ENDOCARDITIS 159 



if the valves have been previously affected with inflammatory processes. 

 Consequently it is very apt to appear in such diseases as distemper, 

 septicaemia, pyemia, articular rheumatism, and in rare instances in tuber- 

 culosis; it may also follow wound abscesses, chronic ulcerated inflam- 

 mations of the skin (dermatitis), and as a consequence of some unknown 

 bacterial invasion. Frohner and Jensen have observed an infectious 

 malignant endocarditis. 



Pathological Anatomy. — "While we differentiate between endocar- 

 ditis verucosa and endocarditis ulcerosa (endocarditis diphtherica, endo- 

 carditis maligna), one may follow the other. The former (the milder 

 form) commences with the formation of various sized wart-like protuber- 

 ances on the free edges of the valves and their attachments, and also on 

 the trabeculte and papillary muscles; when the latter are attacked, it 

 may cause necrosis and tumefaction of the endocardium. This condition 

 may cause the formation of eml)oli which get into the circulation, are 

 liberated, and produce grave conditions in various organs of the body. 

 The aortic and the bicuspid valves are more frequently affected; the 

 pulmonary and tricuspid valves, very rarely. 



Clinical Symptoms and Course. — There may be little or no fever in 

 the onset of the disease, but if there is fever present it is generally high. 

 The general condition is greatly disturbed, increased irregular heart 

 action, pulse Aveak and irregular; on ausculation the pulsation is heard 

 and little change is noticed in the early stages before any material 

 alteration has been made in the valves. Later, when the deposits become 

 organized, the heart beat is muffled and the two sounds of the heart 

 become one, or an early systole and diastolic murmurs. The respirations 

 are more or less accelerated and labored, there is cyanosis of the visible 

 mucous membranes and with these symptoms there may be certain met- 

 astatic changes in other organs. 



The course of the disease varies; in some cases death occurs in a 

 very short time, in the majority of cases, hoAvever, the disease progresses 

 slowly, the symptoms may increase in severity; they may decrease in 

 severity and the animal be comparatively well for w'eeks, and then the 

 acute symptoms may recur and the disease become chronic. In mild 

 cases animals may take complete recoveries, but this is comparatively 

 rare. 



Therapeutics. — Rest, avoid any excitement, cold compresses, such 

 as an ice-bag over the region of the heart; where there is a small irregular 

 pulse we should administer digitalis, strophanthus, or caffeine. ^^ hen 

 dangerous symptoms appear, subcutaneous injections of camphor, ether, 

 or atropin. For the fever we should use salicylate of soda, aspirin, 

 cinchona, antipyrin or antifebrin. 



