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 them the organisms which are now generally recognised as being associated with the rheumatic state.

In his Harveian Oration in 1898, Sir Dyce Duckworth makes the interesting statement that Matthew Baillie learned from Dr. David Pitcairn, of St. Bartholomew's Hospital, that rheumatism was frequently the cause of disease of the heart, a fact that had not been previously recognised. Another important class of lesions which have come into prominence in modern times are those affecting the myocardium, both acute and chronic, chiefly of an inflammatory and degenerative nature. The acute changes in the cardiac walls are a source of serious danger under various circumstances—as in connection with high fever, pneumonia, diphtheria, typhoid fever, and septicæmia—and their causative relation to infective organisms or toxins is also a matter of much interest and significance, which is still being worked out.

2. One of the most striking advances made in modern times in relation to the circulatory system is in the knowledge which has been gained of the structural changes which affect the blood-vessels, especially the arteries and arterioles, and of the causes by which they are produced. Several distinct morbid changes have now been clearly differentiated, although their ultimate effects may be very similar. Adequate recognition of arterio-sclerosis and other vascular organic changes is the key to the understanding of numerous symptoms and ailments; while they account