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 . here. Theapex-beat was in the sixth in-terspace, 4^ inches to left ofthe midsternal line, of thecharacter of a faint tap in anarea of diffused impulse (). A presystolic thrill ranup to and ended with thisfaint, sharp tap, and therewas marked epigastric pulsa-tion. Relative dulness was in-creased in all diameters, from third interspace to sixth, and from2 inches to right of median line to 5 inches to left of the first sound was
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 . here. Theapex-beat was in the sixth in-terspace, 4^ inches to left ofthe midsternal line, of thecharacter of a faint tap in anarea of diffused impulse (). A presystolic thrill ranup to and ended with thisfaint, sharp tap, and therewas marked epigastric pulsa-tion. Relative dulness was in-creased in all diameters, from third interspace to sixth, and from2 inches to right of median line to 5 inches to left of the first sound was thumping, heard throughout prsecordia, andfollowed quickly by a scarcely perceptible second sound, the aorticsecond being weak and the pulmonic second markedly harsh murmur of greatest intensity in the mitral area began im-mediately after the second, ran up to and ended with the nextensuing first sound, and was not transmitted into the axillary re-gion. The lungs revealed impaired resonance at the posteriorbases, with some moist rales. The liver was palpable two finger-breadths below the inferior costal margin, but the spleen was not. Fig. 50.—Location of Apex and KelativeDulness in Case of Mitral Stenosis(p. 270). 272 DISEASES OP THE HEART palpable, and there was no evidence of free fluid in the urine was scanty, dark-coloured, and contained a trace of albu-min. The temperature was ° F. and respirations 28. Herstomach was very irritable, and for several days she had not beenable to retain nourishment. Four hours after her admission her pulse had increased inrapidity and feebleness, and so few of the pulse-waves reached thewrist that the heart-rate had to be counted with the stethoscope. Itwas beating 180 per minute. Cyanosis had deepened, cough anddyspnoea were very bad, rales had grown more numerous, and theliver had increased in size. Her condition was so critical that shewas given a hypodermic injection of ^ of a grain of morphine with-g1^
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