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THE HARVEIAN ORATION, 1904 33 unalterable by any form of treatment. The method fails if from any reason it is found impracticable to slow down the heart, for example, if asthma, bronchitis, or pneumonia, or great nervous excitability co-exist.

I submit that these measures are rational, their objects being by affording rest to give opportunity for the exercise of the vis medicatrix naturae which is our sheet anchor, nay, indeed, to stimulate that natural reparative process which alone can effect restoration.

It may be objected that there are two difficulties in our path. First, in regard to diagnosis, how are we to distinguish the signs of commencing endocarditis from those of mere dilatation? In the great majority of instances in which marked and continuing bruit occurs, endocarditis is present and not mere dilatation, but I admit that in some cases discrimination is difficult. The wisest course is, if in doubt, to treat as endocarditis. Secondly, some physicians complain, as those at the Johns Hopkins Hospital have recently done, that they find difficulty in inducing private and hospital patients to submit to a sufficiently long period of rest. Occasionally that is so in the case of foolish or thoughtless persons, but in general, if the danger to which the heart is exposed be calmly and plainly stated