Pediatrics : the hygienic and medical treatment of children / by Thomas Morgan Rotch.

  • Thomas Morgan Rotch
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Pediatrics : the hygienic and medical treatment of children / by Thomas Morgan Rotch. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    1142/1220 (page 1056)
    ingly rare, even in extreme cardiac enlargement, to find the relative dulness E E' E of as great an extent as is represented in this diagram. The abso- lute dulness as represented in the diagram I have met with in most cases of enlarged heart where the enlargement is great and the sternal region is involved. Diagram 19. Enlarged heart (Rotch). §f| A, area of absolute dulness caused by an enlarged heart ; ||||]||| B, liver; fljjJI B', that portion of the liver which is covered by the right lung; |;sV| C, lung; E E' E, the line marking the area of relative dulness of the enlarged heart; S> sternum; (S), nipple; 1, 2, 3, 4, 5, 6, ribs; ---(broken line), border of lung. On referring to Diagram 17, we find that the dulness which occurs in a pericardial effusion may correspond to that of an enlarged heart through its whole area, but that the dulness of the effusion is also found in an additional area corresponding to a part of the fifth rib and fifth interspace. Absolute dulness, therefore, in the fifth right interspace 3 or 4 cm. (1| or 1J inches) from the right parasternal line in cases of pericarditis uncomplicated by pleural or pericardial adhesions becomes a valuable means of differential diagnosis from an enlarged heart. I have found in my experiments on the adult pericardium that the abso- lute dulness could be detected iu the fifth right interspace when from 70 to 80 c.c. of fluid had entered the pericardium. In order to illustrate to you the difference between the area of dulness produced by an enlarged heart and that produced by a pericardial effusion, I have marked on this boy (Case 508, page 1057), eleven and a half years old, the boundaries of the area of absolute dulness in an enlarged heart, in a small pericardial effusion, and in a large pericardial effusion.