562 ACUTE CARDIAC INFLAMMATIONS. 



qiiently encountered tlian any other cardiac lesion, and to 

 exceed in frequency the same morbid alteration in the invest- 

 ing membrane and sac of the heart. If by this it is meant to 

 be stated that endocarditis of itself, and apart from other 

 diseased conditions, is of more frequent occurrence than asso- 

 ciated with a similarly diseased state of other cardiac struc- 

 tures, I can hardly agree to it. If, hoAvever, its occurrence 

 with pericarditis be considered, and the combination of the 

 double inflammatory action be regarded as one, I am quite 

 prepared to endorse the finding that endo-pericarditis is the 

 most frequently observed of cardiac lesions. When occurring, 

 as it usually does, associated with the same morbid state of the 

 other serous structures of the heart, it may be safely regarded 

 as a more serious condition than pericarditis, not so much from 

 the immediate results of the diseased action as from the 

 ulterior consequences of the structural changes incident to 

 endocardial inflammation. 



Moderate pericarditis may subside, and no permanent 

 textural changes of a serious nature follow. Moderate endo- 

 carditis probably rarely disappears without leaving changes in 

 connection with those fibro-serous structures the valves, which 

 are liable to steadily increase, and finally seriously impair the 

 functional activity of the heart. 



Appearing as a symptomatic condition, the primar}^ states 

 with which it is connected may all be conveniently grouped as 

 those in which the blood is charged with some unhealthy or 

 poisonous material. It is particularly observed in rheumatism, 

 several specific fevers of an enzootic or epizootic type, in 

 pyaemia, and many forms of septic infection. 



The idea that the irritation inducing it is directly convc3'cd 

 to the membrane by the contaminated and heated blood is 

 neither chimerical nor without facts to support it. 



h. Anatoinical Gliavactevs. — Rarely are we fortunate enough 

 to see the endocardial membrane in its first stage of hypememia 

 and heightened colour. Usually it has passed this, presenting 

 an opaque, cloudy, and swollen appearance. 



Where heightening of the colour is observed, we must not 

 forget that such may be the result of simple imbibition of the 

 blood-colouring matter, as well as the natural sequence of 

 inflammation. The results of this disturbed activity are, in 



