Enfermedades Del Sistema Circulatorio

PART III.

DISEASES OF THE CIRCULATORY SYSTEM.
I. DISEASE OF THE PERICARDIUM.
PERICARDITIS. Definition.—An inflammation of the pericardium or serous covering of the heart. Varieties.—Acute, Plastic or Fibrinous, Subacute or Sero-fibrinous, which includes the Purulent and Hemorrhagic; Adhesive or Chronic Pericarditis. ACUTE PLASTIC PERICARDITIS. Synonyms.—Fibrinous Pericarditis ; DryPericarditis. Etiology.—This form of pericarditis occurs more frequently in the young and middle-aged than at any other period of life, and occurs in males far more frequently than in females. It may be divided into primary and secondary forms. The primary form occurs very rarely, though bruises or injuries of various kinds may result in so great an irritation and determination of blood as to give rise toinflammation. The old idea, once so prevalent, that cold was the exciting cause, is rapidly giving way before more careful observation and experimentation, and nearly all writers are now agreed that pericarditis is a secondary affection. Metchnikoff goes so far as to declare that there can be no such a condition as idiopathic pericarditis. First in importance as a causal factor may be classedrheumatism; Bouillard declaring that in every case of rheumatism there will be some lesion of the heart; and while we regard this as a very extravagant statement, we may be quite conservative and yet place rheumatism as the cause in at least fifty per cent of all cases of pericarditis. Chronic nephritis and tuberculosis may give rise to the acute form, but
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is more common in the subacute variety. Toxins from the infectious diseases seem to influence the pericardium quite early, resulting in inflammation. Scarlet fever, measles, diphtheria, influenza, and tvphoid fever in particular, give rise to it, though any infectious fever may have its influence inthe same direction. The extension of the inflammatory condition from neighboring organs, especially pleurisy and pneumonia, is a frequent cause, more of this form than of the other varieties. Carcinoma by poisoning the blood and encroaching upon neighboring tissues may give rise to this form. Pathology.—The changes that occur may be general or local, usually the latter, and are similar to thosewhich occur in pleurisy and peritonitis. At first the membrane is red, smooth, injected, and swollen, but soon becomes rough and thickened by the deposit of a fibrinous exudate. As a result of the friction of the surfaces, the membrane becomes roughened or wrinkled, resembling tripe in appearance, and when the exudate is thick, this friction results in giving the membrane a jagged-looking surface,giving rise to the shaggy or hairy heart of the older writers. In this variety there is but little serous fluid, the natural secretion being arrested or greatly diminished. The myocardium may also be affected; in fact, there can scarcely ever be a severe pericarditis without involving more or less tlie heart itself. Where the disease has continued for some time, the heart is apt to be flabby anddilated, with more or less fatty degeneration. If adhesions of the two surfaces have taken place, there is apt to be hypertrophy of the heart. At other times the nutrition of the heart is so impaired as to give rise to atrophy. Symptoms.—Primary Form.—If the disease is primary, which is very rare, and if the patient be a young subject, there will be a chill, followed by a febrile reaction, a dryskin, scanty secretion of urine, constipation, and the general symptoms of an inflammation. There is pain in the precordial region that varies from a dull, aching sensation to one of an intense, sharp, lancinating character, which extends from the nipple to the back and down the left arm. There is a sense of great anxiety, and though there may be but little pain. the
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