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

  • George Alexander Gibson
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.

    75/408 (page 55)
    errors. Further, it must not be forgotten that temporary excitement, such as the excitement caused in the majority of persons by being subjected to physical examination, stimu- lates the heart to increased vigour, and therefore to a louder first sound and a stronger pulse. If, therefore, an opinion be formed by a rapid examination under such circumstances, it will most probably be incorrect. Even when the first sound is so weak as to be inaudible at the apex, the second sound may continue to be distinctly audible there, and may give the erroneous impression of being accentuated. When the first sound is thus inaudible, all that is heard at the apex is of course the dup-dup-dup of the second sound, with a longer or shorter silence in between. Instead of the some- what grave tone of the second sound, it often becomes clicking in character. B. Increase in the intensity of the First Sound.—This may present two varieties. In one form the sound is long and grave (as distinguished from short and sharp), a like impression being conveyed to the mind of the observer by the character of the impulse communicated through the stethoscope to the head. When the souncl l25£jhj£jhjracter, it is followed by an abnormally loud second sound. It occurs when the left ventricle is hypertrophied and its muscle well nourished. It is present most typically in cases of cirrhotic kidneys, and in some cases of aortic stenosis and aortic aneurism. In the second variety the first sound is short and sharp, and is not of the same diagnostic importance as the first form. It occurs in persons with healthy hearts who have thin chests, and from comparatively unimportant causes, as mental emotion or slight excitement, flatulence or other symptom of indigestion, or a little extra physical exertion. The indi- viduals who are classed as nervous frequently present this peculiarity of the cardiac sounds. It also occurs in febriculiB, and may be present at the onset of any acute febrile disease. C. Modifications in the tone of the First Sound.—The first