MYOCARDITIS. 



35T 



alar. Even then, however, our opinion will only amount to a some- 

 what vague suspicion. Diagnosis of myocarditis grows more sure, but 

 not certain, when symptoms appear in the course of acute rheumatism 

 which suggest diseases of the heart, while physical examination affords 

 negative evidence of endo- or pericarditis. If, now, rigors should set 

 in, or swelling of the spleen, or pain in the region of the spleen, vomit- 

 ing, or pain in the region of the kidneys, with the presence of albumen 

 and blood in the urine ; in short, if metastases be established, the diag- 

 nosis becomes tolerably certain : but such cases are not common. 



If cicatrices have formed at numerous points in the heart, and if 

 the heart be dilated in consequence, symptoms of dilatation appear, 

 such as we have already described, only they are more severe ; and it 

 is impossible to say, in most cases, what parts the dilatation and de- 

 generation respectively play in retarding the circulation and overload- 

 ing the venous system. Thus, in the diagnosis of mitral insufficience, 

 we may bear in mind that it may possibly have been induced by de- 

 generation of the papillary muscles. Extensive scar-like degeneration 

 of the heart-wall, as well as true cardiac stenosis of Dittrich and 

 chronic cardiac aneurism, causes symptoms of extremely depressed ac- 

 tion of the heart. The beat is scarcely perceptible, the arterial pulse 

 is extremely small and weak as well as very irregular and intermittent. 

 Extreme cyanosis and general dropsy accompany these symptoms. If 

 called upon for a diagnosis in a case of this kind, after exclusion of 

 valvular deformity as a cause of the derangement of circulation, we 

 must count diffuse cicatricial formation as one of the alterations of 

 structure capable of producing the train of symptoms above described ; 

 but we shall hardly ever make an absolutely certain diagnosis by the 

 system of exclusion of other anatomical changes, such as dilatation 

 with atrophy, extensive fatty degeneration, etc., etc. 



As for abscess of the heart and the various results of perforation, 

 we are rarely able to form more than a vague diagnosis after the nu- 

 merous metastases have arisen. We have no means of ascertaining 

 this condition with certainty. 



TREATMENT. We can hardly speak of the treatment of myocardi- 

 tis, having almost denied the possibility of recognizing its existence. 

 Should it be possible to diagnosticate the disease, the treatment would 

 not differ from that of endocarditis. It is, of course, out of our power 

 to remove the cicatrices, or to avert the embolism from perforation of 

 an abscess, or to allay its effects. A mere treatment of symptoms ifi 

 all that can be effected. 



