During the last thirteen years rather more than 300 cases of acute rheumatism have passed under personal care, 52 of which developed endocarditis. In all the eases perfect rest, avoidance of ex ertion. and a light milk diet were adopted. In 13 cases treatment was di rected to the rheumatism only, no special remedies being employed for the cardiac complication; in 1 ease the bruit dis appeared spontaneously; in the others the lesion was permanent. The remain ing cases were treated on a definite plan. As soon as the first indications of a bruit made their appearance, sodium or potas sium iodide in 10 was given thrice daily in addition to the salieylates, and a blister an inch in diameter was ap plied over the apex. As soon as the irri tation of this blister began to subside a second was applied close to it; then a third, and so on, the patient being kept meantime as quiet as possible. exertion. exposure, and excess of nitrogenous food being strictly forbidden. A gradual sub sidence of the bruit was frequently no ticed in ten days. Of these 39 cases 29 were discharged with normal heart sounds, 10 with a bruit. Richard Caton (Liverpool Medico-Chir. Jour.; Med. Record, April 4, '90).
In the various children's diseases the only way in which we can protect the patients from cardiac complications is by insuring bodily quiet and good ventila tion and avoiding exposure to cold.
In gonorrhwa such internal antiseptics as salol and urotropin are advisable.
Antistreptococeic serum may be injected in any ease where we dread that pyogenic organisms may be attacking the heart.
Second, when the disease has actually developed, an ice-bag wrapped in flannel may he kept over the heart if not agreeable or depressing to the patient.
Or, instead of this, a thin layer of cotton wool may be applied. Violent counter irritants arc not indicated. If the heart's action is excited, aconite or bromide of sodium may be administered. Still more efficient, and in case of cardiac distress indispensable, is morphine, used in fully-regulated amounts. Most impor tant of all is absolute bodily quiet, and this should be maintained for at least four to six weeks. In case the heart begins to fail, recourse must be had to digitalis, strophanthus, alcohol, ammonia, and other cardiac stimulants, but in many cases their use will prove unavailing.
Sometimes when the attack has been long continued, arsenic has been found beneficial.
In repeated instances antistreptococcic serum has proved efficacious, even when the disease has been well developed.
An ice-bag over the heart calms the patient and relieves the dyspncea and oppression. If the pain is very great, injections of morphine may be given. Cold baths are useful. The diet should consist entirely of milk, and the patient should receive small quantities of alcohol and quinine or salicylic acid. The alco
hol should be given in the form of Bor deaux wine or champagne, and coffee may be used as a stimulant. Alcohol is particularly hurtful in cases in which there is cardiac distress. The inhalation of oxygen in considerable quantities, at least one hundred quarts a day, gives good results. Quinine is given in the dose of from S to 15 grains a day. Should the heart become feeble, it may be well to give small doses of the tinct ure of digitalis. Plicque (Revue Inter nat. de Med. et de Chir., Apr. 10, '96).
In the treatment of septic endocarditis the strength of the patient must be in creased by all means possible. Milk, eggs, port-wine, brandy, and strong cof fee should be given.
A water-bed is beneficial. The affected joints should be protected, kept at rest, and an ice-bag placed upon them; inter nally, sodium salicylate in solution should be administered. An ice-bag should be kept constantly upon the heart; in case of high fever. another upon the head. If a febrifuge is re quired, 7 grains of quinine in powder or wafers are recommended. If severe diar rhoea supervenes, 15 grains of bismuth subnitrate, or tannic acid, 3 grains, with grain of opium, may be given every hour or two. Ludwig Herzog (Dent. med. Woch., No. 95, '98).
Case of ulcerative endocarditis in a girl, aged 22 years, in which -210 cubic centimetres of antistreptococcic serum were injected, the dose varying from 10 to 20 cubic centimetres. 15 cubic centi metres being given every other day dur ing the last twelve days. The patient improved steadily and recovered. J. M. Clarke (Lancet, July 21, 1000).
Digitalis and strophantbus should not be given, or, if at all, with great cau tion. Thcy are dangerous remedies in these cases. In intense arhythmia strophanthus may, however, be tried cautiously, but it is apt to be unreliable, and, like digitalis, it should only be given in emergencies, and for a very short time. The milder remedies should be tried first. T. E. Satterthwaite (N. Y. Med. Times, May. 1901).
Chronic Endocarditis.
Chronic endocarditis may develop in a previously healthy valve. It is more often a sequel to acute endocarditis. The symptoms are those of valvular disease of the heart, and will be discussed later.
Its etiology is, first, hereditary tend ency to arterial sclerosis. Secondly, cer tain predisposing causes, namely: gout, alcohol, syphilis, and habitual muscular overexertion. Exceptionally the wall of the heart itself is affected by the proc ess, in which case it presents scar-like patches. which are often associated with myoearditis.