. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. tion does not extendto the heart-muscle the heart of a child is very likely to undergoa serious degree of dilatation, and when both these conditions arecombined with endocarditis recovery is very improbable. Thiswas well shown in the case of the ten-year-old coloured boy, fromwhom was obtained the specimen shown in Fig. 13, A\Tien seenfor the first and only time a few days prior to death, this boy wassitting up ill bed on account of difficul
. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. tion does not extendto the heart-muscle the heart of a child is very likely to undergoa serious degree of dilatation, and when both these conditions arecombined with endocarditis recovery is very improbable. Thiswas well shown in the case of the ten-year-old coloured boy, fromwhom was obtained the specimen shown in Fig. 13, A\Tien seenfor the first and only time a few days prior to death, this boy wassitting up ill bed on account of difficulty of respiration and of painin the heart-region. ITis illness had begun with rheumatism andlasted ten weeks, and he had become strikingly emaciated and hiscountenance showed marks of patient suffering. The thorax andabdomen were distended from just below the clavicles to the um-bilicus, were unnaturally broad across the loins, and thus filledout presented a striking contrast to the thinness and smallness ofthe neck and extremities. Breathing was extremely rapid andshallow, and as evinced by the i)ulse the hearts action was also DRY PERICARDITIS 63. rapid and feeble. The skin was dry and scaly and felt hot,although as a matter of fact there was but slight fever. The cardiac impulse was very feeble, and the apex-beat couldnot be clearly defined. Absolute dulness was enormously in-creased in all diameters, reach-ing as high as the second costalcartilages, and transverselyfrom at least 2 inches to theright of the sternum far be-yond the left nipple almostto the anterior axillary line(Fig. 15). This gave to thedulness a pyramidal shapeclosely resembling the outlineof the pericardium distendedwutli fluid, but differing fromit in the circumstance thatthe left border of dulness didnot pass outside the limits ofcardiac impulse. The heart-sounds were feeble, and allover the prgecordium was a loud, harsh systolic murmur, havingits greatest intensity in the mitral area and audible through
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