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November 18, 1950


Author Affiliations

2110 Spruce Street, Philadelphia.

JAMA. 1950;144(12):1022. doi:10.1001/jama.1950.02920120046021

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To the Editor:—  During World Wars I and II many healthy men were rejected for military service because of a normal heart sound that was mistakenly thought to be produced by a pathological heart condition. In a considerable proportion of healthy persons a crunching sound is heard over the xiphoid cartilage and the lower end of the sternum and to their left, in some cases being transmitted as far as the cardiac apex (Solis-Cohen, M.: Am. J. M. Sc.126:131 [July] 1903; Pennsylvania M. J.13:216 [Nov.] 1909; Am. J. M. Sc., 210:333 [Sept.] 1945; Postgrad. Med.3:109 [Feb.] 1948). Although attention to this sound has been directed by many clinicians during the past 130 years, it is mentioned in only a few books on cardiology, physical diagnosis and medicine. Consequently it is regarded by many physicians as a murmur of mitral or tricuspid insufficiency or

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