Excerpt from The Colorado Medical Journal, (Colorado's Local Medical Journal), 1898, Vol. 4: A Journal of Medical Science, of Medical News and Medical Lore

Gentlemen - I wish to show you to-day an instance of the rarest of the valvular diseases of the left side of the heart, aortic stenosis, accompanied, in this case, with mitral insufficiency. After the close of the lecture the patient will pass around the room, that you may have an opportunity to examine him.

M. D 68 years of age, without family history of interest in this connection, has been a miner in this state for nearly forty years. He has experienced, at intervals of several years, several attacks of acute articular rheumatism There is no history of syphilis or of alcoholism, but the patient has done much severe manual labor.

He complains of dyspnoea, palpitation, faintness and dizziness, but almost solely after some sudden change Of posture, notably from the recumbent one to the erect position, or upon exertion.

Upon physical examination we find extensive atheroma in all of the accessible arteries, - a feature of some importance in making the diagnosis of aortic stenosis. We may briefly state that the ex amination Of organs other than those involved in carrying on the circulation has been negative. The impulse of the heart is found in the fifth Space, somewhat outside Of the mamillary line. The area of dullness is decidedly increased, as you may see by follow ing the blue lines drawn upon the patient's chest, and which have been verified by some of those present. The increase in area is almost wholly in a transverse direction, extending from the right edge of the sternum to a line one inch to the left Of the left nipple.

Upon palpation we feel a marked systolic thrill over the sec ond right interspace. The pulse is seventy to the minute, small, but of fair tension. There is no visible pulsation in the arteries of the neck.

With the stethoscope we hear a loud, sawing, systolic murmur over the aortic area. But transmitted beyond the area of the thrill, for it is to be heard in the arteries of the neck and in the femoral and radial arteries as well. With the fingers holding the bell of the stethoscope one easily feels the thrill transmitted through the wall of the chest to the instrument.

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