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almost imperceptible, burr or roughness at the first sound of the heart. The second sound was normal. Two weeks afterwards, palpitation and dyspnoea had become troublesome, and the legs were much swollen. The roughness of the first sound had now become very decided, but no other abnormal sound, from either heart or lungs, was detected. The stomach and bowels seemed to do their duty, though the latter were a little sluggish, and the appetite was not as good as' it had been. The urine wasdoi:10.1056/nejm186110310651306 fatcat:v26glwf3ubas3hdtog577z6tra