Heart’s impulse slow Force increased, Impulse conveys a and heaving as if sharper, more feeble undulatory pressing steadily knocking, may impart sensation; force of against an a shake to the body. successive beats obstacle—in rythm May be felt on the unequal; rythm regular, in force right side. irregular. unequal. First sound is dull, Sounds gain greatly in First sound short, muffled, prolonged loudness and extent abrupt and clear. and weakened almost of transmission, Second sound not to extinction. Second especially if the specially affected. sound full and valves are thickened. clanging; period of silence shortened. Murmur with the first Murmur with the first Murmur with the first sound present at one sound may be present, sound from time and absent at from altered insufficiency of the another. direction of the auriculo-ventricular orifice of the aorta. valves. B. General Functional Symptoms. SIMPLE HYPERTROPHY. HYPERTROPHY WITH SIMPLE DILATATION. DILATATION. Strength unimpaired. Strength tends to Strength fails. Power of continued become impaired. exertion (especially uphill) limited by shortness of breath. Visible mucous Purpleness and lividity Lividity of the mucous membranes healthy or of the mucous membranes. Dropsical of a bright red. membranes effusions of the proportionate to the limbs and other valvular or pulmonary dependent parts which obstruction. pit on pressure. Difficulty of breathing Difficulty of breathing Difficulty of breathing occasional. occurs in paroxysms. great and constant, with occasional aggravations. Pulse full, strong, Fulness of pulse Pulse small and feeble, firm, tense, continues but much later than the resisting and strength and power of heart beat. Regular prolonged without resistance lost. or feeble, fluttering jerk or thrill. and irregular. Venous pulse in the jugulars. Rarely and never Indirectly and more or Palpitation frequent. rapidly the direct less rapidly fatal. Faintness occurs from cause of death. time to time, and may lapse into fainting