Saint Bartholomew's Hospital reports . ch were constant, were aslightly increased impulse and a very loud systolic murmur,loudest at a point midway between the left base and the apex,and audible, but with diminished loudness, at the angle of thescapula. Besides these signs, on some occasions a pr?esystolicmurmur was to be heard at the apex, and a slight thrill to befelt over the cardiac area. Her pulse was always feeble andirregular. She had several fainting fits in June 1875, and was Examples of Malformation of the Heart. 103 admitted into Elizabeth Ward. After a month slie left tiie Hos-pita
Saint Bartholomew's Hospital reports . ch were constant, were aslightly increased impulse and a very loud systolic murmur,loudest at a point midway between the left base and the apex,and audible, but with diminished loudness, at the angle of thescapula. Besides these signs, on some occasions a pr?esystolicmurmur was to be heard at the apex, and a slight thrill to befelt over the cardiac area. Her pulse was always feeble andirregular. She had several fainting fits in June 1875, and was Examples of Malformation of the Heart. 103 admitted into Elizabeth Ward. After a month slie left tiie Hos-pital and was able to work at her trade. In January 1876 aslight cold caused her to be unusually short of breath; shebecame dropsical, and died three weeks after admission to theHospital. During her life it had often been discussed whetherher symptoms and physical signs were due to early and severedisease of the mitral valve or to congenital malformation ofthe heart. The post-mortem examination answered both ques-tions in the Fig. 2.—HEiRT OF Emilt , Tricuspid valve with growths. ? C, Openingin septum. The heart was hypertrophie<l. The right ventricle was markedlydilated. The tricuspid valve {a, fig. 2) was fringed by closely-setgrowths. There was a similar series of growths on the mitralvalve (6, fig. i). The pulmonary orifice was contracted by partialfusion of its valves. The ductus arteriosus was closed. Theaorta and its valves were normal. At the uppermost part of theventricular septum there was an opening about equal to a six-pence in area (c, figs, i and 2). This opening had roundedmuscular edges, and its upper edge was close to one of the aortic 104 Examples of Malformation of the Heart. valves. It of course admitted free communication between theventricles. A cardiac murmur is usually the index of some one form ofvalvular disease. This case shows how essential to accuracy it isto keep the observation and the inference distinct; to think of amurmur a
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