100 THE CIRCULATORY SYSTEM. 
atrophied, or hypertrophied, or be dilated. These conditions are best 
considered in works on general medicine. 
Name the forms of degeneration occurring in the heart, and 
describe them. 
(1) Parenchymatous degeneration of the heart muscle in which the 
muscle fibres are filled to a greater or less degree with albuminous 
granules. This may be followed by a (2) fatty degeneration of the 
heart muscle, portions of the muscle fibre being transformed into larger 
or smaller drops of fat. (3) Fatty infiltration of the heart shows an 
unusual accumulation of fat about the heart and between its muscle 
fibres. Fatty degeneration may be present in the heart valves or in 
spots over the pericardium. (4) Amyloid degeneration of the endo- 
cardium and walls of the bloodvessels is sometimes seen. Lastly 
(5) calcareous degeneration may take place in the products of a 
simple inflammation that may have taken place in the heart. 
Name the different forms of endocarditis. 
Simple acute endocarditis. 
Mycotic or malignant endocarditis. 
Chronic endocarditis, 
Chronic ulcerative endocarditis. 
Tubercular endocarditis. 
Describe simple acute endocarditis. 
This form is most apt to occur as a complication of rheumatism. It 
may consist of a simple swelling of the heart valves, or there may be a 
splitting up of the basement substance of the endocardium and a 
marked increase or growth of connective-tissue cells with the forma- 
tion of fungous masses or vegetations on the surface of the valves. 
These vegetations may break down and ulcerate. This is a simple 
acute ulcerative endocarditis. 
Describe mycotic or malignant endocarditis. 
The lesion may be a primary or secondary affection. It is an acute 
endocarditis incited by the presence of bacteria, most often streptococ- 
cus pyogenes, aureus and albus. The newly-formed tissue soon be- 
comes necrotic. 
What changes occur in chronic endocarditis ? 
The endocardium may be thick and dense, and its free surfaces 
smooth or covered with small vegetations or ridges. It may be infil- 
trated with lime salts. There may be a growth of new connective- 
