Endocarditis.—­Inflammation of the lining of the heart chiefly confined to the valves; it may be acute or chronic.

Simple Kind, Cause.—­Occurs at all ages, but most often in children and young adults.  It most frequently comes with acute rheumatism, chorea, tonsilitis, scarlet fever, and pneumonia.  The valves in the left heart are most often affected, the mitral simply swollen or bearing small growths.

Symptoms.—­If it is caused by acute rheumatism, there may be higher temperature, without increase of joint symptoms.  Heart beats faster and is irregular.  It may run into chronic valvular disease.

Treatment of Endocarditis.—­Preventive.—­Much can be done to prevent this disease by closely watching the patient having the disease that causes it.  The heart should be closely watched.  Acute inflammatory rheumatism is a frequent cause and the heart must be watched continually in this disease.  When the patient has this disease he must be quiet and in bed.  This is essential.  A doctor must be called, for the disease is serious and dangerous.

Diet.—­Should be liquid.  Milk or preparations made with it is the usual diet.  Care must be taken that the stomach and bowels be not disordered.  Gas collecting in the stomach causes much distress to one who has endocarditis or valvular disease.

Caution.—­Avoid early exertion after getting well.

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Chronic endocarditis.—­Usually occurs in persons under middle age.  Generally follows acute endocarditis.  It may be caused by syphilis, alcoholism, gout, and prolonged over-exertion.  The edges of the valve become thickened and then the thickened parts separate and cannot meet exactly and therefore fail to close the opening they are set to guard.

Chronic valvular disease.—­Results of valve lesions.  Narrowing of a valve causes increased difficulty in emptying the chamber of the heart behind it.  Insufficiency of a valve allows the return of the blood through the valve during the dilation of a chamber, thus increasing the amount of blood entering the chamber beyond the normal.  Either trouble causes dilation of the chamber and compensatory hypertrophy.  Enlargement of its wall must take place in order to perform the extra work demanded constantly, for the normal reserve force of the heart muscles can accomplish the extra task only temporarily.  This enlargement increases the working power of the heart to above normal, but the organ is relatively less efficient than the normal heart, as its reserve force is less and sudden or unusual exertion may cause disturbance or failure of the compensation acquired by the enlargement.  If this loss of reserve force is temporary, compensation is restored by further enlargement and by diminution, by rest, of the work demanded of the heart.  Any valvular lesion, whether a stenosis (narrowing) of the outlet or insufficiency from the moment of its