A treatise on auscultation and percussion / by Joseph Skoda; translated from the 4th edition by W. O. Markham.
- Joseph Škoda
- Date:
- 1853
Licence: Public Domain Mark
Credit: A treatise on auscultation and percussion / by Joseph Skoda; translated from the 4th edition by W. O. Markham. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![DISEASES OF THE PERICARDIUM. that neither of these signs has any relation whatever to adhesion of the pericardial surfaces. The bellows murmur arises within the heart or the aorta, through defect of the valves, or from the presence of rough deposits on the lining membrane of the ventricle or the aorta ; the tumbling motion depends on irregularity in the heart’s rhythm, which may occur in various abnormal conditions of this organ, and, indeed, even when it is apparently in a perfectly healthy condition.* Tubercular disease of the Pericardium. This abnormal condition is rarely present in a * [In the Zeitschrift der K.K. Gesellschaft der Aerzte zu Wien, April 1852, there is a paper by Skoda, on the phenomena which indicate adhesions between the heart and pericardium. His diagnosis is based upon the signs which show that the heart’s apex is drawn upwards and to the right, during the systole, and is prevented from moving downwards and to the left. The heart’s apex gives no systolic beat: it is either not per- ceptible, or seems to cause a shock during the diastole. During the systole, depressions become visible in the inter- costal space corresponding to the apex, and frequently in one or more spaces above it, when, in addition to adhesion of the heart and pericardium, there is likewise adhesion of the peri- cardium to the costal pleura. Systolic retraction of the left intercostal spaces does not, of itself, enable' us to diagnose adherent pericardium; it must likewise be shown that, simultaneously with the retraction, the heart’s apex is nowhere urged against the thoracic walls. The systolic retraction of the lower half of the sternum, is a certain sign of adhesion of the heart and pericardium, and of their fixture to the vertebral column. The limits of the dull percussion-sound remain the same, during inspiration and expiration. See Edinburgh Monthly Journal, July 1852. Transl.]](https://iiif.wellcomecollection.org/image/b24991740_0365.jp2/full/800%2C/0/default.jpg)
