DISEASES OF THE HEAP.T AND ITS MEMBRANES. 665 



membrane and upon its free surface. That upon the free surface 

 is often washed away by the current, but, generally speaking, it 

 is found between the folds and upon the free surfaces, constituting 

 warty excrescences upon the valves. 



In a specimen now before me, obtained from a cow which had 

 three months prior to death suffered from rheumatic arthritis, 

 there are no less than five-and-twenty of these excrescences, 

 more or less organised, attached to the surfaces of the tricuspid 

 valve. They vary in size from a pin head up to a large nut ; 

 some of them being in the auricle and some in the ventricle, 

 attached not only to the valves but to the chordse tendinese, 

 carnse columnar, and musculi pectinati, whilst the spaces be- 

 tween tlie tendinous cords are filled with coagulated blood. In 

 the left side of the heart there are also traces of deposition 

 within the mitral valve, having the shape of irregular white 

 spots. It will be thus seen that there is not only a deposition 

 upon the free surfaces, but also an exudation in the membrane 

 itself. In some instances the valves become ulcerated, and 

 even the cardiac walls perforated, establishing a communication 

 between the two cavities. 



The growths of endocarditis differ from those clots or coagula 

 which form during or after the agony of death, and they must 

 not be confounded with the corpora aurantii, which are generally 

 more or less enlarged in aged subjects. The coagula, which form 

 during or after death, are not adherent to the parietes, are soft 

 and easily removed. 



In the treatment of endocarditis particular care must be taken 

 to pursue no treatment calculated to lower the heart's action, as 

 debility of the circulation greatly favours the tendency to coagu- 

 lation of the blood in the heart, and the consequent formation 

 of these coagula. For the same reason, remedies which have 

 the power of modifying the coagulation of the blood, such as the 

 nitrate of potash, or, when debility is present, the bicarbonate of 

 ammonia, are to be prescribed ; and for the reason that inflam- 

 mations, artificial and natural, increase the fibrinous condition 

 of the blood and its tendency to coagulation, blisters, setons, and 

 all other remedies which constitute the so-called counter-irritant 

 treatment, are to be avoided. The treatment recommended for 

 pericarditis is applicable for endocarditis, with this exception, 

 that those sedatives which diminish the cardiac energy are to be 



