DISEASES OF THE HEART. 



is the most frequent cause of endocarditis, yet the number of cases in 

 which rheumatism runs its course without it is far greater than was 

 supposed for a long time, after the frequent coexistence of the two 

 maladies had been recognized. 



The fact that a blowing sound can be heard in the heart, during an 

 attack of acute rheumatism, is not by any means a sufficient evidence 

 of the existence of endocarditis. Such a sound, which may be heard 

 in at least one-half of all rheumatic attacks, depends, in a very great 

 degree, upon the irregular tension of the valves, to which the excited 

 and uneven action of the heart gives rise. According to the careful 

 statistical compilations of Bamberger, the frequence of the complica 

 tion of acute articular rheumatism with endocarditis may be rated at 

 about twenty per cent. 



Next in frequence, endocarditis complicates Blight's disease, ac- 

 companying the acute form which develops after scarlatina, as well as 

 the chronic form. Here, too, the tendency to inflammation in the 

 heart, serous membranes, and lungs, set up by this affection of the 

 substance of the kidney, remains inexplicable. 



The endocarditis which comes on during acute febrile maladies, 

 especially acute infectious disorders, is closely allied to the above 

 mentioned forms. The disease seems to arise frequently from puer- 

 peral fever, while Wunderlich regards measles as the most prolific 

 cause of endocarditis next to rheumatism. According to the experi- 

 ments of Bittroth and Weber ', it seems not improbable that the blood 

 of a fever patient acts as an inflammatory irritant, and that individuals 

 laboring under violent fever, no matter what its cause may be, are 

 liable to secondary inflammation of various organs, and especially to 

 inflammation of the endocardium. If this supposition be true, the fre- 

 quence of the complication of articular rheumatism and endocarditis is 

 attributable to the intensity which rheumatic fever often acquires. 



The existence of a diseased valve is frequently the cause of endo- 

 carditis. It is a matter of common experience, that a patient, at first, 

 may have a simple valvular disease arising from acute rheumatism, 

 but after a time, and without his having had any fresh rheumatic at 

 tack, the valvular affection become a complicated one, compelling u? 

 to infer that it is the result of a latent endocarditis. 



The endocarditis which accompanies myocarditis, and pericarditis, 

 must be considered as the result of extension of the disease by con- 

 tiguity. As a very great rarity, inflammation of the lungs or pleura 

 also spreads to the endocardium. 



ANATOMICAL APPEARANCES. As nearly all the congenital defects 

 of the heart which are attributable to a former endocarditis are found 

 In the right side of the organ, it would seem that the light side of the 



