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

Date:
[1858]
Catalogue details

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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    easily distinguished from the protrusion of the lung which takes place when a sudden respiratory movement concurs with a closed glottis. When M. Groux coughs, the lung protrudes, but not the auricle; when he simply ceases to breathe for several seconds, without either expir- ing or inspiring, the auricle protrudes, but not the lung. Percussion also shows the difference between the two. This gradual filling of the right auricle when respiration is suspended, and the enlargement of its pulsations which follows, is quite in accordance with what is seen in vivisections, when partial asphyxia is gradually induced. In forctd respiratory movement with the glottis closed, the protruded lung con- ceals the auricle, and interferes with the observation of its phenomena. In forced inspiration the heart is drawn back from the thoracic wall. The favorable state, therefore, for noticing the gradual filling of the auricle is intermediate. I presume the movement which I have called B (the lower visible pulsation) to be in connection with the systole of the right ventricle. It is only visible in full inspiration, because it requires the descent of the diaphragm to bring the heart down to the left costal margin, when this movement is observed, and it is a movement of retraction because the systole of the ventricle withdraws it from the surface. A similar movement is occasionally seen in men perfectly well formed, perhaps not in perfect health, but without marked disease of heart. During suspended respiration the apex beat in the usual situation becomes indistinct, and may, perhaps, finally be lost, though I have generally found it continue. At the same time a movement becomes apparent in the third, and then in the second intercostal space. This phenomenon is very curious, and well worthy the attention of physi- ologists. It was attributed by some of those who observed it at the Medico-Chirurgical Society here, to be an actual displacement upwards of the apex. I am rather of the opinion that it is owing to the increas- ing distension of the right ventricle, which throws back the true apex of the heart from the thoracic walls. In the strictly normal condition of parts, the same change takes place, so far as the disappearance of the true apex beat is concerned; but I have not seen the pulsation higher up except in disease. In ad- herent pericardium, and even hypertrophy of the right ventricle, it is not unfrequent. In M. Groux, when the heart's action is excited, it can be easily felt on deep pressure in four intercostal spaces simulta- neously. With regard to the reduplication of the first sound which I for- merly noted, I am still of opinion that it probably contains an auricu-