and changed in shape; instead of lying in ridges as in the pericardium, they assume the form of warty excresences and are attached to the valves or some other portion of the auricle or ventricle, the free end presenting a branched appearance and being perhaps quite long. These excresences sometimes become detached, forming an embolus, and passing through the arteries may become lodged in some distant organ or extremity. The inflammation, unless checked, will involve the sub-serous and fibrous portion of the valve, resulting in thickening and deformity, or the valve may be perforated by ulcerative processes, so that for all future time they will fail to perform their functions properly. If the disease is of short duration some little change in the structure may become corrected and the valve restored to its former usefulness. The deposit upon the surface may be absorbed to a certain extent, just as it is upon the surface of the pleura and a comparative cure performed in that way, but if the condition has existed for many days even, the prospect in regard to recovery is not favorable.

Symptoms. The majority of cases of simple endocarditis are latent and there is no indication of cardiac trouble; it is frequently found postmortem in persons in whom it was not suspected during life. There are certain features, however, by which its presence is indicated with a degree of probability. The patient as a rule does not complain of any pain, or cardiac distress. In a case of acute rheumatism, for example, the symptoms to excite suspicion would be increased rapidity of the heart's action, perhaps slight irregularity, and an increase of the fever, without aggravation of the joint trouble. Palpitation may be a marked. feature and is a symptom upon which

some authors lay great stress. The subjective symptoms of simple acute endocarditis are more obscure than those of any other cardiac disease. The urgency of the symptoms of the disease in which it occurs often masks the few symptoms which attend its development, but when it is extensive and muscular tissue is involved, palpitation and sense of discomfort in praecordial regions are present and there may be dyspnoea. At first the pulse is strong and frequent, later i: becomes rapid, small and irregular. As the disease progresses the propelling power of the heart is diminished, the pulse becomes feeble and sometimes dicrotic. The respirations are accelerated and sometimes labored. There may be paroxysmal dyspnoea; the face may be flushed or may be dusky, pallid or even cyanotic. Auscultation reveals a murmur or murmurs over the various cardiac orifices. The fact that valvular disease may have pre-existed makes it important to carefully examine the heart at the first visit to one suffering with acute rheumatism, chorea, Bright's discase, etc. The most important and constant sign of endocarditis is the systolic murmur, heard with greatest intensity at the apex-this soft blowing or bellows. murmur may be ventricular or valvular. In all cases it is due to roughening or thickening of the endocardium. It is developed early, and when one is on the lookout for endocarditis this will usually be the first evidence of it, although in some instances no murmur is at any time present. Many of these cases become sub-acute or chronic, or the inflammation subsides altogether, and there remains the valvular deformity. Persons so afflicted will ordinarily have a cough upon rising in the morning, with some expectoration. They frequently have headache with dizziness, coldness of extremities and dyspnoea which interferes

with severe exercise; they faint readily and always complain of palpitation. You will find many of these cases which have never been diagnosed properly. If you find a rapid, irregular, intermittent pulse, or much dyspnoea, examine the heart and lungs thoroughly; if you fail to find what you expect, have patient take some exercise, as this may develop the murmur. In chronic cases constant changes are occurring in the heart. First, there is hypertrophy, general enlargement of the heart, which is greatest in the part having to do the most work. It would be greater on the left side in mitral disease, and on the right side in tricuspid disease. The muscles of the heart attempt to do more work than before, which increases their nutrition, and they become thickened. It is common to find the wall of the left ventricle five or six times as thick as the right, when it should be only twice as thick. The inevitable secondary result is atrophy of this wall, it becomes thin and weak, and its cavity enlarged, being sometimes capable of holding twice as much blood as normally. The circulation is easily disturbed; extremities are cold, and the patient frequently subject to congestion of different viscera.

Diagnosis.

Simple endocarditis may be mistaken for pericarditis. A pericardial sound, however, is distinctly a friction, creaking or rubbing sound and is intensified by having patient bend forward, or by increasing the pressure of the stethoscope or examining ear against the chest, while that of endocarditis is soft and blowing. Functional cardiac disturbances occurring during the course of acute febrile disorders sometimes give rise to diagonistic errors. In these, however, murmurs, if present, are most marked at the base of the heart. It is difficult to determine whether a mur

mur is of old or recent origin. If during an attack of rheumatism a murmur is developed under daily examination, it would indicate acute endocarditis. If a murmur exists at the first examination, systolic, soft and blowing and unaccompanied by cardiac hypertrophy, there is reason to believe that it is due to an acute endocarditis, but should it be rough, diastolic and unaccompanied by cardiac hypertrophy, it is probably not due to acute endocarditis. In many cases of acute ulcerative endocarditis, the diagnosis is very difficult, in others with marked embolic symptoms it is easy and readily distinguished from simple endocarditis. The constitutional symptoms are of graver type. The fever is higher, rigors are common, and septic and typhoid symptoms develop. Probably the majority of the cases of ulcerative endocarditis are mistaken for typhoid fever. Points which would help. us to differentiate these cases are, the more abrupt onset in endocarditis, the irregularity of the pyrexia in the early stages, and the cardiac pain; oppression and shortness of breath may be present and rigors are not uncommon. The ulcerative cases usually terminate fatally.

