354 DISEASES OF THE HEART. 



Brightii, the acute exanthemata, and the other infectious maladies, 

 which give rise to endocarditis, or, at least, predispose toward it. 

 With regard to the indications from the disease and the antiphlo- 

 gistic apparatus, we have already and repeatedly declared that the 

 majority of the so-called " antiphlogistics," and, above all, venesection, 

 often as they are employed in inflammation, have no right to the name. 

 But, in spite of contrary assertions on the part of French and English 

 physicians, there is, perhaps, no affection in which the practice of 

 bleeding without special occasion, as well as the employment of 

 calomel and " blue ointment to reduce the plasticity of the blood," is 

 so dangerous as in endocarditis ; and we must entirely agree with 

 Bamberger, when he states his belief that most patients, who die 

 during an attack of this malady, have perished less from the disease 

 than from the treatment. 



Even local blood-letting should only be resorted to where there is 

 pain about the heart, and here we generally have to do with complica- 

 tions. With regard to cold, which we have employed against inflam- 

 mation of internal organs as freely as it has been used in inflammation 

 of external parts, we do not apply it in these cases, unless especially 

 demanded by extreme excitement of the heart's action, inasmuch as, 

 according to our experience, even when applied upon inflamed joints in 

 rheumatism, it has but trifling palliative effect. Indeed, although 

 many cases of endocarditis, which used formerly to escape diagnosis, 

 are now recognized through pleximeter and stethoscope, yet their 

 treatment is no more successful than before ; nay, if the physician find 

 the evidence of the presence of endocarditis an occasion for meddle- 

 some treatment, it were better for the patient had the doctor never 

 learned auscultation. 



The indication as to symptoms calls for venesection in cases where- 

 in overcharge of the pulmonary circulation imperils life by threatening 

 oedema of the lungs, and demands prompt relief by diminution of the 

 volume of the blood. A great acceleration of the pulse and signs of 

 feebleness in the action of the heart, cyanosis, etc., indicate the exhi- 

 bition of digitalis. Should palsy of the heart threaten, stimulants 

 must be used 



CHAPTER V. 



MYOCARDITIS. 



ETIOLOGY. Myocarditis consists of an inflammation of the muscu- 

 lar fibres of the heart, whereby they are softened, become flabby, and 

 finally disintegrate. This destructive process is accompanied by pro- 

 liferation of the perimysium ; the gaps formed by absorption of the 



