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.

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    among tlie rest, something in regard to tlie bad effects of mercury in rheumatic pericarditis. But I have never succeeded in learning anything as to its good effects, tliough on many occasions after- wards I liave administered it with such caution as my knowledge of it inspired. It may be said that I have not done justice to the remedy. In one sense this is true ; for I have very rarely given it, except after other remedies. But surely, with a remedy of the power ascribed to this one, and specially regarded as promoting the absorption ol exudation, it is no real injustice to call it into operation only in cases of a certain degree of severity, and to watch with care its influence n])on cases that have in some degree resisted other treatment. But whether I have done justice to mercury or not in my per- sonal trials of it, I believe I have used it so as to do justice to nature, which is, after all, perhaps a better thing. For, assuredly, if I had adopted the plan of giving mercury instantly, in every case where a slight roughness existed in connection with the first sound of the heart, I should have failed to observe that the immense majority of these cases never went beyond a slight roughness, oi', at most, a slight but decided friction-sound ; that of those which went beyond this, and were accompanied by a degree of effusion, a large proportion had only moderate effusion ; and that, even when con- siderable effusion was present, a good cure was still possible without mercury. I will conclude by mentioning, as nearly as possible, what has been the usual course of treatment adopted in the cases here referred to, in so far as it has differed from that of acute rheumatism, or of the other primary disease. I trust I have not acted under any narrow or bigoted feeling of opposition to established doctrines, any more than of empirical devotion to single remedies. In the very beginning of some cases of pericarditis, where the pain was very marked, and especially where it had strongly the characters of angina, leeches have not unfrequently been applied in moderate numbers. From four to six leeches so applied, and followed by fomentations, have very commonly relieved the pain, and been followed rapidly by improvement. Where relief occurred, but was not complete, the application has sometimes been repeated. More commonly, one application has been all that I have thought requisite; and this only when strength and condition permitted, and when the symptoms had a certain degree of urgency. General blood-letting has not once been practised. Fomentations, sometimes plain and sometimes medicated with opium, friction with camphorated and iodurettcd liniments, and in obstinate cases the use of blisters, have been the chief local remedies besides leeches. To conclude, I believe the principles of the safe treatment of pericarditis to be as follows :—1. To make large allowance for the in- significant and spontaneously healing class of cases revealed more by physical signs than by symptoms, and to regard them as demanding £