ACUTE ENDOCARDITIS IN THE HORSE. HO 



of the endocardium. Digitalis was said to have this effect, especially 

 when given in large doses, intermittently, and for a long time. It is 

 quite certain that such substances can do no more than favour 

 infection. 



Traumatic endocarditis, resulting from cardiac lesions produced by 

 infected foreign bodies, is chiefly a laboratory disease. Endocarditis 

 and myocarditis sometimes co-exist, and it has been sought to explahi 

 the former on the basis of extension to the serous membrane of 

 inflammation of the heart muscle ; but, in most cases of this kind, the 

 muscular and serous tissues are simultaneously attacked. 



Depending on its nature, and the species or virulence of the 

 microbic agents which produce it, endocarditis may remain localised, 

 soon lose its infectious character, become chronic, and only produce a 

 few innocent fibrous lesions, being then described as benign (the form 

 most commonly seen in the horse) ; or it may preserve its original 

 infective, spreading character, when it is known as malignant endo- 

 carditis. 



I need only rapidly recite the generally accepted symptomatology 

 in order to convince you that this disease has been credited with effects 

 for which it is in no way answerable, but which result from a general 

 infection, of which the endocarditis is only an accompaniment. Pro- 

 found depression, absolute loss of appetite, high fever, warmth of the 

 skin, acceleration of the chief functions, dyspnoea, violent cardiac 

 action, "purring tremor" (fremissement cataire), metallic heart 

 sounds, sometimes irregularity of the heart, intermittencies, venous 

 pulse, a murmur during the first or second sound ; at a later stage, 

 paresis or paralysis, albuminuria, and icterus (produced by visceral 

 emboli) ; finally, loss of strength and collapse ; such are said to be the 

 principal symptoms produced by acute endocarditis, under the varying 

 forms which it may assume. 



In point of fact the condition generally passes unperceived, masked 

 by the symptoms of the accompanying disease. When it occurs as a 

 primary affection the general symptoms scarcely diifer from those 

 accompanying many other diseases of the viscera. The only special 

 symptoms are those recognised on auscultation, and the sole symptom 

 by which it is identified is the murmur. 



This is sometimes systolic, originating in the auriculo-ventricular 

 orifice — a feeble, soft sound, deep in some patients, strong and 

 vibrating in others. In the latter case, which is exceptional, the 

 "purring or vibratory tremor " may be detected by applying the hand 

 over the pra:;cordial region ; but the symptom, though mentioned 

 by all authors, is distinctly uncommon. Sometimes the murmur is 



