06b ACUTE CARDIAC INFLAMMATIONS. 



pain is great, is to be carried out with Avatclifiilness and care. 

 Following the employment of a moderate blood-letting Avhere 

 blood is abstracted, and also where blood-letting is not carried 

 out, full and repeated doses of salines, as the bicarbonate of 

 potash, alternated after some days with iodide of potassium, 

 will be found most useful. 



Should debility or exhaustion set in, stimulants must not be 

 withheld, but are best administered in small or moderate 

 doses, and often; and where little food is taken, are judiciously 

 coijibined with good gruel or beef-tea. The acute and highly 

 developed symptoms attendant on endocarditis are, however, 

 less to be feared than the concurrent or consequent valvular 

 lesions, with the usual attendant change of cardiac structure 

 and restriction of cardiac orifices. When resulting from pycTmia 

 and other blood-contaminations the same general princi^^les 

 must guide our treatment. The cardiac lesions must be made 

 subordinate to the primary and inducing. 



II. Acute Myocarditis — Carditis. 



Inflammation of the true muscular structure of the heart, 

 there is little doubt, does occur, if not throughout the entire 

 organ, at least in a circumscribed and superficial manner, in 

 certain cases of peri- and endo-carditis, where, from contiguity, 

 the muscular fibres participate in the morbid action progress- 

 ing in the investing membrane. Like the inflammations 

 occurring in these membranes it seems also to owe its exist- 

 ence to pytemic and septicasmic conditions, in which states 

 the deeper-seated textures are more likely to be involved, and 

 the termination to be the formation of abscesses and fatal de- 

 struction of tissue. 



The anatomical characters in the few cases which I have 

 seen were darkening and softening of the cardiac structure, the 

 intimate elements of which were moistened with slightly bloody 

 serous fluid and pus. 



The symptoms of this condition, which are not diagnostic, 

 are chiefly weakened and irregular cardiac action. 



One of the few cases of secondary carditis which have come 

 under my observation is interesting, as showing the extent to 

 which serious changes may occur in connection with the 



