, mitral murmur, the two absolutely synchronous, but a very much louder than 6, so that by comparison total murmur is heard loudest in the direction of the aorta. \n\n6. The quick exhaustion, the purple face after exercise, the almost daily headache, without or with constipation indifferently, the inability to endure close rooms or large assemblies, are so many affirmative signs of mitral disease. Add to this, the mitral murmur is heard with extreme distinctness as high as under the middle of left clavicle, and under angle of left scapula ; lower toned than over aorta, because it is a lower and different murmur. Increased second sound of pulmonary artery can not be made out positively. \n\nTreatment, — Mrs. B. has taken abont a quart of compound spirits of lavender, and four ounces of spirits of ammonia, about one ounce of quinine, about six hundred aloetic pills, has been bled at the arm twice, four to six ounces for angina pectoris with fever, has been dry-cupped and leeched at the precordia for pain in the heart during fever, has taken digitalis occasionally for excessive rapidity of heart-beats, has taken large quantities of bitartrate of potassa as a diuretic, for swelling of feet and legs, and this with a cathartic of oleum ricini has always afforded immediate relief to the circulation with* out impairing health. She has taken perhaps ounces of muriatic acid in three drop doses after eating, to promote digestion, which for the last three years has been painful without the acid. (The hint concerning muriatic acid in dyspepsia, occasioned by organic disease, I get from Trousseau.) \n\n8. Result, — Her present condition is not unsatisfactory, when the incurable nature of the affection is considered. The hypertrophy has greatly increased : there is more frequent complaint of uneasiness about the heart ; fatigue is not so well borne ; digestion is accomplished with more difficulty ; constipation is habitual ; hematosis is less \n\ncomplete ; the muscles are becoming flabby ; the extremities do not swell so much as formerly, because assimilation is less active, but on the whole she seems in pretty good health, and by treating symptoms as they arise, according to rational ideas now possessed by the profession, she may live yet many years ; perhaps ten, or even twenty, but without constant care and close observation, she might die in a few months, that is, simply by leaving the disease to take its own course. The object of treatment is, in this case, to diminish the labor the heart has to perform, by guarding the integrity of the functions of the skin, lungs, alimentary canal, renal organs, liver, etc., and last, but far from least of all, the nervous system, by preventing mental and moral disturbances, and keeping all causes of grief, depression, anxiety and hopeless desires out of the way. Late physiological researches have made it probable that no causes are so potent in hastening the fatal course of organic disease of the heart as those which act reflexly from impressions made on the nerves of special sense ; and, on the other hand, through these same means the advance of heart disease may be greatly retarded and occasionally held at a stand-still for months or years. \n\n9. Summary, — Is there a certain infallible sign pathognomonic of incompetency of the mitral valves? I do not believe there is any one sign or symptom on which we can rely. But if there is a murmur heard loudest above the left nipple, synchronous with the heart's impulse against the ribs, and at the same time there is increase in the intensity of the second sound of the pulmonary artery, (heard in the second left intercostal space, about half an inch from the sternum, and propagated directly upwards), it is as certain as anything can be that there is mitral regurgitation. But this increased second pulmonic sound cannot always be made out ; still we cannot say, therefore, that the diagnosis cannot be made ont. It cannot be made out with the same rigid certainty, but it can be made so clear as not to leave a reasonable doubt. For example : the murmur is heard above the nipple, the pulse alike weak in both wrists, patient not seeming in good condition as to blood-making power, uncomfortable feeling in the chest, quick exhaustion and lividity of face on rapid exercise, hypertrophy of heart. \n\n10. With two or three of these signs well established, we are sure of mitral regurgitation ; a persistently weak, irregular or intermittent pulse adds to the certainty of the affection. \n\na. All that is known of the cause of intermittent pulse may as well be suggested here, as there will be constant occasion of naming it, to aid in explaining organic lesions. The proximate cause of intermittent pulse is arrest of the systolic movement of the heart, and the remote cause of this arrest is a difficult and unsolved problem in pathology ; but there is reason to believe its origin lies rather in a lesion of some portion of the cerebro-spinal axis, than in any alteration in the structure of the heart itself. This intermittent pulse is the clue that leads us to the remote cause of the organic alterations in the heart, viz. : a primary alteration of the molecular substance of those portions of the brain and cord which preside over nutrition and elimination. This is not an attempt at an explanation of the efficient cause of intermittent pulse, but a dim suggestion as to the places in which that cause is to be sought. It seems sometimes to depend on some obstruction acting like a valve at the orifice of the aorta. The ear is conscious of a systolic movement, and of its arrest when about to be completed ; and during this momentary arrest there is neither sound nor murmur, but the blood itself seems to stand still in the whole arterial system ; and, indeed, it no doubt does, for the arrest occurs directly after the diastole, and ex- \n\ntends not only over the pause between that and the systole, but also occupies the period of part or all of the systolic movement ; and sometimes the arrest is longer than a complete pulsation. In the latter case, there is a sense of suffocation, attended with feeling of profound exhaustion, and a feeling of *' waves^' in the brain, wliich latter feeling interrupts consciousness, and even sensation, for an appreciable instant. The patient often seems abstracted or pre-occupied, and gives postponed and undecided answers to simple questions, from inability to decide quickly and respond promptly, because the brain, from unequal supply of red blood is not always ready to command. \n\nh. Intermittent pulse, considered by itself, is without significance in the present state of knowledge ; but taken in connection with hypertrophy of the left ventricle, mitral incompetency and direct aortic murmur, it still adds ^to the dangerous import of other symptoms. It aids us in the discrimination of aneurism from valvular affection ; for in the former the pulse may be absent from one wrist, but not intermittent in both ; while in valvular disease nothing is more common than intermittent pulse. If there is aneurism and the pulse is intermittent, we may be sure there is valvular disease also ; and it \n\nwill be quite probable that the mitral and aortic valves are incompetent, particularly the mitral. There is an intimate relation between the frequency of the hearths beats and intermittent pulse. Under the immediate effect of a dose of ammonia and lavender, the intermittence will disappear. It seldom or never occurs when the pulse is above 85. It is very common when the pulse sinks below 75, either from unknown causes, or under the influence of digitalis. Yet, if there be no organic disease, digitalis will not develope the intermissions ; but, however extensive the organic lesion, cardiac stimulants, during their action, abolish the intermission. \n\na. It is remarked above, that \" it\" (intermittence) \" seldom or never occurs when the pulse is above 85.\" This needs explanation to seem exact. It is understood that the patient is in repose ; not under the influence of any mental, moral or bodily excitement, and that the heart is not driven beyond the limit of endurance, {a) by some temporary stimulus, for example : excessive indulgence in stimulating drinks ; {h) by violent exercise, such as running uphill, or with all possible speed ; (c) by fright or anger ; {d) by mania, or delirium tremens ; (e) by the agony of angina 'pectoris^ and the violent motions of desperation in the effort to breathe, such as beating the air, \n\nclutching the throat, rapid change of position, etc., etc. Under any of these unusual circumstances or conditions, the pulses will \" hang,'' or intermit, even while the ventricles succeed in accomplishing even 120 beats a minute, as in Case 3 below ; but in such cases, when the usual condition of the patient, as to repose, etc., returns, the pulse will become slower ; the intermissions will give place to simple irregularity in time and tone, and finally under remedies properly selected and graduated, the pulse will become regular in time first, and (if the dilatation of the heart is not too far advanced, or if the fatty degeneration be only incipient,) soon after in tone ; but if the sedative — say digitalis — be continued until the pulse falls below 70, though it be full and strong, the intermittence will return, either as to a part of a systole, while the pulse in the intervals of the intermissions, say for ten, twenty, forty, or even a hundred beats, may be regular in time and tone. \n\nb. When the heart is affected with organic disease, excessive increase of its function from external causes develope irregular, remittent and intermittent pulse ; excessive retardation in the heart's beats induce remittent and intermittent, but not otherwise irregular pulse. It is not affirmed that similar causes never induce similar \n\nstates of the pulse in persons in good health, free from anemia, and free from organic disease ; but one may venture to remark that such a result is at least improbable, and is rarely observed, though sought for with great diligence. The rhythm of the heart is so hedged about by all influences, that any material disturbance is almost inconceivable in the absence of alteration of the blood as to quality or quantity in. special localities, (local congestions or local anemias,) or of abnormities of the heart, arteries, or cerebro spinal axis. But respectable gentlemen and respectable authors assert that intermittent pulse 'per se is no evidence of a pathological condition anywhere. One must be permitted to doubt the essential truth of unproved affirmations. Intermittent pulse is not a normal condition, and if persistent independently of volition, under certain definite conditions, such as those suggested above, it cannot fail to be of grave significance. \n\nc. There are rare cases of rhythmical intermittence, depending on some congenital abnormity, and there are well^ attested cases, but entirely exceptional, in which the systoles-are somewhat under the control of volition, and in which intermittence can be caused by mere volition ; but such cases must be acknowledged to be ab- \n\nthe theory here suggested. \ne. The normal condition of the heart can be normally performed only when the organ is sound in structure, and supplied with proper nutrition in proper quantity, and when it has natural or healthy blood to exercise its function upon, and in quantity proportional to its dynamic structure. Depraved blood supplied to the corronary arteries may cause both irregularities and pain : even spasm, genuine angina pectoris^ may be produced from the same cause. Anemic patients often complain of uneasiness and even positive pain about the heart, and I have seen recently a case of anemia in which there was fixed pain in the third left interspace close to sternum. \n\nPrecordial uneasiness in anemic subjects, is as constant a symptom as irregular and feeble pulse ; and there is every reason to believe this pain and this uneasiness ara the results of defective nutrition' of the heart itself; and it is quite certain, as the anemic condition disappears, as red blood discs increase in number, the uneasiness and pain diminish and disappear at the same \n\na less accented degree. \nh. Finally, extreme excitement and extreme depression develope intermittent pulse from the same cause — defective nutrition and innervation, either relative or absolute ; but in repose the pulse seldom or never intermits, unless it falls below 70 per minute, and then irregularity is less marked than remission or intermission. \n\n11. In mitral regurgitation the heart increases more in width than length. It is important, when there is any doubt of the degree of semilunar incompetency attending the mitral defect, to take this fact into consideration ; for, if the heart is not sensibly elongated, the aortic valvular incompetency will be very slight or entirely absent. \n\n12. Treatment, — a. For m/itral regurgitation a great deal of passive exercise in the open air is of the first importance. This can be accomplished by riding, or sea voyages. Walking should not be recommended, nor indeed any considerable voluntary exercise ; but passive exercise cannot be too much or too constantly insisted upon. \n\nh. Well ventilated sleeping-room — that is, a room in which air is admitted through an opening of two square feet, with no gauze or curtain over it ; comfortable warmth to be maintained by bcd-clotheSj not by the exclusion of the atmosphere. \n\ngiven freely, say a pint a day. \nk. If the patient is strong and full-blooded, a purge should be given whenever there is any tendency to congestions or effusions ; the nonstimulatino- diuretics are always serviceable, given two or three days, at intervals of two or three days. \n\nany medicated bath. \nThe labor of the heart must be lightened from time to time, in bad cases, by purging, by diuretics, and even by leeching and cupping over the base of the heart, or by leeches at the anus. \n\nIt is doubtful whether bleeding at the arm, or in any considerable quantity, would ever be indicated in mitral regurgitation. The angina pectoris^ which comes on with such violent paroxysms, will yield to dry cups in two or three minutes, quite as certainly as to scarifications or leeches followed by cups. \n\nMr. Turk street, with mitral disease and \naortic incompetency, had a most frightful paroxsym. His face and hands were purple ; he beat the air wildly with his arms : suffocation seemed imminent ; his pulse had ceased ; the heart beat 130 per minute ; irregular and intermittent. He was bathed in a sweat of agony, gasping for breath, with doors and windows open. Four cups were placed over the region of the heart, but before the fourth one had been set, his paroxysm began to subside, and within less than five minutes, his pulse became tolerably \n\nregular at the wrist, and the heart beats had fallen to 120, and much increased in strength. The cups were left on three hours, and, on being removed, contained more than a drachm each of serum and blood, which had been drawn through the skin. \n\n14. I am not quite sure the cups would not do as well on some other part of the body ; indeed, there is reason to believe they would, inasmuch as their beneficial effect must be principally reflex ; but the patients always want something done about the region of ihe heart, where they say the anguish centres. ^ \n\n15. I said above, A. \" If the pulse run above 90, digitalis and solution of perchloride of iron are indicated.\" If there is bronchial irritation, with dark muco-sanguineous expectoration, I would add tartrate of antimony, in small doses, to the digitalis and iron. \n\na. The iron and antimony should be alternated with the digitalis, instead of being given at the same time. A drachm of the solution of the perchloride of iron with five grains of potassio tar- \n\n* I sliaU have occasion in the following pages to allude to mitral disease many times, and will attempt to explain the mode of death in this affection in some subsequent paragraph. \n\ntrate of antimony in a pint mixture, composed of equal parts of distilled water and simple syrup, will constitute a preparation of which a teaspoonful or more may be given every two hours, with decided diuretic and tonic effect. If there is albuminuria, it modifies or arrests it very promptly, unless the kidneys, one or both, are acutely inflamed. If such is the case, leeches, or scarification and cups over the kidneys, followed by warm fomentations will be required before the diuretic effects of the iron can be realized. \n\nb. The passage of the iron into the circulation and through the kidneys should be verified by adding gallic acid to the urine subsequently voided, when if iron be present, the urine will instantly become inky. I constantly employ this mixture of iron, or the mixture with the antimony omitted, as a tonic, diuretic, and a sedative to the heart ; and it seems to me to greatly aid the action of digitalis. The perchloride of iron ad ministered thus largely diluted, is probably both preventive and curative of anemia, and thus it must tend to protect and restore the heart itself in the overwork to which it is constantly subject wl\\en organically affected. \n\nproper and rational diet in affections of the heart. For this reason, it would seem fit that he should be early informed of the nature and tendency of his disease, and the reasons of the modifications which are requisite in diet, exercise, etc. It is a mistake to suppose a patient can be made materially worse by being informed of his true condition ; the deterioration will be only temporary, and when the first fright or dread has passed off, the patient will be in a better condition for treatment than when oppressed with vague and irrational fear^, or hopes which he will too soon learn are baseless or improbable. No medication will avail, without the most carefully and rationally regulated diet, both as to quantity and quality. \n\nd. Nothing is more fatal than the theory of treatment which proposes absolute rest in bed, with low vegetable diet for organic diseases of the heart. It will hasten death in almost every case, by the additional injury it entails on the heart's substance, by deteriorating the quality of the blood supplied to the coronary arteries, and to the ganglia, which preside over cardiac innervation. \n\nis maintained at its normal standard of excellence, or as nearly so as possible with the constant progress of a disease whose tendency is always fatal. \n\nthe following : \nCase 5. — The patient, now under treatment, has mitral regurgitation, with all its attendant and consequential ills; hypertrophy and dilatation of both ventricles, aortic semilunar, and tricuspid insufiiciency, oedema of the lungs, and cough with venous blood-tinged mucous : dropsy universal, orthopnoea uninterrupted, dyspnoea so great as to induce almost constant perspiration, g. Here are the clinical symptoms observed at last visit. A large-framed man, aged 35, is sitting almost perpendicular in bed, (his constant attitude,) his face is moist, his breathing labored, cough frequent, venous blood-tinged expectoration, universal dropsy, everywhere in lungs coarse moist rales, and occasional whistling respirations— no first sound at apex, but an indistinct murmur ; intensely increased second pulmonic sound heard over third left cartilage ; aortic second sound replaced by a murmur heard loudest on sternum, between ends of third ribs — \n\naortic regurgitant murmur — tbe radial pulse full, strong, visible, large, resisting and regular, and 120 ; the epigastric pulsation of abdominal aorta is much more forcible and visible than apex impulse ; the carotids throb ; when the two index fingers are placed on the subclavian arteries in the subclavian triangles, the arteries strike the finger ends at each systole, with the abrupt tap of a hammer — a short, quick, flat, decided blow. Mechanism of first sound appreciated by the ear at apex, but no sound ; hearths impulse two inches to the left of nipple in fifth and sixth interspaces ; systolic thrills, to the touch, all over the lieart, especially in third and fifth interspaces, and third right space close to sternum. Jugular pulse ; basic systolic murmur not audible above the second right cartilage ; heart beats exceedingly tumultuous, with moderate but marked heaving impulse at the precordia ; large, full veins everywhere on arms and legs ; nails purple ; a semi-livid hue to the whole body. Copious pink urates have been deposited for months ; liver much enlarged ; head* ache constant, but mind clear ; appetite absent ; digestion and assimilation very bad ; bowels constipated ; pulse 120 ; temporal arteries crawl like worms. \n\ndiagnosis in this case, nor of prognosis. Death is certain and imminent. In this case, though purgatives, diuretics, expectorants and even diaphoretics and perhaps precordial depletion are indicated, and absolutely necessary to the prolongation of life, even for a few days, yet stimulants, and tonics, and concentrated nutrients are equally and quite as imperatively required. \n\nAnd this is the treatment pursued, and directly it is suspended, even for a few hours, all the symptoms and subjective sufferings are worse and much less tolerable. \n\ni. Here whiskey, ammonia, especially the muriate, [because while it, the muriate of ammonia, unloads the liver and fortifies the heart indirectly, if not directly, it certainly diminishes the tumult of the heart, and steadies and retards its beats,] and perchloride of iron, and elixir of bark, and beef juice, and egg-nogg may be given not only with impunity, but with great advantage, and well-founded expectation of adding weeks, or even months, to life by their judicious use. Such a case should occupy a room twenty feet square and fifteen feet high, and the mercury should stand at 60, while two large windows should remain wide open day and night. He should also be wheeled about the room in a chair, that he \n\nprolongation of life. \nI am the more minute in all this detail of treatment because it is applicable to all forms of heart disease, with obvious restrictions and limitations. \n\nDisease of the Semilunar Valves of the Aorta. Direct and Regurgitant Murmurs — Differential Diagnosis of. Treatment of Disease of the Aortic Val^^s, and its CompijcAtions. \n\n2. A murmur with the heart's systole, louder in the direction of the aorta than in any other direction, indicates roughened semilunar valves of aorta, [provided that the chest is not deformed, and there is no anemia.] \n\n3. A murmur coincident with the second sounds or replacing second sound, heard loudest between third and fourth ribs, left side, and close to the breast-bone, and hence downwards indicates aortic regurgitation. \n\nfourth rib, and when so heard can only be con. founded with tricuspid murmur, or the murmur of of aneurism of the descending aorta. It can be distinguished from the tricuspid murmur : a, because in the murmur from incompetency of the tricuspid there is jugular pulse coincident with hearts systole, while the aortic regurgitant is coincident with the diastole of the heart, h, in roughened but not incompetent tricuspid valves, the murmur is synchronous with the hearths diastole, that is with the second sound, and is propogated down the sternum ; hence by auscultation and percussion alone, aortic regurgitation and direct tricuspid murmur cannot be distinguished ; and it is probable that by the nature of the proposition these two affections can never be distinguished in this manner ; but, if we hear the murmur loudest between third and fourth ribs, close to sternum on left side, coincident with the heart's diastole, or the second sounds (emitted by still healthy pulmonic valves,) it is certainly aortic regurgitation, and the murmur heard down the sternum will proceed from this cause alone, or from this and tricuspid roughness combined. But as the tricuspid roughness is of infinitely less consequence than aortic valvular incompetency, it may be merged in the latter and ignored in tbo diagnosis and the treatment, with- \n\nout the least detriment to the patient. \nc. We distinguish aortic regurgitant murmur from that of aneurism, by the fact that the murmur of aneurism is always synchronous with the heart's systole^ while tlie regurgitant murmur is always synchronous with the diastole. If there is any difficulty in establishing these synchronisms, on account of rapidity of heart's movements, it can be remedied by giving small doses of digitalis, every half-hour, until the pulsations are reduced to sixty or seventy beats per minute, when the discrimination will not be very difficult. \n\n25. There may or may not be dropsy of the extremities in aortic regurgitation ; and, if the feet and legs are swollen, this condition may be irregularly intermittent, depending upon the diet, activity of the alimentary canal, or of the functions of the skin and kidneys, by which the circulation may be so far relieved as to prevent or reduce cellular infiltration of the extremities. \n\n26. All valvular diseases, in fact all diseases of the circulatory apparatus, are, iheoretically, likely to produce dropsy of the extremities. But in practice, long standing cases of valvular incompetency [three years, Walshej have been seen in which there was no oedema of the extremities. \n\nvis a fergo, which consists in the ventricular systole, reinforced and supplemented by arterial elasticity, it is difficult to understand -how if the vis a terfro is removed, as it is to a great extent, in incompetency of the aortic valves, there should not be uniformly hemic stasis in the capillaries, and consequential serous infiltration of the extremities, h. In point of fact, I believe that the cases of long standing in which dropsy of the extremities is absent are exceptional. \n\nc. The following sentences of Walshe perhaps explain the frequent absence of oedema in this affection. '' The cerebral capillaries can only be affected secondarily through the pulmonary class ; and the systemic capillaries are much in the same position. Regurgitation may exist to the highest amount without oedema of the extremities.\" Grant that arterial pressure, aided by muscular contractions, valves in the veins, and diastole of the right ventricle, might keep the blood in equable and uniform motion through the capillaries, still how could the arterial pressure take eflfect and urge the blood towards the apex of a hollow cone, the base of which remains open, as it does in aortic incompetency.? Until cases are cited to verify assertion to the contrary, it will still be probable that the amount ofcedema of the extremities will be one of \n\nd. The sequential hypertrophy or that attending aortic incompetency, while at each ventricular systole it increases the distension of the aorta, and while this very distension increases the force of the succeeding recoil, must have a tendency, by adding to the impelling force of the blood, to diminish the tendency to capillary stasis and transudation ; hence hypertrophy in aortic regurgitation is alleviative until it becomes excessive, or until mitral incompetency sets in, and thus retrograde pressure through the pulmonic vessels on the right ventricle, and so on the cavas, and their venous and capillary tributaries, annuls the benefit of, or renders injurious the advancing hypertrophy. \n\ntowards a fatal termination. \n27. Pain in the region of the heart is an exceptional symptom in either mitral or aortic valvular disease. There is always, if the patient's attention be called to it, a sense of discomfort, fullness, or pressure, or weight, or unnatural solidity about the lieart ; and when aortic valvular and mitral diseases co-exist, as they do in the \n\ngreat majority of cases, the sense of discomfort is greatly increased, and there is generally considerable oppression of the chest, and often a dry coughs disposed to be paroxysmal, or to result from fatigue rather than to be continuous. To persons afflicted with aortic regurgitation, close rooms are intolerable ; any weight on the chest, or tight garments compressing the thorax, are unendurable, without great suffering ; violent exercise causes lividity of face and hands, and a sense of imminent suffocation. The patient often feels, on ascending a hill or stairs, as though he must inevitably fall on arriving at the top, and instinctively seizes something for support. There are occasional flashes of oblivion of all things, substantial or abstract ; a sort of suspension of every trace of intellection and special sense, for an appreciable instant ; there is reiterated tendency to heart forgetfuhiess ; that is, the heart seems inclined to rest, and is re-aroused by a sudden inspiration, or throwing up of the hands, or by a start. \n\n28. The hypertropy of the heart that attends this disease is often very manifest to the naked eye, as well as to percussion. The ribs are seen to be sensibly higher over the left than right side ; the hearths impulse is felt over a wider space, and more to the left, and lower. There is \n\na metallic clang to the systole, and especially is the clang heard over the beginning of the pulmonary artery, hetweeii the second and third ribs, left side, close to the sternum. The precordial dullness on percussion is increased in extent, and in jecoral similarity. The j)ulse should be diminished in force, in consequence of regurgitation, pure and simple ; but if the mitral incompetency, co-existing with that of the semilunar valves, is slight, and the hypertrophy considerable, the pulse may be strong and full, but will have an appreciable recoil, sufficient to suggest the idea of a backward current in the artery. In short : \n\nb. The aortic semilunar valves are certainly incompetent when tJiere is a murmur without a sound, prolonged and heard above the base of the heart, synchronous with the hearts diastole ; and when this same murmur is heard at the same time down the sternum, there being no jugular pulse, and when there is_ also hypertrophy and dilatation of the left ventricle, \n\nI must not omit the sign pathognomonic of Dr. Corrigan :• that is, visible pulses of all the superficial arteries, and vermicular onward motion of the tortuous arteries ; the artery moves forward in the direction of its axis — locomotion of the pulses — the radials, temporal and tibials, where \n\nthey run nearest the surface, are those in which the moving pulses are most frequently visible ; *' but in highly marked cases, the carotid, brachial, axillary, femoral and external iliac arteries distinctly present it.\" (Walshe.) \n\nBut although there are few or no cases of aortic incompetency without visible pulses, there are certainly many cases of visible pulses without aortic incompetency. I saw a case not many weeks since, in which all the superficial pulses were visible, a case of aortic aneurism and hypertrophy of left ventricle, in which the pulse was 120, when uncontrolled. The patient died of rupture of the aneurism into the esophagus ; the aortic valves were perfectly competent, tested by water poured into the cut aorta, and by inspection of the valves. Though always present in, visible pulses are not pathogomonic of semilunar incompetency. \n\nd. Dilatation of ventricle is determined principally by clearness and quickness of the systolic movement of the heart ; for though the systolic sound, first sound, be abolished by mitral and tricuspid incompetency, yet the systolic movement \n\nremains as a determinable fact, and occupies an appreciable time, and takes place in -an appreciable manner ; and it is by the manner and time occupied in this systolic movement^ other things not opposing, that dilatation of the ventricle is made out. If all the facts mention^ in paragraph h are present, aortic valvular incompetency is absolute, (if there is no deformity in the chest of the patient, no tumor, etc..) but if one of those facts are wanting, the diagnosis lacks demonstration. For example, if hypertrophy and dilatation are absent, incompetency is improbable. If the murmur down the sternum be absent, the upper murmur may depend upon roughness on the inner surface of the aorta ; but in this case, the murmur will generally be hounded hy a sound, that is, wil terminate in the click of closure of the aortic valves, though not always, especially if there is mitral regurgitation, fatty degeneration of heart tissue, constricted mitral orifice, or when the aortic valves or the aorta itself is thicker and less elastic than natural ; in all these cases, the pound, though its mechanism be present, may not reach the most practised ear ; but the diagnosis of aortic valvular incompetency is made certain only by the concurrence of the facts mentioned above. \n\ntions. \na. Aortic incompetency, in its beginning, may exist alone, or without mitral defect. In such case the lungs will not have become congested, as in mitral lesion, and we shall not have to contend with the annoying cough, or the spitting of dark blood, transuded from the pulmonary vessels. But there will be the same need of lessening the labor of the heart by all means consistent with the hygiene of the whole system. For example? in aortic incompetency, absolute quiet is indicated for that alone ; but absolute quiet is incompatible with digestion and nutrition, and the case would terminate fatally all the sooner in conse. quence of a low grade fever which would be generated. The treatment is rest, as to voluntary exercise, but passive exercise in the open air, without a day's interval, such as travelling by stage or rail, in ordina-ry vehicles, or on horseback ; the absence of all excitement and annoyance ; a light but nutritious diet. The patient may eat a little at a time, four times a day, much rather than an abundant meal twice a day. Small meals disturb the circulation much less than large. \n\nBut, UDfortunately, few persoi|j|^an follow the passive exercise treatment. They lack the means, or they are hindered by family ties, or the dread of being away from friends, or a disinclination to this species of exercise, and principally would they be hindered by a doubt of its efficiency : and this no doubt would increase, when after several months they found themselves no better ; whereas, a patient should be abundantly satisfied, in almost all lesions of the heart, if he gets no worse. When we hold an affection of the heart in check, we accomplish all that can with any reason be asked of us. When we alleviate symptoms— not entirely remove them^ — we do all that a tolerably well educated patient will believe possible. We can prolong life, but we cannot say to our patient that he is no more liable to death than he would be were his heart perfectly sound. \n\nd. In aortic incompetency, the patient is liable to sudden attacks of fainting, from anger or violent excitement, or over exercise. Absolute quiet, free exposure to the air, dry cups to the precordia, or if cups are not at hand, a few drops of boiling water over the base of the heart, or a mustard plaster will restore the circulation. A copious draught of cold water might cause instant death, by reflex shock to the already exhausted \n\nheart. A spoonful of brandy and water, or a few drops of spirits of ammonia, with spirits of lavender and water, would aid immediate restoration ; hot applications to the soles of the feet, or leeches to the end of the alimentary canal, are slow but unobjectionable temporary remedies. \n\nThe bowels must never be constipated for a day ; this can be avoided by taking daily at bedtime an aloetic or compound rhubarb pill, or a pill of the following : \n\na. R. Aloes, Rhei, Comp. ext. Colocynthidis, aa, dr. ij ; Ext. Xucis Vomicae, scruple j. Mix, and make, according to art, into sixty pills. \n\n29. Formula a will be found convenient and efficient in almost all cases, and rarely contraindicated. If dropsy should occur, either general or local, it is to be treated not as an idiopathic dropsy, id est, a hydremia, or anemia, but it must be met with purgatives, diuretics, low diet and diaphoretics, that the overloaded circulation which is its cause may be relieved as soon as possible ; and to assist this purpose, absolute rest should be enjoined, and the hearths action diminished with small doses of digitalis, often repeated, or digitalis alternated with aconite. \n\nand nothing more : \na. Aortic incompetency admits reflux of blood into left ventricle, at the instant when the direct current is entering it through the mitral orifice ; hence the ventricle is overloaded and gradually enlarged — dilated and hypertrophied— the more frequent the heart beats the less the opportunity for regurgitation, and hence the less the ventricular engorgement ; but digitalis '' slews'^ the heart beats, and hence allows more time for aortic regurgitation, and hence increases the dilatation of the ventricle. \n\nb. Now, all this is true, but still it is no objection to the guarded use of digitalis. The argument against it deals with logical extremes, and is conclusive against digitalis from that point of view ; but the drug should be given to slow an excited heart, beating with excessive frequency, say more than 90 per minute, but not to reduce it below 80 or 85, for then it would become injurious, not only by favoring dilalation, but by increasing the already almost peculiar tendency to sudden death. Digitalis may be given, but with more caution than in any other valvular disease, and with quite as much caution as in \n\ndilatation of the left ventricle. A minute dose often repeated — say every fifteen minutes — is infinitely safer than a larger dose at correspondingly long intervals ; a half a drop of the fluid extract every ten or fifteen minutes will often be found sufficient to keep the pulse at 85, when without it, it would ascend to 100 or 110. \n\nc. I am in the habit of giving, empirically, in every affection of the heart, where there is uneasiness, pain or much discomfort, a fourth of a grain of quinine, with the sixteenth or thirtysecond part of a grain of opium from three to six times a day. I double or quadruple the dose at times, when there is renal, pleuritic or hepatic pain, and patients more frequently ask for a repetition of this remedy than of any other ; but if there is headache, which is of frequent occurrence in valvular diseases, the smallest dose of opium appears to make it worse, while small doses, one fourth or one-half grain of quinine, often repeated, gives prompt and steady relief. \n\nThe weight of the patient must be reduced from time to time by diminished diet, such as lean meat and dried meats, with a little stale bread, in small quantities, without vegetables or liquid food. Even water should be drank sparingly. By these means the blood may be diminished in \n\nmain unimpaired. \nIt is by no means desirable to add any form of spangemia to organic disease of the heart ; and, although reduction of the heart's work is imperative, it is of the highest importance not to reduce its own strength and tone, while attempting to diminish the blood, which is at once it sustenance and its burden of toil. \n\nThe law applicable here is applicable in every organic disease of the heart, with modifications suitable to each case ; to wit : the heart must be aided by diminishing the labor it has to perform, without diminishing its own proper vigor or functional ability. \n\n5. .Aortic obstruction — constriction of aortic orifice — is indicated by a murmur coincident with the systole. The^r^^ and second sounds of the heart may remain unimpaired, but as aortic constriction must induce hypertrophy, we should find the impulse of the heart occupying a larger space, and the systolic shock increased, but in practice this is not always so. \"^ . \n\nBut it may as well be stated here, that there is no known pathognomonic sign or signs of aortic constriction. Its existence may be made out with extreme probability, but never with the absolute certainty of mitral or aortic regurgitation. \n\n6. Nothing can be determined by the pulse of exclusive significance ; it is likely to be regular in force and rhythm ; but if the hypertrophy of the ventricle is pronounced, it will be hard and and small, and have a wiry feel. Systemic dropsy is not a concomitant of aortic constriction ; cough is not present, although there must be tendency to engorgement of the lungs, when the blood flowing into the ventricle from the pulmonary veins, encounters, as it must, an amount of blood entirely excessive. There may be a slight cough, but if it is persistent, and the lungs not inflamed or tuberculous, and if there is no catarrh, either constriction or incompetency at the mitral orifice must be suspected as a complication. A persistent aortic constriction entails (Walsh) a dilatation of the mitral orifice, and hence the murmur of mitral regurgitation from insufiiciency, when the mitral valve itself is perfectly sound. \n\n7. The anemic murmur is not persistent ; murmur from unevenness of the internal surface of the ascending aorta, is heard louder farther up the sternum than that from constriction of the orifice. \n\na, A marked fact in constriction of aortic orifice, is that the murmur is frequently heard in so many places and at such remote distances from its origin. It is heard under the right clavicle near the axilla ; it is heard in the carotid, in the interscapular spaces, in all the intercostal spaces as low as the sixth, and in nearly as many of the left interspaces. \n\nh. It is of slow progress towards a fatal termination, and is susceptible of becoming null as to its injurious systemic effects, by the hypertrophy of the ventricles, left and right. I say left and right, because this is the order in which their hypertrophy occurs in aortic constriction. \n\n8. JVarroiving of the aorta is sometimes a congenital condition, probably an intra-uterine arrest of development. The striking case mentioned by Latham exhibited the aorta and all its principal branches entirely free from disease, but more than one-half less than their natural capacity ; the heart was found enormously enlarged and its cavities dilated. In Meckel's case (1750) quoted by Latham, the patient was a puny girl of 18. She had been from time to time subject to palpitation, and anguish, and trembling of the limbs, from infancy to her fourteenth year, and thenceforward the palpitation and anguish had \n\nbecome constant and more severe until her death. Upon dissection, the heart was found enormously enlarged, and the aorta, throughout its whole course, especially through the -chest and all its principal branches, marvellously narrowed. The heart had both its ventricles dilated, and their substance more soft than natural ; its auricles also dilated, but the left to a degree far greater than any other cavity. It was capable of containing the enormous quantity of twelve ounces, while the corresponding ventricle only contained foHr. The aorta was not more than half the diameter of the pulmonary artery.