United States Naval Medical Bulletin Volume 9 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1915 Excerpt: ...must be taken not to be misguided by the transmitted impulse, as a seeming impulse can be felt at times in the sixth space, which is really the transmitted beat from the fifth space through the rib. To be located accurately, the apex beat must be actually felt, best by the flat tip of the index or middle linger. The space can be determined only by actually counting the ribs. Inspection is unreliable. In some cases inspection indicated the apex beat to be in the fifth, and it was found on counting to be in the fourth or in the sixth space. In other cases inspection indicated the apex beat in the fourth or the sixth space, and it was actually found in the fifth space. In a specific case the apex was so far below the nipple (7 cm.) that it seemed absolutely certain that the beat must be in the sixth space at least. The recruit, however, had a "long" chest, and actual count showed the beat to be in the normal fifth space. In other cases the apex appeared to be sufficiently high to be in the fourth space without doubt, but the actual count showed it to be in the fifth space. In the Navy, and presumably, therefore, in any set of muscular men, the nipple in the greater per cent of cases is a good guide to the normal location of the heart's apex. In these men, who are as near one physical type as it is possible to get a set of men, some nipples are much higher or lower than the greater per cent, and therefore the only safe rule is to count the rib spaces. In 93 per cent of the reenlistments and 85 per cent of the recruits the heart's apex was found in the fifth space. In one case there was a slight deformity of the sternum, and the second space was just above a ridge, which was more prominent than the ridge below which the second space is usually found. I...