Treatment.—If the inflammation arise as a consequence of another disease, that other dis ease must be treated. The special treatment directed to the heart may take the form of bleeding by placing several leeches on the chest. This, of course, would only be adopted by medi cal advice, and it would be applied only in acute attacks of otherwise strong persons. Blisters over the heart, iodine paint, and poultices, &c., are also employed. Stimulants are required if weakness is great and there is a tendency to faintness. Other drugs are also useful to relieve pain, or to diminish the action of the heart, but they are dangerous except in skilled hands.
Diseases of the Valves of the Heart inner lining membrane of the heart (endocar dium, see p. 298) is even more liable to inflam matory affections than the pericardium, and the term endocarditis is the scientific term applied to them. It is, however, usually the valves that specially suffer (as we have seen, p. 299, they are formed partly by folds of the endocar dium), and on this account we shall consider the affections under the special heading DIS EASES OF THE VALVES.
The nature of the disorder is also akin to that which affects the outer lining membrane. The blood-vessels of the valves are congested and the substance of the valves becomes thickened. Coagulable material is also deposited on them ; and warty growths form in consequence. The results of this are various. The thickening and growths on the valves prevent their free play, and hinder the due performance of their all-important duties. Moreover, they become puckered and contracted, so that they are no longer able completely to close the passage which it is their business to guard. They may also become so rigid and unyielding as to offer a permanent obstruction to the free passage of the blood in the direction in which they ought to be freely open. Standing out at an angle from the wall of the passage, and refusing to bend from this position, they bar to a greater or less extent the flow of blood past them. This rigid attitude may be the result, not only of inflammatory thickening, but also of the deposit, within the substance of the valves, of chalky matter, which makes them hard and inelastic, a condition apt to arise in old age and to affect not only the valves but also the walla of the arteries throughout the body. Now
what must be the effect of such states as these 'I It can only he properly understood by reference to the functions of the valves, as already de scribed on p. 299. Take the left side of the heart, for it is in the valves of the left side that the disorder is commonest. We have seen that there are, on this side, two valves. There is the mitral valve between the upper and lower chambers, which is open on the contraction of the upper chamber to permit the blood to be driven into the lower, and which, as soon as the lower chamber conti acts, closes to bar the return of blood to the upper chamber. Suppose, first, that this valve has become contracted and too small properly to close the passage. Then it is plain that when the lower chamber contracts, the communication between it and the upper one not being completely cut off, all the blood is not driven into the vessel (aorta) that rises from the ventricle (the lower chamber), but part passes back again into the auricle, which thus becomes overfull because it receives back part of the blood which it had, but an instant before, sent onwards. Suppose, again, that the valve is standing out rigidly in the fair way, then, when the auricle contracts, the blood is obstructed in its passage downwards to the ventricle, and it is hard work for the auricle to get itself thor oughly and quickly emptied. The second valve on the left side is at the place of communi cation between the ventricle and the great artery springing from it—the aorta,—and when the ventricle contracts, the blood should be pro pelled into the artery, and the valve should thereafter close to prevent it returning again to the chamber (see p. 300). If the valve is incom petent, that is, if it does not properly close the opening, when the ventricle is relaxing the valve does not completely hinder the blood re turning, and part of it pours back to the ven tricle. Thus it is never properly and satisfac torily emptied. Regurgitation is the term applied to the return of blood in this way. If, again, the valve be rigidly standing out from the wall of the aorta, the blood driven out of the ventricle does not find a free passage, it is delayed in its exit, and the heart has to contract more vigorously to overcome the resistance.