. Diseases of the heart and thoracic aorta. , that reduplication of thesecond sound, in cases of mitral stenosis, can be best explained thus:—The first element of the reduplication is the normal second sound;the tension in the aorta being feeble, it is the pulmonic element whichhas the chief share in the production of such second sound. The secondelement of the reduphcation is the sudden tension of the abnormal mitral-curtains produced after the relaxation of the left ventricle. I am notprepared to say that systole of the auricle is essential to produce thissudden tension ; it may be quite pos
. Diseases of the heart and thoracic aorta. , that reduplication of thesecond sound, in cases of mitral stenosis, can be best explained thus:—The first element of the reduplication is the normal second sound;the tension in the aorta being feeble, it is the pulmonic element whichhas the chief share in the production of such second sound. The secondelement of the reduphcation is the sudden tension of the abnormal mitral-curtains produced after the relaxation of the left ventricle. I am notprepared to say that systole of the auricle is essential to produce thissudden tension ; it may be quite possible that the reaction of the dis-tended pulmonary veins and left auricle may be sufficient to cause it may occur previously to the auricular contraction, the latteroccasioning or reinforcing the presystolic murmur, separated by a slightinterval from the second element of the reduplication. Dr Sansom illustrates his theory, the only one in addition to thatadopted in the text which seems to me probable, by the followingdiagram :—. Fig. 40.—Diagram illustrative of the mechanism of pseudo-reduplication of theheart sounds. [After Sanso/n). Ideal section through the left auricle (A) and left ventricle (V); , mitralcurtains ; the arrows show the direction of the blood current during the ventriculardiastole and auricular systole. Diagnosis of Diseases of the Heart, p. 120. 166 Diseases of the Heart. 2. Asynchronous closure of the individual segments of one valve,aortic or pulmonary. —(Guttmann.) 3. That the first element of the reduplication is the audible snapwhich attends the systolic closure of the valve segments, separated, byan appreciable interval, from the diastolic snap (of the arterial systole).—(Dr George Balfour, Lancet, March 5, 1881, p. 396.) 4. That the reduplication of the second sound originates at thenarrowed orifice itself; and that the two elements of the phenomenonin question, which form a sound which is always more or less muffled andimpure, ar
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