MYOCARDITIS.
Definition.—Myocarditis is a change in the heart-muscle, the character of which may be either inflammatory or de generative, resulting in a diminished in tegrity of the tissue.
Varieties.—The disease may either be acute or chronic, local or diffuse. Tbe acute and the chronic forins are so differ ent in their origin and course that they seem more like two separate diseases than modifications of a single disease. In both, however, the important result from a clinical stand-point is the deterioration of the muscular fibre and consequent im pairment of function.
Symptoms.— I. ACUTE INLYOCIRDITIS may have an abrupt onset; but it is more often insidious, merging itself with the symptoms of the primary disease, for acute myoearditis is always the resillt of some previous morbid condition. Its be ginning may be attended by an increase of fever, or even a true rigor; the patient may complain of discomfort or pain in the cardiac region. The pulse becomes rapid and feeble; and, if an unfavorable course is taken, it subsequently grows weak and intermittent, and, toward a fatal termination, noticeably infrequent.
Parenchymatous myocarditis in chil dren manifests itself by asystolc, lasting some days to several months, without change in the cardiac rhythm. Weill and
Barjon (Rev. AIens. des Mal. de l'Enfance, Dec., '96).
In cases of myocarclitis pressure on the region of the heart gives rise to a much more heightened activity of the heart and increased volume of the pulse than in healthy persons. De 'Renzi (ltivista Clin. c Terap., No. 2, '97).
Dilatation ensues. as shown hy a dis placement of the apex-beat toward thy left and an increase in the area of cardiac dullness. The first sound at the apex becomes feeble and indistinct: there may • .. a. place a gallop . ... \ ba:.-e of the heart the . s I :mud may be accented r•- ,icattd. The general condition•• atant shows the stress of his (s prostrate in bed with pul • . dysprwea„ increasing, . •-s -, and perhaps coma or delirium. rfc(. t cirtulation may °mt . _ s tv and albuminous urine; en. t of the liver, perhaps accom .• w ith catarrhal jaundice; and ca ..!0_ f the stomach. with vomiting.
amlition thus sketched is not in .r.al lv i•rt.,Lnt; milder attacks serve erelv tc ao7ravate the general weakness tiJe and to delay, but scarcely L.,mpromise bis recovery.