ACUTE PERICARDITIS. 557 



pericarditis is usliered in with considerable febrile symptoms, 

 and a rather hard or harsh pulse, somewhat increased in 

 frequency ; there is also pain, particularly when made to 

 change position ; the respiration is disturbed, or there may be 

 distressing dyspnoea. 



AVhen the inflammatory action is moderate in character, 

 when the fibrinous exudate has not been excessive, and the 

 amount of serous fluid secreted is trifling, we may have only 

 moderate constitutional disturbance and inappreciable local 

 signs of disease. Of this we are satisfied by after-death 

 examinations. 



When, however, the effusion has been considerable, pressing 

 upon and impedmg the functional activity of the heart, while 

 the muscular tissue has undergone change with adhesions and 

 organizations of exudate distributed over a large space, we 

 may have a difl'erent train of sjnuptoms. Fever is still marked, 

 but the pulse is altered, having lost its hard or harsh character, 

 becoming feeble, fluttering, unequal and irregular ; we may 

 have both carotid pulsation and jugular regurgitation, with dis- 

 tressing dyspnoea, all indicative of obstruction in the thoracic 

 circulation. 



There is also often cough, much debility, coldness of the 

 limbs, with oedema both of these and of the trunk. It is always 

 necessary to bear in mind that we must not be governed by a 

 consideration of any one separate symptom, seeing that many 

 of these, both general and local, are found accompanying 

 diseased conditions of other organs of the thoracic cavity. 



In that particular form of influenza-fever or distemper in 

 which the serous and fibro-serous structures of the body are 

 largely involved, and which in particular seasons and certain 

 districts appears as an epizooty, a very prominent and serious 

 complication or symptom is pericarditis. Here the symptoms 

 may not at once attract attention to this particular structure 

 as being largely involved, and they are often much mingled 

 with those indicative of the involvement of other structures 

 and organs, both of the thorax and elsewhere. 



In these cases the physical or local signs of this condition 

 are sometimes very well marked, at others very much dis- 

 guised. They are well marked when there is Httle involve- 

 ment of the lungs and pleura, and they are much obscured 



