. Diseases of infancy and childhood . Fig. 107.—Natural Size of Bowles Stethoscope for Examining Children. 2. The apex beat is hard to detect in the infant. In the child palpa-tion shows this easier than in the adult. 3. The area of dullness is comparatively large. (There are threestages in infancy and childhood during which differences are noted in rela-tive and absolute dullness.) (See Figs. 103^ 104, and 105.). Fig. 108. A Convenient Stethoscope for Children. Made by Gr. Tiemann & Co. and by George Ermold, New York City. 4. Murmurs are heard over comparatively large areas. A study ofdiffere
. Diseases of infancy and childhood . Fig. 107.—Natural Size of Bowles Stethoscope for Examining Children. 2. The apex beat is hard to detect in the infant. In the child palpa-tion shows this easier than in the adult. 3. The area of dullness is comparatively large. (There are threestages in infancy and childhood during which differences are noted in rela-tive and absolute dullness.) (See Figs. 103^ 104, and 105.). Fig. 108. A Convenient Stethoscope for Children. Made by Gr. Tiemann & Co. and by George Ermold, New York City. 4. Murmurs are heard over comparatively large areas. A study ofdifferences in the quality of the sounds and points of greatest intensity willhelp us here. 5. The rate may be increased and the rhythm altered by slight causes. 6. In rachitic children and in those affected by empyema or pleuraleffusions and adhesions the apex may appear in an abnormal position. 7. Prominence of the precordia is sometimes marked. ]Normally theloudest sound is the first sound at the apex; the weakest sound is thesecond sound at the aortic cartilage. This accords with my experience, THE HEART. 321J though it does not soeiu to be generally recognized that the pulniouic necoudsound is in early life stronger than the aortic sound. Table No. 40—Classification of Cardiac Diseases. Time ofOccurrence. Intra-uterine existence or very early infancy. Extra-uterine existence (infancy or childhood). Nat
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