202 THEORY AND PRACTICE 



toms of cardiac affection are associated with rheumatism, in- 

 fluenza or any septic condition. 



Endocarditis may be distinguished from pleuritis by the ab- 

 sence of any friction murmur, absence of pain when the chest 

 wall is percussed and the absence of effusion in the cavity of 

 the chest. It may be differentiated from pericarditis by the ab- 

 sence of friction sounds and want of an enlarged area of dull- 

 ness on percussion. 



Treatment. — Blood-letting is contra-indicated. If you can 

 purify the blood the heart may recover. Give antiseptics, such 

 as salol, hyposulphite of soda, bicarbonate of soda, etc. To 

 guard against the chronic induration of the valves give iodide 

 of potash. This should be given in 1 to 2 dram doses early in 

 the disease and may be repeated two or three times a day for 

 several weeks. In all cases see to the hygiene — good nourishing 

 food and warm quarters. Absolute rest is necessary. 



Endocarditis is usually fatal. In the autopsy there are black 

 patches on the lining of the heart. These may extend around 

 the valves. 



Acute valvular disease cannot be distinguished from endocar- 

 ditis, and chronic valvular affections are generally the result of 

 endocardial inflammation. The valves of the left side are the 

 ones most often affected, — the mitral and the aortic semilunar. 

 The lesion may be mere inflammation and swelling or it may con- 

 sist of organized vegetations upon the surface of the valve. Ad- 

 hesions may occur and the chordae tendinae may be shortened or 

 lengthened. The fibrous tissue may become changed into carti- 

 lage or bone or it may become the seat of lime deposits, resulting 

 in ulceration, ruptures and fissures. If the heart dilates too much 

 there may be atrophy and shrinking of the valves. 



Symptoms.— Yci\vu\2LT disease may be indicated by a venous 

 pulse, by a jerking, irregular and intermittent pulse, by palpita- 

 tion and dyspnoea, attacks of vertigo, congestion of the brain and 

 dropsical swelling of the limbs. Simple dilatation of the heart 

 usually accompanies the valvular disease. 



Treatment. — When the pulse is irregular or irritable, iron, 

 gentian and ginger may be given. For the jerky violent action of 

 the heart give 20 to 30 drop doses of digitalis or of veratrum 



