Investigations into some morbid cardiac conditions : including the Cartwright prize essay on the heart in debility / by William Russell.

  • Russell, William, 1852-1940.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Investigations into some morbid cardiac conditions : including the Cartwright prize essay on the heart in debility / by William Russell. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    the second space; fourth, murmur from about the nipple line inwards over a triangular area, the left boundary of which is formed by a line drawn from below the nipple to a point in the second left space from one to two inches to the left of the sternum, and often heard at the same time over the sternum adjoining this area; fifth, murmur in the second right space ( aortic area ); sixth, murmur in the third and perhaps the fourth right space ; seventh, murmur over the manubrium sterni; eighth, murmur beyond the apex towards the axilla. In different cases the stages vary somewhat, and they frequently overlap each other. The explanation of these various phenomena has now to be sought for. I will say nothing on the subject of precordial pulsation, as not only its degree but its presence often depends largely on the physical qualities of the chest wall. When present it may, as has been already pointed out, give valu- able information. The accentuation of the pulmonary second sound is to be regarded as evidence that the tension in the pulmonary circuit has been increased. This is not, in the early stage, due to mitral regurgitation, but to accumulation of blood in the left heart, which, as has been seen, takes place as soon as the heart manifests its debility by a weakened systole. Accentuation is judged of in two ways : first, by comparison with the second sound in the second right space ; second, by comparison with the first sound. Both aid in the formation of an opinion. The murmur in the second left space is of great interest for many reasons. Hughes, as has been seen, was the first to claim for the pulmonary artery a share in the basic murmur of chlorosis, and it has been granted to it by many F