ulse, and, in cases of
pericardial effusion, the increased area of dullness over the cardiac
region. When the disease is associated with influenza or rheumatism,
some of the symptoms may be obscure, but a careful examination will
reveal sufficient evidence upon which to base a diagnosis. When
pericarditis develops as a result of or in connection with pleuritis,
the distinction may not be very clearly definable, neither will many
recover. When it results from a wound or broken rib, it almost
invariably proves fatal.

_Pathology._--Pericarditis may at all times be regarded as a very
serious affection. At first we will find an intense injection or
accumulation of blood in the vessels of the pericardium, giving it a red
and swollen appearance, during which we have the friction sound. In 24
to 48 hours this engorgement is followed by an exudation of
sero-fibrinous fluid, the fibrinous portion of which may soon form a
coating over the internal surface of the pericardial sac, and may
ultimately form a union of the opposing surfaces. Generally this
adhesion will only be found to occupy a portion of the surfaces. As the
serous or watery portion of this effusion is absorbed, the distinctness
of the friction sound recurs, and may remain perceptible in a varied
degree for a long time. When the serous effusion is very great, the
pressure exerted upon the heart weakens its action, and may produce
death soon; when it is not so great, it may cause dropsies of other
portions of the body. When the adhesions of the pericardial sac to the
body of the heart are extensive, they generally lead to increased
growth, or hypertrophy, of the heart, with or without dilatation of its
cavities; when they are but slight, they may not cause any
inconvenience.

_Treatment._--In acute or subacute pericarditis the tincture of
digitalis may be given in 20 to 30 drop doses every hour until the pulse
and temperature become reduced. Whisky or carbonate of ammonia may be
given regularly as stimulants. Bandages should be applied to the legs;
if the legs are very cold, tincture of capsicum should be first applied;
the body should be warmly clothed in blankets, to promote perspiration.
When the suffering from pain is very severe, 10 grains of morphin may be
given by the mouth once or twice a day; nitrate of potassium, half an
ounce, in drinking water, every six hours; after the third day, iodid of
potassium, in 2-dram doses, may be substituted. Cold packs to th