Licence: Public Domain Mark
Credit: Lectures on diseases of the heart / by Edwin M. Hale. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![three inches to the left of the median line. The median line extending from the same point on the sternum, and a line extending transversely from the point of the apex-beat to meet the median line, will form the two other sides of the triangle. The limits to which the deep eardaic region extends have been already denned in giving the boundaries of the space which the heart occupies within the chest. The dulness over the superficial eardaic region is more decided than over the deep-seated eardaic region, owing to the fact that it is not covered by lung. This dulness can be recognized by light percussion. It requires forcible percussion to mark out the dulness over the deep eardaic region. [ For full and minute directions to examine by percussion, consult Walshe or Flint on Diseases of the Heart,] If the dulness, found on examination of a patient, exceeds the limits given above, we may conclude that some kind of enlargement exists. The heart, in proportion to its increase in volume, pushes aside the anterior border of the left lung, leaving a large portion of its anterior surface uncovered and in contact with the thoracic walls. The degree of dulness within the superficial eardaic region is greater than in health in proportion to the enlargement. Increased extent and degree of superficial dulness are signs of enlargement of the heart, provided the adjacent organs are healthy. The pres- ence of phthisis, chronic pleurisy, enlargement of the liver, dilatation of the stomach, aneurism of the aorta, enlarged spleen, ascites, pregnancy, may cause difficulty in making a correct diagnosis by means of percussion. The limits of this work will not permit us to go further into this subject. For full and exact knowledge relating to the physical diagnosis of abnormal conditions discernable by percussion, reference must be had to the works previously alluded to. THE SOUNDS OF THE NORMAL HEART. When the ear is applied over the eardaic region, during the natural movements of the heart, two successive sounds are heard, each pair of which corresponds with one pulsa- tion ; there is also an interval of silence between each recur-](https://iiif.wellcomecollection.org/image/b2105633x_0040.jp2/full/800%2C/0/default.jpg)
