. Heart disease, with special reference to prognosis and treatment. e transmitted. The pulsus bisferiens is sometimes met with in aorticincompetence, more commonly when there is concomitant AORTIC 1NC0MPETEACE. 14 3. stenosis. It is a peculiar double beat, best felt when thefingers exert a moderate pressure on the artery, less than isnecessary to bring out fully the collapsing character of thepulse, but more than is employed to appreciate can be readily demonstrated by the spyhginograph. It isproduced by a double systolic effort, which can sometimesbe felt or heard in the heart i
. Heart disease, with special reference to prognosis and treatment. e transmitted. The pulsus bisferiens is sometimes met with in aorticincompetence, more commonly when there is concomitant AORTIC 1NC0MPETEACE. 14 3. stenosis. It is a peculiar double beat, best felt when thefingers exert a moderate pressure on the artery, less than isnecessary to bring out fully the collapsing character of thepulse, but more than is employed to appreciate can be readily demonstrated by the spyhginograph. It isproduced by a double systolic effort, which can sometimesbe felt or heard in the heart itself, and which frequentlyjrives rise to a double rush of blood audible in the to DEspine, of Geneva, the normal systole of theheart is a deux temps, or a double contraction, of which this isan exaggeration. The pulsus bisferiens can not uncommonlybe induced by an effort, which throws additional work onthe heart; for instance, in one case it was not present whilethe patient lay quietly in bed, but was brought out whenhe held up both his FIG. 8.—PULSUS BISFERIENS. Irregularity of Pulse.—Though the pulse of aortic in-competence is for the most part regular in force andfrequency, in advanced cases, especially when the heart isbeginning to fail, irregularity of pulse is not irregularity is first manifested by the occurrence of ashort and rapid pulsation of less force and amplitude thanthe ordinary wave, and occurring at irregular intervals. Itsucceeds the previous beat very quickly, and is followed bya longer interval than usual. It would seem to indicatean effort of the heart to supplement an inadequate andinefficient preceding contraction, or to be an abortivesystole. Later on, the irregularity, both in force and 144 HEART DISEASE. frequency, becomes more general and more marked,though the pulse is still recognizable as that of aorticregurgitation. Estimation of the Extent op the Lesion. The amount of blood which returns into the ventr
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