ON A SIMPLE INSTRUMENT FOR EXAMIN- 

 ING THE COMPETENCY OF THE TRI- 

 CUSPID AND MITRAL VALVES. 



(Repi'intcd from -S^. Bartholomew's Jloapital Heports, voJ. xiv, 1878.) 



It lias often seemed to me tliat tlie present metliod of examiiiin;:j- 

 tlie tricuspid and mitral valves of the heart in a post-mortem 

 examination is not so satisfactory as that which we use for the 

 aortic and pulmonary valves. In examining the latter, we pour 

 water into the aorta and pulmonary artery, and actually see 

 whether the valves are competent or not ; but in the case of the 

 tricuspid and mitral valves we determined their competency 

 either by simple inspection, or at most by pouring a little water 

 into the ventricular cavities, and observing the appearance of the 

 valves as they float upwards upon it. It has occurred to me 

 that a simple instrument, such as has been used for experiments 

 on the cardiac sounds, niisT;lit be useful for ascertaining- the com- 

 petency of these valves under such conditions of pressure as 

 they are subjected to during life. Such an instrument may be 

 very readily made from the nozzle (A) of an ordinary india-rubber 

 enema syringe. This consists of a,n ivory tube, about 2 J inches 

 long, with a horizontal shield about half an inch from one end. 

 The longer end of the nozzle' is pushed through the auriculo- 

 ventricular orifice, and onwards through the ventricle (B), until it 

 projects on the outside of the ventricular wall close to the apex. 

 It is then pulled through, and a tliick india-rubber ring (C) is. 

 pushed over it, so that the wall of the ventricle is compressed 

 between the ring outside and the ivory shield of the nozzle inside. 

 The nozzle is then connected by a piece of india-rubber tubing 

 either with a tap or with an cueina syringe. If v/ater be now made 

 to pass into the ventricle through tlie nozzle, the valves (D) float 

 upwards, and become flrmly opposed. The aorta and pul- 

 monary artery are now firmly held with the finger and tinimb, 

 so as to prevent the water from flowing out at tiie ventricle 



