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.