Part II
GENTLEMEN: I shall call your attention in this and following lectures to the
INFLAMMATORY AFFECTIONS OF THE HEART.
Inflammation of the heart may affect one or more of the structures which compose that organ. The investing serous membrane may be alone inflamed, constituting the disease known as pericarditis. When the membrane lining the cavities, or the endocardium, is the seat of inflammation, the affection is called endocarditis. Inflammation of the muscular tissue, or substance of the heart, is designated myocarditis or carditis.
Although these different inflammatory affections may exist each independent of the others, they are often associated. In many cases of pericarditis, carditis co-exists. Myocarditis very rarely occurs except in connection with inflammation of either the investing or lining membrane of the heart.
The importance of these diseases cannot be overrated, and their study is of the highest importance. They are seated in the great vital organ of the body. They involve great suffering and danger to life. Their remote consequences are very grave. All organic affections of the heart have their origin in the inflammatory. Too many physicians neglect to study this class of affections, greatly to their own detriment and that of their patients. The homoeopathic treatment of inflammatory cardiac affections, if skillfully applied, is vastly superior to the ordinary methods. The late improvements in physical examination greatly facilitate correct diagnosis, and enable us to combat these diseases with the happiest results.
PERICARDITIS.
Acute pericarditis – Anatomical characters – Morbid changes – Causes and pathology – Connection with rheumatism – With albuminuria – With Bright’s Disease, pyaemia, etc. – Symptoms – Of the heart – Of the circulation – Of the respiratory symptoms – Digestive organs – Brain and spinal cord – Physical signs of pericarditis – Signs furnished by auscultation, percussion, palpation, inspection, and mensuration – Summary – Diagnosis – Prognosis – Treatment.
Inflammation of the investing membrane of the heart is less common than endocarditis, but it is a more serious affection as regards immediate danger.
This membrane is like the serous tissues in other portions of the body, and inflammation results in the same changes in this, as in the pleural and peritoneal membranes. It is more dangerous than the other serous inflammations, because of the small size of the pericardial sac, and the fact that the heart-substance consists of muscular tissue, also because of the important function of the organ and its physiological relations.
In treating of pericarditis the following points will be considered: 1. The morbid changes incident to the disease. 2. Its causes and pathological relations. 3. The symptoms, signs diagnosis, prognosis, and treatment.
Like other inflammatory affections, this has an acute, sub- acute, and chronic form.
THE MORBID CHANGES.
The inflammation is seldom diffuse, and is generally limited to single spots. The membrane at first looks injected, opaque, sometimes spotted, in consequence of slight extravasations. Acute inflammation speedily leads to exudation of lymph. This exudation takes place, in most cases, probably within a few hours from the commencement of the inflammation. It is at first of a jelly-like consistence, and adheres slightly to the membrane, forming a thin layer, either limited to the base of the organ and about the roots of the large vessels, or extending more or less over the pericardial surface. The heart, at this stage, is said to present an appearance like that of hoar frost, or to a “layer of liquid gelatine spread upon the parts with a camel’s hair pencil.” The exudation goes on, and generally, but not invariably, more or less liquid effusion varies in quality and quantity. It may amount to a few ounces or to a several pints. the exudation either consists of plastic lymph, mixed or not with serum, or blood, very seldom of serum alone.
The first stage extends to the time when the accumulation of lymph is sufficient to be determined during life by symptoms and physical signs.
The second stage embraces the period during which an appreciable amount of liquid continues.
The third stage comprises the duration of the disease after the resorption of the liquid.
These stages have been called stages of exudation, of liquid effusion, and of adhesion.
If the disease do not prove fatal, the liquid is gradually absorbed, and adhesion follows; or absorption occurs without adhesions; or a membrane may be formed from the plastic exudation; or the effused fluid may be changed to pus. The adhesions may be firm and extensive, or delicate and thread-like.
A liquid effusion sufficient to be manifested by physical signs may take place at a period of the disease, varying from one to four days from the date of the attack.
Death usually occurs during the period of liquid effusion.
The effusion is sometimes absorbed quite rapidly, in other cases slowly. In the latter instance, a condition obtains which has been called dropsy of the heart.
