This frequently results from chronic endocarditis. They may either be contracted or distorted, preventing accurate closure, or ulceration may occur through the valves. Vegetations and a peculiar deposit may take place under the tissue of the valves, and occasionally there is a deposition of cartilaginous or osseous matter, and in rheumatic or gouty subjects, of the urate of soda, or the valves may become atrophied or wasted away. The effects in slight cases may occasion but little difficulty, but in severe it is apt to produce hypertrophy and dilatation, dropsy, local inflammations, and ultimately death. These results are owing to an impediment in the forward movement of the blood, and to the regurgitation of the same, producing an accumulation behind. This is plainly illustrated in an affection of the mitral valve. If its orifice is contracted by deposits, the blood accumulates in the left auricle by the impediment, and distends it; congestion of the pulmonary veins is the consequence; the lungs share in the congestion, and pulmonary apoplexy may be the result. This of course occasions an insufficient supply of blood to the general system, which the heart is willing to relieve, and, therefore, makes greater efforts, but becomes hypertrophied or enlarged in so doing. Again, suppose some insufficiency in the mitral valve, owing to ulceration, for example, the blood will regurgitate into the left auricle at each pulsation, it produces the same effects. If the semilunar valves are contracted, a less supply of blood is sent to the general system, but congestion of the heart and consequent enlargement and dilatation of the left ventricle may occur. The general symptoms of valvular disease is difficulty of breathing, increased by muscular efforts, or emotion, palpitations, the pulse intermittent or jerky. Distinctive murmurs accompany these affections; in mitral deficiency we hear a prolonged murmur in a low key, like whispering the word "who," in contraction of the aortic valves we have a comparatively superficial sound like whispering the letter "z:" in regurgitations we hear squashing sounds.

TREATMENT. -- The mitigation of the urgent symptoms may be accomplished by ladies'-slipper, hops, or henbane. In violent action of the heart cherry laurel water may be given with the henbane. Hot foot-baths and mustard plasters may also be necessary. In sudden palpitation and difficulty of breathing, the compound spirits of lavender should be given. Collinsonia is the proper remedy if hypertrophy of the valves is suspected. In valvular insufficiency the tonics and a liberal diet should be prescribed. Conium, belladonna, digitalis, irisin, veratrum, stramonium, and cannabis sativa, are also extensively used in various combination, if they are indicated.