According to the best authorities on medicine, this disease is the result of infective processes; but when the student desires to know what infective process has brought it about, he will learn that it has been caused by some other disease established by an infective process, and he gets nowhere in his investigation in regard to the origin of the disease.

   If the student will bear in mind that, primarily, there is but one source of infection, and that is in the alimentary canal, he will have no trouble in tracing all diseases back to their own origin. Toxin poisoning from putrefaction in the intestine, plus constitutional diathesis, or plus organic diathesis, supplies the origin of all organic diseases, which should be called affections. Infection or toxemia starts a process known as rheumatism. The same identical cause will develop pericarditis in a subject who has a cardiac diathesis; and this is the source of the infection that causes this disease.

   Etiology.--It is very doubtful if this disease is ever anything more than symptomatic. A wound in the chest involving the pericardium, and an inflammation of the pleura, may extend to the pericardium; but when this is true it is symptomatic; hence, barring injuries to the pericardium, diseases of this character must be symptomatic and due to infection through the blood. Injuries have been found to come from passage of foreign bodies in the trachea, such as needles, pins, or small pieces of bone which have found their way through the esophagus. These are rare, however.

   The disease is common at any age. Children with scarlet fever, who are badly cared for, are liable to develop this disease. The characteristic form in anemia is acute fibrinous pericarditis.

   Symptoms.--The principal symptoms are precordial oppression. People with this disease will want to sleep with the head high--with several pillows--especially if there is an effusion in the sac. Pain is never very intense, and is usually more marked in the early stages. The most pronounced case that has ever come under my observation was that of a child five years of age. She had scarlet fever. After the rash had disappeared and she appeared to be convalescing, she lingered on and did not improve satisfactorily. She sat up in bed, not being able to lie down on account of the difficult breathing. When I was called I found radical dullness over the region of the heart, and gave it as my opinion that there was an effusion in the pericardium; which, at my next visit, I withdrew with an aspirator. The fluid withdrawn appeared to be pure blood. However, it could not have been. It was probably a little thinner than normal blood. I removed twelve ounces, and the child made a good recovery. This was a case of hemorrhagic pericarditis--the only case I have ever seen.

   The material thrown into the pleura is usually of the character of serum. The symptoms generally are slight: a shortness of breath and an increasing pallor. Seemingly without symptoms to justify it, the physician will find a pronounced accumulation. Great restlessness is one of the principal symptoms; and where the accumulation is large, relief must be procured by aspiration, or the patient will be worn out from difficult breathing and lack of sleep.

   Definition.--Inflammation of the lining membrane of the heart. It is usually confined to the valves, and, when spoken of correctly, it should be called valvular endocarditis. It is divided into two forms--acute and chronic.

   The acute is characterized by the presence of vegetations and a loss of power to close. In the chronic form there is a slowly developing hardening, resulting in a thickening and more or less deformity.

   This disease is without doubt a symptomatic affection. When the profession gets to the point of being exact in its language, this will be spoken of as an affection rather than as a disease.

   Etiology.--Endocarditis is always found in conjunction with other physical derangements. The profession instantly thinks of rheumatism when the disease is spoken of. Years of indiscretion in eating improperly combined foods, overeating on proteins, starches, and sugars, keeping the system in a plethoric state, and a decidedly toxemic state of the blood from absorption of toxins generated in the intestine, will bring about this condition. When it has developed to a point where resistance is broken down, rheumatism; and it may be that the patient will suffer rheumatic pains, but at no time be thrown into his bed with a four- to six-weeks' run of inflammatory rheumatism. Where rheumatism of this character develops, it seldom leaves the heart free. Indeed, the heart is subject to this blood infection continually, and with no rheumatic development it is possible for valvular endocarditis to develop without the patient ever having an attack of inflammatory rheumatism.

   Since bacteriology has been accepted by the profession as the chief etiological factor in the development of all diseases, we find the very best authorities declaring that tonsillitis, rheumatism, etc., cause this form of heart disease, and that the cause of the rheumatism is absorption of germs through the tonsils.

