338 MOKBID ANATOMY.
lower front part of the chest and extending around to the back ; the pain lasting through the day with slight cough and hemoptisis ; and from this time he had d}^spnoea on any unusual exertion. When Dr. Gage saw him on the 21st, a very distinct purring thrill was felt over almost the whole front of the chest, very strong over the heart, and most intense over the aortal valves. Dulness over the heart to the extent of 4 in. Systolic and diastolic bellows murmur very superficial, and heard 1 or 2 inches from the chest ; most marked over aortal orifice, and heard along the aorta and great vessels from the arch. Impulse increased, and strong in the subclavians. Pulse about 80, small, thrilling, and occasionally intermitting.
On the evening of Jan. 20th he went, as. a spectator, to a dance ; was out late, and drank somewhat freely. After his return home he had great dyspnoea, and vomited severely. On the 21st he had frightful paroxysms of suffocation, with cold perspiration and great lividity ; and during the follow- ing night he was in extreme agony. On the 22d he was kept quiet by opiates, but he died that night.
On dissection, a serous eifusion was found in the cavities of the thorax and abdomen. The heart was more than twice its usual size ; the right ventricle being relatively thicker than the left. The interventricular opening had the form of a half circle, and would easily admit the little finger ; the crescentic edge toward the. septum being thick and rounded. The pulmonary valves were nearly or quite normal. The aneurism, which arose from one of the pouches just at the aortal valves, was extremely delicate and thin, and would just admit the last phalanx of the fore- finger and about one-fourth of the next. These points are, nearly all of them, shown in the preparation.
Dr. G. supposed that the aneurism dated from the lift- ing of the stone, but that the interventricular opening was congenital. It appeared to me, however, t*hat both of these conditions were due to the lifting, insufficient as the cause may seem to have been, in consideration of the pre- _ viously perfect health, the date of symptoms from that time, the condition of the pulmonary valves, which seem to be so very generally abnormal in one way or another in
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