The patient, who is an Italian-born housewife, was first admitted to the Presbyterian Hospital in April 1914, at the age of 25. Her previous health had been good except for a week in 1906 when she had been kept in bed because of severe pain in the region of the heart and in the left lower chest posteriorly. Further details of this illness are lacking. She had married in 1908 and had had three pregnancies. The first two infants had died shortly after birth. The third was well and vigorous at the age of 2 months.
Six months before admission and while pregnant for the third time, she had caught a severe cold with a troublesome cough. Following this she developed swelling of the feet and legs, which did not grow worse until after delivery; then when she got up and walked about