ATROPHY OF THE HEAKT. 95 



very cautious, and induce him to look to the head instead of the 

 prsecordia. 



Pericarditis, like endocarditis, may come on in the course of acute 

 rheumatism, without being denoted by pain, or any sympiom sensi- 

 ble to the patient. , The region of the heart should therefore be fre- 

 quently scrutinized by the stethoscope in rheumatism, and proper 

 measures be adopted as soon as there is the first indication of 

 murmur. 



Frequency of the disease. — Dr. Latham shows that the heart is 

 much more frequently inflamed in acute rheumatism than is often 

 imagined. Out of 136 cases of that disease, the heart was inflamed 

 in 90, about two-thirds ; of these 90 cases there were 63 of endo- 

 carditis ; 7 of pericarditis ; 11 of endocarditis and pericarditis com- 

 bined, and 9 in which the seat was doubtful. 



Out of this number there were but three deaths ; but yet in the 

 great majority of those who recovered, there was some deviation 

 from the healthy state remaining, which, no doubt, laid the founda- 

 tion of subsequent chronic disease of the valves. 



Morbid appeara7ices in acute 'pericarditis. — The membrane in- 

 tensely red ; perhaps ecchymosed, its cavity containing serum with 

 flakes of lymph ; and both the inside of the pericardium and the 

 outside of the heart covered with a layer of lymph of variable thick- 

 ness ; sometimes the opposing surfaces adhere ; sometimes they are 

 free, and the lymph is flocculent, or corrugated, making the heart's 

 surface look like tripe. 



Of endocarditis. — The affected portion of the valves is generally 

 found thickened, pink, and fringed with deposits of lymph. 



Treatt)ie7it. — The treatment of inflammation of the heart is the 

 same as that of acute rheumatism, only modified to meet the emer- 

 gency. Bleeding must be employed, if the general state of strength 

 and excitement show it to be demanded, and that it can be borne ; 

 cupping between the shoulders., or leeches to the prcecordia^ are in- 

 dispensable. Full doses oi" opium, at bedtime, to ensure sleep; and 

 calomel, with smaller doses of opium, in such quantities as the seve- 

 rity of ihe disease may demand during the day ; purgatives, so as 

 to clear out the abdominal viscera, and colchicum are the main 

 remedies. And it should be observed that it will be right to leech or 

 cup the instant any abnormal sound is heard in the region of the 

 heart, although no symptom of uneasiness there may be complained 

 of by the patient. When the acute state has subsided, blisters will 

 hasten the absorption of effusion or deposit of lymph. 



HYPERTROPHY, DILATATION, AND ATROPHY OF THE HEART, AND 

 ANGINA PECTORIS. 



Hypertrophy signifies a preternatural increase of the muscular 

 substance of the heart; and there are generally said to be three 



