412 DISEASES OF THE PERICARDIUM. 



repeatedly. Of course, the treatment of this affection can only be a 

 treatment of symptoms, and in most cases it is limited to an exhibition 

 of stimulants. 



CHAPTER V. 



TUBERCULOSIS OF THE PERICARDIUM. 



TUBERCLES in the tissue of the pericardium are only seen in acute 

 miliary tuberculosis. The grayish nodules here visible do not undergo 

 further metamorphosis, and the patient dies, consumed by fever, with- 

 out betraying any symptoms of the existence of tubercles in the peri- 

 cardium. 



It is far more common for tubercles to form in the young pseudo- 

 membranes which develop on the pericardium in the course of a chronic 

 pericarditis. We nearly always find a haemorrhagic effusion in the 

 sac in these cases, and observe its walls to be studded with drusy 

 prominences, which are at first translucent, but may afterward become 

 yellow and cheesy, although they rarely soften into " tubercular pus." 

 The symptoms of this form of tubercle of the pericardium are undistin- 

 guishable from those of chronic pericarditis. 



CHAPTER VI. 



CANCER OF THE PERICARDIUM. 



CANCER of the pericardium is almost always an extension of can- 

 cerous disease from the sternum or mediastinum. Sometimes it grows 

 diffusely, so that a large part of the sac degenerates into cancer ; some- 

 tunes it forms solitary rounded masses, or flat nodules upon the mem- 

 brane. More rarely it appears independently after extirpation of an 

 external cancer ; and then other nodules upon other organs and upon 

 other serous membranes are nearly always found. The formation of 

 cancer in the pericardium is nearly always combined with a collection 

 of liquid within the sac, which, like the liquid found in cancer of the 

 peritonaeum or pleura, contains " fibrin of tardy coagulation." It is pos- 

 sible, only in the very rarest instances after removal of a cancer of the 

 breast, to diagnosticate the formation of cancer of the pericardium by 

 the evidence of a gradually increasing effusion in the sac. 



