Heartburn

“ Irritation of the sensory nerve-endings in the stomach wall from the presence of an increased proportion of acid, organic or mineral, in the stomach contents is accountable for the well known symptom heartburn. Water-brash is a term applied to eructation of a colourless, almost tasteless fluid, probably saliva, which has collected in the lower part of the oesophagus from failure of the cardiac sphincter of the stomach to relax ”

“ I am gall, I am heartburn. God's most deep decree
Bitter would have me taste: my taste was me;
Bones built in me, flesh filled, blood brimmed the curse.
Selfyeast of spirit a dull dough sours. I see
The lost are like this, and their scourge to be
As I am mine, their sweating selves; but worse. ”

“ Cardialgia is a painful condition of the stomach, usually referred to its cardiac orifice, and is popularly known as heartburn. It is met with in both functional and organic disease of the stomach. It is very constantly present in chronic catarrhal gastritis, and evidently depends upon the presence of an acid, for it is usually promptly relieved by alkalies, such as chalk, magnesia, soda, or alkaline saline waters. Food containing much fat, starch, or sugar should be avoided.
Nausea and vomiting are only occasional symptoms of functional dyspepsia. ”

“ Hence people in Grief, &c. labour under a double Disease, which, on account of the anxiety, weight, and oppression that is felt from the Blood stagnating about the Heart, is commonly termed Heart-breaking.
An Uneasiness or Anxiety, and Palpitation of the Heart, are the last Symptoms that are commonly felt of the [28] Night-mare, which proceed from the cause lately mention’d; as ’tis then necessary that the Heart should contract itself more frequently, in order to discharge the Blood collected in the Vena Cava, the right Sinus Venosus, and Auricle, during the fit. ”

“ Oppression about the heart, as if it had stopped beating, as going into convulsions. Feels as if a spasm of the heart, tetanic. As if the blood too thick to circulate. Thinks she would have died but for the Camphor I gave her. Felt as she did when near dying of hemorrhage. Brain is active, intellect clear, thoughts vivid, the whole being intensified. Next morning, sense of constriction at base of lungs. Some cough. Clammy feeling of skin. Very sensitive to air.
No. 2. Causes a glow all over, hands sweat. Some pain in finger joints. Throat feels obstructed. ”

“ In the vast majority of cases, however, this lull in the symptoms is deceitful, and lasts only from a few hours to a day, when the gravest stage of the disease sets in. The pulse soon becomes small and thready, beating only thirty or forty to the minute, and the heart often works vigorously after the pulse can no longer be felt at the wrist. The nausea and vomiting return and become constant, the respiration is often embarrassed, the tongue becomes dry and brown, the skin is cool and dry, there is often a distressing hiccough, and the thirst is insatiable. ”

“ Burns are caused by flames, highly heated solids, or very cold solids, as solid carbonic acid; scalds, by steam or hot fluids. Burns may cause death from shock, suffocation, œdema glottidis, inflammation of serous surfaces, bronchitis, pneumonia, duodenal ulcer, coma, or exhaustion. A burn of the skin inflicted during life is followed by a bleb containing serum; the edges of this blister are bright red, and the base, seen after removing the cuticle, is red and inflamed; if sustained after death, a bleb, if present, contains but little fluid, and there are no signs of vital reaction. ”

“ The original disturbing heart sensation may be due to nothing more than some slight distention of the stomach by gas, or by a rather heavy meal, but once the dread of the presence of a heart condition of some kind comes over the individual, all the subjective feelings in the cardiac region are emphasized and the discouragement that results further disturbs both heart and patient.
Palpitation of the heart is scarcely more than a solicitous noting of the fact that the heart is beating. ”

“ If a patient with a damaged heart has a sudden dilatation, of course his symptoms are so serious that the physician is immediately summoned. If, however, he has a slowly developing insufficiency of the heart muscle, his first symptoms are more or less indefinite cardiac pains, slight shortness of breath, slight attacks of palpitation, a dry, tickling, short cough occurring after the least exertion, some digestive disturbances, often sluggishness of the bowels, gastric flatulence, possibly nosebleeds, and sooner or later some edema of the lower extremities at the end of the day. ”