CAUSES, AND PATHOLOGICAL RELATIONS.
Acute pericarditis is rarely an idiopathic or primary disease. In the great majority of cases it is a secondary affection. There are many cases of which it is an occasional concomitant, but in the larger proportion of instances it occurs either in the course of acute articular rheumatism, or the renal affection known as Bright’s disease.
Of 847 cases of rheumatism, collected from various sources, and analyzed by Dr. Fuller, it existed in 142, or about one to every six cases.
Of 50 cases collected by Dr. Flint, it existed in 19, or more than one-third.
Rheumatism is more likely to become complicated with pericarditis in the young than in the aged, and occurs oftener in females than in males.
The more acute the rheumatic affection, the greater the liability to pericarditis; and it occurs oftener during first attacks than in subsequent.
That there is an intimate relation between acute rheumatism and pericarditis admits of no doubt, but the common notion that there is a metastasis from the joints to the heart is erroneous, although some cases appear to support the supposition. The facts are that pericarditis often precedes the affection of the joints, and the inflammation of the joints does not usually subside when the heart is affected.
The true explanation of the apparent transfer of the disease, and of the relation existing, is, that the pericarditis and affection of the joints depend upon the same condition of the blood. The analogy of structure between the pericardium and the synovial membranes will account for the liability of the former to become inflamed when the latter are affected.
The connection between pericarditis and albuminuria and uraemic phenomena is now quite definitely ascertained.
Of 35 cases of pericarditis analyzed, with respect to causation, by Dr. Taylor, renal disease existed in 13.
Of 50 cases collected by Dr. Flint, renal disease was present in 7. Of 292 cases or renal disease analyzed by Fredrichs, pericarditis occurred in 13. Of 135 fatal cases of pericarditis analyzed by Dr. Chambers, the kidneys were diseased in 36.
Renal disease existed in a larger proportion of the cases of pericarditis which end fatally than of those ending in recovery. The explanation of this is, pericarditis developed in connection with Bright’s disease usually ends fatally; whilst in connection with acute rheumatism recovery takes place in a large proportion of instances.
What is the relation between pericarditis and certain renal affections? It is well known that serous inflammations are apt to become developed in connection with Bright’s disease. These inflammations are attributed to the accumulation of urinary principles in the blood, from faulty excretory function in the kidneys. the excess of urea, or the decomposition of its products in the blood, act as poisonous agents, giving rise to inflammation of the pericardial and other serous membranes.
Pericarditis may be associated with pleurisy or pneumonia. It must not be supposed, however, that it obtains by means of extension, but results from the same pathological cause.
Pyaemia frequently co-exists with pericarditis. Wounds, and surgical operations, in tissues remote from the heart, sometimes give rise to pericarditis. The explanation is, the blood becomes poisoned so as to cause serous inflammations.
SYMPTOMS OF ACUTE PERICARDITIS.
The symptoms of pericarditis vary with the three periods of the disease. They are modified by the amount of fluid effused during the second period, and again during the absorption of the fluid in the third stage. The intensity of the inflammation may be in ratio to the severity of the pain.
In some cases, however, pericarditis may run its course with but little pain or febrile movement attendant. But this is equally true of inflammation in any organ, especially in the serous tissues.
The symptomatology of pericarditis is best treated of by taking it up in the following order, namely: The symptoms relating to the heart, and afterwards those referable to the circulatory, respiratory, and nervous system.
Hale wrote Lectures On Diseases Of The Heart, Materia medica and special therapeutics of the new remedies Volume 1, Materia Medica And Special Therapeutics Of The New Remedies Volume 2, Saw Palmetto: (Sabal Serrulata. Serenoa Serrulata), The Medical, Surgical, and Hygienic Treatment of Diseases of Women, New Remedies: Their Pathogenetic Effects and Therapeutic Application, Ilex Cassine : the aboriginal North American tea, Repertory to the New Remedies with Charles Porter Hart, The Characteristics of the New Remedies, Materia Medica and Special Therapeutics of the New Remedies, The Practice of Medicine, Homoeopathic Materia Medica of the New Remedies: Their Botanical Description etc.