PERICARDITIS.
Inflammation of the pericardial sac is usually associated with endo carditis, and is only a part of a general rheumatic carditis, the special treatment of which is detailed in the article on Endocarditis. This may be here briefly summarised for convenience : Absolute rest in bed in the horizontal position, changed to the sitting posture should the sac become distended with effusion. Ice should be applied to the prRcordial region, and if this does not afford comfort poultices or warm compresses should be applied. Leeches, cupping (dry or wet) and blisters may be used, Morphia being occasionally necessary to relieve severer pain. When the ice-bag is used its application should not be continuous. Wynter strongly recom mends the local application of Salicylate of Methyl (i in 4 of oil or lanolin).
Internally Salicylates may be continued in moderate doses combined with Alkalies, and many authorities recommend inunction with is per cent. Mercury or Crecle's Colloid Silver (Collargol) Ointment. This silver salt (r gr. in roo mins. water) may be injected intravenously or given per rectum where there is any reason to suspect that ulcerative endocarditis complicates the case.
When extensive effusion has occurred, diuretics like Iodides in 2o-gr.
doses, Agurin, Diuretin or Uropherin in is gr. doses or the stronger Theobromine derivatives—Theophylline, Theocin, Euphyllin—mav be administered in 5-gr. doses.
If the effusion continues to increase paracentesis of the sac should be carried out by the methods mentioned in the preceding article.
Poynton has drawn attention to the fact that very rarely, if ever, does the distension of the sac require tapping in simple rheumatic cases, the dyspncea, &c., being caused by the great dilatation of the heart, which should be relieved by Digitalis or Strophanthus, or by Strychnine hypo dermically.
Adherent this condition can be diagnosed and the hypertrophied heart can no longer continue to carry on the circulation against the serious handicap of the adhesions the operation of cardiolysis or thoracostomy should be resorted to. It consists in the removal of a portion of the overlying ribs with their costal cartilages, and sometimes of the lower part of the sternum. The operation has been rendered less fatal by the method of performing it under differential pressure, which reduces the dangers arising from opening of the pleura to a negligible quantity.