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Treatment





Category: Uncategorized
Source: Disturbances Of The Heart

If pneumonia or gonorrhea is supposed to be the cause of the
endocarditis, injections of stock vaccines should perhaps be used.
If the form of sepsis is not determinable, streptococcic or
staphylococcic vaccines might be administered. It is still a
question whether such "shotgun" medication with bacteria is
advisable. Patients recover at times from almost anything, and the
interpretation of the success of such injection treatment is
difficult. Exactly how much harm such injections of unnecessary
vaccines can produce in a patient is a question that has not been
definitely decided. Theoretically an autogenous vaccine is the only
vaccine which should be successful. The vaccine treatment of
ulcerative endocarditis was not shown to be very successful by Dr.
Frank Billings [Footnote: Billings, Frank: Chronic Infectious
Endocarditis, Arch. Int. Med., November, 1909, p. 409.] in his
investigation, and more recent treatment of this disease, when
caused by the Streptococcus viridons, by antogenous vaccines has
confirmed his opinion.

Other treatment of malignant endocarditis includes treatment of the
condition which caused it plus treatment of "mild" endocarditis, as
previously described, with meeting of all other indications as they
occur. As in all septic processes, the nutrition must be pushed to
the full extent to which it can be tolerated by the patient, namely,
small amounts of a nutritious, varied diet given at three-hour
intervals.

Whether milk or any other substance containing lime makes fibrin
deposits on the ulcerative surfaces more likely or more profuse, and
therefore emboli more liable to occur, is perhaps an undeterminable
question. In instances in which hemorrhages so frequently occur, as
they do in this form of endocarditis, calcium is theoretically of
benefit. Quinin has not been shown to be of value, and salicylic
acid is rarely of value unless the cause is rheumatism.

Alcohol has been used in large doses, as it has been so frequently
used in all septic processes. If the patient is unable to take
nourishment in any amount, small doses of alcohol may be of benefit.
It is probably of no other value. It is doubtful whether ammonium
carbonate tends to prevent fibrin deposits or clots in the heart, as
so long supposed. In fact, whenever the nutrition is low and the
patient is likely to have cerebral irritation from acidemia,
whenever the kidneys are affected, or whenever a disease may tend to
cause irritation of the brain and convulsions, it is doubtful if
ammonium carbonate or aromatic spirit of ammonia is ever indicated.
Ammonium compounds have been shown to be a cause of cerebral
irritation. Salvarsan has not been proved of value.

Intestinal antisepsis may be attained more or less successfully by
the administration of yeast or of lactic acid ferments together with
suitable diet. The nuclein of yeast may be of some value in
promoting a leukocytosis. It has not been shown, however, that the
polymorphonuclear leukocyte increase caused by nuclein has made
phagocytosis more active.

Malignant endocarditis may prove fatal in a few days, or may
continue in a slow subacute process for weeks or even months.





Next: Chronic Endocarditis

Previous: Diagnosis



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