A treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them : comprising the author's view of the physiology of the heart's action and sounds, as demonstrated by his experiments on the motions and sounds in 1830, and on the sounds in 1834-5 / by J. Hope.

  • Hope, James, 1801-1841.
Date:
1839
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them : comprising the author's view of the physiology of the heart's action and sounds, as demonstrated by his experiments on the motions and sounds in 1830, and on the sounds in 1834-5 / by J. Hope. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    ble of it. Further, there are no circumstances of structure or resistance to occasion valvular or muscular extension. Finally, no third sound of the heart is ever heard. M. Bouillaud, indeed, has pronounced this last assertion to be inaccurate; and, in proof, he cites cases of disease of the heart in which he had heard, and caused a great number of persons to hear, three, or even four sounds instead of two during a single rhythm. These supernumerary sounds he ascribes to auricular contractions, but he labours under an entire misapprehension. The truth is, that the sounds really result from ventricular contractions, but con- tractions so feeble as not always to produce a pulse perceptible at the wrist. The proof is, that, in almost all such cases, the third and fourth sounds are every now and then attended with a barely perceptible pulse, which inevitably connects the sounds with ven- tricular contractions. Sometimes the pulse can be felt in the carotid when it is imperceptible in the radial. These cases are far from uncommon. I have notes of twenty or thirty, and my limits alone prevent me from transcribing several before me. The first sound is best heard at that part of the precordial region where there is dulness on percussion from the heart being in contact with the chest; for the sound is best conducted to the surface through a solid medium, without the intervention of the spongy, ill-conducting tissue of the lungs. The second sound is best heard over the semilunar valves, viz. on the sternum, opposite to the inferior margin of the 3d rib, and thence for about two inches upwards, along the diverging courses of the aorta and pulmonary artery respectively, the sound high up the aorta, proceeding mainly from the aortic valves, and that high up the pulmonary artery being mainly from the pulmonic. This subject is more fully developed at p. 3. It has not been fully under- stood by other authors, nor was it by the writer in the first edition of this work.* For an account of the extent over which the healthy sounds are audible and the circumstances which occasion variations, the reader is referred to Dilatation, sounds of; and also to Hypertrophy. * The author of the Rational Exposit. has criticised that edition, but seems to have forgotten that I supplied him with the criticisms. My rectifications were published previous to his criticisms in the appendix to the 2d edit, of the present work.