Lectures on Diseases of the Heart (Paperback)

Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: LECTURE VI. ENDOCARDITIS. Definition Anatomical Characters Causes and Pathology Symptoms Physical Signs Diagnosis Prognosis Treatment. Gentlemen: I shall, in this lecture, take up one of the most important of the inflammatory affections of the heart; more important than pericarditis, because of the serious valvular lesions which it usually leaves. An inflammation of the membrane which lines the cavities of the heart, and is duplicated to cover the valves, is called endocarditis. It is not more than fifty years since this disease has been clearly described and recognized, but clinical experience has demonstrated that it is by no means infrequent. In the majority of cases it occurs as a complication of acute rheumatism. The inflammation may be acute, sub- acute, and chronic, but these distinctions are not of practical value. ANATOMICAL CHARACTERS. This inflammation is said to be confined, in the vast majority of cases, to the membrane lining the cavities of the left side of the heart. The lining membrane of the right auricle and ventricle is rarely inflamed, and when inflamed it is also present on the left side. All portions of the endocardial membrane .of the left side are not equally subject to inflammation. You must bear in mind that it generally attacks the membrane covering the valves and lining the orifices, and that it is in these situations that it leaves the most troublesome results. There are two reasons for the tendency to attack these localities. 1st. The membrane here is most exposed to the blood-currents; the valvular portion is in constant motion, and is almost constantly in a tense or strained condition. 2nd. The membrane is here underlaid by fibrous tissue, and not, as in oth or situations, in close proximity to the muscular walls...