The first step in making an examination of the heart is to expose the patient's chest in a good light, and, sitting at his right side, carefully inspect the chest. The position of the apex beat, heaving, bulging, retraction of interspaces, etc., can easily be seen if visible. After careful inspection has given all the data which it is possible to obtain, one next lays the palm of the hand over the heart and attempts to palpate the apex beat. The thrust of the apex in a hypertrophied heart can readily be felt, and one can feel whether the heart is regular, irregular, intermittent, or has other change in rhythm. The shock of the closing valves, particularly the aortic, can be felt, and that and the forcible apical impulse are very suggestive signs of hypertrophy and hypertension. Thrills may also be felt and can be timed in relation to the heart cycle. =Percussion= It is to percussion that we next proceed, and for the data in regard to the size of the heart, it is, for our purpose, the most valuable of all the physical methods of heart examination. First and foremost we wish by percussion to learn the actual size of the heart, in other words what is ordinarily called the relative cardiac dullness. With the absolute dullness we are not concerned. That irregular area represents, as has been said, actually the =limits of lung resonance=. The heart may or may not be covered with lung; there may or may not be the incisura cardiaca. What I wish to insist upon is that the size of the area of absolute dullness can give us no data in regard to the size of the heart. What we must endeavor to learn is the actual size of the heart as nearly as our crude means will permit.