Pulse: Rate 100, rhythm irregular. The irregularity was due to
extra-systoles. The radial arteries were just palpable, without
evidence of pathological thickening or tortuosity. Blood
pressure: systolic 130 mm. of mercury, diastolic 80 mm. of
mercury.
Heart: The heart was clinically not enlarged. The cardiac sounds
were feeble, there was no accentuation of the second sound in
the aortic area, nor were any cardiac murmurs audible. There
were no vascular changes observable in the vessels of the fundi.
There was no evidence of cedema or of congestive heart failure.
5. Respiratory Examination: Chest movement satisfactory. There was no
impairment of percussion noted. Auscultation revealed no impairment of
air entry, no alteration in the breath sounds, and the absence of any
adventitious sounds.
6. Alimentary-renal Examination: There was slight distention of the
abdomen, due to increase in the gaseous content of the intestines. There
was no evidence of ascites. The spleen was not palpable, nor was there
any evidence of glandular enlargement. The liver was just palpable, one
finger’s breadth below the right costal margin, but there was no
evidence of enlargement upwards. Urinalysis: no sugar or albumen
present.
7. Skeletal Examination: The patient’s rigidity limited the examination
of joints. There was limitation of movement of the neck due to muscular
hypertonus. The hypertonus was so marked in the lower dorsal and lumbar
region as to produce rigidity of the spine. Attempts to move the joints
passively stimulated involuntary contractures of the muscles. There was
evidence of crepitus in both knee-joints.