Hypertrophy of the Heart. 319 



surface than is natural, the kings being healthy, it is probably due 

 to hypertrophy of the heart. If very clear on the right side the5' 

 indicate increase of the right ventricle. The heart's impulse is 

 usually strong and may be felt on both sides, and it may be over 

 the whole chest. 



Percussion usually shows a more extended dulness in the re- 

 gion of the heart but the blows must be pretty forcible to bring 

 out the deeper resonance, otherwise it will come only from the thin 

 layer of lung. These results are of the greatest value in the 

 dog. 



The pulse is usually regular and if excited to irregularity and 

 intermission quickly returns to its natural state when the patient is 

 left at rest. 



As hypertrophy is usually associated with dilatation of the heart 

 the following table abridged and modified from Dr. Walshe will 

 prove valuable by presenting side by side the signs indicating hy- 

 pertrophy with and without dilatation, and simple dilatation. 



TABLE CONTRASTING THE MAIN SYMPTOMS OF HYPERTROPHY 

 AND DII<ATATION. 



A. General Physical Signs. 



SIMPI<E HYPERTROPHY. HYPERTROPHY WITH DI- SIMPLE DILATATION. 



LATATION. 



Heart's impulse slow Force increased, sharp- Impulse convej-s a 

 and heaving as if press- er, more knocking, may feeble undulatory sensa- 

 ing steadily against an impart a shake to the tion ; force of successive 

 obstacle — in rythm reg- body. May be felt on beats unequal ; rythm 

 ular, in force unequal, the right side. irregular. 



First sound is dull, Sounds gain greatly in First sound short, 

 muffled, prolonged and loudness and extent of abrupt and clear. Second 

 weakened almost to ex- transmission, especially sound not specially af- 

 tinction. Second sound if the valves are not fected. 

 full and clanging; per- thickened, 

 iod of silence shortened. 



Murmur with the first Murmur with the first Murmur with the first 

 sound present at one sound may be present, sound from insufficiency 

 time and absent at an- from altered direction of of the auriculo-ventricu- 

 other. the orifice of the aorta, lar valves. 



