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CYANOSIS, definition of, 169; causes of, |

169-71; physical signs and general
symptoms of, 171 ; prognosis of, 172;
treatment of, 172.

“Heart, softening of;" of the cornea'

155.
FIBRE, cardiac, in hypertrophy, 125; in

dilatation, 137-8; in softening, 152.
FORAMEN ovale, patulous, its influence in

the production of cyanosis, 169.
FREMITUS friction, see “Friction fremi.

tus."
FRICTION fremitus or thrill, cardiac, how

produced, 14-15; pericardial, its cause,
74; diagnosis of pleuritic and pericar-
dial, 57-8.

DEATH, modes of, from thoracic aneu-

rism, 216.
DELIRIUM in connection with pericarditis,

77-83, and endocarditis, 106-7.
DIASTOLIC impulse, where perceived, 9-10;

how produced, 9-10, and 12.
DIGITALIS, action of, in regulating the

heart, 144-5.
DILATATION of the heart, varieties of,135;

how produced, 136-7; physical signs
of, 138-9; symptoms of, 139; diagnosis
of, 140; prognosis of, 141-2; treat-
ment of, 142-5.
-- of the aorta, see “Aorta, dilata-

tion of.
-- of the pulmonary artery, 238-9.
DISSECTING aneurism, see “ Aneurism,

dissecting.”
DIURETICS, value of, in cardiac dropsy,

123-4.
DROPSY, cardiac, where first observed,

123; mechanism of, 116, and 131; con-
ditions of heart productive of, 117,
131, and 143; treatment of, 121-5,

and 143-5.
DYSPEPSIA in connection with heart dis-

ease, 140-1.
DYSPHAGIA caused by aneurism, its cha-

racter, 207-9.
DYSPNEA, caused by aneurism, its dis-

tinctive features, 204-5.
-- peculiarities of cardiac, 140-1.

HÆMATEMESIS caused by aneurism,

195, and 211.
HÆMOPTYSIS caused by aneurism, 194.

and 211.
HEAD symptoms, see “ Brain, affection

of,” and “ Cerebral disturbance.”
HEART, position of, in relation to chest

walls, 1; position of, subject to vari.
ation, 2; displacements of apex of,
7-9; rhythm of, 9-10; alterations
in rhythm of, 13, and 15; alteration
in rhythm of, due to functional causes,
185; impulse of, character of, and
where perceived, 4-5; impulse of,
how modified, 5, and 11; diminished
impulse of, how produced, 11; in-
creased impulse of, how produced, 11-
12; alterations in character and rhythm
of impulse of, 12-13; normal sounds
of, 24-39; adventitious sounds in,
42, see “Murmurs ;” abnormal pulsa-
tion of left auricle of, in connection
with phthisis, 9; measurements of a
healthy, 138.
-- rupture of, 157-61.
- sounds of rhythm of, 24 ; character
of, 25; causes of, 34; theories as to
causes of, 26-34; causes which modify
the intensity and character of, 35-7;
causes which modify the rhythm of,

38-40; reduplication of, 39-40.
-- valvular disease of, acute, patho.

logy of, 95-9; physical signs of, 100;
diagnosis of murmurs produced by,
101-6; general symptoms of, 106-7;
prognosis of, 107-8; treatment of, 107.

EMBOLISM, 106-7, and 174-8, and 199.
ENDOCARDIAL murmur, see “Murmur,

endocardial.”
ENDOCARDITIS, chronic, see “ Valves,

chronic disease of.”
- acute, pathology of, 95-9; physical

signs of, 100-5; general symptoms

of, 106 ; prognosis of, 107-8.
ENDO-PERICARDITIS, statistics of, 109;

physical signs and treatment of, 109.

FATTY degeneration, of the heart, see

173; causes of, 173-4; physical signs

and symptoms of, 174.
HEART, fibrinous concretions in, varieties

of, 174-8; physical signs and general
symptoms produced by, 175-6; progno-
sis of, 175, and 177; treatment of, 177.
- functional derangement of, varieties
of, 178-9; physical signs of, 179-80;
general symptoms of, 181-2; diagnosis
of, 182-3; treatment of, 183-5; pro-
gnosis of, 185 ; alterations of rhythm
connected with, 185-7.
HOARSENESS, caused by aneurism, its dis.

tinctive features, 183.
HYDROPERICARDIUM, its cause, 123, and

131.

