406 DISEASES OF THE PERICARDIUM. 



great reliance. Even ice-bladders have been applied upon the cardiac 

 region. Digitalis is suitable in cases where the beat of the heart is 

 very frequent and insufficient, causing cyanotic and dropsical symp- 

 toms. Its effect here is often very marked. Calomel and blue oint- 

 ment, in spite of the praise of English physicians, are not only useless 

 but hurtful. As to the employment of diuretics, drastics, preparations 

 of iodine, and blisters, what we have said, while treating of pleuritis, 

 applies equally well here. Impoverishment of the blood, which occurs 

 in protracted cases, requires nourishing diet and iron. Threatening 

 heart-palsy demands stimulus. 



When a recent pericarditis comes on in acute rheumatism, we may 

 assume that it will do as well, and perhaps better, without treatment. 

 As long, therefore, as nothing save the physical signs betrays its exist- 

 ence, it is better to refrain from active interference. The astonishing 

 number of recoveries in Bamberger*s collection of cases occurred under 

 a thoroughly expectant treatment. It is only under conditions men- 

 tioned above that we should apply leeches, cold, etc. In order to pro- 

 mote absorption, Bamberger lays stress upon the application of warmth 

 and moisture, and especially upon flying blisters. Paracentesis is to 

 be performed when the distress of the patient, especially from the 

 dyspnoea, imperatively demands aid. The result is merely palliative, 

 as a rule ; but, even to afford the sufferer opportunity, after the opera- 

 tion, to pass the night in his bed (perhaps for the first time in a long 

 period) and to enable him to sleep a little, is a great gain. Whether 

 in other cases the operation can effect a radical cure, our limited ex- 

 perience does not permit us to decide. Particulars of the operation 

 are to be found in the hand-books on surgery. 



CHAPTER II. 



ADHESION OP THE HEART AND PERICARDIUM. 



ANATOMICAL APPEARANCES. Adhesion of the pericardium and 

 heart is one of the consequences of pericarditis. Its pathogeny and 

 etiology have been given in the previous chapter. The adhesion is 

 sometimes partial, sometimes total. Sometimes it consists in a firm 

 agglutination of the surfaces, sometimes long bands and fibres are the 

 media of connection. In a clinical point of view, the condition of the 

 epicardium is of much more importance. There is occasionally so 

 little thickening of the adherent pericardial faces that tne pericardium 

 seems to -have disappeared; in other cases the epicardium is converted 

 into an indurated, unyielding case, in which we find masses of even a 

 bony hardness. Again, in circumscribed spots where the fusion of Ihe 



