DISEASES OF THE CIRCULATORY SYSTEM. 217 



First stage, or stage of hyperemia, congestion, or engorgement; 

 second, stage, or the stage of exudation and effusion; third stage, or 

 the stage of absorption. 



There is a dryness of the membrane, which is congested; soon 

 an exudation of lymph scattered in patches takes place, which 

 .gives the dry, shaggy appearance, and is called dry pericarditis. 



Then an effusion of a sero-fibrinous fluid is presented, with 

 flocculi floating in it and at times mixed with blood; the serous 

 effusion accumulates at the base of the heart, where the folds of 

 the membrane are loose, and as it increases in amount it runs down 

 and pulls the pericardium. 



What becomes of these products ? 



The watery parts may be absorbed, the fibrine undergo fatty 

 degeneration, or become organized and form false membranes and 

 bind the heart to the pericardial sac. 



What are the symptoms ? 



It is generally preceded by a chill, followed by symptoms of 

 fever; the skin becomes hot, there is dryness and redness of the 

 visible mucous membranes, and a very high temperature. 



The principal symptoms are connected with the circulation 

 of the blood; the pulse is hard and very quick, it often being 100 

 per minute, and it is very rare in the beginning of any other 

 -affection to get so rapid a pulse. 



Give the physical signs. 



On percussion, in the early stages, no change, while during 

 the stage of effusion, cardiac dulness is enlarged. 



Auscultation should give some valuable results; early, when 

 the membrane is dry and reddened, a friction sound may be heard 

 ttnd at the same time as the beat of the heart or the pulse, and 

 not influenced by breathing. 



It is often hard to tell whether the sound is intra- or extra- 

 pericardial. It may be a pleuritic sound, which is more commonly 

 heard. 



During the stage of effusion, auscultation shows the friction 

 sound being lost (as the effusion accumulates) on account of the 

 layers becoming separated; the heart sounds less distinct or absent, 

 and during the third stage the heart sounds are more distinct and 

 ^the friction sound returns. 