   I cannot readily understand why medical men generally should be at a loss to comprehend the etiology of rheumatism and endocarditis. Treatment for the disease has been so very unsatisfactory that there has been no settled conviction in regard to the cause, and bacteriology seems to have satisfied the medical mind. There is no question but that these diseases are all due to toxin poisoning, but it is not any different--the poisoning is not any different--from the toxin poisoning that is at the base of all other acute and chronic derangements of the human body.

   Treatment.--The treatment for this disease must be the same as for all diseases; namely, correct the nutrition, get rid of the source of infection, and then nature will eliminate the poison. If there are abscesses in any part of the body, they must be drained. If there is a source of infection--for example, from the pelvic organs--these organs must be properly treated. Drainage must be established to get rid of this source of infection. The feeding must be corrected. The care of the body must be made as nearly perfect as possible.

   The treatment for simple endocarditis should be about as follows: If the cardiac symptoms are not too pronounced to preclude a two- or three-minutes' hot bath of a morning, a bath should be given as hot as the patient can bear, followed with a quick cold sponge-bath. This should be followed with a lot of dry towel-rubbing. Then, before going to bed at night, give dry towel-rubbing. If the patient is in full flesh, no food should be taken for at least one week. The second week the patient should not have anything more than fruit morning, noon, and night. The third week, two meals of fruit and one heavier meal--a dinner in the evening, consisting of meat--two or three times a week. The lightest meat should be used--lamb, chicken, fish, or eggs--with cooked, non-starchy vegetables and a combination salad. The alternate dinners should be a decidedly starchy food, with one or two cooked, nonstarchy vegetables and a combination salad. Patients should avoid worries and anxieties. Everything that has a depressing effect must be shunned. If the proper care is taken of the skin and the eating, according to the above instructions, the very worst forms of this trouble can be overcome.

   Treatment for this affection need not be any different from that of the acute form. Perhaps it will not be necessary to fast the patient for the first week. Give fruit for three meals a day; then take fruit for two meals, and the regulation dinner for the third meal. There are no two cases alike--no two people can be treated exactly alike; hence whatever conditions are necessary to be met, must be met. If rest is demanded more than anything else, such patients should be put to bed and all excitement of all kinds removed. If they are able to be up and around, attending to light duties, they must retire early and get up late, avoid all kinds of annoyance, and stay away from theaters and crowds where the atmosphere is bad.

   This is a functional derangement of the heart that may have many causes. Indigestion is a common cause. Fright, worry--in fact, overworked emotions--may become a cause of heart palpitation. Heart palpitation is one of the first indications of depleted blood or loss of blood. Anemic people suffer with palpitation. Those who use tobacco, coffee, tea, or other stimulants daily and excessively arrive at a stage where they will be troubled severely with heart palpitation.

   When women are going through the change of life, they are often troubled with this symptom. Young girls coming into puberty are troubled with this symptom very often. The hysteric and neurasthenic are very prone to have this symptom, but there is nearly always dyspepsia as the exciting cause.

   Onanism and excessive venery are common causes. When a youth complains of palpitation, and there are dilation of the pupils, cold, clammy hands and feet, and a doughy skin, there is not only indigestion, but there is a strong probability of self-abuse. The same symptoms developed in maturity point to excessive venery. In some subjects the palpitation is accompanied by flushing of the skin; in others, by deathly pallor. A palpitation that follows exertion, or a short run, or violent exercise of any kind, indicates an absence of exercise. Those who carry a little too much flesh, and whose hearts are pressed upon, will have an increased action of the heart, with precordial oppression--they will be pressed for breath. This is an indication that more exercise should be taken.

   Treatment.--Correct whatever the cause is. Where it is a result of the use of stimulants, stimulants must be stopped. If it is the result of imprudent eating, overeating, or anything of that kind, the cause must be removed,

   This means absence of rhythm of the heart-beat.

   A flushing of the skin about the face and neck, coming in patches, indicates sympathetic nervous irritation of the heart. Where this symptom is extreme it is an indication of chronic toxin poisoning from gastro-intestinal indigestion; or it may be due to the use of stimulants--coffee, tea, alcoholics, tobacco, etc. Excessive venery is one of the causes. Regulating the diet and correcting the life of the patient will usually control the worst forms of this derangement.

