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Endocarditis having been diagnosed, especially if there is palpation or pain, an ice bag over the heart is often of considerable value, but not so efficient as in pericarditis. It often tends to quiet the heart, and may be of some value reflexly in slowing the inflammation. Children, in whom this complication so frequently occurs, generally do not bear the ice bag well.
More and more exercise, sweatings from Turkish baths, electric-light baths, body baking, vigorous massage and more or less purging are all valuable. Anything which reduces the general weight will help the heart. The prognosis is often good. It should be understood that especially in acute conditions a positive separation of endocarditis from myocarditis is incorrect.
It is not sufficiently recognized that a subacute arthritis, recurring tonsillitis, open and concealed infections in the mouth, and even a condition of the system with acute, changeable and varying joint and muscle pains may all develop a mild endocarditis, even with subsequent valvular lesions.
There is much to suggest that in rheumatism we have to deal only with a further stage in those catarrhal infections to which so much infantile ill-health is to be attributed, and that endocarditis and arthritis, when they arise, signalise the entry of these catarrhal, non-pyogenic organisms into the blood stream, overcoming at last the barrier of lymphoid tissue which has hypertrophied to oppose their passage.
If such narrowing occurs without aortic insufficiency at the age at which it usually occurs, it may not seriously affect the heart. It may follow acute endocarditis, but it most frequently follows chronic endocarditis or atheroma, in which the aortic valves become thickened and more or less rigid; this condition most frequently occurs in men.
The greater the amount of myocarditis, the more doubtful is the heart strength in the near future. The greater the amount of endocarditis, the greater the doubt of freedom from future permanent valvular lesions. This inflammation of the endocardium is generally confined to the region of the valves, and the valves most frequently so inflamed are the mitral and aortic.
In early childhood it is possible that it may be associated with left-side endocarditis. A special treatment of the heart, if any is needed, would probably not be indicated unless there was associated tricuspid insufficiency, when digitalis might be used. If this rare condition occurs, it is probably congenital.
Not infrequently and probably more frequently than we recognize, recovery without any of the pathologic lesions just described follows mild endocarditis.
Since we have learned that bacteria are probably at the bottom of almost any endocarditis, the terms suggested under the classification of endocarditis as "mild" and "malignant" really represent a better understanding of this disease. They are not separate entities, and a mild endocarditis may become an ulcerative endocarditis with malignant symptoms.
One of the most frequent is the Streptococcus viridans. If a more malignant form of endocarditis develops on a mild endocarditis, the diagnosis is generally not difficult. If, without a definite known septic process, malignant endocarditis develops, localized symptoms of heart disturbance and cardiac signs may be very indefinite.
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