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. Two Objections to the Proposed Method 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 to the patient, and also if the hope of perfect recovery be held out to him through the agency of prolonged rest, he will agree to give this method a fair trial. Such, at least, has been my experience. Successful Results obtained For twenty years continuously this method has been carried out. The results have been striking. The comparative absence of permanent heart disease after endocarditis has been in marked contrast to its frequency prior to the adoption of the treatment by rest. So striking indeed is the change that I confess it now seems to me that it would be an immoral act on my part to omit these measures in any recent case of endocardial disease. If we make it a rule to watch carefully for incipient valvulitis and if, when we find it, we secure for the heart prolonged rest, I believe that it is in our power to diminish, in a most material degree, the frequency of chronic valvular disease of the heart. FOOTNOTES [1]Dr. Payne, Harveian Oration, p. 51 [2]In all estimations of date I have taken the lower limit, thus probably much understating the remoteness of the events recorded. [3]Hieroglyphic inscription on Temple of I-em-hotep at Philae. See Brugsch, _Thesaurus_, p. 783 [4]Maspero, _La Mythol. Egypt._, p. 80 [5]Brugsch, _Thesaurus_, V, 923 [6]Peyron, _Acad. Sc. de Torino._, Ser. II, Tom. III, 1841, p. 40 [7]See Plate I [8]Maspero, _His. Anc. de l’Orient_, I, 240 [9]See Plate II [10]De Rougé, _Insc. du Temps. d’Edfou_, II, 89 [11]Eusebius on Manetho; Lauth, _Manetho und der Turiner Königspapyrus_, 144 [12]See Plate III [13]Erman, _Die Märchen des Papyrus Westcar_, I, S 22 [14]Pliny, _Nat. Hist._, xix, 5 [15]Fo. 103 [16]Fo. 99 [17]Fo. 99 [18]Fo. 100 [19]Fo. 101 [20]Leeman, _Mons. Egypt du Musee. d’Antiq. Leiden_, 1839 [21]Brugsch, _Recueil de la Mon. Egypt_, I