“ A normally-sized heart with irregularity, increased frequency, and a variable systolic murmur in the mitral area, is characteristic of tobacco poisoning. A heart enlarged on both sides, and acting irregularly without murmur, is (apart from cardiac failure) suggestive of strain in early life.
Cardiac symptoms taken individually are of less diagnostic value than signs. No symptom is pathognomonic. Palpitation is a nearly universal phenomenon of cardiac disease and disorder. Faintness and actual faints are not uncommon in cases of early cardiac strain, gouty heart, and nervous disturbances. ”

“ Good general elimination by catharsis, warm baths to increase the peripheral circulation, a low diet for a few days, abstinence from any toxin which could cause this cardiac irritation, extra physical and mental rest, sometimes nervous sedatives such as bromids, and perhaps a lowering of the blood pressure by nitroglycerin, if such is indicated, or an increase of the cardiac tone by digitalis if that is indicated, will generally remove the cardiac irritation and prevent the extrasystoles, and the heart will again become regular. ”

“ Sometimes it produces unconsciousness without being fatal. In attempting resuscitation employ artificial respiration, and if there are any signs of life treat as directed for shock. If there are burns complicating the case, of course the burns must be treated. When there is SHOCK the patient lies in an apoplectic state, the surface pale; there is faintness, trembling, cold perspiration, low temperature, feeble pulse, and probably nausea and vomiting. Keep the patient’s head low, give aromatic ammonia, and apply heat to the extremities and to the stomach. ”

“ Symptoms.—They are often long absent; headache, dizziness, faintness, flashes of light, difficult breathing, and palpitation on exertion, and pain in the heart region may occur early. The pain may be dull and localized, or sharp and radiating to the neck or left arm. When compensation fails, we have difficult breathing, which is worse at night, swelling of the eyes and feet, cough, anemia. Sudden death is more common in this than with any other valvular disease. You can hear a soft blowing sound by listening with your ear. ”

“ The fever increases, and there is more pain and oppression of the chest, particularly during deep respiration after exercise. Palpitation is more severe. There may now be night-sweats, tire patient waking in the morning to find himself drenched in perspiration, exhausted, and haggard. Bleeding from the lungs occurs, and creates alarm and astonishment, often coming on suddenly without warning. The hemorrhage usually ceases spontaneously, or on the administration of proper remedies, and in a few days the patient feels better than he has felt for some time previously. ”

“ In fatal cases death usually results from exhaustion, the result of the systemic poisoning, but occasionally it is due to a failure of the heart to propel the blood through the solid lung, to suffocation, or a complication, such as inflammation of the covering of the heart (pericarditis) or lining of the heart (endocarditis) . ”

“ When the heart-burn proceeds from debility of the stomach, or indigestion, the patient ought to take a dose or two of rhubarb; afterwards he may use infusions of the Peruvian bark, or any other of the stomachic bitters, in wine or brandy. Exercise in the open air will likewise be of use, and every thing that promotes digestion.
When bilious humours occasion the heart-burn, a tea-spoonful of the sweet spirit of nitre in a glass of water, or a cup of tea, will generally give ease. If it proceeds from the use of greasy aliments, a dram of brandy or rum may be taken. ”

“ The injurious action of this is also shown by the fact that persons whose skin is burnt to a large extent, die, as a rule, by intoxication. Certain opinions have been advanced which ascribe such a death to a change in the constitution of the blood after extensive burns. I am inclined to think that death may be due to the fact that the skin respiration is, in such a case, more suppressed, as the body is enveloped in bandages which, like sticking plaster, do not admit of air circulation; and also because there is no elimination. ”

“ The weak action of the heart, and its febrile state, should be the natural causes which conduce to the present irregularity in the catamenia, and insomnia at night; the poverty of blood in the liver, and the sluggish condition of that organ must necessarily produce pain in the ribs; while the overdue of the catamenia, the cardiac fever, and debility of the respiration of the lungs, should occasion frequent giddiness in the head, and swimming of the eyes, the certain recurrence of perspiration between the periods of 3 to 5 and 5 to 7, and the sensation of being seated on board ship. ”

