Clinical and pathological notes on pericarditis / by W.T. Gairdner.

  • Gairdner, Sir William Tennant, (1824-1907)
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Clinical and pathological notes on pericarditis / by W.T. Gairdner. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    34/38 (page 32)
    I find it impossible to arrange the facts of my experience in tins' matter in the statistical form. For, in the first place, I do not know how many cases of really acute pericarditis I have treated: and in the present state of our knowledge, as indicated in a preceding part of this paper, it aiay safely be said, that every attempt to number such cases must involve elements of most serious fallacy. But, in the second place, I do not know how many of the cases I have treated have got well in the end, and looking to the remote conse- quences ; some of them, for instance, may have recovered for the time with more or less of adhesion of the pericardium. Of this only I am certain, that, as physician to the Royal Infirmary, I have not had under my care a case of rheumatic pericarditis fatal during the acute period of the attack. Let me try to turn this fact to its pi'oper use, as regards what may be called the heroic methods, bleeding and mercurial salivation. I believe that the profuse employment of blood-letting in inflam- mations has long been diminishing, and that in Edinburgh, at least, it is pretty nearly extinct. I shall not, therefore, occupy space in demonstrating that that is a wrong thing which, to the best of my knowledge, very few indeed are in the habit of doing. For many years past, I have not heard that any physician in Edinburgh has used a lancet in rheumatic pericai'ditis. At all events, I am very sure that the lancet is used most sparingly by the profession in general, and has been so for many years past.^ But I am not so sure about mercury. Undoubtedly the use of this treacherous mineral is now marked by very great caution; and we almost never hear of those bad consequences which are the direct result of excessive mercurial action. But is its use, as some even now use it, expedient or necessary ? And in rheumatic peri- carditis in particular, would patients recover better, or worse, were no mercury exhibited ? Without altogether holding the question as decided, I am strongly inclined to answer both of these ques- tions in a sense unfavourable to the use of mercury. My own use of this much vaunted and much abused remedy has been rather experimental than founded on conviction. The reserve with which I have used a remedy which has so much testimony in its favour, may appear to require some explanation. The truth is, that, as a student, it was my fortune to serve in the hospital under a very bold mercurialist—a man of the most humane charac- ter, and of the most entire conscientiousness, who proved his sin- cerity in regard to this subject by undergoing, in his own person, three distinct salivations in the course of his fatal illness. Under this gentleman's directions I learned much that was valuable ; and, ^ Since the statements in this paragraph were published (after being read in the Medico-Ohirurgical Society), I have learned that my colleague, Dr Warbur- ton Begbie, has on tliree occasions employed venesection in pericarditis with a favoiu-able result. I am not the less convinced that in his hands, as in others, the lancet has been used most sparingly, as stated in the text.