230 
A CASE OF ENDOCARDITIS, &C. 
Symptoms . — He had a sad dispirited appearance. His skin 
was hot — the respiration somewhat accelerated— the respiratory 
murmur natural — the beating of the heart strong — the pulse full 
and quickened — the mucous membrane of a yellowish red colour 
— considerable lameness of the left fore-foot, with tenderness at 
the scapulo-humeral articulation. 
Diagnosis . — Acute articular rheumatism, with strong febrile 
reaction. 
I ordered him to have warm gruel, and to be warmly covered, 
reserving my future proceedings until I saw him in the morning. 
21sf . — He had lain down during the remainder of the night, and 
had no evacuation of urine or dung. I abstracted eight pounds 
of blood. It was red, coagulated in less than seven minutes, and 
the black clot was scarcely two lines in depth. The white coagu- 
lum filled the remainder of the glass into which it was received, 
with the exception of a small portion of serosity. I administered 
some emollient injections in the course of the day, recommended 
a very restricted diet, and applied a liquid blister over the whole 
of the shoulder, which I supposed to be the seat of rheumatismal 
pain. 
22 d. — The affection of the shoulder has disappeared, and 
seems to have attacked the right hip joint, which is exceedingly 
tender when pressed upon, and which is- the seat of very great 
lameness. Seven pounds of blood were abstracted, the appear- 
ance of which was the same as that abstracted yesterday. A 
blister was applied over this new seat of weakness and pain. 
23 d. — He does not now attempt to rise, although the pain and 
the lameness seem to have quite disappeared. The respiration 
is evidently painful, and the labour of breathing is very great. 
There is great acceleration in the movement of the flanks, with 
difficult passage of air through the respiratory passages. There 
is considerable resonance when percussion is applied, and the 
beatings of the heart are unusually strong. There is no unusual 
sound on auscultation of the cardiac region. The pulse is full, 
and much accelerated. Eight pounds of blood were withdrawn, 
and a blister was applied over the apparent seat of lameness. 
24 th . — He is now constantly lying down ; but the pain and the 
lameness seem to have completely disappeared. The heaving of 
the flanks is now greatly accelerated, and the murmur in the 
bronchial passages is every where audible. There is evident 
resonance on percussion. The pulsation at the heart is very 
strong, but there is no particular sound when auscultation is 
applied to the cardiac region. The pulse is full and much acce- 
lerated. Eight pounds of blood were again detracted. 
In the presumption that there might be inflammation of the 
