1. CONGENITAL CARDIOMYOPATHY & HOMOEOPATHY:TREATING THE HEART WITH A HEARTGyandas G. Wadhwani MD(Hom) Chief Medical Officer (Homoeopathy) Directorate of AYUSH, Govt. of NCT of Delhi. India. Email- homoeopathygyan@gmail.com

2. ..Frequently stemming from an aching heart that is impervious to any modern instrument, they are not hidden from an ear cultivated to listen for the inaudible sigh, nor are they concealed from an eye sensitive to the un-shed tear.. The most cost effective way to reach the diagnosis is for the doctor to become fully engaged with the total human presence Bernard Lown, M.D., Professor Emeritus Cardiology, Harvard School of Public Health, inventor of defibrillator and cardiovertor 3. Cardiomyopathies are diseases of the myocardium associated with cardiac dysfunction. 1995 World Health Organization (WHO)/ International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies 4. Classification of cardiomyopathies Dilated cardiomyopathy 5. Classification of cardiomyopathies Hypertrophic cardiomyopathy 6. Classification of cardiomyopathies Restrictive cardiomyopathy 7. Non-compaction Cardiomyopathy Congenital disorder with hypertrophied LV with deep trabeculations Decreased systolic function Can be isolated or along with other congenital heart diseases Facial abnormalities and neurologic problems also occur in high proportion 8. Embryology The heart develops from a simple tube into a complex organ with four chambers. During early embryogenesis, trabeculations emerge in the luminal myocardial layers of the ventricles enabling the myocardium to increase its mass in the absence of epicardial coronary circulation. Trabeculations effectively increase surface area this developmental step serves to provide adequate oxygenation from the ventricular cavity. 9. Embryology With the completion of the ventricular septation (eight weeks in human embryos), the trabeculae start to solidify at their basal area ascending to the apex, adding substantially to the thickness of the epicardial compact layer. This compaction process, coinciding with the invasion of the coronary arteries into the myocardium from the epicardium, is more pronounced in the LV than in the RV and results in a more trabeculated endomyocardial surface of the RV 10. Embryology Noncompaction cardiomyopathy is therefore supposed to be the result of an arrest or failure of the compaction process of the myocardial trabeculae during endomyocardial embryogenesis... 11. Markedly thickened two-layered myocardial wall: a thin, compacted epicardial layer (small arrows) and a non compacted endocardial layer (bigger arrows) consisting of prominent trabeculations and intertrabecular recesses. The noncompacted layer is more than twice as thick as the compacted layer. 12. Chronology of disease identification The first case report of a 33 years old lady with persistence of left ventricular myocardial sinusoids as an isolated anomaly was published in 1984. Engberding R, Bender F, Echocardiographic detection of persistent myocardial sinusoids, Z. Kardiol. (1984);73: pp. 786788 13. Chronology of disease identification In 1985, the description of both the angiographic and the echocardiographic characteristic features published in a German radiology journal paved way in the research for identification and diagnosis of a new disease Goebel N, Jenni R, Gruntzig A R, Persistierende myokardiale Sinusoide (Persistent myocardial sinusoids), Rofo (1985);142: pp. 692693. 14. Chronology of disease identification In 1986, a case of 21-year-old male patient with progressive heart failure and cardiomyopathy of obscure aetiology was published with investigation reports. Two-dimensional echocardiography identified a markedly thickened myocardium with prominent trabeculations and intertrabecular recesses (channellike structures) in the apex and at the posterolateral wall of the severely hypokinetic LV. The same structures were visualised by left ventricular angiography and resembled a honeycomb-like inner contour in both ventricles. Later on, autopsy too confirmed the echocardiographic and angiocardiographic findings. Jenni R, et al, Persisting myocardial sinusoids of both ventricles as an isolated anomaly: echocardiographic, angiographic, and pathologic anatomical findings, Cardiovasc. Intervent. Radiol. (1986);9: pp. 127131.. 15. Epidemiology An epidemiological survey on the prevalence of cardiomyopathy in Australia shows a male predominance and also that 9.2% of patients with unclassified cardiomyopathy have Left Ventricular Non-Compaction Nugent A.W. et al. National Australian Childhood Cardiomyopathy Study: The Epidemiology Of Childhood Cardiomyopathy in Australia. N Engl J Med 2003; 24: 1703-1705. 