PERICARDITIS. 147 



Auscultation gives nothing but pure heart-sounds, and with the 

 above symptoms you may have a callous degeneration of heart or 

 a pure idiopathic hypertrophy; during life it is impossible to de- 

 termine which; as the treatment in both cases is the same, it is of 

 no practical value. This consists of protection against excitement 

 or great bodily exertion ; give nutritive, easily digested food ; and, 

 if the heart is irregular, heart-tonics. 



DISEASES OP 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 connec- 

 tion with infectious or inflammatory diseases of the neighboring 

 organs, especially pleuritis or pleuro-pneumonia. 



Pathological Anatomy. It either occurs in the acute or 

 chronic form. The anatomical alterations that it produces on both 

 surfaces of the pericardium correspond to those on the pleura 

 caused by pleuritis. The most common form is sero-fibrinous 

 pericarditis, with copious liquid exudates in the pericardium and 

 masses of fibrinous lymph attached to the surface of the pericar- 

 dium; in very rare instances the folds are attached to each other. 

 When this condition has been present some time the pouch 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 palpita- 

 tion, the pulse becoming weak and indistinct, with marked irregu- 

 larity 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 attacked or when they are separated this 

 sound disappears. 



There may be an increase of temperature, caused by the com- 

 pression of the lungs, and the slightest exertions cause marked 

 increase in the respiration (Siedamgrotzky and others). As soon 

 as the disease becomes advanced the same symptoms that are seen 

 in any case of defective heart-action are noticed; the lessened 



