Les maladies du coeur et la circulation dans l'enfance et l'adolescence . peu au-dessus de la second ri^ht cartilage costal.comme indiqué dans le diagramme. Le murmure se fait synchronouslywith l'apex-beat et le pouls carotidien. Le bruit de la sténose anaortic est peut-être le plus largement distribué de tous les souffles cardiaques valvulaires ; elle est portée vers l'extérieur par le sang-courant de la sous-clavière, carotides, et axillaire. Parfois nous en avons entendu dans la fémorale, et même dans le losange.Certains auteurs indiquent qu'ils ont reconnu le murmure que l'evenistant dorsalis pedis artères. Ils ont aussi une verywide dist

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Diseases of the heart and circulation in infancy and adolescence . little above the second ri^ht costal cartilage.as marked in the diagram. The murmur occurs synchronouslywith the apex-beat and the carotid pulse. The bruit of anaortic stenosis is perhaps the most widely distributed of allthe valvular murmurs ; it is carried outwards by the blood-current to the carotids, subclavian, and axillary. In somecases we have heard it in the femoral, and even in the popliteal.Some authors state that they have recognized the murmur evenistant as the dorsalis pedis arteries. They also have a verywide distribution within the chest encasement, as, for example, we have noted them over the sternum, at the apex, over theleft lobe of the liver, and in puny, thin children at almost anypart of the chest. The pulse in aortic obstruction depends greatly upon thedegree of stenosis: small if this is extreme; usually, however, it is full and strong, giving evidence of ventricular hyper-trophy, which arises early. Its characters are well illustratedin the accompanying tracing :. Child six years. Aortic stenosis, with autopsy. (Blache.) It is necessary to differentiate an aortic systolic murmur from a mitral systolic. In order to distinguish them we first the point of maximum intensity. Furthermore, the lie murmurs are rarely of the same timbre and quality. The aortic most usually is the rougher and more accentuated. in, mitral systolic murmurs are not transmitted into the arterial circulation, but into the axilla. and Circulation in Infancy and Adolescence, 131 The effect on the cardiac cavities is much the same as al-ready described for aortic regurgitation, as are the generalconstitutional symptoms, so that a repetition would be super-fluous, particularly as sooner or later the two murmurs willalmost always be found to coexist. DISEASE OF PULMONARY ARTERY VALVES. Beyond question post-natal disease of the pulmonary valvesor orifice is a clinical rarity. We have already considered, at some leng

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