664 sroRADic diseases. 



circulation, and a serious interference with the heart's action, 

 paracentesis is to be performed; a small trocar being used, 

 which is to be introduced carefully at the side of the sternum, 

 between the cartilages of the fifth and sixth ribs. 



ENDOCAEDITIS. 



As a sequel to articular rheumatism, endocarditis is a more 

 frequent form of disease than the last described one. It is an 

 inflammation of the membrane lining the cavities of the heart, 

 and presents symptoms similar to those of pericarditis ; the 

 difference being that in its purity the blowing sound — the 

 " bellows murmur " already referred to — takes the place of the 

 to-and-fro friction sound. The marked venous pulse, and the 

 want of correspondence between the pulse and the cardiac 

 impulse, laid down as diagnostic of this disease by Leblanc and 

 Gamgee, are seen in other cardiac affections, and are of no 

 diagnostic value. I am, however, of opinion that the clonic 

 spasms of the superficial muscles, already mentioned, along 

 with hurried breathing and a tendency to syncope, if the head 

 be suddenly elevated, or the animal in any way disturbed, are 

 more marked in this than in any other cardiac affection. It is 

 very true that in cardiac degeneration there is a tendency to 

 syncope from debility of the circulation. This condition, how- 

 ever, differs from acute endocarditis by the absence of febrile 

 disturbance. Endocarditis is much more fatal than any other 

 acute cardiac affection, for the reasons that it is often associated 

 with a mal-condition of the blood ; that it leads to valvular 

 alterations, and to a deposition of fibrinous coagula on the valves, 

 which destroy life by interfering with the circulation of the 

 blood, or, carried away by the blood to other parts of the body, by 

 obliterating the capillaries of other organs, leading to softening, 

 abscesses, or sudden death, or undergoing degradation by poison- 

 ing the circulatory fluid. 



Morbid Anatomy. — The first effect of inflammation of endo- 

 cardium is seen in the form of red spots, streaks, and patches. 

 The redness is always most intense in the neighbourhood of the 

 valves, which in some instances lose their integrity, and become 

 ruptured or detached from their tendinous cords. Supervening 

 upon this, lymph is exuded both into the substance of the 



