HYDROPERICARDIUM. 499 



ude, as in Bright's disease, chronic affections of the spleen, cancerous 

 cachexia, etc., the pericardium is not usually affected until a late 

 period. 



ANATOMICAL APPEARANCES. According to the explanation of the 

 foregoing paragraph, only collections in the pericardium, of a liquid 

 containing but little albumen, are to be regarded as hydropericardium. 

 If the liquid contain fibrin, it belongs to the inflammatory effusions. 

 Sometimes small quantities of disintegrated blood are mingled with 

 the serum. In such cases the nutritive state of the capillary walls has 

 deteriorated so that they become ruptured. The frequent occurrence 

 of small haemorrhages into the skin (petechice), in general dropsy, is 

 an analogous condition.* 



The quantity of the liquid effused is very variable. A collection 

 of an ounce or an ounce and a half of liquid in the sac is not to be 

 regarded as pathological. In cases which are not rare, the amount 

 may be as much as four or six ounces ; in others, particularly when 

 the affection arises from disturbance of the circulation, it may exceed 

 several pounds. When the effusion is very large, the pericardium is 

 dull-white and lustreless, the fat has disappeared from about the heart. 

 Sometimes its connective tissue is cedematous. 



Copious dropsical effusion into the pericardium distends it, com- 

 presses the lungs, and dilates the thorax exactly like pericardial ex- 

 udations. 



SYMPTOMS AND COURSE. Our remarks upon the subject of 

 hydrothorax are equally applicable to that of hydropericardium. 

 Although, to the minds of the ancient physicians, " water on the 

 neart " used to be a most formidable malady, as even now is the case 

 among the laity, yet it has no real title to rank as an independent 

 disease. But not only is accumulation of liquid in the pericardium al- 

 ways a secondary affection, depending either upon some derangement 

 of the circulatory or respiratory apparatus, or else upon a morbid con- 

 dition of the blood, but the very symptoms imputed to water on the 

 chest, and so much dreaded, proceed chiefly from the primary disease, 

 and are not caused by the pericardial effusion. When, prior to the 

 introduction of physical examination, a diagnosis of hydropericardium 

 was often confirmed post mortem, it was due to the fact that the 

 symptoms upon which the diagnosis was based nearly always arose 

 from such diseases as emphysema and valvular disease of the heart, 

 which ultimately resulted in dropsical affections, and therefore in effu- 

 sion into the pericardium. 



A large serous effusion into the pericardium undoubtedly has the 



* We shall treat of fibrinous dropsy in cancer of the pericardium, just as we have 

 spoken of it in cancer of *Jie pleura. 



