EXUDATIVE PERICARDITIS DUE TO FOREIGN BODIES. 385 



and does not readily yield. The liver becomes hypertrophied, congested 

 and engorged with blood, and when the animals live for some weeks, 

 shows the appearances known as cardiac or nutmeg liver. 



Treatment. The treatment of pericarditis due to the presence of 

 foreign bodies is at present merely palliative. Often the only thing 

 to be done is to slaughter the animal. 



We need not go back to the methods formerly recommended. All 

 are illusory or mischievous, such as the use of purgatives to arrest or 

 reverse the progress of the foreign body, removal of the foreign body 

 after opening the rumen, puncture of the pericardium, etc. 



In 1878 Bastin successfully opened the pericardium and extracted 

 the foreign body through a window produced in the thoracic wall. 



This operator recommends that after drawing the left limb forward 

 and incising the skin and muscles, the operator, with his hand bound 

 round with a cloth, should perforate the pleura, and then having found 

 the foreign body, proceed to extract it. By this method it seems difficult 

 to cause perforation of the pericardium, which would certainly lead to 

 the production of pneumo-thorax complicated with fatal septic pleurisy. 



It must be borne in mind that the two pleural sacs, right and left, 

 descend as far as the sternum (Fig. 173), and that it is not possible to 

 touch the pericardium directly without perforating the pleura. 



Moussu has drained the pericardium through the pleura in the hope 

 of relieving the pressure on the heart and facilitating the reabsorption of 

 the oedema, in order to permit of the subsequent slaughter of the animal, 

 but has had unsatisfactory results. Lastly, he has practised median 

 trepanation of the sternum in the infra-pericardiac region. Here again 

 the operation is difficult, because of the (Edematous infiltration of all the 

 substernal region, while it is so dangerous to the patient, which must be 

 cast and may suddenly succumb, that it is of no use in ordinary practice. 



There is probably only one condition in which it would be possible to 

 attempt intervention with a fair chance of success, that is, when there 

 exists a fibrous connection between the pericardium, lung, and wall of 

 the chest on the right or left side. 



In such cases aspiratory puncture or incision of the pericardium in 

 an intercostal space might prove of service, because it would not expose 

 the animal to the danger of pneumo-thorax. 



The only difficulty lies in ascertaining beyond all question the existence 

 of such an adhesion before attempting operation, and this is really very 

 great, even having regard to the form of the dulness and the absence of 

 all respiratory sound in the lower third of the thoracic cavity and cardiac 

 zone. The pulmonary lobe between the heart and chest wall may be 

 thrust upwards and l)e partially adherent to the pericardium and to the 

 parietal pleura, and at the same time it may be impossible to avoid 

 D.c. • c c 



