THE MNORSE—THE ORGANS OF CIRCULATION. 95 
before the serous matter has accumulated, not heard after that effusion; when 
these {riction-sounds cease the heart-beats are muffled; later still, the effu- 
sion increasing, the impulse of the heart is not well defined, but is a flutter 
in uncertain beats, giving a peculiar pulsation to the hand; breathing grows 
more distressing ; movement aggravates the 
pain; pulse feebler, being even imperceptible 4 
at the jaw; legs and ears cold; chest, abdomen, 
legs, and other parts dropsical; death soon 
ensues. In some of the more advanced stages, 
striking upon the parts near the heart produces 
a dull sound near that organ, but does not dis- 
turb the bronchial and respiratory sounds, 
which are affected in hydrothorax, or water in 
GENERAL SymMPTOM OF HEART 
DISEASE. 
the chest. In pleurisy, the frictional sounds 
occur during the respiratory movements of the lungs; in dropsy of the 
heart, during the beats of the heart. The reader should be very careful to 
take note of these distinguishing symptoms. 
TREATMENT.—During the inflammatory stage, when the sound of the 
heart is lessened, with strong, regular impulse, and hard, strong and quick 
pulse, give aconite every two hours; or alternate it with bryonia, especially 
in complications with rheumatism. For irregular or intermittent action of 
the heart, give ten to twenty drops of digitalis every four hours; and when 
the disorder follows or accompanies rheumatism (in which case the beats are 
usually jerking), alternate digitalis with colchicum, Give arsenicum or apis 
in the second stage, when the serous matter has distended the sac which 
envelops the heart, particularly if dropsical swellings exist in other parts. 
Acetate of potassa will induce free action of the kidneys and lessen the 
tendency to dropsy, and a teaspoonful may be given much diluted witin 
water. In extreme cases, and when the collection of fluid is great, it may 
be drawn off with a trocar or an aspirating needle, as in hydrothorax or 
dropsy of the chest, the puncture being made by askillful hand between the 
fifth and sixth ribs. Hot fomentations applied to the chest will tend to aliay 
the inflammation. Mustard and flaxseed poultices will also be of service. 
Keep the surface of the body warm, and bandage and hand-rub the legs. 
Blood-letting is highly injurious in this disorder, as in most others. 
ENDOCARDITIS._INFLAMMATION OF THE HEART. 
This is a very frequent complication of rheumatism, or may result from 
an undue strain in severe work, is dangerous, and may lead to many serious 
disorders of the heart. 
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