396 DISEASES OF THE PERICARDIUM. 



per cent, of the cases observed have been complicated with acute rheu- 

 matism. 



Next in frequence, pericarditis complicates Bright's disease, tuber- 

 culosis, particularly tuberculosis of the lungs, chronic disease of the 

 heart, and aneurism of the aorta. In all these cases, as it seems to 

 me, the primary disease gives rise to a predisposition to pericarditis ; 

 but the latter is not a sequel, only a complication of the primitive com- 

 plaint, and is not to be regarded as secondary in the narrow sense 

 of the word. 



It is otherwise in the pericarditis which attends septicaemia and 

 kindred conditions, puerperal fever, severe scarlatina, small-pox, etc. 

 Here the disease belongs to the consequences, and is not a complica- 

 tion ; the infection manifests itself by a series of inflammatory disturb- 

 ances, attacking the skin, the joints, and the pericardium. 



ANATOMICAL APPEARANCES. In the bodies of many, and especially 

 of old persons, we find upon the visceral surface of the pericardium a 

 number of fine papillae, consisting of delicate, vascular connective tissue. 

 Still more frequently we find irregular, whitish, flat tendinous deposits, 

 called maculce albidce, lactce (SehnenflecJce). These, likewise, consist 

 of new connective tissue, springing directly from that of the pericar- 

 dium, from which they can only be detached by force, and by whose 

 epithelium they are covered. If the pericardial proliferation be of in- 

 flammatory origin (a matter still sub judice), like the thickening and 

 adhesions of the pleurae, they appear to proceed from inflammation, 

 which produces a merely nutritive exudation, a pericarditis sicca. 



As the growth of villi and the formation of maculae albidae are not 

 recognizable during life, but are mere accidental post-mortem discover- 

 ies, we shall give them no further attention. 



In discussion of the subject of exudative pericarditis, our attention 

 will be occupied, first, with the changes undergone by the pericardium ; 

 second, the quality and quantity of the exudation. 



At the commencement of the disease the pericardium appears more 

 or less reddened, in consequence of a dense capillary injection spring- 

 ing from the deeper parts, with here and there extravasations in the 

 form of irregular, dark-colored, homogeneous red spots. The tissue is 

 relaxed by serous infiltration, and can be very readily torn ; the sur- 

 face, the epithelium having fallen, is dull and void of glitter. The 

 membrane soon takes on a shaggy appearance ; fine villi, papillae, and 

 folds develop by the proliferation and generation of young connective 

 tissue-cells, constituting the first step in the formation of pseudo-mem- 

 branes, and of the adhesions of the pericardium, which remain after 

 pericarditis. 



Pericardial effusions present all the modifications which we have 



