. A practical treatise on medical diagnosis for students and physicians . -sounds; (2)in estimating the nature of the lesion that produces the murmur; (3) injudging, in the case of the murmur of mitral obstruction, of the presenceor absence of that disease. Distinction from Normal Sounds. Normal sounds are soundsof tension; murmurs are sounds of rhythmical vibration. The normalsounds of the heart have been described by the syllables ubb dupp MS PHYSICAL DIAGNOSIS OF DISEASES OF THE HEART, ETC. od and abnormal sounds of endocardia] origin by vf uv iw,Vuah r by lull vowel-sounds as oo u ah and a
. A practical treatise on medical diagnosis for students and physicians . -sounds; (2)in estimating the nature of the lesion that produces the murmur; (3) injudging, in the case of the murmur of mitral obstruction, of the presenceor absence of that disease. Distinction from Normal Sounds. Normal sounds are soundsof tension; murmurs are sounds of rhythmical vibration. The normalsounds of the heart have been described by the syllables ubb dupp MS PHYSICAL DIAGNOSIS OF DISEASES OF THE HEART, ETC. od and abnormal sounds of endocardia] origin by vf uv iw,Vuah r by lull vowel-sounds as oo u ah and aw bymusical bones, or by interrupted tones, or by general sounds as urror /•/■. The Nature of the Lesion. The murmurs may besofl or blow-ing, rough or rasping, musical <»r whistling. They may be high or lowin pitch. Murmurs thai arc rough and high in pitch arc usually dueto disease of the valves, causing thickening r stiffening of the leaf-lets, or to the projection of an atheromatous plate into the lumen of the X, Maximum intensity of pulmonary. O, Area of murmur of anaemia. orifice. Such conditions occur in chronic endarteritis and chronic endo-carditis or valvulitis. On the other hand, murmurs that are soft and lowin pitch are usually due to a physical condition which causes swelling ofthe valve or occlusion by soft exudations; they are heard in endocarditisof rheumatic origin, or the malignant form of endocarditis. The onlymurmur that has special characteristics is the murmur of mitral ob-struction. It is a prolonged murmur of a churning or grinding character,sometimes rippling as if fluid were being forced through a narrow is usually presystolic, but may occur in the middle of the diastole. Loudness. The loudness of the murmur is not of special significance,although, in general, it may be said that it indicates good compensation,and that the heart-muscle is sufficiently strong to meet the demands ofthe circulation. Murmurs are louder in the recumbent tha
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