ACUTE ENDOCARDITIS WITH VALVULITIS. 5G3 



the majority of cases, most distinctly visible near the orifices 

 of the heart, and in connection with the valvular structures 

 which guard these. 



This preference in endocarditis for seizing on the valves and 

 their appendages, the chordae tendinere, is characteristic of all 

 forms of the diseased action, but chiefly of that where it is de- 

 veloped in association with rheumatism and rheumatoid inflam- 

 mations. This may be so far accounted for when we consider 

 that the cardiac valves are in part made up of white fibrous 

 tissue, which seems peculiarly the seat of the specific inflam- 

 matory action. 



The form in which these results develop themselves is to 

 some extent determined by the anatomical formation of the 

 valves, they being constructed in part of fibrous tissue peculiarly 

 disposed between duplicatures of the membrane. When in- 

 flamed they become thickened in two ways, first from aug- 

 mentation in bulk of their intimate structure, and second 

 from aggregations of a warty character, by proliferating cell- 

 elements on their outer surface and free margin ; these latter 

 being steadily added to by the deposition of fibrinogenous 

 material from the blood with which they are bathed. 



These excrescences are of variable size and form, generally 

 numerous, situated, as we have said, both upon the surface of 

 the valve, its free margin, and its intimate texture. In some 

 cases they partake of a cartilaginous or calcareous character, 

 these materials being deposited sometimes in layers, at others 

 in points or masses. 



The continued existence or repetition of the inflammation, 

 and the increase of these warty growths, tend to restrict the 

 cardiac orifices and interfere with the action of the valves. 

 They may undergo certain changes, as softening and dis- 

 integration ; or they may be removed in whole or in part. 

 The portions thus set loose may mingle with the general 

 current of the circulation, and in this way may be carried to 

 distant parts of the body and find a lodgment in tissues and 

 organs, obstructing the blood-supply in these, and inducing 

 paralysis or minute and destructive changes, terminating in 

 general disturbance and death. 



Symptoms. — The symptoms by which endocarditis may be 

 detected, or by which it may be differentiated from pericarditis, 



36—2 



