Congenital fissure of the sternum : opinions in the case of Mr. Eugene A. Groux.

Date:
[1858]
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Licence: Public Domain Mark

Credit: Congenital fissure of the sternum : opinions in the case of Mr. Eugene A. Groux. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    the instrument a little downwards, and to the left, so as to cover a part of the pulmonary artery, the sound became double; the whole heart-sound being expressed by the syllables lubb-durrup, instead of lubb-dup as usual, obviously from the two sets of valves closing in suc- cession, not simultaneously. This want of coincidence in the closure of the aortic and pulmonary valves is only occasional, but as it often presents itself as a phenomenon of disease, it is satisfactory to be able thus to trace it to its cause. The only remaining observation which I have to record is that of a short rasping murmur, heard in the course of the right carotid artery, and which must be produced there, as it is not audible in the aorta or over the course of the innominata. Br. C. Radclife Hall and others of Plyniswood, Torquay, state: The most prominent pulsation is occasioned by the right auricle. It seems to us that three distinct degrees of distance of sound, indicating as many distinct sources, may be made out from above downwards; the sound over the presumed auricle being far more superficial and bell-like than either the one above (aorta,) or the one below (right ventricle.) Dr. J. Hughes Bennett, Edinburgh: Has no doubt that the pulsa- tion above is that of the aorta, the prominent undulating one in the centre is that of the right auricle, and the inferior one observable on his taking a deep inspiration is that of the right ventricle. Dr. W. T. Gairdner, of Edinburgh, also gives a lengthy opinion, which, as it has not been published, we give in full. The upper visible pulsation (A) is auricular; probably of the right auricular appendage. It precedes the arterial pulse which is felt above it by a very ap- preciable interval. It precedes the apex beat by an interval appreciable, but not so easily appreciable. Care must be taken to press lightly on the pulse A, in making this observation, otherwise the ventricle is felt pulsating below what I take to be the auricle, and is of course synchronous with the apex beat. It precedes the lower visible pulsation (B) by an appreciable in- terval. The only difficulty here arises from the fact that the move- ment is in opposite directions. B is rather a movement of retrac- tion than a proper pulsation. The pulsation A increases, and the auricle slowly fills under the eye when M. Groux suspends respiration for a time. This phenomenon, like the welling of water into a basin which fills from below can be