248 
P A T H O 
le troifieme jour, remplacent eeux de l’invafion, ne reft- 
ent les memes que pendant peu de temps, apres lequel le 
vifage s’altere davantage, la face prend tous les traits de 
celle fi bien depeinte par Hippocrate ; la douleur cefie 
en tout ou en partie ; il y a des friffons fugaces, des de- 
faillances longues et incompletes, des fuffocations, une 
anxiete infupportable ; une infiltration generale furvient: 
Je malade meurt enfin, le plus fouvent a I’improvifte, foit 
en voulant fe lever, fqit en buvant, foit en changeant de 
pofition.” 
The treatment of chronic carditis, and the above- 
mentioned form of pericarditis, confifts in keeping the 
heart in a ftate of comparative reft by occafional bleeding, 
and a diet of the molt fparing kind ; in counter-irritating 
the Ikin by bliftering, or by a feton, and by the gradual 
introduction of mercurial remedies. In the mean time 
the adtion of the bowels, of the Ikin, of the kidneys, and 
indeed of all parts of the fecernent fyftem over which 
medicine has any controul, fliould be gently excited. 
Acute carditis, i. e. of the mufcuiar fubftance, termi¬ 
nates in abfcefs, ulceration, gangrene, or rupture. Gan¬ 
grene inuft be of rare occurrence, fince the rupture 
would molt probably take place before the former acci¬ 
dent could occur. We have no means of knowing, du¬ 
ring life, that abfcefs or ulceration exifts. The former 
may exift without fymptoms ; for Benivenius gives a 
cale of a criminal, who, before his execution, feemed 
perfectly well, in wdiofe heart, however, an abfcefs was 
difcovered on difleCtion. 
From the cafes hitherto recorded, it feems that abfcefs 
is more rare on the internal than on the external furface 
of the heart. On the contrary, ulcers are molt common 
on the infide of the heart. Ruptures are the frequent 
mode of termination of ulcers in the heart. Rupture 
may occur, however, from violent and fudden exertion ; 
but thefe cafes are few in number. It is remarkable that 
ruptures of the right ventricle are lefs frequent than 
ruptures of the left; and that, in the latter cafe, the rup¬ 
ture feldom happens at the thinneft part of the mufcu¬ 
iar fubftance. It is needlefs to add, that thefe ruptures 
muft.be followed by inftant death. A rupture of the 
cardae tendinse may occur, however, without this fudden 
fatality. • On difleCtion of rupture of the heart, the peri¬ 
cardium is invariably found full of coagulated blood. 
Increafe of fubftance of the heart, or hypertrophy, and 
diminution, or atrophy, morbid dilatation, and contrac¬ 
tion, are all affediions which may arife from chronic irri¬ 
tation of the mufcuiar fubftance of the heart. This is 
only, however, a furmife : it is certain that the above- 
mentioned ftate may come on without any afteCtion of 
the heart’s fubftance, but from obftrudtion or difeafe in 
contiguous vifcera. The caufe of morbid hardnefs or 
foftnefs of the heart is fuppofed to be poffibly chronic in¬ 
flammation ; but nothing is known precisely on that 
head. 
Pericarditis terminates in an effufion of water, in tu¬ 
bercles, granulation of various kinds, and more common¬ 
ly in adhefions. When effufion takes place in the peri¬ 
cardium, and the cafe is unattended with organic dif- 
eafes of the heart, we have, in addition to the fymptom 
of deranged function exhibited in carditis, a deep livid 
colour of the lips ; fometimes a cough ; a conftant fenfe 
of weight in the region of the heart; frightful dreams, 
the fubjeCl of which is generally impending fuffocation. 
The weight at the cheft is generally aggravated by the 
recumbent pofition ; the eafieft pofture being a gentle in¬ 
clination forwards, the hands refting on the knees. 
Thefe are all the fymptoms obfervable in hydrops pe¬ 
ricardii of I'm a 11 dimensions ; that is to fay, when one 
pound or fo of water is eft'ufed: but, when the com¬ 
plaint is more exceflive, (for the effufion is faid to have 
reached the extent of eight pounds,) we have, as fome 
authors fay, much more marked fymptoms. Senac avers, 
that he has feen the fluctuation of the fluid contained 
LOGY. 
within the pericardium, between the third, fourth, and 
fifth, ribs ; and Corvifarc mentions that he once felt it. 
