Pain may demand an opiate. A fair amount of sleep for the patient is im perative. For this purpose bromide of sodium is useful and paraldehyde seems especially suitable, because it is some what stimulating. Robust patients in an abrupt and stormy onset of the disease may be benefited by leeches applied over the heart; but venesection and such car diac sedatives as aconite are to be avoided.
Some patients obtain more relief from hot than from cold applications. Blisters are to-day little used, although some au thorities believe that they hasten the ab sorption of effusion. Cantharides is con , tra-indicated in nephritic cases. No in ternal remedies seem to have any specific effect either in preventing or curing the inflammation.
If, as is likely to happen in the progress of the disease, the pulse becomes irregu lar, intermittent, and of low tension, re sort must be had to digitalis.
The bowels should be kept open by salines, and acetate of potash may be em ployed as a diuretic. Moderate amounts of easily-digested nourishment should be given at brief intervals.
One must be guided by the etiological factor. The application of ice, with such quietude of body as can be secured, and the control of the heart by small doses of strophanthus and digitalis is advised. If exploration of the pericardial sac is necessary, the use of careful incision recommended rather than of puncture.
The treatment of pericarditis in chil dren should be directed against the causal and accompanying disease. The excited heart's action is controlled by rest in bed, by strophanthus or digitalis, and by the application of ice locally. Ichtliyol ointment (from 20 to 30 per cent.) is useful, and in some cases the old calomel treatment and mercurial ointment may be of value. Surgical treatment may be indicated; in that case incision to mere puncture is pre ferred. A. Baginsky (Berl. klin. Woch., Nov. 2S, '9S).
In rheumatic pericarditis the treat ment is first prophylactic. While the salicylates do much toward relieving the articular pain, they are of little value in preventing cardiac complications, except in that they shorten the duration of the disease. Small doses of sulphate of qui nine may also be valuable as a support ant and prophylactic treatment. After the pericarditis has once been established the chief part of the treatment should consist in local counter-irritation.
Plicque (La Presse Med., June 4, '98).
Prolonged rest in bed (two or three months) after acute cardiac inflamma tions in children is important because acute cardiac inflammation of a severe type is of much greater gravity in chil dren than in adults. Both the endocar dium and pericardium are often simul taneously involved, and there is great tendency to acute dilatation. The car diac muscle of children is less resistant to strain than that of adults; this ren ders it liable to acute dilatation, and this is much encouraged by the concurrent pericarditis. The liability of these at tacks to be complicated with pneumonia is also to be remembered. Holt (Ar chives of Pediatrics, vol. xvi, No. 12, 1900).
Sodium salicylate in large doses, given day and night, continued for some time after articular symptoms have disap peared, recommended. In pericarditis without effusion the writer advises scarification, ice and methyl-salicylate locally, and opium, digitalis, milk diet, and perhaps the nitrates internally. Sodium benzoate, theobromine, and normal salt solution enemata or injec tions may also be of service. After ef fusion occurs, either venesection, dig italis, theobromine, paracentesis peri cardii, or pericardiotomy is resorted to according to the needs of the case. H. finchard (Jour. des Praticiens, Nov. 1, 1902).
It has been stated that rheumatic cases almost always recover; this is true even when large effusions are developed, so that some delay in paracentesis is justi fiable here; but in general it is better to be prompt in the removal of any large effusion. One purpose of this is to re lieve the heart of mechanical embarrass ment, and another is to discover the character of the effusion, for purulent pericarditis has a better chance of recov ery if permanent drainage is early estab lished. For other particulars with regard to aspiration see DIAGNOSIS.
Several surgeons have made independ ent studies of the best method for drain ing the pericardial sac. In a general way it may be said that an important point is to avoid opening the pleural cavity, which might cause pneumothorax or empyema.