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It is essential for the welfare of the patient, especially after a long illness before the complication of endocarditis could occur, and in rheumatic fever, in which all meat and meat extractives have been kept from the diet, that small doses of iron should be administered daily.
If endocarditis occurs in the fetus, it is the right side of the heart that is affected; in children and during adolescence it is most frequently the mitral valve that is involved; while in the adult or in old age it is the aortic valve that is most liable to become diseased.
A certain proportion of cardiac diseases in children, especially endocarditis, seems to be due to a general septic infection which results in the so-called septic, infectious or malignant endocarditis.
The contrast between a man whose associational centers are keen and a man in whom these centers are dulled or lost is the contrast between life and death. In accordance with the law of adaptation through natural selection, phylogeny, and association, one would expect no pain in abscess of the brain, in abscess of the liver, in pylephlebitis, in infection of the hepatic vessels, in endocarditis.
Meningitis, pneumonia, diphtheria, typhoid fever and rarely rheumatism may all cause this severe form of endocarditis. Ulcerative endocarditis was first described by Kirkes in 1851, was later shown to be a distinctive type of endocarditis by Charcot and Virchow, and finally was thoroughly described by Osler in 1885.
No doubt it is one of those cases of unsuspected endocarditis. Acute. I take it," raising his shaggy brows interrogatively, "that nothing had occurred to excite Sir Charles?" "On the contrary," replied Harley, "he was highly distressed about some family trouble, the nature of which he was about to confide to me when this sudden illness seized him."
Nitroglycerin may act as well as whisky in the kind of cases mentioned. Caffein stimulation in any form is generally inadvisable during inflammation of the heart. The duration of acute endocarditis varies greatly; it may be two or three weeks, or the inflammation may become subacute and last for several months.
The term "chronic endocarditis" should be reserved for a slowly developing sclerosis of the vavles.
In all infaret occurs in one of the organs of the body there must of necessity occur a necrosis of the part and an added focus of infection. If a peripheral artery is plugged, gangrene of the part will generally occur, if the patient lives long enough. If pneumonia or gonorrhea is supposed to be the cause of the endocarditis, injections of stock vaccines should perhaps be used.
The differences in inflammation in the two cases is really one of degree, and the classification is made to coincide with this probable fact. it is, of course, clinically recognized that endocarditis following certain diseases, especially rheumatism, is of the simple or mild type, while that termed ulcerative endocarditis may occur apparently as a primary or general infection, and the causative bacteria, as a rule, are readily discovered in the blood.
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