Nitrum (kali nitricum) ought to prove curative in some cases of pericarditis, especially if it appears as a complication of acute rheumatism or Bright’s disease. It has many symptoms which indicate its use in cardiac inflammation.
Gelsemium is rarely indicated in acute inflammations of the heart. It may be useful in the first stage, and for a very short time. It is useful in cases having a catarrhal origin; rarely, if ever, in rheumatic pericarditis; and never when from diseases of the kidneys.
The symptoms calling for its administration are: chilliness, then fever, with feeling of dullness, heaviness and swimming in the head (occiput); stitching sensation in the region of the heart; constrictive pain around the lower part of the chest; sudden attacks of suffocation; inspiration of a sighing and catching character; expirations sudden and forcible; heart’s sounds intensified; pulse full, rapid, soft.
For these symptoms the proper dose lies below the 2nd dilution. No result will be gained in inflammatory affections if the higher attenuations are used. Its administration should not be continued after the pulse becomes slower and softer, unless we change the dilution to the 6th or 12th, for if indicated in the third stage, it is for the tendency to paralysis of the heart, which is a primary effect of the medicine.
Veratrum viride. The same remarks are applicable to this medicine that have been applied to gelsemium. It may, however, be given in those cases of idiopathic or rheumatic pericarditis that are ushered in by violent fever, full, hard, bounding pulse, with congestion to the head, throbbing carotids, etc. The pain is burning, constant, with oppression of the chest; sensation as of a heavy load on the chest; heart’s action violent and tumultuous; respirations rapid, labored, and sighing. Dose, 1 drop of the tincture, or first decimal dilution, repeated every two hours.
Unlike the veratrum alb., it cannot be used in the second or third stages, unless we have the rare phenomena of vomiting, cold skin, pulse 20 or 30, and here it must be given in the 6th dil.
In cases of poisoning by verat. v. (in cats) serum to the amount of 13 to 1/23 was found in the pericardium.
Colchicum has been recommended for pericarditis, especially rheumatic. Baehr says, “it seems to us to be improperly ranked among cardiac remedies.” In cases of poisoning, no pericardial lesions were observed; in fact the pericardial sac was found empty. Muller, however, says that colchicum is more suitable for pericarditis than endocarditis. Baehr asserts that all the heart- symptoms are secondary from loss of fluids. In Laurie’s Practice a case is reported where colchicum removed the following symptoms (after lach. and ars.): dullness on percussion over a larger space; friction-noise at the sternum stronger than before, impulse more powerful, but the natural heart -sounds impaired ad distant; great dyspnoea and faintness on the slightest movement; oppression after eating or drinking ever so little; no cardiac pain; position on the back, with head and shoulders raised.” This would seem to prove that it was useful in the second stage. It is probable that the best indication for colchicum in pericarditis is the co-existence of rheumatic inflammation elsewhere, and the urinary symptoms indicating that medicine.
Dose: The dilutions from the 1st to the 6th Tartar emetic, according to Russell, is a good remedy in some cases of rheumatic pericarditis, and for the following urgent symptoms: “Great dyspnoea, and violent pain at the heart, with cough.” But he evidently does not believe it to be a specific remedy, but removes this dyspnoea, etc., by its action on the lungs, and its effect on “the pulmonary branches of the pneumogastric nerve, by sympathy with the cardiac.”
Dose: Grain doses of the 2nd or 3rd dec. trituration.
Kalmia latifolia. Of this remedy Hering says, “No remedy in the whole materia medica has such control over the pulse, except digitalis.” “In diseases of the heart which alternate with rheumatism, or have originated in rheumatic attacks, kalmia must become important.” No clinical reports have been made to substantiate this statement, nor do we know of any reliable symptoms of the medicine indicating its use. If useful at all, it is in the first stage.
