Symi^toins, Diagnosis. 1047 



symptoms of pulmonary edema. Sometimes death occurs sud- 

 denly at a time when the general condition of the animal is 

 still fairly satisfactory. Recoveries are rare in cases which 

 are clinically well marked and usually follow upon a period of 

 convalescence lasting several weeks. However, even in those 

 cases which take a comparatively favorable course, chronic 

 changes remain w^hich influence the heart action unfavorably. 

 In extensive adhesions the heart beat is weak and the thorax 

 is depressed in the region of the heart (Roll). 



The course of traumatic pericarditis varies in the several 

 cases, but is usually insidious, extending over weeks and months, 

 and even longer, during which time the symptoms usually 

 increase gradually or with transitory remissions. Eventually 

 digestive disturbances become more and more evident and finally 

 a soporose condition develops, accompanied by paralysis-like 

 debility, probably due to the absorption of putrefactive poisons 

 from the exudate (de Bruin). In many cases metastatic, puru- 

 lent inflammatory foci form in various organs, for instance in 

 the joints and tendon sheaths, and in such cases the disease may 

 terminate with the clinical picture of pyemia. Other complica- 

 tions are pneumonia and pleurisy, gastric and duodenal catarrh, 

 etc. Sudden death is not a very rare occurrence in any stage of 

 the disease and follows either upon injury or perforation by the 

 foreign body of the heart muscle or of the larger blood vessels 

 of the heart, or through the influence of sapremia. On the other 

 hand, protracted cases are observed occasionally, in which the 

 well-marked symptoms gradually diminish in intensity, the 

 nutrition improves and the animals may even be put to work 

 (Mathis, Jensen). Sometimes spontaneous recovery occurs, the 

 foreign body either breaking through to the outside or returning 

 into the reticulum. 



Diagnosis. During the initial stage the symptoms are not 

 sufficiently characteristic to make a positive recognition of peri- 

 carditis possible, although the development of an acute peri- 

 carditis is suggested by the very great sensitiveness of the pre- 

 cordia, and by the pounding, often arhythmic heart beat which is 

 altered decidedly by even comparatively slight external influ- 

 ences. Later the friction sounds or the various splashing 

 sounds, together with the decided enlargement and peculiar form 

 of the cardiac dullness unite to make up a characteristic clinical 

 picture, which is developed further by symptoms of blood stasis 

 and by edema, and which it is almost impossible to mistake. It 

 is, however, not to be forgotten that none of these phenomena 

 are pathognomic in themselves and that some of them may be 

 absent, not only in traumatic pericarditis but also in other 

 inflammations of the pericardium. 



For the diagnosis of a commencing traumatic pericarditis the high 

 pulse rate (100-110 a minute) with a normal or at most maximal normal 