\" \n\nThese were evidently congenital malformations of the aorta, and the enlargement of the heart was a necessary consequence, and perhaps an indispensable condition for the continuance of life. \n\nBut constriction of a short segment of the aorta will have the same effect on the heart as this general narrowing of the aortic trunk and its principal branches. \n\n9. The treatment of aortic constriction is in no wise peculiar, and would be the same, with limitations, as that of aortic or mitral regurgitation. When the patient becomes over fatigued or excited, the pulse is very likely to become oppressively intermittent, perhaps to the extent of eight \n\nor ten times a minute. When such a condition supervenes, absolute quiet should be enjoined, and the heart stimulated to regular contractions, by a dose of lavender and ammonia, or by dry cups. A little blood abstracted from the precordia by leeches, or scarifications and cups would almost instantly relieve the overtasked organ, not entirely by reflex action, but by absolutely diminishing the fullness of the vessels near the base of the heart, for it will be borne in mind that the internal mammary artery rests upon the costal cartilages, a short distance from the margin of the sternum ; it sends branches to the upper part of the pericardium — pericardiac arteries — also to the skin covering the base of the heart — anterior perforating arteries — hence blood abstracted from the precordia would be abstracted from the near vicinity of the heart itself — namely, from the membrane investing it. And it is for this anatomical reason that local depletion is insisted upon in pericarditis by a late author (Markham). \n\nBut however this matter be explained, one thing is well known to all observers, that the local abstraction of blood in the vicinity of the hearths valves rapidly relieves all cases of angina pectoris in the various forms of unsound heart. \n\nI am not oblivious of an apparent discrepancy in this statement with a fact previously stated, that neuralgic pain, of which angina pectoris is undoubtedly an example, depends on some local anemia. But this is more apparant than real — for the anemia may [be relative or absolute — absolute when the total mass is diminished ; relative when there is merely obstruction to its movement through some part. Again, a structure may be overwhelmed with venous blood in a state of stasis ; for example, the arm below a ligature ; the brain and upper extremities from a tumor pressing on the descending cava. In this case there would be pain in the head, perhaps, and yet there is excess of blood ; but there is diminution of arterial blood circulating in the obstructed parts — this is relative anemia. \n\nExcess of non-oxygenated blood is equivalent as to the production of pain, to diminution or defect of arterial blood — anemia. The pain induced by this venous stasis or retardation, might be relieved by local depletion, while pain from direct anemia of red blood should be relieved by arterial stimulants and hsematogens. The pain of angina 'pectoris is probably often if not always caused by local retardation of the blood current, that is, by venous congestion — relative anemia. \n\nBut it cannot be ignored that this local depletion is much more applicable to acute inflammations of the inside or outside of the heart, especially of the latter, than to sudden accessions of congestion or anguish in chronic changes of the heart's structure, such as the affection under consideration— constriction of the aortic orifice. If the paroxysm or excessive palpitation in this chronic affection of the heart, or of most others of the same organ be not promptly relieved by dry cups, sinapisms, or by leeches or scarifications, the overtasked heart should be relieved by a small amount of blood taken from the arm. This is rational in theory and verified in practice. *' I consider that T have seen life preserved by timely abstraction of blood (by venesection) in cases of chronic valvular diseases of the heart, where the organ was so overwhelmed and laboring as to render death imminent.^' (Markham.) \n\n10. Care must be taken that too much blood, relatively to the condition of the patient, be not taken from the arm, lest by the alteration of the normal ratio of globules and fibrin, or by the feeble action induced in the heart, the formation of clot be favored, and death be caused in an instant. Such accidents have occurred, to the horror of the physician, who bled with the most \n\nhonest intentions, and under the influence of the dictation of the classic authors in medicine. But under the present rational ideas of the uses of blood-letting — merely to relieve an immediate and urgent necessity — there is little danger of a careful physician allowing more blood to flow than is absolutely requisite to relieve the congestion of the heart or lungs. Concerning the treatment of aortic constriction itself, we know absolutely nothing. All we can do is to prevent the accidental complications which attend it from suddenly destroying life. \n\n11. Like all other chronic diseases of the heart, it has no known essential (denoting its essence) symptom ; and hence we cannot direct our treatment t(^g^e cure, or the arrest, or even the deterioration of the disease in its intimate nature. We see not the disease, but its effects ; namely, constriction, incompetency, etc. These are the anatomical alterations which the disease has produced, but they are not the disease itself. This lies behind the visible effect. It exists anterior to it in the blood, and in the ultimate structure of nerve and brain substance. \n\nIn chronic affections of this kind, then, we can only treat symptoms. But what are symptoms ? Latham has eloquently and well said, *' They are \n\nnot mere signs of the disease, but they are direct emanations from it ; not things in themselves nugatory, but eminently real. They are natural sensations unduly exalted, or unduly depressed, or variously changed or perverted. They are natural functions hurt, hindered or abolished. \n\nAccordingly, it often happens, even where the disease is best understood, that we treat the symptoms of the disease only, just as if we had no knowledge of anything beyond them. Therefore, when we have confessedly no strict knowledge beyond them, (which is the case ipi chronic aflfections of the heart,) and the aim of our practice must need centre in the symptoms; we are not to lament over the shortcomings of our art, and its straitened capacity for doing good ; for, it does not follow that, if we knew the disease ever so well, we would treat it otherwise than we are now treating its symptoms, or that what we are now doing for the symptoms would not be the best and would not be all that could be done for the disease itself.\" \n\ntic constriction or obstruction. In the former case, the murmur is coincident with second sound — of the pulmonary artery, when that of the aorta is replaced by the murmur — in the latter case, the murmur is synchronous with the first sound, and both first and second sounds are audible. It is more common in old people, but young people are by no means exempt from it. \n\nWere I called upon for an opinion in a suspected case of this kind, I should attempt a diagnosis by .exclusion. It could be determined that the murmur was not mitral regurgitation from its location and direction, and from the persistence of mitral^r^^ sound, if the mitral orifice were not also incompetent. It is not aneurismal from the absence of dysphagia, of sense of a foreign body in the thorax, of thrill on digital pressure in the intercostal spaces. It is not aortic regurgitant, for it is not coincident with the diastole, etc., etc. \n\nI^ must not leave the consideration of alterations of the aortic orifice, without alluding to an unexplained fact in connection with aortic regurgitation ; that is, extreme tendency to instanta\" neous death. \n\ntion of the circulation, as well as when walking or when motionally excited. The freer the heart is from any other lesion, Walshe says, the more likely is the patient to instant death from aortic regurgitation. The- assurance of life is much longer if to the aortic, mitral regurgitation and ventricular hypertrophy ,be added. Even the addition of that most fatal of all valvular affections tricuspid insufficiency^ is preferable to aortic regurgitation, pure and simple. \n\nthe least evidence of labored circulation. \nDeath occurs from syncope. It is a \" fainting away'' from which the patient never awakes. This peculiar tendency in aortic regurgitation was first publicly noticed by Chomel, and next by Aran. (Walshe.) \n\nHopitauXj 9th June, 1860. \n\" In 1844, M. H., Minister of Finance under the reign of Louis Phillipe, was working one morning with one of the ministry. The absence of a document compelled the latter to absent himself for \n\na few moments. When he returned, five minutes or more after his departure, he found th€ minister with his body inclined backwards over his chair, his right arm hanging over the arm of the chair, still holding the pen with which he had designed to write his signature to the document. All the means employed in such cases were resorted to in order to restore M. H. to life, but in vain ; he was dead. \n\nThe autopsy, made by Blandin, revealed no lesion either in the brain or lungs. The heart was very large and loaded with fat ; its right cavities, distended with black blood, were a little dilated and very much thinned. The left ventricle was greatly hypertropied and enormously dilated. Excepting a few nodosities, the mitral valve was healthy ; but the aortic orifice was much constricted, and the sigmoid valves entirely ossified. There were a few cretacious deposits in the aorta. \n\nIt is important to add that the health of M. H, had exhibited no grave derang^ement which could have presaged the sudden stroke which teiininated his existence. He had never had any of the general symptoms pertaining to diseases of the heart, \n\nquently saw at La Pitie, a sub-officer of the guard of Paris, who had long frequented the hospital for advice concerning palpitation of the heart, and a constant difficulty of respiration. In this case there was ascertained to be a double hruit de souffle at the base of the heart, and the diagnosis was aortic insufficiency. He had neither dropsy nor anasarca. For many months M. Mauriac did not see this patient, when he learned that he had died suddenly. One of his comrades, who was on duty with him, left him alone to copy some document ; when he returned, at the expiration of a few moments, he found his friend dead in front of his desk. At the autopsy, no lesion was found anywhere, except insufficiency of the valves of the aorta, with hypertrophy and dilatation of the left ventricle of the heart. \n\nOne year after this, Mauriac observed the following case : A young man, twenty-six years old, of robust constitution, about five months before entering into the hospital, had suffered for a fortnight with pains under the left false ribs. Six weeks before;* he had palpitation for the first time, and one month previous, that is, on the 3d of March, he was taken with obstructed or impeded respiration and pains in the left groin, which radiated along the lower extremity of the same side. The* 2d of April, his condition was \n\nas follows : Slight emaciation : partial distension T3f the veins of the neck; visible arterial pulsations ; skin warm and moist ; 88 to 92 pulsations, vibrating, irregular, intermittent at the arterial diastole from time to time. The heart is considerably enlarged. The maximum of impulsion takes place in the fifth intercostal space, 11 centimeters ^ from the axis of the sternum ; it measures vertically 11 centimeters upon the median line, and more than IC centimeters obliquely from right to left. The impulsion is thrilling, and accelerated at times, as if the heart struggled to overcome an obstacle. The ear applied over the apex, perceives a double bruit de souffle, the* second much softer, more mellow and prolonged than the first. Ascending towards the base of the heart, this double stethoscopic phenomenon persists and seems to reach its maximum of intensity under the second and third intercostal spaces, on the left side, in the vicinity of the sternum, also under the corresponding portion of this bone. This double bellows-murmur is also very marked in the aorta, the dullness of which is sensibly increased. Finally, in whatever place the ear is applied, there is not heard \n\nany trace of the second normal beat of the heart. Bellows-murmur diastolic, intermittent, and very strong in the carotids. There is neither fever nor oedematous swelling of the abdominal extremities. \n\nThe 8th of April, the 6th day after his entrance into the. hospital, the patient died suddenly, at seven o'clock in the morning. During the last few days of his life he complained of a feeling of severe oppression and a sensation of uneasiness at the epigastrum ; the morning of the day before his death, he complained of great difiSculty of respiration ; however, he still kept about ; in the evening he supped as usual ; during the night he had some suffocating attacks, his sleep was agitated and painful • at seven o'clock in the morning he awoke and lay tranquilly in bed. All at once he lost all consciousness, his head fell back, his limbs straightened and were convulsively agitated, his face became rapidly purple, and almost immediately grew pale, and in less than ten minutes he died. \n\nThe heart, emptied of its clots, measures 0.13 centimeters from base to point, also transversely at the level of the base. The pulmonary orifice was 0.075 millimeters in circumference. The ventricle is a little dilated and hypcrtropied. \n\nThe right auriculo-ventricular orifice is somewhat enlarged ; its valves are supple and transparent ; the left presents some granulations on the auri cular surface. Very marked dilatation of the right auricle. \n\nThe aorta is dilated immediately after its issue from the heart in such a manner as to assume a position more anterior than usual, and crowd the pulmonary artery backwards; the dilation extends as high as the origin of the left subclavian ; it has, however, preserved the flexibility of its walls ; finally, in the neighborhood of its orifice it exhibits a beginning of atheromatous alteration. The left ventricle is enormously dilated. The dilatation affects solely the arterial portion, and the mitral valve is forcibly pushed backwards, also the fleshy columns inserted into it, which latter are atrophied rather than hypertropied. The diameter of this ventricle is 7 centimeters, the thickness of its walls 13 millimeters. The mitral valve is supple, but the tendons which subtend it are thickened. Insufficiency of the sigmoid valves of the orifice of the aorta. A clot is prolonged to a height of 52 millimeters above the origin of the vessel, and adheres to the greatly altered right valve. The anterior and posterior sigmoid valves are thick- \n\nened and indurated, and have lost their elasticity, and contain, particularly at their bases, cretace- ous and cartilaginous granules ; their separating partition is much thickened. The right valve is almost entirely destroyed at its middle. \n\nDr. Mauriac proceeds to investigate the mechanism of sudden death, to study the elements of prognosis, and the therapeutical indications to be deduced from a knowledge of this mechanism. \n\nWhen there exists, says M. Mauriac, an insulfi* ciency of the sigmoid valves of the aorta, and when the hiatus which is the consequence of this is insufficiently large to permit the re-entrance of a considerable quantity of blood, at the instant of the hearths diastole, into the interior of the left ventricle, the latter becomes more or less distended, and it is compelled to increase its activity to impel into the whole arterial system this excess of blood, added to the amount which comes from the lungs. There results a hypertrophy of the walls and a dilatation of the cavity of this ventricle. \n\nSo long as these lesions do not go beyond a certain point, and particularly so long as they remain simple, that is to say, not complicated with any other morbid change, they oppose the stagnation of the blood in the lungs and in the \n\ncardiac cavities ; and are, therefore, salutary because they prevent the insufficiency from producing any considerable perturbation in the equilibrium of the general and pulmonary circulation. But hypertrophy and dilatation of the left ventricle of the heart, consecutive to valvular insufficiency, tend almost always to indefinite increase ; and in proportion as they increase they lose more and more the character of a, so to speak, normal and physiological hypertrophy and dilatation, because they become the seat of vsecondarj lesions, which embarrasses the circulation in the hearths own vessels and alter its muscular fibre. \n\nNevertheless, when the hiatus of insufficiency is small, when there is not considerable stricture of the aortic orifice, or complete rigidity of the aortic valves ; when the inflammatory morbid process which has produced the insufficiency and the lesions at the origin of the aorta, is arrested and definitively extinguished, it is possible that the hypertrophy of the left ventricle having reached that degree which the maintenance of the equilibrium of the circulation requires, will desist in its progressive development and remain stationary during the remainder of life. M. Mauriac considersit certain that such a condition exists in those individuals who have been for a long time aflfected with aortic insufficiency, and \n\nwho finally suffer only slight inconveniences referable to the heart, such as palpitations or momentary dyspnoea, etc. He has seen cases in which auscultation left no doubt of the existence of an insuflSciency of the aortic semilunar valves, who had not even supposed they had any disease of the heart ; percussion in tliese cases revealed only slight enlargement of the heart. The hypertrophic process had no doubt subsided, and to this cause they were indebted for their undisturbed health. \n\nUnfortunately, hypertrophy and dilatation of the left ventricle rarely remains circumscribed within these limits. There are many causes which tend constantly to augment these two lesions in which consists all the danger of insufficiency, and the action of which culminates in perturbations of the hearths own circulation. \n\nThe organo-pathological development of hypertrophy and dilatation of the left ventricle, consecutive to sigmoid insufficiency, presents three stages : one stage of simple and salutary hypertrophy and dilation which augments the labor of the heart, and may counteract in part for the injurious' effects of the valvular alterations ; a stage of hypertrophy and dilatation complicated with the preceding lesions, and with more or less fatty \n\ndegeneresceiice. Fatty degenerescence is very frequent in aortic insufficiency ; it is the last step of morbid organization of which the ventricular walls become the seat, when hypertrophy and dilatation are not arrested in their first stage. Among the numerous causes of this complication, M. Mauriac thinks that which plays the greatest part is the progressive enfeeblement of the interstitial circulation of the heart, either when this enfeeblement depends upon aortic insufficiency itself, or, at the same time, upon alterations in the origin of the aorta and cardiac arteries. Still, as these alteration? run a course essentially chronic, as well as the valvular lesions, it results that it is only at a very advanced period of cardiac disease that degenerescence is observed. \n\nWhen it has invaded the whole organ, there is observed a considerable thinning of the walls, dilatation and extreme flaccidity. Hypertrophy of the walls is, then, in this phase of the malady replaced by their atrophy ; but the dilatation persists and tends even to become increased, if death does not intervene and suddenly remove the patient. • \n\nHence, we arrive at the conclusion that the organic cause which induces sudden death in cases of aortic insufficiency^ is hypertrophy and dilatation of \n\nFrom the instant these lesions have taken place, the patient is momentarily in danger of sudden death. Finally, this mode of the termination of life never occurs in those cases that, consecutively to innoclusion of the aortic valves, have only moderate dilatation and hypertrophy. All the observations collected by M. Mauriac prove this fact in a categoric manner. \n\nchanism of sudden death. \nThe heart, the centre of sympathy, upon which are accumulated, by reflex movement, all the impressions of the organism, whether morbid or physiological, becomes, in consequence of the lesions suffered, excessively susceptible to the perception of these impressions. Thus, every moral perturbation, every affection of the mind, which disturbs or tires the centres of innervation, all fatigue proceeding from excessive muscular exercise, or from whatever expense of nervous influx, are so many eausQs which may accidentally induce *death. \n\nUnder the influences of any of these causes, the ventricular systole is enfeebled, becomes incomplete, drives into the arterial system only a por- \n\ntion of the blood which was accumulated in the ventricular cavity, at the moment ot the diastole. But the elasticity and contractility of the aorta and its branches not being duninished, it re-acts upon the blood-columns, and impels a recurrent jet through the hiatus of insufficiency with the same energy as previously. \n\nIt follows that, after the second systole, the heart is overcharged with a mass of blood exceeding the amount it contained at the instant it was surprised with the debilitating action of the accidental cause. If it recover its energy, the circulating equilibrium may be restored ; but if its feebleness continue, the difficulty increases, and the quantity of blood which accumulates in its cavity is augmented at each systole, and at each reaction of the aorta upon the liquid column which is no longer shut off from the heart by the complete partition which is made in the normal state by the aortic volves. \n\nThe accumulation in the ventricular cavity of the blood which comes from the lungs and the different arteries, dilates the left ventricle more and more ; and, finally, it can no more contract. \n\nFrom all that precedes, it follows, that as to the prognosis, that of all the diseases of the hearts there is none the result of which is so difficult to \n\nShock of the point of the heart several times the thickness of a finger outside of a line vertical with the left nipple, energy of its impulse, absence of normal resonance over a considerable extent, indicating that the hypertrophy and dilatation of the left ventricle have reached that degree where sudden death by instant cessation of the movements of the heart becomes imminent ; all these are signs of the worst significance. \n\nresult can be drawn from abnormal murmurs. \nThe depressihility of the pulse, which is observed at its highest degree when the hiatus of insufiSciency is very large, should be regarded as a sign of bad import. Among functional troubles, accessions of dyspnoea, above all^ when accompanied with violent palpitations, are also of serious significance ; it is the same with syncope, which, extremely grave in all affections of the heart, without exception, is much more so in aortic insufficiency than in any other disease of the organ. \n\nThe resources of science are, unfortunately, too often powerless in this affection. All the efforts of the physician should be directed against the most imminent danger, that of syncope, by all the hyt^ienic means susceptible of detaining in its progress the evolution of the organic lesions. The facts demonstrate the danger of the method of Valsalva, of which indications have been imagined to exist in the fullness and apparent force of the arterial diastoles. Bleeding should be practiced only with very great moderation, and only in cases where there exists an engorgement of the lungs which impedes the general circulation. \n\nSedatives and cardiaco-vascular hyposthenisants are indicated as palliatives in all cases where there are violent palpitations, dyspnoea, or precordial anxiety. Finally, the true curative indications are deduced from the course of the morbid process, of which the walls of the heart are the seat ; it is especially by revulsive treatment, (cupping, scarifications, temporary blisters, cauteries, etc..) that the indications of treatment are fulfilled. \n\n1. Skoda says he has never observed deficiency of the valves of the pulmonary artery, or constriction of its orifice^ in consequence of faulty valves, [By '* faulty'^ he means diseased or altered, but not defective or incompetent.] Should incompetent pulmonic valves occur, the incompetency would be certainly recognized by a murmur in place of the second sound, of the pulmonary artery, and this murmur would be heard loudest between second and third ribs, near sternum left side, and from that point directly dow^nwards. There would be hypertrophy and dilatation of the left ventricle in a less marked degree than in aortic regurgitation, and hence the impulse of the heart would be felt over a less extent than in the latter affection. The murmur of pulmonic regurgitation has a sighing quality, (Hope) not observed in aortic regurgitation. This sighing murmur is also heard in connection with diminished second pulmonic sound, when the valves of the pulmonary artery are slightly defective, but not so much so as to prevent the flapping of the valves. (Hope's experiment.) \n\n2. The pulmonic valves are also liable to become roughened, in a chronic manner, from exudation of plastic matter, or from the deposition of analogous tissue, without destroying their competency. In such case there would be a murmur synchronous with the systole, heard loudest in second left interspace, and propagated directly upwards. \n\nmonary valves. \n4. The slightest compression, as of a tumor, a congested portion of lung, a foreign body upon the pulmonic artery or aorta, produces murmur and thrill synchronous with the hearths systole. \n\n5. The second sound, much diminished, might be heard in many places on the chest, even were the pulmonic valves utterly incompetent, if those of the aorta were still sound ; but the second souna heard would proceed from the aortic, not the pulmonary valves ; and so, when the aortic valves are incompetent, so as to furnish no sound, a much diminished second sound will quite probably be heard in the second left interspace, proceeding from the sound pulmonic valves ; for the \n\nsecond sound is caused by the shutting back, at the same instant, of both sets of sigmoid valves, just as the first sound results from the synchronous closing of right and left auriculo-ventricular valves. Practically, lesions of the pulmonic valves may he ignored in the diagnosis of unsound heart, \n\n6. Constriction of the mitral orifice. Diastolic murmur from this cause is exceedingly rare, even when the constriction is considerable ; this defect of murmur results from the feeble force with which the blood flows from the left auricle into the left ventricle. The auricle is a feeble muscle, and not being supported by a valve, could hardly inject the blood flowing into it from the pulmonary veins into the ventricle, with force sufficient to develope a murmur, unless the constriction should not have a very small orifice, and even then the murmur must be feeble, and would certainly be preceded by a loud murmur of mitral regurgitation. \n\n7. Mitral diastolic murmur is certainly very rare. Latham says it is a clinical curiosity ; there is no murmur because there is no impelling force from behind. Markham met with less than a dozen cases in eight or nine years, a, Austin Flint, on the contrary, seems to have been peculiarly fortunate in detecting this murmur ; he \n\nsays : *' It [mitral direct murmur] is by no means so rare as has been supposed. I saw at one time last winter six cases of it in Belle Vue Hospital) and several others at Blackwell Island Hospital.'^ \n\nh. I have never yet been able to detect mitral direct murmur, although I have had many cases in which there could scarcely be a doubt of mitral constriction. \n\n8. Sometimes the murmur is attended with a palpable thrill at the left 2^^(ix—fremissement cataire; in well marked cases where the action is vigorous, a loud and prolonged murmur is heard at apex and upwards, in direction of left nipple. This affection causes hypertrophy of left auricle and right ventricle, pulmonary congestions; aortic sounds and beat of arteries, weak in proportion to constriction ; hasmoptysis of venous blood frequent and easily excited ; breathlessness easily induced by over-exertion ; rest and quiet in an especial manner produce ease and comfort. Skoda^s symptom, increased second sound of pulmonary artery, is here well marked, and relatively intensified on account of the weakness of the Ze/if ventricular systole and diminished second sound of aortic valves. \n\nsometimes prolonged. The murmur is sometimes wanting, where the constriction is found after death. The absence of the murmur may be reasonably attributed to weakness of auricular systole, or to smoothness of constricted orifice. The murmur comeS and goes even wlien orifice is greatly contracted : this is probably due to varying force of heart's action. \n\n10. Skoda says, in mitral constriction hypertrophy occurs rapidly ; that it is attended with a prolonged murmur, extending even into the period of the systole of the ventricle. During systole no sound, or an indeterminate sound, in heard in left ventricle ; again, a murmur (systolic) may he heard there, because deficiency of the mitral valves is generally associated with constriction of mitral orifice. Sounds of aorta weak, heart's impulse increased and perceptible even, over a greater extent than natural. \n\n11. Hope says the murmur is feeble, soft, usually on a lower key than a whispered who; absent unless the contraction is considerable ; absent also when the contraction is greats providing the current is perternaturally weakened by softening, or extreme dilatation of heart, or by both. In such cases, there is almost invariably murmur of regurgitation ; hence the disease of the valves \n\nwould not be overlooked. This murmur is exceedingly rare, originally thought frequent by confounding it with a murmur of regurgitation. '•' I have never known purring tremor accompany a diastolic mitral murmur, the current being too feeble to produce it.'^ When contraction is great, pulse is more or less small, weak, intermittent, irregular and unequal, in consequence of the supply of blood to left ventricle being insufficient and irregular. 0. J. B. Williams, quoted by Hope, says : \" When there is contraction of the mitral orifice, there is usually more hypertrophy than dilatation in the left ventricle.\" \n\n12. In this last quotation, there must be perfect accord among all thinkers. Also in the dilatation with hypertrophy of the left auricle and right ventricle, but the discrepancies concerning the thrill— fremissement cataire — from mitral disease, are seemingly irreconcilable. Markham says, it is frequent. Corvisart says, it is \" sensible a la main appliquie sur la region precordialeJ^ Hamernik says, it is like the hum of a spinningwheel. Skoda says that in certain cases vibrations are felt when the hand is laid on the precordial region — the fremissement cataire of Laennec. \n\nbelieves it possible. \n14. There is a case in this cit}^ now in which the thrill is indubitable ; but it no more resembles the purr of a cat or the hum of a wheel than it does the filing of a saw — but it does accurately simulate the thrill felt by placing one's finger on a gum-elastic tube, a few lines in diameter, connected with a hydrant with the water turned on. The obstruction of the water produces a palpable thrill and an audible murmur closely simulating mitral murmur and thrill ; but in the case to which allusion is here made, mitral regurgitation is undoubted, yet neither Walshe nor Hope ever observed the thrill in any valvular disease. It is probable that the occurrence of the thrill is extremely rare, and in a diagnostic point of view entirely valueless, for pressure on any bloodvessel by any substance might develope a thrill under favorable circumstances. \n\n15. I cannot leave this disputed ground without one more allusion to Skoda's very positive dicta — yet it should be observed that his assertions are unsupported by accompanying clinical facts, and that while they seem logical, they are nullified by the case cited by Walshe, and by two or \n\nmurmur. \n16. But to Skoda ; he says : \" The more constricted the mitral orifice is, the longer will be the time necessary for the flow of the blood into the ventricle, and the more prolonged and louder the murmur. It is in cases of this kind especially that vibrations are felt, when the hand is laid upon the prsecorclial region/^ — the cat-purr of Laennec. \n\n17. The first clause of this quotation is obviously exact ; but the second, '' the more prolonged and louder the murmer/' is doubtful in theory, and contradicted by the facts above alluded to. The blood flowing from the auricle through a smooth^ circular or regularly elipliform contraction into the ventricular cavity, would be in the last degree unlikely to developc a murmur, however great the hypertrophy of the auricle. Liquid flowing through the constricted end of a tube, if the constriction be smooth^ does not generate a murmur, unless the impelling force be relatively (to the size of the stream) very great. \n\nThat is, murmur depends not on the contraction or roughness merely, but on the momentum of the liquid flowing through the aperture ; and \n\nin mitral constriction the momentum will be slight, except in cases of great hypertrophy of left auricle, and only in such cases will murmur be likely to be developed, and then it will occur only at the moment of the auricular contraction 7 that is, barely pre systolic — so near the systole as to be easily confounded with regurgitant diastolic murmur ; and as the mechanism of this murmur is the same as that of the regurgitant, it should be no mere sighing, but should have the same abrupt blowing character. Liquid flowing with great velocity and continuously from the end of a tube emits a sighing murmur, but not when it depends on an interrupted vis-a-tergo, like the contraction of an auricle suddenly. But liquid flowing through a constriction in the continuity of a tube, whether the constriction be rough or smooth, will be attended with murmur^ and if rough with thrill also ; and in cases where the thrill is manifest, it would be well to exclude aortic regurgitation, and even mitral regurgitation, by the most rigid logic, before attributing the thrill to constriction of the mitral orifice. \n\n18. But there being necessarily any murmur at all, and e?=pecially its being attended with palpable or visible thrill would seem to be as much opposed to theory as to facts. Still, it would be extremely \n\nfortunate if we had some sign pathognomonic of mitral constriction, for it is the one of the affections of the heart next to aortic regurgitation and tricuspid constriction most likely to teraiinate rapidly and suddenly, and it is one, if recognized positively, that may be treated with every expectation of prolonging the life of the patient far beyond the limit it would reach if the case were left to itself. Verification of hypertophous dilatation of the left ventricle, exclusion of aortic regurgitation, the presence of pulmonic congestion and hemoptysis, increased second sound of pulmonary artery, a feeble, irregular, unequal, intermittent pulse, would render positive the existence of mitral constriction, even if no murmur at all were present. \n\n19. Thus in constriction of this orifice, if a murmur be developed at all, it will immediately precede a systolic regurgitant murmur, and will be propagated towards the left apex, and diminish and disappear before arriyin,!^ at the second interspace. \n\n20. Constriction of the mitral orifice would add to the unfavorable prognosis of mitral regurgitation. The same principles of treatment are applicable here as in other cardiac lesions. The heart must not be alloVed to beat too fast — more \n\nthan 80 — the weight of the body must be diminished, while tlie quality of the blood is maintained at a healthy standard. • Abundant passive exercise in the open air, more a meat than vegetable diet, a quiet mind, slow bodily movements, baths, diuretics, aperients, occasional precordial counterirritation, or even depletion ; all these may be requisite, according to the condition of the body and the general health. It is not possible to follow any prescribed details of treatment for any length of time. The treatment must be constantly modified, to suit the ever varying exigencies of each case. \n\n21. In a former chapter, two diagnostic signs, one of endocarditis — a murmur ; one of pericarditis— a friction sound, were given. It was not said said that the affections could exist without these relative diagnostic signs ; but it is not probable that an endocarditis ever occurs and runs its course without developing and maintaioing during much of its progress a bellows murmur. It is not probable that the friction sound is ever absent at all times during the course of a pericarditis. \n\na. The friction sound is less persistent' in pericarditis than murmur in endocarditis, because of the early effusion of serum in the former affection by which the serous surfaces are kept apart, and thus friction prevented. But as no such effusion takes place in inflammation of the heart's cavities^ the murmur indicating it is likely to.be. persistent until its termination in death, recovery, or in permanent unsoundness of the heaf t without inflammation ; in the latter contingency, the 7nwrmur continues and becomes an index of ^hi^onic disease of the valves. \n\n22. But murtnurs may exist and closely sfmulate endocardial murmur, from inflammation of the inside of the heart, or from valvular disease and yet they may indicate neither the one nor the other. Whenever there is meclianical impediment to the circulation from valvular disease, thereJ is iti almost every case a mi^rmwr audible. But there are murmurs without the valvular impediment, yet not without cause ; but this cause is not always an impediment to the circulation^ \n\n23. Take, for example, those cases in. which the murmur comes and goes, as it does sometimes in convalescence from rheumatic endocarditis. Hejie the murmur doubtless depends on so«ie?