HEART, 101 
tissue cells in the endocardium. Some of these cells may live, others 
degenerate, so that the endocardium may be destroyed in places. Fibrin 
is in it, and Jater it may become infiltrated with lime salts. 
What are the changes in chronic ulcerative endocarditis ? 
Large ulcers or perforations may be formed by chronic endocarditis. 
Upon these ulcerations blood clots may form, so that the gross appear- 
ance of the diseased part resembles the changes produced by mycotic 
endocarditis. 
Describe tubercular endocarditis. 
It may occur with tubercular pericarditis or with general miliary 
tuberculosis. The changes produced are similar to those produced by 
tubercular inflammation elsewhere. 
What is myocarditis, and what are the different varieties of this 
inflammation ? 
It isan inflammatory change affecting the heartwalls. The inter- 
stitial tissue and bloodvessels being involved primarily ; secondary to 
this there are degenerative changes in the muscle fibres. The varieties 
of myocarditis described are : 
(1) Interstitial myocarditis, which may be acute and purulent or 
chronic with the production of new connective tissue, and (2) Syphil- 
itie myocarditis. 
Describe the different forms of myocarditis. 
In the acute purulent form there may be a diffuse infiltration of 
the heartwall with pus. Or the pus may occur in circumscribed 
patches forming abscesses which contain pus, broken-down muscle and 
necrotic tissue. The abscess may open into the pericardial sac or into 
the heart cavity, or may produce an aneurism in the heartwall. With 
the chronic form of myocarditis there is a growth of new connective 
and granulation tissue in the heartwall accompanied by an atrophy of 
the muscle fibres. Syphilitic myocarditis gives rise to the same 
changes as chronic myocarditis. In this form the pericardium and 
endocardium may be thickened, but gummata of the heart are rare. 
What other changes of pathological interest have been observed in 
the heart ? 
The heart valves may become fenestrated, or may be the seat of 
aneurism, or there may be a hemorrhage into the valve tissue. The 
heartwall may contain sacs (filled with blood) which communicate 
with the heart cavities. These are aneurisms, and may be formed by 
