. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. ole, or on systole only. It may or may not accompany the\alvular sounds. It is of very limited distribution, is not conducted,and is of a fine crepitant ([ualitN or has a shifting, rubbing, rasping orclicking sound. 65G DISEASES OF THE CIRCULATORY SYSTEM In the case of a bov suffering from recurrent chorea and pericar-ditis, there was a loud scraping friction at the apex with murmurs otmitral and aortic regurgitation. I was able m this case to contirmthe statement of Walsh, that a loud per
. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. ole, or on systole only. It may or may not accompany the\alvular sounds. It is of very limited distribution, is not conducted,and is of a fine crepitant ([ualitN or has a shifting, rubbing, rasping orclicking sound. 65G DISEASES OF THE CIRCULATORY SYSTEM In the case of a bov suffering from recurrent chorea and pericar-ditis, there was a loud scraping friction at the apex with murmurs otmitral and aortic regurgitation. I was able m this case to contirmthe statement of Walsh, that a loud pericardial friction ma>- rarelybe heard behind, between the scapula^, to the left of the spine, iliefriction mav for the first day or two be of a crepitant quality andthen acquire a rubbing quality. I observed this change in a childfour years of age. The patient sufiered from dilatation of the lettventricle with mitral insufficiency and stenosis with friction for two davs was crepitant in quality and just audibleover the fourth and fifth spaces, to the left of the left border ot the. FiG. 172.—Pericardial area of dulness due to effusion in boy, aged six years. Chorea,endocarditis and pericarditis; x, apex beat before effusion; o o o o, friction murmur;outer curved line shows general shape of distended pericardial sac. sternum and then acquired a loud rubbing quality. The nuirmur issometimes very evanescent or may disappear or reappear at shortinter\als. The sounds may be intensified by causing the i)atieiit tolean forward. When effusion appears the friction sounds mayentirely disappear, or may be heard only in areas around the greatvessels or indistinctly over the precordium. A knowledge of thesefacts is imixirtant in making a diagnosis of fiuid in the pericardialsac. The friction sounds ma\ reai)])ear l)taiiiedin children as in adults with the respiratory moxenients of the arc intensified on expiration and disappear when respiration ia DISEASES OF
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