^7 struction at the orifices of the heart wbiehi^, sjo \n\nnearly removed by the process of recovery as to cause a murmur only during exertion — during increased action of the heart ; while directly the patient is in repose and the heart has had rest, the murmur vanishes, to recur upon subsequent exertion, and finally to vanish altogether when the patient is well. \n\n24. A patient has uneasiness about the heart ; it is even painful. The pulse is accelerated ; the impulse of the heart is increased ; the sound louder ; nothing more ; or, perhaps the patient says he gets fatigued sooner than formerly ; no murmur is heard on auscultation, if the patient have been some moments in repose ; but if he be directed to swing his arms violently, or walk briskly, and the ear be then applied to the precordia, endocardial murmurs are immediately manifest, and gradually vanish, even while one is listening. Now, here then is possibly the beginning of unsoundness of the heart, and possibly the murmur is the result of some alteration, of a temporary character in the quality or quantity of the blood relatively to the dynamic condition of the heart at that particular time, or during a period of one or more days. Should the murmur continue, that is, become persistent, even though it continue of the ^' come and go'^ character, it is \n\nan organic murmur, simply because inorganic murmurs from spaneemia, or merely dynamic changes in the heart itself, are in the very nature of the proposition not persistent, because their cause is not persistent, neither in its existence nor in its consequences. \n\n25. There are cases in which a systolic murmur is developed immediately before death ; and in the absence of post-mortems, it is impossible to say whether such murmurs are the result of inflammatory action — pericarditis — set up at that moment, of coagulation of the blood near the pulmonic or aortic orifices, of coagulation in the mitral orifice, by which its valves are rendered incompetent, of span^emia, or finally of dynamic alterations in the heart itself, occurring immediately before dissolution ; and the inquiry for the cause is unprofitable, for the patient dies, and the murmur is a mere declaration that death is imminent, and no longer to be warded off. \n\n26. A murmur is easily developed in children, by pressure of the ear, or of the stethoscope, when there is no cause of a murmur within the body, a, A murmur may occasionally be developed in adults in the same manner, but in such case, the practised ear will easily distinguish tlie false from the true murmur by its quality. /;. \n\nChicken- breast, though scarcely a deformity, may so displace and impinge the heart as to develope a murmuri Increase of area of precordial dullness to percussion, and extensive precordial impulse, are diagnostic signs of hypertrophy. Yet both these signs occur in chicken-breast ; and if to these be added a systolic murmur, we have the complete signs of hypertrophy with valvular disease; and yet there is neither the one nor the other. Iri this case the murmur is easily produced, if absent, by the pressure of the stethoscope'/ ' \n\ntnuC' Tie respiratory murmur can be excluded as a source of .error, by directing the patient to hold his breath an instant, d, Latham says a murmur 4s often heard between the upper edge of the 'Second and the lower edge of the third left costal cartilage, and an inch along and between each of these ribs the murmur is systolic bellows-like, unmistakable in character. At the same time it is heard nowhere else in the heart, or arteries, or lungs. It occurs in phthisical patients, or in those who are justly suspected of being so. Whether this murmur proceed from tlie pulmonary ^artery in its first division, in consequence of its own disease, or in consequence of pressure upon it from consolidated or altered lung, is unknown. \n\nWhenever there is suspicion of tuberculosis, the presence of this murmur will tend to confirm it ; otherwise, it has no known value. \n\n27. There is also the well known anemic murmur. These murmurs may be present not only in typical anemia — aglobulia — that is, defect of red blood globules, but also in hemorrhagic anemias, in typhus, in cholera, in all exhaustive afi'ections, and in alm^ost every variety of span 83mia. \n\n28. Just how depravity of the blood causes murmurs in the heart, we cannot say ; but the fact remains ; and so soon as we remove the blood disease, the murmur disappears and returns no more. The anemic murmur cannot be confounded with that of unsound valves, on account of the accompanying symptoms. These are overwhelming in number and obviousness : '* the surface Dale and cold, palpitation and dyspnoea, appetite perverse, digestion imperfect, nutrition insufficient, secretions scanty and unhealthy, pain everywhere, a shattered nervous system and an enfeebled brain.\" These are not symptoms of unsound heart, but almost peculiar to anemia. \n\n29. It has been considered a law, that a diastolic murmur proceeding from the heart is always an organic murmur, and that if it take the place \n\nof the second sound, it is of valvular origin — semilunar — but there is reason to believe that a diastolic murmur may be generated in certain dynamic conditions of the heart, depending upon defective innervation, through particular nerve filaments, by which the function of a segment of a valve might be temporarily impaired so as to render the whole valve incompetent for a limited period. A clot might also so entangle a valve as to prevent its closure for a time, and yet eventually be all washed away and carried iiito the torrent of the circulation, either in complete solution or as emboli, to cause obstructions in remote organs. Walshe says that he has met with some few instances of inconstant murmurlike quality of the diastolic sound at the base, which appeared to him to be possibly dependent on disordered dynamism of the aortic valves. *' It remains for future inquiries to determine, also, whether temporary reflux, with its murmur, may not be caused by dynamic imperfection, without structural change in the valves.\" \n\n30. Those haemic murmurs that characterize aneurisms, or indicate pressure on arterial or venous trunks, by abnormal growth, or foreign bodies, either in or out of the body, are excluded from consideration in this estimate of inorganic murmurs. \n\nThere is little doubt that one accustomed to auscultation of the heart would distinguish an inorganic from an organic murmur, in almost every case, by the mere quality, pitch, tone, streno;th and duration of the murmur alone. \n\nCarditis. \n31. By inflammation of the heart's membranes, is understood something altogether different from \" disease of the heart.'' The latter phrase is vulgarized in and out of the profession so as to mean the concrete condition of the heart in a state of chronic, not acute, unsoundness. Inflammation of the heart's membranes is a phrase the import of which would be understood by the profession, and the use of which is limited to the profession. It is divided into two varieties, one pertaining to the inside — endocarditis — the other to the outside of the heart — pericarditis. These two affections originate in similar though not continuous membranes ; the one, endocarditis, attacks the lining membrane of the heart's cavities ; the other, pericarditis, attacks their investing membrane— the sack in which the heart is enveloped. \n\na. Omitting details of gTeat interest, but not absolutely necessary to accurate diagnosis, these diseases are distinguished by signs so exclusively characteristic, that if the heart's membranes are inflamed at all, it can generally be made out whether the affection is one or both of the varieties mentioned. \n\nh. The characteristic sign of endocarditis is an endocardial murmur^ systolic in time, occurring suddenly in a person with fever or acute rheumatism, in whom it had never occurred before. One can never be absolutely certain of the endocardial inflammation, until the bellows murmur is heard, no matter how great the pain in the heart, how gred-t the palpitation, how irregular, or intermittent or unequal the pulse, or how hot and livid the skin. Treatment of course should not be postponed until the murmur be heard, neither can it be positively said there is no endocarditis before the murmur is heard ; but, on the contrary, it may be reasonably suspected without the murmur; but not positively made out. c. The murmur is essential to the positive diagnosis, (Latham.) \n\nc/. The murmur occurring for the first time, during the presence of constitutional inflammatory symptoms, determines that the general inflammation has touched the endocardium. \n\ne. The seat of the greatest intensity of the murmur determines — in limits — the chief seat of the inflammatory process. The murmur is usually heard loudest at those parts of the thoracic walls which are nearest that portion of the heart from which the murmur originates. A systolic mur.mur may be heard over the right or left ventricle, or over the aorta alone, or over the pulmonary artery, or over two or more of these parts at the same time. \n\n/. The sounds may be normal, or louder, or duller, or more indistinct, or shorter than natural, and at times they may be almost inaudible, from the weakness or temporary restraint of the hearths contractions ; or, in consequence of great ejffusion in the sac of the pericardium, when that membrane is also affected. \n\ng. The valves are sometimes rendered incompetent for a few hours or days only, and during this time a murmur of regurgitation — mitral — may be heard at left apex, or a diastolic murmur may be heard over the third left cartilage, and thence down the sternum from incompetency of the aortic valves. \n\n32. If the pulmonic valves should become incompetent, (a thing which scarcely ever occurs,) a diastolic murmur would be heard, loudest in second (pulmonic) interspace, and thence directly \n\nupwards. The aortic diastolic murmur is not infrequent after the first few days of endocarditis. 33. Pericarditis is not known to be an idiopathic disease. It is chiefly the result of acute rheumatism ; rarely of Bright's disease of the kidneys. It may attend or directly follow ^ny of the exhaustive diseases — as typhoid fever, variola, scarlatina, diphtheria, pyaemia frequently, (one in seven cases of pyaemia have pericarditis, but pysemia itself is very rare) ; it is sometimes associated with pleuritis, or pleuro-pneumonia, but has no known dependency on the?e lesions ; with albuminuria from any cause — wherever there is albuminuria, the heart should be watched for endo-pericarditis. I have seen it with scurvy in three instances in the late civil war ; with influenza, erysipelas and consumption; hepatic abscess of left lobe — a case observed by the author at Fort Yuma in 1861, verified by post-mortem examination— very rarely with cancerous and tuberculous diatheses. Of course it may be produced by any direct injury to the pericardium, as wounds, blows, fractured ribs. etc. \n\nIt is more likely to follow or attend rheumatism in youths than in adults ; in females than in males ; hence it is more frequent in these classes of persons than in adult males. Soldiers are more liable to scurvy than civilians, hence \n\npericarditis from this cause. \na. Its moir't obvious \"^jmi^tom is the anxious and drawn expression of the features, and the absolute immobility of the patient, as to voluntary muscular motions ; but this symptom is not always present, and when present is also a sign of pleuritis. \n\n6. The characteristic, the diagnostic audible sign is a friction murmur, or rather a friction sound. If one attempts to describe the abnormal murmur he hears in pericarditis, it will be by some similie into which enters the friction of two surfaces of a greater or less degree of moisture, or dryness, or roughness. It would never occur to imitate the friction sound of pericarditis by modifications of the respiratory act, while it would never occur to imitate the '* bellows mur. mur'^ — '' bruit de souffle f murmur of endocarditis in any other manner except one called in the aid of external atmospheric murmurs. \n\nThe friction sound may be loud or low-toned, sharp or dull, single or double, but it always suggests the idea of attrition, and never that of expiration or inspiration, or blowing ; and so the contrary. \n\nslight severity. \nc. The pericardium is peculiarly insensible when inflamed, in Bright s disease, and patients often persist' in denying the existence of symptoms referable to the heart ; but in these cases pressure with the flat hand over the heart will cause a degree of uneasiness which is intolerable, although it may not be precisely pain ; and this insensibility is not confined to pericarditis in Bright's disease, but occurs especially in asthenic pericarditis. Hence the ** chief local symptom'^ (pain) avails little in diagnosis, much less than immobility and lying on tlie back, the anxious look, attendant rheumatism and inflammatory febrile pulse. \n\ne. There may or may not be bulging of the precordia from pericardial efi'usion. There may or may not be friction — fremitus — appreciable to palpation. The heart's impulse is generally greater in extent but not in force, and may even be much weaker than natural. \n\nroots of the great vessels, thus leading to the suspicion of endocarditis, when the endocardium, valves and vessels may be entirely healthy. \n\n34. It is believed, also, that pleuritic effusions, in very rare instances, so contort the vessels at their orifices as to produce incompetency of valves, thus causing diastolic murmurs heard even at the apex and down the sternum, the peculiar seats of orgastic regurgitant murmurs, \n\n35. I recently saw, for a few moments, during my first and only visit, a case of pericarditis^ remarkable for the rapidity of its progress and for its fatal termination. When I saw the patient, he was suffering with frightful dyspnoea, which was supposed by his attendants to be ** asthma, aggravated by wind on the stomach\" — [There was epigastric fullness, which is not uncommon in pericarditis, second stage] — for which they were administering stimulants and nauseants, in bulky doses, to cause emesis ; the patient was held, sitting upright, although he desired to lie down ; his skin was livid and bathed in viscid perspiration ; his pulse was exceedingly rapid, small, irregular, intermittent, unequal ; his extremities cold ; his voice reduced to a whisper ; deglutination, even of fluids, difficult. Percussion of the precordia was impracticable, but during the instant I listened at the \n\nheart, I heard a dull, wet* second sound, (no first sound,) and a faint murmur, systolic in time — no friction sound. My diagnosis, to my own mind, was rapid but not exhaustive : pericarditis, with either very considerable effusion, incompetent mitral valves, or fatty heart with incompetent mitral valves. The fatty heart was rendered doubtful, by the persistence of the pulse, which in the last hours of this affliction is generally absent, or answers to the systoles perhaps ten or twenty times only in a hundred. The absent first sound was as accountable on the supposition of effusion, as of softened heart ; t hence, on the pulse alone, I excluded the latter. I had the melancholy good fortune to assist at the j)ost mortem^ some forty-eight hours later. The left ventricle was generally dilated ; the mitral valves were incompetent from analogous deposits ; the beginning of the aorta was atheromatous ; there were some patches of lymph on the vir-ceral du-* plicature of pericardium, and very considerable serous effusion ; amount not measured, but supposed to reach eight ounces. The proper tissue of the heart was softer than natural — not examined microscopically. \n\nThe duration of this case might have been indefinitely prolonged, had the serious damage to the heart been recognized at the beginning instead of the end of the last week of life. A recumbent position, aconite and veratrum viride in minute and alternate doses, saline evacuants, \"^ saline diuretics, leGches and cups at the precordia, sinapisms to the knees, ankles and elbows, suspension of food, except beef juice in small quantity, no stimulants, properly so called, except on the special indication of failing pulse and threatened syncope ; then, brandy, or ammonia and lavender. With this treatment from the beginning, it is probable that the pericarditis would have terminated in complete recovery ; the mitral disease being slight, would have been harmless for the time ; the fatty degeneration, if certainly present, which was not proved, would not necessarily have caused death so soon. \n\n36. There seems to be great discrepancy in authors, Latham and Skoda, for example, concerning the distinctive characters oi friction sound (exocardial) and bellows murmur (endocardial). \n\n37. To my mind it is clear that a sound whose similie is friction must in the natu re of the proposition be dissimilar from one whose similie is \n\nmurmur ; and this is the precise actual difference between the two murmurs. They are recognized by distinct names, friction murmur and bellows murmur^ all through the literature of diseases of the heart, from Corvisart to Walshe. \n\n38. Walshe and others say, the murmur, when there is doubt of its extra.- or intra-cardiac origin, may be identified as exocardial, by being more superficial and more diffused than endocardial murmurs, Skoda says flatly that in his opinion they cannot be so distinguished. Boillaud experienced great difficulty in discriminating attrition and valvular murmurs. \n\n39. Hope makes the distinction by no means difficult. The existence of the two classes of murmurs is indubitable, as all writers on the heart, since Collin, in 1824, distinguish them as being referable ; the valvular murmurs to the endocardium ; the attrition murmurs to the exocardium. \n\n40. Skoda recognizes the existence of the two classes of murmurs. After acknowledging the new-leather attrition sound, which is very rare, the rustling and rubbing sound (frequent), the scratching sound, from bony, chalky, or fibro-cartilaginous concretions, rubbing against each other, or some part of the pericardium during the heart's movements, he says : \" There is no doubt that all \n\nthese different friction sounds of the pericardium have a real existence. -se- ^ ^ * ^ According to my own experience, there is no kind of endocardial murmur, with the exception of the whistling, which may not be imitated by a friction sound of the pericardium ; and no pericardial murmur which may not resemble an endocardial murmur.^' \n\n41. Hope and Markuam believe the distinction of the murmur from the friction not difficult ; the former did not find it difficult to discriminate between attrition sounds and murmurs, '' even when the two classes of sounds existed simultaneously and each was double.'^ The former discriminates by listening for the murmurs of the semi-lunar valves two or more inches up the aorta or pulmonary artery, where attrition murmurs are generally inaudible ; and by listening to the murmurs of the auriculo-ventricular valves, a little above the apex of the heart, where they are sure to be loudest, whereas, attrition murmurs may be louder at other parts of the heart where they happen to be generated. \n\ncertainly from attrition. \n43. Second sound valvular murmurs — diastolic murmurs — are never rough, as the diastolic currents are in the nature of the forces causing them, too feeble to produce rough murmurs. A diastolic mitral murmur is faintly audible; a diastolic aortic murmur is louder, but still smooth. Diastolic pulmonic murmurs almost never occur.. Systolic tricuspid murmur is known by its smooth blowing quality, and by the attending jugular pulse. \n\n44. '' Attrition murmurs are almost always attended by vibratory tremor.\" This \" tremor\" I have never been able to verify, even where pericarditis was undoubted before and verified after death. \n\n45. Markham says : '* a fremitus is said to be sometimes felt over the precordial region when the hand is laid thereon.\" Skoda places no reliance upon this sign. On the contrary, Latham relied greatly upon it as a distinctive sign. He has often seen an undulatory motion between the cartilages of the second and third ribs, or be- \n\ntween cartilages of third and fourth ribs, left side, during the dull percussion and exocardial murmur period of pericarditis. He also often felt vibratory motion in the same interspaces, second and third, and nowhei'e else. The undulatory motion and vibratory motion often occurred simultaneously, but he thought the vibration the more frequent. They were sometimes present between the cartilages of second and third, and third and fourth left ribs, simultaneously— tactile fremitus, \n\n46. Walshe says it is rarer and more migratory and superficial to the touch than valvular thrill, distinguished from pleural fremitus by causing the patient to hold his breath ; not implicitly reliable, because its mechanism is unknown, and it may arise from causes external to the pericardium, and be present during suspension of the breath. But, if present with the exocardial friction, it is a valuable aid in the diagnosis. \n\n47. Stokes says, attrition murmurs are apt to undergo frequent and sudden changes of character and of situation which are very pathognomonic, because valvular murmurs change little in character, and not at all in situation. \n\nHope and others, is very discrepant with Latham, who never observed the fremitus, except in the second and third left cartilage interspaces. Can it be possible so careful an observer as Latham mistook a pulmonic valvular thrill for a pericardial /remito ? \n\n49. Finally, concerning the murmurs. It is probable they are distinguishable by most observers— the attrition from the valvular — or that the cases in which they are undistinguishable are exceedingly rare, or that there are cases in which both classes of sounds occur, each being modified by the other, so that each becomes unrecognizable for a longer or shorter period ; but patient and repeated observation would in the end discriminate in almost every case between an attrition and valvular murmur. \n\n50. But it is of no vital importance whether the distinctive diagnosis be made at all, for the two diseases are essentially similar in immediate effects, and in indications of treatment ; and the indications of treatment are by far of greater importance than any theoretical considerations of the distinctive characters of the two diseases. \n\nin Edinburgh or London. \n52'. In more than a hundred cases of rheumatism treated by me in Arizona and Southern California during the years 1862 and 1863, I saw but one in which I was able to verify that the inflammation had afiected the heart ; yet in every case I sought diligently and frequently the symptoms of rheumatic carditis. \n\ntaken in the field. \nCase of Acute Endocarditis^ apparently idiopathic^ with Emboli. — Argo, a soldier, aged 25, tall, fair-haired, muscular, came on the sick list for a cough. Ordered brown mixture — he did not seem much sick. \n\nSecond day. Argo breathed short; •had fever in the evening. Ordered saline purge and quinine, five grains with half a grain of opium, when his fever should go ojQf; continue cough mixture. He had no crepitation in chest ; some few rather coarse rales ; no pain in the chest, but coughed severely at times ; little or no expectoration : respiration 45 ; pulse 110, feeble, small. \n\nbut he is able to walk ; his respiratien 45 ; pulse 90, very weak and small ; nails, ears, lips, etc., livid ; says he has no pain, but feels \" tight here,\" placing his hand on the sternum, at its junction with fourth and fifth ribs. \n\nAuscultation revealed no abnormal sounds in either of the lungs ; over some portions of the lung respiration scarcely audible, and in other small portions, no air entered. \n\nThe hearths impulse, at the fifth space to the right of left nipple, very feeble ; sounds are exceedingly weak. There was something indeterminable and undefinable about the quality of the stytole, and this with the tightness over the base of the heart, made me uneasy about the result. Ordered cups and sinapisms over the precordia, syrup of ijenega for the cough, and beef tea for diet. At four a. m. he died, without any of the nurses in his ward observing him until he was quite dead. They heard a very \" wheezy breathing\" a few moments before he was found dead. \n\nPost-mortem at nine a. m. same day. On opening thorax, anterior aspect of lungs appeared natural ; no adhesions of either lung ; no tubercles. On lifting out lungs, lower lobes of both were found congested posteriorly, and very dark, \n\ngested posteriorly. \nSize of heart and external aspect normal ; no effusion in pericardium ; no lymph patches, no white spots, nor congested coronary vessels. On removing and washing heart, in both right and left ventricles were found pale clots, like strips of washed muscle wound and interlaced with fleshy columns and tendinous cords, and under the valves. The right auricle was completely plugged with a semi-organized looking clot, which I peeled out from its matrix, as a false membrane peels out from the sinuosities of the fauces. These clots, after being removed and thoroughly washed of all their soluble portions, weighed ninety grains. The endocardium pre. sented numerous signs of inflammation, especially about the auricles and valves ; left auricle contained no clot ; valves were competent, and no orifice was appreciably constricted. These clots must have been formed before death, which evidently occurred the moment the right auricle became so filled with the clot that no more blood could enter and pass through it from the vencs cavce. \n\nof this occurrence, there were many cases of rheumatism in camp, which was attributed to sleeping on the green salt grass, with only one blanket. I do not think this was a case of simple embolism from the accidental de* velopment of the coagijjlatlng principle ^ of the blood, and I am sure it did not result from fatty degeneration of the heart, by which it was rendered incapable of emptying its cavities, for the heart's substance was firm, and normally free from fat. \n\n54. During the last four years, I have seen several cases of pain and uneasiness about the heart during the course of acute rheumatism. In one there was great anxiety of expression, and extremely small and feeble pulse, which made me fear carditis and the formation of emboli, I gave in this case whiskey and water, alternated with fluid extract of digitalis, in minute doses, every hour, without interrupting the usual rheumatic treatment with propylamin and laudanum. The patient recovered. \n\n56. The diet must be diminished in quantity a'nd in blood-making quality, if the disease, as most frequently happens is of acute rheumatic origin — in othei; words, if it is sthenic in quality. \n\n57. Blood may be taken (if the patient be fullblooded, or in good blood-making condition,) from the arm, to the extent of a pound, early in the attack, the earlier the better, and this may be followed by five, ten or twenty leeches (according to the violence of the attack and condition of particular case,) to the precordia, and these may be followed by compresses, wrung out of hot water, laid over the leech bites, not merely to promote the flow of blood, but to alleviate the' precordial anxiety and tightness of the chest, which will be thus accomplished in a surprisingmanner. \n\nbe quadrupled immediately. \n59. If the heart beats more than 90, and especially if its beats are not rhythmical, half a drop of fluid extract of digitalis and five drops of McMunn's elixir of opium may be given every hour, until pulse falls to 75, and increases in size and regularity. Syncope must be guarded against instantly and hourly. \n\nat the arm at all. \n61. Leeches, scarifications and cups to precordia, sinapisms and friction to the joints, a blister around each knee or elbow joint, with a brisk and certain purge, (calomel fifteen or twenty grains at one dose, is the best,) followed by saline diuretics, combined with minute doses of tartrate of antimony and posassa, (say tlie thirty-second part of a grain hourly,) hot bottles to the loins and feet. Some or all of tliese means, or others on the same principles, will, in most cases, be found quite sufiBcient to mitigate the attack, and conduct the disease to its usual result, namely, termination in recovery. \n\n62. It is very rare that rheumatic pericarditis or endocarditis treated rationally, or let alone, terminates fatally ; but it is altogether probable that the worst consequences — chronic unsoundness of the valves from endocarditis, or pericardial adhesions from pericarditis, maybe prevented altogether, or greatly modified by rational treatment. \n\n63. In the nature of the case, this theoretical probability can never bo demonstrated ; for, if some time after, a case of marked endo-pericarditis, treated rationally, and apparently entirely cured, should die of some other aifeciion, and the \n\nheart should be found intact, it would not follow that the treatment had saved it ; and were it found chronically diseased, it would not follow that the treatment had been defective, excessive or erroneous. \n\n64. But, if a patient of mine should die apparently of rheumatic pericarditis, I should doubt my diagnosis, or be dissatisfied with the energy or rationality of my treatment. Not so with the asthenic forms of pericarditis ; these are much more likely in their own nature to be fatal from the beginning. \n\n65. In asthenic rheumatism, no matter from what source the asthenia springs, pericarditis should not be treated antiphlogistically. Carbonate of potash and of ammonia internally, counter-irritation, good nourishment and moderate doses of wine or brandy, form the staple agents of treatment. (Walshe.) \n\n66. I would caution, in the use of alcoholic stimulation, to watch its effects constantly. The pulse should not be carried above 85 ; on the other hand, it should not be allowed to fall below 70. It can be maintained in these limits generally, (except when the pericarditis accompanies renal degeneration,) with small doses of digitalis and laudanum. \n\n67. Alkalies — bicarbonate, of potash, liquor potassse, are tlieoretically if not practically worthy of trial in very large doses in the fibrinous diathesis, especially if there be any suspicion of emboli in the heart or arteries. I need not say these remedies are to be largely diluted. \n\n68. If a stimulant is required, carbonate of ammonia, or aromatic spirits of ammonia and tincture of lavender ^ may be given in conjunction with the alkalies (69). \n\n69. The enormous doses of brandy, a pint or more a day, recommended by Todd and Bowman, are repugnant to theory and prohibited by unprejudiced clinical experience, a. Can any one doubt that intoxication induces venous congestion of the corronary veins, as of others ? \n\nCan any one doubt that congestion of the heart and lungs increases the labor of the heart (already requiring alleviation,) and thus diminishes its dynamism ? Is it supposed that impaired dynamism of the heart is conducive to the restoration of its inflamed serous envelope ? \n\n70. It cannot be denied that brandy diminishes the coagulability of the blood, and thus would tend to prevent the formation of intra-ventricular clot \n\nin endocarditis ; but so does chloroform diminish or prevent coagulability ; so does electricity and many poisons, but we cannot deduce from this one fact, their therapeutic utility. \n\n71 . We know that alcohol given in large doses to sthenic or plethoric patients increases their fever, adds to their irritability, congests the liver, impairs pulmonic funqtions, diminishes the action of the skin, and does not always act on the kidneys ; that it impairs appetite and assimilation ; that it is unquestionably objectionable in Bright^s disease, even in not very large doses. \n\n72. I do not object to brandy in any disease, but I cannot help thinking that it ought to be used in much smaller quantities in acute affections than recommended by the distinguished authors just mentioned. \n\n73. Patients with any form of organic affection of the heart bear brandy very indifferently, and generally object to it very strongly, from a firm conviction that it makes them worse. Besides, in organic affections of the heart, acute or chronic, the liver is rarely exempt, and all drinkers know the antipathy of this organ, whenever so little disturbed, to large doses of brandy or whiskey. Soda-water suits it much better. \n\n74. It seems to me. the general experience of mankind should be somewhat regarded in reference to the commonest articles of daily use, and this general experience is opposed to excessive employment of the hydro-carbons in acute and inflammatory diseases. \n\n75. Recapitulation. — a. The treatment of pericarditis and endocarditis is nearly the same. h. The latter is more injurious in its consequences, and hence requires more care in treatment, c. There are two forms : the sthenic and asthenic of both lesions . d. The sthenic is treated antiphlofristically^ in the rational sense, by which neither salivation nor exhaustive depletion is understood ; that is, it is treated with aperients, watery diuretics, alkalies, digitalis, opium, propylamin, counter-irritation, heat locally applied) local depletion, general depletion to relieve a pressing need, but not to arrest inflammation, etc. e. The asthenic is treated on general principles, specially applied. /. Haematogens — beef-juice, egg-nogg, vegetable alkaloids, bromide of potassium, perhaps cod-liver oil — counter-irritation and frictions, dry cups to the precordia, arterial and nerve stimulants, nutritious diet. \n\nthe heart. \nM. Gemlin ascertained that this remedy augments remarkably the secretion of bile, and it has often been noticed that when uric acid increases* bile decreases, and visa versa,. Hence, if we increase the bile, we diminish the rheumatism. Mr. Ure recommends a drachm of this sulphate to be dissolved in half a pint of water, and swallowed before breakfast. It will be followed by one or more motions, of biliary description. \n\nfibrin. \nh. It may be given because it is an alkali, to prevent the tendency of the blood to become acid, and also as a solvent of fibrin, to prevent the precipitation of this material on the valves of the heart and other portions of the endocardium. It is probable that the fibrinous matter found on the valves of the heart is produced both from inflammation of the lining membrane and from precipitation, when it is in excess in the blood, and when, the circulation is very much impeded \n\nor very much slowed, even for a moment, fromany accidental cause. I am aware that stasis alone will not induce coagulation, but it is not denied that coagulation is thus hastened, under favorable conditions. ^ \n\nto produce any sensible effect. \nj. As a diuretic in pericarditis in Bright's disease, I should expect great benefit from gallic acid, in from thirty to sixty grains at a dose in as- much- water as the patient could conveniently drink, four or five times a day. The hot-air or vapor-bath is especially recommended as a sudorific in this variety of pericarditis, because it can be' administered in bed, without disturbing the patient and without raising the head, which often causes great prostration. \n\nk. Purgatives are to be employed with great caution, in either the sthenic or asthenic forms,' but especially in the latter. Suphate of mag^\" nesia should not be employed. \n\n76. The chronic forms of these lesions are to be treated on general principles, it being understood that they can be alleviated, but not cured. \n\nby the accumulation of fluid in the pericardium, there can be no question of the propriety of tapping near the base of the heart, upper angle of fourth left interspace, and re-injecting a small quantity, of equal parts, tincture of iodine and distilled water, at the temperature of the blood, before removing the canula of the trocar. Iodine injections are recommended by Aran. This iodine liquid has been proved harmless to serous membranes in numberless examples. \n\npromote absorption. \n79. A dry nutritiojis diet and diuretics are recommended, with great reason. Iodide of potassium taken internally could not retard absorption of lymph and serum, and by many is supposed to materially aid this process. But I have never observed such a result either in this or allied effusions. \n\n80. Here passive exercise in the open air, and even sea voyages may be advised, with prospect of alleviation and arrest of the slow inflammatory process. The trial of alkaline springs should be made, if possible. \n\na. It should be borne in mind that the prognosis as to fatality is more serious in pericarditis than in endocarditis. The latter is rarely fatal, whereas the former terminates in death with sufficient frequency to have induced M. Louis to estimate the deaths from this cause at one in six of the cases attacked. Walshe had seen only seven or eight fatal cases of fatal rheumatic pericarditis. Death rarely occurs in pericarditis *' before the tenth or twelfth day.\" It may occur, however, within thirty-six hours, or be postponed some weeks. \n\nh. We have also chronic forms of both these affections, but from what has been already said of the acute forms. and of valvular diseases, the treatment of chronic endocarditis is obvious, and that of pericarditis requires but mere mention. The hypertrophy and dilatation of the left ventricle attending chronic pericarditis are less serious than when these affections are the result of valvular disease ; the treatment of these conditions of the heart will be considered in a subsequent chapter. As for the rest, the treatment is to be directed to the absorption of the effused fluid, and to fortifying and controling the action of the heart. It is doubtful whether local applications to the prjBcordia will be of much benefit, except for the modification of reflex symptoms ; \n\nbut most of the discutient class of unguents, tinctures and liniments, as well as blisters, setons, cauteries, etc. are still recommended as of possible utility. In chronic pericarditic effusion, paracentesis of the pericardium, as already suggested, is unobjectionable, after a reasonable trial of other remedies. ♦ \n\nsuggested. \nd. Acute carditis is not susceptible of diagnosis in the present state of knowledge; that it has a real existence is well proven by post mortem observation, but it has no known clinical signs by which it can be discriminated from endo-pericarditis. Hence, it is obvious its separate treatment it not a subject of rational consideration. Fortunately it is a rare affection. Similar remarks are applicable to the chronic form of carditis, \n\ne. Hemorrhage within the proper substance of the heart does occur, but we have no diagnostic symptoms. So effusion of the blood into the pericardium — hcemo-pericardium — and under the endocardium — hcemo-endocardium — are without diagnostic symptoms of any value. (Edema of \n\nthe present state of knowledge. \n/. Hydro-pericardium is recognizable, if the dropsy be considerable by the pyramidal outline of pragcordial dullness, the same as in the effusion stage of ])iricarditis. (The apex of the dullness being aBove its natural point, and rising to the second or perhaps to the first cartilage, Avhile the base does not fall proportionally, indeed not at all, but remains at the lower margin of the sixth rib.) The visible impulse is undulatory, unless the effusion be slight. A sensation of oppression at the praecordia is often though not always felt ; the pulse is not affected. The dropsy must depend on some altered condition of the blood, conjoined with some other organic lesion ; hence the general symptoms will be those of the subjacent affection, and the treatment will be the same as that of other dropsies, though diuretics and cathartics will be found less efficient. Dry cupping, blisters and electricity, one or the other, may be applied at or near the praecordia with considerable hope of benefit. \n\ng, Paracentisis, and subsequent iodinized in3ections, so as to excite adhesion of the pericardial surfaces, may be found advisable under particular circumstances ; but the principal hope of cure \n\non which this effusion depends. \nh. The diagnosis and treatment of cases in which air or gasses find ingress to the heart's cavities or beneath its membranes cannot be rationally considered, and hence the treatment must be suggested by the special indications, in any suspected case. \n\ni. Cardiac atrophy, whether limited to the muscular walls or valves of the heart, is clinically unrecognizable, and an anatomical curiosity, and may be clinically ignored. \n\nj. Hypertrophy of the valves of the heart, would, at first view, seem to be the result of endocarditis, but it may rationally result from excessive function, and consequently excessive nutrition, as a result of hypertrophy pure and simple. It cannot be recognized clinically, and if suspected its treatment is merged in that of hypertrophy. \n\nHypertrophy. Dilatation. \n81. Hypertrophy \\^ not very frequently an idiopathic disease. Like dilatation, it is generally the outgrowth of some previously existing lesion of the valves or vessels proceeding from the heart; of some impediment, (as of a tumor or a consolidated lung,) to the free movement of the heart. \n\n82. It may be caused by excessive nourishment, too free living, and excessive drinking, excessive labor in which the strength is taxed to the utmost. Gymnasts, stevedores, furniture-movers, iron-moulders, athletes, all furnish examples of pure hypertrophy. It is comparatively rare in females, except in those who have borne many children. \n\npertrophy of right sooner than the left ventricle. \n84. The hypertrophy attending free living and sedentary habits is apt to be attended with fatty metamorphosis, and is of much more dangerous significance than hypertrophy pure and simple from excessive function. \n\nhypertrophous. \n86. Left ventricle in a hypertrophous state is recognized by praecordial bulging, widened interspaces, heaving, sustained impulse, when the side of the observer's head is laid over the heart ; regular rhythm, force of impulse unequal ; extent of, increased ; maximum of, about the left nipple. \n\na. Unless there is associated dilatation, the apex beats will rarely extend to the left of left nipple, or below thq seventh rib. h. If there is dilatation alsp, the apex may be carried much farther beyond the nipple, and as low even as the eighth rib. c. In this case the visible impulse will be much greater, more knocking, heard distinctly and clearly some indies from the thorax ; the impulse is also less heaving ; the heart merely strikes, without raising the ribs and interspaces, and the whole prsecordial surface, down as far as to the left of and below the left nipple, seems agitated in extreme case of dilatation with hypertrophy. \n\n87. In the case I have in mind, Mrs. D , of \nSan Francisco, a young married lady, the thumping of the heart could be heard several feet, and the appearance of the impulse was that of the skin over the emaciated thorax, being raised in \n\nnumerous places in a sort of undulating rhythm, suddenly and a hundred and twenty times a minute. This was a case of enormous eccentric hypertrophy, and terminated fatally a few days after my first and only visit. \n\n88. Dullness to percussion may extend from the second to the eighth rib, and from two inches to the right of the sternum to three inches outside of a vertical line drawn through the left nipple. In exceptional cases, \" the percussion sound may be toneless and high-pitched all over the left lateral regions of the thorax, and vocal fremitus null, just as if pleural effusion existed.