HYPERTROPHY of the heart, see Heart,

hypertrophy of.”

HEART, valvular disease of, chronic, 110-

25; cause of, 100; murmurs produced
by, 112; symptoms caused by, 113-6;
diagnosis of murmurs caused by, 117-
20; prognosis of, 118-19; treatment
of, 120-5.
- thickness of walls of a healthy, 127;
weight of a healthy, 127.

- hypertrophy of, 125; varieties of,
125; causes of, 125-6; physical signs of,
127-9; general symptoms of, 128 ;
how connected with apoplexy, 129-30;
how related to enlargement of the
thyroid gland and dilatation of the in-
fra-thyroid arteries, 132 ; prognosis of,

133; treatment of, 134-5.
- dilatation of, 135-44; varieties of,

135; causes of, 136-7; physical signs
of, 138; symptoms of, 140-1; diagnosis
of, 141-2; prognosis of, 142-3; treat.
ment of, 143-6.

atrophy of, 146; structure of,
146; causes of, 147; physical signs
and general symptoms of, 147.

induration of, 148; cause of, 148;
morbid anatomy of, 148; physical
signs, general symptoms, and treat-
ment of, 149.
- softening of, 150-7; causes of,
150; class of persons in whom it occurs,
151; microscopical appearance of, 152;
physical signs and general symptoms
of, 153-4; arcus senilis in connection
with, 155; diagnosis of, 155-6; pro-

gnosis of, 156; trcatment of, 156-7.
- rupture of, 157-61; causes of, 157;

statistics of, 158; mode of death in,
158; signs of, 159; treatment of,
159.

aneurism of, 162; seat of its occur.
rence, 162; symptoms and physical
signs of, 162.

fatty degeneration of, connected
with angina pectoris, 164-6.

conditions of productive of
dropsy, 117, 131, and 143; malforma-
tions of, 170; malposition of, 172-4. -
- malposition and displacements of,

congenital, 172; as result of disease, 1

IMPULSE, cardiac, see “Heart, impulse

of ;” diastolic, where perceived, 9-10,
how produced, 9-10, and 12; aneurismal

character of, 198; sometimes double, 198.
INDURATION of the heart, see “Heart,

induration of.”
INNOMINATE artery, position of, in rela-

tion to chest walls, 3; aneurism of,

218-19,
INSPECTION of the chest, information

respecting heart to be derived from,

4-10.
INTELLECT in pericarditis, 77-83; see

“Brain, affection of,” and “ Cerebral

disturbance."
INTRATHORACIC tumours, diagnosis of,

from aneurism, 208, and 215-16.
IRREGULAR action of the heart, see

“Heart, alterations in rhythm of.”

JUGULAR veins, cause of distension of,

116; pulsation of, how caused, 116, and
140.

KIDNEYS, their affection in connection

with pericarditis, 77; with valvular
disease of the heart, 117.

LARYNX, affection of, in connection

with thoracic aneurism, 182.

25.

LUMBAR abscess, diagnosis between, and ing, 105 ; difficulties in the diagnosis
abdominal aneurism, 229-30.

of, 117-18; prognosis of, 118-19; treat-

ment of disease connected with, 120-
MALPOSITION of the heart, 172-4.
MANIACAL delirium, in connection with MURMURS, table exhibiting the seat and
pericarditis, 77-83.

cause of the different, 51.
MEASUREMENT of a healthy heart, 138; -- intensity of, not a reliable guide in

of the thickness of the walls of a diagnosis, 48.
healthy heart, 127.

- exocardial or pericardial mechan.
MEDIASTINAL tumours, see “ Intratho ism of, 56; character of, 56-7; diagno-

racic tumours, diagnosis of, from aneu sis between exocardial and endocardial
rism,” 208, and 215-16.

murmurs, 58; and between peri-
MENINGITIS, simulated in pericarditis, cardial and pleuritic friction sounds,
77.

