ENDOCARDITIS 79 



mendable are digitalis (5iv) followed by strophanthus (5j). 

 Heart weakness may best be combated by subcutaneous 

 injections of oil of camphor. Where fever is present, 

 acetanilid (§j) or salicylate of soda (3j to ij) may be tried. 



Chronic Endocarditis. — Etiology. — This condition which 

 occurs in dogs, horses, swine and cattle in the order named 

 usually follows acute endocarditis (septicemia, articular 

 rheumatism of cattle, influenza of horses, erysipelas of 

 swine and hog cholera). Otherwise the disorder may 

 develop gradually following the abuse of the heart (over- 

 exertion, refrigeration, psychic influence). In animals it is 

 rarely due to arteriosclerosis. In rare instances valvular 

 troubles may be congenital (defects in the valves, oval 

 foramen, or septum). Tumors leading to stenosis of the ostia 

 are rare causes. 



Pathologically valvular troubles lead either to insufficiency 

 or stenosis of the valve or ostium concerned. Commonly 

 these are combined. 



General Symptoms. — The clinical features of valvular 

 disease may be divided into two stages: (a) The stage of 

 compensation, and (b) the stage of disturbance in compen- 

 sation. 



(a) From a resulting compensatory hypertrophy the 

 trouble with the valve may be for a long time overcome. 

 Clinically, no symptoms exist other than either a systolic 

 or diastolic murmur with hypertrophy of the left or right 

 heart. The general condition and efficiency of the patient 

 is not much disturbed. 



(b) In the stage of disturbance in compensation the 

 compensatory hypertrophy has been partially or totally 

 overcome. Dilatation displaces hypertrophy. This induces 

 symptoms of heart weakness (increased, weak, inequal, 

 irregular pulse), congestion of the lungs (dyspnea), conges- 

 tion of the mucous membranes and the slfin (cyanosis), 

 undulation of the peripheral veins (venous pulse), irregu- 

 larity of the heart (vertigo), congestion of the kidneys 

 (albuminuria), and in general to cardiac hydropsy (anasarca, 

 ascites, hydrothorax, hydropericardium), as well as anemia, 

 emaciation, and weakness. 



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