At the present time the tendency among some writers is to make the ductless glands the responsible agents in almost all diseases. Arteriosclerosis is no exception to this tendency. Sajous, for example, divides the morbid process producing arteriosclerosis into three types; (1) autolytic, (2) adrenal, (3) denutrition. In the first type he finds the pancreas to be the most important gland. It supplies an internal secretion which "takes a direct part in the protein metabolism of the tissue cells, and also in the defensive reactions within these cells, as well as in the phagocytes and in the blood stream." This being the case exaggeration of this digestive process has tissue destruction as its result, arteriosclerosis among them. In the adrenal type Sajous argues that adrenalin produces lesions experimentally, therefore the adrenal gland has a profound influence by its internal secretion in connection with the sympathetic system in producing degenerations leading to arteriosclerosis. The denutrition type has as its particular gland the thyroid. The sclerotic process in the arteries is due to the lack of thyroid as in cases of myxedema. After a long résumé of his ideas he concludes "that arteriosclerosis is the result of excessive or deficient activity of certain ductless glands, the thyroid and adrenal in particular." No one can dogmatically deny the part which the ductless glands may play in the production of arteriosclerosis, but it hardly seems that there is enough actual experimental evidence to show that they take such an important part as Sajous believes. Until further and more convincing evidence is offered by competent investigators, I prefer to look with some skepticism upon the ductless gland theory of the causation of arteriosclerosis. The field lends itself too easily to speculation and imagery. Some are already allowing themselves the mental debauch of this nature. CHAPTER VII THE PHYSICAL EXAMINATION OF THE HEART AND ARTERIES =Heart Boundaries= In order to be able to estimate the departures from normal in the boundaries of the heart, it is essential that there be a definite appreciation of the boundaries of the normal heart in relation to the chest wall. It is frequently stated that the right limit of cardiac dullness is normally, in the adult, just at the right border of the sternum. This is not strictly accurate. Careful dissections at the autopsy table and x-ray plates of the chest made at a distance of two meters from the tube show that the border of the right auricle is from one to one and a half and even two centimeters from the edge of the sternum at the level of the fourth rib, and on the living subject this can be also demonstrated. The right border of the heart usually is from 3 to 4 cm. from the midsternal line at the level of the fourth rib.