Exploration of the chest in health and disease / by Stephen Smith Burt.

  • Burt, Stephen Smith.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Exploration of the chest in health and disease / by Stephen Smith Burt. Source: Wellcome Collection.

    210/250 page 188
    mal position ; and often over tlie left ventricle a thrill is communicated to the hand dmmg the last portion of the second silence of the heart, that runs up to the apex-beat. The j^resence of this thrill, even in the absence of a bruit, strongly points to stenosis. Upon auscultation, a harsh, grating, unusually loud murmur is heard just above the apex, where also it is most intense ; yet, however loud, it has a very limited area of difEusion, and is rarely if ever con- veyed to the back. This bruit is auricular systolic, or, with respect to the ventricle, presystolic in rhythm; that is to say, it occurs during the latter part of the second silence of the heart, while the auricle is con- tracting, or just before the systole of the left ventri- cle. The pulmonary second sound is intensified, and the degree of accentuation is thought to indicate the amount of the obstruction. On the other hand, there is so little stress upon the aortic second sound that it is almost inaudible at the mitral area. There may be also a reduplication of the cardiac second sound from a lack of simultaneous action of the two sides of the organ. A mitral presystolic mumiur, as a rule, is not diflficult to recognize. It is lost as the stethoscope is moved far in any direction from the a]Dex, and while listening, if the examiner will place a finger upon the
    digitised image 1
    digitised image 2
    digitised image 3