. Journal of radiology . screen. This tug-ging was accentuated during M EDI ASTINOPERI CARDITIS—ERNST deep inspiration, forcibly pullingthe left diaphragm for a distanceof at least three centimeters witheach pulsation of the observation along theheart margins did not reveal simi-lar fixations, with the exceptionof an area along the left superiorventricle border of the heart, atwhich point very moderate trac-tion of the lung markings could beobserved. However, the fixationwas not very marked and notnearly so graphic as those ob-served in the apical region of the heart. The posteri
. Journal of radiology . screen. This tug-ging was accentuated during M EDI ASTINOPERI CARDITIS—ERNST deep inspiration, forcibly pullingthe left diaphragm for a distanceof at least three centimeters witheach pulsation of the observation along theheart margins did not reveal simi-lar fixations, with the exceptionof an area along the left superiorventricle border of the heart, atwhich point very moderate trac-tion of the lung markings could beobserved. However, the fixationwas not very marked and notnearly so graphic as those ob-served in the apical region of the heart. The posterior mediastinalspace density was definitely in-creased. The radiographic observationscorroborated the above findings,with the exception of the fluoro-scopically observed left cardiodia-phragmatic tug. The actual fixa-tion could not be visualized on theradiographic plate. The obliquediameter of the heart was 19 centi-meters, while the transverse dia-meters totalled centimeter,at the usual one meter target Fig. 2—Cardiolysis (Brauers operation). Resection ofthe third, fourth and fifth ribs and cartilages in orderto free the pericardium from its adhesions to theperiosteun of the anterior chest wall. The adhesionswere not directly severed, but the fixed bony struc-tures were removed to allow the heart to descend to alower level in the thoracic cavity, thereby relievingthe anterior tension on the pericardium. Operationby Dr. Harvey G. Mudd. Page Thirty-three M KDIASTIXOIKRKW RDITTS Operation In view of the above clinicaland more recent conclusive Roent-genological findings, cardiolvsis(Brauers operation), was finallyadvised, and Dr. Harvey G. Mnddoperated on January 21st, 1920,under a local black anaesthesia. Aresection of the third, fourth andfifth left ribs was made for a dis-tance of from three to fonr inches,beginning along the left border ofthe sternum and extending to-ward the axilla slightly beyondthe limits of the cardiac pulsa-tions. Immediately followin
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