24G 
PATHOLOGY. 
heart, we fhonlcl naturally expe£l to find more increafe 
In the quicknefs and force of its motions : for, to more 
rapid circulation through the pulmonary circles we refer 
rednefs of the fkin ; to the fame increafe through the 
aortal fyftem, arifing from quickened aflion of the ven¬ 
tricles, we refer the quick pulfe; and tothefe united, the 
increafed heat. The tame fymptoms belong alfo to that 
early ftage of carditis which has not pafled the bound 
named excitement, and to inflammation of the mem¬ 
brane which lines the heart and arteries. From this it 
follows, that the primary fymptoms of inflammation, in 
whatever ftruiShire of the heart it may be fituated, pro¬ 
duces the fame fymptoms while it is within certain li¬ 
mits as to violence; but this is by no means true of 
thofe grave phlogofes which attack particular fpots of 
the heart, or attack it generally in a violent manner. 
Nor is it true of the fevered forms of pericarditis or ar¬ 
teritis, (the term by which wedefignate phlogofis of the 
inner membrane of the heart and arteries.) In thefe, the 
fymptoms betray the following variations. Molt authors 
have afierted, that between acute pericarditis and actual 
carditis there is no difference. Indeed Dr. Baillie and 
others have fated that they are never found feparate on 
diflection. Laennec, however, denies this. In carditis, in 
common with other thoracic inflammations, we have 
difficulty of breathing, febrile heat, and third. From 
the peculiar fenfibility of the nerves with which the heart 
is connedled, extreme anxiety and oppreflion are met 
with, the countenance betraying the deeped didrefs. 
From the increafed fenfibility of the nerves, the motions 
of the heart are felt by the patient : this confitutes what 
is termed palpitation. Palpitation is more generally felt, 
however, from arterial increafe in the motions of the 
heart. It is fometimes fo great, that it is felt even in 
the carotids and the head. One fide or cavity of the 
heart, afling more rapidly than its correfpondent one, 
naturally induces irregularity of pulfe ; it likewife in¬ 
duces an accumulation of blood in one cavity to fo 
great a degree, as to fufpend its aftion : hence arifes 
fyncope. Pain is likewife prefent: it is ufually de¬ 
scribed as of a fharp and gnawing kind, fituated under 
the dernum, and is highly aggravated by mufcular mo¬ 
tion. The recumbent podure is often uneafy, the pa¬ 
tient feeling eafied when the body is bent forwards. 
That inflammation of the heart has exided without all 
thefe fymptoms is no objection to the account here of¬ 
fered, for pain is often abfent in other phlogofes com¬ 
monly charadlerifed by it. It may happen that irregular 
aft ion of the mufcular fibres of the heart may not occur, 
in the fame way that fpafmodic contraction of the muf¬ 
cular coats of the bowels does not always attend phlogo¬ 
fis of the internal membrane, though it does fo com¬ 
monly. And, if the latter propofition be admitted, we 
fhall have no difficulty in accounting for the abfence of 
fyncope and irregularity of pulfe. It is to be noticed, 
that inflammation of the mufcular fubdance of the heart 
is a difeafe of rare occurrence. Laennec doubts if a 
cafe has appeared in which inflammation occupied the 
whole of the druCture in quedion. Phlogofis of parti¬ 
cular portions, ending in abfeefs or ulceration, are more 
common ; but dill the majority of cardites feem to be 
membranous affections. 
The following are the fymptoms of acute pericarditis, 
as deferibed by Laennec. “ Les contractions des ventri- 
cules du coeur donnent une itnpulfion forte, et quel- 
quefois un bruit plus marque que dans 1’etat naturel; a 
des intervalles plusou moins longs furviennent des pul- 
fations plus faibles et plus courtes, qui correfpondent a 
des intermittences du pouls, dont la petitede contrade 
extraordinairement avec la force des battemens du 
eceur; quelquefois il peut a peine etre fenti. Lorfque 
ces figne-s furviennent tout-a-coup chez un hornme qui 
n’avait jamais Cprouve de fymptomes de maladie du 
creur, il y a une grande probabiiite qu’il ed attaque de 
pericardite. Aflez ordinairement le malade eprouve une 
dyfpnee plus ou moins grande, des angoiiles, une anx- 
iete inexprimable; il ne peut faire quelques pas, ou fe 
remuerun peu brufquement dans fon lit, fans epronver 
des fyncopes. Le fentiment de douleur, de chaleur, ou 
de poids a la region du cceur, ed un fymptome beaucoup' 
plus rare, mais qui fe rencontre cependent quelquefois. 