\" (Walshe.) \n\n89. The diagnosis of hypertrophy, without or with marked dilatatfon, is not difficult, a. Besides the percussion and auscultory signs mentioned, there is in hypertrophy the marked symptom of persistent force of the pulse. \n\nb. The pulse may vary in the course of a single day from 65 to 110, and from being full, hard and resistant, to being compressible, full and soft — rarely irregular or intermittent ; and when these conditions are present, other lesions exist in the heart. c. The patient will be strong, vigorous and full-blooded, of florid complexion, and apparently robust health, d. A case of this \n\nkind now on my mind is a young man, aged 25, who can lift six hundred pounds, and who is in the habit of lifting two and three hundred at a time daily. \n\ne. The strength is not lessened, but the dyspnoea becomes intolerable, from prolonged or excessive exertion, and cough supervenes. \n\nf. The patient wants his head tilted forward when he sleeps, rather than have his shoulder raised with his head. There is no orthopnoea, but the liead aches if lying in a line with the trunk. This symptom is not always present. g. The varying frequency of the pulse is doubtless exceptional in the case now under consideration, h. There is no dyspepsia, but little pain in the heart, but more or less uneasiness, and a sense of fullness ; frequently dizzy on stooping ; the conjunctiva habitually red ; sleep disturbed with strange dreams. [In this case the symptom was removed by thirty grains of bromide of potassium daily, at bed. time.] i. No increase of sexual desire in this case, as has been supposed on theoretical grounds, j. There is a systolic blowing murmur at base of varying loudness and not persistent. When the heart beats with unusual violence the murmur is very distinct ; when \" slowed^' and subdued with digitalis, it is \n\ninaudible, /c. I suspect this murmur is not rare, for water forced through a tube of varying calibre with considerable violence, emits a murmur at the point of variation in the diameter of the tube. /. The extremities do not swell, nor is there ascites, m. In this case there is frequent pain in the right side, and occasional congestion of the liver, n. The bowels are disposed to constipation ; nutrition and hematosis is excellent. 0. There is no lividity of the nails, or ears, or lips; no coldness of hands or feet, except occasionally some hours after excessive fatigue, p. Dilatation may have begun in such a case, and be yet so slight as to be overshadowed by the hypertrophy. \n\n91. Few physicianji now believe in the cure of hypertrophy. \" On the other hand, it is not difficult to remove or greatly mitigate the symptoms of simple hypertrophy in the majority of cases, and render life, not merely tolerable, but comfortable.'^ \n\na. I have elsewhere (p. 61 passim) shown how this may be done, by diminishing the weight of the body, by means of restricted and dry diet. b. The heart must have less blood to impel, but it must have good blood for its own sustenance, or we may have fatty metamorphosis added to our hypertrophy, c. The patient may be cupped or leeched at the prascordia once a week, if necessary ; purged occasionally ; take diuretics most of the time — solution of perchloride of iron and digitalis, with antimony — baths every other day ; plenty of passive exercise, until he is made quite comfortable, and all severe symptoms are removed, d. If the hypertrophy were caused by excessive exertion or labor, that must be stopped, of course ; if by excessive eating and idleness, a restricted diet and some exercise must be enjoined, but much more caution in depletion will be required in treating this class of cases, than that in which the hypertrophy results from excessive function of the heart i tself. \n\nCase. — Mrs. J. S. consults me concerning bronchitis. She has taken all the nostrums and specifics, has been relieved often ; sometimes has thought herself cured ; but the annoying cough and frothy expectoration returns again and again, when she thinks she is nearly cured. On \n\nlistening at the prsecordia, I hear a systolic murmur ; move my ear to left apex and it is much louder ; hearths impulse increased in extent and vigor. Apex beat farther to left than normal ; the head is lifted by the throb of a hypertrophied heart ; the sounds are nearer to the ear and more neatly accented than normally. She has incompetent mitral valves, dilatation with hypertrophy, the latter still in excess ; turgescence of lungs from refluent current ; mechanical compression of left lung from enlarged heart ; hence initative cough, with increased mucous expectoration. \n\nGive a calomel purge, followed by syrup of wild cherry and tincture of aconite ; restrict diet one half. In three^ days the cough has disappeared, and the patient feels much better, though her garments fitting less snugly, she \" fears she is losing flesh f^^ \n\nShe is losing flesh, and must never again carry so much flesh, if she hopes to be free from her *' bronchitis.\" This is one case of a whole class in which loss is gain. A heart which will utterly fail to impel 16 or 17 pounds of blood — the normal amount — will get along with 14 or 15 pounds with little or no difficulty. It must not be inferred from this, that therefore bleeding to the \n\namount of one or two pounds will answer the purpose and prove beneficial. The weight of the body must b^ diminished in the same proportion. If we wish to abstract a pound of blood from a patient with dilated heart, we must do so by reducing the patient eight pounds in flesh, by means of low diet, or, in cases of urgent need, by total abstinence from food until the effect is produced, it is remarkable how soon the overtasked heart will recover its tone when the patient entirely abstains from food, and takes small doses of some nerve sedative to quiet the irritability which hunger sometimes induces. The pressure disappears from the chest, as weight diminishes, and very*soon, say from three to five days, the patient, if not yet in the dropsical stage, will say he is better than ever, and that he scarcely knows he has a heart. Even now, a single full meal will bring back all his consciousness of his heart and of its unnatural condition. \n\n93. It is only when other organic diseases have come on, or when dilatation becomes excessive that life is in jeopardy. \n\n94. Dilatation will not be difficult of diagnosis, a. This has already been given to some extent (IF 89) in speaking of hypertrophy. \n\n95. a. The pulse is weak and irregular in force and rhythm ; rarely intermittent, b. Apex beat indistinct and not lowered ; percussion dullness increased vertically more than transversely ; impulse undulatory ; ribs not bulged, unless there is also hypertrophy ; systolic sound, shorter, clearer and more superficial than in health ; defective nutrition ; dyspepsia more or less marked, dropsy, especially of lower extremities; tendency to emaciation ; cold extremities ; feeling of being chilly from defective circulation ; palpitation on the least excitement; great praecordial uneasiness; ringing of the ears, headache, indisposition to any labor, mental or bodily ; somnolence, in the advanced stages of the disease ; eviderK^e of congested liver and kidneys ; sexual inclination weakened ; superficial pulses not visible ; symptoms of bronchitis and pulmonary oedema ; in the last stages of the disease, orthopnoea complete: asthmatic paroxysms ; occasional respiratory forgetfulness, a fatal symptom; frequent nausea and anorexia ; livid discoloration in spots; occasional sphacelus of the finger tips or toes, from capillary stasis ; leaden, almost black lips, particularly in the morning. \n\n96. Some or all of these symptoms may be present in a single case, a. When but a few of them are present, even the auscultatory and per- \n\nalready said. \n98. As to the treatmeritj it is radically different from hypertrophy. a. The treatment is eminently sustaining, directed to the improvement of the quality of the blood, without diminution of its quantity even, for it is not likely to be in excess. \n\n99. Solution of perchloride of iron, largely diluted, is here of special service as a diuretic and tonic, a. Opium and quinine combined are constantly required, not more than two or three grains of quinine a day is requisite. It may be given in three or four pills, one at a time, each pill to contain from an eighth to half a grain of opium. \n\nb. If the pulse be rapid, above 90, digitalis may be given in syrup of wild cherry, in half drop doses hourly, until the pulse fall to 85, but it must be given with greater caution than in any affection of the heart, except fatty degeneration. \n\nc. The bowels may be moved daily with any mild aperient; perhaps formula a, page 59, will be found convenient. An aloetic pill daily at bedtime, or a castor-oil capsule maj^ answer as well. \n\nfor the same purpose, and are often indicated. \ne. Dry cups to the heart in case of extreme palpitation or anp^ina often afford instant and enduring relief. /. Blood must rarely be taken. g. Passive exercise is of great utility, h. The patient must lead a cheerful life, and not be exposed to annoyances and hardships ; voluntary exercise, such as walking or horseback riding must not be tolerated, except with great caution. No violent emotion or passion should be indulged. ('* rupture of a dilated heart has occurred in actu coitus^) Animal diet is preferable ; much drink of any kind, even if it be milk, is to be avoided; the diet should be rather dry than the contrary, but well prepared and easily digestible. Cold sponge baths may be used, if they agree with the patient, not otherwise. Perhaps tepid or hot salt water bathing is on the whole the best. The clothing, especially of the extremities, should be warm and light; intercurrent diseases must be treated on general principles modified to suit the actual condition of the heart. \n\n100. Ammonia and lavender will afford speedy relief to depressed nervous sensations, and prsecordial faintness. a. In the •latter stages, the patient should be always watched in sleep, on \n\naccount of the strong tendency to respiratory forgetfulness, by which life might be suddenly arrested, long before the necessary fatal issue of the disease. I will close the consideration of dilatation by a condensed abstract of a peculiar mode of treatment suggested by Piorry, of Paris, in 1858. \n\n101. By a series of observations, carefully made, with the aid of the plessimeter, Piorry satisfied himself that the heart and liver of a person in health diminish in bulk by forced inspirations. He next undertook to apply this discovery to the diagnosis and treatment of enlarged liver and heart, I have not attempted to repeat his experiments, but they seem rational, and the opinion of M. Piorry, who has applied himself to percussion and auscultation for now nearly forty \n\nfacts. \n102. M. Piorry selected a hysterical patient, who had nothing the matter with either the heart or liver ; he limited the heart by percussion, and found it occupied a space of 11 centimeters ^ from right to left ; the liver occupied a space of 14 centimeters, from above downward. (I omit the other measurements.) This done, he directed \n\nthe patient to breathe forcibly twenty times in succession, and then repercussed: instead of 11 he found 9 to 9| for the heart ; andinstead*of 14, about 12i for the liver. This is not all. He now directed the patient to hold her breath, whereupon he demonstrated that the two organs named not only returned to their natural dimensions, but that they slightly increased in bulk. \n\n103. Now, as this experiment has had the same result on all patients, it is easy to see its influence upon the diagnosis and treatment of diseases of these two organs. \n\na. What is said above, is, moreover, in complete accord with what is daily observed in pathological anatomy. Uniformly, when a person dies of asphyxia from mucous engorgement of the bronchi, the heart and liver are found to be much enlarged and gorged with blood ; whereas, on the contrary, when the respiration is unobstructed up to the last moment of life, these organs are found to be small and bloodless. \n\n104. The practical applications of this phenomenon are the following : It aids in establishing the diagnosis : a. Of hypertrophy and dilatation of the heart ; h. Of hepatemia (congestion of the liver), together with lesions of nutrition of this organ. \n\n105. It aids in determining the rational treatment of dilatation and congestion of the heart, and ©f some of the organopathic conditions which are the consequences of these* diseases. \n\n106. Diagnosis of dilatation and of hypertrophy of the heart. Hitherto we have had but little more than the following symptoms by which to distinguish dilatation from hypertrophy of the heart : more extensive dullness at the praecordial region, heart beats feeble, absence of impulse ; if these signs were perfectly well marked, we could establish the diagnosis of dilatation beyond question ; but in the majority of cases there was room for doubt of the exactness of the diagnosis ; but by the aid of the physical signs I am about to describe, the diagonsis cannot for a moment remain doubtful. \n\n107. Let us suppose two well-marked cases, one of hypertrophy^ the other of dilatation of the heart. Let us now limit the volume of the heart very accurately, by the aid of percussion ; now let us cause the patient to breathe forcibly several times in succession ; let us now measure the heart again with the same accuracy ; we shall find in the case of hypertrophy that tlie heart has undergone no change ; whilst in the case of dilatation, we shall find that the heart has returned to about \n\n108. If it be a case of partial dilatation, \"or a partial hypertrophy^^ the cavities of the heart, only the dilated cavity will return to its normal state, while the hypertrophied ventricle will remain unaltered by the forced respirations. \n\n109. If, as most frequently happens, the dilatation be accompanied with hypertrophy, the diagnosis will be still more easy, because in such case, the only slight diminution of the increased volume of the heart, will indicate dilatation with hypertrophy. \n\n110. In dilatation, the heart diminishes, by emptying itself of the blood which it contains. A long time ago, Piorry observed that after bleeding a patient with dilated heart, this organ was found diminished in bulk. \n\n111. The application of this same principle to diagnosis of congestions, or permanent alterations in the volume of the liver is at once obvious. \n\n112. Treatment of dilatation of the heart, and its consequences. The treatment of hypertrophy or dilatation, or the two conjoined, follows directly from the means of diagnosis, \n\nfrequently the better,) amelioration of the symptoms will very soon become manifest. In most cases, especially in dilatation with hypertroph3'5 the cure will not be so radical, but the patient will experience great relief, and by the disease being thus kept stationary, existence may be prolonged far beyond the limit it would otherwise only reach. Piorry says he has cured or relieved a great many cases by these extremely simple means. \n\nThe resultant dropsies, also, often rapidly disappear under the same treatment. This is equally applicable to similar conditions of the liver, and to the serous infiltrations resulting from obstruction to the portal circulation. It is only by the aid of the plessimeter that these nice variations in the volume of the heart or liver can be made out. \n\nWhatever one may think of this mode of diagnosis and treatment, it is certainly worthy of trial, especially as it is in the last degree harmless. \n\nOF THE Heart. Cases. \n114. The diagnosis of softening of the heart is not easy nor absolute. This affection occurs in consequence of adynamic diseases, typhus, typhoid, diphtheria, variola, scarlatina, etc. ; and it results from diathetic conditions of the blood, in which the quality ef the fibrin is deteriorated, or the proportion of the red globules is diminished, or that of the white globules increased, as in cyanosis, purpura, scurvy, leucohaemia, glycohaemia and acute phthisis. \n\n115. The heart softens, at least superficially, in pericarditis, and throughout the thickness of its walls in carditis, in hemorrhagic or serous infiltration, in fatty external deposit it is softened superficially, and in fatty degeneration it is softened in portions of the walls of one or both ventricles or auricles, or throughout its entire sub: stance, ventricles, auricles, valves and investing membrane. The detailed analysis of these conditions does not come within the scope of this epitome. \n\nments. \nCan this kind of softening be verified clinically and exclusive of softening from fatty infiltration or fatty degeneration ? T think this question may be promptly answered in the negative. Nor are the causes of the different varieties of softening so clearly appreciable that we may with great probability infer that, in a given case, the softening is or is not attended with fatty degeneration or infiltration. \n\nStill most careful observers will have a settled opinion in their own minds, based on more or less satisfactory reasons. Indeed, the diagnosis of softening, as distinguished from degeneration^ can be rationally made out, and that too with sufficient nearness to constitute a basis for rational treatment, \n\na. For example : a young adult of active habits, and accustomed to plain food and to total abstinence from alcoholic drinks, is attacked with typhoid fever, and in the course of one, two or three weeks presents the symptoms of softening, viz.: feeble, irregular pulse ; much diminished or absent first sound of the heart (there being no mitral regurgitation); heart's impulse invisible \n\nat times, and when visible unaltered in location ; impulse, also, but slightly appreciable to the touch, or entirely impalpable ; the extremities presenting a leaden hue (all valvular diseases susceptible of exclusion) ; suppose this case to have prsecordial uneasiness, vrith occasional transient pains in the vicinity of the heart ; would it not be extremely probable that he had simple softening without degeneration or even dilatation ? Yet the symptoms and physical signs are undistinguishable from those of degeneration. \n\n117. In such case, if the diagnosis of simple softening were correct, the patient would in all probability rex^over within a period of from six to twelve months, under the use of tonics, nutritious diet, moderate exercise, both passive and active,' dry frictions, and cold or tepid spongebaths, morning or evening, as should best agree with the particular case. Such a case might be allowed moderate doses of whiskey or brandy, or half an ounce, three times a day, of a mixture composed of equal parts of cod-liver oil, whiskey, and syrup of wild cherry bark, or perhaps, better still, Guffroy's cod-liver extract. \n\nMarkham (London, I860,) as having been benefitted by \" cod liver oil in combination with steel,'' were subjects of softening without degeneration ? \n\n119. However this may be, we would hardly on theoretical grounds give cod-liver oil to a case with fatty heart; and we should be extremely cautious in the use of stimulants ; while, in a case of this kind, both would be indicated in reasonably large doses. As intimated above, (115) the prognosis in softening — non-fatty — is very favorable, and would suggest an early and complete recovery. \n\n120. The diagnosis of fatty degeneration, though never absolute and exclusive, is made out with so much rationality as to be practically but little less than demonstration. \n\nThe diagnosis is based on the symptoms already mentioned (115 &,) to which may be added defective memory of recent events, inability to perform mental or bodily labor for any considerable length of time; in bad cases, the pulse less frequent than the systole of the heart. Respiratory forgetfulness is often observed ; dyspnoea is not unfrequent; and whenever this occurs, the liver habitually congested, rapidly enlarges; relative increased sharpness to second sound of heart. \n\n121. The arcus senilis has no value as a symptom of this disease, except in so far as it*is in harmony with the general leaden hue of the nails, lips, ears, ete. \n\n122. Syncope, and loss of consciousness without fainting, are likely to occur several times in the slow course of this disease ; for it is eminently a chronic affection, lasting from a few years to the number of years of human life. \n\n123. Its favorite subjects are persons of luxurious and epicurean habits. Persons who take no exercise and drink freely, are especially liable to this form of softening. \n\n124. Case. — G. N., of San Francisco, height 5 feet 10 inches, corpulent, weight 170ft)s., single,living in perfect idleness on ample income, a very free-liver, aged 38. Drank more than usual on Feb. 7th, 1867, his last birth-day ; in the evening fell in a^fit. On coming out of this, a few hours after he fell again, but quickly recovered, having sustained no injury but a cut in the skin of the occiput. Fits epilepti-form. \n\n125. He took 30 grains of bromide of potassium, repeated every six hours ; had several good naps during the night, and seemed much better on the morning of the 8th. Before night signs of delirium supervened. He talked clearly of all mat- \n\nters of his past life, told anecdotes with clearness and fluency, but could not remember anything then occurring, from one minute to another ; did not recollect whether he had eaten or drank, or taken the medicine ordered. At 11 a. m., 8th, no pulse except at intervals, then exceedingly weak ; Tieart beats 150 per minute ; respiration varying from 50 to 80 in three successive minutes ; delirium very mild and subjective ; heart's impulse feeble. The apex strikes the thorax in the fifth interspace, directly under the left nipple. No murmurs on auscultation ; first sound of the heart exceedingly feeble, as if it were an attempt at a contraction which it was unable to complete. The second sound was also muffled, or defective in accent. Respiratory murmur good, except where the left lung was pushed upwards, and condensed by the enormous liver. My diagnosis Avas fatty degeneration, with dilatation; the epileptiform fits resulting from defective supply of arterial blood to the brain, in consequence of heart disease; also, mild delirium tremens. \n\n9th. 11 A.M. Heart beats 140 ; no pulse at wrist ; sweat drenching in abundance, but not viscid nor cold. Has persistent clonic spasms, particularly of fingers and wrist joints. He lies flat on his back, and will have no pillow except \n\nthe corner of one to raise his head to the level of his body. Bromide of potassium, digitalis, whiskey and beef juice fail to produce any amelioration ; by the advice of his consulting physician, he is allowed to have laudanum in such doses as are usually given in delirium tremens, which the consulting physician believed he had,\" pure and' simple. At the fifth dose, given halfhourly, he was asleep ; heart beats 140, no pulse ; respiration 32 ; eyes closed, sleep profound, some stertor, clonic spasms of mouth and jaw, pupils not larger in the shade than the head of a pin. One hour later, that is, the 9th, at 10 p.m. he died without having awoke. His respiration was the same, 32, and his heart beats 140 up to the instant of death. His heart stopped, not gradually but abruptly and finally at the same instant. There was no final convulsion. \n\n126. Post mortem fourteen hours after, in the presence of several distinguished physicians. There was found fatty degeneration of heart and liver. Heart increased about one-tliird in size. There was no sign of inflammation in or out of the heart ; no dropsy ; no clots in the heart or vessels ; heart pale and flabby ; both sets of valves examined with care and found perfect ; liver extended above the third rib, was extremely friable and pale. The heart was very soft, being \n\neasily rubbed to a pulp between the thumb and finger ; on section, it presented pale fawn-colored spots on the cut surfaces of both ventricles; these were more distinct than on the surfaces of the heart before being cut. Examination under the microscope showed abundance of oil-globules and amorphous pale muscular substance, but few striated fibrillar. Externally the heart was not encumbered with more than the usual amount of fat, and this was principally about the base of the right ventricle. \n\nThis man never knew he had any disease of the heart, but had complained of oppression about the pra)cordia before the 7th Feb., and had told a friend he was going to have his heart examined some day, soon. An opiate in large doses is the very worst drug that can be given in degeneration. In this case it is not probable that it hastened the fatal result, for the case would have died in a few hours more, in convulsions, had the nervous system been left to itself; but it is observed that it diminished respiration (from an average of 65 to 32) without affecting the heart beats, which was equivalent to increasing the dyspnoea ; the dyspnoea increased the congestion of the liver and the engorgement of the hearths cavities. \n\n127. Case of Rupture of the Heart ; Fatty Softening ; Dilatation. — Q., died suddenly. The autopsy revealed the following facts : The beginning of aorta was atheromatous ; the right coronary sinus v/as converted into an aneurismal sac the size of a hen's egg. The coats of the artery were so lar ruptured on the anterior part of the sac, that ecchymosis was visible under the external serous covering. This rupture was incomplete, and about the size of the little finger nail. There was also rupture of the apex of left ventricle, through the ventricular wall which at this point was not a line in thickness. The rupture was incomplete, like that of the aneurismal sac, extending only to the viceral layer of pericardium, which was glossy, and exhibited no sign of inflammation.- No blood had escaped, either from the aneurismal sac, or the apex of ventricle under the pericardium. There was a faint attempt at reparation in both places, shown by the deposition of lamince of fibrin, but this attempt had evidently been quite abortive ; the deposited laminae were almost black, and dirty looking. The place of rupture of the ventricle was indicated externally by the ecchymosis seen through the pericardium. The heart was full twice the normal size, very soft, and evidently degenerated, by the sub^tit.ition of fat for sarcous elements. \n\nMitral valves incompetent ; aortic valves perfect ; the other valves were not examined. The subject was a quadroon, aged 30, fine-looking, not emaciated. The pleural sac and peritoneum were distended with effusion ; the liver was much enlarged, the lungs healthy. There were several chafes of pleuritis, with deposition of lymph, on the mural layer of pleura, near the apex of the left lung, posterior aspect. \n\n128. This was a case of sudden death. The f)ost mortem reveals the proximate cause to have been rupture of the left ventricle. The rupture occurred in consequence of dilatation, conjoined with degeneration of structure elements. The aneurismal incomplete rupture was also much aided by 4he fatty degeneration of the aortic walls. \n\n129. Violent traumatic rupture of the heart, even when the laceration is very extensive, does not necessarily cause instant death, not even fainting. Morel-la-Vallce saw a case in detail at the hospital of St. Anthony, Paris, in 1858. A man of sixty was thrown from an omnibus, a wheel of which ran over his chest, crushing it in a frightful manner. He was immediately carried into the hospital in front of which the accident occurred. Although in a dying condition, he \n\nmade some signs to his wife, who was with him, breathed a few times, but was pulseless, and expired. On examination, the left ventricle was lacerated the whole length of its anterior aspect; the upper part of the septum of the ventricles and the left auricle were also torn completely through ; the mitral valve was torn in pieces, the tendinous cords were torn out, and remained hanging to the shreds of a fleshy column. \n\n130. The injury to the heart appeared to result from excessive pressure. Although the sternum and ribs were much fractured, no osseous fragment corresponded with any rent of the heart. \n\n131. This case, though not properly within the scope of my subject, is interesting in a physiological point of view, as showing what extensive injury the heart itself may sustain without causing instantaneous death, or even loss of consciousness. But to return to my subject— fatty heart — is recognized with great difficulty ; but tlie most reliable negative symptom, is the absence of dropsy. The most reliable positive symptoms are, liability to \" heart faintness\" and intermittent pulse, while the systoles of the ventricles are regular and 7iot intermittent. In the advanced stage of fatty degeneration — and this is the stage in which our attention is most frequently called to it — this \n\nsymptom of pulse weak or absent, out of proportion to the systoles, is nearly always present. There is another marked symptom in this stage ; that is, a muffled toneless first sound, quite distiaguishable from the accented sound from dilatation without degeneration, and also, relatively higher toned and more accented second sound. Precordial uneasiness or distress is also a marked and frequent symptom. \n\n132. Summary of Treatment , — There is scarcely a doubt that fatty degeneration may be arrested, and that the unaffected portions of the heart may be so far fortified as to perform the work of a sound organ, so that its deficiencies will cause no suffering, or even uneasiness, to the subject. This amelioration can be brought about by hygienic and medicinal means in many cases. \n\n133. The hygienic means are frequent bathing — twice a week — pure air night and day; uniform temperature of the surface of the body, by light, warm clothing, passive exercise in salubrious districts of country; such as carriage, boat and horseback riding ; little or no benefit from walking need be expected. Food should be nutritious and easily digested. Fish, meat, game, and a rather limited amount of vegetable food may be allowed. Less fatty, starchy or saccharine matter should enter into the diet than in other diseases, \n\nexcept there be good reason to believe that the softening of the heart is non-fatty. All alcoholic beverages should be avoided, except for the immediate feeling of faintness. All sudden excitements, or causes of emotions^ should be avoided vrith great care. \n\n134. The most relioble medicinal remedies are solution of ] erchloride of iron, largely diluted — a drop to a drachm of water — strynchia, brucia, arsenic. * Quinine and opium are not to be forgotten (see page 63, c.) ; aloetic pills, or some equivalent, are required from time to time, or formula a, (page 57,) may be employed with advantage. Electro-magnetism, of very low tension, applied over the pneumogastric nerves, or over the heart itself is worthy of trial. I have no experience of its eJBfects in these cases, but theoretically believe it must be beneficial, if applied once or twice a day, with great caution, for many months. The use of it for a few times could have no result. \n\nthis city, and has proved fatal in many instances \n* Of all the preparations of arsenic, that first recommended by Athar Ali Khan, of Delhi, is most used by me. R. White arsenic, grains 2 ; black • pepper, grains 100. M. Make, according to art, into sixty pills. S. Dose, one a day for a week, and finally three a day indefinitely. \n\nwithin my own observation. It favors the formation of clots in the heart — a cause of sudden death. In almost all cases of rupture of the heart, without external violence, fatty degeneration is the predisposing cause — all cases of rupture die within a few moments. \n\n136. It is one of the diseases of the heart that may be treated with the most rational hopes of amelioration and indefinite prolongation of life, if recognized and treated before it has become complicated with excessive dilatation, or before it has reached that stage in which the pulse is irregular, very weak, tremulous and intermittent at the wrist, before fainting fits are frequent ; in short, before the greater, instead of the less portion of the heart has undergone fatty substitution. In this last stage, any treatment — the most rational— can barely alleviate temporarily, without the slightest hope of retarding the onward progress of the disease. \n\n137. Angina Pectoris, or '* sujffocative breast pang,\" is a disease from which the poor are usually exempt. It attacks about nine males to one female. It scarcely ever occurs before the fortieth year, seldom before the fiftieth. It is usually protracted in its course. Death lias been known to follow within two hours of the first \n\naverage duration is unknown. \n138. No disease of the heart is more certainly recognizable than angina pectoris. It consists of spasm and pain in the breast, generally about the lower portion of the sternum, but sometimes as high as the upper end of this bone. The pain runs through the breast to the back, and down the left arm. There is a sense of suflocation, and a feeling that death is imminent. This feeling of speedy dissolution is never wanting, any more than the pain, the suffocation and the constriction about the heart. It comes suddenly, without warning, and goes suddenly and completely. A patient of mine was walking in the street; all at once he dropped down on the pavement, with intense tearing pain, and a feeling of suffocation and instant death. He immediately arose, before two gentlemen near him, who sprang to his assistance had -time to reach him. For an instant, he says, he must have been unconscious, %r he does riot remember falling, but was conscious while getting up. The gentlemen who wished to help him asked how he came to fall so suddenly and get up instantly. He answered that he did not know, and asked how long he had been down ? They replied, '' No time at \n\nall ; 3^011 got up as soon as you fell, before wo could get to you.-' This man has had no attack since, but by my advice lie has arranged his affairs. A paroxyir^^m of angina pectoris may last several minutes ; that this was a case in which material unsoundness of the heart, its valves and of the thoracic aorta were present is indubitable, from examinations carefully made, previous and subsequent to his fall. \n\n139. In order to appreciate the manner of diagnosis J it is proper to glance at the usual pathological condition of the heart in fatal cases, \n\na. In almost all cases, the heart walls, especially of the right ventricle are thinned. The heart is usually softened, generally by fatty metamorphosis. Neither clots in the heart nor emboli in the arteries have been found. The corronary arteries are frequently more or less ossified or constricted by atheromatous deposits. JYo matter what the cadaveric rigidity may be, the ht art will always be found soft;. \n\n140. The pain of angina is neuralgic, not that of tenderness. It depends, then, on lack of supply of red blood to the heart itself, or upon impaired nutrition or irritation of that branch of tlie vagus which supplies the heart. \n\nporarily diminishing the supply of arterial blood to, or retard the return of venous blood from the heart; or any cause which shall impair the normal function of the vagus may produce a paroxysm of angina pectoris. No causes could be more likely to induce such defect of blood supply to the heart than fatty metamorphosis, or dilated heart, or narrowed corronary arteries — the three precise con* ditions in which we find angina most likely to occur. Here, for the hundredth time, theory and fact coincide. \n\n141. We may expect in most cases of angina pectoris a feeble, small and over frequent pulse, as in dilatation; but from the pulse alone nothing can be determined in this affection. The diagnosis rests entirely on the character — the unmistakable character of the paroxysm — great dread of death, a feeling of inability to breathe, for fear of hurting the heart, or causing death, more than a conscious ness of real inability to take a full inspiration. \n\nThe Treatment of the attack itself is not often committed to the physician, because it is over before he arrives ; but in protracted paroxysms, or in those of frequent recurrence in the same day he may be present. \n\nprompt relief. Stimulants, in small, often repeated doses, should be given at the same time, if the patient can swallow. A touch of the cautery between the shoulders, will undo the spasm of the heart most promptly. If the stomach is full, it should be relieved by a prompt ^emetic — sulpliate of zinc or powdered ipecac, a large dose in a goblet of tepid water. If the patient be of full habit, and if it be known that the heart is not dilated, and if serious fatty degeneration be not suspected, ard if the pulse be nearly natural in size and fullness and not slow, bleeding at the arm is certainly indicated, or blood may be taken by scarification and cups from the praecordia, if not thought proper to risk the opening of a vein. \n\n143. But the most important part of the treatment of a subject of angina pectoris is that directed to the postponing of the recurrence of the attack, which is sure to come again, sooner or later, and with more violence ; and the more v frequently the greater the number of paroxysms already* endured. All emotional influences must be avoided. The temper must be controlled. The passions indulged with the greatest moderation. The natural calls of the body obeyed with deliberation ; hence the bowels must not become \n\ncostive, nor the bladder distended. There must be no violent or forced work, or exercise, or amusement. No severe or rapid intellectual labor; no excesses of any kind — moral, esthetic, physical, mental or emotional. Daily passive exercise in^ the open air ; slovr walking on level ground in open spaces, as in the country or suburbs, or unfrequented streets, may be permitted. \n\n144. Riding in a carriage is much preferable to riding on horseback, however easy the gait of the animal, because of the labor of mounting and dismounting, and the risk of sudden motions of the horse, which might bring on a fatal paroxysm. \n\nTonics are generally indicated, also stimulants and nitrogenous nutrients, in rational quantities. If anemia be present, iron must be employed, and cod liver oil, in the modes already stated, as in dilatation, or in softening, without^ fatty metamorphosis. \n\n145. Dr. Walshe, with great theoretical propriety, says, \" The removal of gout, chronic rheumatism, or old standing skin diseases, should be very cautiously, if at all attempted, in the subject of angina ; relief of those complaints is unquestionably sometimes followed by increased severity of the cardiac affection.