. A practical treatise on medical diagnosis for students and physicians . rea of dulness upAvard; (7) accen-tuated pulmonary second sound; (8) reduplication ; (9) the absence of thepulse of aortic regurgitation and of hypertrophy of the left ventricle. Tricuspid Regurgitation or Incompetence. Structural disease atthe tricuspid orifice is of comparatively rare occurrence. Incompetence ismore frequent, and is due to dilatation with relative insufficiency of thevalve-orifice. It occurs secondarily to obstructive lung diseases, as em-physema and cirrhosis, and is secondary to obstruction and regur

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. A practical treatise on medical diagnosis for students and physicians . rea of dulness upAvard; (7) accen-tuated pulmonary second sound; (8) reduplication ; (9) the absence of thepulse of aortic regurgitation and of hypertrophy of the left ventricle. Tricuspid Regurgitation or Incompetence. Structural disease atthe tricuspid orifice is of comparatively rare occurrence. Incompetence ismore frequent, and is due to dilatation with relative insufficiency of thevalve-orifice. It occurs secondarily to obstructive lung diseases, as em-physema and cirrhosis, and is secondary to obstruction and regurgitationat the mitral orifice which lead to stasis in the lungs. Symptoms. The symptoms were detailed in speaking of the mitralvalve affections. They are those of obstruction in the pulmonary circu-lation and engorgement of the systemic veins. Physical Signs. (Plate XXXtlL, Fig. 1.) Inspection. The physicalsigns of dilatation of the right heart are seen. An impulse in the epi-gastrium is noted. This is seen especially between tlie xiphoid cartilage PLATE XXXlll.riG. 1..