. 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. nal colic. Xeither couldhe remember any injury orlocal suppurating process,and he had never had rheu-matism, pneumonia, gonor-rhoea, or other infection. The patient was tall, ema-ciated, j)ale, and of a slightyellow hue, and his conjunc-tiva? were faintly icteric. Theradial arteries were thick-ened, and the pulse, of onlymoderate tension, was regular and equal, 100 to the minute. Afeeble cardiac impulse was diffused from epigastrium to the a
. 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. nal colic. Xeither couldhe remember any injury orlocal suppurating process,and he had never had rheu-matism, pneumonia, gonor-rhoea, or other infection. The patient was tall, ema-ciated, j)ale, and of a slightyellow hue, and his conjunc-tiva? were faintly icteric. Theradial arteries were thick-ened, and the pulse, of onlymoderate tension, was regular and equal, 100 to the minute. Afeeble cardiac impulse was diffused from epigastrium to the apex-beat, which, weak and accompanied by soft thrill, was situatedin the sixth interspace, 10 cen-timetres to left of medianline. Relative cardiac dulnessat the level of the fifth costalcartilage extended from 5 cen-timetres to right of the mid- sternal line to 14 centimetresto left of the same (Fig. 30).The first sound at the apexwas obscured by a murmurand the second was impure,but over right ventricle bothwere more distinct, while atthe base both were faint, thesecond being scarcely audible,the pulmonic second the loud-er of the two; both aortic. Fig. 31.—Area of Maximum Audibility(shaded) and Transmission of MurmurIN Case (p. 166). 166 DISEASES OF THE HEART tones were distinct, but feeble in the cervical arteries. A liarslisystolic niurmnr was heard at the apex, and was transmittedinto the middle of the axillary region and to the median linein front, yet not above the third interspace (Fig. 31). Thelungs were negative and the abdomen was flabby, moderately tym-panitic, not tender, while in the location of the gall bladder a softroundish body could be plainly made out. The urine collectedover night and analyzed next day gave following results: Quan-tity, 800 cubic centimetres; cloudy, specific gravity, ; reac-tion acid; colour, reddish-yellow; urea, per cent; mucin pres-ent ; a slight trace of albumin; no sugar; no bile; no blood; 2granular and a few hyaline casts
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