   Some people naturally have rapid hearts, and there are others who naturally have slow hearts. This is told by the profession, and laymen will readily believe that it is possible. Where the range is below sixty-four pulse-beats to the minute, or above seventy-eight, regularly day after day, there is a cause for it; it is not natural, but pathological. Where the pulse drops below the normal it is due to obstruction of the circulation, and also to abuse of the digestion and assimilation. This is one of the symptoms of excessive venery in youth, to self-abuse. This depressed condition, or slow heart-beat, may first be preceded by a too rapid heart; for over-stimulation and shocks of all kinds will first send the heart flying. Then, as the organism becomes accustomed to the abuse, the heart requires more and more stimulation to keep it at its high rate of speed; and as there is possibility of a falling-off of the exciting cause from many reasons, it would be perfectly natural for the heart to go below the normal, and continue below the normal until there has been a readjustment and a reorganizing of nerve impulses--until the enervation has been overcome and nerve resistance established.

   Violent exercise and fever produce rapid heart action. A continuous state of fear will develop rapid action of the heart. Brain tumors, blood clots on the brain, etc., causing pressure on the nerves of the heart, will cause rapid heart action. Ovarian irritation and uterine diseases frequently cause rapid heart action. But beyond and back of these symptoms are indigestion and more or less emotionalism. Rapid heart action oftener comes from chronic irritation of the stomach than from any other cause. The irritation may be caused by acid fermentation of foods, coffee, tobacco, alcoholics, etc. We cannot have irritation of the stomach without a cause; hence where there is irritation of the stomach, causing rapid heart action, it must be considered that the stomach is only a go-between which passes on the effect from other causes.

   This is supposed to be a family peculiarity. Napoleon's heart-beat was about forty to the minute, and he died of cancer of the stomach. No doubt the mental strain under which he lived had a depressing effect upon his digestion and heart action. There is no question but that he kept up a constant gastric irritation from the anxiety he must have had concerning his activities. His life was so intense that his nerve energy was drained away, enervating the stomach and bowels, When he ate, he did not have the nerve energy to do perfect digesting; hence more or less fermentation, decomposition, and toxin poisoning took place. This produced hardening of the tissues, especially ulceration and cancer of the stomach. This is the price that an ambitious man pays for success.

   Neuralgia of the heart, or breast pang, is a sympathetic affection. It is caused by a hardening of the blood vessels. It is supposed that the root of the aorta, and the coronary arteries, are hardened. The fact of the matter is that such diseases often come from an enervated state of the nervous system from overindulgence in stimulating foods, stimulating drugs, and excessive venery.

   Symptoms.--The disease is characterized by agonizing pain in the region of the heart. The patient will be walking along the street, be taken suddenly with a spasm, and be compelled to take hold of any object that comes to hand, and hold to it to keep him from falling. Not that the legs cannot hold him up, but the pain is so excruciating that is is liable to force him to the ground. More men are affected than women. In all severe cases the patients feel as if every attack they have would be the last. It is strictly a disease of adult life, and I should say it is a sign of premature aging.

   If the disease follows apparently as a sequel of other diseases, such as influenza, so far as the preceding disease is concerned it has nothing to do, except that it is the last straw which breaks down complete resistance and makes the victim subject to the disease. The paroxysms are usually induced by a little exertion or overstimulation--a. cup of coffee, or smoking a strong cigar, or walking up a slight incline, or attempting to climb stairs; anything that takes sudden muscular effort is liable to precipitate an attack. I believe that those who have cultivated an irritable state of the mind and who are steeped in stimulating habits are the type of people who come down with this disease.

   Diagnosis.--The patient may have a slight precordial pain and sense of distress or uneasiness in the region of the heart, which radiates down the arm or up the side of the neck. The first indication of it will probably follow a slight exertion; it may be induced by an unusual meal or overindulgence at the table. Pain in the region of the heart and radiating to the arm, in any subject who is advanced in years or who is prematurely broken down, and who has lived a strenuous life and is known to be the victim of stimulating habits, may be declared to be due to angina pectoris.

