A warm linseed poultice, upon which a little Unguentum Belladonnat is smeared, is an effective remedy, or the green extract, rubbed up with Glycerin, may be painted over the cardiac area when there is cardiac pain and distress. Occasionally the application of leeches may be useful.
Blistering gives more satisfactory results than any other method of treatment. This plan of treating in a routine way all cases of rheumatic fever was first carried out systematically by the late Dr. A. Harkin, and the writer had many opportunities of observing the results which he obtained by placing a large blister over the cardiac area in cases where no cardiac complications existed. The temperature usually fell rapidly with the pulse-rate, and the joint pains were for a time markedly relieved. This was before the introduction of the salicvlate treatment, when the physician had no remedy save opium for the relief of the constitutional symptoms. Since then Caton has shown that a blister may he used as a preventive of endocarditis, and of permanent valvular disease when applied after endocarditis has supervened. He applies the vesicant between the clavicle and nipple to the skin supplied by the first four dorsal nerves with the view of stimulating the trophic centres. In con junction with blistering Caton insists upon a prolonged rest of 3 months in bedAnd the steady administration of Iodide of Sodium with occasional doses of Calomel. It will, however, be wise to combine the iodide with full doses of alkalies.
In the later stages especially salicvlates should be avoided owing to their depressing effects upon the cardiac muscle when long continued.
Cardiac tonics—Digitalis and Strophanthus—must be used cautiously, and only then when signs or symptoms of heart failure or weakness are present. Though the pulse-rate may be reduced by these agents the strength of the ventricular contractions is also markedly increased, and this will only increase the mischief when the heart muscle is unimpaired. Sudden failure should be met by Strychnine hypodermically and alcohol avoided when possible, since this stimulant, whilst temporarily helping the heart, usually increases the pulse-rate at the same time.
Iron, Quinine, or the vegetable Bitter Tonics and a change of air and scene are valuable agents in restoring the strength and vigour after the prolonged rest in bed. Exercise should be permitted tentatively at first and with much caution; a return to the active duties of life should be postponed till after the cardiac muscle has attained its normal tone.
Endocarditis occurring during scarlatina, chorea and tonsillitis even where no other rheumatic manifestation is present. must be treated upon exactly similar lines.
The presence of pericarditis does not contra-indicate the use of the before-mentioned remedies, though additional agents may he required, as will he found detailed under Pericarditis. It is 11, good practical rule to assume where a pericardial inflammation is present in rheumatic patients that endocardial mischief always accompanies it.