Fig. 182.—Appearance of an animal suffering from pseudo-pericarditis (infra-pericardial abscess). The dotted outline indicates the space occupied by the heart, which is thrust upwards.
Diagnosis. The attempt to diagnose this condition accurately must not be regarded merely as a result of scientific curiosity. Under certain circumstances the diagnosis may be of very great importance. While the patient affected with pericarditis due to a foreign body is beyond all hope of recovery, certain cases of pseudo-pericarditis appear amenable to treatment.
The diagnosis, therefore, is of great importance, and the practitioner should spare no effort to confirm it, bearing in mind the symptoms enumerated, and remembering that the normal sounds of the heart never completely disappear.
An aseptic exploratory puncture with a long, fine needle will sometimes prove of great assistance.
Prognosis. Although grave, the prognosis is less so than in true pericarditis.
Treatment. If clearly recognised, both subpleural and subpericardial abscesses seem curable. By freely puncturing the pus-filled cavity through an intercostal space, the liquid may be evacuated and recovery may occur. Healing is favoured by carefully washing out the cavity with a non-irritant disinfectant.
The only precaution required in making such punctures is to avoid the internal thoracic artery and vein, the intercostal artery, and the lower cul-de-sac of the pleura.
CHAPTER III.
ENDOCARDITIS.
If the symptoms of pericardial diseases are well defined, we cannot say the same of diseases of the heart, properly so-called. Such affections often pass unnoticed, being detected only on post-mortem examination. Moreover, cardiac diseases are rare. Very frequently they are only of a secondary nature, accompanying or following better recognised conditions, such as infectious diseases, post-partum infections, etc.
Causation. Endocarditis, i.e., inflammation of the endocardium and valves, is rarely primary, simple and benign. It was formerly thought to be the result of chills or of the rheumatic diathesis. These simple forms of endocarditis usually escape observation, though careful examination in the first instance reveals them.