The physical signs of cardiac disease, for the use of clinical students . um, and in a line drawn transversely along the fourthrib, or in the male, through the nipple {vide Fig. VI.). Thenormal limits are as follows:—Dulness commences at the thirdrib and terminates at the sixth rib, but this latter limit cannotbe ascertained satisfactorily, owing to the junction of cardiacand liepatic dulness. Percussing from left to right, dulnessshould commence just within the nipple line, and should nottransgress the right border of the sternum. Though in healththe right auricle reaches to half an inch to t
The physical signs of cardiac disease, for the use of clinical students . um, and in a line drawn transversely along the fourthrib, or in the male, through the nipple {vide Fig. VI.). Thenormal limits are as follows:—Dulness commences at the thirdrib and terminates at the sixth rib, but this latter limit cannotbe ascertained satisfactorily, owing to the junction of cardiacand liepatic dulness. Percussing from left to right, dulnessshould commence just within the nipple line, and should nottransgress the right border of the sternum. Though in healththe right auricle reaches to half an inch to the right of the rightborder of the sternum, it lies beneath the comparatively thickborder of the right lung, and cannot be distinguished by percus-sion. It is to be noted, however, that there is often some slightdiminution of resonance for barely a fingers breadth along theright sternal margin at the level of the right auricle, in cases in PERCUSSION. 29 which there does not seem to be, from other evidence, anyenlargement of the auricle. This may be due to approxima-. Fig. VI. represents the method of percussion described in the text. The clear spaceindicates the normal anatomical area of the heart, the asterisks marking the spotswhere percussion, in the directions indicated, first detects the influence of the under-lying solid organ upon the lung resonance (as mentioned in the text, in healthdulness is hardly ever detectable to the right of the sternum). The dots representthe boundaries of abnormal dulness :—Extension upwards, indicating pericardialeffusion. Extension to the right, indicating enlargement of the right to the left, indicating enlargement of the left ventricle. The normalposition of the apex-beat is represented by an asterisk. The depressed apex-beat bya dot. The inferior extremity of vertical dulness is unsatisfactory. Valuableinformation as to the lower limit of the heart may be obtained from taking intoconsidei^ation the upper border of t
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