CHAPTER III. 

 ENDOCARDITIS. 



If the symptoms of pericardial diseases are well defined, we cannot 

 say the same of diseases of the heart, properly so-called. Such affections 

 often pass unnoticed, being detected only on post-mortem examination. 

 Moreover, cardiac diseases are rare. Very frequently they are only of a 

 secondary nature, accompanying or following better recognised condi- 

 tions, such as infectious diseases, post-partum infections, etc. 



Causation. Endocarditis, "i.^., inflammation of the endocardium and 

 valves, is rarely primary, simple and benign. It was formerly thought to 

 be the result of chills or of the rheumatic diathesis. These simple forms 

 of endocarditis usually escape observation, though careful examination in 

 the first instance reveals them. 



Much more frequei^tly, however, endocarditis is secondary, malignant, 

 infectious and infecting. This variety occurs as a complication of post- 

 partum infection or of very serious general conditions, such as peri- 

 pneumonia, gangrenous coryza, aphthous fever, tuberculosis, etc. To 

 detect it, not only must the original disease be accurately diagnosed, but 

 all the changes the disease is producing in important organs must be 

 followed. 



While it is generally admitted that all forms of endocarditis, even of 

 the most benign character, are originally due to infection, it is certain that 

 in those of the second group the organisms which have entered the blood- 

 stream through a lesion of the uterus, lung or other tissue, are endowed 

 with very great virulence. They attack some point on the endocardium, 

 and produce either ulcerations which become covered with fibrous clots, 

 or exuberant new growths of a pathological nature, which generally are 

 papilliform, fragile, and prone to become detached by rupture of their 

 pedicle and thus to be launched into the general circulation and to form 

 emboli. The surface of these infected vegetations, like that of the ulcera- 

 tions, becomes covered with fibrinous clots, which are readily loosened, 

 form emboli in their turn, and infect distant organs. 



Symptoms. The general symptoms of infectious endocarditis are by 

 far the most important. They consist of prostration, loss of appetite, 

 severe thirst, and high temperature. The local symptoms consist 



