186 KITPJTE OF AMYL IN ANGINA PECTORIS. 



February 1st, Professor Maclagan's term of office having 

 expired, Professor Bennett took charge of the clinical wards. 



On February 6th the patient began to complain of pain in 

 the back, neck, head, thighs, and elbow-joints ; he had no appe- 

 tite, was perspiring profusely, and his pulse was 116, full and 

 strong. Next day the pain was most severe in the shoulders, 

 back, hip, and knee-joints. 



On the 8th he was examined by Professor Bennett and the 

 clinical class, and the following was found to be the condition 

 of his circulatory system : — Apex beat 2^ inches below and 

 2-i inches to the outside of the left nipple. On palpation, pul- 

 sation is felt over the whole left front and side of thorax, most 

 strongly between the fourth and sixth ribs, and faintly over the 

 supra-clavicular region. 



Cardiac dulness commences at the middle line of the sternum 

 and extends laterally outw^ards for o inches. 



A loud, double, blowing sound is heard over the whole of the 

 cardiac region, but is loudest at the base. Over the right 

 sterno-claviciilar articulation a single blowing is heard. Pulse 

 104, strong and jerking. The respiratory system was normal, 

 the skin covered with an acid sweat, the tongue furred, no 

 appetite, urine high-coloured and slightly albuminous. The 

 pain in the joints continued along with pain in the neck in the 

 line of the carotids, but the pain in the cardiac region was 

 absent. 



On the 11th the pulse fell to 80, and the pain in the joints 

 diminished, but the patient was still troubled by pain in the 

 left ear, and along the line of the carotids, with violent pulsation 

 in them at night. 



On the 18th the rheumatic pains in the joints and shoulders 

 had entirely disappeared, but the pain in the cardiac region came 

 on during the night. 



On the 19th four ounces of blood were taken from the arm, 

 with immediate relief from the pain and violent pulsation, and 

 the pain over the heart, which usually came on at 3 a.m., was 

 much less on the ensuing night. 



25th. — Patient's appetite remains imimpaired by the pain, 

 and he takes all his food, consisting of steak diet, beef tea, 



