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Post Mortemmyocarditis

lost and myocarditis


The post-mortem appearances presented in cases of myocarditis, like the symptoms during life, are not very obvious, though quite distinct when carefully looked for. They consist chiefly in loss of consistence in the- ventricular walls, for the disease is generally lim ited to the left ventricle. The muscular substance is darker in color than natural, it has lost its naturally firm consistence, and may be so soft as to break down on being pressed between the finger and thumb.

On microscopic examination the individual fibres are seen to have lost more or less completely their normal striated appearance and to be gin.nular in aspect. The inflammation may even go on to suppu ration, as in Mr. Stanley's case already quoted. But that is rare.

The treatment of myocarditis essentially consists in keeping the heart agoing till the inflammation is over and the weakened muscular fibres regain their normal condition. Absolute quiet and rest must be

insisted on ; good nourishment and a liberal allowance of stimulants are important. Opium may be of service by relieving pain, allaying restlessness, and storing nerve power. At the same time the rheu matism to which the myocarditis is attributable is not to be lost sight of. The undoubted tendency of the salicylates to disturb the nerve centres and enfeeble the cardiac action in a certain number of cases is a reason why they should not be given; but salicin, which has no such untoward effect, should be given in a sufficient dose to counter act the rheumatic process—fifteen to twenty grains every two or three hours.

When the acute symptoms are subdued and the immediate danger of heart failure is over, a distinctly tonic treatment is called for.