The sound in the cardiac region is nearly as loud as at the corresponding location on the left side. Apex beat is absent. One notices only a faintly visible rising of the left nipple, which is located in the fourth intercostal sphere. The tones are pure and moderately strong. Heart palpitations not present, even though the cardiac action is irregular. Radial arteries noticeably sinuous, of medium thickness, their walls somewhat thickened, tension moderate, pulse fairly faint. The carotids likewise show a faint pulse. Strong swelling of the vena jugul. int. sinistra. Of the superficial veins, the jugulares externae laterales and anteriores and the lateral cutaneous veins of the rib cage are swollen and their walls simultaneously thickened. The vena saphena dextra forms a thick, solid, cylindrical cord. Tongue somewhat bluish, cool, moist, minor coating. Abdomen strongly bloated; abdominal walls rather tense. Ascites with non-significant meteorism. The boundaries of the hepatic dullness cannot be precisely determined. Order: Infus. rad. Senegae (3ij) . . . Liq. Ammon. Anisat. 3j, Elaeosacch. Menthae crisp. 3j, 1 tablespoon every 2 hours.
Evening: pulse 112; respiratory rate 40; temperature = 36.7°
23 Oct.: slept little at night. Pulse 112; respiratory rate 32; temperature = 36.5°
Appetite good; 4 watery bowel movements since yesterday. Urine very sparse, reddish brown, clear, no sedimentation. Very severe, excruciating paroxysms of coughing. The sputum consists of a small number of gray, strongly translucent round lumps dotted with black spots, which contain, apart from numerous corpuscles of phlegm, a substantial number of larger cells filled with black molecula and a strikingly large number of black particles not contained within cells. Without exception the black corpuscles show a sharply delineated, angular but very irregular shape. In part this circumstance, in part the considerable size of many of them gave me the idea that this was not black pigment, but possibly inhaled coal particles. When asked about his work because of this, the patient relates that from 1848 until three and a half months ago he was employed loading and unloading charcoal, that in doing this work he was constantly in a dusty atmosphere and frequently expectorated black sputum.
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