. The Roentgen rays in medicine and surgery as an aid in diagnosis and as a therapeutic agent : designed for the use of practitioners and students . heart is often difficult to place by percus-sion, because it lies away from the chest wall. The thickness of thiswall is another important factor to be taken into account when consid-ering the accuracy of percussion. That is, varying distances of theborder of the heart from the chest wall and variations in the thicknessof this wall would affect the results obtained by percussion. In a word, percussion as a rule indicates what hes near the innersid
. The Roentgen rays in medicine and surgery as an aid in diagnosis and as a therapeutic agent : designed for the use of practitioners and students . heart is often difficult to place by percus-sion, because it lies away from the chest wall. The thickness of thiswall is another important factor to be taken into account when consid-ering the accuracy of percussion. That is, varying distances of theborder of the heart from the chest wall and variations in the thicknessof this wall would affect the results obtained by percussion. In a word, percussion as a rule indicates what hes near the innerside of the chest wall (but not much beyond, as is shown by the failureto determine the cardiac border in pulmonary emphysema); but when DISPLACED HEART 283 a heart is much enlarged to the left it may lead the practitioner to a wronginterpretation of the conditions present. Small hearts may be recognized by an X-ray examination, and alsothe presence of an abnormal condition in congenital ability to recognize with certainty that the heart is smaller thannormal may be of much service to the patient both in treatment Fig. 165. Catherine P. January 2, 1899. X-ray tracing. Full line shows position of left borderof heart; broken line, its position as determined by percussion. (Cut one-third life size.) If by an X-ray examination we find in any patient (excluding acutediseases) an enlarged heart, we should consider among the probablecauses the presence of valvular lesions, arterio-sclerosis (especially inmiddle age and after), renal disease, and emphysema of the lungs; thislast condition would be very obvious by an X-ray examination. SECTION IV DISPLACED HEART We will now further examine the heart when the normal outhnesdescribed in the first section have been modified by conditions existingoutside of this organ. Various causes acting from without may change 284 THE ROENTGEN RAYS IN MEDICINE AND SURGERY the position of the heart, and this variation in pos
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