. 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. ominent, particularly at theleft of the sternum, but was not pigeon-breasted. The apex-beatwas in the sixth left interspace, 2 inches from the sternum, strongand diffused. There was a soft, not very distinct thrill in the second andthird left interspaces close to the sternum, which was not syn-chronous with either systole or diastole, but was most pronouncedat the end of expiration and beginning of inspiration. It seemedto follow the apex-sh
. 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. ominent, particularly at theleft of the sternum, but was not pigeon-breasted. The apex-beatwas in the sixth left interspace, 2 inches from the sternum, strongand diffused. There was a soft, not very distinct thrill in the second andthird left interspaces close to the sternum, which was not syn-chronous with either systole or diastole, but was most pronouncedat the end of expiration and beginning of inspiration. It seemedto follow the apex-shock by a very brief instant, and to run intothe long pause. Absolute cardiac diihicss was but slightly in-creased, whereas the relative appeared rather too broad. Theheart-sounds were feeble and obscured l)y ;i loud harsh murmurthat seemed to be systolic and audible throughout the entire prae- CONGENITAL DISEASES OF THE HEART 699 cordia, but most plainly at the base, and ,was transmitted to thelower angle of the left scapula. Upon closer observation it was perceived that at the site ofthe thrill the murmur became a continuous remitting roar, having. Fig. 107.—IIkakt from Case on p. «y8, shovvinu Cuncentkic IIvpertuophv uf Left\kntricle and Sound passed through Patent Ductus Arteriosus. its maximum intensity just after the first sound and its minimumtowards the end of the long silence, but never entirely ceasing. 700 DISEASES OF THE HEART Everywhere the quality of the bruit seemed to be the same. Thelungs, abdomen, and urine were negative, but the blood examina-tion showed a pronounced reduction in the percentage of hsemo-globin. The precise nature of this lesion was not clear, but was evi-dently congenital. In time, however, the affection was decided tobe either patency of the foramen or of the ductus arteriosus. Ascompensation appeared threatened, appropriate treatment was in-stituted, and soon a satisfactory degree of hypertrophy became re-established. To make a long story
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