“ Fifth day.—Coldness in the back after eating. Drawing from the neck to the epigastrium. Pain in the right clavicle. Weight on the orbits, at night. 145. The feet are icy-cold. Headache above the eyes, at ten o’clock in the morning. Stomach-ache when eating, as if too empty. The heart feels as if beating from above downwards. Internal pain between the shoulders. 150. The inner nose is ulcerated. He is pursued all over by the idea of death, especially when alone. He can only think of death with great depression of spirits. Ineffectual desire to weep. Lancinations in the meatus and auditorius. ”

“ Symptoms.—Acute cases. Sudden onset, vomiting, diarrhea, the heart beats fast with throbbing arteries, bulging of the eyes, enlarged thyroid gland. Death may occur in a few days.
Chronic Cases.—There is usually a gradual onset of tachy cardia,—fast beating of the heart,—pulse being 100 to 180 or more, if excited. Later there are throbbing of the arteries and of the thyroid glands.
Bulging of the eyeball is sometimes extreme. There may be fever and usually is anemia, emaciation, weakness, nervousness, perspiration, difficult breathing, dark color of the skin. It usually lasts several years. ”

“ Kindred organs are called upon to do the work of body covering, and danger lurks in forced exertion. A chill precedes a fever; the pores are closed; intense heat is generated; the fever is cured when perspiration with subsequent evaporation is restored. A very striking exemplification of these facts is given in cases of cutaneous burns where large areas are affected. Respiration is increased to exhaustion, and kidney discharges are highly colored with waste that ordinarily is eliminated through the pores. If an extreme proportion of skin area is seared, suffocation ensues. ”

“ This is called the cold or algid state of the disease. The condition may go on getting worse till the heart stops, the patient being quite conscious to the end. Frequently it is impossible to tell whether the patient will live or die, when suddenly the sickness lessens, the body begins to get warm, the face flushes, and restlessness subsides. The patient may go through this reactionary stage to perfect recovery, or he may relapse into his former state of diarrhœa and vomiting, ultimately dying from heart failure and collapse. ”

“ The symptoms that ensued were characteristic of its double action. In an hour they all had burning in the throat, gullet, and stomach, followed by nausea, dysuria, and vomiting; weakness and stiffness of the limbs; giddiness, blindness, and dilated pupil; great faintness, convulsive breathing, and small pulse. One of them, an elderly woman, who took the largest share, had an imperceptible pulse, stertorous breathing, and total insensibility even to ammonia held under the nose. Next day she continued lethargic, complained of headache, and had an eruption like flea-bites. ”

“ The first symptoms are acceleration and strengthening of the pulse, with very transient excitement, then sudden giddiness, fainting and great sickness, accompanied with a weak, quivering pulse. These effects are for the most part transient and trifling, but not always. Some degree of somnolency is not uncommon. Dr. Marshall Hall has given an interesting account of a young man who smoked two pipes for his first debauch, and in consequence was seized with nausea, vomiting, and syncope, then stupor, stertorous breathing, general spasms and insensible pupils. ”

“ What I wish to maintain is that in cardiac degeneration of any kind, in chronic cardiac dilatation, and in the enlarged heart of Bright's disease and of emphysema, just as in ordinary valvular disease, attacks of distress, alarming both to patient and doctor, often occur which call for nothing more in the way of treatment than attention to some intercurrent influence—an indigestible meal, loaded bowels, a nervous shock, a thoughtless effort, a passing hardship or nervous strain. Digitalis and its allies, strychnine, alcohol, nitrites, iodides and the rest are out of place in such an event. ”

“ The loss of a sufficient quantity of blood is often prevented by patients being apparently worse, after the first or second bleeding. This change for the worse, shows itself in some one or more of the following symptoms, viz. increase of heat, chills, delirium, hæmorrhages, convulsions, nausea, vomiting, faintness, coma, great weakness, pain, a tense, after a soft pulse, and a reduction of it in force and frequency. ”