Diagnosis, Prognosis. 1101 



placement of the puncta maxima. (Figs. 188, 189.) The 

 nature of the pulse is of great importance for diagnosis ; in fact, 

 its significance is often decisive, and the same is true for the 

 character of the arteries and veins. Finally the frequency of 

 the_ several valvular anomalies must be considered on making 

 a diagnosis. 



"With the determination of a valvular lesion the proof has 

 not yet been afforded that this lesion is based upon a chronic 

 endocarditis, although valvular disease depends upon this in a 

 great majority of cases. The actual cause of a heart lesion can 

 only then be ascertained with absolute certainty in living 

 animals if the development of the disease could be traced from 

 an acute endocarditis, in connection with an infectious disease 

 or with chronic arthritis. On the other hand, the absolute dis- 

 appearance of endocardial murmurs and of the symptoms of 

 insufficiency, after the systematic administration of cardiotonic 

 remedies and during physical rest admits the assumption of a 

 muscular insufficiency. 



Prognosis. Although the prognosis of chronic valvular 

 lesions is always unfavorable in regard to the possibility of 

 healing, the various forms of valvular anomaly require different 

 interpretation with respect to their effect upon life and the use- 

 fulness of the animals. Stenosis of the ostia is in general a 

 more severe disease than is insufficiency of the related valves, 

 and disease of both valves of the heart is always more dan- 

 gerous. Of comparatively the least dangerous significance are 

 diseases of the aortic opening, because the strong-walled left 

 ventricle maintains its functioning power for a fairly long time. 

 Disease of the left auriculo-ventricular opening must be judged 

 less favorably because the right ventricle is capable of less 

 exertion and because in addition oxidation is interfered with 

 by the persistently increased pressure in the lungs. The val- 

 vular lesions which are localized in the right heart are always 

 of very unfavorable significance ; that of the pulmonary opening 

 because the lungs receive less blood, that of the right auriculo- 

 ventricular opening because the auricle which is to produce 

 the compensation is incapable of doing so. 



The symptoms oi ineompensation are always serious, and 

 the more so the less they are to be referred to external con- 

 ditions. Of course, the prognosis is the less favorable 

 the less the animal can be protected against exciting and 

 exhausting influences. If the disease has existed only a short 

 time, the age ?ind general condition of the patient must be con- 

 sidered. 



Treatment. Since healing of valvular lesions is impossible 

 of accomplishment, the treatment must attempt to postpone an 

 aggravation of the fairly good condition by a proper regulation 

 of the diet, as long as symptoms of ineompensation have not 



