Adherent Pericardium. Dry Pericarditis. 449 



witli softening and degeneration (fatty, calcic, fibroid) of the 

 heart walls, and it may be, dilatation or contraction of the heart 

 cavities. 



Symptoms. The symptoms are in many cases obscure. 

 Changes, amounting to even general calcification, may occur, 

 and yet the function is not incompatible with fairly good health. 

 I have seen the heart of a fat wild duck completely invested 

 with calcareous matter, but the bird seemed, in no way, to 

 have suffered. In cases of calcification of auricle or ventricle in 

 the horse, which is habitually called on for active exertion, the 

 general symptoms of heart disease were manifested under such 

 conditions. Palpitations, irregularities, inequalities and inter- 

 missions of the heart beats and pulse, dyspncea on slight exer- 

 tion, stocking of the limbs, dropsies, ascites, hydrothorax, 

 venous pulsations, cyanotic membranes, and even muscular 

 cramps in the limbs may be evident. When more or less of 

 these general symptoms follow an acute pericarditis, and persist 

 after the subsidence of fever and local tenderness, or of pericar- 

 dial effusion, and in the absence of all indications of dilatation, 

 contraction, valvular and other diseases of the heart, adhesion 

 may be suspected. No symptom is pathognomonic, though 

 some have been held to be so. There may be a retraction of the 

 chest wall during systole in cases where the heart is adherent to 

 the wall. This is most marked behind the left elbow. Auscul- 

 tation may show a perceptible prolongation of the first sound, 

 due to the retarding of the ventricular contractions from firm 

 adhesions to surrounding parts. In partial adhesions this is 

 most likely to be obvious toward the base of the heart, which is 

 usually most extensively adherent. In man a rebound or shock 

 against the ribs has been noticed on the occurrence of diastole, 

 and which is naturally attributed to the dragging of the sud- 

 denly released adhesions. A sudden collapse, on the occurrence 

 of diastole, of the previously tense jugular veins, may be referred 

 to the same cause. With complete adhesion the shock of the 

 apex of the heart may be weakened even to extinction. If the 

 impulse is increased higher up, this symptom is all the more sug- 

 gestive. The gradual weakening of the pulse, even to extinc- 

 tion during inspiration, has been held to be diagnostic, but this 

 often occurs independently, as in the advanced stages of pneu- 

 29 



