Albany medical annals . nt illness commenced a year ago with painand weakness in the legs, followed soon after by dyspnoea and cough onexertion. Gradually his legs and abdomen became swollen. Some threemonths ago he was obliged to give up work. In January he entered ahospital, where he remained three weeks. During the past two monthshis abdomen has been tapped about once each week and at each tappingtwo and a half to three gallons of clear yellow fluid have been withdrawn. Physical Examination.—Tall, emaciated man with protuberant abdomen,exhibiting orthopnoea and cyanosis. Cervical veins grea
Albany medical annals . nt illness commenced a year ago with painand weakness in the legs, followed soon after by dyspnoea and cough onexertion. Gradually his legs and abdomen became swollen. Some threemonths ago he was obliged to give up work. In January he entered ahospital, where he remained three weeks. During the past two monthshis abdomen has been tapped about once each week and at each tappingtwo and a half to three gallons of clear yellow fluid have been withdrawn. Physical Examination.—Tall, emaciated man with protuberant abdomen,exhibiting orthopnoea and cyanosis. Cervical veins greatly distended. Alarge venous sinus is situated at the junction of the right external jugularwith,t|ic subcl?*dan vein, shown fairly well in the accompanying photo-igrapb., Marked venous pub^ttion can be seen in this sinus and in the veins To Illustrate Dr. Huns and Article on Clinical Studies ofthe Circulation with the Polygraph, Especially in Regard to theVenous Pulse. A Ibarn Mtdical Annals, January, HENRY HUX AND CLINTON B. HAWN 3 connected with it and can be felt distinctly with the finger in a super-ficial vein running downward from the sinus and which can be compressedagainst the clavicle. Liver greatly enlarged. Marked ascites and edemaof legs. Area of cardiac dulness greatly increased horizontally. Cardiacaction fairly regular. Loud, blowing, systolic murmur heard over the pre-cordia, loudest at apex and propagated into axilla and back, splashingsound can be heard below apex, synchronous with the heart beat. Accentu-ation of pulmonic second sound. A few moist rales at the base of eachlung. Urine, sp. gr., , much albumen, a few finely granular casts. Afew out of many polygrams taken in this case at various times are givenat the end of this paper. In the first tracing (No. i) the cardiogram is very poor; theimperfection in it being mainly due to the rapid and excessiverespiratory movements, but the tracing of the venous pulse isquite remarkable. It
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