16. Epidemiology Due to its recent establishment as a diagnosis, and it still being unclassified as a cardiomyopathy by the WHO, it is not fully understood how common the condition is. Some reports suggest that it is in the order of 0.12 cases per 100,000. The low number of reported cases though is due to the lack of any large population studies into the disease and have been based primarily upon patients suffering from advanced heart failure. 17. Genetics This condition is diagnosed either sporadically or with a familial tendency due to chromosomal anomalies and the age of onset of complaints varies widely. The American Heart Association's 2006 classification considers noncompaction cardiomyopathy a genetic cardiomyopathy. Some genetic links warrant screening of 1st degree relatives 18. Clinical features Its common clinical presentations involve heart failure, ventricular tachyarrhythmia and thromboembolic events. 19. Diagnosis Echocardiography MRI 20. Prognosis The prognosis in a symptomatic patient is generally poor, with progression to chronic heart failure and death, including sudden death. 21. My Experience 22. A 5 + months child (DOB 1-5-09) diagnosed with biventricular non-compaction was brought by her parents on 30-10-09. She had also been suffering with recurrent episodes of bronchitis for which she was on nebulizer (Budecort and Asthaline). During her last hospitalization from 23-9-09 to 6-1009, she had also been put on Eltroxin 25 mcg due to elevated TSH levels. 23. The parents had been advised about the possible need for advanced cardiac support and possible heart transplantation. O/O: child was tall for her age, thin, emaciated, dark eyes and hair, angle below glabella 24. History of Presenting Complaints Birth weight: 2kgs Apgar scoring: 7, 8, 9 Mild physiological jaundice at birth 25. Echocardiography report on day 8 was: Biventricular noncompaction. Thickened TV and moderate TR. TR max PG= 24mmHg. Patent foramen ovale, right to left shunt. Dilated RA & RV. Biventricular dysfunction LVEF 50%. Normal arch. 26. She continued to be well. She again underwent Echocardiography at the age of six weeks, which revealed: Persistent biventricular non-compaction with mild TR and LVEF 45%. 27. The child was breastfed till the completion of 4 months. She had been given all vaccinations as per the recommendation of pediatrician. Last vaccinations 4/9/09: OPV, DPT, Hib 5/9/09: Prevnar, Rotarix 28. The child continued to be asymptomatic and was well till September 2009, when it rained in Delhi for few days. She started with running nose, which progressed to cough, fever and wheezing. She was diagnosed as a case of bronchiolitis and admitted to Sitaram Bhartiya Institute. 29. Since she continued to have rapid breathing, irritability and intermittent vomiting, she was hospitalised in Escorts Heart Institute on 23rd September 2009. At the time of admission she was found to have - tachy-apnoea - severe tachy-cardia - gross hepatomegaly 30. Echocardiography report at the time of admission revealed, Noncompacted dilated LV with severe LV dysfunction. LVEF 1520%... 31. After her discharge from Escorts on 6-10-09, she suffered with another episode of cough, vomiting and fever and though her fever subsided, her coughing, irritability and occasional throwing up had persisted till she was brought to us. Her mother also remarked that many a times at night she felt warm and the temperature would be around 99.4-99.8F with hot head, palms and soles. 32. She again underwent echocardiography at Escorts on 19-10-09 to see the impact of treatment thus far. The report stated, No significant change from previous echo 33. Family history Father: Cholelithiasis Paternal uncle: Functional murmur P Grandfather: CABG P Grandmother: Borderline DM (after her father had died with CA) Mother: Allergic rhinitis M Grandmother: Hypothyroidism, Asthma, Sciatica M Grandfather: His father had died with CA 34. Personal history Appetite: was having intense appetite always and was ok now too in spite of all illnesses and treatments (6-7 feeds/ day) Thirst: More; Does not let go of her bottle Sleep: On right side Perspiration: On forehead & head T/R: Kicked off her covers 35. Intra-uterine history Conceived 3 years after marriage Both the parents were working No nausea/ vomiting all through the pregnancy Reddish itchy, painless eruptions on back throughout