106 CANIiviJ MEDICINE AND SURGERY 



every fifteen minutes to effect, then every hour to 

 maintain the effect. In the second stage, when the 

 high fever has subsided, give 1-64 grain of digitalin 

 and 1-100 grain of strychnin three times a day. 

 Continue the aconitin if the temperature rises above 

 102 degrees Fahrenheit. In addition to the above, 

 five to fifteen grains of potassium iodid three times 

 daily should be given in milk to assist in the absorp- 

 tion and elimination of the exudate. The bowels 

 must be kept active with repeated doses of calomel, 

 and stimulants must be given if necessary. In 

 cases of great effusion of exudate, paracentesis peri- 

 cardii must be performed early. The operation con- 

 sists of introducing a fine trocar and cannula, with 

 all aseptic precautions, through the sixth intercostal 

 space, low down near the sternum and into the 

 pericardial sac, and allowing the fluid to drain away. 



Acute Endocarditis 



Acute endocarditis, or acute ' inflammation of the 

 ' endocardium, is by no means such a rare condition 

 as is generally thought. In the generality of cases 

 it is produced by the entrance of bacteria into the 

 blood stream. It is a sequel to septicemia, pyemia, 

 septic metritis, distemper, and rheumatism. 



Symptoms. — There is tempestuous heart action, 

 with a palpitating, irregular, and later diffused beat. 

 The number of heartbeats frequently outnumber the 

 pulse rate, which often varies from 120 to 240 a 

 minute. In addition to its rapidity the pulse is 

 irregular, intermittent, and very weak, often barely 

 perceptible. The heart sounds, at' first normal, be- 

 come blurred, the first often running into the sec- 

 ond, so that it is hard to distinguish them. Later, a 

 blowing sound is heard during systole and a pro- 

 longed rustling or vibrating during diastole. The 

 temperature rises to 105 or 106 degrees Fahrenheit, 



