400 DISEASES OF THE PERICARDIUM. 



these phenomena to irritation of the cardiac ganglia,. If the pulse be 

 both frequent and small, pericarditis may assume a strong resemblance 

 to typhus and other asthenic fevers. The sick man is collapsed, is ex- 

 tremely restless, sleeps badly, and starts from his sleep ; he becomes 

 delirious, until at last somnolence sets in. The more imperfect and 

 hurried the action of the heart becomes, so much the more marked are 

 the symptoms of circulatory obstruction; the countenance becomes 

 congested and cyanotic, and the breathing rapid. If a fresh obstacle 

 to respiration be added to this passive hyperaemia of the lung, should 

 the lung be compressed by a huge pericardial effusion, the dyspnoea 

 may become intense. The patient lies upon the left side, as it is the 

 left lung which is the most compressed, and freer play is thus afforded 

 to the right side of the thorax, or else he sits upright, or bent forward 

 in bed. Even when the function of the heart is not suffering mate- 

 rially from the effects of the pericarditis, dyspnoea, and very severe 

 dyspnoea, too, may arise through compression of the lung, so that, as 

 acceleration of pulse is not a very common symptom, pain in the car- 

 diac region, palpitation, and subsequent dyspnoea, must be pronounced 

 its most frequent subjective signs, if it produce any functional derange- 

 ment at all. 



If pericarditis be a complication of tuberculosis, Bright's disease, 

 chronic disease of the heart, or aortic aneurism, its invasion is equally as 

 insidious as, if not more so than, when it arises in rheumatism. With- 

 out physical examination, its diagnosis would be impossible. After long 

 duration, the malady develops a series of symptoms, which we shall 

 describe as chronic pericarditis. If it set in in the course of grave 

 blood-disease, there are absolutely no subjective symptoms. In such 

 maladies the sensorium is usually much benumbed by the asthenic 

 fever, and the great apathy of the patient renders him insensible to 

 pain and distress far more violent than any arising in pericarditis. It 

 would seem that depression of the cardiac action is most intense in 

 cases of purulent effusion, but, without physical proof, we are unable 

 to decide with certainty whether the acceleration and contraction of 

 the pulse, already rapid and small, be due to the prostration or to the 

 pericarditis. 



With regard to its course and termination, the forms of the disease 

 which accompany pneumonia, pleurisy, and acute articular rheumatism 

 generally have a favorable issue; the disease is acute, and ends in 

 complete recovery. If, as often happens, it have not given rise to any 

 subjective symptoms, the change for the better is only to be recognized 

 by physical examination. Palpitation, pain, and dyspnoea, if present, 

 usually soon subside, as also does any frequence of the pulse which 

 may appear. This favorable result is far less common hi the forms of 



