These affections we shall divide into two classes: a. Acute, b. Chronic.
a. Acute Disease of the Heart.
Acute inflammation of the heart seldom exists alone, but is nearly always connected with rheumatism. So generally is this the case that it is sometimes called "rheumatic inflammation of the heart."
The patient suffering perhaps from rheumatism, becomes anxious, peevish and flighty. There is an oppression and hurried beating of the heart, palpitation, and perhaps a dry cough. Pain is felt on pressing over the region of the heart, and is increased by a deep inspiration. The pulse is very irregular, generally weak, small and contracted.
The head is of course considerably affected, and not unfrequently is mistaken for the seat of the disease. The patient may become very obstinate, cunning, or taciturn, or excessively stupid, and at length perhaps maniacal, exceedingly restless, or shaken with convulsions.
Besides being frequently the result of the transition of rheumatism to the heart, this disease may arise from cold, violent blows, injuries, etc.
The prominent remedy is Aconite, a dose every half hour, in alternation with, or followed by Bryonia, Nux-vom., Cocc, Ars., Cannabis, Dig., Bell., Phos., Spigelia, a dose once in from one to three hours. See palpitation of the heart.
b. Chronic Affections.
Difficulty of breathing, and palpitation of the heart, particularly on ascending an eminence. Shortness of breath, violent beating of the heart like the blows of a hammer; the beating extends over a larger space than usual; occasional pain, although neither this nor palpitation are always present. Pulse sometimes intermittent, at others excessively irregular; slow, weak, and faltering, or quick and fluttering. There are generally headache, irritability of temper, sometimes cough, spitting of blood, and dropsical swelling of the legs.
We have already described, in the chapter on anatomy, the formation and functions of the heart, but to impress the matter still more strongly on the mind of the reader, we will recapitulate some facts here. The heart, the great central point, the balance-wheel of the circulation, contains four chambers; into these the blood passes from every part of the body, and by their contraction is forced out, and conveyed through the appropriate channels, arterialized and charged with life, to the most remote parts of the system.
To make the matter still more plain, let the foregoing diagram represent the passage of blood through the heart.
For the sake of convenience I have represented the heart in the form of a square. This, however as the reader is well aware is not the case. The arrows represent the current of blood. A and b represent the right heart, divided into two chambers by the valve or folding-door which is seen partly open, the blood passing through, as represented by the arrows.
1 indicates the vein through which venous or defiled blood enters the heart from the head, and 2 represents the vein through which the venous blood from all the rest of the system, ascending, mingles with the descending blood from the head at e and enter together.
Into the first chamber, or auricle, of the right heart, a, we have then entering the blackened and impure blood from every part of the system. Passing through the valve or folding-door, it enters the lower chamber or ventricle b, and from thence at f passes into the lungs g, and there undergoing a chemical change, in which its impurities are exchanged for oxygen, the life-giving property of air, it quits the lungs at h, ascends behind the great artery i and enters the first chamber of the left heart c, descends through the folding-door or valve into the lower chamber d, and now, having passed through the entire suit of rooms, thrown off its impurities and become again charged with life, it passes from the heart into the great aorta i, and is conveyed on its mission of life to every part of the system.
We have seen that the blood is forced from one chamber to the other by the contraction of these chambers or pouches, how is it then, for instance, that on the contraction of the lower chamber of the right heart, the blood is not forced upward into the upper chamber as well as downward into the lungs? This is obviated by the valve which is seen opening downward. The contraction of the chamber closes this valve, and prevents the blood ascending.
The same arrangement also exists at f and i, thus preventing the blood returning to the heart. It will very readily be perceived that the heart has a most important function to perform, and that any derangement of its machinery is speedily felt throughout the system. These valves must play with the utmost nicety, these chambers must contain the requisite amount of strength, and where this mechanism is prevented from the full performance of its duty, serious results are the consequence.
We are now prepared to look at the cause of some of the diseases of the heart.
The valves it has been seen, to perform their functions aright, transmitting the blood from one chamber to the other, and preventing its return, must open and close with the utmost freedom, and fit with the greatest nicety. They, however, sometimes lose their soft and flexible character and become stiff, bony and immoveable. The valve or door between the upper and lower (a and b) chamber of the right heart, remaining perhaps half open, and fixed in its potition, prevents the blood from passing with the freedom, it would have done if the valve had remained wide open, into the lower chamber, and on the contraction of that chamber, is no obstacle to its being forced into the upper chamber as well as into the lungs.
The consequence therefore is, that a deficient amount of blood is forced into the lungs, a portion being driven back into the upper chamber. Thus it will readily be seen, that the upper chamber is constantly gorged and distended with blood, and this partial stoppage or stagnation of course produces a like stagnation of the blood flowing into this chamber. It will very easily be perceived then that there can be no free transmission of venous blood from the brain through the stagnant vein opening into the upper chamber, and the choked up and congested state of that chamber must, as a matter of course, produce congestion and engorgement of the brain The vessels of the brain are engorged, because they cannot empty themselves into the already engorged vein (1), which is gorged because it cannot empty itself into the distended chamber a, distended, because the blood not only cannot pass freely into the lower chamber, but a portion of what does pass, is driven back.