558 CIRCULATION OF BLOOD AND LYMPH. 



the heart beat with results such as are shown in Fig. 233. The 

 figure shows clearly the general fact that the first sound is heard 

 very shortly after the beginning of systole and the second one 

 immediately after the end of systole. The first sound is therefore 

 systolic, and the second sound diastolic. A more exact and de- 

 tailed study of the time relations of the heart sounds has been made 

 by Einthoven and Geluk.* These authors obtained graphic records 

 of the heart sounds. The sounds received first by a microphone 

 were transmitted to a capillary electrometer and the movements 

 of the latter were photographed. As one result of their work they 

 give the schema shown in Fig. 234. It will be seen from this figure 

 that the first sound begins about 0.01 sec. before the cardiogram 

 shows the commencement of systole, and that for the first 0.06 sec. 



Fig. 233. -To show the time relation of the heart sounds to the ventricular beat 

 (Marey) : V.D., Tracing of the ventricular pressure in the right ventricle of the horse. Be- 

 low the two marks show, respectively, the time of the first and second sounds. The first 

 occurs immediately after the beginning of systole, the second immediately after the begin- 



the sound is heard only over the apex of the heart (a-6). Over the 

 base of the heart (second intercostal space) the first sound is heard 

 (b to c-d) just at the time when the semilunar valves are opened 

 (6'), that is, at the beginning of the period of emptying according 

 to the classification given on p. 552. The first sound ceases long 

 before the ventricular contraction itself is over, a fact which 

 would seem to indicate that the muscular element in the first sound 

 is not a muscular sound, such as is given out by a contracting 

 skeletal muscle. The beginning of the second sound seems to mark 

 exactly the time of closure of the semilunar valves. The character 

 and the time relations of the murmurs that accompany or replace 

 the heart sounds form the interesting practical continuation of this 

 theme; but the subject is so large that the student must be referred 

 for this information to the works upon clinical methods. ' 



The Third Heart Sound. Several observers* have called 

 attention to the fact that in certain individuals a third heart 



* Einthoven and Geluk, "Archiv f . d. gesammte Physiologic," 57, 617, 

 1894. Einthoven, ibid., 1907, vol. 117. Fahr, "Heart," 4, 147, 1912, 



fThayer, "Boston Med. and Surg. Journal.'' 158, 713. 1908; Einthoven, 

 "Archiv f. d. ges. Physiol.," 120, 31, 1907; Gibson, "Lancet," 1907, II, 1380. 