pregnancy; > post puerperium Sneezing tendency of mother had increased for which she took cetrizine for some time in 2nd/ 3rd trimester 36. Intra-uterine history During 2nd trimester local homoeopathic doctor asker her to take kali pos 6x for 1 month Herbal pest control at home at the end of 2nd trimester due to which she was uneasy Pedal edema 7th month onwards GTT/ HbA1C borderline in last trimester Had contractions in 32nd week, hospitalised; ante-natal fetal echo showed severe TR with normal RV flow. Thereafter on bed rest. 37. Intra-uterine history At the beginning of 9th month, driver had chicken pox; took Natrum mur 200, 1-2 doses as preventive 10 kg weight gain in all pregnancy Appetite: Markedly increased all throughout the pregnancy; hungry even after a full meal at 2-2 hours (though always had good appetite) No marked desires/ aversions Delivered through LSCS at 37 weeks. During surgery found loops twice around neck; cried at birth. 38. O/E: Weight: 5 kgs Occasional expiratory rhonchi Split HS2 39. Analysis Tall for her age Reddish itchy eruptions on back all through pregnancy Appetite increased during pregnancy; in child too 40. Prescription Sulphur LM1 OD 41. Follow up She did not suffer with any further attacks of bronchitis thereafter. She also started gaining weight gradually. 10-12-09: 7 kgs During February 2010, her parent reported that she had become extremely scared of bathing. Rx Sulphur LM 7, 2nd cup OD In March, she had started enjoying bathing again so she was thereafter continued same way. 42. Follow up She cut her 1st tooth left lower incisor in 2nd week of April 2010 (while on Sulphur LM9 OD) By July 2010 she had cut out 7 teeth, 2 more were showing and he was 8 kgs. 43. Follow up Repeat echocardiography on 9-11-10 revealed, No change from the last echo. Dilated cardiomyopathy. Non-compacted LV. LVIDd= 4.5cm (Z score +5.5). LVEF 20%. Trivial TR 44. Follow up The reports did not show any improvement in LVEF, but she was doing fine (on Sulphur LM 14). She also developed a few boils on upper lip and left cheek. Her TSH levels had dipped to below normal by October 2010 so her Thyroxine was discontinued. 45. Follow up In the month of January 2011, her father was transferred to Kolkata (while on Sulphur LM 16, 2nd cup, every 3rd day, wt. 9 kgs). Her family thereafter decided to consult some senior homoeopathic physician in Kolkata! 46. Follow up Towards the end of January/ early February she again suffered with LRTI along with high fever and respiratory distress. The allopathic doctors prescribed her medications along with wysolone. Since she continued to be worse in spite of allopathic and homoeopathic treatment, she was hospitalised on 8-3-11. 47. Follow up Echocardiography report dated 8-3-11 revealed, Dilated LV cavity. Noncompaction of LV. Severe biventricular systolic dysfunction with LVEF=12%... 48. In desperation, the parents contacted us again telling us about her worsening condition. The senior homoeopathic physician was not willing to divulge his prescription. The presenting features were: - persistent cough - poor appetite - constipation, passing stools once in 3-4 days, hard - craving for chocolates and sweets 49. Analysis: -Clearly Sulphur was not the right remedy in her case. The drug selection was wrong miasmatically. - She needed a sycotic remedy (cord around neck at birth is a sycotic manifestation) - H/o LRTI with respiratory distress and persisting cough - Desire for sweets/ chocolates - Constipation - Prevnar is a pneumococcal conjugate vaccine, that she had received just before falling ill. 50. Prescription Rx Pneumococcin LM1 OD (One of the triad of indications of homoeopathic remedy Pneumococcin, as learnt from Prof. L.M. Khan is: history of pneumonia/ LRTI, craving for sweets and constipation) 51. Follow up She again improved gradually. Soon after starting the medicine, not only did her cough disappear but her bowel movement changed to 3-4 times soft stool every day (3rd day onwards). 52. Follow up She again became active, did not suffer with any new attack of cold, cough, fever or respiratory distress. Her last Echo done in August 2011 shows LVEF 27%. 53. Follow up She continues to be well ever since Her LVEF thereafter has varied between 3035%. She speaks well and has recently joined school. She now weighs about 19 kgs 54. NOTES 55. INTRA-UTERINE LIFE : INSIDE DARKNESS ILLUMINATES PRESCRIBINGIntra-uterine life is the earliest phase of life spent by an infant in the quiet, dark atmosphere of mothers womb 56. Past is not a dead history. It is the living and essential material out of which the patient as a person makes himself/ herself a whole self and by which the homoeopathic prescriber prescribes according to the anamnesis of the case and builds the possible indicated remedy for the eradication of the most obstinate disease. 