James J. Waring 6 1 9 



Blood. Hb. 11.2 gr.; red blood cells, 3,950,000; white blood cells, 9,850. 

 Differential count: neutrophiles 67 per cent, lymphocytes 25 per cent, endo- 

 thelial cells 7 per cent, eosinophiles 1 per cent. Wassermann test +4. Eagle 

 Hocculation test, positive. Blood sugar 80, nonprotein nitrogen 14. 



On 1-28-35 catheterization showed 150 cc. residual urine. Utotropin gr. X 

 t.i.d and acid sodium phosphate gr. XX t.i.d. were given until 2-4-35 '^vhen the 

 urine became bloody. They were then discontinued. The urine resumed nor- 

 mal appearance on 2-1 1-35. 



On 1-29-35 portable A-P X-ray film of chest showed immense enlargement 

 of the cardiac silhouette (fig. 1 .) 



On the morning of 1-30-35, 560 cc. of straw-colored serous fluid was aspirated 

 from the pericardial sac. No attempt was made to withdraw all the fluid. The 

 blood pressure before aspiration was 160/95, ^fter aspiration 135/90. Heart 

 sounds were now faintly audible. The area of cardiac dullness seemed but 

 little aff^ected by the removal of the fluid (fig. 2). The Wassermann test on 

 the pericardial fluid was +4. After aspiration, a portable A-P X-ray film of the 

 chest showed very little reduction in size of the cardiac silhouette. 



Microscopic examination of the fluid removed from the pericardium: The 

 sediment after centrifugation was highly cellular. It was composed chiefly of 

 monocytes, a few small lymphocytes, and only an occasional polymorpho- 

 nuclear leucocyte. A few acinar structures lined with cuboidal epithelium con- 

 taining hyperchromatic granular nuclei were present. No acid-fast organisms 

 or other bacteria were found by smear or culture. 



On 1-31-35 he was given 1 cc. Salyrgan intravenously and on 2-1-35 2 cc. 

 Salyrgan intravenously. He was given also theobromin sodium salicylate gr. X 

 t.i.d. every other day until 2-5-35. Meanwhile, the area of cardiac dullness 

 rapidly diminished. A six-foot posteroanterior film (fig. 3) on 2-4-35 showed 

 a cardiac silhouette of normal size, a cloudy left costophrenic angle, possibly 

 due to a small amount of pleural effusion and a triangular area of platelike 

 atelectasis or interlobar effusion in the right lung. 



The first electrocardiogram on 2-4-35 (^S- S) showed changes characteristic 

 of myxedema. Notes on this and subsequent electrocardiograms are shown 

 in table 2. 



On 2-9-35 '^^^ BMR was —40. Thyroid therapy was begun cautiously wath 

 small doses of desiccated thyroid, i/^ gr. daily, increasing the dose until by 

 3-19-35 he was taking i/o S^- fo^^^ times daily. Antiluetic treatment consisted 

 of daily inunctions with blue ointment, sodium iodide intravenously, and later 

 potassium iodide by mouth. 



On 2-12-35, when the BMR was —40, tests for hearing defects showed partial 

 perceptive deafness, which later improved under thyroid therapy. 



On 2-19-35 the total plasma proteins were 6.2, albumin 3.1, globulin 2.9, 

 fibringogen 0.2. The albumin-globulin ratio was 1.07. 



On 2-22-35 a lumbar puncture showed the spinal fluid under normal pres- 

 sure. The fluid was clear, contained very few cells, sugar 71 mg. and total 



