Notes of a Case of Cystine Calculus Diagnosed before Operation

F. A. Southam
1876 BMJ (Clinical Research Edition)  
Dec. 23, I876.] THE BRITISH MEDICAL 7OURNAL. 817 distinct-one produced by the left, the other by the right ventricle. Well recognised differences in character between them are recognised. How does Dr. Leared explain these, if the sounds be the product of collision of the blood, and not of tension of the ventricular walls and valves ? 4. The first sound undergoes remarkable modifications-(a) in dilatation of the ventricles; still more (b) in stenosis of the mitral orifice. It is not weaker, and
more » ... is not weaker, and is indeed often louder, than usual; but it is short and sharp, like the second sound. This is easily explained in the case of dilatation, if the ventricular walls and valves are supposed to be the origin of the sound. An explanation on the hypothesis of collision of moving ventricular and standing aortic blood is requested. 5. In dilatation of the ascending aorta, and in aneurism, the aortic second sound is not only louder than in the normal state, but greatly changed in tone. The increased and modified resonance is easily understood, and is, indeed, strikingly suggestive of the change in the walls of the vessel, if the sound result from the tension and vibration of the enlarged area of resonant membrane, but could scarcely be the effect of increase in the size of the column of blood.
doi:10.1136/bmj.2.834.817 fatcat:udihaxjoszbk5p3preh44mxxme