Treatment


Categories: Uncategorized
Sources: 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.





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