Diseases of the chest, throat and nasal cavities : including physical diagnosis and diseases of the lungs, heart and aorta, laryngology and diseases of the pharynx, larynx, nose, thyroid gland, and œsophagus / by E. Fletcher Ingals.

  • Ingals, E. Fletcher (Ephraim Fletcher), 1848-1918.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the chest, throat and nasal cavities : including physical diagnosis and diseases of the lungs, heart and aorta, laryngology and diseases of the pharynx, larynx, nose, thyroid gland, and œsophagus / by E. Fletcher Ingals. Source: Wellcome Collection.

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    usually indicates dilatation of the vessel, and the commencement of an aneurism. By inspecting the chest, we obtain information regarding the form oj the cardiac region and the position and character of the apex beat Enlargement or budging of the precordial region may be normal'but It is frequently due to enlargement of the heart or effusion into the pericardial sac. In this latter instance, the intercostal spaces are more promineut than in the former. The unusually distinct pulsations often seen in children and emaciated per- sons have been mistaken for bulging ; but such errors may be avoided by careful inspection and palpation. Rachitis may cause bulging of the precordial region, but iii such in- stances a corresponding depression is usually found on the posterior aspect of the chest, immediately to the left of the spine, and the spine is generally curved. Prominences anteriorly caused by aneurisms of the aorta are found only above the fourth rib. Depiression in the prcBcordial region, of a permanent character, usu- ally indicates previous pericarditis with adhesion of the two surfaces of the pericardium to each other, and of the pericardium to the costal pleura. Care must be taken not to confound with this condition tliose rhythmical de- pressions which may occur independent of adhesions, as the result of atmo- spheric pressure. These take place when the heart is enlarged and the left lung contracted, provided the person has thin and elastic chest walls. Inspection reveals any alteration in the position, character, and force of the apiex heat. The apex is crowded upward and outward by hyper- trophy of the left lobe of the liver or by abdominal tumors. It may be carried directly upward to a point above the fifth rib by pericardial effusions; it is raised by contraction of the left lung, as in fibroid phthisis. It is crowded downward and to the right, when the left lung is enlarged by emphysema, or it may be drawn in the same direction by contraction of the right lung. It is crowded to the right by collections of fluid or of air in the left pleural sac, or by large tumors occujiyiug that side of the chest; to the left, by corresioouding conditions upon the right side. It is forced downward by aneurisms or by other medias- tinal tumors and is drawn downward and inward by hypertrophy of the right ventricle. It is carried downward and to the left by hypertrophy of both ventricles, but in uncomplicated hypertrophy the apex seldom extends more than an inch to the left of its normal position. It is also carried downward, and often far to the left, by enlargement of the heart, as the result of dilatation or of dilatation and hypertrophy combined. The significance of alterations in the position of the apex beat is shown at a glance in the following table: