. The diseases of children : medical and surgical. ic fever the circulation is disturbed and the cardiac beats increase innumber, the first cardiac sound being wanting in sharpness, or there maybe a murmurish sound heard ; if this disappears during convalescence weare hardly justified in saying that an endocarditis has existed. That endo-carditis does occur at times during an attack of scarlet fever or during con-valescence is certain ; it is, however, rare to find the valves affected in a fatalcase of scarlet fever. Malignant or ulcerative endocarditis arises in some instances
. The diseases of children : medical and surgical. ic fever the circulation is disturbed and the cardiac beats increase innumber, the first cardiac sound being wanting in sharpness, or there maybe a murmurish sound heard ; if this disappears during convalescence weare hardly justified in saying that an endocarditis has existed. That endo-carditis does occur at times during an attack of scarlet fever or during con-valescence is certain ; it is, however, rare to find the valves affected in a fatalcase of scarlet fever. Malignant or ulcerative endocarditis arises in some instances in connec-tion with the rheumatic state, being engrafted on to an ordinary rheumatic en-docarditis ; it occurs in connection with acute nephritis, suppurative periostitisand osteomyelitis. It appears sometimes to follow scarlet fever. Recentobservations have shown the presence of septic micro-organisms, suchas streptococci, staphylococci, and Fraenkels pneumonia diplococci onthe valves in malignant endocarditis, and it would appear as if a simple. ssa iBBBBBBBBBBBBBBiSBBBiTSBBUiBBBBaBBBSaaBaerSBBBB ligBimBaSeaii^^SaMiBSBP^* Fig. 78.—Temperature Chart of a case of Endocarditis supervening on the sixth day of amild Scarlet Fever ; there were no joint lesions, the bruit persisted, and dilatation of theleft ventricle followed. endocarditis afforded a suitable soil for the development of these pyogenicmicro-organisms. We have several times got cultivations of streptococcion gelatine from blood drawn from the finger in cases of malignant endo-carditis. The symptoms of simple endocarditis, such as occurs during rheumatism,are not distinctive. There is often precordial pain, perhaps some dyspnoea,usually some fever of an intermittent type (see fig. 78), though this, in someinstances, may be due to the rheumatism present ; indeed, the only symptomupon which any reliance can be placed is the presence of a bruit: it is certain,however, that endocarditis may exist without a bruit being p
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