Transcriber's note: Text enclosed by underscores is in italics (_italics_). Small capital text has been replaced with all capitals. Minor typographical errors have been corrected without note. Irregularities and inconsistencies in the text have been retained as printed. * * * * * HEART DISEASE IN MIDDLE AND ADVANCED AGE The Lettsomian Lectures ON DISEASES AND DISORDERS OF THE HEART AND ARTERIES IN MIDDLE AND ADVANCED LIFE _Delivered before the Medical Society of London, Session 1900-1_ BY J. MITCHELL BRUCE, M.A., LL.D., M.D., F.R.C.P., _Physician to Charing Cross Hospital; Consulting Physician to the Hospital for Consumption and Diseases of the Chest, Brompton_ LONDON: HARRISON AND SONS, ST. MARTIN'S LANE PRINTERS IN ORDINARY TO HIS MAJESTY 1902 _To_ JOHN H. MORGAN, C.V.O., M.A. Oxon., F.R.C.S. Eng. _President of the Medical Society of London, 1900-1901 from his friend and colleague The Writer_ CONTENTS LECTURE I. PAGE Introduction 1 Natural State of Heart and Arteries after 40 3 Causes of cardio-vascular disorder and disease 6 Physical Stress 6 Nervous Influences 8 Cardiac Poisons 9 Disturbances of Metabolism 9 Gout 9 Syphilis 10 Acute specific fevers 11 Chronic affections 11 Complex causes 11 Old-standing Rheumatic Lesions 13 Family heart 14 LECTURE II. Clinical Characters and Course 14 Clinical Characters and Course of Tobacco Heart 15 Clinical Characters and Course of the Heart in Alcoholism 18 Clinical Characters and Course of the Heart in Gout 20 Clinical Characters and Course of the Heart in Obesity and Glycosuria 22 Clinical Characters and Course of Cardiac Strain 23 Clinical Characters and Course of Cardiac Strain before 40 25 Clinical Characters and Course of Syphilis of the Heart 28 Clinical Characters and Course of cardio-vascular disease from Nervous Strain 29 LECTURE III. Diagnosis, Prognosis and Treatment 30 Differential Diagnosis 31 Value diagnostically of different physical signs 33