of the body. Some have attributed the origin of nearly all cases of dropsy to valvular disease; this opinion however, is destitute of convincing evidence; and yet, it should lead us to look to cardiac disease for the origin of very many cases of serous effusion. Anasarca usually takes place after the valvular disease has existed a long time, and the red corpuscles of the blood begin to be deficient. This variety in the majority of cases precedes thoracic effusion, whether in the pleura or pericardium. Usually œdema of the face first appears; then anasarca of the hands, and lastly, of the lower extremities. The obstruction to the circulation is so great as to produce a bluish tint of the lips, slight puffiness of the face, and prominence of the eyes. Physical Signs.-The signs most observable are the bellows murmur, and the purring tremor. A more particular description of these may be found in the general remarks upon the morbid sounds of the heart. These sounds vary according to the valves affected. Contraction of the semilunar valves gives rise to the bellows murmur or some of its modifications during systole. Dilatation of the auriculo-ventricular valves produces during systole similar sounds, but a little more feeble, and their location is over the diseased valves. Regurgitation may take place through the semilunar valves and yet no physical sign be apparent; this occurs in those cases in which the parietes of the orifice are smooth. Contraction of the auriculo-ventricular orifice sometimes causes during ventricular diastole, a rough sound. Disease of several valves at the same time causes a variation in the rhythm so that the first and second sound become blended together, resulting in the production of a confused purring or thrilling sensation. The rules for the diagnosis of disease of each class of valves, as laid down by Drs. Hope and Pennock, are as nearly correct as ány, and I, therefore, insert them in an abridged form. Signs of disease of the aortic valves.-One of the murmurs above alluded to is heard during systole, on the sternum, near the lower margin of the third rib, extending along the course of the aorta. It is superficial, resembling the sound of a whispered r. When the seat of the murmur is in the aorta, not in the pulmonary artery, it may be known by its being confined in the former case to the course of the aorta, in the latter to that of the latter vessel. In disease of the aortic valves the sounds are louder than in those of the auricular. Regurgitation at the aortic valves causes a murmur during ventricular diastole, heard more distinctly along the course of the aorta than that caused by disease of the auricular valves it gives rise to a peculiar jerking pulse. It is distinguished from a systolic murmur by its occurrence during diastole, being prolonged during the interval of ventricular repose. Signs of disease of the mitral valve-When the valve is permanently open, the systcle is attended with a murmur from the regurgitation. It may be rough or rasping. Its key is low, more or less like whispering who: yet sounds loud, near the apex of the heart, a little to the sternal side of the nipple. The purring tre When the valve mor frequently results from this regurgitation. is contracted partly preventing the ingress of blood into the ventricle, the murmur is heard during venticular diastole, but is not so distinct as in the former case. The pulmonary and tricuspid valves are so seldom diseased, that no separate description is neces sary. TREATMENT. This is necessarily palliative, and consequently, the curative means are not of so much use as in pericarditis and endocarditis. The principal benefit derivable from medical treatment, consists in the proper use of preventive meaus, in avoiding the influence of all those causes which tend to excite the heart to abnormal action. Something may sometimes be done towards preventing the further deposition of lymph or fibrin upon the endocardial membrane. In case there is an acid state of the blood, whether as an antecedent or consequent to rheumatic affections, the use of alkalies and general depuratory remedies, will be indicated, and will be of decided utility. The use in small doses of the following compound will materially aid in the removal from the blood of that acidity which is an attendant of rheumatism. R Irisia a. a. gr. x., Soda bicarbonatis gr. XX., Dose,-gr. i., to gr. iii., as occasion requires. Enough should be given to produce a laxative effect. In connection with this some alterative sirup may often be taken with advantage. The cardiac symptoms are usually in the inverse ratio to the feebleness of the capillary circulation. Means, both hygienic and remedial, should, therefore, be used in order to prevent the congestion of blood to the internal organs. Warm clothing, nourishing, but easily digestible food, the occasional use of a warm bath, not long continued; in short of all the revulsive means-are the principal things upon which dependence should be placed. A life free from excitement of every kind should be led by those afflicted with chronic cardiac disease. When the palpitation is severe and the dyspnea is great, complete repose should be enjoined. Sinapisms may be applied to the chest, and pediluvia to the