Diseases of the heart and arterial system : Designed to be a practical presentation of the subject for the use of students and practitioners of medicine.
- Babcock, Robert H. (Robert Hall), 1851-1930
- Date:
- 1910
Licence: Public Domain Mark
Credit: Diseases of the heart and arterial system : Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![are connected with the external jugular veins, and are (1) in- spiratory swelling of the veins, known as KussmauVs sign, and (2) diastolic collapse of the veins, known as Friedreich's sign. In my experience these signs are not as frequently met with as is the drawing inward of the interspaces, and I do not recall an in- stance of diastolic collapse of the veins. Kussmaul's sign is pres- ent when i^ericardial adhesions prevent the dilatation of the right auricle that normally takes place during inspiration. Instead of the inspiratory act exerting an aspirating effect upon the contents of the veins, and thus collapsing them, the opposite effect is pro- duced, and the jugulars become visibly distended. Diastolic col- lapse does not appear to l)e limited necessarily to the jugulars, since Broadbent has observed it in the superficial veins on the front of the chest, and says it was due to traction of fibrous bands on the coats of the internal mammary vein uniting this vessel to the peri- cardium, and causing its sudden dilatation during ventricular re- laxation. In the case of the cervical veins their diastolic collapse is probably to be explained by the aspiratory force exerted by the sudden diastolic rebound of the right auricle, pulled upon as it is by adhesions between it and surrounding parts. Two other physi- cal signs that remain to be considered are best perceived by the hand, and are therefore described under palpation. Palpation.—In some exceptional instances the hand laid over the apex perceives a distinct sudden shock not synchronous with systole, but with diastole. It is spoken of, therefore, as the dias- tolic shock or rebound. It is caused by the pulling of fibrous adhe- sions which, put on the stretch during systole, pull the heart sud- denly back against the chest-wall after systole has ended. Such a rebound can scarcely be occasioned by any other condition than ex- ternal pericardial adhesions, and therefore by some is considered pathognomonic of the disease under discussion. I have observed it but twice, once in the patient whose case I have reported, and the other time in a man at Cook County Hospital who had, in addition, aortic insufficiency. The second ])lienomenon observable 1)V palpation is tlio pulsus paradoxus. Normally the pulse l)ecomes fuller and stronger to- wards the end of inspiration, smaller and weaker towards the end of expiration. In the paradoxic pulse, on the contrary, the re- verse obtains, strong ins]>iration causing a diminution in the force](https://iiif.wellcomecollection.org/image/b21229533_0144.jp2/full/800%2C/0/default.jpg)
