AFFECTIONS OF THE VALVES AND ORIFICES OF THE HEART. 579 



both obstructive and insufficient, preventing tlie flow of the 

 blood from the cavity and permitting also its regurgitation, 

 the murmurs Avill be both systolic and diastoHc. 



The pulse in the first of these conditions — of simple aortic 

 obstruction — is not materially altered, although the heart's 

 action may be forcible. In the other — where valvular insuffi- 

 ciency exists in addition to obstruction — it is jerking, wanting 

 in the regular swell or sustained wave of either health or 

 hypertrophy ; the blood feels shot past the finger in separate 

 masses. 



When the valvular structure between the ventricle and 

 auricle of the left side is diseased, either impeding the passage 

 of the blood into the ventricle, or permitting of regurgitation 

 into the auricle, there is usually a tendency to pulmonary 

 complications, with cough, dyspna3a, and general distress, par- 

 ticularly on excitement or severe exercise, while the pulse is 

 markedly irregular and unequal both in force and volume. 

 Murmurs of both systolic and diastolic character may be 

 heard, but not generally, and in none are they to be de- 

 pended on. 



To determine the systolic or diastolic character of a 

 murmur, the pulse, during auscultation, ought to be noted 

 either at the jaw or the fore-arm. If the sound is systolic, it 

 will of course be heard synchronously, or nearly so, with the 

 pulse ; if diastohc, it will not be synchronous. 



The general or functional symptoms of this form of cardiac 

 disease may be regarded as mainly owing directly to disturb- 

 ance or obstruction in the pulmonary capillary system, or in 

 that of the systemic circulation. With disease of the valves of 

 the right side, the auriculo- ventricular, is usually associated 

 dilatation of the right cavities, often of itself the only 

 abnormal condition, and the direct result of pulmonary obstruc- 

 tion ; or both may be encountered following mitral disease. 



Here, although we may not by physical signs or sounds be 

 able to satisfy ourselves of the altered condition, the effects 

 produced on the circulatory system, particularly the venous, 

 are quickly and often distinctly marked. As the direct result 

 of venous turgescence, or internal pressure, we have a tendency 

 to general dropsy, shown by accumulations of fluid in the 

 serous cavities and spaces of the connective-tissue throughout 



87—2 



