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Endocarditis - Heart Disease.
It is, of course, impossible to detect by any ordinary means the presence of this exudation on the surface of the valves and of the endocardium, but the properly trained physician can readily dis- cover such a condition by applying the ear to the chest, for the beating of the healthy heart is accompanied by certain sounds, which may readily be distinguished by listening over the chest rbetween the fourth and sixth ribs, a little to the left of the breast bone ; and although there are certain variations in different indi viduals, yet the sound caused by the circulation of the blood through the heart is essentially the same in all healthy persons. But so soon as this circulation of the blood through the heart is disturbed by disease of the valves, so soon as the blood fails to flow always through the organ in the proper direction, and begins to flow backward through these diseased valves, the sounds heard by placing the ear over the heart are quite different from those of the normal chest. In this way, therefore, it becomes easy, after acquiring proper experience, to detect disease of the heart valves.
By post mortem examination it is found that the exudation which takes place on these valves is often arranged in the shape of tittle masses or bunches looking like warts or pimples ; sometimes these masses attain considerable size, becoming as large as a bean, or even a hazel nut. As will be mentioned later, these little masses constitute a constant source of peril to the patient's health, or even life ; for they are constantly washed by the stream of blood passing with great force through the heart ; and it not infrequently hap pens that small pieces wrill be torn off and carried along in the cur rent of blood, just as trees on the bank of a stream may be under mined and swept away by the current. So long as these little masses circulate in the blood there is no particular danger ; but they are apt to become lodged in the arteries in various parts of the body, blocking up the blood vessel, and thus cutting off the supply of blood from some of the organs. The result of this must be a suspension, partial or complete, of the functions of that organ thus deprived of blood. This is the explanation of many cases of so-called apoplexy ; in these cases the individual drops suddenly to the floor, paralyzed in some of his limbs, or perhaps falls unconscious, and dies in a short time. The explanation is simply that some fragments of this exudation have been washed off from the heart valves, and have lodged in some of the blood vessels going to the brain, cutting off the supply of blood to this organ, and thus causing paralysis.
Symptoms*- Inflammation of the lining membrane of the heart occurs, in the vast majority of cases, as an incident in the course of other diseases, especially of acute rheumatism. As has been already remarked in discussing rheumatism, the chief danger from this disease lies in the possibility that inflammation of the heart may occur. Before the use of salicylic acid, it was estimated that endocarditis occurred in one-third to one-half of all the cases of acute articular rheumatism.
Whenever, then, the patient has a protracted attack of acute rheumatism, the possibility, in fact probability, must be borne in mind that an inflammation may occur in the heart. This will usually be indicated by a dull, heavy pain in the region of the heart. In other cases the sensation does not amount to pain, but is rather a feeling of distress. There is usually, at the same time, very rapid and irregular action of the heart, indicated by palpita tion. But the only positive means for recognizing the affection consists in applying the ear (either directly or indirectly, through the stethoscope) to the chest, whereby the sounds of the heart, indicating disease, may be detected. In many cases, endocarditis is associated with pericarditis, and the recognition of both diseases requires considerable skill and experience on the part of the physi cian, since many of the symptoms are common to both diseases.
Treatment.- The treatment of endocarditis is merely that of the disease with which it is associated, generally acute rheumatism ; in tact, the inflammation in the hea'rt may be regarded as a part of the disease.
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