d we may
find a regurgitant pulsation in the jugular vein. Occasionally it
happens that the heart contracts more frequently than the pulse
beats--that is, there may be twice as many contractions of the heart in
a minute as there are pulse waves in the arteries. The pulse is always
very fast. In some cases we find marked lameness of the left shoulder,
and when the animal is turned short to the left side he may groan with
pain, and the heart's action become violently excited, although
pressure against the chest wall will not produce pain unless roughly
applied. The animal is not disposed to eat or drink much; the surface of
the body and legs are cold--rarely excessively hot--and frequently the
body of the animal is in a subdued tremor. In nearly all cases there is
partial suppression of the urinary secretion. The symptoms may continue
with very little modification for three or four days, sometimes seven
days, without any marked changes. If large fibrinous clots form in the
heart the change will be sudden and quickly prove fatal unless they
become loosened and are carried away in the circulation; then apoplexy
may result from the plugging of arteries too small to give further
transmission. If the animal manifests symptoms of improvement, the
changes usually are slow and steady until he feels apparently as well as
ever, eats well, and moves freely in his stall or yard. When he is taken
out, however, the seeming strength often proves deceptive, as he may
quickly weaken if urged into a fast gait, the breathing becomes
quickened with a double flank movement as in heaves, and all the former
symptoms reappear in a modified degree. An examination at this stage may
reveal valvular insufficiency, cardiac hypertrophy, or pulmonary
engorgement.

In fatal cases of endocarditis death often occurs about the fourth day,
from the formation of heart clot or too great embarrassment of the
circulation. Endocarditis may be suspected in all cases where plain
symptoms of cardiac affection are manifested in animals affected with
influenza, rheumatism, or any disease in which the blood may convey
septic matter.

Acute endocardial inflammation may be distinguished from pleuritis by
the absence of any friction murmur, absence of pain when the chest wall
is percussed, and the absence of effusion in the cavity of the chest. It
may be distinguished from pericarditis by the absence of the friction
sounds and want of an enlarged area of dullness on pe