. Physical diagnosis . s and at another evidences of mitralregurgitation alone. Either murmur may disappear altogether fora time and reappear subsequently. This is peculiarly true of the pre-systolic murmur, which is notoriously one of the most fleeting anduncertain of all physical signs. As a rule the same inflammatory changes which produce mitralregurgitation in early life result as they extend in narrowing themitral valve, so that the signs of stenosis come to predominate inlater years. Coincidently with this narrowing of the diseased valvea certain amount of improvemeut in the patients sym
. Physical diagnosis . s and at another evidences of mitralregurgitation alone. Either murmur may disappear altogether fora time and reappear subsequently. This is peculiarly true of the pre-systolic murmur, which is notoriously one of the most fleeting anduncertain of all physical signs. As a rule the same inflammatory changes which produce mitralregurgitation in early life result as they extend in narrowing themitral valve, so that the signs of stenosis come to predominate inlater years. Coincidently with this narrowing of the diseased valvea certain amount of improvemeut in the patients symptoms maytake place, and Rosenbach regards the advent of stenosis in such acase as an attempt at a regenerative or compensatory change. Inmany cases, however, no such amelioration of the symptoms follows. (2) Aortic Regurgitation with Mitral Disease. The signs of mitral disease occurring in combination withaortic regurgitation do not differ essentially from those .of pure Systolic murmurover dilated-~i[--Y-aortic Maximum intensityand diastolic mur-m u r, conductedup and down. Systolic murmur. Fig. 145.—Aortic and Mitral Regurgitation. The shaded areas are those in which the murmurs are loudest. mitral disease except that the enlargement of the heart is apt tobe more general and correspond less exclusively to the right ven-tricle (see Figs. 145 and 146). The manifestations of the aortic le- 256 PHYSICAL DIAGNOSIS. sion, on the other hand, are considerably modified by their associa-tion with the mitral disease. The Corrigan pulse is distinctly lesssharp at the summit and rises and falls less abruptly. Capillary lst 1st I 2nd l|j|j 2nd Jliliiiini liiniiiiiiiiiiii lliiiiiiiii, In LLLLi Fig. 146.—Showing Relation of Murmurs to Heart Sound in Regurgitation at the Aortic and Mitral Valves. pulse is less likely to be present, and the throbbing of the peripheralarteries is less often visible. (3) Aortic Regurgitation toitli Aortic Stenosis. If the aortic valves are narrowed a
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