1100 Valvular Diseases. 



iunity because these animals are usually slaughtered before the 

 occurrence of these symptoms. 



The disease takes a more rapid course in very young and 

 in very old animals, because both lack the strength which is 

 required for a sufficient compensation. Congenital heart lesions 

 lead to death, with symptoms of severe blood stasis, usually 

 during the first few weeks or months of life, although occa- 

 sionally the animals become older. Such cases have been 

 observed by Thomas, Walley, Johne, Hutyra, Lienaux. 



Diagnosis. The recognition of valvular disease is only pos- 

 sible on the basis of an exact examination, which also considers 

 the clinical pictures described above. In the interpretation of 

 the results the following points should be considered, in addition 

 to the conditions which have already been related. 



Sometimes so-called anorganic murmurs are heard without 

 valvular lesions and without any impediments to the circulation 

 in the heart ; these murmurs are heard more frequently during 

 systole, only very rarely during diastole. These murmurs may 

 be eliminated if in addition enlargement of a portion of the 

 heart or accentuation of the second sound can be demonstrated, 

 or if a thrill can be felt (" fremissement cataire"). 



The absence of murmurs does not exclude the presence of 

 a valvular lesion, because in case of slight insufficiency or 

 stenosis, especially at rest, murmurs are not produced which are 

 transmitted to the chest wall with sufficient , intensity, and 

 because in severe insufficiency the formation of murmurs may 

 not occur, as in such a case the regurgitation of the blood does 

 not take place through a narrow slit; finally, in the stage of 

 incompensation too feeble contractions of the heart may cause 

 the murmurs to disappear. In all these cases cardiac remedies 

 and muscular exertion which have the effect of strengthening 

 the contractions of the heart usually cause the murmurs to 

 reappear. It appears therefore advisable in all cases in which 

 a suspicion of heart disease exists, which includes all cases of 

 dyspnea the nature of which is not quite evident, to examine the 

 animals immediately after work and particularly to auscultate 

 the heart region. Nor should it be forgotten that in aortic 

 aneurysm murmurs are heard which correspond to the endo- 

 cardial murmurs. 



In domestic animals the recognition of the several valvular 

 anomalies is always successful in the stage of compensation, 

 sometimes also in compensated cases, if the character of heart 

 beat, heart sounds and cardiac dullness is observed and the 

 punctum maximum of the murmurs is ascertained ; a task which 

 is not particularly difficult in horses. A murmur which has 

 originated in any section of the heart is naturally heard most 

 strongly at that place where the related part of the heart is 

 nearest to the chest wall ; but a decided dilatation of the heart 

 with displacement of the heart sections produces also a dis- 