^' \n\n146. Rheumatism^ which occupies so important a place in the consideration of pericarditis and endocarditis, requires mere mention. It is justly dreaded on account of the occult effects it is likely to leave in the organism. Persons who had rheumatism years ago, are constantly seeking medical advice for some trouble about the heart, although at the time of the rheumatism no heart symptoms were observed. Is it not probable that some lesions of the heart, though not derived from rheumatism result from similar diseased aetion, or from the presence in the blood of similar morbific elements ? \n\n147. I will assume that rheumatism is recognizable by all physicians, and will merely allude to what appears to me to be two well-marked varieties of this affection. The one I will call inflammatory rheumatism, which is most to be dreaded, as to its effects on the heart ; the other I will call neuralgic rheumatism. The former is attended with fever, tenderness and acute pain and immobility of the muscles and joints implicated. The latter is recognized by a persistent dull ache, increased to an ache with partial numbness, by excessive use of the affected limb or part, but never attended with those flashes of agony which characterize pure neuralgia. This \n\nkind of rheuraatism is certainly curable in the great majority of cases with quinine and opium in combination, given in small doses, aided by colchicum and whiskey given in regular doses and in mixture. Alcoholic beverages are to be avoided ; vinegar, sugar and fruits must not be used. If there is anemia, cod-liver oil, with syrup of wild cherry and whiskey will hasten the cure. From one to six months of this treatment will be required, in neuralgic rheumatism of the hip joint after gonorrhoea, or in neuralgic rheumatism of the lumbar region, or of the shoulders, or feet and ankles. \n\n148. Acute or chronic inflammatory rheumatism is certainly curable in a great majority of cases by propylamin and laudanum, and aloetic aperients. But I am of the opinion that it will often be found requisite to give ten times the dose recommended by Dr. Awenarius, who first recommended it in this disease. I have cured so many cases with these means alone, that I now use scarcely anything else. I have had no success with stimulants, nor with fatty food. Here, as in neuralgic rheumatism, vinegar, sugar, fruits, fermented beverages, etc., are not tolerated, except there be anemia as a complication. \n\nstimulating liniments, and anodyne cataplasms; indeed, moist heat, no matter how applied, so that the air is excluded from the affected part. Cathartics and small bleedings are no doubt often of great benefit in the beginning of the affection, if the patient be of full habit and in good blood-making condition ; but after the first few days, bleeding is worse than useless. The aloetic pills, on the other hand, may be continued during the whole course in laxative doses. \n\n150. Absolute rest, in an apartment of uniform and rather high temperature materially hastens the cure. The diet should consist of rather thin broths, with plenty of salt and no pepper. No other alkali than the propylamin will be needed. \n\nThe sulphate of manganese, already mentioned, I have no experience in, but it is well worthy of trial as a preventive of the cardiac effects of rheumatism. \n\nCynosis and Atelectasis. \n151. The anatomical relations of the g;reat blood vessels of the chest render the diseases of these structures most dangerous in their tendencies and results. \n\n152. Under the head of thoracic aneurism may be comprehended aneurism of the aorta, or of the innominata, pulmonary or bronchial arteries. The diagnosis of thoracic aneurism in its earlier stashes is always difficult and frequently quite impossible ; for although its presence is always attended with more or less objective and subjective symptoms, still there is no known pathognomonic indication upon which we can place implicit reliance. As the tumor progresses in growth, and fluctuation and pulsation become evident, of course there can no longer remain any doubt as to the nature of the disease. The diagnosis of aneurism of the aorta will be aided by a consideration of the mechanical effects such an enlargement might be expected to produce, and also the peculiar functional disturbances which would most likely ensue from the consequent pressure upon surrounding and adjacent structures. \n\n153. Thus, if a patient present no satisfactory evidence of a stricture of the oesophagus, and yet dysphagia be present, with an apparent obstruction to the passage of food at a point just opposite the second intercostal space, aneurism of the arch may be suspected. A similar obstruction in the oesophagus at a lower point might be owning to enlargement of the descending aorta, and if still lower and just above the diaphragm, aneurism of the thoracic aorta where this vessel is crossed by the oesophagus would be probable. The attendant functional derangements vary with the location of the aneurism. Thus, spasmodic laryngeal aflections would indicate pressure upon the recurrent branch of the pneumogastric nerve, at a point corresponding with the posterior and inferior portion of the arch of the aorta, and hence be suggestive of aneurism at this point, or of the arteria innominata. If constriction of the chest be a prominent symptom, aneurism of the ascending portion of the arch, with consequent pressure upon the cardiac plexus would be probable ; if orthopnoea or asthma, the commencement of the descending portion, etc. \n\n154. Displacement of the heart, not otherwise accounted for — weak systole — contraction of the pupils from pressure upon the sympathetic nerve, evidence of aneurismal diathesis, hasmoptysis, \n\nangina pectoris, raucous voice, aphonia, intercostal neuralgia ; pain radiating from the chest, or fixed at the upper portion of the thorax, swelling of the feet or infiltrated condition of the eyelids are signs which will be construed by the intelligent physician, as their import in any given case may jastify. \n\n155. As the tumor enlarges, it may project above the sternum, or by its pressure produce absorption of the osseous and cartilaginous walls of the chest, presenting itself as a soft, palpable and pulsating tumor. The above remarks are all, more or less, applicable to aneurism of either the pulmonary arteries or of the innominata ; the peculiar modifications dependent upon the anatomical relations of these vessels being remembered. Thus, in aneurism of the innominata, the tumor can be felt and its boundaries defined ; it may also produce dyspnoea and dysphagia, by its pressure upon the nerves concerned in respiration and deglutition. Its pressure upon the subclavian artery may obliterate the pulse at the right wrist ; or, if upon the trachea, threaten sufibcation. A full consideration of the lesions of this short but important artery belongs more properly to the province of surgery than to that of practical medicine. \n\n156. Aneurisms of the pulmonary or bronchial arteries are comparatively rare, and their diagnosis is, perhaps, in most cases impracticable. We should here, however, expect the symptoms to be more intimately connected with pulmonary complications than in similar affections of the aorta or innominata. In such obscure cases the practitioner should be guided by the light of anatomy and physiology, without which the most simple problem in diagnosis may become an incomprehensible mystery. \n\n157. Auscultation and percussion are invaluable as enabling us in many instances to diagnose thoracic aneurisms before their presence could be communicated to the senses through any other channel ; they are neither, however, infallible, and as is true of all other means at our command, are only susceptible of a limited practical application. \n\n158. The ''aneurismal bruit'^ is neither constant nor pathognomonic, but is of value when taken in connection with other signs. \n\n159. When this bruit is present, it is not unlike the sound produced by whispering the letters h-w-he e u-w, thrown together in the form of a word ; it may, however, vary in pitch and intensity, be slightly musical, rasping or blowing, or \n\nall these variously combined. A \"jogging^' sound is supposed to indicate aortic dilatation. When these sounds are heard, they are, of course? systolic, and must be distinguished from valvular murmurs by their location, direction of propagation, etc. Percussion may be of value. It can prove that resonance is decreased over the region of the disease in these cases ; it tells- us nothing more, however, except the probable size of the tumor. It does not tell us whether the dullness is caused by a fibrous, encephaloid or aneurismal growth. \n\n160. Treatment, — The disease is incurable; and if we can prevent, temporarily the fatal issue, it is all that can be expected. Spontaneous cure is a theoretical possibility, but too remote to constitute a foundation for reasonable hope. The treatment should consist of such management of the case as will be most likely to keep the circulation equalized, and in theory better still if the heart's action is constantly kept below its normal force. The habits of the patient should be strictly regular and temperate in all things. Venereal excesses should be especially forbidden, and passive rather than active exercise permitted. In some advanced cases, absolute rest must be enjoined. Tracheotomy may temporarily prolong life where laryngeal symptoms threaten imme- \n\ndiate suffocation. The treatment of aneurisms of the innominata is more properly a surgical topic. The innominata has been ligated a number of times, but only once successfully. \n\n161. Cyanosis is generally the result of a congenital defect in the heart, such as the non-closure • of the foramen ovale, and of the ductus-arteriosus. There may be a congenital opening in the septum ventriculorum. It may also depend on arrest of growth, either before or after birth, of the root of the pulmonary artery, whereby its orifice is rendered permanently too small ; this may be the only congenital defect, the venous and arterial blood not mixing at all. In this case, the blue tinge of the skin is as easily accounted for as in the other malformations. \n\nRoKiTANSKY has seen cases of narrowed pulmonary artery without cyanosis. This fact has been often remarked by other observers. The foramen ovale is frequently open, and yet there is no commingling of arterial and venous blood, unless the pulmonary orifice is constricted. Hence it is probable that obstruction at the ostia of the heart, from constriction or other cause, combined with patent foramen ovale, open septum ventri. culorum, patent ductus arteriosis, or insufficient tricuspid valves, is necessary to the production \n\nof cyanosis. The venous stasis, and red and purple blood mixture, theories are neither true alone, but when both exist at the same time, cyanosis must result. But really the consideration of this disease hardly comes within my theme— it belongs to works on malformations of the heart, among which that of Dr. Peacock is excellent; but I will merely add, that we shall find hypertrophy of the right ventricle, etc., etc.. the same catalogue as that which results from mitral obstruction and patency. The treatment is not peculiar, but more difficult, because it has to do with children who have not yet arrived at accountable age. Passive exercise, slow movements, restricted and select diet, pure air, special treatment on reflex principles, of the paroxysms of dyspnoea or syncope that frequently occur, are all that can be suggested. The affection is in the end fatal, and this result may be postponed, but not averted, even by the most rational treatment. \n\n162. The lividity of atelectasis of the lungs, (non-distension of air vesicles,) sometimes manifested in the new-born, cannot be mistaken for cyanosis, resulting from malformed heart. The former sometimes disappears after a violent fit of coughing ; the latter is persistent during life. \n\nI. If the patient, otherwise in good health, complain of uneasiness in the prsecordial region, cardiac disease may be expected. \n\nII. If a murmur be heard at the base systolic in time, (that is, with the first sound of the heart) which diminishes in intensity as the ear is moved towards the left nipple, it indicates roughness of the semilunar valves, or constriction or roughness of the aortic orifice. \n\nIII. If a systolic murmur be heard at the prsecordia, and if it increase in intensity as the ear is moved toward the left nipple, and diminish as the ear is moved up the sternum, it indicates mitral regurgitation^ that is, insufiiciency of the mitral valves, \n\nIV. A murmur heard at the base of the heart (about the junction of the third ribs with the sternum,) thence down the sternum, coincident with the diastole, (second sound of the heart,) indicates aortic regurgitation. If to this sign be \n\npulse at the wrist, aortic regurgitation is certain. \nV. A murmur coincident with the second sound heard about the left nipple, or in the fifth interspace below and to the right of left nipple, and along the heart towards its base, and no where else, indicates mitral constriction; [\\his murmur is very rarely heard.] If to this be added a slight cough, the lungs being .sound, and hypertrophy of the right ventricle — mitral constriction is indubitable. \n\nVI. A murmur heard loudest above the base of the heart in the upper part of the thorax, indicates aneurism of the aorta, or innominata, or subclavian artery. If to this sign be added a pulse of unequal strength in the two wrists, or absent in one wrist, aneurism is almost certain. Difficulty of deglutition and paroxsyms of dyspnoea add greatly to the probabilities of aneurism ; indeed, with the preceding signs, render it indubitable. \n\nnor very resistant, if the first sound of the heart be clear and more distinct, and seem nearer the ear, and have more of a knocking character, than normal, there is dilatation of the heart. If there be much bulging of the interspaces, and if the pulse be strong for dilatation and not strong enough for hypertrophy ; if the apex be outside of the left nipple and below the sixth rib, there is hypertrophy with dilatation. If there be also dropsy of the lower extremities, the probabilities of dilatation become certainties. \n\nIX. Basic murmur, coincident with first sound, heard loudest at the junction of the third costal cartilage with the sternum, and thence down the sternum, attended with persistent jugular pulse, indicates almost positively tricuspid regurgitation— insufficiency of the tricuspid valves — if to these two signs general turgidity of the venous system be added tricuspid regurgitation becomes certain. \n\nX. An endocardial murmur^ whether systolic or diastolic, whether at the base or apex, heard suddenly during the course of an acute rheumatism, or after a violent blow on the prsecordia, or during Bright^s disease of the kidneys, indicates endocarditis in the most positive manner. \n\nthe prJECordia, (IT 5, p. 11.) that is, over the fifth left costal cartilage, while the patient holds his breath, indicates pericarditis, in the most positive manner. \n\nXXL Softening of the heart, without fatty degeneration, occurs only in cases of asthenic or adynamic diseases of an inflammatory nature. If in such cases the pulse grow feeble out of ratio, with the intensity of the adynamic disease — for example, a typhus or typhoid fever — and remain weak and unequal, become easily excited and fluttering, if at the same time the patient feel steady praecordial uneasiness, softening, of the non-fatty variety, is extremely probable. \n\nXIII. If the same symptoms mentioned in the foregoing rule be observed ivi^hon-vivant of luxurious and idle habits, especially if he be at the same time an intemperate drinker, /a/^y degeneration of the heart is almost indubitable. If to these symptoms be added epileptiform seizures, and if the respiration varies greatly in uniformity as to frequency and force without any external cause, and at the same time the patient be over forty years old, fatty degeneration may be considered certain. \n\nthe suffocation praecordial pain, the dread of imminent death, have once occurred, so as to be described by the patient in these or similar terms, without having been questioned by the physician. The symptoms pertain, in their clearness and pertinence, to no other affection. \n\nXY. A murmur coincident with the first sound heard at the base and propagated up the aorta, in an anemic person, or in a person whose blood under the microscope exhibits defect of red or excess of white globules, is an inorganic murmur, and indicates merely altered condition of the blood, or altered dynamism of the heart. \n\nI. The first and most important principle to be kept in view in treating a diseased heart is to diminish the labor it has to perform. \n\nII. This is done in two ways, a. Directly, by diminishing the amount of blood in the body; h. By diminishing the functional activity of all tlie organs not directly concerned in secretion, and by increasing the functional activity of the skin, liver, kidneys, lungs and ialimentary canal. \n\nHI. a. Bbod may be abstracted directly, either from the arm by venesection, or from the praecordia by cups, when from general plethora or overwhelming local congestion, a sudden diversion to the blood current is deemed essential; or the total quantity of blood in the system may be diminished by reducing the weight of the body — the loss of eight pounds of weight is the loss of one pound of blood. \n\nh. Blood never is to be taken with a view of cutting short an inflammation, or curing either an acute or clironic affection, but merely for ihe purpose of relieving an urgent symptom, or arresting an imminent catastrophe. \n\nc. On the other hand, bleeding is not so hazardous as many would wish us to believe, d. If the digestive organs are unimpaired, loss of blood by hemorrhage is restored with astonishing rapidity, e. In this respect, anemia from traumatic hemorrhage or venesection is widely different from pathological anemia, depending on lesions of nutrition, assimilation and innervation ; in short, on lesions of all the organs of the body. /. Blood deterioration in this case is repaired with extreme slowness, and this is not to be used as an argument against venesection, leeching, or cupping. A few pints of beef tea will restore as \n\nbleeding. \nTV, So local bleeding, even in anemia of slow growth and long duration, is not always objectionable to mitigate a threatening local symptom. a. For example : take a case in another department of pathology. A child of six months, more or less, badly nourished with insufficient mother^s milk, and cow^s milk and farinaceous mixtures, has chronic diarrhoea. In the course of treatment we intentionally diminish without arresting the diarrhoea : the child now has tonic spasm of the fingers and toes, the eyes pitch back under the brow, or look straight onward, seeing nothing; it rolls its head and moans, and starts with sudden shrieks. This child is anemic, very pale, waxy almost, but its head is burning hot. Now, if a single leech be applied at the anterior fontanello and allowed to fill, and after it drops oflP, the bleeding be encouraged by the application of compresses wrung out of hot water, not only over the bite, but over the whole top of the head, for the space of a whole hour; if this be done within the first twelve hours after the tonic spasm becomes manifest, the chances are more than two in three the child will recover, providing it be nourished with beef juicCj and medicated solely \n\nwith minute doses of creosote subsequently, and kept warm at the abdomen and extremities. 6. Now, (his is a case in which an apology is needed for bleeding, if an apology is ever needed; yet I have bled in twenty recorded cases in this manner, and in seventeen have had the satisfaction of seeing my little patients recover. \n\nnot required in diseases of the heart. \nYI. By abstinence from hard labor, mental or physical; by abstinence from all severe exercise, and by avoiding all violent emotions or passions, the demands of the heart are obviously lessened, and hence its labor lightened. \n\nYII. By aperients regularly taken, by diuretics often repeated, by hepatic stimulants taken from time to time, by unobstructed access to the atmosphere at all hours of the day and night, by baths, frictions and abundant passive exercise, the functions of the liver, skin, lungs, kidneys and alimentary canal are certainly increased, and that not in a way to be detrimental to alimentation, assimilation and nutrition. \n\nVIII. Whatever degree of sedative impression we desire to make on the heart, must be made slowly, not suddenly. A violent blow on the pit of the stomach will stop the heart forever. A \n\nthousand light blows or a heavy weight would produce but little effect. Small doses of cardiac sedatives, often repeated and carefully watched, are better than large ones, however judiciously administered. \n\nIX. The quality of the blood must he main' tained as near the normal standard as 'possible^ while its quantity may he diminished by restricted diet, and certain evacuants^ in proportion as the disease of the heart advances. \n\n163. Heart disease destroys life in three ways: a, by syncope ; 5, by apncea ; c, by so interfering with assimilation as to cause gradual destruction of life from inanition — starvation, not from defective food or defective appetite, but from defective assimilation and aeration of the blood. \n\nBy far the most common special organic disease of the heart is that of the mitral valves. Insufficiency of the mitral valve is exceedingly common in this city : cases may be counted by hundreds. Now, what is the result ? Insufficiency of this \n\nvalve is not incompatible with the longest life. If the insufficiency be slight, but little blood is repelled at the ventricular systole into the left auricle, and this becomes slightly or not at all hypertrophied ; the left ventricle in such case may remain unhypertrophied. But the usual course is, the left auricle thickens; the pulmonary vessels become congested, more or less, with the refluent blood; this reacts on the right ventricle, which becomes hypertrophied. Here the case may remain stationary for years, or for life; and rational treatment may greatly help to insure this result ; but usually, from neglect or otherwise, the disease advances. The thin-walled right ventricle, being only designed for impelling the venous blood through the pulmonary arteries and capillaries around to the left side of the heart, laboring under the great burden of rejecting the increased volume of blood thrown back up*on it from the powerful left ventricle, now itself reinforced by hypertrophy, and aided in its damaging ability by the dilated pulmonary vessels, begins to dilate. Now nature steps in again, to counteract one disease by another. The tricuspid valves become incompetent, from the dilatation of the right ventricle, and part of the venous blood is repelled by the systole of the right ventricle upon the vena cavce, and again \n\nthere is rest. Even now, by judicious treatment, by reducing the weight of the body, and hence the volume of blood, while assimilation is not allowed to become impaired, life may continue for many years, and the patient die perhaps of old age. But generally no steady persistent treatment is permitted by the patient. He goes from one good physician to another, and obeys none long enough to receive permanent benefit, and in the nature of the case he is unable to treat himself judiciously ; hence the disease enters on its third and last stage. The heart in its enfeebled condition being overworked, by having to impel too much blood relative to its ability, makes new efi'orts at reparation in detail, only to hasten the ultimate result : that of rendering the heart totally incapable of performing its functions ; thus, the left ventricle becomes more hypertrophied, and if the left auricle has not yielded to dilatation in excess of hypertrophy, the left ventricle may also become slightly dilated at first ; but this dilatation never advances far, for the left auricle soon yields, and becomes so dilated as no longer to be able to afiect the ventricle by its contractions. By this time the dilatation of the right ventricle has become enormous, and in excess of its hypertrophy. The tricuspid is now constantly insufiicient ; the jugular \n\npulse is always visible, night and day ; the lungs are congested ; the breath gives out on the least hurry. There is oedema of the lower extremities, dyspepsia, congested liver, still more oppressed respiration, greater lack of aeration of blood in the pulmonic>esicles; face looks purple, or deep red, perhaps maroon-colored. The patient is very much disposed to be cold, seldom perspires; there is occasional spitting of blood; the pulse becomes weaker and less uniform, even in its weakness. The end of such a case is obvious; but often such a progress and result might be almost indefinitely postponed. Insufficiency of the mitral valve, while it is the most comnjon, is fortunately the least fatal in its tendency of all the organic diseases of the heart, and the most controllable by systematic treatment. \n\n164. Mitral constriction, if slight, is not incompatible with tolerable health and long life; but when the constriction is considerable, its consequences follow in more rapid succession. Here the left heart remains unaffected, or may become atrophied for lack of work ; for obviously, if the constriction is so great as to admit but half the blood current in a given time, the left heart has but half work to perform. A moderate constriction nature compensates, by the hypertrophy of \n\nthe right ventricle, and probably of the pulmonary arterial walls also. The right ventricle also becomes hypertrophied all the more when the constriction is considerable, and this is, of course, curative in its tendency; and if the hypertrophy of the right ventricle balance the constriction of the mitral orifice, so that by its action the same amount of blood is forced through in a given time, as though it were not constricted, then the hj-pertrophy is absolutely compensatory, and practically the patient is cured. This no doubt does sometimes happen and continue through a long life. But generally it is far otherwise. \n\n165. The blood not being able to flow into the left ventricle in normal volume, accumulates in the left auricle, which hypertrophies by increased function ; but still being unable to impel the blood onward as fast as it arrives, part of its contractile force is expended backwards upon the pulmonary veins, which becoming congested, impede the onward current from the pulmonary arteries, and so back to the right heart, as in mitral insufficiency. Insufficiency being almost always joined with constriction, we get the same train of symptoms exaggerated, to which may be added tendency to syncope, and sometimes, though rarely, death from this calise ; because enoufrh \n\nblood may not reach the arteries, in consequence of the constriction, to supply the brain ; but almost always death occurs by apncea, as previously stated. \n\n166. Disease of aortic valves, whether insufficiency or constriction, produces an opposite train of symptoms, and is more speedily lethal in its tendency; and, indeed, is less controllable by treatment, whether hygienic or remedial. \n\n167. Aortic obstruction, indicated by a systolic murmur, loudest at the base, that is, about the middle of the sternum, opposite to the third intercostal spaces, and aortic insufficiency, indicated by a diastolic murmur, heard loudest at the same place, and propagated down the sternum, are more commonly met with jn middle or advanced age than in earlier life, and more frequently in males than females; while females are more liable to mitral disease than to any other affection of the heart. \n\n168. These two affections of the aortic valves, when of long standing, are generally attended with enormous eccentric hypertrophy of the left ventricle, and final incompetency of the mitral valve, congestion of the pulmonary vessels, and finally, if the patient live long enough, hypertro- \n\nphy and dilatation of the right heart, tricuspid regurgitation, engorged systemic veins, impaired blood, serous infiltrations, dyspnoea, cough, syncope and death. The order mentioned is the usual one in which nature attempts restoration at every step of the advancing disease. \n\n169. Hypertrophy of the left ventricle is compensatory of obstruction or regurgitation at the aortic valves, or of both; dilatation is a new step in the fatal direction, and then mitral regurgitation comes in as. compensatory to that. Left auricular hypertrophy and dilatation tends to prevent the excessive injury to the pulmonary vessels, by recoil from the ventricle, and then, when this resource fails, the pulmonic valves increase in strength, and the right ventricle takes on hypertrophy, as a new compensation for the ever widening mitral orifice. \n\n170. Then another step in disease is dilatation , of the right ventricle, followed by a compensatory lesion, namely incompetency of the tricuspid valves, with its attendant regurgitation ; then disease, in the giving way of the valves of the veins, before the refluent venous current and the attendant venous congestions; then a final and last effort at compensation in serous exosmosis or dropsy. \n\n171. Thus it is seen that each advance of the disease is met bj a compensatory lesion, which, while it adds to the sum total of organic damage, retards the fatal progress of each integral lesion, reinforced, as it is, with all its antecedents. \n\n172. At each of these compensatory struggles, art is able to give nature valuable aid in the prolongation of life, and in averting sudden accidents. \n\n173. A small aortic obstruction or a trifling insufficiency of the semilunar valves, may be so accurately compensated for by hypertrophy as to produce inappreciable results, and not noti(;^bly shorten life. A considerable insufficiency, without obstruction, may be so compensated by hypertrophy as to produce no evil consequences, so long as the mitral valves remain competent ; and this latter result may be indefinitely postponed by such treatment as has been suggested in former chapters. . \n\n174. The narrowing of the aortic orifice to one-fifth its normal condition, is not incompatible with the continuation of life and the enjoyment of unsuspected health, providing it be recognized, and the patient placed under rational treatment and constant care; for it is quite probable the left ventricle may become so strengthened \n\nby hypertrophy and innervation, as to be able to propel the blood with a velocity sufficiently increased to compensate for the defective aperture through which it has to pass. \n\n175. Still it is not denied that aortic valvular diseases are generally fatal at no long period after their recognition, much more promptly than other valvular lesions. A little hurry, a violent passion, a sudden motion, is liable to surprise the heart and cause its arrest for an instant, during which syncope takes place, from lack of supply of arterial blood to the ganglia, and this syncope is too often final. \n\n176. Tricuspid regurgitation is a fatal affection and only less dangerous as to the imminence of its result than aortic valvular disease. A fatal termination may be a long time postponed, by diminishing the volume of blood in the system, by means of restricted diet, diuretics, evacuants, etc., according to the general principle often suggested in the course of this volume ; that is, by reducing the iveigkt of the body without impairing the quality of the blood. But the progress of tricuspid lesions cannot be retarded to the same degree as those of the mitral or even semilunar valves. And, while it is well known that occasional dynamic incompetency of the tricuspid, or slight organic \n\nincompetency is not incompatible with unsuspected health, yet it is no less true that considerable incompetency of this valve is incompatible with assimilation, and with oxygenation of the blood, and hence must prove fatal within a comparatively short period from the moment when it becomes well established. \n\n177. Fatty degeneration^ admits of postponement within narrow limits, as to its result ; but the fatal end will arrive when least expected, and often much sooner than the symptoms would seem to render probable. \n\nAcute pericarditis is seldom fatal. Acute eiidocarditis is somewhat more frequently fatal, but not more so than pneumonia. It almost always leaves disease of tlje valves, which in the end but perhaps not for half a century, produce death by annulling the function of the heart. \n\ncause death in from three hours to as many days. \n179. Ruptures of the heart, de natura suarum are rapidly, though not instantly fatal. Cardiac dropsies are curable by means already indicated. \n\n180. Hypertrophy y or hypertrophy with dilatation^ pure and simple, are possibly curable ; but such a result is as improbable as that both or either of these lesions can exist without organic disease \n\nof the valves, of the lungs, or of the arteries ; or at least without the presence of some external obstruction to the circulation of great and persistent inertia. \n\nFinally : it may be affirmed that after the first chronic lesion of the heart, the others come on — first, compensatory; second* deteriorative; third, compensatory ; fourth^ more deteriorative ; fifth, compensatory ; and so on, until its function is annihilated. \n\nCorrollary, The whole object of treatment is to aid nature in these purposes, by diminishing the work the heart has to do, in proportion as its functional ability diminishes, that is, in proportion as its organic lesions advance. \n\nMatter Inadvertently Omitted in Chapter V. \nIncompetency and constriction of right auriculoventricular orifice, — Incompetency of the tricuspid valves is recognized by tolerably certain signs, not difficult of recognition or appreciation. Thus, if there be persistent jugular pulse in all positions of the body, especially the upright, tricuspid incompetency is almost certain. There may or may not be a blowing murmur heard over the tricuspid, (that is, over the sternum between the ends of the fourth interspaces at the right margin of the breast-bone,) such a murmur would be propagated up and down the sternum, in the direction of both the venae cavae; but on account of the feeble condition in which the right ventricle usually is, from dilatation, at the period of tricuspid incompetency, the murmur would be inaudible a short distance from its origin; it is, perhaps, never heard at the apex. The murmur is much less frequent than the disease it indicates, because, as already remarked, it is not always audible ; and, moreover, it is often marked by a loud regurgitant murmur, as mitral incompetency generally precedes and co-exists with tricuspid incompetency. Tf the incompetency is considerable, there is generally oedema of the lower extremities, though dropsy is not a \n\nnecessary result of any degree of valvular disease. This affection is likely to induce headache from cerebral congestion, and perhaps true softening of the brain, from habitual venous congestion. The treatment is that of dilatation^ and other valvular diseases. \n\nTricuspid constriction will rarely, if ever, furnish an audible murmur. If heard at all, it should be loudest at the ensiform cartilage, or over the cartilage of the fourth right rib ; if associated with tricuspid incompetency, there might be a double murmur. In the present state of knowledge, the positive diagnosis of tricuspid constriction is simply impossible. This is not much to be regretted, for it must be miraculously rare, and if present, it has no fatal or dangerous significance, unless it be very considerable. \n\nThere are several typographical mistakes, and some errors in syntax in different forms, the proofs of which I did not have an opportunity to revise, but as they do not affect the meaning of the text, they are not referred to in the errata. \n\nOmit \" backwards,\" first line, page 22 ; page 102, for \"growth\" read growths ; page 160, for \"shreds of a fleshy column\" read shreds of the fleshy colunms ; page 95, for \" hypertrophous dilatation\" read hypertrophy with dilatation. \n\nT 8, page 12. \" The first sound of the heart is caused by the closure of the auriculo-ventricular valves, mitral and tricuspid,\" etc. In asserting this, I mean that the closure of the auriculo-ventricular valves is the chief cause of the first sound, and a cause which is no longer debatable, since it has been repeatedly demonstrated as the most efficient, and at least the climax of all the causes of the first sound. But every well-practiced ear will appreciate the beginning of a sound in the systole of the heart, of which the sudden tension of the auriculo-ventricular valves is the complement ; thus, in incompetent mitral valves, we appreciate a dull, muffled, indefinite systolic sound, terminated by the murmur of regurgitation, instead of by the click of closure of a perfect mitral valve. This dull, prolonged, muffled, undulatory sound, is, to my mind, undoubtedly the muscular element of the first sound, reinforced by the pressing stroke of the heart against the thorax, and perhaps also by the rush of blood through the aorta and pulmonary artery. I am sure the mechanism and time of the first sound is appreciable, by the duration and force of an indeterminable muffled sound, even when both the tricuspid and mitral valves are incompetent. \n\na, page 33. \" But there is reason to believe its origin — [arrest of the systolic movement of the heart] lies rather in lesion of some portion of the cerebro-spinal axis, than in«,ny \n\nalteration in tlie structure of tlie heart itself.\" I grant tins suggestion admits of no positive proof in the present state of knowledge. The lucid experiments of Claude-Bernard have shown that irritation of the pneumogastric nerve slows or arrests the heart's contractions. Now, this is accomplished whether the irritation be applied directly to the pneumogastric nerve, between the heart and brain, or to the roots of the pneumogastric in the lateral tract ; or to a branch of the pneumogastric ramifying on the heart itself ; or, in short, to any sensitive filament in any part of the body not of the pneumogastric. If the irritation affects a sensitive nerve, it is instantly reflected through the sympathetic upon the heart ; and if the sensation be sufficiently violent or painful, the heart is arrested either temporarily or forever; if momentarily, the pulse intermits ; if temporarily, the pulse stops several beats ; if the arrest is only partial, the pulse hesitates, but goes on. Now, all these phenomena are observed in the variations of the pulse in the different lesions of the heart. Hence I am compelled to modify the suggestion in the text, quoted at the head of this note, and substitute something like the following formula : There is reason to believe the origin of arrest of the systolic movement of the heart lies sometimes, in lesions, of the cerebro-spinal-axis — for example, lack of supply of arterial blood to the portion of the encephalon, in which the vagus originates ; [in consequence of an atheromatous or ossified artery, etc., etc.,] or some defect in the cerebrum, by which the motor function fails to respond promptly to sensation, or irritation, etc. But it is altogether probable that the cause of arrest of systolic movement, whether temporary or perpetual, may and does often exist in the very substance of the heart itself, or in the quality or quantity of the blood circulating through it, or in the occasional irritation produced by some analogous or heterologous growth in or about the heart. So whether the influence, irritation, sensation or impression, come from the \n\nAPPENDIX. 203 \nsurface of the body through the sensitive filiments, through the cerebrospinal axis, or from the internal organs or tissues through the sympathetic, or from the cerebrum encephalon itself, in consequence of an intellection, an emotion, or physical impediment, it is liable to cause arrest of the systolic movement, or complete suspension of the heart's action for a moment or forever, according to the nature and force of the influence, etc. \n\nCauses op Dropsy. — Dropsy is caused by something more than mere venous or capillary obstruction. The blood must become deteriorated in albumen before true dropsy can take place. Dropsy is a demonstrative evidence of anemia. There can be no dropsy without anemia, but there may be excessive anemia without dropsy, because the transudation of serum does not take place, even in true hydremia of the blood, unless there is also obstruction to the circulation. Dropsy does not take place until the protein principles (which in the blood are 79 in 1,000,) are reduced to 63 or 58 in 1,000. It will be understood that dropsy is not an exudation of inflammation ; the dropsical liquid contains no coagulable fibrin, an \" exudation does. The cause of dropsy in Bright's disease is the diminution of albumen in the blood by the albumenuria, in consequence of which the serum charged with still more albumen, is apt to transude, and thus the blood is still further impoverished, not merely by the abstraction of albumen and fibrin in solution, but by the endosmosis chloride of sodium [eight jDarts of chloride of sodium replace one of albumen] and water for its solution. The diminution of albumen and increase of salts andtcater are rigorously coincident facte. This diminution of albumen in the blood, then, is the true cause of its capability of transudation ; and now, if we have any obstruction to the circulation, we have dropsy. \n\n204 APPENDIX. \nextreme constriction of tlie tricuspid orifice may be present and dropsy be absent. Here we may have only one condition of dropsy — obstruction to the venous circulation — wliile the blood may contain its normal ratio of albumen, and so be incapable of transudation : but once impair this ratio from 75 to 60 in 1,000, and we.have dropsy. The integrity of the blood is maintained by respiration and alimentation ; obstruct either and we induce a condition favorable to dropsy ; hence the necessity of just alimentation, and the freest respiration in chronic diseases of the heart, since these are always obstructive to the circulation. \n\nThe true indication of treatment for the cure of dropsy is obvious — restoration of the blood to its normal condition as to albumen, and removal of the obstruction to the circulation. The latter in case of heart disease is impossible in a direct but not in a relative sense. Thus, the weight of the body may be reduced, and so the blood 1 to 8 ; and in some cases it is practicable to so reduce the quantity of blood, without impairing its quality, that the obstruction may become null. If the blood be restored to its normal quality at the same time, the transudation will be arrested, and the existing dropsy will disappear by the natural secretory functions, stimulated to unusual activity for a few days. \n\nvalve. \nIt is now well understood that the cause of death in lesions of the aortic valves is the lack of supply of arterial blood to the ganglia, both cerebro-spinal and sympathetic, and that the mode of death is by syncope. The immediate cause of death in aortic lesion is very well stated by M Mauriac, page 82. \n\nThe cause of death in mitral lesions is altogether different. Death is here caused by habitual congestions of all the organs behind the mitral valve, the lungs, liver, kidneys, etc. Death, when it occurs immediately, in mitral disease, is always by apncea, and 'never by syncope. The breathing becomes difficult, long before death; the engorged capillaries transude their excess into the cellular tissue, and cause those oedematous infiltrations of the lower extremities so frequent in mitral regurgitation. There are attacks of acute congestion and even of inflammation of the kidneys, attended by albumenuria, by which the blood is stil more permanently deteriorated. As the disease advances, albumenuria becomes more frequent and less curable. Now there is progressive loss of flesh, recurring serous infiltrations (which are removable by purgatives, dry diet, diuretics, expectorants, etc. ;) but the struggle of art with an incurable disease cannot last always, and if the patient does not die in a sudden paroxysm of apnma, from pulmonary congestion and bronchial engorgement, he eventually succumbs to the exhausting nature of the disease, and dies from defective alimentation and aeration of the blood combined. \n\nd. page 108. I do not wish to be imderstood that any considerable eff'usion into the pericardium would not cause prsecordial bulging, but simply that an efl\"usion may be so slight as to cause no appreciable alteration in the contour of the thoracic walls. I have also omitted a sign which is very distinctive of the effusion stage of pericarditis, when the effusion is considerable ; that is, the marked increase of triangular dullness in the direction of the apex of the rude triangle represented by the heart and roots of the great vessels. \n\nThe apex of this dullness has been known to rise as high as the left clavacle, and the whole triangular dullness to occupy the whole front and lateral portion of the thorax, w^liile the base of the triangular dullness did not fall below its usual place, the lower margin of the sixth rib. \n\nPage 110. \" The absent first sound was as accountable on the supposition of effusion, as of softened heart.