=Morbid Sounds.= =Murmurs.= The distinct and superadded sounds heard in disease are usually designated murmurs. They originate in the interior of the heart (endocardial) or externally to the heart (pericardial). The =endocardial= sounds mostly arise from some abnormal conditions of the valves or orifices and consist in a blowing or rushing noise which usually accompanies or displaces one of the heart sounds, though it may precede or succeed these. The following table modified from that of Bartle and Roger presents at a glance the relations of these different sounds and their significance. Blowing or Hissing Murmurs. Blowing murmur before │Narrowing of the auriculo-ventricular orifice. the first sound. │ Vegetations or coagula on the valves. │Strongest toward the │ Blowing murmur with the│ base of the heart. │Narrowing of the aortic first sound. │ Propagated along the │ opening. │ great arteries. │ │Strongest toward the │Narrowing of the │ apex of the heart. │ pulmonary artery or │ Not propagated in the│ insufficiency of the │ great arteries. │ auriculo-ventricular │ │ valves. │Double rushing sound │Insufficiency of the Blowing murmur with the│ heard over the great │ arterial (semilunar) second sound. │ arteries at each beat│ valves. │ of the heart. │ │Double rushing sound in│ Blowing murmur after │ the arteries with │Aneurism (dilatation of the second sound. │ each beat of the │ the great aorta.) │ heart. │ From the table it will be seen that each orifice in the heart may become the seat of two perfectly distinct and independent murmurs; one due to constriction of the orifice in which case the sound is produced with the onward progress of the blood wave; and one due to dilatation of the orifice or insufficient closure of it by the valves, when the sound is due to a recoil or regurgitation of the blood. There is a further sound due to mere roughness of the valves in cases of disease when the sound will be with the normal current of blood, though a second or regurgitant hiss is often heard from the valves being at the same time insufficient to close the orifice. Another blowing murmur is usually heard over the heart and coincident with its first sound in the bloodless state (anæmia). This is not necessarily connected with any diseased condition of the heart itself. The nature of these murmurs differs in special instances. They may resemble the soft whisper of the words _who_ or _awe_, of the double letter _ss_, or the single letter _r_, according as they are soft or hard and purring.