Endocarditis. 335 



pulse, violent, but irregular in force, sometimes double ; pulse 

 feeble, irregular, unequal, or intermittent ; sometimes though not 

 at all constantly a venous pulse in the lower end of the jugulars. 

 In chronic induration of this valve, or in osseous, or cartilagino- 

 ous degeneration the same symptoms are shown. The more gen- 

 eral symptoms may, however, require exercise to develop them. 



Induration, etc., of the Right Auriculo- Ventricular (tri- 

 cuspid) valve. The symptoms are almost identical with the last. 

 Venous pulse is constant, and, particularly after exertion, the 

 veins generally are distended. Dropsies are more common. 



Narrowing of the Mitral orifice. In addition to the same 

 general symptoms as the last named lesions, there is a sighing, 

 blowing, purring or rasping sound, according to the degree of 

 narrowing, heard before the first sound of the heart. It is the 

 noise of the blood rushing through the narrowed orifice between 

 auricle and ventricle. It is usually loudest behind the middle of 

 the shoulder on the left side. Feeble pulse, frequent imminence 

 of suffocation and filling of the limbs, etc. , are nearly constant. 



Narrowing of the Tricuspid orifice. Symptoms nearly 

 identical with the last. Venous pulse more constant. Blowing 

 murmur sometimes loude.st on the right side of the chest. 



Induration or insufficiency of the aortic valves. Blowing 

 murmur with the second sound of the heart. Double rushing 

 sound in the carotid with each heart's beat. There is an apprecia- 

 ble interval between the beat of the heart and corresponding pul- 

 sation at the jaw. 



Induration or insufficiency of the pulmonary valves. Blow- 

 ing murmur with the second heart sound, but no corresponding 

 double sound in the carotid, nor any marked retarding of the 

 pulse. 



Loose coagula in the heart or adherent ones (^polypi) produce 

 one or other of the above class of symptoms, according to the 

 particular orifice they tend to block or the valves whose function 

 they impair. 



Anaemia and leukaemia may have blowing murmurs with the 

 first or second heart sound. 



Embolism. Plugging of arteries. Another class of symp- 

 toms sometimes supervenes because of loose clots being washed 

 on into the arteries, and blocking them when they reach those 