59-60.
MITRAL murmur, systolic or regurgitant, - venous character of, 60-1; fre-

auscultatory signs of, 52; other phy. quency of, 61; cause of, 62-3.
sical signs and general symptoms of, MUSCULAR contraction, sound of, under
115; diastolic or obstructive, ausculta what circumstances heard during the
tory signs of, 55; other physical signs action of the heart, 29, and 40.

and general symptoms of, 113.
MURMURS, arterial, cause of organic,

NERVOUS influence, perversion of, its in-
16; and functional, 45-7.

fluence on the action of the heart, 178;
- aneurismal, 200-2.

its probable influence in the causation
-- cardiac, 42; mechanism of, 42.

of murmur, 101.
- endocardial, seat of, 42; mechanism
of, 42; character of, 42-3; causes of
organic, 44-5; causes of functional,

OBSTRUCTION or obliteration of the
45-50; causes which modify the cha-

arch of the aorta, 232-5.
racter of, 42, and 48; diagnosis be-

EDEMA of lower extremities in connection
tween organic and functional, 48-9, and

with cardiac disease, see “Anasarca.”
55; systolic aortic, auscultatory signs of,

— of the face, neck, and upper ex-
52; physical signs and general symp-

tremities, in connection with thoracic
toms of, 113; systolic pulmonary, aus-

aneurism, 194-5.
cultatory signs of, 52; physical signs

CESOPHAGUS, ulceration of, in connection
and general symptoms of, 114; systolic

with aneurism, 195, and 209.
tricuspid, auscultatory signs of, 53 ;

ORIFICES of the heart, chronic disease of,

110-25.
physical signs and general symptoms
of, 116; diastolic aortic, auscultatory

ORTHOPNA, in connection with hyper-
signs of, 54; physical signs and gene-

trophy of the heart, 131; in dilata-
ral symptoms of, 114; diastolic mitral,

tion of the heart, 141.
auscultatory signs of, 55; physical
signs and general symptoms of, 113; PAIN in the back and chest caused by
diastolic pulmonary, auscultatory signs aneurism, character of, 209.
of, 55; physical signs and general PALPATION, indications derivable from it,
symptoms of, 115; diastolic tricuspid, 10-16.
auscultatory signs of, 56; physical PALPITATION, see Aorta, functional pul.
signs and general symptoms of, 114; 1 sation of.”
diagnosis of seat of, 101-3, and 117-18; PAPILLARY muscles, irregular action of,
diagnosis between recent and old-stand productive of endocardial murmur, 47.

PARACENTESIS thoracis in chronic peri- | PULMONARY valves, position of, in relation
carditis, 93.

to the chest walls, 2.
PERCUSSION, sound of, in region of heart, PULSATION, of the heart, 11; of aortic
18.

aneurism, 198.
PERICARDIAL effusion, signs of, 71-5; | -- venous, how produced, 10, and
diagnosis of, from hypertrophy and

116.
dilatation of the heart, 21.

PULSE, radial, in aortic obstruction, 113;
PERICARDITIS, chronic, paracentesis tho ditto, regurgitation, 114-15; in mitral
racis in, 93.

obstruction, 114; ditto, regurgitation,
-- acute, 64-94 ; constitutional origin 115; in pulmonary obstruction, 114;
of, 65-6; its frequent connection ditto, regurgitation,115-16; in tricuspid
with acute rheumatism, 65-6; other regurgitation, 116; in hypertrophy of
diseases with which it is associated, the heart, 130; in dilatation of the
66; differences between rheumatic heart, 140; in atrophy of the heart,
and non-rheumatic, 67; pathological 147; in softening of the heart, 153;
effects of, 68-70; physical signs of, in fatty heart, 153; in functional pal-
71-5; general symptoms of, 76-82; pitation, 179; in aneurism of the arch,
prognosis of, 83-4; treatment of, 210; infrequency of, produced by pulse-
84-90; diagnosis of adhesions resulting less systoles of the heart, 41, and
from, 91-2.

155.
Posture in hypertrophy of the heart, PUPILS, state of, in thoracic aneurisin,
131; in dilatation of the heart, 141;

195.
in aneurism of the arch of the aorta,
205 ; in ventral aneurisin, 227; in con REDUPLICATION of sounds of the

traction of the pulmonary artery, 240. heart, 39-40.
PRÆCORDIAL region, boundaries of, 2; RETICULATION of the valves, cause of,

form and position of, 2; how af. 111.
fected by respiration and by pos.

