PERICARDITIS. 399 



portion. Frequently, absorption is incomplete ; the folds of the peri- 

 cardium are then only partially adherent ; in other places, the residua 

 of the exudation appear in the form of puruloid or cheesy masses, 

 which afterward not unfrequently are converted into a chalky paste, 

 which may seem embedded or impacted in the flesh. 



When death occurs at the height of acute pericarditis, or in the 

 course of the chronic form, we find the traces of cyanosis, and not un- 

 commonly discover dropsical effusions in the body. 



SYMPTOMS AND COURSE. As pericarditis hardly ever attacks a 

 person in good health, or appears as a solitary and independent disease, 

 it is difficult to describe its course distinctly. Moreover, when this 

 malady sets in upon some preexisting disorder, its symptoms often 

 modify those of the latter so little that they are exceedingly apt to be 

 overlooked. When pleuritis or pneumonia extends into the pericar- 

 dium, a diagnosis, or even a suspicion, of the complication is often im- 

 possible without physical examination ; and, as the latter too often fails 

 us here, " a participation of the pericardium in the inflammation " often 

 remains undiscovered until the autopsy is made. 



When acute articular rheumatism is the complicating disease, it is 

 quite rare for attention to be called to the existence of pericarditis by 

 any rigor, aggravation of the fever, acceleration or retardation of the 

 pulse, pain in the region of the heart, palpitation, dyspnoea, or terror. 

 It should be our invariable rule daily to auscult the chest of a rheu- 

 matic patient, even though he do not complain, for all the above-named 

 symptoms may be wanting, and yet pericarditis, and even a copious 

 effusion, may exist. When subjective symptoms do occur, however, 

 pain and palpitation are the more frequent of the signs. The pain 

 usually affects the left side of the epigastrium, and spreads more or 

 less over the chest. It is sometimes piercing, sometimes duller, and is 

 almost always aggravated by a firm pressure upward upon the epi- 

 gastrium. Excessive pain almost always signifies implication of the 

 pleura or lung in the inflammation. Palpitation is generally met with 

 where the action of the heart is embarrassed, and where the organ has 

 difficulty in fulfilling its task. It is easy to understand that pericarditis 

 can impede the function of the heart through pressure upon it by the 

 exudation, by serous infiltration of its muscles, and by participation of 

 the latter in the inflammation. On the other hand, it is singular that 

 palpitation, and other symptoms indicative of embarrassment of the 

 heart's action, should not be a more common source of complaint. 

 Sometimes the pulse becomes very frequent when the disease sets in 

 in other cases, it is temporarily retarded. We have already spoken of 

 this latter symptom while upon the subject of endocarditis, and have 

 there expressed our view that it is a matter of pure theory to ascribe 



