Transactions . ofwhich are unusually low, owing to the enlargement of the heart and emphysematousenlargement of the lungs, displacing those organs.—5a. Liver lowered by a deepinspiration. Physical signs.—Pulse rises, and falls back suddenly—tortuous, creeping, andvisible to the eye. Systolic and diastolic bellows-noises over the upper part of thesternum, and above the sternum, unaccompanied by normal, sharp, second sound,excepting near the second costal cartilages; there the second sound of the pul-monic valves is audible. Near the apex, systolic, rasping noise, beginning with asharp sound ; d
Transactions . ofwhich are unusually low, owing to the enlargement of the heart and emphysematousenlargement of the lungs, displacing those organs.—5a. Liver lowered by a deepinspiration. Physical signs.—Pulse rises, and falls back suddenly—tortuous, creeping, andvisible to the eye. Systolic and diastolic bellows-noises over the upper part of thesternum, and above the sternum, unaccompanied by normal, sharp, second sound,excepting near the second costal cartilages; there the second sound of the pul-monic valves is audible. Near the apex, systolic, rasping noise, beginning with asharp sound ; diastolic, rasping, or bellows sound. Bellows noise heard along thewhole left side of the spine ; loudest below the scapula. Impulse at the apex, andover the left costal cartilages, extending over the whole region of dulness, strong ;also, feebler over the lower part of the sternum. 554 ON CHANGES IN THE SITUATION L. 13.—ENLARGEMENT OF THE HEART. Wary TOiMLixsoN, aged 27; Mitral and Aortic Lower margins of the lungs; that of the left lung remarkably low.—2a. Lower margins of the lungs lowered by a deep inspiration.—3. Outlines ofthe hearts superficial dulness, wider to the right and left of the sternum, and muchlower than in the healthy state.—3 a. Hearts superficial dulness lowered and narrowed by a deep inspiration 4b. Concentric curves: seat of impulse in the tranquil state^strongest over apex; felt from the second cartilage to the seventhrib; over the second intercostal space, a flapping, sharp, second impulse coincided OF THE INTERNAL ORGANS. 555 The actual lateral dimensions of the heart maybe arrived at with tolerable accuracy by means ofdeep percussion over the lungs to each side of thesternum. The seat of the apex is readily ascer-tained by its thrusting impulse. The extent and force of the impulse varies withthe nature, extent, and seat of the hearts enlarge-ment. If the left ventricle be enlarged, both wallsand cavities being increa
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