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September 23, 1944


Author Affiliations

Memphis, Tenn.

JAMA. 1944;126(4):233. doi:10.1001/jama.1944.82850390003008b

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B. W. H., a white boy aged 10 years, was admitted to the Methodist Hospital Oct. 2, 1943 with a history of fever for the preceding four days and complaining of pain in the left lower chest, anorexia and general malaise.

X-ray examination at this time revealed a lobar pneumonia of the left lower lobe, infiltration of both hilar regions and slight enlargement of the heart, but no abnormality in contour.

Physical examination revealed an acute inflammation of the tonsils and tonsillar pillars. There was bronchial breathing and moderate dulness over the left lower lobe. Examination of the heart revealed a palpable thrill, a very loud blowing systolic and a subdued diastolic murmur about 2 centimeters to the right of the mitral area. These murmurs were not transmitted to the axilla or posteriorly. A tentative diagnosis of lobar pneumonia and congenital heart disease was made.

Laboratory studies showed 54 per

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