. Physical diagnosis . of 207 cases, between the ages of twenty andtwenty-nine, showed an accentuation of the pulmonic second, whileafter the thirtieth year the number of cases showing such accentua-tion became smaller with each decade, until after the sixtieth yearwe found an accentuation of the aortic second in sixty-six out of sixty-eight cases examined. These facts are exhibited in tabular form in Vierordt: Die Messung der Intensitat der Herztbne (Tiibingen,1885). See also Hochsinger, Die Auscultation des kindlichen Herzens;Gibson, Diseases of the Heart (1898) ; Rosenbach, Diseases of the
. Physical diagnosis . of 207 cases, between the ages of twenty andtwenty-nine, showed an accentuation of the pulmonic second, whileafter the thirtieth year the number of cases showing such accentua-tion became smaller with each decade, until after the sixtieth yearwe found an accentuation of the aortic second in sixty-six out of sixty-eight cases examined. These facts are exhibited in tabular form in Vierordt: Die Messung der Intensitat der Herztbne (Tiibingen,1885). See also Hochsinger, Die Auscultation des kindlichen Herzens;Gibson, Diseases of the Heart (1898) ; Rosenbach, Diseases of the Heart(1900); Allbutt, System of Medicine. AUSCULTATION OF THE HEART. Ill Figs. 110 and 111 and appear to show that the relative intensity ofthe two sounds in the aortic and pulmonic arteries depends pri-marily upon the age of the individual, the pulmonic sound predomi-nating in youth and the aortic in old age, while in the period ofmiddle life there is relatively little discrepancy between the two. DECADES. m%- —100%. Fig. 110.—Showing the Per Cent of Accentuated Pulmonic Second Sound in Each Decade. Based on 1,000 cases. It is, therefore, far from true to suppose that we can obtain evi-dence of a pathological increase in the intensity of either of thesecond sounds at the base of the heart simply by comparing it withthe other. Pathological accentuation of the pulmonic secondsound must mean a greater loudness of this sound than shouldbe expected at the age of the patient in question, and not simply agreater intensity than that of the aortic second sound. The same12 178 PHYSICAL DIAGNOSIS. observation obviously applies to accentuation of the aortic secondsound. Both the aortic and the pulmonic second sounds are sometimes o/_ | 0-9 10-19| 20-29130-39 140-49 J 50-59! 60-69 | 70-79|
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