ACUTE ENDOCARDITIS. 



469 



the luDg, kidney, liver, spleen, etc., are thus produced ; they may 

 even reach as far as the coronary arteries (abscess of the heart). 



In warty endocarditis the microscope shows an exudation and a 

 cellular infiltration of the sub-endocardial connective tissue; in 

 ulcerous endocarditis the tissues are necrosed, and transformed into 

 granulous masses which are rich in micrococci. According to 

 Ziegler, these two forms differ only in the degree of intensity of 

 the process. The first sometimes ends in the resorption of the 

 exudate and recovery, at other times in a connective neoformation 

 of leucocytic origin : the valves become thickened, shrunken, and 

 form abnormal adhesions (insufficiency and contraction of chronic 

 endocarditis) ; in certain cases the thrombotic exudate, which is 

 carried away by the circulatory flow, is thrown into the kidney, 

 brain, etc., where it produces infarct, which, as a rule, ends in 

 cicatrization. The tissue which is subjacent to the thrombotic 

 exudate becomes necrotic ; it is the seat of a true " diphtheric " in- 

 filtration. 



While in man endocarditis is generally localized in the left heart, 

 in animals it is the right heart which seems to be mostly affected. 

 In nine cases of endocarditis observed by Meyer the inflammation 

 involved the tricuspid valve eight times, the mitral valve four 

 times, and the aortic valves twice only. In the ox right endocar- 

 ditis is frequent (Bollinger, Ruchte) ; in man, on the contrary, it is 

 very rare and ordinarily of foetal origin. 



Symptoms. Acute endocarditis is marked at first by a tumult- 

 uous action of -the heart, the beatings of which are strong, violent, 

 are felt over a great surface, and which may also shake the whole 

 body. At times their number exceeds that of the pulsations 

 (Trasbot) ; in the horse we have found 160 cardiac contractions 

 per 70 pulsations. The circulation is accelerated ; in the ox and 

 horse we count 80 to 160 pulsations per minute ; the pulse is 

 irregular, intermittent, very weak, often imperceptible. 



The heart sounds are normal at the beginning, but soon they 

 lose their clearness ; the first becomes dull, and is sometimes con- 

 founded with the second ; at times an auscultation reveals abnormal 

 endocardial bruits, especially a systolic blowing at the first sound. 

 More rarely we perceive a diastolic bruit, which is quivering and 

 vibratory, and is very important from a diagnostic point of view. 

 Hyperthermia is constant. In the septic forms the temperature is 

 always high ; in the horse Trasbot has found it 40° to 41 ° C. 



