This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1912 edition. Excerpt: ...wall. The really crucial question which should always be asked is, Is the heart enlarged or decreased in size? The position of the apex beat alone can not determine this, nor can the limit to the right of the sternum. The distance between these two points and the depth of the dulness at a distance of 5 cm. from the midsternal line on the left side, will give the size of the heart as nearly as can be obtained in the living subject. A series of measurements in normal adults average 13 to 14 cm. and 9 to 10 cm. respectively. For women they are about 1 cm. less in each direction. The elaborate mechanism known as the orthodiagraph is probably the best means of determining the actual limits of the heart, but few men have such an expensive instrument, and, moreover, at the bedside such an instrument could not be used. From comparative measurements I concur in the belief of those who affirm that careful percussion will furnish equally as accurate limits. The first step in making an examination of the heart is to expose the patient's chest in a good light, and, sitting at his right side, carefully inspect the chest. The position of the apex heat, heaving, bulging, retraction of interspaces, etc., can easily be seen if visible. After careful inspection has given all the data which it is possible to obtain, one next lays the palm of the hand over the heart and attempts to palpate the apex beat. The thrust of the apex in a hypertrophied heart can readily be felt, and one can feel whether the heart is regular, irregular, intermittent, or has other change in rhythm. The shock of the closing valves, particularly the aortic, can be felt, and that, together with the forcible apical impulse, are very definite signs of hypertrophy and hypertension. Thrills...