REPORT OF CASE
—A negro laborer, aged 39 years, was admitted to the Pennsylvania Hospital, Sept. 1, 1919 (service of Dr. Arthur Newlin), complaining of upper sternal pain, dull and aching in character and referred to the right scapula. He had been working intermittently, but had not taken to his bed before entering the hospital. For five months he had been troubled with cough, expectoration (never bloody) and dyspnea on exertion. His sleep was sometimes disturbed by pain. Nycturia (once or twice). No history of venereal disease obtainable.
—Lies comfortably in bed. The left pupil is larger than the right; both pupils seem sluggish. The teeth are poorly kept. A distinct tracheal tug is noted.
—Anteriorly, at the third costosternal juncture, is a spherical mass about the size of a hen's egg which pulsates visibly, and over it a systolic thrill can be felt. Expansion of