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

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
66 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.

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

"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.

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.

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; treatment 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,

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

LUMBAR abscess, diagnosis between, and
abdominal aneurism, 229-30.

MALPOSITION of the heart, 172-4.
MANIACAL delirium, in connection with
pericarditis, 77-83.

MEASUREMENT of a healthy heart, 138;
of the thickness of the walls of a
healthy heart, 127.

MEDIASTINAL tumours, see "Intratho-
racic tumours, diagnosis of, from aneu-
rism," 208, and 215-16.

MENINGITIS, simulated in pericarditis,
77.
MITRAL murmur, systolic or regurgitant,
auscultatory signs of, 52; other phy-
sical signs and general symptoms of,
115; diastolic or obstructive, ausculta-
tory signs of, 55; other physical signs
and general symptoms of, 113.
MURMURS, arterial, cause of organic,
16; and functional, 45-7.

aneurismal, 200-2.

cardiac, 42; mechanism of, 42.
endocardial, seat of, 42; mechanism
of, 42; character of, 42-3; causes of
organic, 44-5; causes of functional,
45-50; causes which modify the cha-
racter of, 42, and 48; diagnosis be-
tween organic and functional, 48-9, and
55; systolic aortic, auscultatory signs of,
52; physical signs and general symp-
toms of, 113; systolic pulmonary, aus-
cultatory signs of, 52; physical signs
and general symptoms of, 114; systolic
tricuspid, auscultatory signs of, 53;
physical signs and general symptoms
of, 116; diastolic aortic, auscultatory
signs of, 54; physical signs and gene-
ral symptoms of, 114; diastolic mitral,
auscultatory signs of, 55; physical
signs and general symptoms of, 113;
diastolic pulmonary, auscultatory signs
of, 55; physical signs and general
symptoms of, 115; diastolic tricuspid,
auscultatory signs of, 56; physical
signs and general symptoms of, 114;
diagnosis of seat of, 101-3, and 117-18;
diagnosis between recent and old-stand-

ing, 105; difficulties in the diagnosis
of, 117-18; prognosis of, 118-19; treat-
ment of disease connected with, 120-
25.

MURMURS, table exhibiting the seat and
cause of the different, 51.

intensity of, not a reliable guide in
diagnosis, 48.

exocardial or pericardial mechan-
ism of, 56; character of, 56-7; diagno-
sis between exocardial and endocardial
murmurs, 58; and between peri-
cardial and pleuritic friction sounds,
59-60.

- venous character of, 60-1; fre-
quency of, 61; cause of, 62-3.
MUSCULAR Contraction, sound of, under
what circumstances heard during the
action of the heart, 29, and 40.

NERVOUS influence, perversion of, its in-
fluence on the action of the heart, 178;
its probable influence in the causation
of murmur, 101.

OBSTRUCTION or obliteration of the
arch of the aorta, 232-5.
EDEMA of lower extremities in connection
with cardiac disease, see "Anasarca."

of the face, neck, and upper ex-
tremities, in connection with thoracic
aneurism, 194-5.

ESOPHAGUS, ulceration of, in connection
with aneurism, 195, and 209.
ORIFICES of the heart, chronic disease of,
110-25.

ORTHOPNOEA, in connection with hyper-

trophy of the heart, 131; in dilata-
tion of the heart, 141.

PAIN in the back and chest caused by
aneurism, character of, 209.
PALPATION, indications derivable from it,
10-16.

PALPITATION, see "Aorta, functional pul-
sation of."

PAPILLARY muscles, irregular action of,
productive of endocardial murmur, 47.

PARACENTESIS thoracis in chronic peri-

carditis, 93.

PERCUSSION, Sound of, in region of heart,
18.

PERICARDIAL effusion, signs of, 71-5;
diagnosis of, from hypertrophy and
dilatation of the heart, 21.
PERICARDITIS, chronic, paracentesis tho-
racis in, 93.

acute, 64-94; constitutional origin
of, 65-6; its frequent connection
with acute rheumatism, 65-6; other
diseases with which it is associated,
66;
differences between rheumatic
and non-rheumatic, 67; pathological
effects of, 68-70; physical signs of,
71-5; general symptoms of, 76-82;
prognosis of, 83-4; treatment of,
84-90; diagnosis of adhesions resulting
from, 91-2.

