Studies in cardiac pathology . des, all of which are very firm and never umbilicated. They do not invade the myocar-dium, which is firm and dark reddish-brown in color. The tissue between the nodules is darkpurplish-red in color and appears to contain hemorrhages. There are no nodules on theexternal portion of the visceral pericardium. The left ventricle measures cm. in heart is somewhat enlarged; the cavities are of fair size, and all the valves are thin anddelicate. Microscopic Examination: No especial changes are noted in the myocardium. Thepericardium is the seat of exten
Studies in cardiac pathology . des, all of which are very firm and never umbilicated. They do not invade the myocar-dium, which is firm and dark reddish-brown in color. The tissue between the nodules is darkpurplish-red in color and appears to contain hemorrhages. There are no nodules on theexternal portion of the visceral pericardium. The left ventricle measures cm. in heart is somewhat enlarged; the cavities are of fair size, and all the valves are thin anddelicate. Microscopic Examination: No especial changes are noted in the myocardium. Thepericardium is the seat of extensive tuberculosis. Covering the heart muscle there is a thicklayer of granular tissue, composed chiefly of epithelioid cells and small round-cells. Every-where throughout this tissue one sees enormous giant-cells and typical tubercles. In thegranulation tissue surrounding the tubercles blood-vessels are fairly numerous. There areno areas of caseation. (Case reported by the author, Univ. of Pennsylvania Med. Bull., July, 1904.). Fig. 38. 128 STUDIES IN CARDIAC PATHOLOGY surrounding structures. The latter is met with chiefly in males, isindependent of valvular lesions, and often occurs in individualswho give no history of antecedent infections. The former variety,which is often seen in valvular disease, is associated with markedhypertrophy and dilatation, and with extensive extrapericardialadhesions. Calcification of the pericardium sometimes follows,and myocardial atrophy resulting from constriction has beendescribed. Fenton found that out of 150 cases of adherent pericarditis, in which thecause of death was specifically stated in the postmortem records to have beenthe direct result of the heart lesions, 65 were found during the first three dec-ades, and 17 during the last four; while where death followed upon causesunconnected with the heart, 13 only were found during the last three decades,and 55 in the last four. He also found a history of rheumatic fever in most ofthe cases
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