Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . eing essentially the same,jo of a grain of strychnine sulphate three times a day was or-dered. As the temperature remained normal and the murmurhad not increased, two days later tincture of digitalis was cau-tiously administered. Withintwenty-four hours the leftventricle had come down 0.5centimetres, and upon thedigitalis being increased, thenext twenty-four hours wit-nessed a still further diminu-tion in the extent of relativecardiac dulnes

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Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . eing essentially the same, jo of a grain of strychnine sulphate three times a day was or-dered. As the temperature remained normal and the murmurhad not increased, two days later tincture of digitalis was cau-tiously administered. Withintwenty-four hours the leftventricle had come down 0.5centimetres, and upon thedigitalis being increased, thenext twenty-four hours wit-nessed a still further diminu-tion in the extent of relativecardiac dulness to the left. Inthe course of the next weekor ten days the heart meas-ured but 10 centimetres to theleft of the median line, andwas normal at the right (Fig.32). Two months subsequently, after the patient had beenwithout medicine for severalweeks, and had returned to his usual mode of life, the left ven-tricle measured but 9 centimetres, a reduction of more than 3centimetres since the date of my first examination. Was this caseto be regarded as one of acute endocarditis following croupouspneumonia ? Certainly not. It was one of simple acute dilata-. Fio. 32.—Diminution of Eelative CardiacDulness in One Week, under Treat-ment. Case (p. 185). ACUTE ENDOCARDITIS 187 tion, chiefly of the Lefl ventricle, resulting primarily from asthe-nia of the heart-muscle in consequence of the effect of the toxinsof the pneumococcus. Treatment.—Clinical experience the world over accords withthe conclusion naturally drawn from a consideration of the pathol-ogy and morbid anatomy of acute endocarditis—viz., that whenthe process has once become established, we possess no means ofcausing absorption of inflammatory product or restoring the endo-cardium to a healthy state. It should be our aim, therefore, toprevent where we cannot cure. Our first duty is to study the effi-cacy of prophylactic measures. Our efforts in this direction shouldnot be restricted to prevention of endocarditis, but should