Dans quelques cas, la region du cceur rend un fon mat; 
mais le plus fouvent ce figne n’ed pas bien evident.” 
When the membrane which lines the cavities of the 
heart and large arteries-is inflamed, condituting arteritis, 
we obferve the following circumflunces. The complaint 
fometimes arifes fpontaneoufly, but more frequently as 
a confequence of fevere febrile adeCtions, fmall-pox, 
meafles, or rheumatifm. When it comes on vicarioufly 
with the latter difeafe, all the phenomena of carditis are 
uncommonly fevere except fyncope, which is often not 
prefent. 
This difeafe has alfo fupervened on extenfive furgical 
operations. It fometimes begins as phlebitis, or inflam¬ 
mation of the vifeus; fometimes as arteritis, or inflam¬ 
mation of the arteries ; occafionally it produces death, 
while confined to one or other of thefe vefiels, but more 
frequently the lining of the heart becomes implicated 
before the fatal event. The fymptoms of the complaint 
are—general rednefs of the lkin; increafed pulfation of 
the arteries, fo great as to be viiible at the didance of 
fome paces from the patient ; and the ufual fymptoms 
of carditis foon follow'. Early in the difeafe, if its de¬ 
velopment is not fudden, the patient is redlefs, impa¬ 
tient, watchful, irritable: lie experiences partial flufli- 
ings, which gradually increafe both in frequency and 
extent : his bowels are inactive, but his pull'e is imper¬ 
ceptibly aftefted. By and bye, he complains of a deep- 
feated pain in fome part of the abdominal or thoracic 
regions, and feldom fails to deferibe it as being hot, lan¬ 
cinating, fpafmodic, and increafed by flight exertion. 
Difturbance-of the vafcular fyflem now comes on : refpi- 
ration is accelerated, and the breath feels offenfive from 
its heat. The mouth, however, remains humid, the 
tongue red, the lips moid and natural. Rigors at lad 
are felt ; and, as the difeafe advances, the internal pain 
becomes more did’ufed. The original flufliings give 
place to a true febrile date of the cutaneous furface; and 
the difquietude is fucceeded by head-ache, naufea, lan¬ 
guor, and depreffion. Inappetency and quenclilefs third 
prevail. The bowels are more obdinate; the mouth 
tades bitter. The pulfe, in fome indances, is hard,drong, 
and tumultuous ; in others, wiry and irregular. If tran- 
fient deep is obtained, it is unrefreihing and interrupted 
by dartings and frightful dreams. About this time 
cough begins. This fometimes is dry, frequent, teaz- 
ing; fometimes it recurs in violent and tedious parox- 
yfms, and is accompanied with expectoration of fetid 
mucus, the clots'of which are occafionally dreaked with 
florid blood. When the difeafe has, at length, acquired a 
formidable afcendancy, all its previous fymptoms, and 
the fymptomatic fever (which is generally the inflamma¬ 
tory), are greatly aggravated. The patient’s counte¬ 
nance fuddenly ffirinks, becomes pallid, haggard, cada¬ 
verous. His Arength finks; his emaciation is extreme. 
His lips are crimfon or livid ; his tongue red, fmooth, 
moid. At the fame time his breathing is rapid, difficult, 
irregular; the head-ache intenfe; ..the pulfe hard, la¬ 
bouring, intermittent, accelerated to iio —130. Confe- 
cutive to the former deep internal pain, a didrefsful 
fenfe of condriftion, mod frequently in the cardiac, prae- 
cordial, or epigadric, region, is edabliflied. Spafms not 
unlike thofe of tetanus, in many cafes, occur under the 
xyphoid cartilage, and in the line of the diaphragm. 
The countenance and extremities grow cedematous. 
Forcible palpitations of the heart, and, in fome indances, 
of the abdominal aorta, fo as to be diflinftly felt 
through the integuments, now predominate. The arte¬ 
ries pulfate with alarming and painful violence, and the 
aCtion of the more fuperficial is quite vifible: that of 
