Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell.

  • Gibson, George Alexander, 1854-1913.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    condition the systolic impulse against the thoracic wall is felt at the apex, while at the base the shock of the closure of the semilunar valves can be felt when the thoracic wall is thin or the cardiac action excited. When the organ is feeble its impulse may only be felt by making the patient bend forwards ; when it is hypertropJiied the measured thud is very characteristic. Pulsation is felt over a loide area when the heart is enlarged, and it usually corresponds with the area over which it is visible. Both the systolic impulse and the vibrations set up by the closure of the semilunar valves are felt at the apex in many persons, more especially in those with thin chests, or who are clinically known as of a nervous temperament. Irregularity in the time and force of the impulse occurs in many morbid conditions, more especially in mitral lesion, and in fatty, debilitated, and dilated hearts. It is also present in some nervous aflf'ections. Thrills are sometimes to be felt over the precordia, either at the apex or at the base. The sensation has been compared to the feeling experienced when the hand is placed on the back of a cat when it is purring; it has accordingly been called fremissment cataire. They are most commonly produced at the mitral, the aortic, or the pulmonary orifices. At the mitral orifice they may be systolic, or diastolic, or distinctly pre-systolic, and are felt at the apex : at the aorta or pul- monary artery they are almost invariably systolic, and are felt at the base. They are caused by narrowing of the orifice at which they occur, and for their production the blood has to flow with considerable force. As a consequence of this they disappear if the nutrition of the cardiac muscle becomes much impaired, and reappear with its rehabilitation. Cardiography.—The movements of the precordia can be registered by means of the cardiograph. Tracings obtained by this graphic method show the sequence and duration of the cardiac movements; they give clear indications of such