CHRONIC ENDOCARDITIS: VALVULAR ALTERATIONS. 479 



Special literature contains but one case of this alteration. Boisy 

 has found, in a cow, the second sound replaced by a rasping bruit ; 

 venous pulse was much accentuated, the respiration laborious and 

 subsultory ; he observed besides an almost imperceptible arterial 

 pulse and ascites. At the autopsy this author observed cauliflower 

 vegetations which were developed upon the valves of the pul- 

 monary artery. 



YIII. Contraction of the pulmonary orifice. It gives 

 rise to a systolic bruit (a blowing an hypertrophy of the 

 right heart, a stagnation in the venous system, and dyspnoeic 

 phenomena. 



This alteration is also very rare ; Huth has, however, met with 

 it in the horse. Daring the subject's life he observed the exist- 

 ence of the blowing bruit, which was synchronous with the pulse. 

 After a slight exercise dyspnœa became intense, the heart beat vio- 

 lently, and the breathless animal was compelled to stop. 



Diagnosis of valvular affections. A variety of circumstances 

 obscure the diagnosis of valvular diseases. Abnormal systolic and 

 diastolic bruits may exist without the least organic lesion of the 

 valves; they are designated under the name of anorganic bruits ; 

 they are observed in anemia, leukemia, etc. ; on the other hand, a 

 valvular affection does not always lead to a pathological bruit at 

 the start, its most important diagnostic symptom may be wanting. 

 Two or several valvular alterations are often associated ; contrac- 

 tion and insufficiency coexist frequently ; the most complex forms 

 are possible. Lastly, in the majority of cases these affections only 

 attract attention and are only recognized in their last stage, when 

 they all become evident by their almost similar functional symp- 

 toms (circulatory troubles in the lungs and the venous system). 

 An anatomical diagnosis is, therefore, quite difficult. However, we 

 have to point out that in cases where several valves are in volved, tlie 

 troubles produced by one of these generally dominate the scene ; it 

 is consequently possible to formulate a probable diagnosis. Here 

 are the principal points which permit us to establish a differential 

 diagnosis of the various valvular diseases. 



1. The systolic bruit (blowing) exists in mitral or tricuspid in- 

 sufficiencies, in aortic or pulmonary contractions. The first are 

 quite frequent ; the latter is, so to speak, not worth being noticed. 

 Tricuspid insufficiency is especially observed in the ox and is 

 accompanied by a venous pulse. In mitral insufficiency the pulse 



