PERICARDITIS. 401 



the disorder which complicate Blight's disease, disease of the heart, 

 tuberculosis, and, rarest of all, ; n the purulent pericarditis accompany- 

 ing septicaemia, etc. 



Death is not a common consequence of acute pericarditis ; that is 

 to say, the disease is not often the sole and immediate cause of death. 

 When it occurs in a rheumatic case, the disordered action of the heart 

 suddenly, or else gradually, increases to cardiac palsy ; the pulse be- 

 comes small and irregular ; the consciousness is completely lost ; en- 

 gorgement of the pulmonary veins produces cedema of the lungs, and 

 the patient dies. Death may be all the more speedy, if the pericarditis 

 be complicated by pleuritis or pneumonia. The termination of tuber- 

 culosis, Bright's disease, etc., may also be accelerated by such a com- 

 plication, but the disease then almost always assumes a chronic form. 

 Cases in which, from the beginning, the effusion has been purulent, 

 almost always end fatally ; but it is difficult to decide how much of 

 this evil result is due to the local affection, the pericarditis, and how 

 much to the constitutional disorder which it complicates. 



As a third mode of termination, acute pericarditis may pass into 

 a chronic state. A small number of cases of chronic pericarditis pro- 

 ceed from the acute rheumatic form of the disease. It is more com- 

 mon, however, as an accompaniment of the cachectic conditions and 

 cardiac disease which we have so often spoken of. The malady, which 

 probably always at first assumes the acute form, does not get entirely 

 well, and sooner or later (just as in many cases of pleurisy), the in- 

 flammation breaks out afresh. The exudation is extremely profuse, 

 the dyspnoea severe. After a while the symptoms abate again ; but 

 new relapses often follow, and the disease goes on for months. We 

 have said that the substance of the heart becomes extremely soft, re- 

 laxed, and discolored ; and, accordingly, we often find the pulse very 

 small and irregular, the veins overloaded, and the patient dropsical. 

 The more copious the exudation in the pericardium, so much the more 

 severe not only does the dyspnoea become, but the cyanosis and drop- 

 sy. Much of the blood which ought to be in the arteries is crowded 

 into the veins, and cannot gain access to the right heart ; for the lat- 

 ter, compressed by exudation, is unable to dilate, as in other cardiac 

 diseases. It is only in very rare instances that chronic pericarditis 

 terminates in complete recovery. Death by cedema of the lungs and 

 slow suffocation is the most frequent ending, and, in almost every case, 

 the disease is attended by sequelae : 



1. First among the sequelae of pericarditis stands adhesion of 

 heart and pericardium, to be treated of in the next chapter. 



2. We have already learned how dilatation of the heart becomes a 

 sequel of this disease (Chap. II.), and that the longer the attack lasts 

 so much the more is this likely to happen. 



27 



