XIX. The apex-beat. The heart-sounds. 



/. Appliances. A cardiograph and a transmitting tambour 

 (Marey) or materials for constructing them. A stetho- 

 scope; a stand and support; clamps; a kymograph; two 

 tambour pans Nos. 1 and 2; thin sheets of rubber; thread; 

 corks; sealing wax; tambour holder; straws; needles; 

 parchment paper; chronograph. 



2. Preparation. With the materials furnished by the dem- 

 onstrator construct a cardiograph and a recording tam- 

 bour, [Appendix A., Nos. 8-9.]. Join the tube of the 

 cardiograph to the tube of the recording tambour with 

 a rather thick-walled rubber tube 50 centimeters in 

 length. Fix the recording tambour with clamp and 

 support, and bring it into adjustment for tracing the 

 cardiogram upon the kymograph. Adjust chronograph, 

 j. Operation. Let a student remove the clothing from the 

 region of the apex beat of the heart and take, upon the 

 table, a recumbent dorso-sinistral position. In some 

 cases, however, better results are obtained if the sub- 

 ject sits beside the table. Place the button of the 

 receiving tambour upon that point of the thorax most 

 affected by the apex beat of the heart. The move- 

 ments of the chest wall will be faithfully transmitted 

 and magnified by the two tambours. 

 4.. Observations. 



(1) Note the exact point upon the chest where the apex- 

 beat is most distinctly marked. Is it the same for 

 different members of the class? 



In recording the location of the apex- beat use the 

 bony landmarks of the chest rather than the nipple. 



