Endocarditis. 331 



In complicated forms of percarditis attention must be given 

 mainly to the constitutional affection; thus in infljienza a stimula- 

 ting and supporting treatment is demanded, and in rheumatism 

 colchicum, acetate of potass, salicylate of soda, salol and similar 

 agents must be freely administered, though not to the exclusion 

 of counterirritants to the region of the heart, and other measures 

 demanded bv the heart diseases. 



ENDOCARDITIS. 



Definition. Psthology and lesions, congestion of the endocardium cover- 

 ing the valves, valves liable through friction and strain, exudation in or on 

 the serosa rendering it opaque, coagula of fibrine on the surface, 

 secondary endocarditis mycotic, microbes, changes in serosa, distortions and 

 degenerations of valves. Symptoms, as in pericarditis, with violent heart 

 impulse of varying force, clear metallic sound, blowing murmurs, weak 

 pulse decreasing in force, irregular, intermittent, absence of local tenderness, 

 no friction sound, no increase in area of dulness, if lesions are in right 

 heart — venous pulse, venous congestion, dropsies. Valve lesions, in mitral 

 valve — general heart symptoms and murmur with ist heart sound, 2d sound 

 may be repeated and exceptionally a venous pulse — in tricuspid valve — 

 same with constant venous pulse, venous congestion and dropsy ; narrow- 

 ing of the mitral orifice — general heart symptoms and blowing murmur 

 before the ist sound ; narrowing of the tricuspid orifice — same with mur- 

 mur sometimes audible on the right side ; insufiiciency of aortic valves — 

 general heart symptoms and murmur with 2d heart sound, double rushing 

 sound in arteries and delay of pulse beat at jaw ; lesions in pulmonary 

 valves — same but without double rush in arteries, or delay of pulse beat at 

 jaw. Loose coagula. Embolism. Causes, as in pericarditis and strain on 

 valves, and poisons and microbes in the blood. Prognosis grave. Treat- 

 ment, as in the early stages of pericarditis, antirheumatics and germicides 

 more, and diuretics less desirable. For clots iodides, alkalies. 



Definition. Inflammation of the serous membrane lining the 

 chambers and covering the valves of the heart. 



Pathology and Morbid Anatomy. The causes and symptoms 

 will be better understood after the diseased conditions have been 

 comprehended. The earliest changes are the reddening and thick- 

 ening of the lining membrane of the heart but above all of that 

 covering the valves. The valves are particularly exposed to in- 



