ENDOCARDITIS 107 



and great difficulty in breathing and quickened res- 

 piration are noticed. Acute endocarditis may lead 

 to death within a few hours, be prolonged for weeks, 

 or merge into the chronic form. , 



Treatment. — Absolute quietness and the avoid- 

 ance of all excitement are essential. The heart's 

 action must be regulated by the administration of 

 digitalin and aconitine, and an ice pack or counter- 

 irritant applied to the cardiac area. Staphylobac- 

 terins have in many cases given good results, and 

 should be given a trial. 



Chronic Endocarditis and Valvular Defects 



Chronic endocarditis usually leads to valvular de- 

 fects, which are inability to close or stenosis. The 

 inability to close, or insufficiency, arises from shrink- 

 age of the valve itself and shortening of its ten- 

 dinous fibers, this preventing the valve from com- 

 pletely closing the opening which it guards. Insuf- 

 ficiency and stenosis of the orifices usually go hand 

 in hand, the result being certain secondary an- 

 atomical changes in the body, as hypertrophy and 

 dilatation of the heart, engorgement of the liver, 

 kidneys, and spleen, dropsy (ascites) of chest and 

 abdomen, anasarca, and emaciation. 



Stenosis is produced by the thickening of the 

 valves and endocardium, the edges of the orifice 

 and of the valves sometimes being covered with 

 polypi-like growths or vegetations. Both orifices 

 and valves lose their elasticity and mobility, pre- 

 venting the normal amount of blood being driven 

 through without increased force. 



Symptoms. — The general symptoms of valvular 

 defects are an easily excited activity of the heart 

 with acceleration of the pulse and beat, palpitation, 

 an irregularity of beat and pulse, abnormal sounds 