Prognosis. The prognosis of simple endocarditis as regards life is, as a rule, favorable. In the majority of cases permanent lesions of the valves or orifices remain. Some cases that begin as simple exudative endocarditis subsequently become of a malignant ulcerative type. The fatal issue in endocarditis is generally due to embolism of different viscera. The prognosis in chronic cases is not as unfavorable as generally supposed and with proper care a patient may live many years. The lungs are the organs most often involved. Probably a majority of these cases terminate in diseases of the lungs. In all these cases you should examine the posterior and in

ferior portions of the lungs for any filling up of these parts. A sub-acute pneumonia, or possibly oedema, may be found there. It is liable to affect the kidneys very early, and they, only partially or poorly performing their functions, we eventually get a general ana

sarca.

Treatment.-Every means of resting the heart should be persistently employed, and even after the patient has. apparently recovered, protection of the chest against changes of temperature should be secured by application of a light layer of cotton, wool or flannel. The diet should be simple and nutritious; an excess of liquid should be avoided in order to lessen intra-cardiac pressure. Warm baths should be given from one to three times in twenty-four hours. When pain is severe, hot applications should be made to the praecordial region. Endocarditis, when a complication of acute articular rheumatism, does not often require special treatment, as those remedies and general measures which best control the rheumatism will prove most efficient.

Colchicine on account of its action on the articular inflammation and its influence in the prevention of cardiac complications is highly extolled by many of our school and is worthy of consideration.

Aconite.-High temperature, anxiety, great swelling of the joints with acute pain, restlessness and pulmonary congestion.

Veratrum Viride.-The action of the heart is much more violent than under aconite; heart beats loud and strong with great arterial excitement; constant dull burning in region of the heart; active congestion of the chest.

Spigelia.-Violent palpitation with anxious oppression of the chest; feeling in the region of the apices as though a

dull pointed knife was slowly driven through it. Pulse weak and irregular.

Bryonia. Is often indicated in connection with attacks of rheumatism; joints red, stiff and swollen, with stitching pains from slightest motion or touch. Pulse full, hard and rapid.

Cactus.-Sensation of constriction about the heart. Very acute pains and stitches in the heart; feeble, irregular pulse; palpitation; inability to lie with. the head low. Colchicum.

Endocarditis following

acute rheumatism; tearing pain in the cardiac region, pulse small, rapid and trembling.

Rhus Tox.-Is called for in cases associated with acute rheumatism when the well-known rhus symptoms are present.

Belladonna.-Is sometimes indicated, especially in the rheumatic endocarditis of children.

After subsidence of the acute symptoms, administration of medicines having an absorbent and resolvent action, such as sulphur, iodine, spongia, and iodide of potassium tend to lessen the extent of the inevitable damage to the orifices and valves. In chronic cases with dilatation and threatened failure of circulation, alcohol should be given in moderate quantities, along with such remedies as arsenic, the indications for which are dyspnoea, weak and irregular pulse, with diminution of arterial tension, anxiety, mental agitation, anasarca, albuminuria; strophan-irregularity of heart's action, praecordial pains, palpitation, dyspnoea, valvular disease with regurgitation, oedema, general anasarca; apocynum-urine scanty, oedema, general anasarca, with great thirst; apisoedema, retention or suppression of urine; kalmia-excessive action of the heart, rheumatic pains in the region of the heart, pulse irregular, quick and

weak, hypertrophy; crataegus praecordial oppression, rapid and feeble heart's action, valvular insufficiency, cardiac hypertrophy.

HOMEOPATHY IN OHIO.

By R. B. CARTER, M. D., Akron, Ohio.

In the kingdom of Saxony and in the town of Meissen, on the 10th day of April, 1755, was born one whose mission to humanity can scarcely be over estimated, and it would seem as though his humble parents must have in some measure realized this for they gave to him the surname of "Samuel."

His father, a painter of porcelain, naturally discouraged the son's early evidenced desire for a higher education, but the parish school-master favored him. with such efficient instruction as to enable him to enter the University of Leipsic at the age of twenty, when he was qualified to speak and write six different languages.

