222 PHYSIC 



continuation of the same line of enquiry, and its treatment 

 correspondingly improved and made more scientific. 



Since the above observations were made on the subject 

 of rheumatism generally, and in its various phases and 

 methods of manifestation, we have to a little further extent 

 pursued our enquiries regarding the occurrence of meta- 

 stasis to the heart, or cardiac rheumatism. 



The occurrence of cardiac complication during or after 

 the currency of an attack of acute rheumatism becomes 

 much clearer to us in its etiology and pathology by the 

 application of these views to its consideration. 



Thus cardiac rheumatism, with resultant peri-carditis and 

 endo-carditis, is to be regarded as due to a metastasis of 

 the toxic matter of the disease from the more distant, 

 deep, or peripheral parts of the body and spinal cavity 

 along the trunks of the pneumogastric nerve or nerves to 

 the fibres distributed to the heart, and thence into and 

 throughout its muscular substance ; where, driven by the 

 sustained working and action of that never-ceasing and 

 continually moving mechanism, it is projected into its 

 very innermost parts, consisting of its series of muscular 

 eminences and valves and lining endo-cardial, as well as 

 enclosing peri-cardial, membranes, by direct communica- 

 tion from the one to the other and from first to last. 



Chronic rheumatic arthritis, moreover, may be said to 

 result, in some cases, if not in many or all, from the 

 percolation or infiltration of toxic material, from the 

 muscles through the tendons, periosteum, bones, and 

 cartilages, and thence through the synovial lining of the 

 joints themselves into their central cavities and contained 

 fluids. 



In cases of this description, of the more acute order, 

 the rate of pathological change may be both rapid in rate 

 and destructive in the extent of its incidence, or slow and 

 more ankylostotic or exostotic, when more or less osseous 

 material is deposited during exacerbations of the disease 

 in the periosteal texture or the superficial layers of the 

 bony textures involved. 



A case of the latter description might be cited in illus- 

 tration as it was closely observed and noted by its subject 

 from inception to cessation of the characteristic symp- 