\" This has has been objected to, because it is said water is a good conductor, and should transmit the first sound if it were present In answer, I have only to say, that in this case more than half of the first sound was absent by defect of mitral valves ; and it is certain that the remaining portion could not be heard as well through eight ounces of effusion as if the effusion were not present ; moreover, the absence of the first sound in fatty degeneration in the last stage is unaccountable if the two sets of auriculo-ventricular valves are competent ; that is, the absence of that portion of the first sound caused by the click of the auriculo-ventricular valves ; for although from the degeneration of the fleshy columns, on the contraction of which depend the click of the valves, the sound should be diminished, yet if they shut with suflScient force and promptness to resist the resilience of a sound aorta, they should emit a sound as audible at the praecordia, as that proceeding from the same valves when the heart is oppressed with a distended pericardium, and its own dynamism thereby materially diminished, as also by the impediment to the circulation of the blood in its own substance, which must further materially diminish the vigor of the systoles. Hence, the proposition quoted seems to me not inexact. \n\nand atrophy of muscular tissue, there is considerable dropsy. In this latter condition only temporary benefit can be hoped for, and the salines cannot be used with the same energy and persistence as in the less asthenic dropsies. As a general rule, whenever there is defective alimentation, and hence impaired hematosis, the \" warm\" aperients or carthartics are preferred to the salines : aloetic, or compound colocynth, pills, or pills of rhubarb, aloes and senna, to which some carminative may be added, are perhaps the best, both in theory and practice. But if the dynamic condition of the patient is such as to tolerate it, (and that of the case mentioned was such an one,) the saline treatment is much the best. A diuretic mixture, composed of infusion of digitalis, acetate of potash, spirits of nitrous ether and cinnamon water, is one of the most- active diuretics with which I am acquainted. [We need not exceed a drop an hour of the fluid extract of digitalis.] It must be remembered that diuretics produce less effect on effusions in the pericardium than on cellular infiltrations. \n\nPage 120, ^ 53. \" Embolism from the accidental development of the coagulating principle of the blood.\" The coagulating 'principle (which is globulin, according to A. Schmidt, who demonstrated it, and whose experiments have been repeatedly verified,) is never developed \" accidentally\" in point of fact, but is often left undestroyed by accident, and this accident is doubtless the chief cause of emholism. Oldb ulin is a principle common to all the histologic elements, but it is an integral part of the blood globule itself — hence the superior coagulating energy manifested by blood globules. Blood drawn slowly, coagulates slowly, because the lining of the blood-vessels in its normal state has the power of neutralizing the globulin, else the blood could not remain fluid. It may be stated, then, that so ^ong as the blood is uncon- \n\ntaminated with any substance containing free globulin — as, for example, a slired of lymph — and so long as the walls of the vessels are in their normal condition, coagulation of blood in the vessels will not take place, however, slow or frequently interrupted the circulation may become, whether from the action of veratria, by which the contractility of the heart is impaired, or from the action of digitalis, or potassium salts, by which the vagi are probably irritated and the heart's systoles thus retarded, or whether from incompetent mitral valves, by which a systole is wasted,'as to its effect in propelling the blood ; none of these cause or even tend to cause coagulation of the blood without the presence of the coagulating principle. But directly a blood-vessel becomes diseased in any one spot, say from inflammation so extensive as to cause exudation of lymph on its inner coat, on that point, we have a coagulating principle present, and the production of minute emboli or thrombi begins. So, if there be calcarious deposit in an artery, on a valve, or the endocardium, and the deposit be not covered with the healthy lining of the artery, or the healthy endocardium at that point, we have a present negative cause of coagulation of the blood before death — negative, because the action of the living lining of the vessel is necessary to the decomposition of the globulin. So uhenever, from any cause, a portion, small or large, of surface of a vessel, or of the heart in contact vyith the blood, has lost its vitality — that moment coagulation may begin at that point. The torrent of the blood may prevent the formation of emboli, and thus secure the patient from harm. Thus, in the living organism, fluidity of the blood is maintained by the healthy vascular walls, and by the simple physical action of the decomposition of the globulin, or its transformation into fibrinogen. \n\ntion of the dissolved fibrin of the blood ; thus it should favor the production of thrombi in all lax conditions of the system. Of course it would be less injurious in stlienic than in asthenic inflammations ; it is less likely to do harm in large than in small doses, because less likely to be absorbed. \n\nThe following tables of Bigot, on the thickness of the walls of the ventricles, from Walshe, are of real practical value. The measurements are in French lines. \n\n\" The mean thickness of the wall of the right auricle has been estimated at about one line French by M. BouUand, that of the left at one line and a half.\" \n\nAortic constriction. \nIncompetency of pulmonary orifice and constriction of the tricuspid orifice, are so infrequent, and so little known, that they cannot be estimated as to their effects. \n\nValvular diseases are not generally causes of sudden death ; they are susceptible, as to their effects, of great alleviation, and perhaps to arrest as to their progress. But it must always be borne in mind in estimating the prognosis, that one of them— aortic incompetency — is liable to kill suddenly, and without any marked warning of imminent danger. \n\n1 to 10 inclusive, ribs; a a supra-clavicular region; 6 6 clavicular; c c infra-clavicular; d d mammary; e, t infra- mammary; /supra sternal; g upper sternal ; h lower sternal; i i integuments turned back; ff nipples; k right auricles; I right ventricle; m left auricle, appendix almost solely seen; n left ventricle; o pulmonary artery; p arch of aorta; the letter g^ indicating upper sternal region, is also on the aortic arch, transverse portion; p (farther to the right) vena) cavte superior; rr innominate veins; s innominate artery; tt subclavian veins. The dotted lines indicate the outlines of the thoracic regions; the dark lines the edges of the luugs. The heart and vessels are supposed to be \n\nAN INITIAL FINE OF 25 CENTS \nWILL BE ASSESSED FOR FAILURE TO RETURN THIS BOOK ON THE DATE DUE. THE PENALTY WILL INCREASE TO SO CENTS ON THE FOURTH DAY AND TO $1.00 ON THE SEVENTH DAY OVERDUE. \n\n"},"tokens":{"kind":"number","value":55202,"string":"55,202"},"source_dataset":{"kind":"string","value":"common-pile/pre_1929_books_filtered"},"source_dataset_id":{"kind":"string","value":"diseasesofheartt00woosrich"},"original_source":{"kind":"string","value":"public_library"},"provenance":{"kind":"string","value":"public_library_1929_dolma-0023.json.gz:1476"},"url":{"kind":"string","value":"https://archive.org/download/diseasesofheartt00woosrich/diseasesofheartt00woosrich_djvu.txt"}}},{"rowIdx":597,"cells":{"id":{"kind":"string","value":"AsVGNnxpMcYZFNP5"},"title":{"kind":"string","value":"1: The Romantic Era"},"text":{"kind":"string","value":"1: The Romantic Era\n-\n- 1.1: Romanticism in Literature\n- As a literary movement in England, Romanticism could be said to have fired its first salvo in 1801 with William Wordsworth’s (1770-1850) “Preface” to the Lyrical Ballads. Lyrical Ballads is a collection of poetry that Wordsworth co-published with Samuel Taylor Coleridge (1772-1834). The term “Romanticism,” describing this movement, came after the fact. Romanticism lasted until the mid-1820s, with the deaths of the poets Percy Bysshe Shelley (1792-1822) and George Gordon, Lord Byron (1788-1824).\n-\n- 1.2: Historical Context\n- The Romantic era was characterized by revolutions, including the American, the French, and the Industrial. The American Revolution had an impact on all of Europe. In addition to the American Revolution, England experienced its own economic revolution—commercial, agricultural, transportation, and in industrialization. The French Revolution evoked the American Revolution and England’s Glorious Revolution as revolutionaries smashed institutions, destroyed the monarchy, and built a new order.\n-\n- 1.3: Samuel Taylor Coleridge (1772-1834)\n- Although brought up in a fairly conventional Anglican family—Coleridge’s father was vicar of his parish and master of a grammar school—and expected to enter the clergy, Samuel Taylor Coleridge explored radical religious and social thought from his days at University of Cambridge onward. His poems express radical views on the mutuality of humans and nature, of divinity, of imagination, and of poetry itself. His major works include The Eolian Harp, The Rime of the Ancient Mariner, and Kubla Khan.\n-\n- 1.4: William Wordsworth (1770-1850)\n- Unlike Blake, William Wordsworth was born into the upper middle to upper class. When he was orphaned in 1778, he was cared for by his aunt and uncle. In his poetry, Wordsworth tries to understand the human mind, especially during intense moments or states of excitement. All humans, regardless of class, experience emotions; and Wordsworth believed that in states of excitement, humans reach a level of dignity, power, and authenticity that is poetic.\n-\n- 1.5: William Blake (1757-1827)\n- While comparatively unknown in his lifetime, William Blake shared Romantic ideals of independence, subjectivity, and imagination. He expressed these ideals in both his life and art. He synthesized text and image through his published poetry, in what he described as illuminated manuscripts. Much of his work functioned through synthesis, of good and evil, innocence and experience, thought and feeling, desire and restraint, imagination and reality.\n-\n- 1.6: Charlotte Smith (1749-1806)\n- Charlotte Smith’s father, Nicholas Turner, was a wealthy gentleman who nevertheless lived beyond his means. She received the education her society deemed sufficient for women. Smith preferred writing poetry, then a more respected genre than fiction, and identified herself as a poet. She infused her sonnets with emotion and personal sensibility with her sincere affection for nature. They directly influenced Wordsworth and Coleridge, modeling for these writers a responsiveness to nature.\n-\n- 1.7: Mary Shelley (1797-1851)\n- Mary Shelley was born to important writers and philosophers, Mary Wollstonecraft and William Godwin. Claire received a formal education; however, Mary educated herself, mainly through reading her father’s many books. She early showed literary aspirations, publishing a poem entitled “Mounseer Nongtongpaw” when she was only ten. Her writing advances and advocates for women’s roles not only in the family but also in society, challenging the patriarchy and misogyny current in her time.\n-\n- 1.8: Percy Bysshe Shelley (1792-1822)\n- Percy Bysshe Shelley was probably the most intellectual of all the Romantic poets; he was certainly one of the most well-educated. He was a non-conformist thinker, a philosopher, and a rebel. All of these characteristics join in his theory of poetry and poetic output, with their commitment to radical politics and their visionary idealism. Like Byron, Shelley was born into an aristocratic family and was in line to inherit a large estate. Instead, Shelley became the river that made its own banks.\n-\n- 1.9: John Keats (1795-1821)\n- John Keats, like Blake, was trained in a profession. He studied to be a surgeon and was expected to earn his own living. Because his society consequently placed him within the labor class, Keats’s decision to write poetry, a “genteel” art, was in itself a radical act. His poetry is characterized by its sensuality, to the point of sensual overload, and its pursuit of beauty—often (but not always) idealized like Greek art\n-\n- 1.10: George Gordon, Lord Byron (1788-1824)\n- George Gordon was born into an aristocratic family. In 1812, he published the first two cantos of Childe Harold’s Pilgrimage. It became a sensation, and Byron “woke up and found himself famous.” The most characteristic feature of Byron’s writing is its autobiographical quality. As in his life, his poetry blended “virtue” with “vice.” In almost all of his writing, Byron’s strength of expression is clear, a strength which he himself likened to the spring of a tiger.\nThumbnail: Posthumous portrait of John Keats by William Hilton. National Portrait Gallery, London. (Public Domain; William Hilton via Wikipedia )"},"tokens":{"kind":"number","value":1073,"string":"1,073"},"source_dataset":{"kind":"string","value":"common-pile/libretexts_filtered"},"source_dataset_id":{"kind":"string","value":"https://human.libretexts.org/Courses/Skyline_College/LIT_232%3A_Survey_of_British_Literature_II_(Skyline)/01%3A_The_Romantic_Era"},"original_source":{"kind":"string","value":"libretexts"},"provenance":{"kind":"string","value":"libretexts-0000.json.gz:22784"},"url":{"kind":"string","value":"https://human.libretexts.org/Courses/Skyline_College/LIT_232%3A_Survey_of_British_Literature_II_(Skyline)/01%3A_The_Romantic_Era"}}},{"rowIdx":598,"cells":{"id":{"kind":"string","value":"nUjsRfwSPl7-UUNi"},"title":{"kind":"string","value":"Introduction to Electricity, Magnetism, and Circuits"},"text":{"kind":"string","value":"3.2 Electric Potential and Potential Difference\nLEARNING OBJECTIVES\n- Define electric potential, voltage, and potential difference\n- Define the electron-volt\n- Calculate electric potential and potential difference from potential energy and electric field\n- Describe systems in which the electron-volt is a useful unit\n- Apply conservation of energy to electric systems\nRecall that earlier we defined electric field to be a quantity independent of the test charge in a given system, which would nonetheless allow us to calculate the force that would result on an arbitrary test charge. (The default assumption in the absence of other information is that the test charge is positive.) We briefly defined a field for gravity, but gravity is always attractive, whereas the electric force can be either attractive or repulsive. Therefore, although potential energy is perfectly adequate in a gravitational system, it is convenient to define a quantity that allows us to calculate the work on a charge independent of the magnitude of the charge. Calculating the work directly may be difficult, since and the direction and magnitude of can be complex for multiple charges, for odd-shaped objects, and along arbitrary paths. But we do know that because , the work, and hence , is proportional to the test charge . To have a physical quantity that is independent of test charge, we define electric potential (or simply potential, since electric is understood) to be the potential energy per unit charge:\nELECTRIC POTENTIAL\nThe electric potential energy per unit charge is\n(3.2.1)\nSince U is proportional to q, the dependence on q cancels. Thus, does not depend on . The change in potential energy is crucial, so we are concerned with the difference in potential or potential difference between two points, where\nELECTRIC POTENTIAL DIFFERENCE\nThe electric potential difference between points and , is defined to be the change in potential energy of a charge moved from to , divided by the charge. Units of potential difference are joules per coulomb, given the name volt (V) after Alessandro Volta.\nThe familiar term voltage is the common name for electric potential difference. Keep in mind that whenever a voltage is quoted, it is understood to be the potential difference between two points. For example, every battery has two terminals, and its voltage is the potential difference between them. More fundamentally, the point you choose to be zero volts is arbitrary. This is analogous to the fact that gravitational potential energy has an arbitrary zero, such as sea level or perhaps a lecture hall floor. It is worthwhile to emphasize the distinction between potential difference and electrical potential energy.\nPOTENTIAL DIFFERENCE AND ELECTRICAL POTENTIAL ENERGY\nVoltage is not the same as energy. Voltage is the energy per unit charge. Thus, a motorcycle battery and a car battery can both have the same voltage (more precisely, the same potential difference between battery terminals), yet one stores much more energy than the other because . The car battery can move more charge than the motorcycle battery, although both are batteries.\nEXAMPLE 3.2.1\nCalculating Energy\nYou have a motorcycle battery that can move of charge, and a car battery that can move of charge. How much energy does each deliver? (Assume that the numerical value of each charge is accurate to three significant figures.)\nStrategy\nTo say we have a battery means that its terminals have a potential difference. When such a battery moves charge, it puts the charge through a potential difference of , and the charge is given a change in potential energy equal to. To find the energy output, we multiply the charge moved by the potential difference.\nSolution\nFor the motorcycle battery, and . The total energy delivered by the motorcycle battery is\nSimilarly, for the car battery, and\nSignificance\nVoltage and energy are related, but they are not the same thing. The voltages of the batteries are identical, but the energy supplied by each is quite different. A car battery has a much larger engine to start than a motorcycle. Note also that as a battery is discharged, some of its energy is used internally and its terminal voltage drops, such as when headlights dim because of a depleted car battery. The energy supplied by the battery is still calculated as in this example, but not all of the energy is available for external use.\nCHECK YOUR UNDERSTANDING 3.4\nHow much energy does a AAA battery have that can move ?\nNote that the energies calculated in the previous example are absolute values. The change in potential energy for the battery is negative, since it loses energy. These batteries, like many electrical systems, actually move negative charge—electrons in particular. The batteries repel electrons from their negative terminals () through whatever circuitry is involved and attract them to their positive terminals (), as shown in Figure 3.2.1. The change in potential is and the charge is negative, so that is negative, meaning the potential energy of the battery has decreased when has moved from to .\n(Figure 3.2.1)\nEXAMPLE 3.2.2\nHow Many Electrons Move through a Headlight Each Second?\nWhen a car battery powers a single headlight, how many electrons pass through it each second?\nStrategy\nTo find the number of electrons, we must first find the charge that moves in . The charge moved is related to voltage and energy through the equations . A lamp uses joules per second. Since the battery loses energy, we have and, since the electrons are going from the negative terminal to the positive, we see that .\nSolution\nTo find the charge moved, we solve the equation :\nEntering the values for and we get\nThe number of electrons is the total charge divided by the charge per electron. That is,\nSignificance\nThis is a very large number. It is no wonder that we do not ordinarily observe individual electrons with so many being present in ordinary systems. In fact, electricity had been in use for many decades before it was determined that the moving charges in many circumstances were negative. Positive charge moving in the opposite direction of negative charge often produces identical effects; this makes it difficult to determine which is moving or whether both are moving.\nCHECK YOUR UNDERSTANDING 3.5\nThe Electron-Volt\nThe energy per electron is very small in macroscopic situations like that in the previous example—a tiny fraction of a joule. But on a submicroscopic scale, such energy per particle (electron, proton, or ion) can be of great importance. For example, even a tiny fraction of a joule can be great enough for these particles to destroy organic molecules and harm living tissue. The particle may do its damage by direct collision, or it may create harmful X-rays, which can also inflict damage. It is useful to have an energy unit related to submicroscopic effects.\nFigure 3.2.2 shows a situation related to the definition of such an energy unit. An electron is accelerated between two charged metal plates, as it might be in an old-model television tube or oscilloscope. The electron gains kinetic energy that is later converted into another form—light in the television tube, for example. (Note that in terms of energy, “downhill” for the electron is “uphill” for a positive charge.) Since energy is related to voltage by , we can think of the joule as a coulomb-volt.\n(Figure 3.2.2)\nELECTRON-VOLT\nOn the submicroscopic scale, it is more convenient to define an energy unit called the electron-volt (eV), which is the energy given to a fundamental charge accelerated through a potential difference of . In equation form,\nAn electron accelerated through a potential difference of is given an energy of . It follows that an electron accelerated through gains . A potential difference of () gives an electron an energy of (), and so on. Similarly, an ion with a double positive charge accelerated through gains of energy. These simple relationships between accelerating voltage and particle charges make the electron-volt a simple and convenient energy unit in such circumstances.\nThe electron-volt is commonly employed in submicroscopic processes—chemical valence energies and molecular and nuclear binding energies are among the quantities often expressed in electron-volts. For example, about of energy is required to break up certain organic molecules. If a proton is accelerated from rest through a potential difference of , it acquires an energy of () and can break up as many as of these molecules ( per molecule molecules). Nuclear decay energies are on the order of () per event and can thus produce significant biological damage.\nConservation of Energy\nThe total energy of a system is conserved if there is no net addition (or subtraction) due to work or heat transfer. For conservative forces, such as the electrostatic force, conservation of energy states that mechanical energy is a constant.\nMechanical energy is the sum of the kinetic energy and potential energy of a system; that is, . A loss of for a charged particle becomes an increase in its . Conservation of energy is stated in equation form as\nor\nwhere and stand for initial and final conditions. As we have found many times before, considering energy can give us insights and facilitate problem solving.\nEXAMPLE 3.2.3\nElectrical Potential Energy Converted into Kinetic Energy\nCalculate the final speed of a free electron accelerated from rest through a potential difference of . (Assume that this numerical value is accurate to three significant figures.)\nStrategy\nWe have a system with only conservative forces. Assuming the electron is accelerated in a vacuum, and neglecting the gravitational force (we will check on this assumption later), all of the electrical potential energy is converted into kinetic energy. We can identify the initial and final forms of energy to be , , , .\nSolution\nConservation of energy states that\nEntering the forms identified above, we obtain\nWe solve this for :\nEntering values for , , and gives\nSignificance\nNote that both the charge and the initial voltage are negative, as in Figure 3.2.2. From the discussion of electric charge and electric field, we know that electrostatic forces on small particles are generally very large compared with the gravitational force. The large final speed confirms that the gravitational force is indeed negligible here. The large speed also indicates how easy it is to accelerate electrons with small voltages because of their very small mass. Voltages much higher than the in this problem are typically used in electron guns. These higher voltages produce electron speeds so great that effects from special relativity must be taken into account and hence are beyond the scope of this textbook. That is why we consider a low voltage (accurately) in this example.\nCHECK YOUR UNDERSTANDING 3.6\nHow would this example change with a positron? A positron is identical to an electron except the charge is positive.\nVoltage and Electric Field\nSo far, we have explored the relationship between voltage and energy. Now we want to explore the relationship between voltage and electric field. We will start with the general case for a non-uniform field. Recall that our general formula for the potential energy of a test charge at point relative to reference point is\nWhen we substitute in the definition of electric field (), this becomes\nApplying our definition of potential () to this potential energy, we find that, in general,\nFrom our previous discussion of the potential energy of a charge in an electric field, the result is independent of the path chosen, and hence we can pick the integral path that is most convenient.\nConsider the special case of a positive point charge at the origin. To calculate the potential caused by at a distance from the origin relative to a reference of at infinity (recall that we did the same for potential energy), let and , with and use . When we evaluate the integral\nfor this system, we have\nwhich simplifies to\nThis result,\nis the standard form of the potential of a point charge. This will be explored further in the next section.\nTo examine another interesting special case, suppose a uniform electric field is produced by placing a potential difference (or voltage) across two parallel metal plates, labeled and (Figure 3.2.3). Examining this situation will tell us what voltage is needed to produce a certain electric field strength. It will also reveal a more fundamental relationship between electric potential and electric field.\n(Figure 3.2.3)\nFrom a physicist’s point of view, either or can be used to describe any interaction between charges. However, is a scalar quantity and has no direction, whereas is a vector quantity, having both magnitude and direction. (Note that the magnitude of the electric field, a scalar quantity, is represented by .) The relationship between and is revealed by calculating the work done by the electric force in moving a charge from point to point . But, as noted earlier, arbitrary charge distributions require calculus. We therefore look at a uniform electric field as an interesting special case.\nThe work done by the electric field in Figure 3.2.3 to move a positive charge from , the positive plate, higher potential, to , the negative plate, lower potential, is\nThe potential difference between points and is\nEntering this into the expression for work yields\nWork is ; here , since the path is parallel to the field. Thus, . Since , we see that .\nSubstituting this expression for work into the previous equation gives\nThe charge cancels, so we obtain for the voltage between points and\nwhere is the distance from to , or the distance between the plates in Figure 3.2.3. Note that this equation implies that the units for electric field are volts per meter. We already know the units for electric field are newtons per coulomb; thus, the following relation among units is valid:\nFurthermore, we may extend this to the integral form. Substituting Equation 3.2.2 into our definition for the potential difference between points and , we obtain\nwhich simplifies to\nAs a demonstration, from this we may calculate the potential difference between two points ( and ) equidistant from a point charge at the origin, as shown in Figure 3.2.4.\n(Figure 3.2.4)\nTo do this, we integrate around an arc of the circle of constant radius between and , which means we let , while using . Thus,\nfor this system becomes\nHowever, and therefore\nThis result, that there is no difference in potential along a constant radius from a point charge, will come in handy when we map potentials.\nEXAMPLE 3.2.4\nWhat Is the Highest Voltage Possible between Two Plates?\nDry air can support a maximum electric field strength of about . Above that value, the field creates enough ionization in the air to make the air a conductor. This allows a discharge or spark that reduces the field. What, then, is the maximum voltage between two parallel conducting plates separated by of dry air?\nStrategy\nWe are given the maximum electric field between the plates and the distance between them. We can use the equation to calculate the maximum voltage.\nSolution\nThe potential difference or voltage between the plates is\nEntering the given values for and gives\nor\n(The answer is quoted to only two digits, since the maximum field strength is approximate.)\nSignificance\nOne of the implications of this result is that it takes about to make a spark jump across a () gap, or for a spark. This limits the voltages that can exist between conductors, perhaps on a power transmission line. A smaller voltage can cause a spark if there are spines on the surface, since sharp points have larger field strengths than smooth surfaces. Humid air breaks down at a lower field strength, meaning that a smaller voltage will make a spark jump through humid air. The largest voltages can be built up with static electricity on dry days (Figure 3.2.5).\n(Figure 3.2.5)\nEXAMPLE 3.2.5\nField and Force inside an Electron Gun\nAn electron gun (Figure 3.2.2) has parallel plates separated by and gives electrons of energy. (a) What is the electric field strength between the plates? (b) What force would this field exert on a piece of plastic with a charge that gets between the plates?\nStrategy\nSince the voltage and plate separation are given, the electric field strength can be calculated directly from the expression . Once we know the electric field strength, we can find the force on a charge by using . Since the electric field is in only one direction, we can write this equation in terms of the magnitudes, .\nSolution\n- The expression for the magnitude of the electric field between two uniform metal plates is\nSince the electron is a single charge and is given of energy, the potential difference must be . Entering this value for and the plate separation of , we obtain\n- The magnitude of the force on a charge in an electric field is obtained from the equation\nSubstituting known values gives\nSignificance\nNote that the units are newtons, since . Because the electric field is uniform between the plates, the force on the charge is the same no matter where the charge is located between the plates.\nEXAMPLE 3.2.6\nCalculating Potential of a Point Charge\nGiven a point charge at the origin, calculate the potential difference between point a distance from , and a distance from , where the two points have an angle of between them (Figure 3.2.6).\n(Figure 3.2.6)\nStrategy\nDo this in two steps. The first step is to use and let and , with and . Then perform the integral. The second step is to integrate around an arc of constant radius , which means we let with limits , still using . Then add the two results together.\nSolution\nFor the first part, for this system becomes which computes to\nFor the second step, becomes, but and therefore . Adding the two parts together, we get .\nSignificance\nWe have demonstrated the use of the integral form of the potential difference to obtain a numerical result. Notice that, in this particular system, we could have also used the formula for the potential due to a point charge at the two points and simply taken the difference.\nCHECK YOUR UNDERSTANDING 3.7\nFrom the examples, how does the energy of a lightning strike vary with the height of the clouds from the ground? Consider the cloud-ground system to be two parallel plates.\nBefore presenting problems involving electrostatics, we suggest a problem-solving strategy to follow for this topic.\nProblem-Solving Strategy: Electrostatics\n- Examine the situation to determine if static electricity is involved; this may concern separated stationary charges, the forces among them, and the electric fields they create.\n- Identify the system of interest. This includes noting the number, locations, and types of charges involved.\n- Identify exactly what needs to be determined in the problem (identify the unknowns). A written list is useful. Determine whether the Coulomb force is to be considered directly—if so, it may be useful to draw a free-body diagram, using electric field lines.\n- Make a list of what is given or can be inferred from the problem as stated (identify the knowns). It is important to distinguish the Coulomb force from the electric field , for example.\n- Solve the appropriate equation for the quantity to be determined (the unknown) or draw the field lines as requested.\n- Examine the answer to see if it is reasonable: Does it make sense? Are units correct and the numbers involved reasonable?\nCandela Citations\n- Download for free at<EMAIL_ADDRESS>Retrieved from<EMAIL_ADDRESS>License: CC BY: Attribution"},"tokens":{"kind":"number","value":4243,"string":"4,243"},"source_dataset":{"kind":"string","value":"common-pile/pressbooks_filtered"},"source_dataset_id":{"kind":"string","value":"https://openpress.usask.ca/physics155/chapter/3-2-electric-potential-and-potential-difference/"},"original_source":{"kind":"string","value":"pressbooks"},"provenance":{"kind":"string","value":"pressbooks-0000.json.gz:65184"},"url":{"kind":"string","value":"https://openpress.usask.ca/physics155/chapter/3-2-electric-potential-and-potential-difference/"}}},{"rowIdx":599,"cells":{"id":{"kind":"string","value":"fd_--PXpwyJwENdW"},"title":{"kind":"string","value":"2.5: Contributions to Science"},"text":{"kind":"string","value":"2.5: Contributions to Science\nThere are also a number of\nJewish\nand\nChristian\ntraditions. The Bible’s Old and New Testaments contain numerous astronomical references. The Jewish Bible, or Old Testament, refers to stars, constellations, and eclipses. The Christian New Testament has astronomical references, such as the Star of Bethlehem, denoting the birth of Jesus. The\nGreeks\nwere credited with development of scientific principles, starting around 500 BC. Alexandria, Egypt was a great library and research center that opened around 300 BC, and survived until it was destroyed by fire. A couple of Greeks, to note, included Eratosthenes, who determined Earth’s circumference by measuring the Sun’s shadow at two points on Earth around 240 BC, and Hipparchus, who developed a stellar brightness magnitude scale that is still in use today. There were also a number of significant\nIslamic\ncontributions from around the 8th and 9th Centuries AD. Muslims kept and translated historical records, developed Algebra, and developed many constellation and star names. Some examples of star names still used today are Aldebaran and Algol (Al: “the”). The researchers were not only Muslims, but also included Jews and Christians. Hindus also worked with the team of researchers and indirectly with the Chinese."},"tokens":{"kind":"number","value":260,"string":"260"},"source_dataset":{"kind":"string","value":"common-pile/libretexts_filtered"},"source_dataset_id":{"kind":"string","value":"https://phys.libretexts.org/Bookshelves/Astronomy__Cosmology/Introduction_to_Astronomy_(Lumen)/02%3A_Historical_Astronomy/2.05%3A_Contributions_to_Science"},"original_source":{"kind":"string","value":"libretexts"},"provenance":{"kind":"string","value":"libretexts-0000.json.gz:42730"},"url":{"kind":"string","value":"https://phys.libretexts.org/Bookshelves/Astronomy__Cosmology/Introduction_to_Astronomy_(Lumen)/02%3A_Historical_Astronomy/2.05%3A_Contributions_to_Science"}}}],"truncated":false,"partial":false},"paginationData":{"pageIndex":5,"numItemsPerPage":100,"numTotalItems":121460,"offset":500,"length":100}},"jwt":"eyJhbGciOiJFZERTQSJ9.eyJyZWFkIjp0cnVlLCJwZXJtaXNzaW9ucyI6eyJyZXBvLmNvbnRlbnQucmVhZCI6dHJ1ZX0sImlhdCI6MTc4MDk1MzI5Mywic3ViIjoiL2RhdGFzZXRzL3NjaS1kYXRhc2V0cy9zY2ktYm9va3MiLCJleHAiOjE3ODA5NTY4OTMsImlzcyI6Imh0dHBzOi8vaHVnZ2luZ2ZhY2UuY28ifQ.tQneAftTd8SA94MOvBkVx4WLmfQjljbxcy3fsRzTVRWw5qMTAYO0BgyB1tPFi0lqv-F8yj-09WRv61Wb14r0Aw","displayUrls":true,"splitSizeSummaries":[{"config":"default","split":"train","numRows":121460,"numBytesParquet":6252455763}]},"discussionsStats":{"closed":0,"open":1,"total":1},"fullWidth":true,"hasGatedAccess":true,"hasFullAccess":true,"isEmbedded":false,"savedQueries":{"community":[],"user":[]}}">
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XPCu85HAwwF-TpQA | A manual of military surgery, for the use of surgeons in the Confederate States army; with explanatory plates of all useful operations. By J. Julian Chisolm ... | PREFACE TO FIRST EDITION.
In putting forth this Manual of Military Surgery for the use of Surgeons in the Confederate service, I have been led by the desire to mitigate, if possible, the horrors of war, as seen in its most frightful phase in military hospitals. As our entire army is made up of volunteers from every wa... | 224,046 | common-pile/pre_1929_books_filtered | manualofmilita00chis | public_library | public_library_1929_dolma-0020.json.gz:4598 | https://archive.org/download/manualofmilita00chis/manualofmilita00chis_djvu.txt |
CoUHM_Rn7SZ1X1u5 | Experiments with spray solutions for preventing insect injury to green logs / by F.C. Craighead. | (Requisites of a practical spray — Con. It must first prevent all insect injury for from one to three
TREE INSECTS.
During the past few years there has been/an increasing demand for practical spray that "will prevent insect attack to crude forest prodcts such as green sa/w logs and timbers used in rustic constr... | 5,452 | common-pile/pre_1929_books_filtered | experimentswiths00crairich | public_library | public_library_1929_dolma-0024.json.gz:4837 | https://archive.org/download/experimentswiths00crairich/experimentswiths00crairich_djvu.txt |
YyczH3ueT6Cc3BMc | 12.2: Planning the Topic | 12.2: Planning the Topic
To examine each of these steps more closely, this chapter provides a sample speech topic to demonstrate how the principles of persuasion theory discussed in Chapter 11 apply to Monroe’s Motivated Sequence as outlined above. Pretend a speaker wishes to deliver a speech to persuade audience membe... | 1,067 | common-pile/libretexts_filtered | https://socialsci.libretexts.org/Bookshelves/Communication/Public_Speaking/Messages_that_Matter%3A_Public_Speaking_in_the_Information_Age_3e_(Misner_and_Carr)/12%3A_Motivating_Others_to_Action/12.02%3A_Planning_the_Topic | libretexts | libretexts-0000.json.gz:25677 | https://socialsci.libretexts.org/Bookshelves/Communication/Public_Speaking/Messages_that_Matter%3A_Public_Speaking_in_the_Information_Age_3e_(Misner_and_Carr)/12%3A_Motivating_Others_to_Action/12.02%3A_Planning_the_Topic |
ugb6l5DMsgtogsSg | American History to 1865 | 12. Cotton Is King: The Antebellum South, 1800–1860: Introduction
Nine new slave states entered the Union between 1789 and 1860, rapidly expanding and transforming the South into a region of economic growth built on slave labor. In the image above (Figure 12.1), innumerable enslaved workers load cargo onto a steamship ... | 254 | common-pile/pressbooks_filtered | https://louis.pressbooks.pub/americanhistory1/chapter/ch-12-cotton-is-king-the-antebellum-south-1800-1860-introduction/ | pressbooks | pressbooks-0000.json.gz:58749 | https://louis.pressbooks.pub/americanhistory1/chapter/ch-12-cotton-is-king-the-antebellum-south-1800-1860-introduction/ |
L0r-Wb2oR0rbfeBO | Hymns and Spiritual Songs | R. Palmer
I GIVE my heart to Thee,
O Jesus most desired;
And heart for heart the gift shall be,
For Thou my soul hast fired:
2
Thou hearts alone wouldst move,
Thou only hearts dost love;
I would love Thee as Thou lov’st me,
O Jesus most desired.
3
What offering can I make,
Dear Lord, to love like Thine;
That Thou, the ... | 250 | common-pile/pressbooks_filtered | https://pressbooks.pub/hymnbook/chapter/i-give-my-heart-to-thee/ | pressbooks | pressbooks-0000.json.gz:96607 | https://pressbooks.pub/hymnbook/chapter/i-give-my-heart-to-thee/ |
7BnoDaNffWkMuhFo | Fundamentals of Biology I | 220 Respiratory System
Learning Outcomes
- Identify the structure and function of the respiratory system
The Respiratory System is vital to every human being. Without it, we would cease to live outside of the womb. Let us begin by taking a look at the structure of the respiratory system and how vital it is to life. Dur... | 1,695 | common-pile/pressbooks_filtered | https://library.achievingthedream.org/herkimerbiologyfundamentals1/chapter/respiratory-system/ | pressbooks | pressbooks-0000.json.gz:78312 | https://library.achievingthedream.org/herkimerbiologyfundamentals1/chapter/respiratory-system/ |
msY9JJ9a33Pgb4w0 | Introduction to Astronomy | Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.
