234 DISEASES OF THE HOKSB. 



recovery may begin equally as early. In subacute or in chronic cases 

 the effusion may slowly become augmented until the pressure upon 

 the lungs and interference with the circulation becomes so great that 

 death will result. Whether the attack is acute, subacute, or chronic, 

 the characteristic symptoms which will guide us to a correct diagnosis 

 are the friction sound, which is always synchronous with the heart's 

 action, the high temperature with hard, irritable pulse, and, in cases 

 of pericardial effusion, the increased area of dullness over the cardiac 

 region. When the disease is associated with influenza or rheumatism, 

 some of the symptoms may be obscure, but a careful examination 

 will reveal sufficient evidence upon which to base a diagnosis. When 

 pericarditis develops as a result of or in connection with pleuritis, the 

 distinction may not be very clearly definable, neither will many 

 recover. When it results from a wound or broken rib, it almost in- 

 variably proves fatal. 



Pathology. — Pericarditis may at all times be regarded as a very 

 serious affection. At first we will find an intense injection or accu- 

 mulation of blood in the vessels of the pericardium, giving it a red 

 and swollen appearance, during which we have the friction sound. 

 In twenty- four to f orty -eight iiours this engorgement is followed by 

 an exudation of sero-fibrinous fluid, the fibrinous portion of which 

 may soon form a coating over the internal surface of the pericardial 

 sac, and may ultimately form a union of the opposing surfaces. 

 Generally this adhesion will only be found to occupy a portion of the 

 surfaces. As the serous or watery portion of this effusion is ab- 

 sorbed, the distinctness of the friction sound recurs, and may remain 

 perceptible in a varied degree for a long time. When the serous 

 effusion is very great, the pressure exerted upon the heart weakens its 

 action, and may produce death soon; when it is not so great, it may 

 cause dropsies of other portions of the body. When the adhesions 

 of the pericardial sac to the body of the heart are extensive, they gen- 

 erally lead to increased growth, or hypertrophy, of the heart, with or 

 without dilatation of its cavities ; when they are but slight, they may 

 not cause any inconvenience. 



Treatment. — In acute or subacute pericarditis the tincture of digi- 

 talis may be given in 20 to 30 drop doses every hour until the pulse 

 and temperature become reduced. Whisky or carbonate of ammonia 

 may be given regularly as stimulants. Bandages should be applied 

 to the legs ; if the legs are very cold, tincture of capsicum should be 

 first applied ; the body should be warmly clothed in blankets, to pro- 

 mote perspiration. When the suffering from pain is very severe, 10 

 grains of morphine may be given by the mouth once or twice a day ; 

 nitrate of potassa, half an ounce, in drinking water, every six hours ; 

 after the third day, iodide of potassa, in 2-dram doses, may be sub- 

 stituted. Cold packs to the chest in the early stages of the disease 

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