378 STRONG AND CROWELL. 



swelling and pain in both legs. There was no particular pain 

 on pressure over the calves. The right knee jerk was exag- 

 gerated, but the left seemed slightly diminished. The pulse 

 was 104. On the sixty-first day the note reads as follows : Point 

 of maximum impulse of the heart distinctly visible 10 centi- 

 meters to the left of the median line ; no visible pulsation of the 

 vessels of the neck; the heart sounds are clear at the apex and 

 base. There is no tenderness of the calf muscles; the oedema 

 of the legs has disappeared. The knee jerks are active. On the 

 sixty-second day it was noted that the impulse over the cardiac 

 area was not so marked. On the sixty-third day the note reads : 

 Impulse just visible 10 centimeters from the middle line 5 centi- 

 meters below the nipple. Pulse 110 after exercise. Knee jerks 

 active. On the sixty-fourth day oedema of the legs again ap- 

 peared. On the sixty-fifth day the note made was as follows: 

 Complains of pain in the chest, abdomen, and neck; pulse 120; 

 epigastric and prsecordial pulsation visible; there is marked 

 oedema of both legs; the knee jerks are active. On the sixty- 

 seventh day at noon the note was as follows: Not eating; pulse 

 96; respirations increased; marked prsecordial and epigastric 

 pulsation. He complains of weakness and epigastric pain. At 

 4 p. m. the pulse was 100 ; the respirations 40 ; and the epigastric 

 pulsation marked. He ate but little. On the sixty-eighth day 

 the knee jerks were still active, but he complained particularly 

 of pain in the abdomen and legs. On the sixty-ninth day he 

 complained of pain over the abdomen and in the thighs. There 

 was marked epigastric pulsation, and the pulse was 106, full, and 

 bounding. The knee jerks were active. There was still oedema 

 of the legs. On the seventieth day the systolic blood pressure 

 was 100 millimeters Hg. On account of the general condition of 

 this patient, he was sent to the prison hospital. On the seventy- 

 first day the pulse was 100, the knee jerks were active, the 

 patient appeared drowsy. On the seventy-second day at noon 

 the following note was made : Complains of feeling sore all over 

 the body, and there is marked hypersesthesia of the muscles of 

 the calves ; he is very drowsy ; the face is puffy ; there is marked 

 oedema of the legs; the point of maximum impulse is not dis- 

 tinctly visible; it is palpable about 2 centimeters outside the 

 nipple line and 4 centimeters below the nipple. On the seventy- 

 third day the pulse was 104, and the knee jerks doubtful. He 

 was still drowsy. On the seventy-fourth day the pulse was 120, 

 respirations 24. He complained of pain in the chest and in the 

 muscles of the legs and arms. There was slight epigastric 



