Transactions . of the sternum. As the lungs arekept asunder from the great vessels by the pericar-dial bulge, they lap partially round that bulge andlie by its side ; and they take its direction. Theform of the separation of the lungs from each otherbehind the upper part of the sternum, when inducedby, is quite characteristic of, pericardial effusion. In the subject of diagram 19 the distension of thesac lessened the volume of the heart, by squeezingout the contents of the cavities and raising its lowerborder. The lungs were pushed much apart fromeach other ; the central tendon, instead of bei
Transactions . of the sternum. As the lungs arekept asunder from the great vessels by the pericar-dial bulge, they lap partially round that bulge andlie by its side ; and they take its direction. Theform of the separation of the lungs from each otherbehind the upper part of the sternum, when inducedby, is quite characteristic of, pericardial effusion. In the subject of diagram 19 the distension of thesac lessened the volume of the heart, by squeezingout the contents of the cavities and raising its lowerborder. The lungs were pushed much apart fromeach other ; the central tendon, instead of beingflat or slightly convex upwards, was pushed down,and formed a bulge into the cavity of the abdomen,which displaced the liver to a considerable extent.(See diagrams 12 and 19.) The same displacementsare induced in the living by pericardial effusion. OF THK INTERNAL ORGANS. 529 19.—ARTIFICIAL DISTENSION OF THE PERICARDIALSAC BY FLUID. Alfred Duke, aged 36, Patient of Mr. White; CompoundFracture of both I. Right lung before the distension of the pericardium; 1. Left lung beforethe distension of the pericardium ; Inner margins of both lungs displacedby the distension of the pericardium 2. Outlines of the pericardium before arti-ficial distension ; 2a. Outlines of the pericardium after artificial distension by fluid ;26. Anterior margin of the central tendon of the diaphragm, where it is adherentto the pericardium, displaced downwards by the pericardial distension ; 2 c. Down-ward bulge of the central tendon, caused by the pericardial distension ; 2. Lowerboundary of the heart before the pericardium was distended ; 2d. Lower boundary of the heart raised by the pericardial distension 4. Vena cava.—7. Liver; 7«». Lower edge of the liver displaced downwards by the pericardial distension. «• Stomach. (See pp. 527-28.) 530 ON CHANGES IN THE SITUATION For instances of pericardial effusion in the livingsee diagrams L. 9, 10, and 11. In all of them theeffusion and
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