Prognosis in acute cardiac inflamma tion of a severe type is much worse in childhood than in later life. There are three reasons for this: (1) the frequency with which both the endocardium and pericardium are involved, (2) the great tendency to acute dilatation, and (3) the liability of these attacks to be compli cated with pneumonia. Holt (Archives of Pediatrics, Dec., '99).
Treatment.—Absolute rest in bed is very desirable if the patient is able to enjoy it. In many cases, however, the sufferer cannot assume the horizontal position, but is obliged to sit either propped up in bed or in a chair where he may bend his knees. For such un fortunates, sleep is often best obtained by providing them with a shelf or rest in front of them at about the level of the elbows, on which they may lean, bending forward. There are special tables made with a leaf reaching over the bed.
ill primary weakness and dilatation of the heart which develop chiefly in am-elide and scrofulous children, they should be taken away from school at once, kept absolutely quiet in fresh air (preferably at the sea-side), and given the best possible diet suitable for their age and digestive power. Martins (Con gress of Inter. Med., Carlsbad, Apr. 11 to 14, '99).
The diet is of nearly equal importance with bodily rest. It should be bland, easily digested, and given in small amounts at intervals of two or three hours. Some cases have seemed to do well on a purely-milk diet, particularly such as have suffered from high arterial tension. In most, however, a variety of rather concentrated, but simple, viands is preferable. Thus we may allow eggs, fowl, underdone beef or mutton, beef juice, and gruels made with one-half milk and one-half water. Alcohol as a beverage or long-continued tonic is use less and harmful. It should be reserved for emergencies, unless, indeed, the pa tient has become so accustomed to it that a small amount of whisky or dry wine is almost necessary to stimulate the appetite and digestion. it is the view of some that habitual alcoholic stimula tion is more desirable in old age than in earlier life; but the writer's experience has satisfied him that, in the condi tion under consideration, great caution should always be used in regulating the administration of alcohol.
Constipation and flatulence interfere with abdominal respiration and impede the venous circulation. Laxatives are consequently of great value, and more especially hydragogic cathartics. En largement of the liver increases the ad visability of their employment. In suit able cases the relief from a purge is al most magical. It seems to produce the same mechanical effect that venesection would IN-itliout the loss of strength which the latter measure involves. The fa vorite drug is mercury, either in the form of blue mass or the mild chloride. This may be followed the next morning by a dose of sulphate of magnesium or sodium in concentrated solution. It is said that the advantage of mercury over other cathartics is that it not only de pletes the veins, but dilates the capilla ries, and thus lessens the obstruction which the weakened heart has to over come. Another efficient and not very unpleasant remedy for the same purpose is composed of equal parts of bitartrate of potassium and compound jalap pow der, of which the dose is 1 or 2 tea spoonfuls. By far the best cardiac stim ulant in this condition is digitalis. It should be given in efficient doses. If the desired effect is not obtained with ordi nary amounts, the remedy should be gradually pressed until either there is improvement or nausea interferes with its further administration. In some cases it may be given by means of an enema when the stomach altogether rejects it. Its well-known cumulative action should be remembered, and it should not be longer continued if nausea begins or the amount of urine diminishes. In fact, practically, one must be ready to sus pend it about as soon as it produces a marked satisfactory effect (see DIGI TALIS). As substitutes for digitalis, tincture of strophanthus, caffeine, and sulphate of sparteine may be employed, their probable efficacy being in the order named.
Pellets of cactina,1/100 grain each, one I being given every two hours during the day; especially effective in weak and dilated heart. Nola cordial as a cardiac tonic. Campbell (Montreal Med. Jour., June, '95).