508 
REPORTS OF CASES. 
August 19th.—Very bad. Temp. 106°; pulse nearly im¬ 
perceptible ; complete immobility; takes absolutely no food. 
Exploration renewed; dull sound opposite two thirds of the 
surface of the left lung; the beatings of the heart are violent, 
strong; the first shock is accompanied by a strong bellowing 
sound (bruit de souffle); the first shock of the heart is double. 
The beatings of the heart and the bellowing sound can easily 
be heard as high as near the vertebras and over at least two- 
thirds of the horizontal surface of the chest. At the ri^ht 
side both the cardiac beats and the bellowing sounds are also 
heard on a large surface. 
The diagnosis is easily made then; it is a case of acute 
endocarditis. Had I explored the chest for cardiac disease at 
the first examination, or at least at the second, I would have 
easily made a correct diagnosis, whilst on account of not hav¬ 
ing done so it was only when the symptoms of the disease 
were too prominent that I discovered its true nature. 
Prognosis. —Fatal. Here again I was mistaken, for the 
patient made a good recovery. 
Treatment. —It consisted of salicylate of soda, 4 drachms ; 
digitalis in powder, 15 grs., twice a day; alcohol, 1 ounce, : 
every four hours with 4 ounces of water. A very peculiar 
circumstance of the case is the extremely profuse perspiration 1 
which began at 5 p. m. on the 18th of August and lasted con- : 
tinually till late during the night of the 20th, and ceased only 
during the day of the 21st. The temperature at 8 p. m. the 
19th is 105no food has been taken during the day ; absolute 
immobility. 
August 20th.—Temp. 1052°; pulse^i little stronger; great 
prostration, can hardly stand, refuses all food ; perspires all 
day. 
Same treatment. 
No change is noticeable in auscultation. 
August 21st—Perspiration continues, but less profuse; 
temp. 105°; pulse as yesterday; eats nothing yet. The car¬ 
diac beats are not so strong and not audible on so large a sur¬ 
face. Towards the evening the perspiration decreases; she 
dries up except under the belly, on the neck and in the flanks/ 
Same treatment. 
