1042 



all the süiinds in the chest. In order to examine the heai't sounds 

 the subject must hold his breath for a few seconds. 



It requires some practice to distinguish the heart sounds. At first 

 a confusion of rustling, blowing, and crackling sounds is heard. 

 However, the moment the subject holds his breath oidy the well- 

 marked heart sounds can be made out, and then we become con- 

 scious of Jour iiiunnurs, not tioo. When first listening to the two 

 loudest more defined sounds we distinctly hear one long, coarse 

 sound, and a second which is short and faint: the ordinary type of 

 the heart sounds over the apex. If we can divert our attention from 

 these sounds and try to single out the two much softer murmurs, 

 which seem to come from afar, we become aware that the first of 

 them commences before the frsi ventricular sound and undouhtedJi/ 

 runs ujy till the latter is heard and, even seems to coincide ?riih it 

 for a short time. In the pause betiveen the prst and the second 

 ventricular sound an • additional short and faint nniiinur is noticeable. 



Passing the tube lower doum or moving it a little higher up causes 

 the two faint murmurs to disappear, in order to re-appear again, 

 whenever contact with the auricle is again effected. 



No doubt, we are here dealing with the auricular sounds that 

 have given rise to so niuch controversy. To raise the plausibility of 

 this assertion, 1 may add that, with persons subjected to esophagos- 

 copy, the site of the auricle was ascertained by measurement and that 

 it was always at this very spot that the auricular sounds occurred. 

 Besides the four murmurs under consideration one of our subjects 

 exhibited a tiflh faint murmur, taking place after the second ven- 

 tricular sountl. It may be typitied as follows: „„Jv^,, ^ 



It appeared to me essential that these auricular sounds shotdd be 

 recoi'ded. 



The chief obstacle was that, besides the sound vi!)rations impulses 

 arise from (he movement of the heart, viz. at the apex beat, owing 

 to the impact against the chest-wall, and along the esophageal path 

 in consequence of the pressure on the rubber ball. Various methods 

 lia\e been suggested to preclude the passage of these foreign im- 

 pulses. EiNTHOVEN ') and his pupils made the tube, connecting the 



1) W. EiNTHOVEN and Gkluk. On the recording of heart sounds. ResearcP.es in 

 the physiol. lab. of I^eyden. Sec. Series 1896. 



G. Fahr. On simultaneous records of the heart sounds and the electro-cardiogram. 

 Heart. Vol. 4. No. ± 1912. 



P. J T. A. Battaerd. i'\irther graphical experiments on the acoustic pheno- 

 mena of the heart. 



