254 DISEASES OF THE HORSE, 
against the chest wall will not produce pain unless roughly applied. 
The animal is not disposed to eat or drink much; the surface of the 
body and legs are cold—rarely excessively hot—and frequently the 
body of the animal is in a subdued tremor. In nearly all cases there 
is partial suppression of the urinary secretion. The symptoms may 
continue with very little modification for three or four days, some- 
times seven days, without any marked changes. If large fibrinous 
clots form in the heart the change will be sudden and quickly prove 
fatal unless they become loosened and are carried away in the cir- 
culation; then apoplexy may result from the plugging of arteries 
too small to give further transmission. If the animal manifests 
symptoms of improvement, the changes usually are slow and steady 
until he feels apparently as well as ever, eats well, and moves freely 
in his stall or yard. When he is taken out, however, the seeming 
strength often proves deceptive, as he may quickly weaken if urged 
into a fast gait, the breathing becomes quickened with a double flank 
movement as in heaves, and all the former symptoms reappear in a 
modified degree. An examination at this stage may reveal valvular 
insufficiency, cardiac. hypertrophy, or pulmonary engorgement. 
In fatal cases of endocarditis death often occurs about the fourth 
day, from the formation of heart clot or too great embarrassment of 
the circulation. Endocarditis may be suspected in all cases where 
plain symptoms of cardiac affection are manifested in animals af- 
fected with influenza, rheumatism, or any disease in which the blood 
may convey septic matter. 
Acute endocardial inflammation may be distinguished from pleu- 
ritis by the absence of any friction murmur, absence of pain when the 
chest wall is percussed, and the absence of effusion in the cavity of 
the chest. It may be distinguished from pericarditis by the absence 
of the friction sounds and want of an enlarged area of dullness on 
percussion. 
Treatment.—The objects to be attained by treatment will be to 
remove or mitigate as much as possible the cause inducing the dis- 
ease; to find a medicine which will lessen the irritability of the heart 
without weakening it; and, last, to maintain a free urinary secretion 
and prevent exudation and hypertrophy. So long as there is an 
increase of temperature, with some degree of scantiness of the urine, 
it may be safe to believe that there is some degree of inflammatory 
action existing in the cardiac structures, and as long as any evidence 
of inflammatory action remains, however moderate in degree, there 
is a tendency to increase or hypertrophy of the connective tissue of 
the heart or valves, thereby rendering it almost certain that the 
structural changes will become permanent unless counteracted by 
persistent treatment and complete rest. 
