PERICARDITIS. 



451 



pericarditis are in reality of a traumatic nature. It seems to be a 

 habit with practitioners to call rheumatismaP^ any pericarditis 

 which is found at the autopsy, in the absence of a vulnerating body 

 within the lesions. As a general rule no account has been taken ol 

 the fact, for example, that pointed foreign bodies may return into 

 the stomach after having involved the heart. Anyhow, we must 

 only advance the diagnosis of rheumatismal pericardiiis with the 

 greatest reserve. Pericarditis which appears in the course of a 

 septic metritis — more frequent than the traumatic form — is but an 

 isolated phenomenon, the terminal of a long series of organic altera- 

 tions. (For pericarditis occurring in the course of consumption, 

 see Tuberculosis.) 



In the article on traumatic inflammation of the stomach and 

 diaphragm we have mentioned the mode of penetration of foreign 

 bodies into the pericardium ; we must, however, remember that this 

 organ is situated at a distance of a few centimetres only from the 

 stomach, from which it is only separated by the diaphragm. This 

 proximity explains the frequency of wounds of the pericardium and 

 the heart by vulnerating bodies which have been accidentally swal- 

 lowed. Pericarditis consecutive to penetrating traumatism of the 

 chest, to fractures of the ribs, or to blows made by horns (Mathieu), 

 is very rare. 



Pathological anatomy. The alterations of the pericardium 

 and of the heart are generally much marked ; it is exceptional to 

 find the alterations of inflammatory process close to its commence- 

 ment. We find a liquid or solid pericardial exudate, adhesions 

 between the heart and the pericardium, its thickening and dilata- 

 tion, lesions of the myocardium, and secondary alterations in the 

 lungs, diaphragm, etc. 



The pericardial exudate is most variable in its composition. It is 

 serous or fibrinous, purulent, hemorrhagic, putrid ; clear or milky, 

 whitish, flaky, yellowish-gray, greenish-yellow, reddish, red-brown, 

 dirty red, etc. ; on microscopic examination, we find elements in it 

 of most varied figures : red and white globules, drops of fat, bac- 

 teria, etc. It is often mixed with gas, developed in the pericardium 

 itself or derived from the reticulum ; at times this gas has a more 

 or less fetid odor, in other instances it is odorless (pneumo-pericar- 

 dium). The quantity of exudate is sometimes considerable (ten to 

 fifteen litres) ; the pericardium is much distended by it, it com- 

 presses the lungs, the heart, and especially the auricle and the large 



