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April 8, 1968


JAMA. 1968;204(2):165-166. doi:10.1001/jama.1968.03140150069022

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The Book of Revelation has nothing on today's case report. The latter is usually characterized by all manner of information offered not as simple facts but as discoveries brought to light by the medical detective who has flung open the curtain on hidden events and conditions. The patient did not simply have shortness of breath; the history of the present illness revealed that she had it. She had had rheumatic fever in childhood, but this cannot be stated without saying that the past history revealed that episode. The cardiac murmurs were not merely heard and the splinter hemorrhages of the nail beds not merely observed; these (lo and behold) were revelations of the physical examination. Because of persistent, low-grade fever, a blood culture was taken and this, to no one's surprise despite the manner of telling it, revealed—naked save for the green tunics—Streptococci viridantes. The white blood cell count