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 of the right auricle, sec-ondary to mitral was at no time amarked symptom, except twoor three paroxysms a fewhours before death, whenpatient seemed to have pain inleft lung. During the lastfew weeks of life there wasmoderate oedema of ankles andshins, also puffmess, but nopain, in left wrist and to sixty hours be-fore death patient becamecomatose, with cold extremi-ties, very rapid, feeble, andirregu
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 of the right auricle, sec-ondary to mitral was at no time amarked symptom, except twoor three paroxysms a fewhours before death, whenpatient seemed to have pain inleft lung. During the lastfew weeks of life there wasmoderate oedema of ankles andshins, also puffmess, but nopain, in left wrist and to sixty hours be-fore death patient becamecomatose, with cold extremi-ties, very rapid, feeble, andirregular pulse, and the trunk and lower extremities becamestudded with small brownish-red spots, that had all the charactersof cutaneous embolisms. Death, which took place June 24th,seemed to be the result of gradual cardiac asthenia. The autopsy, made by Dr. W. A. Evans thirteen hours afterdeath, was briefly as follows: Very large numbers of petechia?over abdomen, chest, and legs, about the size of a pea. Some inter-stitial splenitis and perisplenitis and zones of connective-tissuegrowths representing old infarcts. These were generally subcap-sular. 11. Fig. 29.—Apex-beat and Absolute Dul-ness Later in Same Case as Fig. 28. 162 DISEASES OP THE HEART Liver.—Fatty infiltration—nutmeg. Large numbers of smallislands of connective-tissue increase, quite generally distributedin subcapsular zone. A small mass of calcareous material in lowerportion of right lobe, superficial. In left lobe a small fresh in-farct about 6 millimetres in diameter. Left Kidney.—Slight parenchymatous nephritis. Right Kidney.—In the cortex an old infarct 1 centimetre indiameter, over this the surface of the kidney depressed. This in-farct, fatty in appearance, reddish, surrounded by a reddish was this infarct which in March had occasioned the bloody andalbuminous urine. Left Pleural Cavity.—No fluid, no adhesions except to dia-phragm. Left Lung.—Congested and cedematous. In anterior edge ofi
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