Page:The Harveian oration 1904.djvu/61

32 THE HARVEIAN ORATION, 1904 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 physio- logical 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 absorp- tion of effusion in the valve cusps. Moreover, repair is only possible during the early stages of endocarditis; later the mischief is permanent,