PRESENTATION OF CASE

A 40-year-old woman was admitted to Billings Hospital from the emergency room on July 3, 1954. Her chief complaint on admission was dyspnea of three weeks' duration. About one month prior to admission, she first noted upper abdominal pain that was rather sharp and that was accentuated by coughing or hiccuping. This pain became progressively worse. About two weeks prior to admission, she noted slight exertional dyspnea and, because of this, was hospitalized elsewhere. At that hospital electrocardiograms, gastric analyses, and roentgenograms of the chest, gallbladder, and gastrointestinal tract, all of which were normal according to the patient, were obtained. Her liver at that time was large and somewhat tender. Her dyspnea grew worse daily. She was told that this was probably caused by anxiety and that she should not consider it of any importance and was discharged. When she came to the emergency room, her dyspnea had progressed to