesis. If there was any suggestion of heart failure he would give Lachesis and would
be surprised if it did not answer. There was one rather interesting point from the homeopathic point of view with regard
to Snake Poisons and that was to think of the first thing which an individual felt when he was bitten by a snake, which was
death, and when death threatened the patient ,the prescriber should think of the Snake Poisons. He mentioned this in a paper
he read on Snake Poisons in Berlin just before the war and it attracted the attention of reporters who were present.
In the Berliner Tageblatte there appeared in headlines, "When death threatens, think of the Snake Poisons."..
Dr. Alva Benjamin said that with regard to the collapse cases one would have thought that Dr. Borland
would have mentioned Veratrum Album for cases of great coldness and excessive sweating. With regard to heart cases he had
had a lot of help from Chamomilla, particularly when the pain was very severe. ..
Dr. W. Lees Templeton said that most of them felt that they had been back at school and he felt not
only humbled but humiliated, for he must admit that he did not get such good results, possibly because one did not always
get the symptoms. Most of the emergencies he saw were unable to give symptoms and one had to judge on appearances. He was
glad, therefore, that Dr. Borland had elaborated on the appearance of the patient, because that was important. With regard
to drugs, he did not find Ant. Tart, useful in heart cases because he believed the pathology was different. He thought
Ant. Tart, had a pulmonary pathology, not cardiac. Carbo Veg. had a great and justifiable reputation as the "corpse reviver"
and it did work when the appropriate symptoms were present. Cold sweat he looked upon as a guiding symptom for Verat.
Alb. and he had verified its value in collapse. He was sorry that Dr. Borland was not more specific in his diagnoses,
e.g. if pain was due to coronary thrombosis he doubted if the high potency alone would ease this particular pain in a
matter of minutes.
The wait with the patient for four or five hours for the second presentation was a serious matter when
one was called out in the middle of the night, and like confinements many of these emergencies did occur at night. Why was
this, he wondered?
Excerpt from : The British Homoeopathic journal, March 1946
Dr.FHLew
drfhlew@yahoo.com
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