175 Elliptical Galaxies
Elliptical galaxies are those galaxies classified according to their shape and size. The shapes go from round – soccer-ball like – to extreme elongated – football-like – and are classifie... | 130 | common-pile/pressbooks_filtered | https://library.achievingthedream.org/fscjintroastronomy/chapter/elliptical-galaxies/ | pressbooks | pressbooks-0000.json.gz:21909 | https://library.achievingthedream.org/fscjintroastronomy/chapter/elliptical-galaxies/ |
xxjEv6UUPP0vI3fk | UH Microeconomics 2019 | CRITICAL THINKING QUESTIONS
- Finding a life partner is a complicated process that may take many years. It is hard to think of this process as being part of a very complex market, with a demand and a supply for partners. Think about how this market works and some of its characteristics, such as search costs. Would you ... | 396 | common-pile/pressbooks_filtered | https://pressbooks.oer.hawaii.edu/microeconomics2019/chapter/critical-thinking-questions-7/ | pressbooks | pressbooks-0000.json.gz:93763 | https://pressbooks.oer.hawaii.edu/microeconomics2019/chapter/critical-thinking-questions-7/ |
0jSmTETu00fafd7V | African American History and Culture | 42 Introduction
African Americans and the Civil War
Module Introduction
When the Civil War began in April 1861, President Abraham Lincoln’s paramount goal was the preservation of the union not the abolition of slavery. Though Lincoln detested slavery, viewed it as a moral sin, and believed it should not expand into new... | 692 | common-pile/pressbooks_filtered | https://library.achievingthedream.org/fscjafricanamericanhistory/chapter/introduction-9/ | pressbooks | pressbooks-0000.json.gz:35071 | https://library.achievingthedream.org/fscjafricanamericanhistory/chapter/introduction-9/ |
YmaDz3AAZE5oWgiE | 16.9.4: What Should the Nurse Do? | Jinmei, a 28-year-old pregnant female at 36 weeks’ gestation, presents to the labor and delivery unit with complaints of abdominal discomfort and irregular contractions. She is a gravida 2, para 1, with a history of a vaginal delivery. Jinmei reports no significant medical history or complications during this pregnancy... | 313 | common-pile/libretexts_filtered | https://med.libretexts.org/Bookshelves/Nursing/Maternal-Newborn_Nursing_(OpenStax)/16%3A_Electronic_Fetal_and_Uterine_Contraction_Monitoring/16.09%3A_Assessments/16.9.04%3A_What_Should_the_Nurse_Do | libretexts | libretexts-0000.json.gz:41077 | https://med.libretexts.org/Bookshelves/Nursing/Maternal-Newborn_Nursing_(OpenStax)/16%3A_Electronic_Fetal_and_Uterine_Contraction_Monitoring/16.09%3A_Assessments/16.9.04%3A_What_Should_the_Nurse_Do |
AmpbAd75AqKUkMun | 12.1: Waves | 12.1: Waves
Learning Objectives
After reading this chapter you should:
- know the parts of a basic wave
- know the terminology used to describe the motion of a wave (i.e. period, frequency, speed etc.)
- understand the circular motion of water particles involved in wave motion
- understand the difference between deep w... | 499 | common-pile/libretexts_filtered | https://geo.libretexts.org/Courses/Diablo_Valley_College/OCEAN-101%3A_Fundamentals_of_Oceanography_(Keddy)/12%3A_Waves/12.01%3A_Waves | libretexts | libretexts-0000.json.gz:21712 | https://geo.libretexts.org/Courses/Diablo_Valley_College/OCEAN-101%3A_Fundamentals_of_Oceanography_(Keddy)/12%3A_Waves/12.01%3A_Waves |
8BHESSJRSmBycrEi | Atwater, Minnesota: 1934-1935 | 86 Myron wins first in Oratory Contest
February 14th, 1935
Dear Corinna,
Your letter written Sat. and Sun. here. Well, you had a good day in New York in spite of the unpleasant part of it. I am sure you tried to be tactful with Eleanor on Monday. I expect it’s all patched up by this time. It would be fine to go on a Su... | 1,050 | common-pile/pressbooks_filtered | https://mlpp.pressbooks.pub/atwater1934/chapter/chapter-86/ | pressbooks | pressbooks-0000.json.gz:59190 | https://mlpp.pressbooks.pub/atwater1934/chapter/chapter-86/ |
sZWgr_esgiIbL5cL | What Burlingame did; a true story of a young electrician, | accept these inventions that
figure in our daily lives with but little thought of the interesting stages they go through from the first idea in the brain of the inventor to the finished product.
We profit by a study of the
lives of others and particularly those who attain success solely through their own efforts, o... | 1,004 | common-pile/pre_1929_books_filtered | whatburlingamedi00clevrich | public_library | public_library_1929_dolma-0019.json.gz:4937 | https://archive.org/download/whatburlingamedi00clevrich/whatburlingamedi00clevrich_djvu.txt |
lftjYrymePjnq9jh | 7.11.3: Public Health Response | 7.11.3: Public Health Response
Public health efforts to reduce smoking may have had the most significant effect on cancer rates in the past decade. Between 2005 and 2021 smoking rates decreased from 20.9% to 11.9% of adults (CDC, 2023c). In 2012, the CDC launched the first federally funded anti-smoking campaign called ... | 507 | common-pile/libretexts_filtered | https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/07%3A_Major_Diseases/7.11%3A_Cancers/7.11.03%3A_Public_Health_Response | libretexts | libretexts-0000.json.gz:51344 | https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/07%3A_Major_Diseases/7.11%3A_Cancers/7.11.03%3A_Public_Health_Response |
iQ5EoRMXmKDqKxTn | 13.21: Galaxies (Exercises) | 13.21: Galaxies (Exercises)
For Further Exploration
Articles
Andrews, B. “What Are Galaxies Trying to Tell Us?” Astronomy (February 2011): 24. Introduction to our understanding of the shapes and evolution of different types of galaxies.
Bothun, G. “Beyond the Hubble Sequence.” Sky & Telescope (May 2000): 36. History an... | 1,246 | common-pile/libretexts_filtered | https://phys.libretexts.org/Courses/Grossmont_College/ASTR_110%3A_Astronomy_(Fitzgerald)/13%3A_Galaxies/13.21%3A_Galaxies_(Exercises) | libretexts | libretexts-0000.json.gz:39236 | https://phys.libretexts.org/Courses/Grossmont_College/ASTR_110%3A_Astronomy_(Fitzgerald)/13%3A_Galaxies/13.21%3A_Galaxies_(Exercises) |
xhqkekYJ0aGDaLbB | 12.3A: General Organization of the Somatosensory System | 12.3A: General Organization of the Somatosensory System
The somatosensory system is composed of the neurons that make sensing touch, temperature, and position in space possible.
- Describe how the somatosensory system is composed of neurons that make sensing touch, temperature, and position in space possible
Key Points... | 941 | common-pile/libretexts_filtered | https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundless)/12%3A_Peripheral_Nervous_System/12.3%3A_The_Somatosensory_System/12.3A%3A_General_Organization_of_the_Somatosensory_System | libretexts | libretexts-0000.json.gz:45699 | https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundless)/12%3A_Peripheral_Nervous_System/12.3%3A_The_Somatosensory_System/12.3A%3A_General_Organization_of_the_Somatosensory_System |
sQr1vDlE1lPPo-sN | The anatomy and physiology of the human body : containing The anatomy of the bones, muscles, and joints, and the heart and arteries / by John Bell ; and, The anatomy and physiology of the brain and nerves, the organs of the senses, and the viscera, by Charles Bell. | PREFACE.
To those, who are at all acquainted with books on anatomy, the appearance of a new one on the subject will not be surprising. To those, who are not yet acquainted with such writings, I have only to say, that I have written this book, because I believed that such a one was needed, and must be useful. I have en... | 242,046 | common-pile/pre_1929_books_filtered | anatomyphysiolog11bell | public_library | public_library_1929_dolma-0011.json.gz:4016 | https://archive.org/download/anatomyphysiolog11bell/anatomyphysiolog11bell_djvu.txt |
VoNe95zHbhuZzlky | National system of highways and landscape designing. Address delivered before the American civic association at Washington, D.C., on December 31, 1915, | March 9, 1916.
Fesolved, That the manuscript submitted by the Senator from Tennessee (Mr. Shields) on January 13. 1916, entitled "A National System of Highways and Landscape Designing," being an address delivered before the American Civic Association, at Washington. D. C, on December 31, 1915, by Cyrus Kehr, of Knoxvi... | 6,055 | common-pile/pre_1929_books_filtered | nationalsystemof00kehr | public_library | public_library_1929_dolma-0019.json.gz:2811 | https://archive.org/download/nationalsystemof00kehr/nationalsystemof00kehr_djvu.txt |
pxON-6KMgJrrm-MV | A practical treatise on watch repairing / by N.B. Sherwood. | 91 PLYMOUTH PLACE, CHICAGO.
Staff Making and Pivoting. Practical directions for making new staffs from raw material. By Eugene E. Hall. Chapter I. The raw material; the gravers; the roughing out; the hardening and tempering. Chapter II. Kinds of pivots; their shape; capillarity; the requirements of a good pivot. Chapt... | 20,965 | common-pile/pre_1929_books_filtered | practicaltreatis00sher_0 | public_library | public_library_1929_dolma-0021.json.gz:3294 | https://archive.org/download/practicaltreatis00sher_0/practicaltreatis00sher_0_djvu.txt |
aQkRhl12zm9a7-Zp | The western grass-stem sawfly (Cephus occidentalis Riley and Marlatt) / by F.M. Webster and Geo. I. Reeves. | The western gra — tem sawfly {C'eplu Marlatt), which has caused much alarm ami irot-a li wheal growers of S'orth Dakota during the season of 1909, is not by any means a ne'w insect, although this is it- first appearance in the
United States a- a serious pest. It was firsl observed in lx'-'<> and has since been ... | 2,553 | common-pile/pre_1929_books_filtered | wstem00unit | public_library | public_library_1929_dolma-0016.json.gz:4091 | https://archive.org/download/wstem00unit/wstem00unit_djvu.txt |
ysUpGcBQS7IGsY_L | Report upon ornithological specimens collected in the years 1871, 1872, and 1873 / U. S. Army, Engineer Dept., Geographical and Geological Explorations and Surveys West of the One hundredth Meridian ; [by H.C. Yarrow and H.W. Henshaw]. | SIE : Lieut. George M. Wheeler has sent to this office reports by Dr. H. C. Yarrow on the ornithological specimens collected on the expeditions of the former in 1871, 1872, and 1873.
SIR : I have the honor to submit, with the letter of Dr. H. C. Yarrow, the inclosed reports upon the ornithological specimenst collecte... | 33,232 | common-pile/pre_1929_books_filtered | reportuponornith00geogrich | public_library | public_library_1929_dolma-0008.json.gz:4064 | https://archive.org/download/reportuponornith00geogrich/reportuponornith00geogrich_djvu.txt |
ygtPORCF7Cnm9lpB | Analysis of mixed paints, | PREFACE.
THIS book was written primarily to meet the needs of the author's own classes in Industrial Quantitative Analysis, and it is given to the public in the belief that there is a demand for a concise work on the analysis of paints and paint products.
Numerous books have been written during the past few years de... | 66,574 | common-pile/pre_1929_books_filtered | analysisofmixedp00hollrich | public_library | public_library_1929_dolma-0012.json.gz:1843 | https://archive.org/download/analysisofmixedp00hollrich/analysisofmixedp00hollrich_djvu.txt |
bWsrkHRvmLrEHk_F | A Manual of Mending and Repairing; With Diagrams | Produced by Chris Curnow, Wayne Hammond and the Online
A MANUAL OF
MENDING AND REPAIRING
WITH DIAGRAMS
BY
CHARLES GODFREY LELAND
NEW YORK
DODD, MEAD AND COMPANY
1896
COPYRIGHT, 1896,
BY DODD, MEAD AND COMPANY.
BURR PRINTING HOUSE, FRANKFORT AND JACOB STS., N. Y.
CONTENTS
... | 94,412 | common-pile/project_gutenberg_filtered | 61786 | project gutenberg | project_gutenberg-dolma-0011.json.gz:2693 | https://www.gutenberg.org/ebooks/61786.txt.utf-8 |
HMCaTU2lH7ED_tym | Biology Part II | 18.1 Introduction
Mary Ann Clark; Jung Choi; and Matthew Douglas
Breathing is an involuntary event. How often a breath is taken and how much air is inhaled or exhaled are tightly regulated by the respiratory center in the brain. Humans, when they aren’t exerting themselves, breathe approximately 15 times per minute on ... | 231 | common-pile/pressbooks_filtered | https://louis.pressbooks.pub/generalbiology2leclab/chapter/introduction-39/ | pressbooks | pressbooks-0000.json.gz:59665 | https://louis.pressbooks.pub/generalbiology2leclab/chapter/introduction-39/ |
EAM1wD6hUALIAQ2y | Nursing Pharmacology-2e | 2.1 Legal/Ethical Introduction
Learning Objectives
- Discuss federal and state laws, regulations, and guidelines for safe medication administration
- Identify drug administration guidelines within the State Nurse Practice Act
- Identify ethical responsibilities related to medication administration
- Identify nursing re... | 417 | common-pile/pressbooks_filtered | https://wtcs.pressbooks.pub/pharmacology2e/chapter/2-1-legal-ethical-introduction/ | pressbooks | pressbooks-0000.json.gz:83636 | https://wtcs.pressbooks.pub/pharmacology2e/chapter/2-1-legal-ethical-introduction/ |
2iiYIzPRRriMNrc5 | Introductory Chemistry | 70 Electrochemical Cells
LumenLearning
Voltaic Cells
A voltaic cell is a device that produces an electric current from energy released by a spontaneous redox reaction in two half-cells.
LEARNING OBJECTIVES
Recall that reduction happens at the cathode and oxidation happens at the anode in a voltaic cell
KEY TAKEAWAYS
Ke... | 2,858 | common-pile/pressbooks_filtered | https://uen.pressbooks.pub/introductorychemistry/chapter/electrochemical-cells/ | pressbooks | pressbooks-0000.json.gz:66243 | https://uen.pressbooks.pub/introductorychemistry/chapter/electrochemical-cells/ |
owjV1_B17qpFkTKh | 1.3 The Processor - History | 1.3 The Processor - History
Microprocessor Evolution
Generations of microprocessor:
- First generation: From 1971 to 1972 the era of the first generation came which brought microprocessors like INTEL 4004 Rockwell international PPS-4 INTEL 8008 etc.
- Second generation: The second generation marked the development of 8... | 656 | common-pile/libretexts_filtered | https://eng.libretexts.org/Courses/Delta_College/Operating_System%3A_The_Basics/01%3A_The_Basics_-_An_Overview/1.3_The_Processor_-_History | libretexts | libretexts-0000.json.gz:40082 | https://eng.libretexts.org/Courses/Delta_College/Operating_System%3A_The_Basics/01%3A_The_Basics_-_An_Overview/1.3_The_Processor_-_History |
2uUFkK_G2LIy-dT- | US History I & II YAWP | 58 Progressive Environmentalism
The potential scope of environmental destruction wrought by industrial capitalism was unparalleled in human history. Professional bison hunting expeditions nearly eradicated an entire species, industrialized logging companies could denude whole forests, chemical plants could pollute an e... | 1,349 | common-pile/pressbooks_filtered | https://library.achievingthedream.org/sanjacushistory2/chapter/progressive-environmentalism-2/ | pressbooks | pressbooks-0000.json.gz:88176 | https://library.achievingthedream.org/sanjacushistory2/chapter/progressive-environmentalism-2/ |
y0QCNbJY2AH-ALqo | 5.7: Chapter Review - Key Terms | Skip to main content
5.7: Chapter Review - Key Terms
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Key Terms
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add-on
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third-party application that can be added to Google, which extends the basic functionality of a program with features that are not already included
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Anyone with the link
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accessibility limit in Docs’s shareabl... | 575 | common-pile/libretexts_filtered | https://workforce.libretexts.org/Bookshelves/Information_Technology/Computer_Applications/Workplace_Software_and_Skills_(OpenStax)/05%3A_Advanced_Document_Preparation/5.07%3A_Chapter_Review_-_Key_Terms | libretexts | libretexts-0000.json.gz:2333 | https://workforce.libretexts.org/Bookshelves/Information_Technology/Computer_Applications/Workplace_Software_and_Skills_(OpenStax)/05%3A_Advanced_Document_Preparation/5.07%3A_Chapter_Review_-_Key_Terms |
7o7xBUb3lCX1LGeV | Introduction to Machining | 10.2 Machine Maintenance
Micky R. Jennings
Machine maintenance is a term for the periodic upkeep of a piece of equipment. Most machines have a section in the operator’s manual that covers the scheduled maintenance for that particular machine. A couple of things that must be done daily on most machines are lubricating a... | 908 | common-pile/pressbooks_filtered | https://openwa.pressbooks.pub/intromachining1/chapter/wa10-2/ | pressbooks | pressbooks-0000.json.gz:46287 | https://openwa.pressbooks.pub/intromachining1/chapter/wa10-2/ |
IJsvvMRVLZwCLO9F | Canadian History: Post-Confederation | 6.1 Introduction
The years from 1914-1945 are marked by turmoil, what one historical text calls “decades of discord.”[1] Not only was there conflict abroad, there was also tension at home. The workings of parliament and the democratic order in Canada underwent change, some degree of transformation, abuse, and challenge... | 726 | common-pile/pressbooks_filtered | https://ecampusontario.pressbooks.pub/histpostconfederation/chapter/6-1-introduction-2/ | pressbooks | pressbooks-0000.json.gz:39379 | https://ecampusontario.pressbooks.pub/histpostconfederation/chapter/6-1-introduction-2/ |
n__4vQUEmc1xMOOg | 17.5: Normandy and England | 17.5: Normandy and England
Norman Architecture
Norman architecture is a style of Romanesque architecture developed by the Normans in lands under their dominion during the 11th and 12th centuries.
Discuss the influence of Normandy and Norman architecture in France and England
Key Points
- The Norman dynasty had a major ... | 6,988 | common-pile/libretexts_filtered | https://human.libretexts.org/Bookshelves/Art/Art_History_(Boundless)/17%3A_Romanesque_Art/17.05%3A_Normandy_and_England | libretexts | libretexts-0000.json.gz:968 | https://human.libretexts.org/Bookshelves/Art/Art_History_(Boundless)/17%3A_Romanesque_Art/17.05%3A_Normandy_and_England |
ei8_NEkbPeuWnYQx | Chemistry 110 | Chapter One
Measurement Uncertainty, Accuracy, and Precision (1.5)
Measurement Uncertainty, Accuracy, and Precision
By the end of this section, you will be able to:
- Define accuracy and precision
- Distinguish exact and uncertain numbers
- Correctly represent uncertainty in quantities using significant figures
- Apply... | 3,198 | common-pile/pressbooks_filtered | https://psu.pb.unizin.org/eshanichemistry110/chapter/measurement-uncertainty-accuracy-and-precision-1-5/ | pressbooks | pressbooks-0000.json.gz:92775 | https://psu.pb.unizin.org/eshanichemistry110/chapter/measurement-uncertainty-accuracy-and-precision-1-5/ |
L_zTunLB35bYWlpB | Report of the Commissioners on Investigation of Water Supply. | The Commission appointed in September last, to whom was referred the petition of Henry J. Barnes and others, asking for an investigation of the water supply of the city, would respectfully submit the following
REPORT:
Although the terms of the order under which the Commission acted were sufficient to warrant an exam... | 95,906 | common-pile/pre_1929_books_filtered | reportofcommissi00bostrich | public_library | public_library_1929_dolma-0018.json.gz:976 | https://archive.org/download/reportofcommissi00bostrich/reportofcommissi00bostrich_djvu.txt |
diSz2OCgnMHJNb-r | Physics 130 | Primary Navigation
Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.
Book Contents Navigation
Preface
10 Introduction
William Moebs; Samuel J. Ling; and Jeff Sanny
Chapter Review
Introduction
13 Introduction
15 Introduction
16 Introduction
17 Introduction
1 Int... | 122 | common-pile/pressbooks_filtered | https://pressbooks.bccampus.ca/physics130/chapter/chapter-16-review/ | pressbooks | pressbooks-0000.json.gz:68735 | https://pressbooks.bccampus.ca/physics130/chapter/chapter-16-review/ |
gGaYv4IzXvYSqrS4 | 13.5: Exercises | 13.5: Exercises
Lab 13 Exercise \(\PageIndex{1}\)
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Draw the following:
Label the following
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Label the following:
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Lab 13 Exercise \(\PageIndex{2}\)
Basic Ear Anatomy
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Match the following items to their proper location
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Label the following on this stylized diagram: Auricle, Auditory canal, Pharyngotympanic tube... | 384 | common-pile/libretexts_filtered | https://bio.libretexts.org/Bookshelves/Human_Biology/Human_Anatomy_Lab/13%3A_The_Somatic_Nervous_System_(Special_Senses)/13.05%3A_Exercises | libretexts | libretexts-0000.json.gz:10107 | https://bio.libretexts.org/Bookshelves/Human_Biology/Human_Anatomy_Lab/13%3A_The_Somatic_Nervous_System_(Special_Senses)/13.05%3A_Exercises |
aSVB2AWObiQvsbwY | 3.2: Reading- The Disadvantages of Communism | 3.2: Reading- The Disadvantages of Communism
Businesses under Communist system have very strict limitations as to what they can and cannot do, which can hamper productivity and innovation.
KEY Points
- In a Communist system, the central authority dictates the means and quantity of production, and places strict rules on... | 890 | common-pile/libretexts_filtered | https://biz.libretexts.org/Bookshelves/Business/International_Business_(Lumen)/03%3A_Different_Strokes_._Political_and_Economic_Systems_Around_the_Globe/3.02%3A_Reading-_The_Disadvantages_of_Communism | libretexts | libretexts-0000.json.gz:1583 | https://biz.libretexts.org/Bookshelves/Business/International_Business_(Lumen)/03%3A_Different_Strokes_._Political_and_Economic_Systems_Around_the_Globe/3.02%3A_Reading-_The_Disadvantages_of_Communism |
qlpSNfanlFL1lNx0 | University Libraries for New Faculty and Graduate Students at Texas State University | Persistent Identifiers
Kristin Van Diest
Learning Objectives
- Learn about Open Researcher and Contributor IDs (ORCIDs)
- Recognize Digital Object Identifiers (DOIs)
- Learn how to leverage the Texas State University Institutional Repository to generate a unique URL for your work
Open Researcher and Contributor ID (ORC... | 664 | common-pile/pressbooks_filtered | https://pressbooks.txst.edu/universitylibrariesforfacultyandgraduatestudents/chapter/persistent-identifiers/ | pressbooks | pressbooks-0000.json.gz:10338 | https://pressbooks.txst.edu/universitylibrariesforfacultyandgraduatestudents/chapter/persistent-identifiers/ |
TN60ziEF075Qg9t1 | The Butterfly Book
A Popular Guide to a Knowledge of the Butterflies of North America | Produced by Mark Young, Greg Bergquist and the Online
[Illustration Front cover]
THE BUTTERFLY BOOK
[Illustration PLATE I, Frontispiece. SPRING BUTTERFLIES. Pyrameis
Cardui, Linn., ♂ (The Painted Lady); 2. P. Huntera, Fabr., ♂ (Hunter's
Butterfly); 3. Grapta Interrogationis, Fabr., ♂ (The Question Sign); 4.
... | 243,493 | common-pile/project_gutenberg_filtered | 41279 | project gutenberg | project_gutenberg-dolma-0006.json.gz:2501 | https://www.gutenberg.org/files/41279/41279-0.txt |
wQcXgsSJSzs0guVJ | 8.4: The Ear | 8.4: The Ear
Audition (Hearing)
Hearing, or audition , is the transduction of sound waves into a neural signal that is made possible by the structures of the ear (Figure 8.5). The large, fleshy structure on the lateral aspect of the head is known as the auricle . Some sources will also refer to this structure as the pi... | 2,631 | common-pile/libretexts_filtered | https://med.libretexts.org/Bookshelves/Gerontology/Biology_of_Aging_(Lumen)/08%3A_The_Special_Senses/8.04%3A_The_Ear | libretexts | libretexts-0000.json.gz:23632 | https://med.libretexts.org/Bookshelves/Gerontology/Biology_of_Aging_(Lumen)/08%3A_The_Special_Senses/8.04%3A_The_Ear |
5TsUg6a0_t5VdCtr | 2: How to access and use the books -- Introduction to Philosophy- Philosophy of Mind | 2: How to access and use the books -- Introduction to Philosophy- Philosophy of Mind
Christina Hendricks
We hope the books (or chapters in the books) will be adopted for introductory-level courses in philosophy, as part of required readings. You may use the books as they are, or create adaptations or ancillaries. One o... | 568 | common-pile/libretexts_filtered | https://human.libretexts.org/Bookshelves/Philosophy/Introduction_to_Philosophy_-_Philosophy_of_Mind_(Salazar_Ed.)/02%3A_How_to_access_and_use_the_books_--_Introduction_to_Philosophy-_Philosophy_of_Mind | libretexts | libretexts-0000.json.gz:20046 | https://human.libretexts.org/Bookshelves/Philosophy/Introduction_to_Philosophy_-_Philosophy_of_Mind_(Salazar_Ed.)/02%3A_How_to_access_and_use_the_books_--_Introduction_to_Philosophy-_Philosophy_of_Mind |
BevuHAhV4Yfg6ItZ | Tom Swift and his electric rifle = or, Daring adventures in elephant land ... / illustrated. | TOM WANTS EXCITEMENT
"HAVE you anything special to do to-night, Ned?" asked Tom Swift, the well-known inventor, as he paused in front of his chum's window, in the Shopton National Bank.
2 TOM SWIFT AND HIS ELECTRIC RIFLE
fore, but not since I've improved it. I'm speaking oj my new electric rifle. I've got it rea... | 45,367 | common-pile/pre_1929_books_filtered | tomswifthiselect00applrich | public_library | public_library_1929_dolma-0014.json.gz:3363 | https://archive.org/download/tomswifthiselect00applrich/tomswifthiselect00applrich_djvu.txt |
F1qrL4WAc8n0GePf | English Composition II | 12 Practice Activities: Personal Pronouns
Determining Person
In the following sentences, determine the person for each pronoun:
- Don’t forget to give Marieke her keys.
- Itzel and Camila were the top ranking doubles team at OSU. They hadn’t been defeated all year.
- You will need three things in order to be successful... | 1,069 | common-pile/pressbooks_filtered | https://library.achievingthedream.org/odessaenglishcomp2/chapter/practice-activities-personal-pronouns/ | pressbooks | pressbooks-0000.json.gz:62712 | https://library.achievingthedream.org/odessaenglishcomp2/chapter/practice-activities-personal-pronouns/ |
9tAuCYkdHh6tObi_ | 7.3: Results and analysis | 7.3: Results and analysis
Effect of different light conditions on the rate of photosynthesis
Data Table
Results of Different Light Conditions on Spinach Leaf Disks
| Light Condition | # Disks Floating | % Disks Floating |
| Dark | ||
| Room light | ||
| Sunlamp |
Graph
Prepare a bar graph of the % disks floating for ea... | 227 | common-pile/libretexts_filtered | https://bio.libretexts.org/Bookshelves/Introductory_and_General_Biology/Unfolding_the_Mystery_of_Life_-_Biology_Lab_Manual_for_Non-Science_Majors_(Genovesi_Blinderman_and_Natale)/07%3A_Photosynthesis/7.03%3A_Results_and_analysis | libretexts | libretexts-0000.json.gz:28929 | https://bio.libretexts.org/Bookshelves/Introductory_and_General_Biology/Unfolding_the_Mystery_of_Life_-_Biology_Lab_Manual_for_Non-Science_Majors_(Genovesi_Blinderman_and_Natale)/07%3A_Photosynthesis/7.03%3A_Results_and_analysis |
qseynieB3IAX2dcO | Anthropology | 5 Chapter 5: Marriage
What does Santa Claus have to do with marriage? Saint Nicholas was a Greek bishop who lived in the 4th century. In those times, and in many places today, dowry was needed to marry a daughter to a suitor. Dowry is paid by the bride’s family to the groom’s family. A story goes that a man with three ... | 5,023 | common-pile/pressbooks_filtered | https://pressbooks.pub/newmexico9/chapter/chapter-5-marriage-mytext-cnm/ | pressbooks | pressbooks-0000.json.gz:74094 | https://pressbooks.pub/newmexico9/chapter/chapter-5-marriage-mytext-cnm/ |
0PmjPZoUQGIASfSS | A system of human anatomy, general and special / by Erasmus Wilson, M.D. ... | TO THE FIRST ENGLISH EDITION.
The favourable reception which my recent Work on Practical and Surgical Anatomy has received, both from the Profession and the Press, commands my first attention and grateful remembrance on again presenting myself to public notice as an aspirant for honours in the field of Medical Science... | 305,579 | common-pile/pre_1929_books_filtered | systemofhumanana00wils | public_library | public_library_1929_dolma-0018.json.gz:1391 | https://archive.org/download/systemofhumanana00wils/systemofhumanana00wils_djvu.txt |
i6JaQ0M7eBWNIgek | Rain or Shine | 1.4 Learning Obstacles and Helps
If you are not comfortable with the foundational principles of math, soil science, or physics, you may benefit from studying resources such as:
- the SSSA Glossary of Soil Science Terms (link)
- Daniels and Haering’s “Concepts of Basic Soil Science” (link)
- the “Math Skills Review” by ... | 1,016 | common-pile/pressbooks_filtered | https://open.library.okstate.edu/rainorshine/chapter/1-4-learning-obstacles-and-helps/ | pressbooks | pressbooks-0000.json.gz:27324 | https://open.library.okstate.edu/rainorshine/chapter/1-4-learning-obstacles-and-helps/ |
2jW6qf1yMykF70wD | The elements of field fortifications, for the use of the cadets of the United States Military Academy, at West Point, N.Y. By J.B. Wheeler ... | PEEFACE.
This text-book is prepared for the use of the cadets of the United States Military Academy while pursuing their course of studies in the subject of '* military engineering."
The endeavor has been made to state concisely and plainly the principles upon which the " art of fortification " is based, and to give... | 70,383 | common-pile/pre_1929_books_filtered | elementsoffieldf00wheerich | public_library | public_library_1929_dolma-0003.json.gz:1888 | https://archive.org/download/elementsoffieldf00wheerich/elementsoffieldf00wheerich_djvu.txt |
njLjaBynhAQnjnx8 | 6.1: Clastic Sedimentary Rocks | 6.1: Clastic Sedimentary Rocks
A clast is a fragment of rock or mineral, ranging in size from less than a micron [1] (too small to see) to as big as an apartment block. Various types of clasts are shown in Figure \(\PageIndex{1}\) and in Exercise 5.3. The smaller ones tend to be composed of a single mineral crystal, an... | 2,966 | common-pile/libretexts_filtered | https://geo.libretexts.org/Bookshelves/Geology/Physical_Geology_(Earle)/06%3A_Sediments_and_Sedimentary_Rocks/6.01%3A_Clastic_Sedimentary_Rocks | libretexts | libretexts-0000.json.gz:48058 | https://geo.libretexts.org/Bookshelves/Geology/Physical_Geology_(Earle)/06%3A_Sediments_and_Sedimentary_Rocks/6.01%3A_Clastic_Sedimentary_Rocks |
1uSlLGWOJEjL3uaX | Engineering mathematics; a series of lectures delivered at Union College, by Charles Proteus Steinmetz. | ble new matter has been added.
The chain fraction has been recognized and discussed as a convenient method of numerical representation and approximation; a paragraph has been devoted to the diophantic equations, and a section added on engineering reports, discussing the different purposes for which engineering reports... | 50,423 | common-pile/pre_1929_books_filtered | engineeringmathe00stei | public_library | public_library_1929_dolma-0010.json.gz:4286 | https://archive.org/download/engineeringmathe00stei/engineeringmathe00stei_djvu.txt |
3B8SzwmrbAmBw6q5 | 26.2: Gymnosperms | 26.2: Gymnosperms
Skills to Develop
- Discuss the type of seeds produced by gymnosperms, as well as other characteristics of gymnosperms
- State which period saw the first appearance of gymnosperms and explain when they were the dominant plant life
- List the four groups of modern-day gymnosperms and provide examples o... | 2,172 | common-pile/libretexts_filtered | https://bio.libretexts.org/Bookshelves/Introductory_and_General_Biology/General_Biology_1e_(OpenStax)/5%3A_Biological_Diversity/26%3A_Seed_Plants/26.2%3A_Gymnosperms | libretexts | libretexts-0000.json.gz:24484 | https://bio.libretexts.org/Bookshelves/Introductory_and_General_Biology/General_Biology_1e_(OpenStax)/5%3A_Biological_Diversity/26%3A_Seed_Plants/26.2%3A_Gymnosperms |
RYO-jGxPKa0Z06n9 | Babel Fish Bouillabaisse II | Technology and Society
Move Fast and Forget Things
August 12, 2019
There has been concern since before the internet existed that we’re amusing ourselves to death, and since then that the internet is making us shallow and unable to focus on complex ideas or long-form texts.
Being plugged in constantly doesn’t always fee... | 886 | common-pile/pressbooks_filtered | https://mlpp.pressbooks.pub/babelfish/chapter/move-fast-and-forget-things/ | pressbooks | pressbooks-0000.json.gz:89448 | https://mlpp.pressbooks.pub/babelfish/chapter/move-fast-and-forget-things/ |
XoSSl2F2_gvODLQq | The need of automatic train control, with facts concerning its development and present status, by W.M. Camp ... | For more than twenty years past it has been the editorial policy of the Railway Review to encourage the use of the automatic train stop, as a necessary supplement to the block-signal system. In this way it has fallen to the writer to study the possibilities of such a means of promoting the safety of train operation, an... | 18,457 | common-pile/pre_1929_books_filtered | needofautomatict00camprich | public_library | public_library_1929_dolma-0007.json.gz:1841 | https://archive.org/download/needofautomatict00camprich/needofautomatict00camprich_djvu.txt |
krCBdd10bQMb7IW8 | 5.8: Jamaica Kincaid (1949- ) | 5.8: Jamaica Kincaid (1949- )
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Jamaica Kincaid (1949- ) Girl Antiguan-American Contemporary Literature Jamaica Kincaid, whose original name is Elaine Potter Richardson, was born in Antigua in 1949. She is currently Professor of African and African-American S... | 276 | common-pile/libretexts_filtered | https://human.libretexts.org/Courses/University_of_Arkansas_Little_Rock/ENGL_3330%3A_Approaches_to_Literature_(McAbee)/05%3A_Poetry/5.08%3A_Jamaica_Kincaid_(1949-_) | libretexts | libretexts-0000.json.gz:28902 | https://human.libretexts.org/Courses/University_of_Arkansas_Little_Rock/ENGL_3330%3A_Approaches_to_Literature_(McAbee)/05%3A_Poetry/5.08%3A_Jamaica_Kincaid_(1949-_) |
VDaHAazsBNWZhI71 | MGMT-1010: Introduction to Business | General Discussion Instructions
In order to prepare for this assignment, READ the information contained in the document “Salty Pawz Background.”
