350 DISEASES OF THE HEART. 



slowly, and as adhesions of the valve-tips and chordae tendineae only 

 take place by degrees, it may happen that, immediately after an attack 

 of endocarditis, there may be no perceptible defect of the valve ; yet 

 valvular disease may become apparent after the lapse of some months. 

 If, however, the chordae tendineae suffer rupture, or if an orifice be 

 blocked up by vegetations, the transition from endocarditis into val- 

 vular disease is immediate. In a previous chapter we have shown how 

 endocarditis may cause dilatation, and afterward lead to hypertrophy 

 of the heart. 



The usual termination of endocarditis is death from disease of the 

 valves, which is almost always its sequel ; but this fatal result does 

 not generally ensue until years have elapsed, and it is rare for a 

 patient to die suddenly of endocarditis alone. Such a termination 

 hardly ever takes place in the form of disease, which complicates acute 

 articular rheumatism. It is somewhat more common in the variety 

 which accompanies Blight's disease, or the infectious maladies, and 

 here it usually is difficult to determine what part in the fatal issue the 

 original disease has played, and what the complication. Palsy of the 

 heart, engorgement of the lungs with consequent oedema, in very rare 

 instances exhaustion through fever, symptoms of softening of the brain, 

 of metastasis into the spleen, kidneys, and liver, even gangrene of the 

 toes, are symptoms with which death may then take place. Recovery 

 from endocarditis may occur often enough if -the valves be spared by 

 the inflammation. White, thickened, and opaque spots, upon the 

 interior of the wall of the heart, are often found post mortem, without 

 having produced any symptoms during life. Even inflammation of the 

 valves may terminate in recovery, if the thickening, which probably 

 always remains, does not derange their function. Experience does 

 not show this termination to be common. Although the valves may 

 act normally at first, yet they are afterward liable to become the seat 

 of fresh irritation, until, at last, deformities arise capable of deranging 

 their function. 



We have hitherto described endocarditis such as complicates rheu- 

 matism of the joints. The functional symptoms, the progress, and the 

 consequences of an endocarditis which complicates an existing disease 

 of the valves present no new feature to the picture. This is also the 

 case in that form of the malady which complicates acute infectious 

 diseases. Here the symptoms of the main affection mask those of the 

 complication so fully, that an exact clinical description of them can 

 scarcely be given; in particular, the delirium, stupor, albuminuria, 

 iaundice, etc., which certainly are very common accompaniments of 

 this form of endocarditis, do not depend upon the endocardial disorder 

 for their cause, but rather are a result of the infection of the blood and 



