Acute inflammation of the membranes of the heart may occasionally arise from exposure to cold; or when no exciting cause is apparent or discoverable. Sometimes it follows blows upon the chest, or other mechanical injuries. It is apt to break out during the progress of specific fevers, but it is most frequently met with in connection with acute or inflammatory rheumatism. The symptoms are usually a singularity of manner, and peculiar expression of countenance, difficult to describe, yet very plain to the observer; a strangeness of deportment, mixed with an aspect of distress or of alarm. To this, are frequently added, pulsation within the chest, a sense of oppression at the stomach, a catch in the breathing, a dry cough; inability or unwillingness on the part of the patient to lie on his left side; pain in the situation of the heart, increased by a full inspiration, or by pressure upon or between the ribs situated above the heart; stiffness and pain in and about the left shoulder, and extending thence down the left arm, and stopping short, perhaps, at the elbow or at the wrist. This last circumstance, however, the pain shooting down the arm, is more common in chronic affections of the heart. There is another symptom, and that is delirium, sometimes quiet, but often wild and furious delirium. There are also the febrile symptoms which accompany the acute rheumatism; or, if the inflammation of the heart occur independently of acute rheumatism, there will usually be fever symptomatic of the local inflamma tion. But, it must be remembered that these symptoms do not always show themselves in the same case ; if they did, the disease would not be so often overlooked as it has been.

Tincture of Digitalis..................Two and a half Drams.

Sweet Spirit of Nitre.................Six Drams.

Infusion of Gentian, sufficient to make Half a Pint.

The number of patients who go to the London Hospitals affected with acute rheumatism, annually, is very large, and it is stated that more than one-half of them have the heart affected.

Patients labouring under rheumatic inflammation of the heart very frequently become affected with delirium, or violent mania, or stupor and insensibility, or convulsions, or all of these in succession ; and you might suppose that they were labouring under inflammation of the brain, or the spinal cord; or of their membranes. Again and again, when death has occurred, and the delirium had been extreme, no traces of disease have been discovered within the skull, nor within the vertebral canal, while marks of violent and intense inflammation have been visible in the membranes of the heart.

The younger the person is who suffers from acute rheumatism, the more likely will he be to have rheumatic inflammation of the heart.

Treatment

In a large proportion of cases, whether they be treated well or ill, or not treated at all, the patients will seem to recover. They will get so far well that you can detect nothing wrong with them; but', if you follow them, in their subsequent lives, you will find that many of them soon begin to feel that they are incapable of doing or enduring all that they could do or endure before their illness : and if this do not soon happen, it happens at last. The first step in the treatment is to abstract blood, by means of leeches, from over the heart; and the sooner this is done after the symptoms set in, the better for the patient. Sir Thomas Watson remarks, if we may ever hope to achieve a complete cure by the early abstraction of blood, it must be in those cases in which strong tokens of the presence of the disease declare themselves; palpitation, pain expressly felt in the region of the heart, tenderness in the spaces between the ribs, frequency of pulse, distress and anxiety referred to the region of the stomach, all springing up together in the course of an attack of acute rheumatism.

From the experience of a number of cases, the late Dr. John Taylor found that the duration of the disease was long or short, according as blood was taken sooner or later after the commencement of the attack. The duration of the cases in which blood was taken away after the first four days, was greater by one-half than of those in which that measure was adopted before the same period. The amount of blood to be abstracted, and the repetition of the application of the leeches, must be regulated by the symptoms, and the progress of each particular case. After the leeches, you may apply poultices or warm fomentations.

The following mixture may be taken:

Acetate of Potash.............................4 Drams.

Tincture of seeds of Colchicum.............80 Minims.

Sweet Spirit of Nitre..........................Half an Ounce.

Water, sufficient to make Half a Pint. Two tablespoonfuls may be taken three times a day. This dose is for an adult.

After the inflammatory symptoms have subsided, it will often be necessary to give stimulants, wine and brandy; with good nourishing diet.