PATHOLOGY. 
the carotids is audible by the patient himfelf, often by 
his attendants. Syncope is frequent ; the paroxyfms of 
dyfpncea protracted and agonizing. The anafarcous ef- 
fufion extends and becomes general. In many cafes 
afcites fupervenes; in others, hydrothorax : in fome, the 
extravafation of ferum is univerfal and profufe. Dyfp¬ 
ncea fucceeds, and the patient is confined to a fitting 
pofture. The lead motion excites cough, and a fenfe of 
indant fuffocation. Wheals and ecchymofed patches 
arife in different parts of the body. Violent convulfions 
enfue; and, in one of thefe, exhauded already and mo¬ 
ribund, he druggies and expires. 
The appearances on diffeCtion are a general and deep 
rednefs of the internal coats of the arteries, veins, and 
heart: fometimes this lad prefents a fpotted appearance : 
it is to be obferved, however, that both purple and fear- 
let rednefs of the internal membrane of the heart and 
large arteries, has been noticed by Hodgfon and Laen- 
nec in fubjefts who had not fufFered indammation. We 
fhall not detain our readers long on the necrotomy of this 
difeafe further than to obferve, that indammation of the 
arteries, whether chronic or acute, renders the veffels 
liable to the depofition of organizable lymph on their in¬ 
ternal furface; to obliteration, dilatation, and aneuryfm ; 
to a cartilaginous and deatomatous thickening of their 
inner coat; to the depodtion of ofleous and other mat¬ 
ters in any part of their druClure; and to become feir- 
rhous, cancerous, fungous, ulcerated, or fphacelated. 
The reader will perceive the difficulty of didinguifliing 
arteritis from fimpie inflammatory fever; but the midake 
is not of much confequence, fincethe treatment is in each 
difeafe the fame. A very clofe analogy is alfo perceptible 
between the fymptoms of this complaint and the form of 
inflammation deferibed before it. As to the duration of 
thefe difeafes, they are various. What we have hitherto 
dated with regard to carditis applies to its mod violent 
form, to that form indeed which runs its courfe in from 
two to feven days. Another form of carditis is now and 
then found which is called the fubacute : this variety is 
charasff erized by fymptoms analogous to thofe of the acute, 
only fomewhat more moderate. There is lefs fevere 
pain and fenfation of burning in the fituation of the 
heart; but which are generally preceded by fhivering, 
and attended with great heat and third, and a quick, 
hard, and fometimes irregular, pulfe. The countenance 
of the patient, at the commencement of the attack, is 
ufually fuffufed, but after a lapfe of a few days becomes 
hollow and dejefled, and has a peculiar irritable look. 
There is a condant date of agitation and great anxiety. 
The palpitations of the heart are not fo vehement; and 
the faintings, if they occur, are ufually of an incomplete 
defeription. If the difeafe run on to a fatal termination, 
the hippocratic look of the face, an abatement of pain, 
flight rigors, extreme anxiety, fenfe of fuffocation, flight 
faintings, and occafionally cedematous fwellings, take 
place a fhort time prior to that event. 
Sub-acute inflammation of the heart is fometimes com¬ 
plicated with Pneumonia, Pleuritis diaphragmitis, and 
organic obdruftions in the great veffels. It has alfo been 
connedted with the fymptoms of Catarrhus fuffocativus 
and croup, though the ufual feat of thofe affections be¬ 
trayed no inflamed appearance on diffedlion. 
The treatment of carditis undereach of thefe forms is 
Ample, but too often ineffedlual. Bleeding is every thing 
in it. We have urged the neceffity of very adtive blood¬ 
letting in mod of the fpecies of this genus we have at 
prefent pafled through. It will be fufficient therefore to 
obferve, that carditis calls for more adlive depletion 
than any other of-the Phlogotica; for, not only mud we 
bleed to reduce inflammatory adfion, as in other Aruc- 
tures, but we mud alfo bleed with the view of letting the 
heart at red; this operation being the only one by which 
rejl can be procured. In addition to thefe meafures, it 
is proper to excite the capillaries by all forts of irritants ; 
as by dradic purges, brifk diuretics, diaphoretics, blif- 
Vol. XIX. No. 1301. 
