CHARACTER OF THE PULSE 157 



follow each other so rapidly, that it is impossible to distinguish one from 

 another. 



In pathological conditions the heart sounds may be increased l)y 

 a number of causes, as in the beginning of certain fevers; but generally it 

 is an indication of hypertrophy. A lessened heart sound is found in 

 any heart weakness, as in degeneration of the heart muscle, in accumula- 

 tions of exudates around the heart in the pericardium, or in emphysema 

 of the lung sections, etc. In such cases, as a rule, the heart sound is 

 imperceptible. 



As can be readily seen, it is by no means easy to hear the heart beat 

 in its normal condition, and the condition becomes more complicated 

 when we have to distinguish pathological sounds — "heart bruits." We 

 distinguish between endocardial heart bruits, which originate in the heart 

 direct, and pericardial heart bruits, which come from the arterial part of 

 the heart and its envelope. The former are divided into organic and 

 inorganic bruits. The organic heart bruits are produced by stenosis 

 (contraction) of the ring and by insufficient or imperfect closing of the 

 valves, which may occvir either in systole or diastole, making the heart 

 sound indistinct, or it may be entirely absent, and the bruit takes the 

 place of the heart sound. The systolic bruit is buzzing or blowing in 

 character, and indicates an imperfect closing of an arterio-ventricular 

 valve (in most cases of disease of the mitrals). The diastolic bruit is 

 rushing or wheezing in character, and indicates a stenosis of the arterio- 

 ventricular ostia, or the imperfect closure of an arterial valve. The 

 inorganic heart bruit is seen in all forms of anaemia, and occasionally in 

 fevers. Pericardial bruits are very similar to pleuritic fi'iction sounds, 

 that is, a scratching or scraping sound. They are located in a sharply 

 defined locality and do not occur in direct rhythm with the heart sounds, 

 but seem to occur between them. They are noticed in pericarditis as 

 soon as there are any fibrinous deposits present and there is not sufficient 

 pericardial fluid present to keep the folds free from contact with the 

 heart. A change in the position of the animal makes quite a difference in 

 the character of the bruit, and it may easily be distinguished from 

 endocardial sounds. The pericardial friction sound is distinguished 

 from the pleural friction sounds by the fact that it is entirely inde- 

 pendent of the movements of respiration. 



Character of the Pulse. 



The pulse is best examined in the femoral artery, inside of the thigh, 

 and it may be felt also, in the radial artery, inside of the forearm. In 

 the examination of the pulse we must take into consideration its fre- 

 quency, its cadence, and its quality. 



