452 



DISEASES OF THE CIRCULATORY SYSTEM. 



veins. When the disease is prolonged it ordinarily terminates in 

 chronic dropsy of the pericardium (hydro-pericardium). The peri- 

 cardial pouch more rarely contains blood which is collected in it 

 after the perforation or rupture of the heart ; a quantity amount- 

 ing to several litres may be found. 



Solid exudates are developed at the expense of false fibrinous 

 membranes, in which the cellular elements have been transformed 

 into a connective tissue. They appear in the shape of fibrinous 

 blades or bands which are attached to the epicardium or distended 

 filamentous proliferation between the heart and the parietal fold of 

 the pericardium. The membranous layers which cover up the 

 heart present special characters ; they constitute spots of the color 

 of egg-yelk or of an omelet, wdth a villous, rugous, and papillons 

 surface, which increase the dimensions of the organs ; this is mam- 

 millated or rugous upon its surface (cor villosum, cor hirsutum). 

 The epicardium itself is thickened, and transformed into a larda- 

 ceous mass which may become incrusted by a calcareous substance 

 and form a globe with a solid shell around the heart. These exu- 

 dates sometimes undergo fatty degeneration, or become reabsorbed 

 leaving milky spots behind, also callous and cicatricial thickening. 



The resistant neoproductions which establish adhesions between 

 the heart and the pericardium represent spots, cords, or some kind 

 of tendons provided with bloodvessels. Sometimes the pericardium 

 is found to be so intimately joined to the heart, that it seems to be 

 completely wanting (cardiac symphysis, ankylosis of the heart). 



The pericardium may acquire the thickness of the thumb and 

 over ; it is often considerably dilated, its capacity may even reach 

 fifteen litres. The thickenings and adhesions of the pericardium 

 are signs of the long duration of the disease. 



The heart is infiltrated with serum ; its fibres are softened ; we 

 find circumscribed fatty degeneration in it, also centres of partial 

 myocarditis, ^mall intermuscular or cavernous abscesses which are 

 provided with a pyogenic membrane. In certain cases, the cardiac 

 wall is hollowed, the cavity containing the foreign body ; in others 

 it shows lesions from ulceration, which are dark red, and sur- 

 rounded by a yellowish zone (wound of the heart). Sometimes the 

 foreign body is located in the heart, at other times it is only more 

 or less enclosed in the myocardium ; finally, in other instances, it 

 swims freely in the pericardium. Camoin has observed a canal 

 which extended from the left ventricle to the reticulum, a canal 