Cactus grandiflorus was strongly recommended by Dr. Rubini for “all inflammatory affections of the heart.” He does not, however, mention pericarditis among his clinical observations, but says it cures pleurisy and inflammations of serous membranes. If homoeopathic to pleurisy, it is probably also to pericarditis. The symptoms seem to indicate its tendency in that direction: “Sensation of constriction of the heart. Dull, heavy pains in region of the heart, increased by external pressure. Pricking pain in the heart, impeding respiration and motion of the body. Very acute pain, and such painful stitches in the region of the heart as to cause him to weep and cry out loudly, with obstruction of respiration. Palpitation of the heart continues day and night. Fever, with great heat, violent pain in the head,” etc. It is to be greatly regretted that Dr. Rubini made no observation of the pulse, or examined the condition of the heart by physical exploration. Such neglect is a loss to science, and utterly unpardonable. Cactus may be indicated in any stage of pericarditis, and the best effects have been obtained from the lowest dilutions.
Cannabis. Baehr seems to confound the cannabis indica (hashish) with cannabis sativa, which latter possesses, in no degree, the cerebral symptoms of the former. Cannabis sativa has been recommended in pericarditis, but upon very unreliable data. Baehr gives the following symptoms of cannabis indica: “Violent palpitation of the heart, sometimes without any anguish, sometimes attended with perfect agony.” It is indicated in cases of pericarditis with cerebral symptoms. Dose, 1st to 3rd dilution.
Sulphur has not usually been mentioned in connection with pericarditis, but its pathogenesis contains many symptoms relating to the heart. From analogy, however, I claim that it ought to receive more attention as a cardiac remedy.
You have been taught how useful it is as a remedy in pleurisy, in the stage of exudation, also its power over obstinate inflammations.
Its action on the pericardium is doubtless the same as on the pleura. If it will cause absorption of plastic lymph in one serous membrane it will in any other. Baehr mentions “a case of pericarditis where uncommonly loud friction-murmurs and a rubbing of the pericardial surfaces against each other, that could even be felt by the hand, and had already existed for upward of three months, disappeared entirely after sulphur had been given for a fortnight.” You may give sulphur with great confidence where there is plastic exudation, if the inflammation seems to linger, not-withstanding the free use of bryonia. (Dose, 1st to 30th.)
Iodine, or iodide of potassa – I prefer the latter – will be found useful in cases quite similar to those for which I have recommended sulphur. Iodide of potassa has great power in causing absorption of morbid products. It removes the plastic and serous exudation in pleurisy and pericarditis. The pathogenetic symptoms recorded in the Symptomen Codex are very suggestive, and closely simulate the pains of pericardial inflammation. (Dose, one-half to two grains in an ounce of pure soft water every four hours.)
The alkaline treatment, although not dynamic, but chemical in its nature, has some claims upon your attention. The theory advanced in its support in this: alkalies are supposed to exert their effect by neutralizing the materies morbi in the blood, and also to eliminate them from the body. The bicarbonate of potassa or soda are the alkalies preferred, and it is considered necessary to give as much as three or four drams daily, until the urine becomes alkaline. It is claimed by Fuller, that rheumatic pericarditis may be prevented if the alkaline treatment is carried to this extent. Dr. Richardson’s researches appear to substantiate this assertion, for of 48 cases in which the “full alkaline treatment” was employed, the heart was affected in but one case. He contrasts these with 110 cases treated by bleeding, nitre, mercury, etc., where the heart was affected in 35. Flint, however, says he has known cases in which pericarditis occurred during the “full alkaline treatment,” and after alkalinity of the urine had been produced. Dr. Russell (homoeopathist), in his Clinical Lectures on Rheumatism, approves of the alkaline treatment, and says that it cannot interfere with the action of specific remedies. He believes that we ought to neutralize and eliminate the lactic acid, and thus remove the cause. He also believes that both aconite and bryonia act by removing the cause which develops the lactic acid, and in this way, perhaps, act as curative agents in rheumatic affections.
I have frequently tested the value of the alkaline treatment, and believe acute rheumatic affections generally run a shorter course under such treatment. You may give ten or twenty grains, or more, of the bicarbonate of soda or potassa, or the citrate of potassa, largely diluted with gruel or pure water, three or four times a day, until the urine becomes alkaline, which condition is readily ascertained by testing that secretion with litmus paper.
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.