Pulfations, moreover, are fometimes felt a little on the 
right of the fternum, and alfo a little higher or lower on 
the left fide than where the heart’s pulfation is commonly 
recognized; thefe arife from the water being impelled, by 
the aftion of the heart, with fome degree of force, againft 
the parieties of the thorax at different points. 
It is reafonable to fuppofe, that with the fiethofcope 
we (hould-experience a found of fludhiation ; and that, if 
the pleura contained fluid, we fliould meet with this at 
fome diftance from the heart, and ifochronous with its 
pulfations. Laenr.ec heard a very diftinCt fluctuation in 
a cafe in which air was contained in the pericardium. 
We fliould not pronounce, on difleCtion, that a patient 
had laboured under this difeafe merely becaufe we found 
a fmall quantity of water in the pericardium, fince a few 
ounces may be poured forthafter death. The effufed fluid 
is generally limpid, and tinged with yellow or red. It 
has been propofed to cure this malady by pundluring the 
pericardium, fome advifing this to be done through the 
ribs, others by trephining the fternum. 
We have not Ipace to detail the other various products 
found in the pericardium : they are indeed the fame as 
in all other ferous membranes. We have a few words, 
however, to fay on adhefion of the pericardium to the 
heart. Many authors have defcribed formidable fymp¬ 
toms as attached to this malady: but it is remarkable 
that more recent inveftigation has fhown, that the fymp¬ 
toms defcribed are as uncertain as in any other difeafe of 
the heart. We quote from Laennec the following re¬ 
markable account. He fays, “ Avant que la converfiou 
des faulies membranes en tilfu cellulaire fut bien connue, 
1 ’adherence du pericarde aucceur a eteregardee par divers 
auteurs comme la caufe de plufieurs accidens graves. 
Lancifi et Vieuffens penfent qu'elle produit conftamment 
des palpitations; Meckel, qu’elle rend le pouls habitu- 
ellement petit ; Senac, qu’elle determine des fyncopes 
frequentes. M. Corvifart lui-meme eft tombe a cet egard 
dans plufieurs erreurs. Had met trois efpeces d’adherences: 
dans la premiere, I’adhefion du pericarde au cceura lieu au 
moyen d’une matiere albumineufe demi-concrete; et c’eit 
la feule qu’il reconnaiffe comme unefuite de la pericardite. 
La fecondeelt l’adherence intime ou par un tifl'u cellulaire 
tres-court: il penfe qu’elle eft l’eftet d’une aftedlion rhu- 
matifante ou goutteufe. La troifieme eft celle qui a lieu 
au moyen d’un tifl'u cellulaire plus ou moins long: la 
caufe de celle-ci lui eft inconnue. Il ne penfe pas, au 
refte, qu’on puilfe vivre et vivre fain avec une adherence 
complice et immediate du coeur au pericarde ou des pou- 
mons a la plevre. Je puis affurer que j’ai ouvert un 
grand nombre de fujets qui ne s’etaient jamais plaint 
d’aucun trouble dans la refpiration ou la circulation, et 
qui n’en avaient prefente aucun ligne dans leur maladie 
mortelle, quoiqu’il y eut adherence intime et totale des 
poumons ou du cceur; et, pour ce qui regarde ce dernier 
organe en particulier, je fuis tres-porte a croire, d’apres 
le nombre de cas de ce genre que j’ai rencontres, que 
l’adherence du coeur au pericarde ne trouble fouvent en 
rien l’exercice de fes fondlions. Il m’a paru feulemenc 
que la contraction des oreillettes devenait beaucoup plus 
obfcure quand dies font adherentes au feuillet fibreux 
du pericarde.” 
The membrane which lines the heart and larger arte¬ 
ries is fubjeCl, independently of the two kinds of red- 
nefs before mentioned, to oifification and cartilaginous 
indurations of certain parts of it; and to many other 
anomalous products, varying from Ample coagulation of 
blood to polypi, tubercles, cyfts, and even hydatids. 
We mull: refer the reader, who wifties to be familiarly ac¬ 
quainted with their appearances when he meets with 
them on difleCtion, to Laennec’s work, in which he will 
find a moft ample account of them. But we fliall quote 
his account of the fymptoms of the oifification and carti¬ 
laginous 
