. 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 . t borderof heart; broken line, its position as determined by percussion. (Cut one-third life size.) If by an X-ray examination we iind 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 DISP
. 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 . t borderof heart; broken line, its position as determined by percussion. (Cut one-third life size.) If by an X-ray examination we iind 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 outlinesdescribed 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 position from the normalmay suggest to the physician the diseased condition that has producedthis change. Displacement of the Heart.—The heart is suspended from above,and is surrounded by the pericardium, which is attached to the blood. Fig. 166. Alex. M. Cut shows the difference in the position of the left border of the heart as deter-mined by the X-rays and by percussion both before and after operation. (Cut one-third life size.) vessels above and to the diaphragm below; and its position may bemuch changed. It appears possible to find it either pushed or pulledinto almost any portion of the thoracic cavity. It may be found so lowin the chest that its pulsations are felt under the ensiform cartilage ; itmay be so pushed to the left that the apex is much outside the nippleline; or upward and to the right, so that the right border is above the DISPLACED HEART 285 line extending from the right nipple to the inner end of the clavicle(see Fig. 163, Harry M., Section III, page 281) ; or it may be pushedstill farther upward to the very top of the thoracic cavity. Figure 168(P.
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