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I place before you, this morning, a patient whose sallow complexion and expression of distress declare him to be a sufferer from chronic disease. He is about 50 years of age, though his whitened locks and bald crown seem to indicate a greater number of years. He is quite thin; his muscles are flaccid, and readily discernible through the dry and inelastic skin. In the left side of the scrotum hangs a considerable varicocele; the veins of the lower extremities are enlarged and tortuous; he is constipated and has long been a sufferer with internal piles. During the winter he complains of a hacking cough, but his thorax is everywhere extremely resonant; he has a chronic bronchitis with some degree of vesicular emphysema. The heart is not enlarged; there are no valvular murmurs, but the second sound is decidedly accentuated over the right ventricle. The liver is of normal size,
LYMAN HM. DILATATION OF THE STOMACH. JAMA. 1897;XXVIII(16):726–731. doi:10.1001/jama.1897.02440160008001b
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