Traumatic Pericarditis. Foreign Bodies in Pericardium. 453 



(Joyeux) ; wall of the abdomen (Mottet) ; intercostal region 

 (Cornette). 



Lesions. The earliest lesions must be in the mucosa and mus- 

 cular and serous coats of the reticulum, but these are rarely 

 noticed by themselves. In the second stage there is a fistula 

 passing through the anterior wall of the reticulum and the dia- 

 phragm and surrounded by a more or less abundant inflammatory 

 exudate. The thickness of this exudate is in ratio with the size, 

 form and sharpness of the foreign body : a fine, sharp, smooth 

 sewing needle may pass with little irritation or exudate, where- 

 as a coarse, rusty wire or nail, or a coarse piece of metal convey- 

 ing septic microbes causes much disturbance and an exudate as 

 large, perhaps, as an infant's head. At a still more advanced 

 stage the fistula with its walls of exudate or neoplasm, extends 

 forward through the mediastinum and outer layer of pericardium, 

 or an adhesion having been established between the two layers, 

 the canal extends to or into the heart itself. As far as to the 

 pericardium the fistula is usually very narrow and follows a gener- 

 ally straight course ; it may even have narrowed after the foreign 

 body passed through, so that it would not admit of its return. 

 In other cases, however, it remains wide and open and it is evident 

 that the offending body has even receded into the reticulum and 

 disappeared, and several fistulae have been found side by side no 

 one of them having lead as far as the heart (Boizy). The wall 

 of the fistula may be congested of a deep red ; or it may be the 

 seat of infiltration with an abundant serous exudate giving it a 

 yellowish or grayish appearance ; or it may be dark in color from 

 pigmentation and hard from fibroid organization in cases of older 

 standing. At intervals it may show one or many abscesses vary- 

 ing in size from a pea, to several inches in diameter, closed or 

 opening into the fistular tract, the pleura or pericardium. The 

 contents of the fistula may be pure, creamy pus, but usually they 

 are dark, frothy and malodorous. 



The adjacent pleura is not infrequently implicated, and there 

 may be extensive collections of fluid and false membranes, the 

 liquid being bloody, pink, grayish or translucent, or again puru- 

 lent, or frothy and foul smelling as in other pleursies. In the 

 same way the pericardium may be involved and become the seat 

 of extensive false membranes and liquid effusion. Sometimes 



