The signs of internal disease, with a brief consideration of the principal symptoms thereof . racticable and in any case is extremely difficult. Therarity of the one contrasted with the frequency of the other affordsample grounds for error if not for excuse. The strongest differential point is that the vascular phenomenaaccompanying aortic insufficiency, are absent in the pulmonary disease. Pulmonary stenosis, also congenital, is caused by union of thevalve segments. Cases are occasionally encountered in which vegeta-tions are the cause of both insufficiency and stenosis (Shattuck). Thecongeni
The signs of internal disease, with a brief consideration of the principal symptoms thereof . racticable and in any case is extremely difficult. Therarity of the one contrasted with the frequency of the other affordsample grounds for error if not for excuse. The strongest differential point is that the vascular phenomenaaccompanying aortic insufficiency, are absent in the pulmonary disease. Pulmonary stenosis, also congenital, is caused by union of thevalve segments. Cases are occasionally encountered in which vegeta-tions are the cause of both insufficiency and stenosis (Shattuck). Thecongenital cases are associated with compensatory lesions of the for-amen ovale or ductus Botalli, or imperfect ventricular septum dueto arrest of development. Inspection: Negative. Palpation. There may be a thrill in the second left intercostalspace. ^ Percussion. Slight enlargement of right heart. Auscultation. There should be a systolic murmur with point of greatest intensity to the left of the sternum in the second interspace. This murmur is not transmitted into the vessels of the neck. The-. PIvATB and Tricuspid Systolic Murmurs. The Hour-Glass Murmer. DISEASES OF THE HEARIJ 221 pulmonary second sound would be absent or replaced by a diastolicmurmur, since incompetency is necessarily associated. The differentiation from the murmur of aortic stenosis presentsdifficulties. The left-sided hypertrophy is absent in the pulmonaryform. ORDER OF FREQUENCY OF THE SIMPLE AND THE COM-BINED CARDIAC LESIONS. Statistics differ materially as to the order of frequency of bothsimple and combined lesions. The following order is as nearly correctas available figures permit: 1. Mitral incompetency. 2. Aortic incompetency. 3. Mitral stenosis. 4. Aortic stenosis. 5. Tricuspid stenosis. The claim of mitral incompetency to supremacy is incompetency and mitral stenosis are practically equal in fre-quency, and the same may be said of the two forms of tricuspid doubl
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectdiagnos, bookyear1906