57. The most fascinating study of the human being emerges once we grasp it from its very roots, from its very most initial stages of growth. It is study of the beginning and its constant evolution up to the present moment of development that constitutes the true study of life. 58. IMPORTANCE OF INTRA-UTERINE LIFE FROM TIME IMMEMORIALGleaning through the pages of history; we can perceive the influence of intra-uterine imprinting in the development of human life from the Hindu Mythology. The life histories of King Dhritrashtra, King Pandu, Vidur and the great warrior Abhimanyu bear testimony to the importance of intra-uterine life. Myths are not only simply myths, rather they have some true and natural background the ground of experience.. 59. ODE TO HAHNEMANNIn the whole history of medicine, the first man who epitomized the importance of intra-uterine life in the darkness of womb in ontogenesis as well as in therapeutics was a philanthropist, a man of truth and courage - Samuel Christian Friedrich Hahnemann 60. He phenomenologically perceived that the profound and indelible imprinting on the fetus in the uterus plays a guiding role in future development of an individual and considered it as the most illuminating part of the past that is reflected upon in the present 61. 5 of Organon - The Art of HealingUseful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause 62. PIONEER OF PHENOMENOLOGICAL MEDICINEHahnemann has lucidly explained this in 'The Chronic Diseases - Their Peculiar Nature and Their Homoeopathic Cure' where he states that: ..Pregnancy in all its stages offers so little obstruction to an anti-psoric treatment that this treatment is often most necessary and useful in that condition..'. 63. What Hahnemann has to say?? FOOTNOTE TO Aph 284 But the case of mothers in their (first) pregnancy by means of a mild antipsoric treatment, especially with sulphur dynamizations prepared according to the directions in the 6th edition, is indispensable in order to destroy the psora that producer of most chronic diseases which is given them hereditarily; destroy it both within themselves and the fetus thereby protecting posterity in advance. This is true of pregnant women thus treated; they have given birth to children usually more healthy and stronger, to the astonishment of everybody. ... 64. "Seeds of health are planted even before you draw your first breath, and that the nine short months of life in the womb shape your health as long as you live."Shaped By Life In The Womb, Sharon Begley & William Underhill, Newsweek 65. SOME FACTS American Psychologists now consider that our life starts from the time of conception and not at the time of birth. During last 25 years lots of scientific data appeared proving that human biological (physical) and psycho-emotional development passes simultaneously since the moment of conception. 66. CONTD Now it is not a secret that a baby leads an active life in the belly: he moves, sucks fingers, turns head to a source of interesting sounds (music has shown to effect cognitive, emotional and psychomotor development of the fetus), plays with umbilical cord. The taste of amniotic fluid changes depending on the food a mother eats. 67. CONTD When a mother worries, a baby starts moving brokenly. A baby experiences all states of a mother on a hormonal level, emotional level and nutritional level. Fear that a mother feels during pregnancy is caught by a baby and kept in human memory for many years. Now a days neurologists and psychologists agree that human character is being formed in pre natal period and after birth correction starts. 68. CONTD In the 1970s and 1980s, we learned that if mothers during pregnancy ingested such substances as the alcohol, cocaine, caffeine, and tobacco, they could harm their babies' physical and mental health, notably, lower the birth weight, height, and head circumference, and impair attention, memory, intelligence, and temperament. 69. CONTD Later, in the 1990s, we came to know that if a mother experiences excessive stress or suffers from an emotional trauma, her baby may be born with certain deficiencies which may persist into adulthood and cause more complications (A mother's excessive Cortisol can reach the baby in the womb and raise the baby's set point for blood pressure forever. This baby, when reach adulthood, is likely to suffer from high blood pressure). 