Diseases of the heart and circulation in infancy and adolescence . m as rules for diagnosis, are,from the presence of adhesions—sometimes in one place andsometimes in another—rendered of little practical value, asshown by the difficulty experienced in making a diagnosis bythese rules in new cases, and even delaying the final solutionof the problem by, through not knowing where or whether,and hence not stating where or whether, adhesions existed,perpetuating erroneous views. Assuming, then, for the present that the infants (first)and the childs (second) pericardium is most likely to be thebest
Diseases of the heart and circulation in infancy and adolescence . m as rules for diagnosis, are,from the presence of adhesions—sometimes in one place andsometimes in another—rendered of little practical value, asshown by the difficulty experienced in making a diagnosis bythese rules in new cases, and even delaying the final solutionof the problem by, through not knowing where or whether,and hence not stating where or whether, adhesions existed,perpetuating erroneous views. Assuming, then, for the present that the infants (first)and the childs (second) pericardium is most likely to be thebest for studying the uncomplicated pericardial-effusion out-lines, and allowing that experiments made as directed in my 96 Keating and Edwards : Diseases of the Heart article in 1878 are correct until they are disproved—which sofar has not been done—the deductions which can be madefrom the results of these experiments are that the fluid ac-cumulates at the bottom of the pericardial sac, where it col-lects on either side of the arched diaphragm like a saddle,. Diagram I.—Small amount of liquid introduced into sac (Rotch). A, The portion of the area of absolutedulness which is still caused bythe physiological dulness of theheart. B • Liver. B , That portion of the liver which iscovered by the right lung. C, Lung. A + D, Area of percussion dulness foundwhen the effusion is small. S, Sternum.@, Nipple. 1,2,3,4,5,6, Ribs. - - - Broken line, Border of lung. Hi P, Illusion. extending to the right and to the left of the sternum; thatthe layer of fluid is a little the thickest in the left diaphrag-matic depression, almost as thick in the right, and then thatit gradually grows thinner as it ascends in the vertical line,and in a small effusion leaves a portion of the heart uncov- and Circulation in Infancy and Adolescence. 97 ered in the region of the 4th left costal cartilage, as seen inDiagram II. The recede before the fluid, as seen inDiagram I., and the absolut
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectheartdi, bookyear1888
