the middle part of the left segment of the heart occurs, (1) in the so-called exercise hypertrophy of the heart; (2) in "pregnancy heart;" (3) in senile hypertrophy; (4) in the hypertrophy of the obese; (5) in certain valvular defects, especially with well compensated mitral insufficiency; (6) as an early symptom in arteriosclerosis ; ( 7 ) in the hypertrophy accompanying nephritis. The frequent weakening of the first sound with the "lifting apex beat" is partially the result of conduction. The

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... lifting apex beat prevents the shaking of the thorax during systole, as it is lifted with the apex. An artificial murmur is produced in the stethoscope with this lifting apex beat, which renders the perception of the first sound more difficult. The louder second sound with hyper¬ trophy is probably due in part to the enlargement of the aorta. Bamberger was the first to emphasize the importance of the lifting apex beat with pronounced hypertrophy of the left ventricle, and also the importance of the louder second aortic sound for the diagnosis of the condition. 124. Relations Between Scleroderma and Tuberculosis.-