The termination, in favorable cases, is more or less adhesion of the pericardial surfaces. Flint considers it doubtful it the exudation is ever completely removed by absorption – leaving the surfaces unattached and free from disease. He also considers it the rule that the pericardial sac is obliterated, from adhesion throughout its entire surface. Of 156 cases of pericardial adhesions analyzed by Louis and Chambers, 111 were universal.
Death occurs in pericarditis from arrest of the circulation, from paralysis of the heart, from the combined effects of the pressure of the liquid effusion and the proximity of the inflamed membrane to the muscular fibres of the organ. It must be remembered that death from the slightest over-exertion may occur during the stage of effusion.
TREATMENT.
The treatment of inflammatory cardiac affections has not yet received that careful study in our school which their importance demands. Notwithstanding this, we can safely assert that our treatment is far more successful than that of the allopathic school; or, with greater propriety it might be said, than the former treatment by that school, which consisted of blood- letting, calomel, blisters, opium etc. The allopathic treatment, as at present adopted by its best practitioners is far more rational than ever before – it is even homoeopathic – as witness the treatment advised by Dr. Flint, who discards blood-letting altogether, and says of
6 mercury, that it should not be used in Bright’s disease, anaemia, or any cachectic state; and other authors deny its efficacy in idiopathic or rheumatic pericarditis. Flint says of opium, that it is a very important and valuable remedy, but the relies more upon aconite and digitalis than any other agents, and these he uses in a strictly homoeopathic manner.
If the homoeopathic school is limited to a few remedies, it is because our provers have not paid sufficient attention to objective symptoms. In but few of our provings has any proper record been made of the cardiac symptoms developed. The objective symptoms have been neglected, and the subjective only vaguely recorded. Not only this, but even in the few reported clinical cases of heart-disease found in our literature, no physical exploration of the chest was made, to confirm the diagnosis, and in many cases we are in doubt whether they were really cases of disease of the heart.
The following are the chief remedies to be selected in pericarditis:
Aconite. The symptoms of the aconite-heart-disease are prominent and unmistakable. It is indicated in the first stage of the disease, or until the exudative process is completed. It is not so often indicated in the second stage – or stage of liquid effusion – and rarely in the third stage. The action of aconite is twofold. Primarily, in large doses it depresses the vitality of the heart even to the point of paralysis. But the reaction which occurs is a secondary effect, and results in hyperaemia and inflammation; but this inflammation does not go to the extent of causing liquid effusion, nor does it cause organized exudation of lymph. The following are the symptoms for which it is indicated in the first stage:
The beats of the heart are move violent and rapid; the pulse hard, strong, and contracted (not full and bounding). The pain, if any is felt in the cardiac region, is burning, lancinating, and constrictive, or stitching. There may be tenderness on pressure over the cardiac region, or in the epigastrium under the ribs. The skin is very hot, with burning and intense thirst. The urine scanty and red. The countenance expresses great anxiety, and there is always present a fear of death. The position of the patient is on the back, with the head and shoulders raised. Any movement aggravates the pain, if any. But cases of pericarditis occur without pain, and here we must depend on physical signs. If fever is present, and the heart’s action is hard and rapid, and pulse hard, and percussion and auscultation shows the first stage, then is aconite still indicated. It is not indicated in the first stage of pericarditis, when the cause is Bright’s disease, or pyaemia, but only in idiopathic, traumatic, or rheumatic cases.
If we expect aconite to act well in this stage, we must give the lower dilutions, 1st to 3rd, or even a few drops of the mother tincture in half a glass of water, a spoonful repeated every hour or two. Nor shall we find it useful after the first 12 or 36 hours. So soon as we discover the pulse to grow weaker, and the action of the heart less violent, the size of the dose must be changed, or some other remedy must be selected. Baehr says, “Aconite is not only indicated at the commencement of the disease, but, in many cases, during its whole course, more especially in rheumatic cardiac inflammations, so long as the organic alterations do not result in paralytic or cyanotic symptoms.”
I cannot support these assertions. Aconite is indicated in the second and third stages, but not on account of any inflammatory action supposed to be existing, but because it is homoeopathic to threatened paralysis. Baehr himself admits this, virtually, when he says aconite is also indicated when the “beats of the heart become slower, or else they remain quick, and grow feeble or irregular; or a feeble and small pulse, not synchronous with the beats of the heart, intermitting or unequal, the temperature is lower, and the number of respirations increase rather than decrease.” But Baehr says nothing about changing the size of the dose when the symptoms change. The physician who gives the same dilution of aconite in the second as in the first stage will be disappointed, and do injury to his patient.
The dose in the second and third stages should never be lower than the third dilution, unless the powers of absorption are very feeble. These stages are similar to the primary stages of aconite-poisoning, when the cardiac nerves are brought to the verge of paralysis. The 30th or 10th is the proper attenuation to use when we give it for feeble and irregular cardiac action.
Asclepias tuberosa will be found useful in some cases of pericarditis. Its action is quite analogous to bryonia. The symptoms point rather to a sub-acute than an acute condition. I have used it in one such case with excellent results. The asclepias-fever is not intense, the pain in the cardiac region is pricking, there is shooting pain near the left nipple extending to left shoulder, with a feeling of constriction in the region of the heart. A dry, spasmodic cough, with some dyspnoea, is generally present. The pain in the chest is relieved by bending forward. There is palpitation of the heart, with pulse 88 and small. It is indicated in sub-acute cases, with liquid effusion, the absorption of which it hastens, and should be used in the lowest dilutions. the asclepias syriaca is indicated in similar conditions, namely, the second stage, when the disease is connected with uraemia, with copious liquid effusion. Its action on the kidneys is similar to colchicum.
Bryonia alba is doubtless one of our most valuable remedies in the first and second stages of pericarditis. Its action begins when the exudation of plastic lymph appears, and as this often occurs very soon, it is best to alternate it with aconite, or follow closely after that remedy. It is indicated in those cases of idiopathic or rheumatic pericarditis, with or without pleurisy, with intense fever, frontal or occipital headache, and acute stitching pains aggravated by the slightest movement. I do not consider it the best remedy in cases of liquid effusion, nor does it do any good in cases of feeble, irregular, or intermittent cardiac action. The heart’s action is not violent or tumultuous, but the friction-murmur is always heard, dulness on percussion is present, the point of apex-beat raised and carried to the left, and the heart’s sounds intensified (at first), then both sounds weakened. It is of no value in pericarditis from Bright’s disease or pyaemia, nor when the effusion is copious, and aeration of blood deficient.
Arsenic. The testimony relating to the efficacy and applicability of arsenic in pericarditis is quite conflicting. Baehr says, “we have never seen any good effects from it in acute conditions. It is a remarkable fact that among the large number of cases of poisoning by arsenic, post-mortem examinations have never yet revealed a single symptom that might lead us to infer that arsenic exerts a specific action upon the heart.”
Dr. Russell, on the contrary, asserts that arsenic exerts a powerful influence on the heart and lining membranes, both internal and external. He quotes Orfila, who found “small spots of a bright crimson color in the left ventricle and on the columnae carneae, and this color penetrated deeply into the substance. The right cavities presented spots on much deeper red – almost black color.” But he did not find the serous membrane inflamed.
If arsenic is homoeopathic or pericarditis, it is to that variety caused by uraemia or pyaemia, in which conditions the nervous life of the organ is poisoned. It may be homoeopathic to carditis, and also to the second stage of sub-acute or chronic pericarditis, with serous or liquid effusion, associated with great irritability and tendency to paralysis.
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.