DISEASES OF THE HEART. 197 



have taken great pains to investigate the subject^ both by- 

 experiment and practice, stand eminently the names of 

 WilHamSj Elliotson, Hope, Stokes, Watson, and Latham in 

 our own country; to which distinguished list we may add 

 those of the foreigners — Louis, Andral, Corrigan, and 

 Bouillaud. Dr. Hope, whose labours have not only greatly 

 augmented the previous small stock of knowledge existing, but 

 have been attended with the important results of correcting 

 errors concerning the action of the heart, into some of which 

 even Laennec had fallen, and which, through his great 

 authority, had become extensively propagated and believed. 

 In order that we may be able to recognise and appreciate 

 the sounds and sensations conveyed to the hand or ear by 

 the action of the heart under disease, it will be necessary 

 for us to make ourselves acquainted with those indications 

 of its movements in a state of health, it being by com- 

 parison of the two that we shall best in the living body 

 discriminate between the normal and anormal condition of 

 the organ. By the hand applied flat against the ribs of 

 the left side, immediately behind the elbow, the impulse of 

 the heart is plainly enough felt, and its pulsations as easily 

 numbered ; but if the ear be applied, or a stethoscope used, 

 two successive sounds, followed by an interval of silence, 

 are heard. " The first motion,^-' says Dr. Hope, " which 

 interrupts the interval of repose, is the auricular systole. 

 It is a very slight and brief contractile movement, more 

 considerable in the auricular appendix than elsewhere, and 

 propagated, with a rapid vermicular motion, towards the 

 ventricle, in the systole of which it terminates rather by 

 continuity of action than by two successive movements. 

 The ventricular systole commeuces suddenly^ and terminates 

 in the diastole, which is marked by the second sound. 

 Synchronous with the systole are — the. first sound, the 

 impulse of the apex against the ribs, and, in the vessels 

 near the heart, the pulse ; but, in vessels at some distance, 

 as the radial (or submaxillary), the pulse follows at a barely 

 appreciable interval." — " The rhythm of the heart — that is, 

 the duration of the several parts of this series — which 