RHYTHM of the heart, 9-10; alterations
ture, 2; percussion sound in, 18; in, 13; of sounds of heart, 24.
causes which influence the percussion

RUPTURE of aortic aneurism, 216; of
sound in, 18-24.

the heart, 157-61; of a chorda ten.
PRESSURE, effect of, on pericardial friction dinea, 160-1; of a valve of the heart,
sound, 58; in, causing venous murmurs,

160-1.
61-2.
PULMONARY, artery, position of, in rela SIGHING, a frequent symptom in dila-

tion to chest walls, 3; functional tation of the heart, 140; in softening
murmur in, 49; impulse produced on of heart, 153; in fatty degeneration
chest walls by, in certain cases of of heart, 153.
phthisis, 9.

Sounds of heart, see “ Heart, sounds of;"
-- inflammation of, 238; dilatation reduplication of, 39-40.
of, 238-9; aneurism of, 239-40; con SPANÆMIA, provocative of cardiac and
traction and obstruction of, 240.

aneurismal thrill, 16; bearing of, on
--- murmur, systolic or obstructive, production of endocardial murmurs,
auscultatory signs of, 52; other 46-8.
physical signs and general symptoms SPUTA in thoracic aneurism, 204.
of, 114; diastolic or regurgitant, aus STERNO-CLAVICULAR ligaments, section
cultatory signs of, 55; other phy of, in thoracic aneurism, 223.
sical signs and general symptoms of, SUBCLAVIAN artery, the left, its position
115.

in relation to the chest walls, 3.

TABLE, exhibiting the occurrences, UNDULATORY movement on the chest,
which take place at different periods when referable to dilatation of the
of the heart's action, 25.

heart, 139; referable to pericarditis,
-- the seat and cause of endocardial 8, and 74-5.
murmurs, 51.

URINE, albuminous, resulting from heart
- the causes which assist in determin disease, 117.

ing the date at which valvular disease
of the heart will prove fatal, 129-30. VALVES of the heart, position of, in re-

the diagnostic differences between lation to chest walls, 2; chronic
dilatation and hypertrophy of the heart, disease of, 110-25; causes of disease
142.

of, 110; varieties of disease of, 110;
the thickness of the walls of a rupture of, 157-8, and 160-1.
healthy heart, 127.

VARICOSE aneurisms of arch of aorta,
- the admeasurement of a healthy 225-6.
heart, 138.

VEINS, enlargement of superficial, dia-
Thrill, arterial, 15-16; cardiac, 14 gnostic of intrathoracic tumour, 194-5.

15; valvular, 14; aneurismal, 198; -- pulsation of, its cause and signi.

venous, 16; pericardial friction, 74. ficance, 116; thrill in, 16.
THYROID gland, pulsation of, in connec VENA cava, superior, its position in rela-

tion with disease of the heart, 132-3. tion to the heart and the chest walls,
TOPOGRAPHY, clinical, of the heart and 3.
great vessels, 1-4.

VENOUS murmur, character of, 60-1 ;
TRACHEOTOMY in thoracic aneurism, frequency of, 61 ; cause of, 62-3.
222-3.

- pulsation, its cause and signifi-
TRICUSPID murmur, systolic or obstruc cance, 10, and 116.

tive, auscultatory signs of, 53 ; physical -- thrill, 16.
signs and general symptoms of, 116; VENTRAL aneurism, see “ Aneurism, ab.
diastolic or regurgitant, auscultatory dominal."
signs of, 56; physical signs and VENTRICLE, right position of, 1; ditto
general symptoms of, 114.

of left, 1-2; signs of dilatation of right,
TUBERCLE, connection of, with aneurism, 130.

217.
TUMOURS, intrathoracic, diagnosis of, WHEEZING caused by aneurism, its

from aneurism, 208, and 215-16. l character, 204-5.

ERRATA.
At page 24, line 5, for “contractile” read “conducting."
At page 136, line 24, for “ depressed” read “ depraved.”

J. E. ADLARD, PRINTER, BARTHOLOMEW CLOSE, E.C.

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