70. CONTD The first and foremost influence on the baby is whether the pregnancy is wanted or unwanted. Bustan and Coker have uncovered the lethal consequences of rejection. In a cohort of 8,000 pregnant women, divided into those who wanted and those who did not want the pregnancy, the unwanted were 2.4 times more likely to die within the first month of life. (Bustan, M. N. and Coker, A. L. (1994). Maternal attitude toward pregnancy and the risk of neonatal death. American J. Public Health, 84(3), 411-414). 71. Fundamental cause and Heart/ Miasmatic AnalysisTeachings of Hahnemann and post Hahnemannian stalwarts like J. H. Allen, Boger, Roberts, Phyllis Speight, Close, Ortega and Paschero guide us in forming the grand totality which of course considers the miasmatic data. 72. Fundamental cause and Heart/ Miasmatic Analysis Miasmatic data is obtained not just from the family history but also from the personal history (vaccinations, suppression of eruptions, discharges, etc.) and also past history (series of illnesses since childhood or at least for last 7 years). 73. To identify the underlying miasm H/O suppressions Family history Past history Modalities Patient as a person Mental symptoms Generals: Desires; Aversions; Sweat etc Tendencies Objective aspects etc. 74. We must never fall into the trap of diagnosing miasm on the basis of nosological diagnosis. Rather identify the peculiar symptoms of each constitution which determine the taint! 75. Tips on Miasmatic Tagging in CVD Generally speaking when heart is involved we mostly consider Syphilitic background. When pathology turns to destruction Syphilis is in advanced form. When hypertrophy and other excessive functioning is present we reminded of the association of Syphilis with Sycosis. In most of the cases with cardiac neurosis or hysterical individuals with cardiac phobias and functional diseases of heart Psora should be kept in mind. 76. Constitutional Medicine And Few Helpful Pointers Towards The Indicated Remedy 77. A constitutional medicine is nothing but a medicinal image synchronous to the Totality of the Symptoms. It is not only the sum of the symptoms, but is in itself a Grand symptom - the symptom of the patient, developed from the remote moment of (intrauterine) conception till the present moment of consultation and is perceived by the physician during the case study, as well as the study of Materia Medica. 78. In essence, constitutional remedies are polychrests - widely used medicines with a wide range of action in chronic diseases and having anti-miasmatic coverage, for the patient as a person, and not for his pathology or for his nosological diagnosis, as per their peculiar symptomatology. 79. Besides the anamnesis, the following few striking features in history may also help us in getting to the right remedy: 80. Location/ Direction of pain Pain in the region of Heart Apex to base: Medorrhinum Pain in the region of Heart Base to Apex: Syphilinum Pain in heart along with left elbow: Arnica Pain radiates to Right: Lil tig 81. Sensations in Heart region peculiar to a few remedies Alive sensation in the heart: Cyclamen Ascending to throat, heart were: Podophyllum Bolts were holding the heart: Cactus Needles were pricking in heart: Lyss, Manc Grasped violently and released alternately: Lilium tig Drops as if were falling from or on heart: Cannabis sativa Numb heart feels: Ovi g. p. Piercing the heart, knife were, > pressure: Lepi Wind about the heart: X ray Plug or a blunt substance as of a: Ranunculus scleratus, Spigelia 82. Causation and Heart Physical H/o Narcotics: Belladonna, Chamomilla, Coffea, Lachesis, Nux vomica, Thuja H/o Smoking: Abies nigra, Cactus, Gelsemium, Ignatia, Lactic acid, Nux vomica, Phosphorus, Staphysagria, Strophanthus H/o Tobacco chewing: Arsenicum, Ignatia, Lycopodium, Selenium, Veratrum album H/o Tea: Abies nigra, China, Dioscorea, Lobelia inflata, Nux vomica, Pulsatilla, Selenium, Thuja Heart strain: Arnica, Borax, Causticum, Coca 83. Causation and Heart Emotional/ Psychological Fright: Aconite, Gelsemium, Ignatia, Opium, Veratrum album Mortification from an offense: Colocynth, Lycopodium, Staphysagria Emotional causes: Aconite, Ambra, Anacardium, Cactus, Calcarea ars, Chamomilla, Coffea, Gelsemium, Hydrocyanic acid, Ignatia, Iodum, Lachesis, Lithium carb, Moschus, Nux moschata, Nux vomica, Opium, Platina, Sepia, Tarentula hispanica 