Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . here is increaseof cardiac dulness to the left,depending upon the natureand extent of the accompany-ing disease of the left heart. Auscultation.—This fur-nishes even less trustworthydata than are obtained by per-cussion. There is generallya blowing, systolic murmur,said to have its maximum in-tensity in the tricuspid area (Fig. 72) ; yet as the dilatation ofthe several cardiac chambers alters the normal relations of theparts, this murmur may
Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . here is increaseof cardiac dulness to the left,depending upon the natureand extent of the accompany-ing disease of the left heart. Auscultation.—This fur-nishes even less trustworthydata than are obtained by per-cussion. There is generallya blowing, systolic murmur,said to have its maximum in-tensity in the tricuspid area (Fig. 72) ; yet as the dilatation ofthe several cardiac chambers alters the normal relations of theparts, this murmur may beheard most distinctly in anyone of several situations. Itmay be at the junction of thefifth and sixth left costal car-tilages with the sternum, overthe ensiform appendix, oreven to the right of the ster-num in the third, fourth, orfifth intercosal spaces, close tothis bone. Gibson, in his remarks onthe Heart in Debility, hasnarrated cases showing thatthe murmur may be heard inthe second left interspace an FlG; ^. 0F Maximum Atoimlity 1 (small circle) and Area of Propaga- inch from the Sternum, in an TI0N of Tricuspid Regurgitant TRICUSPID REGURGITATION 35:» area in which a systolic pulsation is also often observed. In thesecases there was also vrenous pulsation in fehe neck, and bence itseems probable that the murmur was thai of the disease now underdiscussion. This is the site of a systolic murmur frequently audi-ble in chlorosis and anaemia, and variously explained by Naunyn,Balfour, Russell, Bramwell, Handford, Foxwell, etc. (see intro-ductory chapter), and therefore caution is required in the cor-rect interpretation of a bruit in this situation. The tricuspid murmur has a blowing quality, is of no constantpitch, and differs much in loudness, according to the conditionsthat generate it. It is often obscured by other bruits originatingat other orifices, particularly at the mitral. If the auscultator isexperienced, and conditions are favourable, he may be
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