   Toxic angina embraces those cases supposed to be brought on from tea, coffee, and tobacco.

   Treatment.--Any change that will right the errors of life is the proper thing to do. Certainly stimulants must be tabooed. The patient should be put on fruit three times a day, and put to bed, and kept there until comfortable. If there is no desire for fruit, the eating of it is not to be urged; but the patient requires rest.

   The bowels should be cleared out with copious enemas every day for a week. The attacks are remedied by most physicians by the use of nitrite of amyl. Such drugs are not necessary. Besides, the influence of this drug is detrimental. It may be a relief for the time, but the dilation of the blood vessels caused by it only builds more and worse trouble for the future.

Electricity is recommended. It should be recognized as a stimulant, and, instead of being a benefit, it certainly is injurious. Gentle massage to the region of the chest and over the spine should be beneficial if not practiced too often; but the cure must come from removing the causes, whatever they are.

   Definition.--A thickened state of the intima or inner coat of the arteries. It is sequential to changes that take place in the other coats of the arteries. The condition is recognized in large arteries as atheroma and endarteritis.

   Etiology.--When developed in a normal, natural way, it is peculiar to old age. It means aging of tissue. But when the disease presents itself in middle life, it is due to old age of the tissue, if not old age of the patient. It means that those so afflicted have lived a very imprudent life. They have lived in such a way as to age themselves beyond their years. Apparently a certain percentage of the people fall into this state more easily than others, showing that they have inherited a diathesis peculiar to this derangement. It is a case of: parents eat grapes, and the children's teeth are set on edge. Parents have prematurely aged themselves, and this condition has been developing in them sufficiently to build a tendency or a diathesis in the children; and as each generation grows weaker or less resistant under the same influences, they naturally develop symptoms on this order more easily than the parents.

   Those predisposed to early aging will be hastened into it by all kinds of stimulants--tobacco, tea, coffee, alcoholics, excessive venery, excessive indulgences of all kinds that tax the nervous system. Then eating to excess, bringing up arterial pressure, and at the same time turning loose in the system toxins from decomposition in the intestine, represent the most intense etiological factors in the development of this disease.

   Treatment.--Knowing the cause is equivalent to knowing the cure. If a certain style of living brings on arteriosclerosis, it should not require a physician to proscribe that style of living to get rid of the disease; and this is the only treatment necessary. If the inflammation of the lining of the heart and arteries caused by toxins is developing a condition of arteriosclerosis, then whatever is keeping up this toxin poisoning must be stopped. The commonest cause is overeating, and excessive eating of carbohydrate and protein foods, too often eaten together.

   If the irritation of the heart and arteries is due to alcoholism, then certainly consumption of alcohol must be stopped. In nearly all cases, correcting all the errors of life-stopping the use of all stimulants, abandoning excessive eating, and getting rid of nerve irritations, worries, etc.--will bring the disease to a condition of status quo. Then, if the patient is persistent in living correctly, the arteries will soften. If he is in middle life, or even younger, in the course of one to three years all symptoms of the disease will disappear. If he is old, his life will be prolonged and made comfortable by this treatment.

   There are different kinds of aneurisms. What is known as a true aneurism is one in which the sac is formed by one or more of the arterial coats.

False aneurism is where there is a rupture of the coats of the blood vessels and the blood is free (or circumscribed) within the tissues. There is an aneurism produced by an ulceration of the internal coat, the blood separating the coats of the artery. This is known as the dissecting aneurism.

   Etiology.--Aneurism is produced by an accident, as a rule. I have seen a blow on the wrist resulting in an aneurism as large as an ordinary-sized pecan nut. Where there is arteriosclerosis, breaking of the arteries is a common occurrence, because the arteries are brittle.