84. Causation and Heart Sexual Celibacy: Conium, Apis Coitus after: Agaricus, Caladium, Calcarea sulph, China, Kali carb, Nux vomica, Phosphoric acid, Phosphorus, Selenium, Sepia 85. Modalities Postural Aggravation From lying down: Arsenicum, Kali carb, Lachesis, Lilium tig, Natrum mur, Nux vomica, Sepia, Spigelia, Thyroidinum From lying on left side: Baryta carb, Cactus, Lac caninum, Lachesis, Lycopodium, Natrum mur, Phosphorus, Pulsatilla, Spigelia, Tabaccum, Thea From lying on right side: Cannabis indica, Magnesia mur, Mercurius, Rhustox, Stannum, Strophanthus From rising: Cactus From sitting: Magnesia mur, Phosphorus, Rhustox From sitting bent forward: Kalmia From stooping forward: Spigelia 86. Modalities Postural Amelioration Lying on back with shoulder raised: Aconite, Arsenicum Lying on left side: Ignatia, Muriatic acid, Natrum mur, Stannum Lying on painful side: Ambra, Ammonium carb, Arnica, Borax, Bryonia, Calcarea carb, Colocynth, Cuprum aceticum, Ptelea, Pulsatilla, Sulphuric acid Lying on right side: Antim tart, Natrum mur, Phosphorus, Sulphur, Tabaccum Lying on right side with head high: Arsenic, Cactus, Spigelia, Spongia Lying on abdomen: Acetic acid, Ammonium carb, Antim tart, Colocynth, Medorrhinum, Podophyllum, Tabaccum Lying with head high: Pulsatilla, Petroleum, Spigelia Lying with head low: Arnica, Spongia 87. Modalities Rest and motion Aggravates, Motion on beginning: Pulsatilla, Rhus tox, Strontium carb Aggravates Stretching: Medorrhinum, Rhus tox Ameliorates, Motion slow: Agaricus, Ambra, Ferrum acet, Ferrum met, Platina, Stannum, Zincum met Ameliorates, rocking: Cina, Kali carb 88. Concomitant In DIGITALIS, an awful deathly sinking feeling in the abdomen especially in the epigastric region is associated with the characteristic slow, weak, intermittent pulse. In NAJA along with the characteristic nature of pain as if a hot iron is pressed on heart, there is chocking in throat and larynx with hoarseness in heart affection. One organ affected with heart is ovary- as if heart and ovary are drawn together. 89. Alternation Pain heart alternating with rheumatism: Aur m, Benz ac, Kalm Pain heart alternating with pain in great toe: Nat p Pain heart alternating with pain in uterus: Lil tig 90. Accompanied by Exophthalmic goitre accompanied with heart ailments: Cadmium iod Intestinal cancer accompanied with heart ailments: Cadmium met Heart complaints accompanied with difficult respiration: Laur, Tarent Heart ailments accompanied with Sleeplessness: Aur mur, Colch, Crat, Dig, Op, Tab Heart ailments accompanied with Urinary complaints: Laur, Lycopus eu Inflammation heart with scanty menses: Nat m 91. Pulse Frequent when thinking of his past troubles: Sep Intermittent in old people: Tab Irregular stool after: Agar Irregular on slight exertion: Meny, Nat m Irregular, lying on back: Arg n 92. Feels if she moves her heart will fail is, A pretty strong plea for DIGITALIS; Must keep on moving, or heart will stop,GELSEMIUM here comes out easily on top; While with LOBELIA, you will hear her say, That its going to stop, whichever way. With a CACTUS heart, iron band constriction (Chest, uterus, rectum, all share the fiction) then LACH has constriction on waking; ARS A Gets constriction-oppresssion, on walking; youll play TIGER LILY to splendidly comfort her woe, whose heart is alternately clasped and let go. IODUM has a heart simply squeezed and no more: The most violent hearts for SPIGELIA roar.Margaret Lucy Tyler 93. AND TOWARDS THE END.. 94. At my age, with my limited knowledge and experience, I am not in a position to provide or draw any conclusion. All I can say is that the homeopathic literature and Materia Medica are full of information, which can help us in treatment of any dynamic disease. 95. Modern medical terminology and understanding of new disease conditions does not always translate directly into homeopathic language, but it is possible to draw inferences from the extensive descriptions of homeopathic Materia Medica, which is called Phenomenological medicine. 96. Perhaps Hahnemann's greatest gift to mankind was his unfaltering courage and the fearless, bold attitude which he took as his mottoAUDE SAPERE. 97. This motto of his gave me the courage to believe that there is no dynamic disease in the world, whose symptoms cant be matched with the morbid effects of medicine found in our pure Materia Medica, and thus shall not be rapidly and permanently cured/ relieved by it. 98. Hence, my humble sharing with the profession this treatment of the heart with a heart.