oo 



CLINICAL DIAGNOSTICS. 



tice this is often very difficult. As a rule, soft, systolic bruits 

 (they do not occur during diastole) should be very carefully 

 estimated. Organic heart bruits are always accompanied by 

 hypertrophy and often alteration of pulse, further by a con- 

 gestion (stasis) in the pulmonary veins and accordingly an 

 increased pressure in the pulmonary artery, whereby the sec- 

 ond heart's sound is loud and clapping. 



Fie. 27. 



XV- 





Points at which Endocardial Bruits are most pronounced, 

 a. b.— Line of Shoulder. 1.— Left Auriculoventricular Opening. 2.— Portal. 



monary Artery. 



2. The pericardial bruits. These bruits do 

 not come from within the heart itself, but are extra-cardial. 

 They consist in frictional noises due to the pericardium having 

 become so altered that its surface is no longer smooth and 

 slippery, but rough and dry. The bruits are characterized by 

 being scratching, grating or rubbing, frictional tones not in- 



