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Pericarditis and

heart, abdominal, peritoneum, disease, inflammation, cavity, peritonitis, fever and usually

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PERICARDITIS AND HYDROPERICARDIUM.—The pericardium is a membranous bag which invests the heart. It consists of two layers, an inner, serous one, which is firmly attached to the heart-muscle, and an outer, fibrous one, which surrounds the heart as a wide pouch. Inflammation of the interior surface of this cavity causes either an accumulation of a larger or smaller quantity of fluid, or a coalescence of the heart with the pericar dium. Both affections may give rise to severe disturbances of the cardiac activity. Inflammation of the pericardium (pericarditis) occurs in the course of infectious diseases, such as scarlet fever, measles, typhoid fever, pneumonia, pulmonary tuberculosis, articular rheumatism, etc. Hydro pericardium (dropsy of the heart) occurs as a part symptom of general dropsy in heart-defects, in chronic inflammations of the kidneys, etc. In addition to manifestations which are known to the physician only, there occur certain characteristic disturbances, which may lead to the discovery of the disease. In many cases this might otherwise be difficult, for the disease frequently runs an obscure course. At the very onset of the disease there may be present, in the region of the heart, pressing or darting pains which radiate into the left shoulder or into the upper arm. Oppression of the chest, a sensation of fear, impaired or accelerated respiration, palpitation of the heart, and irregular fever may be noted. It should not be overlooked that several of these symptoms are observed in many mild affections of the lungs or of the heart ; but the continuance of the symptoms should cause the sick person to seek expert advice, The duration and course of the disease depend upon the nature of the original affection, and upon the strength of the individual patient. Improve ment usually sets in when the fever, pains, and oppressions diminish. Even after recovery, however, marked irritability of the heart, slight oppressions, and palpitation, may remain for some time. If the symptoms just outlined should occur before medical advice can be obtained, the patient should go to bed immediately and avoid even the slightest bodily exertion. To relieve the pain and anxiety, applications of cold water and ice to the region of the heart will be found very serviceable. The administration of alcoholic drinks in moderate doses is admissible only in case symptoms of cardiac weakness become manifest or, perhaps, for habitual drinkers. Thirst, which is often tormenting, should not be quenched by an abundant administration -of fluids, hut by small pieces of ice and a little cold lemonade. While there is fever the diet should preferably consist of milk, soups, and eggs ; whereas solid food is not to be given until convalescence has set in. It is of

great importance to secure daily movements of the bowels by taking fruit juices, stewed fruits, or mild purges ; or, better still, by frequent enemas of oil or warm water. These directions should be strictly observed during convalescence as well.

PERITONITIS.—Intlammation of the peritoneum, the serous mem brane which lines the abdominal cavity, and which also invests the abdominal organs. It is usually a very dangerous disease, often terminating fatally. Two main forms of peritonitis may he distinguished—the acute and the chronic. The inilammaticin usually proceeds from one of the abdominal organs covered by the peritoneum—stomach, liver. intestine, spleen, uterus, ovaries, etc. In most cases of acute peritonitis the focus of the disease is an ulcer or a suppurative process, which may have been present for a longer or shorter period before involving the peritoneum. The chronic form usually, though not always, originates without the involvement of any abdominal organ.

Acute peritonitis is very frequently caused by the perforation of a gastric or an intestinal ulcer into the free abdominal cavity. Acute suppurative appendicitis is one of the most frequent causes of peritonitis. A sudden rup ture of stomach or intestine, as the result of an injury, may likewise give rise to inflammation of the peritoneum ; but this is a rather infrequent cause of the disease. An ulcer of the gastrointestinal tract may exist for weeks, months, or years before perforation occurs. The depth to which the ulcera tive process has penetrated is the important factor. After the mu-ous and muscular layers have been perforated, the base of the ulcer consists merely of the peritoneum which coats all the abdominal organs. The peritoneum then easily becomes inflamed, gradually grows thinner, and finally tears. The intestinal contents are rich in purulent bacteria, and readily give rise to inflammation when gaining access to the peritoneum. Inflammations of the female genitals, uterus, tubes and ovaries, are likewise apt to involve the surrounding peritoneum, the infectious material proceeding by way of the lymph-channels. Peritonitis may originate also from diseases of the liver and of the biliary passages. A purulent focus in any one of the abdominal organs is always liable to perforate into the peritoneal cavity. Inflammation of the peritoneum is likely to be followed by an accumulation of fluid in the free abdominal cavity, this fluid being at first watery, and later purulent. This brings on a gradual distension of the abdomen, and results in more or less tension of its walls. The distension is also partly due to paralysis of the intestine, and the consequent accumulation of gases.

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