feet. Vegetable diaphoretic compounds may often be used with benefit, in connection with asafoetida and scutellaria. In some forms of heart disease, the kalmia latifolia proves efficacious. Dr. A. Bottom has used a saturated tincture in doses of ten to fifteen drops, or in quantities sufficiently large to slightly affect the sensorial functions, with decided benefit. The probability is that the remedy has the best effect in those cases in which the organic lesions are slight, and the distressing symptoms proceed mostly from functional derangement. A more full trial of the remedy, may reveal its utility as a curative agent. Counter irritation to the chest and upper part of the spinal column is sometimes beneficial. Various other remedies may be used, but the guiding principle in their prescription should be to prevent the progress of the cardiac changes by directing means to the removal of all exciting causes, and to place the system in that condition most favorable to the prevention of the ill effects arising from the cardiac lesions. There are several other organic affections of the heart which require a brief notice. Among these is atrophy, which during life can seldom be recognized by any symptoms to which it gives rise. Pressure, adhesion, deficient nutrition are its most common causes. General treatment is usually best adapted to prevent its progress, and hence such agents should be used as tend to produce consti tutional vigor. Another affection of the heart is softening. This is not very uncommon. It changes the appearance of the heart, causing a pale, purplish, or yellowish color of its texture and a great degree of softness of its muscular fibre. It is often complicated with obesity. and fatty degeneration. It arises from deficient nutrition, from venous congestion, and sometimes from obstruction in the coronary vessels. Dr. Wm. Pepper found it to accompany the prostration caused by sun stroke. The general symptoms are a small, feeble intermittent pulse, feeble cardiac impulse, and syncope. The treatment should consist of tonics and stimulants, wine whey, carbonate of ammonia, capsicum, combined with nourishing and digestible diet. Induration of the heart sometimes occurs; likewise ossification, cartilaginous and calcareous deposits. Fatty deposition is sometimes observed around, and within the textures of the heart. There are two forms of this affection; first, that in which the fat envelopes the heart, pushing the muscular fibre before it; and, secondly, that in which the degeneration commences in the muscular tissue, transforming the muscular fasciculi. These two forms are probably produced by similar causes, and are nearly identical in their nature. It gives to the heart a greasy feeling. Its symptoms are, feeble, slow pulse, syncope, neuralgic pains in the chest, dyspnoea and coma. The arcus senilis, a fatty degeneration of the cornea of old people, is usually accompanied with a similar affection of the heart. The impulse and first sound of the heart is feeble. Tubercles, cysts, hydatids, and partial aneurisms are sometimes observed in this organ. Polypus and concretions of coagulated fibrin are usually found in the right cavities. The Treatment should consist of mild laxatives, and tonics, and the most permanent stimulants, combined with nourishing diet. There is little danger of using too large a dose of pure stimulants. Brandy even may be borne in larger quantities than in most any other disease. CHAPTER VIII. HYDROPERICARDIUM, This term from the Greek vowp water, Ep around, and xapôrα heart, is applied to dropsy of the pericardium. In health there is a small quantity of serum in that cavity, and hence Corvisart considered six or seven ounces necessary in order to constitute disease. It usually accompanies dropsy of other parts of the body. Its most characteristic symptoms are a small, feeble, irregular pulse, lividity of the face and lips, difficulty of dorsal decubitus, and dyspnœa. A variable position of the cardiac impulse has been considered as a characteristic symptom. The physical signs are dullness over a large surface, prominence of the præcordia, diminution of the respiratory murmur. When dependent upon inflammation or upon a general dropsical diathesis it is sometimes curable, but when upon organic disease of the heart, there is little or no hope. The treatment should be similar to that recommended for hydrothorax. CHAPTER IX. FUNCTIONAL DISEASES OF THE HEART. Symptomatic affections of the heart are more common than organic, often exciting unnecessary alarm. Functional cardiac diseases assume various forms, at one time so distinct as to be easily recognized, at another presenting such a group of symptoms as to make the diagnosis extremely difficult. The term nervous is applied to several different conditions of the heart. Among these is palpitation. Oftentimes this is most excessive, and arises from disorder of the digestive organs, from uterine sympathy, or from excitement caused by excesses of any kind whatever. The free use of tea, and more especially of coffee and tobacco, is a very frequent cause. Violent exercise will often produce palpitation. Anæmia existing while tobocco is freely used, tends in a great degree to aggravate the palpitation, and to develop the |