. A practical treatise on medical diagnosis for students and physicians . tolic andtwo diastolic murmurs. The systolic murmurs are aortic obstruction andmitral and tricuspid regurgitation. The diastolic murmurs are aortic re-gurgitation and mitral obstruction. The Direction of Transmission. It depends upon the situation ofthe murmur and the time at which it is produced. Some murmurs are not CHARACTER OF THE MURMURS. 447 transmitted. The transmission is usually in the direction of the currentsthat produce them. Murmurs in the Mitral Area. To the Axilla. A murmur heard atthe apex with the systol
. A practical treatise on medical diagnosis for students and physicians . tolic andtwo diastolic murmurs. The systolic murmurs are aortic obstruction andmitral and tricuspid regurgitation. The diastolic murmurs are aortic re-gurgitation and mitral obstruction. The Direction of Transmission. It depends upon the situation ofthe murmur and the time at which it is produced. Some murmurs are not CHARACTER OF THE MURMURS. 447 transmitted. The transmission is usually in the direction of the currentsthat produce them. Murmurs in the Mitral Area. To the Axilla. A murmur heard atthe apex with the systole and caused by regurgitation at the mitral orifice,is transmitted into the axilla and may be heard at the angle of the murmur produced in the same area before the systole—obstruction—is usually not transmitted. It is heard at the apex, or a little inside ofthe apex, or may rarely have its point of maximum intensity in the thirdinterspace. Sometimes it is transmitted to the axilla and to the angle ofthe scapula. (See Figs. 123 and 126, and Plate XXXII.). intensity and directions of transmission of murmur of aortic regurgitation. Murmurs in the Tricuspid Area. The murmur of tricuspid regurgi-tation is not transmitted. It is heard over a relatively large area, depend-ing upon the intensity of the sounds. (Plate XXXIII.) Murmurs in the Aortic Area. Upward and along the Vessels. Themurmur, systolic in time, heard at the second costal cartilage at the right,due to aortic obstruction, is transmitted in the direction of the blood-current. The sound is conducted by the vessels and by the fluid; it istherefore heard along the course of the aorta and in the carotid along the Sternum and to the Apex: The murmur of aorticregurgitation, heard in the same way, is transmitted downward along thecourse of the sternum. It may be transmitted to the apex, or may beheard along the sternum only. The left ventricle conducts this murmur.(See Figs. 125 and 127, and Pla
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