For some time he largely supported himself by teaching English, French and Italian, finally graduating in medicine at Erlangen in 1779. He served as Hospital Physician in Dresden, where he soon met with marked success and attained a liberal patronage.

His thirst for knowledge seems to have been insatiable, and he continued to investigate the sciences, especially chemistry and toxicology, writing several treatises of acknowledged merit and medical value. He returned to Leipsic for the further prosecution of especial lines of study and in 1796 published the first partial exposition of a new doctrine in an essay on "The New Principle for Ascertaining the Remedial Powers of Medicinal Substances." Other like contributions followed this and the extraordinary nature of his assertions

served to attract hostile criticism, at first alienating many and converting few of his professional brethren of character and influence. The results of his treatment, however, were not to be denied and his fame as a physician extending beyond the confines of Germany, patients flocked to him from all over Europe.

The last eight years of his life were spent in Paris, where he met with the greatest success socially, financially and. professionally, continuing in the active. practice of medicine until he died, in 1843, at the advanced age of eightyeight years. He lived, however, to see the system of medicine of which he was the founder, adopted and practiced by many of the leading physicians of his day and generation.

Dr. Quin, physician to the king of Belgium, introduced Homeopathy into England in 1828; or three years after Dr. Hans B. Gram had established himself in New York City. Today Germany recognizes Hahnemann's birthplace with a magnificent memorial, and France his burial-place in a princely tomb, while the government of the greatest and grandest of the nations of this earth, although it can claim neither his birth nor his burial, yet remembers Hahnemann and recognizes Homeopathy in that glorious combination of bronze and marble so recently dedicated at Washington. It is just possible, however, that the future historian may declare that one of the most enduring and efficacious monuments ever erected to the memory of man was that living one which Hahnemann's disciples in this country dedicated to him in 1844, the next year after his death, when they organized "The American Institute of Homeopathy," which today has a membership of about 2000 of our leading physicians.

I must not forget, however, that the subject assigned me for today is "The Status of Homeopathy in the State of Ohio." There are about 1200 registered as Homeopathic physicians among the practitioners of medicine in the state of Ohio at the present time. Making due allowance for removals, deaths and changes from any causes whatsoever, we believe there are over 1100 active Homeopathic physicians in Ohio today. Of this number about 125 are enrolled as members in good standing in "The American Institute of Homeopathy." About 200 are members of "The Homeopathic Medical Society of the State of Ohio." One hundred. are members of this Society, while the various similar sectional, county and city societies have a membership

of three to four hundred. It is a fact, however, that many Homeopathic physicians belong to two or more of these mentioned organizations and hence it is safe to say that in the neighborhood of one-half of our number do not belong to any medical society whatever, but are gradually becoming afflicted, at least many of them, with a species of dry-rot, which in man, as in the maple, begins at the heart and shows first in the top.

A worker in any line should keep in touch with fellow-laborers and know that he is abreast of the times in thought, method and materials. By refusing to take advantage of the means of grace offered him, such an one not only dwarfs his social life and professional growth, but also wrongs his co-laborer and weakens his own faith by permitting this reflection upon his supposed sincerity. On the other hand, we but half do our duty when we partake of the benefits of this and similar organizations and do not use our influence to increase its membership and extend its advantages.

"In unity there is strength" and as a distinct school of medicine we shall never be able to measure up to our full standard of power until we are able to march shoulder to shoulder and confidently demand those things to which we are reasonably entitled.

Our

Men and brethren, I appeal to you, is it not a fact that having escaped the scyllian rock of ancient prejudice, and having safely passed through the charybdian whirlpool of active criticism, believing now that the current is in our favor, and fair seas lie before us we have possibly too little used our oars and too seldom consulted our compass? noble state boasts two of the oldest and best Homeopathic Colleges in America, but have we, and many of us are alumni of these colleges, always been truly loyal and done our utmost to uphold them and strengthen the hands of those in authority in them? We have some of the best hospitals in the state under Homeopathic control, but have we always stood ready in season and out of season to speak a good word for them and turn business to them? Our Homeopathic text-books, treatises and journals. are no longer a byword and will compare favorably with those of any other school of medicine, but are we giving them the support and encouragement which will make them better and more complete in the near future?

Perchance there may be some honest and reasonable differences of opinion as to the nature and extent of our remissness in the matters already referred to, but certainly there can be no valid excuse for our failure to act harmoniously and energetically in the compelling of proper recognition and at least proportionate representation in municipal, county, state and national affairs and institutions.

Positions in the army and navy of our