Diagnosis, Treatment. 1049 



tonitis with effusion an enlarged area of cardiac dullness may 

 be simulated by an encapsulated exudation in the vicinity of the 

 heart and, in larger animals, especially in cattle, by free fluid 

 exudation. If free exudation is present in the thoracic cavity, 

 the heart beat and the heart sounds are not weakened or only 

 slightly, especially in smaller animals and in the sitting position ; 

 moreover, the dullness is limited horizontally. — An encapsulated 

 pleural exudate or a swelling in the vicinity of the heart may be 

 eliminated in such cases in which the heart has been displaced 

 (see compression of the heart). A dullness due to enlargement 

 of the heart (hypertrophy, dilatation) may have a similar shape, 

 but hardly ever extends so far forward, the heart sounds are 

 heard distinctly, friction sounds and sensitiveness of the pre- 

 cordia are absent. 



About the nature of the exudate external conditions may 

 offer information in so far as pericarditis occurring after cold, 

 in consequence of croupous pneumonia, or of primary pleurisy 

 leads to the formation of a fibrinous or sero-fibrinous exudate, 

 while metastatic periisarditis is usually purulent and accom- 

 panied by high fever. In traumatic pericarditis of cattle the 

 exudate may be sero-fibrinous, purulent or ichorous. The 

 assumption of an ichorous pericarditis is justified by the greater 

 severity of the general symptoms, by the tympanitic and possibly 

 metallic nature of the percussion sound and by the presence of 

 splashing sounds. Traumatic pericarditis is usually manifested 

 by local and venous symptoms similar to those of the rather 

 infrequent tuberculous pericarditis of cattle (Klaber, Lienaux, 

 Wyssmann and others). 



In doubtful cases Gmeiner recommends a test puncture of the pericardium, 

 on the left side within the area of dullness, if necessary also on the right side. 



Chronic pericarditis is very difficult of recognition without 

 an exact knowledge of the history, because most of the symp- 

 toms are observed also in chronic pleurisy and in chronic inter- 

 stitial pneumonia. Only an absolutely exact determination of 

 the shape of the dull area, the nature of the heart beat and the 

 characteristic symptoms of stasis may be of assistance. Chronic 

 myocarditis cannot be differentiated with certainty from chronic 

 fibrinous pericarditis. 



Treatment. If treatment is justified by the fact that the 

 prognosis is not absolutely unfavorable, complete rest must 

 above all be assured. Any disturbance in defecation is to be 

 relieved by small doses of mild laxatives, and the diet must be 

 regulated appropriately. Herbivora should receive good hay, 

 if possible mixed with fresh green feed, also flour- or bran-slop ; 

 carnivora are fed with gruel or broths, also milk. In persistent 

 inappetence artificial feeding (Vol. II.) may become desirable. 



The inflammatory process may be alleviated by cold com- 

 presses. A sac filled with snow or ice and fastened with a wide 



