470 DISEASES OF THE CIRCULATORY SYSTEM. 



From the start the respiration is painful and accelerated to such 

 an extent as to induce us to believe in the existence of pneumonia 

 or pleurisy ; in some cases it becomes dyspnoeic. The general con- 

 dition is alarming; we observe a great weakness, intermittent colics, 

 then symptoms produced by emboli in the lungs (suffocating spells), 

 in the kidneys (hematuria), in the extremities (lameness), and in 

 the brain (apoplectic phenomena). The septic form is often com- 

 ' plicated by hemorrhages. 



There are cases where the course of the affection is subacute : the 

 patients die within a certain number of hours, or a few days at the 

 most ; in other instances it lasts several hours, aud again in others 

 it passes iuto a chronic state. The return of the disease is frequent 

 (Trasbot, Roth). Warty endocarditis is relatively benign, but the 

 septic form is very serious. Its most common termination is death ; 

 it is due to septic infection or to the formation of embolic centres 

 in the lungs, the kidneys, the brain, etc. The valvular form espe- 

 cially acquires a serious character through the lesions left behind. 



Differential diagnosis. When it assumes the subacute form 

 called foudroyant, endocarditis may be confounded with anthrax, 

 septicemia, encephalitis, petechial fever, etc. We are sometimes 

 embarrassed in making the differential diagnosis between this dis- 

 ease and pneumonia at the beginning, also in cases of pulmonary 

 congestion, œdema of the lung, which is also frequently accom- 

 panied by intense dyspnœa. But the difficulties reach their maxi- 

 mum when the observed symptoms are at the same time those of 

 myocarditis and endocarditis. In these cases it is indispensable to 

 make a full and very minute examination of the heart. We must 

 also take this fact into account, that in anemia and leukemia systolic 

 blowings may exist which are similar to those of endocarditis. 

 When this is not accompanied by any abnormal bruit, its intra 

 vitam diagnosis is impossible. 



Treatment. The animals must be withdrawn from all excite- 

 ment and movement; the activity of the heart should be regulated 

 by digitalis ; the fever should be combated with quinine, tartar 

 emetic, and other antipyretics : such are the principal indications. 

 In small animals we may use ice upon the precordial region ; in 

 others we should make continuous irrigation with cold water. The 

 action of the cutaneous derivatives is of the most uncertain kind. 

 When weakness becomes much marked, it must be combated by 

 the administration of camphor, ether, or alcohol. 



