Identifier: medicaldiagnosi00gree (find matches)
Title: Medical diagnosis for the student and practitioner
Year: 1922 (1920s)
Authors: Greene, Charles Lyman, 1862-
Subjects: Diagnosis
Publisher: Philadelphia, Blakiston
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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r in 1914 she carried decided edema of thelegs, some hepatic engorgement, and marked enlargement of the heart, with auricular fibril-lation. A history of recurrent typical attacks of cardiac angina combined with epigastricdistress was obtained and the nature of some of the abdominal pain distinctly suggestedthe participation of the diseased gall-bladder, although no local tenderness or fever waspresent. The heart measured 15.5 cm. in total transverse diameter a-nd decided diffuseenlargement of the transverse and descending portion of the aortic arch was evident in theoriginal negative. The patient was placed at rest and under digitalis with the resultthat all symptoms were relieved promptly and the heart rhythm became extrasystolic. Theoutline of the heart at the end of this period is shown in Fig. 348. Aside from a slightinconstant and untransmitted mitral bruit or murmurishness the heart was silent. She had been told repeatedly that her heart was wholly normal. 646 MEDICAL DIAGNOSIS
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Fig. 348.—Toxic heart after treatment. The total transverse measurement is reducedfrom 15.5 cm. to 13.5 cm., a normal area, apparently, for so large a woman (weight 185+)but actually a greatly enlarged heart primarily of the drop or modified drop type, ina very small-boned individual. It will be noted that with the subsidence of the fibrillationthe right border is lost behind the sternum and the left has lost its mitral configurationabove, though in this printed reproduction the prominence of the left hilus shadow obscuresthe true outline obtained. Despite all warnings the patient so imposed upon the immunityfrom suffering obtained as to create from time to time through rash overactivity a recur-rence of fibrillation and intervals of diurnal edema of the extremities. Finally, while on avisit certain purely abdominal seizures arose which were apparently due to gall-stones alone.Upon her return it was evident that definite fibrillation and other decompensatory signswere present. The p

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