244 IIHEUMATISM. 



exists the slightest constitutional tendency to this imhealthj'- 

 condition the system rapidly succumbs. A deficiency of 

 shelter and of food, with a naturally damp condition of soil, 

 will further ensure an earlier and more confirmed form of the 

 malady ; while the opposite conditions and influences, when 

 existing, may delay or prevent the development of the consti- 

 tutional taint. 



Anatomical Characters. — In the great majority of deaths 

 from acute rheumatism — chronic rheumatism cannot be said 

 to be fatal — the result is reached through the extent or the 

 severity of the cardiac complications ; consequently the appre- 

 ciable structural changes are as a rule most distinctive in 

 connection with the heart and the structures immediately 

 associated with it. These cardiac lesions vary in accordance 

 with the stage or period of development of the symptoms at 

 which death occurs. 



In all cases, even where the heart and investing or lining 

 membranes are the seat particularly of the diseased action, it 

 does not necessarily follow that these symptoms are at once 

 and speedily fatal. The acute stage of the inflammatory 

 process may entirely pass away, the animal may survive for a 

 lengthened period, ultimately to succumb to conditions folloAv- 

 ing as sequela? of the structural changes developed as the 

 result of inflammation of the heart or associated structures. 



When the animal has yielded to the active stages of the 

 cardiac inflammation the changes are generally very well 

 marked, and probably connected with the pericardium or 

 endocardium rather than with the muscular tissue of the 

 heart itself The pericardium is thickened mainly from organi- 

 zation of the inflammatory exudate on its inner surface. This 

 exudation of organizable lymph is not laid on in a uniformly 

 smooth manner, but is characterized by being disposed in an 

 irregularly papillated or reticulated form, while occasionally 

 adhesions connect the visceral and parietal membrane. The 

 sac of the pericardium contains a greater or less amount of 

 fluid of a reddish colour, with occasionally small shreds of 

 lymph floating in it. 



When the endocardium is involved the changes are more 

 frequently and distinctly seen as aflecting the valves guarding 

 the orifices, chiefly those of the left side. These arc found 



