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Symptoms.-The symptoms of pericarditis are apt to be asso ciated with those of other affections existing at the same time, because pericarditis rarely occurs as a primary affection, but usually as a complication of acute rheumatism or of kidney disease. If a patient be suffering from one of these affections, it is the duty of the physician to watch for the development of pain in the region àf the heart. This pain is usually sharp and cutting in character, like that of pleurisy; moreover, it is increased during deep breath ing, so that this disease has been often mistaken for pleurisy. There may be also a dry, hacking cough. In fact, the symptoms gener ally direct the attention to the breathing apparatus, rather than to the heart itself. The action of the heart is however much dis turbed, as may be discovered by the pulse, orbyplacingthehand over the point of the heart between the fifth and sixth ribs. So soon as the exudation begins, the system changes somewhat; the pain and sore ness become less acute, and if the amount of liquid be considerable, there may be some protrusion between the rjbs in the region of the heart. But other and more serious results follow the pres ence of the liquid in the pericardium, because the heart is com pressed by this liquid, and its movements are impeded. The re sult of any impediment to the heart's movement is, of course, an interference in the circulation of the blood, and this interference is manifested by blueness of the face and hands, by a feeling of suffocation, perhaps even delirium and convulsions. Indeed, it sometimes happens that the inflammation in the heart itself is over looked, because the other symptoms, such as derangement of the mind, are so prominent.
The severity of the affection is measured by the amount of exudation; if this be slight, the symptoms are not severe and the danger is not great, but if a large amount of liquid escape into the pericardium, the disease is extremely dangerous and often fatal.
Cause.- Acute inflammation of the pericardium may be pro duced by an injury such as a stab, or by a blow upon the chest, especially if a rib be fractured, in the neighborhood of the heart. Several curious accidents are reported in which pericarditis pro ceeded from unusual causes ; thus, Walsh mentions an instance in which, during the juggler's trick of swallowing a sword, the instru ment passed from the oesophagus into the pericardium, which lies adjacent, and caused a fatal inflammation. Flint also mentions a case in which a set of false teeth were swallowed while the owner was profoundly intoxicated ; the teeth lodged in the lower part of oesophagus, and ultimately worked their way through into the pericardium, inducing a fatal inflammation ; after death the teeth were found in the pericardium. Pericarditis, when it does not result from injuries, is almost always a complication of some other disease, especially acute rheumatism. Until the use of salicylic acid became general for the treatment of rheumatism, pericarditis was a quite frequent occurrence, it being estimated that it occurred in one out of every six cases of rheumatism. It is also a frequent complication of inflammation of the kidneys, of erysipelas, typhoid and typhus fever, and of many of the infectious diseases. The height of the disease is usually reached within a week or ten days, though it does not follow that recovery will begin at the expiration of that period. For in many cases the patient remains in a dangerous condition for two or three weeks, and even when the liquid has become absorbed the patient is by no means out of danger ; for the heart remains weak for a considerable time, and the patient should not be permitted to make any severe exertion. Flint reports a case in which a patient suffering from pericarditis died instantly upon getting out of bed.
Treatment.-In most cases pericarditis is, as has been already remarked, a complication of other diseases; hence the treatment consists, in most cases, of measures adapted for the relief of these other diseases. The treatment for the pericarditis itself consists in the relief of pain by opium, and in local applications over the region of the heart. Before the exudation has occurred, a light mustard poultice may be applied over the heart ; and so soon as there is evidence of the presence of liquid in the peri cardium, the skin may be painted with the tincture of iodine once every day. It is desirable to avoid blistering the skin in this region. If the amount of liquid become so great as to threaten life by impeding the movement of the heart, there is still a resort which has in skillful hands repeatedly saved the lives of patients suffering from pericarditis ; this measure consists in what is termed aspira tion. This means that a very fine needle is inserted through the skin into the pericardium, and the liquid is drawn off by means of a syringe. In this way the pressure on the heart is removed, and the immediate danger is averted.
During convalescence extreme care should be taken to protect the patient against severe physical effort of any sort, since the heart is so weak that a degree of exertion which is not noticed during health, may be sufficient to make the heart stop beating entirely.
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