PERICARDITIS 165 



DISEASES OF THE PERICARDIUM. 

 Pericarditis. 



{Inflammation of the Heart Envelope.) 



Etiology. — Inflammation of the pericardium may originate in a 

 primary way by traumatisms or cold, or, secondarily, in connection 

 with infectious or inflammatory diseases of the neighboring organs, es- 

 pecially pleuritis, or disease of the endocardium and myocardium. It is 

 a question whether this condition can originate from perforation of lung 

 abscesses or from foreign bodies coming from the oesophagus. Tul^er- 

 culosis seems to be the most frequent exciting cause of this disorder. 

 Traumatisms such as gunshot wounds, fracture of ribs, may cause peri- 

 carditis. Cold or rheumatism is said to be a predisposing cause of peri- 

 carditis, but this theory is very doubtful. 



Pathological Anatomy. — Pericarditis occurs either in the acute or 

 chronic form. The anatomical alterations that it produces on both sur- 

 faces of the pericardium correspond to those on the pleura caused by 

 pleuritis and occur in the following forms, fibrous, hemorrhagic, puru- 

 lent or icteric. The most common form is serofibrinous pericarditis, 

 with copious liquid exudates in the pericardium and masses of fibrinous 

 Ij-mph attached to the surface of the pericardium; in very rare instances, 

 the folds are attached to each other. When this condition has been 

 present some time, the pericardium becomes dilated and relaxed and 

 the heart-muscle shows more or less atrophy. 



Clinical Symptoms. — Slight pericarditis rarely shows itself to any 

 marked degree, but in severe cases there is decided palpitation, the pulse 

 becoming weak and indistinct, with marked irregularity in the rhythm. 

 On auscultation there is great dulness all over the region of the heart; 

 finally the heart sound is entirely lost or simply a pericardial rubbing 

 bruit is heard. "When the pericardial folds are attached or when they 

 are separated by effusions this sound disappears. 



There may be an increase of temperature, loss of appetite, and the 

 slightest exertions cause marked increase in the respiration wuth cyanosis 

 of the visible mucous membranes. As soon as the disease .becomes ad- 

 vanced, the same symptoms that are seen in any case of defective heart 

 action are noticed; the lessened arterial pressure causes irregularity in 

 the action of the urinary apparatus, and from venous stagnation dropsy 

 shows itself in different parts of the body, especially in the extremities. 

 As a result of acute infectious diseases, pleuritis and pleuro-pneumonia, 

 we may have acute inflammation of the pericardium and death as a 



