78 
17th. Occasionally the second sound lost its usual definite and sin- 
gle character, and assumed a complex character, approximating to redu- 
plication, and containing at least two elements of sound. This was 
observed towards the close of the examination, when M. Groux was 
somewhat fatigued. 
The pulsations of the oval tumour were examined with great care, 
and with the following results :— i 
At our first examination, when we used an ordinary stethoscope, 
we were not able to discover any special single sound, attending the 
diastole of the tumour. The ordinary double sounds of the heart were 
heard, without any departure from their normal character, except that 
the first sound had a slightly muffled character. 
But on our second examination we came to the following conclu- 
sions :— 
When an observation was made with the flexible stethoscope of M. 
Groux, the bell being simply placed in apposition with the tumour, and 
pressure being, as far as possible, avoided, a single sound was evident. 
This single sound was replaced by a double sound on making even a 
slight degree of pressure, but its distinctly single character could be re- 
produced at pleasure by removing the pressure. 
Under these circumstances, taking the three points or centres of 
sound in the fissure, from above downwards, or from below upwards, 
they might be enumerated as follows :— 
Double sound, Aorta. 
Single sound, corresponding to < Left auricle. 
Double sound, Right venricle. 
The succession in point of time is, as before stated, as follows :— 
_ Tumour. 
Ventricle. 
Aorta. 
There is a peculiarity belonging to this sound (of the oval tumour) 
which, without offering any explanation of it, we think it right to re- 
cord :— : 
The first impression it gives is that of a single, complete, and in- 
stantaneous sound, somewhat analogous to that observed in aneurisms 
with a single beat. But, on more careful and delicate analysis of its 
characters it is found not to be instantaneous, but to rise progressively, 
though still in the shortest possible interval of time, from a minimum to 
@ maximum, conveying the idea that its cause is a vermicular rather 
than an instantaneous or perfectly sudden action. This character is 
found most evident in the very uppermost part of the tumour. 
It was observed that the character of this sound (sound of tumour) 
was not constant: it seemed to have certain periods of a maximum in- 
tensity, and again of a minimum; there was a certain relation not easily 
determinable to the inspiratory or expiratory efforts. A peculiar whiff 
was occasionally observable, but under what precise conditions did not 
admit of being defined. 
