There are in this audience many who have treated cases of acute rheumatism and cases of valvular disease in hundreds of instances. We are all aware that in acute rheumatism, however severe the joint lesion may be, however great the swelling, the pain, the local pyrexia, and the effusion, in the large majority of cases, after the usual treatment all these grave symptoms subside, or if they linger in any joint many of us know how certainly they will vanish if we stimulate the trophic and vasomotor nerves by small blisters applied to the adjacent skin, the final issue in most cases being the restoration of every joint to a normal condition. But, alas, we also know that when the endocardium covering the mitral or aortic valve cusps is in like manner attacked, a like restoration does not take place spontaneously 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 rheumatism, 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? The Rheumatic Joint rests, but not the Rheumatic Heart 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. Disastrous results of Valvulitis if not specially treated