14 THE TONER LECTURES. 



ture ; and the latter brought about not only by sudden efforts, 

 but likely determined also by the gradual textural changes pre- 

 viously caused. 



Let me cite j'ou a case in which, I think, the valvular 

 disease was produced by inflammatory alteration. Only a 

 few days ago a miller came to my office troubled with car- 

 diac pain, and presenting a distinct mitral organic murmur. 

 He had at one time been in the habit of shouldering enormous 

 bags, and of attempting to run when thus weighted. For the 

 last eight j-ears he has only been able to lift the bags very 

 rarely, being annoyed with beating of the heart and shortness 

 of breath — indeed, the latter had become a symptom existing 

 even witliout any exertion. Previously to the time mentioned 

 he remembers to have suffered from severe pain in the heart 

 for three or four days after his lifting freaks, and on one 

 occasion very greatly. 



In examining into the question of the effects of occupation, 

 we find further that excessive expiratory efforts produce affec- 

 tions of the heart or its great vessel. Disease of the coats 

 of the aorta and aneurisms may be thus caused. For instance, 

 in the museum of the Jefferson Medical College is an aneurism 

 taken from the body of a celebrated comet player. And 

 among glassblowers I have been astonished to find how com- 

 mon are cardiac disorders. I call your attention to this table 

 of 24 men examined, and procured for me by the kind exer- 

 tions of Dr. Webb. They were not specially selected, did not 

 apply for medical advice — and, indeed, the only care taken in 

 obtaining them was to get mainly those who had been for 

 some time in the business. Irrespective of the facts which 

 the table discloses, I learned, by conversing with the men, 

 that large numbers of their fellow-workmen were troubled with 

 pains across the chest, and with piles. And, as regards this 

 table, we find among the 24 men only one-half who, on a fair 

 estimate, may be considered as presenting healthy hearts. 



