ULCERATIVE ENDOCARDITIS.
The primary disease of which this is a secondary result may call for prompt treatment: this is sometimes rheumatism associated with previous long-standing valvular disease, erysipelas, pneumonia, gonorrhoea or diphtheria, but as is usually the case the original malady may have dis appeared and left nothing but its sequela behind. Nevertheless a care ful search should be made in every corner of the body for any focus of infection. The micro-organisms which are capable of producing the disease are probably various, and there seems little doubt that they may flourish as easily in the hollows of decayed teeth as in the vegetations on a diseased valve. It is needless to say all such foci should be removed when removal is possible, as in the case of teeth, abscesses, gonorrhoeal discharges, otorrhcea, &c.
As the infective cocci have found their way already to the heart, various drugs have been vaunted as antiseptics given by the mouth in order to effect their destruction in the blood. It is very doubtful if any drug can accomplish so much, hut Sansom maintained that 3o-gr. doses 3 or 4 times a day of Sulphocarbolate of Soda often cured the disease by the action of the free carbolic acid liberated from it in the body. He supple mented this treatment by free inunctions of the acid mixed with oil. Ewart in the same manner employed ointment of Protargol, and sug gested the intravenous injections of Perchloride of Mercury. The newer Arsenical preparations and Salvarsan have also been tried.
Various Sera have been prepared by injecting into the horse numerous strains of staphylococci, streptococci, and pneumococci. These poly valent sera have been credited with curative properties, but their value seems very doubtful when one reflects that their action is not antitoxic, but bactericidal, and Wright maintains that they destroy the natural immunising powers of the body. The serum is useless unless the im munised animal had chanced to be injected with the particular strain of the organism which is causing the disease in the patient, and it can obviously be of no value in rheumatic cases.
Vaccine methods hold out the only hope of combating the disease effectually, the microbe being isolated from the blood of the patient by making a series of blood cultures; the specific strain is injected sub cutaneously in graduated doses of the killed organisms. Already several successes have been achieved by this method of treatment.
The various complications which arise during the progress of the malady should be treated on general principles; thus the rigors which occur in the so-called malarial type of the disease are to he met by extra clothing, hot drinks, &c., and the hot stage with opposite measures as in pyiemia and malaria. Abscesses are to be opened when they form; limbs whose main vessels are plugged must be treated as in gangrene, and cerebral embolism met as in apoplexy.