—N. H., aged 18, complained, July 19, 1917, of the effects of a kick in the epigastrium by a mule. Since the injury the patient had noticed difficulty in breathing, which had steadily increased in intensity. There was a persistent cough, accompanied by expectoration, the sputum consisting of frothy mucus, tinged with bright blood. The abdomen had become greatly enlarged during the previous month; likewise the ankles and legs. The personal and the family history were both negative.
—The face was swollen, with marked puffiness under the eyes. The lips and the tongue were very cyanotic. The pulsation in the jugular veins was pronounced. On lying down the whole face became extremely cyanotic. The lungs were negative. The cardiac impulse was heaving in character and could be seen to extend from the seventh interspace about 1½ inches to the left of the nipple line over the entire