247 
ters, or fridlions with tartarJzed antimony on the chefl, 
or, if in a rheumatic patient, on the legs. It mud not 
be concealed, however, that, except the bleeding and 
purging, little dependance can be placed on thefe mea¬ 
fures. Should they be fo fortunate as to produce a re- 
miflion of fymptoms, we fhould Adivate the patients with¬ 
out lofs of time by mercurial inundlion, and by fcruple- 
dofes of calomel combined with opium. Local bleeding 
feems next to ufelefs in Carditis. In Arteritis, verylarge 
dofes of digitalis may be given with advantage. 
A no-lefs formidable difeafe, and one dill more difficult 
to recognife, is chronic carditis. It proceeds fo infidi- 
oufly, that it often becomes incurably eflablifhed before 
a fufpicion of its true nature has occurred. It fre¬ 
quently fubfids unattended by any pain in the region of 
the heart itfelf. On the contrary, it is apt to induce 
pain, and to refemble affections, in dijlant parts, as the 
epigadrium, the liypogadrium, &c. It is at length af- 
certained to have exided, by the fymptoms of deranged 
circulation, the effeCts of organic change fuperinduced ; 
or perhaps its exidence is not fufpefted during life. The 
fymptoms which have been mod frequently obferved are 
—fome degree of febrile ad'eCtion ; a fmall, quick, and 
irregular, pulfe ; and a peculiar jarring fenfation commu¬ 
nicated to the hand when placed over the fituation of the 
heart. Palpitation of this organ is generally abfent ; but, 
when it does occur, it is inconfiderable in point of ex¬ 
tent. There is ufually no pain, though we fometimes 
meet with a little uneafinefs in the region of the heart: 
at other times a flight degree of obtufe fugitive pain may 
be prefent. When pain is feated in the hypogaflric re¬ 
gion, it is oftentimes attended with fuppreffion of urine. 
Sometimes there is a fenfe of beating in the head. The 
pulfation frequently takes place in the epigadric region, 
which has, in fome degree, the appearance as if it arofe 
from a throbbing tumour. Obdinate vomiting is occa¬ 
fionally prefent. At length dropfical affections fupervene, 
as oedema of the face and extremities, and effuflon into 
the cavity of the thorax ; the breathing then becomes 
more difficult and laborious; the countenance affumes 
an anxious and bloated afpeCt; delirium not infrequent¬ 
ly comes on ; and the patient after much differing, of 
longer or ffiorter duration, finks into diffolution. Chro¬ 
nic inflammation is not uncommonly fuperadded to di¬ 
latation or enlargement, and alfo to other organic affec¬ 
tions, of the heart. 
M. Corvifart deferibes a variety of Pericarditis, which 
he denominates fub-acute. It is lefs rapid in its courfe, 
and lefs obfeurely marked, than acute inflammation of 
this organ, but neverthelefs more marked and rapid than 
the form of difeafe jud detailed. “ L’invafion de la 
peracardite fub-aigue, ed bien rarement marquee par des 
fymptomes vifs qui puiflent fairs regarder la malaaie 
comme devant etre promptement funefle. La pleurefie 
ed la phlegmafie avec laquelle cette pericardite commen- 
$ante a le plus de traits de relfemblance. Comme dans 
cette affeCtion, le malade eprouve d’abord un fentiment 
de chaleur generate dans tout le cote malade de la poi- 
trine ; peu apres, cette chaleur fe concentre vers la region 
du cceur; la fe fait fentir une douleur vive et brulante. 
La refpiration devient promptement haute et genee ; le 
pouls ed frequent, dur, et rarement irregulier; les deux 
pommettes, et particulierement la gauche, font colorees 
d’un rouge vif; tels font les phenomenes de l’invafion : 
mais au troifieme ou quatrieme jour, l’alteration parti- 
culiere des traits, la figure grippee, fur laquelle on voit 
Pexpreffion d’un abattement profond et pourtant d’une 
forte d’irritation, une anxiete condante et exprimable, 
une agitation continuelle, la refpiration haute, penible, 
entrecoupee, les palpitations legeres, les defaillances 5 n- 
completes, d’autant plus eloignees l’une de l’autre que 
la marche de la maladie ed plus lente ; enfin, le pouls 
f ietit, frequent, dur, ferre, concentre, fouvent irregu- 
ier, lie laifl'ent que peu de doutes fur le fiege pofitif de 
rinflammation. Les fymptomes plus graves, qui, vers 
3 S ie 
