The method is very simple; it is merely to give the heart the same
advantages, the same opportunities for repair, so far as we can, that
the joints enjoy; in other words, by every means in our power we lessen
the work to be done by the heart. The most absolute quiet is enjoined,
the patient lies with his head at a low level, pain and fever are
subdued, no excitement is permitted, the patient is made as comfortable
as we can make him, and sleep is encouraged—in fact, we seek to attain
physiological rest. We follow the precept of our ancient Egyptian
brother, declared so many thousand years ago: we give the ailing heart
the nearest approach to rest that is practicable. In addition we
administer sodium or potassium iodide, partly to help in the absorption
of morbid exudations but chiefly to lower vascular tension, just as we
give these drugs in cases of internal aneurism. Lastly, we endeavour to
influence the cardiac vasomotor and trophic nerves reflexly by gentle
and almost painless stimulation of those cutaneous nerves which we know
from physiological data, and from the evidence of the referred pains of
angina to be in close relation with the heart—viz., the first four
dorsal nerves.
I believe, however, that by far the most important factor in the
abortive treatment of endocarditis is rest, rest for many weeks, the
slowing of the heart, the lengthening of the diastole, which is the only
rest-time possible, the careful avoidance of high blood pressures, which
the weakened and softened valve cusps cannot sustain without peril, and
the diminution of the volume of the blood to be moved.
Only then, when functional activity is minimised, can we hope for repair
of mischief, re-formation of destroyed endothelia and absorption of
effusion in the valve cusps. Moreover, repair is only possible during
the early stages of endocarditis; later the mischief is permanent,
unalterable by any form of treatment. The method fails if from any
reason it is found impracticable to slow down the heart, for example, if
asthma, bronchitis, or pneumonia, or great nervous excitability
co-exist.
I submit that these measures are rational, their objects being by
affording rest to give opportunity for the exercise of the _vis
medicatrix naturae_ which is our sheet anchor, nay, indeed, to stimulate
that natural reparative process which alone can effect restoration.