. 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. instances of extensive pericarditis it is heard atscattered points or throughout the pra^cordium. Rhythm of the Friction-sound.—This is the most importantfeature of the pericarditic rul), and the one upon which depend-ence is chiefly placed in the interpretation of its nature. It isvery variable, but whatever its peculiarity in any given case, it isas a rule not limited to systole and diastole, as are endocardialmurmurs. Instead of being syn
. 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. instances of extensive pericarditis it is heard atscattered points or throughout the pra^cordium. Rhythm of the Friction-sound.—This is the most importantfeature of the pericarditic rul), and the one upon which depend-ence is chiefly placed in the interpretation of its nature. It isvery variable, but whatever its peculiarity in any given case, it isas a rule not limited to systole and diastole, as are endocardialmurmurs. Instead of being synchronous with either the first orsecond heart-sound, or bearing a definite relation to these tones,the pericardial rub seems to overlap them or to occur at a time thatis wholly independent of them. Thus, according to Skodr. it mayaccompany, precede, or follow the heart-sounds in what seems tobe a sort of hit-or-miss fashion. The rhythm is very difficult todescribe, but when (nice heard in a typical case is again easilyrecognised. In most instances the friction-murmur is composedof either two or tliree parts, and when of but two, has a to-and-fro. i4.— l^. Ir itlill AlilllAL Friction Sound and Fkemitvs. DRY PERICARDITIS 59 or back-and-fortli rhythm, after the manner of a double aorticbruit, but distinguishable from this by its time and quality. Thevariability in the rhythm of this sound is owing to the fact thatthe roughened pericardial surfaces are made to rub against eachother either during contraction or relaxation of the auricles orduring the corresponding phases of the ventricles. Therefore,when this friction-murmur is made up of three parts, one is pre-systolic, produced by the systole of the auricles, and the other two,of longer duration, fall in the systole and diastole of the infrequently, according to Bauer, each side of the heart canproduce a systolic and a diastolic rub of different duration, so thateach heart-beat may be accompanie
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