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 . e have been the secondary changes wrought by the valvulardefect. If in the lesion nowunder consideration percus-sion does not detect increaseof absolute or relative dulnessto the right and downward,the inference is warranted,•even though there be an in-tense systolic bruit, that theleak is not free, or that beingfree it has nevertheless beenperfectly compensated. Inmost cases of mitral regurgi-tation, however, the lesionhas led to enlargemen
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 . e have been the secondary changes wrought by the valvulardefect. If in the lesion nowunder consideration percus-sion does not detect increaseof absolute or relative dulnessto the right and downward,the inference is warranted,•even though there be an in-tense systolic bruit, that theleak is not free, or that beingfree it has nevertheless beenperfectly compensated. Inmost cases of mitral regurgi-tation, however, the lesionhas led to enlargement of theright ventricle, and in such an«vent, deep-seated if not super-ficial dulness is increased tothe right and inferiorly; and hence the extent to which dulness isincreased is a criterion by which we can judge of the freedom ofthe leak or of the compensation. Secondary enlargement of theleft ventricle is shown by increased dulness of the left (Fig. 39). Mitral regurgitation, it will be remembered, leads to dilata-tion of the left auricle as well as hypertrophy; hence in pro-nounced cases the outline of the deep cardiac dulness at its upper16. Fig. 39. Relative Dulness in a TypicalCase of Mitral Regurgitation. 242 DISEASES OF THE HEART and outer corner, so to speak, is broad and rounded, correspondingto the enlargement of the auricle. It is not always easy to deter-mine this alteration of shape by percussion; yet if firm percus-sion is made, and the chest-wall is thin and yielding, it is some-times possible to determine the extent to which the left auricle hasbeen affected by the regurgitation. Auscultation.—This forms a very valuable means of cardiacexamination, for without the information thus obtained one can-not safely assert that mitral regurgitation does or does not should not be relied upon to the exclusion of other methods ofinvestigation, however, for reasons that will be stated auscultatory evidence of valvular disease lies in certain ac
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