The cause of deposits of fat around the heart or in between its chambers is the same as the cause of general obesity. These patients are likely to be obese, or at least to have large abdomens with large deposits of fat around the abdomen. This fat in itself will interfere somewhat with abdominal respiration. This tends to cause dyspnea, and the heart tends to be disturbed from these causes, if much fat is not really in the pericardium. The symptoms are those of imperfect heart action; the patient is dyspneic on exertion or in leaning over, the heart acts rapidly on such exertion, the patient puffs, perspires easily, and becomes leg weary, sedentary in his habits, and more or less incapacitated for work. He may not be a large eater; if he is, and his eating habit is corrected, the prognosis is better than if he is putting on weight in spite of eating sparingly. The general treatment is that for obesity, and if the heart muscle is intact, various depletion methods may be inaugurated. More and more exercise, sweatings from Turkish baths, electric-light baths, body baking, vigorous massage and more or less purging are all valuable. Anything which reduces the general weight will help the heart. The prognosis is often good. ENDOCARDITIS It should be understood that especially in acute conditions a positive separation of endocarditis from myocarditis is incorrect. Acute endocarditis can probably not occur without some inyocarditis, and myocarditis probably does not occur without some endocardial disturbance and perhaps some pericardial irritation. This is especially true in endocarditis which occurs during any acute infection, even in rheumatism. The greater the amount of pericarditis, the more serious is the acute condition. The greater the amount of myocarditis, the more doubtful is the heart strength in the near future. The greater the amount of endocarditis, the greater the doubt of freedom from future permanent valvular lesions. Endocarditis may be divided into: acute mild (simple) endocarditis, acute malignant (ulcerative, infective) endocarditis, chronic endocarditis and valvular disease. ACUTE MILD ENDOCARDITIS This inflammation of the endocardium is generally confined to the region of the valves, and the valves most frequently so inflamed are the mitral and aortic. There may be a slight inflammation or actual ulceration and loss of tissue. Vegetations more or less constantly occur on the inflamed surfaces, with more or less danger of particles becoming loosened and moving free in the blood stream, causing embolic obstruction in different parts of the body. There is also more or less probability of serious adhesions or contractions occurring from the healing of the ulcerated surfaces. The future health and welfare of the valves depend on the fact that the inflammation has healed without contractions or adhesions.