8 
FR. BLAZEKOVIC. 
overlooked, as it affords almost positive evidence of the correct¬ 
ness of the diagnosis. Hence, we shall notice an alternating rise 
and fall of the pulse, whose beats vary from 80 to 100 and 110. 
The fever, which in the morning is less, in the evening more aggra¬ 
vated, reaches a critical point during the night. The pulse at the 
same time is tense, though equal in beat, and only then intermittent 
if occasional changes of the heart be present. If the inflamma¬ 
tion be limited to the pericardium only, the pulse will be found 
accelerated and changed in the manner described; still the pulsa¬ 
tions are always regular, succeeding each other at equal in¬ 
tervals. 
At the beginning, the heart-beat throbs violently, but is clear ; 
as the diseases progresses, if exudation sets in, a smaller or stronger 
back-stroke is easily detected by the hand. The phenomenon of 
the back-stroke is undoubtedly the result of the resistance and 
obstruction produced by the newly formed exudation. 
Coughing, mostly short and dry, occurs occasionally at the 
beginning of the disease, during the hy perse mic as during the 
congestive stage; later the cough disappears gradually. At the 
very outset of the disease the temperature of the body changes 
frequently after the inflammation is already decided. After ten 
to twenty hours a high fever sets in, which fluctuates between 
38° and 40° Cels. 
On auscultation a friction sound is perceptible, which is also 
felt by placing the hand on the cardiac region, especially if the 
pericardium in the stadium of exudation be covered with effusion. 
The more the serous and plastic exudation increases during the 
course of the disease the more conspicuous are these sounds, and 
according to their nature it is possible to discriminate the kind of 
exudation. If the friction sound be prominent the plastic exuda¬ 
tion predominates, while if the serous exudation predominates a 
flapping sound is heard. According to the quantity of the exuda¬ 
tion the pericardium distends, generally toward the base. If the 
serous effusion fills the pericardium the percussion sound is dull; 
of course, only at the base at first, then higher up and more 
extended. In this condition the cardiac sounds are weak, the 
heart-beat faint and less clear. If only simple pericarditis be 
