ACUTE PERICARDITIS. 559 



accompaniment of any constitutional or general diseased con- 

 dition, and necessarily demands a somewhat difierent treat- 

 ment. Also it must not be forgotten that the treatment of the 

 disease ought largely to depend upon the stage of the morbid 

 process and the existing results which have followed that 

 process at the period of our treatment. 



If in our diagnosis we feel satisfied that the earlier stages of 

 acute pericarditis — indicated by a tolerably full and hard 

 pulse, much cardiac force and irritability, unaccompanied with 

 constitutional debility or the action of epizootic influences — 

 are being passed through, a fair amount of blood-letting Avill 

 tend to do good by lessening the congestion of the heart and 

 tending to allay its irritability. 



This may even be repeated if the circulatory force, as indi- 

 cated by the action of the heart and the character of the 

 pulsations, seem to warrant it ; but more frequently, even in 

 these rarely met with instances of acute sthenic inflammations 

 of the pericardium, will the results we desire to obtain — viz., to 

 lessen the excitation and irritability of the heart — be achieved 

 by following the first blood-letting with small and repeated 

 doses of tincture of aconite. Where pain is a prominent feature 

 the aconite, if not seeming to afford relief during the first six 

 or twelve hours, may be superseded by tincture of opium given 

 in gruel, along with linseed-oil ; while heat and moisture are 

 applied by means of woollen cloths wrung from hot water, 

 and wrapped around the chest for two hours consecutively. 

 When these have been removed, a compound soap liniment 

 containing tincture of opium ought to be smartly rubbed over 

 the sides of the chest. This latter application to be carried 

 out between each fomentation. 



When the earlier stages of the diseased process have passed, 

 and liquid is effused in the pericardial sac, a somewhat different 

 treatment is called for. Bleeding is here inadmissible ; our 

 endeavours must be directed to give the system such assist- 

 ance as may enable it to overcome the depression consequent 

 on the eftusion, and lead to the removal^of the liquid through 

 absorption. Here the application of a smart cantharides 

 liniment to the chest may be expected to operate beneficially, 

 while, instead of aconite, it is highly probable that stimulants 

 with diuretics are called for ; these may with advantage be 



