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 . e did, and hispalpitations disappeared. Upon attempting to smoke again a fewmonths subsequently his symptoms returned and he again aban-doned his smoking permanently, but his palpitations still con-tinued. Examination of his urine two years ago showed it to be nor-mal. Last spring he observed for the first time that a prolongedand severe attack of palpita-tion was followed by the pas-sage of a large amount of paleurine. His digestion is notg
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 . e did, and hispalpitations disappeared. Upon attempting to smoke again a fewmonths subsequently his symptoms returned and he again aban-doned his smoking permanently, but his palpitations still con-tinued. Examination of his urine two years ago showed it to be nor-mal. Last spring he observed for the first time that a prolongedand severe attack of palpita-tion was followed by the pas-sage of a large amount of paleurine. His digestion is notgood, he thinks, there being a rumbling and roaring inthe bowels, some eructations,and occasionally his flatulence isfollowed by diarrhoea, but or-dinarily his bowels are regu-lar. His sleep is good and hishabits are now excellent. The pulse varies much inits irregularity, being steadyfor twenty or thirty seconds,and then intermitting everyfew beats; it is equal, of good volume, and of normal rate. Thereis no perceptible cardiac impulse except when the heart gives amore than usually vigorous contraction. Absolute dulness is nor-. Fig. 36.—Relative Dulness, CaseMitral Insufficiency. 228 DISEASES OP THE HEART nial, but relative dulness measures 1£ inches to right of the sternumand 4^ to the left of the median line in the third interspace (). The sounds are distinct, but the pulmonic second markedlyaccentuated. At the apex and round about the nipple there is afaint, soft systolic murmur, which is heard distinctly only whenthe heart makes a strong contraction after an intermission. Inthe fifth interspace, within the left nipple-line, there is a sugges-tion of a very short presystolic murmur. The systolic murmuris increased somewhat in the recumbent position. There can be no doubt of the existence of a mitral leak, but itis not quite clear whether it is of rheumatic origin or resultedfrom a degree of cardiac overstrain during that game of football,and fr
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