§ 147. Carditis and pericarditis infantum.

These inflammations are not very unfrequent in children, but the symptoms are so deceitful that there is great danger of mistaking the true seat of the disease. It is likewise frequently impossible in these little children, when so restless and tormented by anguish, to ascertain the physical symptoms.

Frequently we only notice great dyspnoea, which sometimes occurs in paroxysms, excessive anguish, constant moaning and tossing to and fro; the painful sensations are frequently described as being in the abdomen, or in the region of the heart. Palpitation of the heart is sometimes present, at other times absent. There is generally violent fever, hot skin, dryness of the lips and tongue, frequent, small and irregular pulse; finally, convulsions and generally collapse, which leads to the suspicion of the brain being affected. Sometimes, however, the symptoms of pericarditis are more distinct. Auscultation should never be neglected (Canstatt).

§ 148. The treatment will be more fully indicated in the chapter on Rheumatism of the heart, or endocarditis. We shall here content ourselves with briefly indicating the remedies referring to that disease.

The first remedy is Aconite, every half hour, after which Nux vom. is sometimes indicated.

If the fever and the local distress should have been moderated by the Aconite, and if oppression, palpitation of the heart, anxiety, apprehension, sadness should remain, Pulsatilla would be most suitable.

If some inflammatory symptoms should still remain, attended with violent anguish, distorted countenance, great prostration of strength and debility, Cocculus will be found most suitable, particularly when accompanied with inflammatory swelling of the knee.

If the symptoms mentioned under Cocculus should be excessively violent, and a little inflammation should still remain, Arsenic should be resorted to.

Cannabis, first, second or third attenuation, is an excellent remedy, after the diminution of the fever by means of Aconite, when the patient complains of a tensive aching pain in the middle of the sternum, with oppression of breathing, frequent shocks in both sides of the chest, and most painful in the region of the heart, accompanied with orgasm and a sensation of fulness about the heart. Distinguished remedies are: Spigelia, Oleander, Tart. emet., Phosphor., Sulphur, Belladonna, Nitrum, Digit., etc.

As we said above, we shall hereafter recur to the treatment of this affection.