400 B.C.: Hippocrates alludes to heart failure

I wanted to make a note here that Hippocrates had no way of knowing about heart failure, or any other diseases of the heart.  So, when the heart caused dyspnea, this would simply be diagnosed as asthma.

However, Hippocrates, and other Greek physicians, did recognize and diagnose as diseases some of the symptoms of heart failure, such as angina (chest pain), dropsy (swelling of the feet and ankles, and hydropsy (fluid in the lungs) and anascara (generalized edema).

In his book "On the Different Parts of Man, Hippocrates said:

Angina arises from blood arrested in the vessels of the neck. (1, page 243)

Here he must have recognized that many people who present with chest pain also have bulging carotid arteries, or the arteries on either side of the neck.   He would have no way of associating this with heart failure.

He continued:

We must bleed in the arm and purge, to divert downward the humours that cause the disease. (1, page 243)

In his book "On Internal Affections," described dropsy, which was the diagnosis when fluid was observed inside the tissue, and he referred to a condition where the fluid caused swelling of various tissues of the body, such as in the feet and ankles, as anascara.

In his book "Predictions and Prognostics," he said that dropsy, like phthisis and epilepsy, are difficult to cure when congenital.  He said: (1, page 129)

For the cure of dropsy, sound viscera and adequate strength, with good digestion, are very essential; good breathing, freedom from pain, equable temperature of the whole body, no emaciation of the limbs, but rather a fulness, although the absence of both is best, with natural softness and size, and the belly soft to the touch. There should be neither cough, thirst, nor dry tongue, whether after sleep, or at other times, as often is the case. The appetite should be good, and after eating no uneasiness. Purgatives should operate promptly, and at other times the stools should be soft and figured. The urine should correspond with the regimen, and with the changes of wines. Labour should be readily supported without feeling fatigued. Such is the best state for an hydropic person, to give the expectation of recovery. In proportion as it deviates therefrom are our hopes to be less sanguine; but they must entirely cease when the reverse of what is above stated is the actual condition; or only be maintained according to the existing state of things.

It is much to be feared that dropsy will succeed large discharges of blood from the stomach and bowels; when connected with fever it will be of a brief character, and few recover. A prediction to this effect may be safely made to the friends of the patient. Large oedematous swellings, disappearing, and recurring again, are more readily cured than in the preceding case. (1, page 129)

Interestingly, he also said:

They are (the symptoms), however  very deceptive, inducing the patient to dismiss his physician, and thus dying without assistance. (1, page 129)

Dropsy of the lung, or fluid in the lung, was treated similar to hydrothorax, with an incision of the chest between ribs to drain fluid from the lung.  (1, page 261)

So he recognized the fact that people suffering from this ailment often did not recognize the symptoms and seek medical attention until it was too late.  This is a common predicament of modern medicine as well.

In "Rationale of Food in Acute Disease: Book IV," he recommends pleurisy, angina and dropsy all be treated with cantharides and other acrids. The patient must also pay close attention to diet, and vomit three times a day for a month. (1, page 221)

In "Semeiotics III: On the Difference of Pulses," Galen said that Hippocrates was the first to use the term "palpitate" as when feeling for a pulse, and "palpitations," as when feeling an abnormal, or rapid beating of the heart. (1, page 602)

The medical profession would not even begin to understand the heart and heart diseases, such as angina and heart failure, until after great minds like Vesalius and Harvey made their great discoveries in the 16th and 17th centuries.

References:

1. Hippocrates, Claudius Galen, writers,  John Redman Coxe, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston

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