Prognosis And Convalescence


Categories: Uncategorized
Sources: Disturbances Of The Heart

The duration of acute endocarditis varies greatly; it may be two or

three weeks, or the inflammation may become subacute and last for

several months. Although mild endocarditis rarely causes death of

itself, it may develop into an ulcerative endocarditis, and then be

serious per se. On the other hand, it may add its last quota of

disability to a patient already seriously ill, and death may occur

from the combination of disturbances. As soon as all acute symptoms

have ceased, rheumatic or otherwise, and the temperature is normal,

the amount of food should be increased; the strongly acting drugs

should be stopped; the alkalies, especially, should not be given too

long, and the salicylates should be given only intermittently, if at

all; iron should be continued, massage should be started, and iodid

should be administered, best in the form of the sodium iodid, from

0.1 to 0.2 gm. (1 1/2 to 3 grains), twice in twenty-four hours, with

the belief that it does some good toward promoting the resorption of

the endocardial inflammatory products and can never do any harm.

Prolonged bed rest must be continued, visitors must still be

proscribed, long conversations must not be allowed, and the return

to active mental and physical life must be most deliberate.



No clinician could state the extent to which the valvular

inflammation will improve or how much disability of the valves must

be permanent. It is even stated by some clinicians that a rest in

bed for three months is advisable. While this is of course

excessive, certainly, when the future health and ability of the

patient are under consideration, and especially when the patient is

a child or an adolescent, time is no object compared with the future

welfare of the person's heart. It is one of the greatest pleasures

of a the clinician to note such a previously inflamed heart

gradually diminish in size and the murmurs at the valves affected

gradually disappear. Although they may have disappeared while the

patient is in bed, he is not safe from the occurrence of a valvular

lesion for several months after he is up and about.



While the discussion of hygiene would naturally be confined to the

hygiene of the disease of which the endocarditis is a complication,

still the hygiene of its most frequent cause, rheumatism, should be

referred to. Fresh air and plenty of it, and dry air if possible, is

what is needed in rheumatism, and a shut-up, over-heated and

especially a damp room will continue rheumatism indefinitely. It is

almost as serious for rheumatism as it is for pneumonia. Sunlight

and the action of the sun's rays in a rheumatic patient's bedroom

are essential, if possibly obtainable.



As so many rheumatic germs are absorbed from diseased or inflamed

tonsils or from other parts of the mouth and throat, proper gargling

or swashing of the mouth and throat should be continued as much as

possible, even during an endocarditis. The prevention of mouth

infections will be the prevention of rheumatism and of endocarditis.





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