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30 THE HARVEIAN ORATION, 1904 excepting in few and rare instances. When regurgitation through the valve, shown by an apex bruit with accentuation of the second pulmonary sound, has occurred in acute rheum- atism, if after treating the rheumatism we leave the affected heart to its own course, and the patient to his, persistent bruit, persistent pulmonary accentuation, hypertrophy, dilatation-in fact, life-long heart disease and its train of attendant evils follow in a large majority of cases, and mar or shorten life. Why should the rheumatic heart be so much more intractable than the rheumatic joint?

No doubt the reason is that the joint can rest. The merciful influence of pain in the part affected insures repose for each affected joint. Suppose it were otherwise. Imagine pain absent and conceive for a moment that we could flex and extend an acutely rheumatic knee or elbow sixty or eighty times per minute continuously, what would be the fate of the joint? Is there any probability that restoration to the normal condition would follow? Few of us, I think, would expect it, for it is a physiological law that repair in a diseased organ cannot coincide with full functional activity. When the endocardium and valve cusps are inflamed pain does not give the signal for rest, for, indeed, pain or no pain, the toiling heart cannot intermit its labours.