POSTURE in hypertrophy of the heart,
131; in dilatation of the heart, 141;
in aneurism of the arch of the aorta,
205; in ventral aneurism, 227; in con-
traction of the pulmonary artery, 240.
PRÆCORDIAL region, boundaries of, 2;
form and position of, 2; how af-
fected by respiration and by pos-
ture, 2; percussion sound in, 18;
causes which influence the percussion
sound in, 18-24.

PRESSURE, effect of, on pericardial friction
sound, 58; in, causing venous murmurs,
61-2.
PULMONARY, artery, position of, in rela-
tion to chest walls, 3; functional
murmur in, 49; impulse produced on
chest walls by, in certain cases of
phthisis, 9.

inflammation of, 238; dilatation
of, 238-9; aneurism of, 239-40; con-
traction and obstruction of, 240.

murmur, systolic or obstructive,
auscultatory signs of, 52; other
physical signs and general symptoms
of, 114; diastolic or regurgitant, aus-
cultatory signs of, 55; other phy-
sical signs and general symptoms of,
115.

PULSE, radial, in aortic obstruction, 113;
ditto, regurgitation, 114-15; in mitral
obstruction, 114; ditto, regurgitation,
115; in pulmonary obstruction, 114;
ditto, regurgitation, 115-16; in tricuspid
regurgitation, 116; in hypertrophy of
the heart, 130; in dilatation of the
heart, 140; in atrophy of the heart,
147; in softening of the heart, 153;
in fatty heart, 153; in functional pal-
pitation, 179; in aneurism of the arch,
210; infrequency of, produced by pulse-
less systoles of the heart, 41, and
155.

PUPILS, state of, in thoracic aneurism,
195.

REDUPLICATION of sounds of the
heart, 39-40.

RETICULATION of the valves, cause of,
111.

RHYTHM of the heart, 9-10; alterations
in, 13; of sounds of heart, 24.
RUPTURE of aortic aneurism, 216; of
the heart, 157-61; of a chorda ten-
dinea, 160-1; of a valve of the heart,
160-1.

SIGHING, a frequent symptom in dila-
tation of the heart, 140; in softening
of heart, 153; in fatty degeneration
of heart, 153.

SOUNDS of heart, see "Heart, sounds of;"
reduplication of, 39-40.

SPANÆMIA, provocative of cardiac and
aneurismal thrill, 16; bearing of, on
production of endocardial murmurs,
46-8.

SPUTA in thoracic aneurism, 204.
STERNO-CLAVICULAR ligaments, section
of, in thoracic aneurism, 223.
SUBCLAVIAN artery, the left, its position
in relation to the chest walls, 3.

which take place at different periods
of the heart's action, 25.

the seat and cause of endocardial
murmurs, 51.

the causes which assist in determin-
ing the date at which valvular disease
of the heart will prove fatal, 129-30.

the diagnostic differences between
dilatation and hypertrophy of the heart,
142.

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

the admeasurement of a healthy
heart, 138.

THRILL, arterial, 15-16; cardiac, 14-

15; valvular, 14; aneurismal, 198;
venous, 16; pericardial friction, 74.
THYROID gland, pulsation of, in connec-
tion with disease of the heart, 132-3.
TOPOGRAPHY, clinical, of the heart and
great vessels, 1-4.

TRACHEOTOMY in thoracic aneurism,
222-3.

TRICUSPID murmur, systolic or obstruc-
tive, auscultatory signs of, 53; physical
signs and general symptoms of, 116;
diastolic or regurgitant, auscultatory
signs of, 56; physical signs and
general symptoms of, 114.

TUBERCLE, connection of, with aneurism,
217.

TUMOURS, intrathoracic, diagnosis of,
from aneurism, 208, and 215-16.