. A practical treatise on medical diagnosis for students and physicians . at the xiphoid cartilage or the head of the fourth or fifth ril>. It is created at the tricuspid orifice, and is heard most dis-tinctly over the lower portion of the sternum, and along the left edge,because the righl ventricle is in apposition with the chest-wall at thisspot. (See 2, Fig. I IT, and Plate XXXIII.) Murmurs at the Second Costal Cartilage or Second Interspace on theRight—the Aortic Arm. When a murmur is heard with greatest intensityat this point, it is usually generated at the aortic orifice, and is c
. A practical treatise on medical diagnosis for students and physicians . at the xiphoid cartilage or the head of the fourth or fifth ril>. It is created at the tricuspid orifice, and is heard most dis-tinctly over the lower portion of the sternum, and along the left edge,because the righl ventricle is in apposition with the chest-wall at thisspot. (See 2, Fig. I IT, and Plate XXXIII.) Murmurs at the Second Costal Cartilage or Second Interspace on theRight—the Aortic Arm. When a murmur is heard with greatest intensityat this point, it is usually generated at the aortic orifice, and is conductedto iliU region by the aorta, which comes nearest to the surface of the chestat this point. (See 3, Fig. 117, and Plates XXXI. and XXXVI.) I. Murmurs in the Second Left Interspace—the Pulmonic Area. Amurmur heard loudest at the second interspace along the left edge of thesternum is generated at the pulmonary orifice ; it is heard loudest in thisarea because the pulmonary artery is nearest the chest at this point. (See4, Fig. 117, and Plate XXXIV.) Fig. Maximum intensity of murmur of mitral regurgitation; systolic; transmitted to the left. The Rhythm or Time of the Murmur. The Kind of determined the point of maximum intensity of the murmur,hence the valve at which it has its origin, we next wish to determine thekind of murmur. A murmur which is produced at orifices when theyshould be closed is known as the murmur of regurgitation, as the valvepermits the blood to flow backward. A murmur that occurs when theblood should in health be passing through an orifice is known as a mur-mur of obstruction, as the flow of blood is obstructed. We have todetermine whether the murmur at an orifice is due to regurgitation or toobstruction. This is ascertained by the time of the murmur. The time of the murmur is determined by comparing it with the heart-sounds, the apex-beat, or the carotid pulse. Murmurs with the Systole. 1. In the Mitral Area. In health during sy
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