Diseases of the heart and circulation in infancy and adolescence . the murmur,or it may be audible to those around. Such a case is recordedby Osier of a child, set. eleven years, in which the murmurcould be heard with great distinctness several feet from thepatient. 1 ] 2 Keating and Edwards : Diseases of the Heart Murmurs are sometimes heard in the recumbent positionwhich are totally inaudible when the patient is erect. Hutch-inson* believes that this is a good diagnostic point, as anaemicmurmurs are best heard with the patient recumbent. We areunable to satisfy ourselves of the fact stated b
Diseases of the heart and circulation in infancy and adolescence . the murmur,or it may be audible to those around. Such a case is recordedby Osier of a child, set. eleven years, in which the murmurcould be heard with great distinctness several feet from thepatient. 1 ] 2 Keating and Edwards : Diseases of the Heart Murmurs are sometimes heard in the recumbent positionwhich are totally inaudible when the patient is erect. Hutch-inson* believes that this is a good diagnostic point, as anaemicmurmurs are best heard with the patient recumbent. We areunable to satisfy ourselves of the fact stated by many authors,that pressure of the stethoscope will intensify valvular mur-murs. Having determined the existence of a murmur, we mustnow definitely locate its seat and its character, whether it is anobstruction in the flow or a regurgitation. This is, of course,determined by the fact that a sound has its maximum intensitynear its seat of production, and, all things being equal, thecloser we approach this seat the louder will the murmurbecome. Aorlic Valve s^JF. Pulmonary Art e ry Valves Mitral Valves The figure, taken from DaCosta, serves to illustrate the fourpoints at which we endeavor to isolate sounds produced inindividual valves, remembering always that the points markedin the illustration are not the anatomical seats of the valves,but are the situation at which our ear will most closely ap- *Am. J. Med. Sci., April, 1872. and Circulation in Infancy and Adolescence. 113 proach the valve; the valves themselves lie about oppositethe third intercostal space at the left border of the sternum andslightly beneath the bone. Placing our ear or stethoscope atthe apical impingement and hearing a murmur at or near thisapex-beat, we conclude that it is produced at the mitral orifice;if its intensity is greatest at the ensiform cartilage or a littleabove it, then we conclude that the tricuspid orifice is at fault;if, on the other hand, we determine that the murmur is heardwith greates
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