   Syphilis is supposed to cause aneurism of the arteries. If this is true, then the statement should be extended to take in scurvy (scorbutus, or what is more recently called acidosis). Indeed, several years of toxin poisoning can put the subject of gouty diathesis in a physical state where the arteries are hard and brittle, and limy deposits will take place in the valves of the heart and large arteries. This is the constitutional state which favors the development of aneurism. In severe cases of arteriosclerosis the inner coat of the blood vessel, known as the intima, may rupture in several places in the length of the artery. These ruptures will be small, and they lead to a bulging and a gradual production of a small cyst, or sac.

   Embolic aneurism is produced by an embolus being lodged in the forks of a blood vessel. The blocking causes a dilation of the proximal side. The embolus does sometimes become limy. Under such circumstances ulceration is liable to take place, and the limy deposit will be thrown out.

   Arteriosclerosis favors this disease, and, according to the leading authorities, syphilis is recognized as the cause. I presume that there are very few, who treat syphilis in the orthodox way, who are prepared to believe that the treatment has as much to do with the hardening of the arteries and in producing disease of the arteries as the so-called syphilis; but this is true. Nearly all the patients with whom I have had to deal have lived in such a manner as to produce acidosis, or the old-time scurvy; and when scurvy is established in the body it will produce the very conditions that are charged to syphilis. Indeed, the style of living that leads to scurvy, and the treatment given to meet the symptoms that are diagnosed, will produce very much the same results. Aneurisms of the thoracic aorta are most commonly located in the arch, but the aorta is subject to the disease in its entire length. Aneurisms of the ascending portion are often small when a rupture takes place. When the rupture is in the pericardium, death quickly follows.

   Those interested in the history and diagnosis of aneurism of the various portions of the thoracic aorta, as well as the abdominal, are referred to the leading textbooks on the subject. Inasmuch as it is a disease which cannot be cured, I see no reason why I should encumber this book with a lot of detail or description that is of no special worth.

   Symptoms.--All the best authors say that there are no positive symptoms. A tumor may be the cause of the chest-wall giving way, and there is no special pain experienced. It is said that every physical sign may be present without a single symptom. An important, but variable, symptom is pain, It is usually paroxysmal-often very severe when the tumor is eroding the vertebrae or perforating the chest-wall. Pain comes and goes. It often radiates down the left arm or up the neck, and without enlargement the disease might be mistaken for intercostal neuralgia or angina pectoris. Where the tumor presses upon the bronchial tubes, a very distressing cough is liable to be the consequence.

   When there is pressure on the recurrent laryngeal nerve, the cough may have a peculiar wheezing sound. This is called "goose-cough." There is difficulty in breathing. In some cases there is loss of voice; in others, wheeziness. In some cases hemorrhage will take place into the bronchial tubes and trachea; in others, into the pleura; and, as stated before, in still others into the pericardium. A considerable percentage of these cases will enjoy pretty fair health, with death painfully imminent all the time. When these cases go, they go quickly. Some have heart symptoms, but it is of a neuralgic character and points to the root of the aorta being affected. Dilation of the pupil is common; this is when the sympathetic nerve is pressed upon. X-ray examination will usually be required positively to diagnose cases that are obscure--those located in the arch and the descending portion.

   Treatment.--A few years ago there was a coil or gold wire put in the aorta of a patient in Philadelphia. The operation received considerable newspaper notoriety. It was, however, absolutely unworthy of any attention. Such novelties detract from the real purpose and object of what the physician should represent to the people. If the profession would turn teacher instead of doctor, it would be much better, because then such diseases would be prevented, No one will have aneurism of the aorta who has not lived an abominable life for years. He has lived a free and easy life, so far as eating, drinking, and being merry is concerned. Life must be haphazard that will lead to the development of arterial diseases. Preceding such conditions there must be from fifteen to forty years of chronic toxin poisoning. If there were a cure for the aneurism, if it could be obliterated in some way, that would not cure the constitutional derangement and the disease of the arteries which sooner or later will take the patient out of existence prematurely.

   The reasonable, rational treatment must be directed to lower the blood pressure, doing everything that can be done to keep down the arterial pressure. If the feeding is proper, and then the environment of the patient corrected so that there will be no unnecessary irritations, excitement, or affairs that irritate the mental nature, etc., he can be put in a very comfortable condition, and may live for a number of years enjoying moderate comfort.