Diseases of the heart and circulation in infancy and adolescence . must,therefore, be admitted, but not that of the semilunar valves. Let us first, then, consider endocardial murmurs, valvulardisease, as at this situation we are able to detect the disease bythe physical signs. These murmurs have acommon quality, they are all blowing;yet the sound itself may present all variations in the musicalscale. Much time has been spent by writers in endeavoringto classify them by their relation to some familiar sound, asrasping, filing, sawing, blowing, cooing, and sighing, all ofwhich are, however, irre
Diseases of the heart and circulation in infancy and adolescence . must,therefore, be admitted, but not that of the semilunar valves. Let us first, then, consider endocardial murmurs, valvulardisease, as at this situation we are able to detect the disease bythe physical signs. These murmurs have acommon quality, they are all blowing;yet the sound itself may present all variations in the musicalscale. Much time has been spent by writers in endeavoringto classify them by their relation to some familiar sound, asrasping, filing, sawing, blowing, cooing, and sighing, all ofwhich are, however, irrelevant, as they teach us but little as tothe real source of a murmur. Most endocardial or valvular murmurs are due to a changeat the valvular orifices, either a narrowing or stenosis or aninsufficiency, with inability to close the aperture, permittingregurgitation. The possible valvular murmurs in the heart(exclusive of certain congenital defects, as slits and perfora-tions) may be represented as follows : (Regurgitation. Mitral valve . < r\\ * ( MITRAL STENOSIS. Aortic and Circulation in Infancy and Adolescence. Ill f . | obstruction. r Regurgitation.\ Obstruction,r \ Obstruction. We thus see that it is possible to have two murmurs ateach valve, or eight in all. Some of these are, however, ofextreme rarity as primary murmurs ; it is rare, indeed, tomeet with a tricuspid stenotic murmur; so, also, are the mur-murs at the pulmonary orifice and valve rare except as con-genital disease, as we saw earlier in our study. So of theseeight murmurs we can practically exclude a tricuspid narrow-ing and consider the murmurs at the pulmonary area as con-genital, with, however, certain exceptions, which we will noteunder the appropriate heading. These murmurs have different effects on the sounds of theheart: some accompany the sound throughout its entire dura-tion ; others, again, may be substituted for the normal sound;again, others
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