Tuberculosis of the pericardium is comparatively common. it may be pri mary in the clinical, rarely in the patho logical, sense, or it may be secondary. The primary form is either a htema togenic infection or is the result of ex tension by contiguity from some trivial focus. The most frequent source of in fection is a tuberculosis mediastinal or bronchial lymph-gland. The primary form is usually chronic, and appears as an obliterative pericarditis. In a large percentage of cases there is an associated mediastinitis, with adhesions to pleura, sternum, and ribs. The symptoms are those of adherent pericarditis or medias tino-pericarditis. In every ease of oblit erative pericarditis of obscure etiology tuberculosis should be suspected, par ticularly if there are no endocardial murmurs. The diagnosis of tuberculosis of the pericardium can usually be made only by excluding other causes, except in rare instances of successful animal inoculation with fluid obtained by tap ping a pleural cavity. Tuberculous pericarditis may not present any char acteristic features at autopsy; hence, microscopical examinations should be made in every case of adherent pericar dium before tuberculosis is excluded. In rare cases a clinically primary tuber culous pericarditis is acute, the exudate being serabrinous, luemorrhagic, or purulent. David Riesman (Amer. Jour. Med. Sci., July, 1901).
Its occasional development in cases of chorea brings to mind the mysterious association between rheumatism, chorea, and endocardial disease. Another impor tant cause is chronic nephritis. Gout, scurvy, purpura hternorrhagica, leukce mia, and cancer also deserve mention. The disease attacks youth and middle life oftener than old age. Addiction to liquor increases the liability to pericar ditis. Males are somewhat oftener at tacked than females.
By extension from contiguous organs the disease is developed in pleurisy and pleuro-pneumonia, endocarditis, puru lent myocarditis, aneurism of the aorta, and also from disease in the bronchial glands, the bones, the esophagus, and even the abdominal viscera. (Osler.) Pathology.—The changes in the peri cardium due to inflammation correspond closely to those seen in other serous membranes, particularly the pleura. The first change is an injection of the super ficial blood-vessels, which may give the whole surface a dull-red color. Fibri nous exudation may consist either of a few stringy deposits, or a more uniform thin membrane, or, again, a thick, irregu lar coating. This coating may be ridgy, honey-combed, or shaggy. In chronic cases it may become of enormous thick ness, and even present plates of creta ceous material.
In cases of sero-fibrinous exudation the amount of fluid varies between two or three hundred cubic centimetres and two litres. There is a record of the enormous
quantity of one gallon. The fluid may be tinged with blood, especially in culosis, cancer, and nephritis. Aged pa tients are apt to have hmmorrhagic fluid. Purulent exudations consist of a creamy or a thinner sero-pus; in some cases they are offensive: "ichorous." In cases of rather long duration or great severity the myocardium is involved in the process to the depth of two or three millimetres, entailing an organic weak ness which gravely affects the prognosis. In case the patient survives the dis ease, permanent changes in the mem brane remain behind. There may be small patches of cicatricial change, or a limited number of adhesions, or, again, the pericardial sac may be entirely obliterated, presenting the condition of chronic adhesive pericarditis.
The changes thus far enumerated re late to the inner surface of the dium; not infrequently the inflammatory process involves its outer surface as well, giving rise to pleuro-pericarditis and mediastinitis, and eventually binding the heart in an unnatural degree to surround ing parts. (See below: CHRONIC ADHE SIVE PERICARDITIS.) Prognosis.—Acute fibrinous pericardi tis is seldom fatal, and most cases of matic origin recover. On the other hand, the disease is very often a terminal phe nomenon in patients very ill with certain -diseases, such as nephritis, pleuro-pneu monia, and sepsis.
Out of 100 cases of pericarditis, 43 eases died and 4 were discharged unre lieved. The etiology seemed to have much influence upon the prognosis, as only 5 of the cases occurring in the course of acute rheumatism were fatal. G. G. Sears (Boston Med. and Surg. Bull., Apr. 22, '97).
Tuberculous pericarditis is almost in variably fatal. The rapid outpouring of a large amount of fluid is dangerous from its mechanical effect, and aspiration may then save life if promptly performed. Cases seemingly desperate may recover, even without intervention.
From 100 cases of paracentesis peri cardii collected, 38.4 per cent. made com plete recovery, the rest dying anywhere from a few minutes to six months or more after the operation. J. H. Burten , thaw (Med. News, Mar. 11, '99).
Treatment.—Pericarditis is not at all a disease in which routine measures are demanded or justified. Some cases, both of the fibrinous and sero-fibrinous variety, may progress to recovery unaided. If there is prmcordial or troublesome palpi tation, dry cold may be employed over the heart; it should be used at first tenta tively. We may employ an ice-bag cov ered with flannel or Leiter's coil.