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 . seems to corroborate the view thatdropsy depends upon the state of the blood and nutrition of thecapillaries, as wrell as upon the degree of capillary and venousengorgement. This patient subsequently succumbed to a thirdattack in the hospital. Mr. B., aged twenty-nine, tailor, consulted me January 9,1900, on account of great breathlessness upon the slightest gave a history of rheuma-tism four years previous, sincewhich time he had
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 . seems to corroborate the view thatdropsy depends upon the state of the blood and nutrition of thecapillaries, as wrell as upon the degree of capillary and venousengorgement. This patient subsequently succumbed to a thirdattack in the hospital. Mr. B., aged twenty-nine, tailor, consulted me January 9,1900, on account of great breathlessness upon the slightest gave a history of rheuma-tism four years previous, sincewhich time he had sufferedwith subacute articular six years ago,with stricture at present the exception of a badeye, nature unknown, at sixyears of age, has had no otherillness. Heart began to trou-ble him one year after therheumatic attack, but was nottreated for heart-disease untilthe summer of 1899. Hissymptoms were great dys-pnoea on effort, cough once in awhile at morning and evening,vertigo upon exercise, somepain between the shoulders, and poor appetite, but sleep pulse while sitting was weak, small, regular, and 90. The18. Fig. 51.—Location of Apex and RelativeDulness in Case oe Mitral Stenosisand Regurgitation (p. 273). 274 DISEASES OP THE HEART examination of the heart discovered the weak apex-beat at thefifth interspace, nipple-line, 3f inches from median line, andpreceded by a short thrill (Fig. 51). The apex-beat was notthumping, but there was marked epigastric pulsation. Abso-lute dulness was increased from right border of sternum, at fourthcostal cartilage, to left of parasternal line. Relative dulnessfrom lower border of third costal cartilage above to junction ofsixth and seventh costal cartilages below, If inch to right ofmedian line and to f of an inch outside of nipple. The pulmonicsecond sound was found accentuated. Second sound was notdoubled at base, but limited to area of the apex-beat was anapparent doubling of the second sound, the
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