A Treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them, comprising the author's view of the physiology of the heart's action / by J. Hope.

  • Hope, James, 1801-1841.
Date:
1846
Catalogue details

Licence: Public Domain Mark

Credit: A Treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them, comprising the author's view of the physiology of the heart's action / by J. Hope. Source: Wellcome Collection.

Provider: This material has been provided by the Woodruff Health Sciences Center Library at Emory University, through the Medical Heritage Library. The original may be consulted at the Woodruff Health Sciences Center Library, Emory University.

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    and that if the wires be passed perpendicular to the tangent of the curved surface of the thorax, between the cartilages of the second and third ribs, half an inch from the left margin of the sternum, the semilunar valves of the pulmonary artery are entered. The aorta, from its origin, curves upwards towards the right, extending between the cartilages of the second and third ribs slightly beyond the right margin of the sternum; at the lower margin of the cartilage of the second right rib, the arch of the aorta commences and inclines to the left, crossing the pulmonary artery where it lies beneath the cartilage of the left second rib, and ascending as high as the first rib, turns downwards. The pulmonary artery, from its origin in contact with the sternum, commences at the left margin of that bone, where it is joined by the cartilage of the third rib, bulges at the interspace between the second and third cartilages close to the sternum, and dips beneath the aorta opposite the junction of the second cartilage and sternum. The right divisions of the heart, being most superficial, from the greater part of the anterior surface ; the right auricle reaches from the cartilages of the third right rib to that of the sixth ; and between the third and fourth, where its extent is the greatest, it extends, laterally, when filled with blood, near one inch and one third to the right of the sternum. About one third of the right ventricle lies beneath the sternum, and the remaining two thirds being to the left of that bone; the septum between the ventricles coincides with the osseous extremities of the third, fourth and fifth ribs, and on the fourth rib is midway between the left margin of the sternum and nipple. A small part, say one fourth, of the left ventricle, presents anteriorly, and when the lungs are separated, a portion of the left auricle is visible between the second and third left ribs two inches from the left margin of the sternum. With the exception of these portions, the whole of the left ventricle and auricle lie posteriorly to the right ventricle ; and the entire left divisions, with the ex- ception of a small portion of the base connected with the pulmonary valves of the aorta, lie on the left of the sternum. In the dead body, the normal situation of the tricuspid valve extends ob- liquely downwards from a point in the middle of the sternum immediately below the third rib, to the right edge of the sternum where that bone is con- nected with the lower margin of the cartilage of the fifth rib ; the mitral valve commences beneath the lower morgin of the left third rib, near the junction of its cartilage with its osseous extremity, (two and a half to three inches to the left of the sternum,) and runs slightly downwards, terminating opposite the left edge of the sternum, where it is joined by the upper margin of the carti- lage of the fourth rib.—P.] When the heart is enlarged, its longitudinal axis becomes placed more transversely, and its lateral diameter is increased. Hence, the right ventricle projects more considerably to the right, some- times under the whole breadth of the sternum; and the left extends far beyond its usual limits to the left, sometimes elevating by com- pression that portion of the lung which overlaps it, so as to bring nearly its whole surface, and the tip of the auricular appendix, into contact with the walls of the chest. In addition to being broader and placed more transversely, the organ descends lower than natu- ral—-its apex sometimes beating between the sixth and seventh ribs, and its pulsation extending to the epigastrium. When the right auricle is dilated or gorged, it extends upwards and to the right, and comes more extensively in contact with the sternum. When the pericardium is distended to the utmost with fluid, it