Identifier: medicaldiagnosi00gree (find matches)
Title: Medical diagnosis for the student and practitioner
Year: 1922 (1920s)
Authors: Greene, Charles Lyman, 1862-
Subjects: Diagnosis
Publisher: Philadelphia, Blakiston
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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h respect to bothphysical and mental exertion, one may perceive as one of the earliest symptomsof this as of other cardiovascular lesions a narrowing of the field of effortless,fatigueless response. So marked may this be and so striking the nervous symp-toms as to lead physicians in many instances to diagnose and treat the conditionas a neurasthenia, that bastard euphemism for dont know Physical Signs.—With respect to the physical signs little need or can be CARDIOVASCULAR SYPHILIS 57 said without entering into a useless repetition of the descriptions of aorticregurgitation, aneurysm, aneurysmal dilatation, or, angina pectoris. Roentgenoscopy and roentgenography afford important information.Both the screen and plate should be used, with sagittal and oblique exposures,and, in the absence of either actual aneurysm or diffuse dilatation, the qualityand outline of the aortic shadow itself and any increased range of pulsatoryexcursion should be carefully noted. Extreme valueof the X-ray.
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Percussion.—This is of slight value relatively but one should always testthe note over the manubrium, third right interspace and third rib and thesecond right interspace for the dulness en casque of Potain, and inspectand palpate carefully for expansile pulsation. Auscultation.—The character of the second sound as heard over thethird left interspace may be of the utmost value before any considerable Dulnessen casque. The split second. 758 MEDICAL DIAGNOSIS degree of aortic leakage is established. It may be blurred and murmur-ish, or remarkably and suggestively clear and intense, and one of the mostimportant variants in the authors experience has been the split second sound,often heard over the third left interspace near the edge of the sternum, or

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