I20 CLINICAL VETERINARY MEDICINE AND SURGERY. 



diastolic, produced b}- aortic insufficiency. Finally, at times one 

 first hears a systolic, followed by a diastolic murmur ; the diastolic 

 sound always appears at a later stage than the systolic, the lesions 

 of the semilunar valves being of slower development, or progressing 

 less rapidly than those of the mitral. In certain patients the heart- 

 beats occur at regular intervals, only seeming rather stronger than 

 usual, and the pulse is normal or somewhat weak. In others the 

 action of the heart is more or less irregular ; intermittencies are rare, 

 and always of brief duration. In the simple forms of acute endocar- 

 ditis, true palpitation and dyspnoea are not seen at rest ; the heart 

 muscle being only affected to a very trifling extent, the lesions do not 

 produce an)' noteworthy external symptoms. Nevertheless, mitral 

 insufficiency may occur in consequence of weakness, or of paresis of 

 the musculi papillares. 



When endocardium and myocardium are simultaneously affected, 

 or when endo-pericarditis exists, the symptoms are more complicated. 

 The descriptions just referred to seem most suggestive of infective 

 endomyocarditis, or of endocarditis preceded, or complicated, by grave 

 pulmonary mischief. 



When in vegetative endocarditis the inflammatory growths on the 

 valves are of large size, the same train of symptoms occurs, but in a 

 more marked form. To symptoms indicative of mitral and aortic 

 insufficiency are added others suggesting stenosis of these orifices. 

 And as, furthermore, the risks of embolism are greater than in simple 

 endocarditis, symptoms pointing to obliteration of vessels in internal 

 organs are more frequent. Cerebral embolism — rare in all animals — 

 is rapidly followed b}- death, or by more or less extensive paralysis ; 

 renal embolism produces albuminuria and haematuria ; intestinal 

 embolism colic ; that of an important artery in a limb, lameness, and 

 sometimes, more or less extensive gangrene ; that of the spleen, and of 

 some other organs and tissues, gives rise to no visible symptoms. 



Malignant ulcerative, or septic endocarditis is recognised, not only 

 by the general signs drawn from auscultation, but by symptoms usually 

 of an extremely grave character, similar to those of a rapidly progressive 

 infection or intoxication, which point to general poisoning of the 

 system by pathogenic org'anisms, or their toxins. Fever is intense; 

 there is great prostration, rigors, sweating, diarrhoea, albuminuria, 

 haematuria, colic, frequent groaning, cyanosis of the mucous mem- 

 branes, rapid acceleratir^ ~)f the heart's action, loss of pulse, and 

 sometimes local ha;mor mages. The symptoms soon become more 

 marked, and collapse is followed by death. This endocarditis may be 

 due to the presence of one or more species of organisms, but is always 