You are required to post to this discussion THREE TIMES, on THREE DIFFERENT DAYS. Please refer to the Discussion Grading Rubric for details regarding how your performance will... | 546 | common-pile/pressbooks_filtered | https://uen.pressbooks.pub/introbusiness/chapter/discussion-supply-and-demand-at-salty-pawz/ | pressbooks | pressbooks-0000.json.gz:97431 | https://uen.pressbooks.pub/introbusiness/chapter/discussion-supply-and-demand-at-salty-pawz/ |
7WhwJt4oPpzm5kjX | A Great Marketing Textbook | 95 6.7 Customer Relationship Management (CRM) Systems
Learning Objectives
- Define CRM systems and explain their purpose
- Describe the types of marketing information CRM systems can capture and why it is valuable for generating customer insights
- Explain how customer relationship management (CRM) systems can help org... | 172 | common-pile/pressbooks_filtered | https://pressbooks.pub/agreatmarketingtextbook/chapter/outcome-market-data-sources/ | pressbooks | pressbooks-0000.json.gz:37425 | https://pressbooks.pub/agreatmarketingtextbook/chapter/outcome-market-data-sources/ |
wXIIGQGQzcNV1aVj | 29.2: Electrocyclic Reactions | 29.2: Electrocyclic Reactions
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- Last updated
- Save as PDF
- Steven Farmer, Dietmar Kennepohl, William Reusch, & Kevin M. Shea
- University of Illinois Springfield
An electrocyclic reaction is the concerted cyclization of a conjugated π-electron system by converting one π-bond to a ring forming σ-bond. The key sigma ... | 564 | common-pile/libretexts_filtered | https://chem.libretexts.org/Bookshelves/Organic_Chemistry/Organic_Chemistry_III_(Morsch_et_al.)/29%3A_Orbitals_and_Organic_Chemistry_-_Pericyclic_Reactions/29.02%3A_Electrocyclic_Reactions | libretexts | libretexts-0000.json.gz:13802 | https://chem.libretexts.org/Bookshelves/Organic_Chemistry/Organic_Chemistry_III_(Morsch_et_al.)/29%3A_Orbitals_and_Organic_Chemistry_-_Pericyclic_Reactions/29.02%3A_Electrocyclic_Reactions |
mVMDzUfBg1R_lrys | 22.8: References | 22.8: References
American Speech-Language-Hearing Association. (n.d.). Swallowing disorders in adults . https://www.asha.org/public/speech/s...ers-in-Adults/
Bencosme, J. (2018). Periodontal disease: What nurses need to know. Nursing , 48 (7), 22–27. doi.org/10.1097/01.nurse.0000534088.56615.e4
Braunstein, G. D. (2022,... | 495 | common-pile/libretexts_filtered | https://med.libretexts.org/Bookshelves/Nursing/Clinical_Nursing_Skills_(OpenStax)/22%3A_Assessment_of_the_Head_and_Neck/22.08%3A_References | libretexts | libretexts-0000.json.gz:10888 | https://med.libretexts.org/Bookshelves/Nursing/Clinical_Nursing_Skills_(OpenStax)/22%3A_Assessment_of_the_Head_and_Neck/22.08%3A_References |
YV3aSbd7OJZ1o3oW | Introduction to Sociology | 210 Reading: Theoretical Perspectives on Aging
What roles do individual senior citizens play in your life? How do you relate to and interact with older people? What role do they play in neighborhoods and communities, in cities and in states? Sociologists are interested in exploring the answers to questions such as thes... | 3,875 | common-pile/pressbooks_filtered | https://library.achievingthedream.org/mvccintrotosociology/chapter/reading-theoretical-perspectives-on-aging/ | pressbooks | pressbooks-0000.json.gz:35755 | https://library.achievingthedream.org/mvccintrotosociology/chapter/reading-theoretical-perspectives-on-aging/ |
mmPpvngnCrBxsE_6 | 11.7: XI Glossary | 11.7: XI Glossary
Agranulocytosis: Extremely low white blood cell count.
Akathisia: Psychomotor restlessness (a feeling of being unable to sit still).
Alogia: Reduction or poverty in speech.
Anhedonia: The reduced ability to experience pleasure in daily activities.
Anosognosia: The inability to recognize that one is il... | 1,106 | common-pile/libretexts_filtered | https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/11%3A_Psychosis_and_Schizophrenia/11.07%3A_XI_Glossary | libretexts | libretexts-0000.json.gz:7134 | https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/11%3A_Psychosis_and_Schizophrenia/11.07%3A_XI_Glossary |
3AdR6w2c708Uc5pu | 7.1: Curvature | 7.1: Curvature
Consider the smooth curve in Figure \(7.1.1\). The curvature of the curve at a point is a measure of how drastically the curve bends away from its tangent line, and this curvature is often studied in a multivariable calculus course. The radius of curvature at a point corresponds to the radius of the circ... | 1,428 | common-pile/libretexts_filtered | https://math.libretexts.org/Bookshelves/Geometry/Geometry_with_an_Introduction_to_Cosmic_Topology_(Hitchman)/07%3A_Geometry_on_Surfaces/7.01%3A_Curvature | libretexts | libretexts-0000.json.gz:45155 | https://math.libretexts.org/Bookshelves/Geometry/Geometry_with_an_Introduction_to_Cosmic_Topology_(Hitchman)/07%3A_Geometry_on_Surfaces/7.01%3A_Curvature |
iZEEuQvJRzEIMwKg | Lifespan Human Development: A Topical Approach | 17.3 Friendships and Peer Relationships
Learning Objectives
- Identify three research traditions that study children’s relationships with agemates.
- Describe differences in boys’ and girls’ friendships.
- Describe benefits of friendship. How do friendships differ from peer relationships?
- Describe sociometric assessm... | 6,724 | common-pile/pressbooks_filtered | https://openbooks.library.baylor.edu/lifespanhumandevelopment/chapter/chapter-17-3-friendships-and-peer-relationships/ | pressbooks | pressbooks-0000.json.gz:81411 | https://openbooks.library.baylor.edu/lifespanhumandevelopment/chapter/chapter-17-3-friendships-and-peer-relationships/ |
Px-c5N1jZKBGf9YC | Principles of Economics | Learning Objectives
- Apply concepts of productive efficiency and allocative efficiency to perfectly competitive markets
- Compare the model of perfect competition to real-world markets
When profit-maximizing firms in perfectly competitive markets combine with utility-maximizing consumers, something remarkable happens:... | 1,979 | common-pile/pressbooks_filtered | https://openoregon.pressbooks.pub/socialprovisioning/chapter/11-4-efficiency-in-perfectly-competitive-markets/ | pressbooks | pressbooks-0000.json.gz:54183 | https://openoregon.pressbooks.pub/socialprovisioning/chapter/11-4-efficiency-in-perfectly-competitive-markets/ |
2gR7AD7fX24xbLJz | A thesis on the cataract, with some remarks on the eye / by Arthur B. Stout. | Dr. James Edward Cornell,
for their constant kindness, while under their observation at the College and Hospital, and the many facilities for improvement afforded him from their private practice, is embraced with much pleasure, by their
OPHTHALMIC SURGERY.
The eye is the most perfect object in Nature ; and, as per... | 22,978 | common-pile/pre_1929_books_filtered | thesisoncataract00stou | public_library | public_library_1929_dolma-0001.json.gz:1465 | https://archive.org/download/thesisoncataract00stou/thesisoncataract00stou_djvu.txt |
_YXol3_HElNlPAnx | A manual of normal histology and organography, by Charles Hill ... | CHARLES HILL, B. S.. M. S., PH.D.. M. D.
PRESIDENT AND PROFESSOR OF ANATOMY, CHICAGO HOSPITAL COLLEGE OF MEDICINE; PROFESSOR OF HISTOLOGY AND EMBRYOLOGY, CHICAGO VETERINARY college; FORMERLY ASSISTANT PROFESSOR OF HISTOLOGY AND EMBRYOLOGY AT THE NORTHWESTERN UNIVERSITY MEDICAL SCHOOL... | 96,186 | common-pile/pre_1929_books_filtered | manualofnormalhi00hill | public_library | public_library_1929_dolma-0014.json.gz:1169 | https://archive.org/download/manualofnormalhi00hill/manualofnormalhi00hill_djvu.txt |
wVbAOD6nMKvY875R | Biographic clinics. | " The improver of natural knowledge absolutely refuses to acknowledge authority, as such. For him, skepticism is the highest of duties; blind faith the one unpardonable sin. And it cannot be otherwise, for every great advance in natural knowledge has involved the absolute rejection of authority, the cherishing of the k... | 59,361 | common-pile/pre_1929_books_filtered | biographicclinic01goul | public_library | public_library_1929_dolma-0009.json.gz:4250 | https://archive.org/download/biographicclinic01goul/biographicclinic01goul_djvu.txt |
wI0e43frtJtvgtkL | 13.32: Reading- Marketing Campaigns and IMC | 13.32: Reading- Marketing Campaigns and IMC
The Marketing Campaign
Determining which marketing communication methods and tools to use and how best to combine them is a challenge for any marketer planning a promotional strategy. To aid the planning process, marketing managers often use a campaign approach. A campaign is... | 1,120 | common-pile/libretexts_filtered | https://biz.libretexts.org/Bookshelves/Marketing/Principles_of_Marketing_(Lumen)/13%3A_Promotion-_Integrated_Marketing_Communication_(IMC)/13.32%3A_Reading-_Marketing_Campaigns_and_IMC | libretexts | libretexts-0000.json.gz:5453 | https://biz.libretexts.org/Bookshelves/Marketing/Principles_of_Marketing_(Lumen)/13%3A_Promotion-_Integrated_Marketing_Communication_(IMC)/13.32%3A_Reading-_Marketing_Campaigns_and_IMC |
W2N9yXuoG9r7VLFd | Research Methods Handbook | 1 Pragmatism
“Essentially, all models are wrong but some are useful.” (Box, 1976)
Pragmatism suspends questions of the final ‘truth’ of research outcomes and focuses only on their usefulness for a particular end. Pragmatists often make use of mixed methods and typically vary their approach depending on the constraints ... | 497 | common-pile/pressbooks_filtered | https://open.library.okstate.edu/gognresearchmethods/chapter/pragmatism/ | pressbooks | pressbooks-0000.json.gz:17497 | https://open.library.okstate.edu/gognresearchmethods/chapter/pragmatism/ |
5g7G2jnJeWctFDXc | Community and Public Health Nursing: A Call to Action | An Introduction to Community and Public Health Nursing
Overview
The focus of this chapter is to provide an overview of community and public health nursing and highlight its importance in protecting, preserving, and promoting the public’s health and safety. The different levels of disease prevention are presented and di... | 9,908 | common-pile/pressbooks_filtered | https://viva.pressbooks.pub/communityhealthnursing/chapter/an-introduction-to-community-and-public-health-nursing/ | pressbooks | pressbooks-0000.json.gz:41586 | https://viva.pressbooks.pub/communityhealthnursing/chapter/an-introduction-to-community-and-public-health-nursing/ |
8gRtNTbMZGgy7LPV | Union foundations: a study of American nationality as a fact of science. By Capt. E. B. Hunt. | As the following discussion of the scientific bases on which our nationality has rested and must rest, was written in September, 1862, the partial coincidence of certain views herein set forth with those embodied in a portion of the President's Message of December, 1862, must be regarded as a natural agreement, and as ... | 22,335 | common-pile/pre_1929_books_filtered | unionfoundations00huntiala | public_library | public_library_1929_dolma-0009.json.gz:4587 | https://archive.org/download/unionfoundations00huntiala/unionfoundations00huntiala_djvu.txt |
fSJXL8DYx4XBmrSU | 4.1: Examining Relationships | 4.1: Examining Relationships
At the end of this section you should be able to answer the following questions:
- What is a statistical relationship?
- What is the difference between a positive and negative relationship?
- What does a Pearson correlation coefficient indicate?
When we discuss relationships or associations... | 799 | common-pile/libretexts_filtered | https://stats.libretexts.org/Bookshelves/Applied_Statistics/Statistics_for_Research_Students_(Fein%2C_Gilmour%2C_Machin%2C_and_Liam_Hendry)/04%3A_Comparing_Associations_Between_Two_Variables/4.01%3A_Examining_Relationships | libretexts | libretexts-0000.json.gz:35652 | https://stats.libretexts.org/Bookshelves/Applied_Statistics/Statistics_for_Research_Students_(Fein%2C_Gilmour%2C_Machin%2C_and_Liam_Hendry)/04%3A_Comparing_Associations_Between_Two_Variables/4.01%3A_Examining_Relationships |
DqWUbF8dAKdA0rNR | Deeds Barn and the Self Starter | DEEDS BARN
and the
SELF-STARTER
[Illustration: The 1912 Cadillac, equipped with self-starter, is the
central exhibit in Deeds Barn.]
Deeds Barn is symbolic of one of the most important developments in the
automotive field. It was here that the mod... | 10,678 | common-pile/project_gutenberg_filtered | 64831 | project gutenberg | project_gutenberg-dolma-0012.json.gz:1192 | https://www.gutenberg.org/ebooks/64831.txt.utf-8 |
4UxYB5kv3JjSWJU4 | AI for Teachers: an Open Textbook | Additional Content
Transformers
Manuel Gentile and Fabrizio Falchi
Transformers are a neural network model designed to overcome the limitations of recurrent neural networks in the analysis of sequences of data (in our case, words or tokens)1.
Specifically, transformers, through the self-attention mechanism, make it pos... | 130 | common-pile/pressbooks_filtered | https://pressbooks.pub/aiforteachers/chapter/transformers/ | pressbooks | pressbooks-0000.json.gz:32356 | https://pressbooks.pub/aiforteachers/chapter/transformers/ |
ICIHTOMiCMP61Chh | History of Applied Science & Technology | Stephanie Guerin-Yodice
Figure 6. Map showing the struggle for power, 2500–2400 BCE. Google Images. CC-BY.
There is evidence that the first conflict over waterways occurred in 2500 BCE between the rulers of Lagash and Umma. Lagash was one of the original established agricultural communities along the Tigris River. Over... | 270 | common-pile/pressbooks_filtered | https://press.rebus.community/historyoftech/chapter/a-case-study-the-tale-of-two-city-states/ | pressbooks | pressbooks-0000.json.gz:64460 | https://press.rebus.community/historyoftech/chapter/a-case-study-the-tale-of-two-city-states/ |
1D8rkA-_UGBG5DDN | NSCC Project Management | Chapter 10: Resource Planning
Learning Objectives
- Use effective methods in estimating, allocating and assigning resources.
- Examine challenges of allocating scare resources and juggling limited resources among multiple projects.
- Discuss five tools and techniques for creating the most accurate estimates.
In the pre... | 4,274 | common-pile/pressbooks_filtered | https://pressbooks.nscc.ca/projectmanagement/chapter/chapter-10-resource-planning/ | pressbooks | pressbooks-0000.json.gz:34610 | https://pressbooks.nscc.ca/projectmanagement/chapter/chapter-10-resource-planning/ |
KTbdGuZvJze_nXuP | Nursing Skills - 2e | 11.3 Oxygenation Equipment
There are several types of equipment a nurse may use when providing oxygen therapy to a patient. Each device is described in detail below.
Pulse Oximeter
A pulse oximeter is a commonly used portable device used to obtain a patient’s oxygen saturation level at the bedside or in a clinic. See F... | 5,125 | common-pile/pressbooks_filtered | https://wtcs.pressbooks.pub/nursingskills/chapter/11-3-oxygenation-equipment/ | pressbooks | pressbooks-0000.json.gz:84096 | https://wtcs.pressbooks.pub/nursingskills/chapter/11-3-oxygenation-equipment/ |
-6RW_l4jBSXZC0jc | Hymns and Spiritual Songs | W. T. Matson
O BLESSED Life—the heart at rest
When all without tumultuous seems,
That trusts a higher Will, and deems
That higher Will, not mine, the best.
2
O blessed Life, the mind that sees,
Whatever change the years may bring,
A mercy still in everything,
And shining through all mysteries.
3
O blessed Life, the sou... | 170 | common-pile/pressbooks_filtered | https://pressbooks.pub/hymnbook/chapter/o-blessed-life-the-heart-at-rest/ | pressbooks | pressbooks-0000.json.gz:96477 | https://pressbooks.pub/hymnbook/chapter/o-blessed-life-the-heart-at-rest/ |
dmA6-yCgjCrUY5NI | Fundamentals of Public Speaking | Chapter 6: Introductions and Conclusions
Below you will find examples of informative and persuasive introductions. Notice that each contains the five elements necessary for a good introduction: an attention getter, the establishment of rapport with the audience, the speaker’s credibility, a clear topic reveal, and clea... | 968 | common-pile/pressbooks_filtered | https://openfl.pressbooks.pub/publicspeaking/chapter/sample-introductions-informative-and-persuasive/ | pressbooks | pressbooks-0000.json.gz:26910 | https://openfl.pressbooks.pub/publicspeaking/chapter/sample-introductions-informative-and-persuasive/ |
21iDlfnfq4x053Px | Sociology of Gender: An Equity Lens | 3.1 Chapter Introduction
Chapter Overview: Let’s Talk About Sex
Sex is an intensely personal and private topic. On an interpersonal level, sex can be pleasurable and create connections between people. In public, it can also be a divisive and politically charged topic. Sex is also used as a weapon or as a means of socia... | 716 | common-pile/pressbooks_filtered | https://openoregon.pressbooks.pub/socgender1e/chapter/oo3-1/ | pressbooks | pressbooks-0000.json.gz:56270 | https://openoregon.pressbooks.pub/socgender1e/chapter/oo3-1/ |
jCJptU8sBADBrylX | The American Race
A Linguistic Classification and Ethnographic Description of the Native Tribes of North and South America | E-text prepared by Adrian Mastronardi and the Online Distributed
Proofreading Team (http://www.pgdp.net) from page images generously made
available by Internet Archive (https://archive.org)
Note: Images of the original pages are available through
https://archive.org/details/americanraceling00briniala
Transcr... | 162,917 | common-pile/project_gutenberg_filtered | 55096 | project gutenberg | project_gutenberg-dolma-0010.json.gz:387 | https://www.gutenberg.org/ebooks/55096.txt.utf-8 |
rva0dSb9dUApXSv4 | The Refugee: or the Narratives of Fugitive Slaves in Canada | London
Nelson Moss
I have lived in a slave State all my life until seven years ago. I am now forty-five. I lived three years in Pennsylvania, in which State I suffered more from prejudice than in Virginia, and there is a great deal here in London, but not so much as in Pennsylvania. I got along well, having energy to a... | 517 | common-pile/pressbooks_filtered | https://pressbooks.library.torontomu.ca/therefugee/chapter/nelson-moss/ | pressbooks | pressbooks-0000.json.gz:91277 | https://pressbooks.library.torontomu.ca/therefugee/chapter/nelson-moss/ |
39WTrvESnFrnfdrw | 2.2: Early Ideas in Atomic Theory | 2.2: Early Ideas in Atomic Theory
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- Last updated
- Save as PDF
Learning Objectives
By the end of this section, you will be able to:
- State the postulates of Dalton’s atomic theory
- Use postulates of Dalton’s atomic theory to explain the laws of definite and multiple proportions
The earliest recorded discussion of t... | 1,870 | common-pile/libretexts_filtered | https://chem.libretexts.org/Bookshelves/General_Chemistry/Chemistry_-_Atoms_First_2e_(OpenStax)/02%3A_Atoms_Molecules_and_Ions/2.02%3A_Early_Ideas_in_Atomic_Theory | libretexts | libretexts-0000.json.gz:3650 | https://chem.libretexts.org/Bookshelves/General_Chemistry/Chemistry_-_Atoms_First_2e_(OpenStax)/02%3A_Atoms_Molecules_and_Ions/2.02%3A_Early_Ideas_in_Atomic_Theory |
kc_ha1LH7RKS-RoS | 4.8: Trace it back | 4.8: Trace it back
Before trusting or reusing information you’ve found, make sure you understand its original context by tracing the claims, quotes, and media back to their sources. This is useful whether you’re exploring a news source, article, or social media post. In this section, we’ll use a few examples to explore... | 2,393 | common-pile/libretexts_filtered | https://human.libretexts.org/Bookshelves/Research_and_Information_Literacy/Introduction_to_College-level_Research_(Iowa_State_University_Library_Instruction_Services)/04%3A_Evaluating_information/4.08%3A_Trace_it_back | libretexts | libretexts-0000.json.gz:33039 | https://human.libretexts.org/Bookshelves/Research_and_Information_Literacy/Introduction_to_College-level_Research_(Iowa_State_University_Library_Instruction_Services)/04%3A_Evaluating_information/4.08%3A_Trace_it_back |
yvPSXxKSueC1oQ54 | Advanced laboratory practice in electricity and magnetism, by Earle Melvin Terry ... | Electrical World v Engineering News -Record Power v Engineering and Mining Journal-Press Chemical and Metallurgical Engineering Electric Railway Journal v Coal Age American "Machinist v Ingenieria Internacional Hectrical Merchandising v BusTransportation Journal of Electricity and Western Industry Industrial Engineer
... | 88,058 | common-pile/pre_1929_books_filtered | advancedlaborato00terrrich | public_library | public_library_1929_dolma-0010.json.gz:47 | https://archive.org/download/advancedlaborato00terrrich/advancedlaborato00terrrich_djvu.txt |
XsWwvVF6LmQdYnku | African American History and Culture | 6 West Africa, 1300 – 1800AD
West Africa, 1300 — 1800AD
From the 14th through the 18th century, three smaller political states emerged in the forests along the coast of Africa below the Songhai Empire. The uppermost groups of states were the Gonja or Volta Kingdoms, located around the Volta River and the confluence of ... | 880 | common-pile/pressbooks_filtered | https://library.achievingthedream.org/fscjafricanamericanhistory/chapter/west-africa-1300-1800ad/ | pressbooks | pressbooks-0000.json.gz:35035 | https://library.achievingthedream.org/fscjafricanamericanhistory/chapter/west-africa-1300-1800ad/ |
RVfZfUfL8AFKTLfW | 100 Ideas for Active Learning | Scenario based learning: branching forms
Scott Farrow
What is the idea?
Scenario-based learning (SBL) provides a learning environment where learners can confront authentic challenges similar to those they will experience as professionals’ post-graduation. SBL provides realistic feedback as they progress through their l... | 1,316 | common-pile/pressbooks_filtered | https://openpress.sussex.ac.uk/ideasforactivelearning/chapter/scenario-based-learning-branching-forms/ | pressbooks | pressbooks-0000.json.gz:37277 | https://openpress.sussex.ac.uk/ideasforactivelearning/chapter/scenario-based-learning-branching-forms/ |
LOQrxDIfG0AjxsT0 | 4.5: The Endomembrane System and Proteins | 4.5: The Endomembrane System and Proteins
By the end of this section, you will be able to:
- List the components of the endomembrane system
- Recognize the relationship between the endomembrane system and its functions
The endomembrane system (endo = “within”) is a group of membranes and organelles (Figure \(\PageIndex... | 2,723 | common-pile/libretexts_filtered | https://bio.libretexts.org/Courses/Reedley_College/Biology_for_Science_Majors_I/04%3A_Cell_Structure/4.05%3A_The_Endomembrane_System_and_Proteins | libretexts | libretexts-0000.json.gz:31268 | https://bio.libretexts.org/Courses/Reedley_College/Biology_for_Science_Majors_I/04%3A_Cell_Structure/4.05%3A_The_Endomembrane_System_and_Proteins |
kWRiRw6NqXC7cpe3 | A Bicentennial Crossroads: 200 Years of Continuity and Change in Rural Illinois | Chapter 3: Fertile Ground for Agricultural Change, Part 1
Agriculture in all of its dimensions—environmental, economic, technological, social, and cultural—remains integral to rural Illinois in all of its dimensions. Changes in agriculture often intersect with changes in other facets of life in our state and have far-r... | 2,203 | common-pile/pressbooks_filtered | https://iopn.library.illinois.edu/pressbooks/bicentennialcrossroads/chapter/fertile-ground-for-agricultural-change-part-1/ | pressbooks | pressbooks-0000.json.gz:23840 | https://iopn.library.illinois.edu/pressbooks/bicentennialcrossroads/chapter/fertile-ground-for-agricultural-change-part-1/ |
sBz30jcMx3xfL53y | 3.2.1: Culture and Society | 3.2.1: Culture and Society
-
- Last updated
- Save as PDF
- Boundless
- Boundless
Culture and Biology
Culture relates to nature (our biology and genetics) and nurture (our environment and surroundings that also shape our identities).
Learning Objectives
Examine the ways culture and biology interact to form societies, n... | 6,375 | common-pile/libretexts_filtered | https://socialsci.libretexts.org/Courses/Cosumnes_River_College/SOC_301%3A_Social_Problems_(Lugo)/03%3A_Race_and_Ethnicity/3.02%3A_Culture/3.2.01%3A_Culture_and_Society | libretexts | libretexts-0000.json.gz:847 | https://socialsci.libretexts.org/Courses/Cosumnes_River_College/SOC_301%3A_Social_Problems_(Lugo)/03%3A_Race_and_Ethnicity/3.02%3A_Culture/3.2.01%3A_Culture_and_Society |
gHnYiCL5dt8n2fHU | Trees in winter; their study, planting, care and identification, by Albert Francis Blakeslee and Chester Deacon Jarvis. | This book may be kept out TWO WEEKS ONLY, and is subject to a fine of FIVE CENTS a day thereafter. It is due on the day indicated below:
Tree identification — Tree study in relation to poetry and art — tree photography — tree ecology — tree measurement — tree collections — tree study in high schools and colleges — fi... | 132,120 | common-pile/pre_1929_books_filtered | treesinwinterthe00blak | public_library | public_library_1929_dolma-0016.json.gz:4647 | https://archive.org/download/treesinwinterthe00blak/treesinwinterthe00blak_djvu.txt |
v8SxrSR8U6SJBr6l | CHD 216 Early Childhood Programs, Schools, and Social Change Course Materials | 76 15.3: Hate is Learned and Can Be “Unlearned”
Prejudice and discrimination persist in society due to social learning and conformity to social norms of the dominant race, which is white. Children learn prejudiced attitudes and beliefs from society: their families, teachers, friends, the media, and other sources of soc... | 1,128 | common-pile/pressbooks_filtered | https://pressbooks.nvcc.edu/chd216/chapter/15-3-hate-is-learned-and-can-be-unlearned/ | pressbooks | pressbooks-0000.json.gz:30999 | https://pressbooks.nvcc.edu/chd216/chapter/15-3-hate-is-learned-and-can-be-unlearned/ |
YMbOPu-Xc1XUScLM | Introduction to Criminology | 8. Sociological Theories of Crime
8.7 Conclusion
Dr. Sean Ashley
In this chapter, we explored the sociological turn in criminology and its development on Turtle Island, the continent that came to be known as North America. We learned that criminologists in the first half of the 20th century were particularly concerned ... | 508 | common-pile/pressbooks_filtered | https://kpu.pressbooks.pub/introcrim/chapter/8-7-conclusion/ | pressbooks | pressbooks-0000.json.gz:65034 | https://kpu.pressbooks.pub/introcrim/chapter/8-7-conclusion/ |
Mc7SbUM3QWDtWIWA | An Inquiry Into the Nature and Causes of the Wealth of Nations | Book I: Of the Causes of Improvement in the productive Powers of Labour, and of the Order according to which its Produce is naturally distributed among the different Ranks of the People
Chapter 11
Rent, considered as the price paid for the use of land, is naturally the highest which the tenant can afford to pay in the ... | 59,361 | common-pile/pressbooks_filtered | https://pressbooks.library.torontomu.ca/wealthofnations/chapter/11/ | pressbooks | pressbooks-0000.json.gz:89252 | https://pressbooks.library.torontomu.ca/wealthofnations/chapter/11/ |
NgPbkbyq7Ctu32gk | 7.2: The Tragical History of Dr. Faustus | 7.2: The Tragical History of Dr. Faustus
DRAMATIS PERSONAE.
THE POPE.
CARDINAL OF LORRAIN.
THE EMPEROR OF GERMANY.
DUKE OF VANHOLT.
FAUSTUS.
VALDES, ] friends to FAUSTUS.
CORNELIUS, ]
WAGNER, servant to FAUSTUS.
Clown.
ROBIN.
RALPH.
Vintner.
Horse-courser.
A Knight.
An Old Man.
Scholars, Friars, and Attendants.
DUCHESS... | 24,831 | common-pile/libretexts_filtered | https://human.libretexts.org/Bookshelves/Literature_and_Literacy/British_and_Irish_Literature/English_Literature_I_(Lumen)/07%3A_Dr._Faustus/7.02%3A_The_Tragical_History_of_Dr._Faustus | libretexts | libretexts-0000.json.gz:49150 | https://human.libretexts.org/Bookshelves/Literature_and_Literacy/British_and_Irish_Literature/English_Literature_I_(Lumen)/07%3A_Dr._Faustus/7.02%3A_The_Tragical_History_of_Dr._Faustus |
MSTzU8QZwq4Ylg60 | Introduction to Neuroscience | Organelles
Objective 5: List the organelles found in neurons and the basic function of each.
If you are reading this, then your body is made up of eukaryotic cells. The prefix eu– means “good, perfect, true”. The root karyon is a bit more problematic. The late 19th century histologists, looking through microscopes, nee... | 4,951 | common-pile/pressbooks_filtered | https://uen.pressbooks.pub/introneuro/chapter/organelles/ | pressbooks | pressbooks-0000.json.gz:80535 | https://uen.pressbooks.pub/introneuro/chapter/organelles/ |
dEX0iQpU1dRqM16k | 36: Letters from an American Farmer (1767) Supplementary Readings | 36: Letters from an American Farmer (1767) Supplementary Readings Last updated Save as PDF Page ID 40691 Robin DeRosa, Abby Goode et al. Plymouth State University/ 36.1: An Unstable Identity- The White American Man 36.2: America- Utopia or Dystopia? 36.3: The Naive and Delusional Farmer 36.4: Men Are Like Plants; They’... | 182 | common-pile/libretexts_filtered | https://human.libretexts.org/Bookshelves/Literature_and_Literacy/American_Literature/The_Open_Anthology_of_Earlier_American_Literature_(DeRosa_Goode_et_al.)/36%3A_Letters_from_an_American_Farmer_(1767)_Supplementary_Readings | libretexts | libretexts-0000.json.gz:42681 | https://human.libretexts.org/Bookshelves/Literature_and_Literacy/American_Literature/The_Open_Anthology_of_Earlier_American_Literature_(DeRosa_Goode_et_al.)/36%3A_Letters_from_an_American_Farmer_(1767)_Supplementary_Readings |
ucpoNUR_l76U7Ivh | Diseases of the heart : their diagnosis and treatment / by David Wooster. | MEMBER OF THE BOTAL ACADEMY OF BiTEDICINE AND SURGEEY OF TURIN,
Assistant Surgeon in tlie "Mexican War," Surgeon (Major) in the late Civil War, Author of " Diphtheria and Congenital Asphyxia " (1859), Founder and former Editor of "The Pacific Medical and Surgical Journal," etc., etc.
Entered according to Act of Cong... | 55,202 | common-pile/pre_1929_books_filtered | diseasesofheartt00woosrich | public_library | public_library_1929_dolma-0023.json.gz:1476 | https://archive.org/download/diseasesofheartt00woosrich/diseasesofheartt00woosrich_djvu.txt |
AsVGNnxpMcYZFNP5 | 1: The Romantic Era | 1: The Romantic Era
-
- 1.1: Romanticism in Literature
- As a literary movement in England, Romanticism could be said to have fired its first salvo in 1801 with William Wordsworth’s (1770-1850) “Preface” to the Lyrical Ballads. Lyrical Ballads is a collection of poetry that Wordsworth co-published with Samuel Taylor Co... | 1,073 | common-pile/libretexts_filtered | https://human.libretexts.org/Courses/Skyline_College/LIT_232%3A_Survey_of_British_Literature_II_(Skyline)/01%3A_The_Romantic_Era | libretexts | libretexts-0000.json.gz:22784 | https://human.libretexts.org/Courses/Skyline_College/LIT_232%3A_Survey_of_British_Literature_II_(Skyline)/01%3A_The_Romantic_Era |
nUjsRfwSPl7-UUNi | Introduction to Electricity, Magnetism, and Circuits | 3.2 Electric Potential and Potential Difference
LEARNING OBJECTIVES
- Define electric potential, voltage, and potential difference
- Define the electron-volt
- Calculate electric potential and potential difference from potential energy and electric field
- Describe systems in which the electron-volt is a useful unit
- ... | 4,243 | common-pile/pressbooks_filtered | https://openpress.usask.ca/physics155/chapter/3-2-electric-potential-and-potential-difference/ | pressbooks | pressbooks-0000.json.gz:65184 | https://openpress.usask.ca/physics155/chapter/3-2-electric-potential-and-potential-difference/ |
fd_--PXpwyJwENdW | 2.5: Contributions to Science | 2.5: Contributions to Science
There are also a number of
Jewish
and
Christian
traditions. The Bible’s Old and New Testaments contain numerous astronomical references. The Jewish Bible, or Old Testament, refers to stars, constellations, and eclipses. The Christian New Testament has astronomical references, such as the S... | 260 | common-pile/libretexts_filtered | https://phys.libretexts.org/Bookshelves/Astronomy__Cosmology/Introduction_to_Astronomy_(Lumen)/02%3A_Historical_Astronomy/2.05%3A_Contributions_to_Science | libretexts | libretexts-0000.json.gz:42730 | https://phys.libretexts.org/Bookshelves/Astronomy__Cosmology/Introduction_to_Astronomy_(Lumen)/02%3A_Historical_Astronomy/2.05%3A_Contributions_to_Science |
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