Diseases of the chest and the principles of physical diagnosis . ^ and intensitj not only in the course of a few. Fig. 215.—Peeic.\kdl^l effusion: the body being frozen in the recumbent posture andviews from behind. The heart is hypertrophied and dilated. Both lower pulmonarlobes are compressed, the left by the effusion, the right by the congested liver which hasbeen forced upward as the result of ascites (recumbent posture). The physical findingsare shown in Fig. 216. (Compare Figs. 175, 377, 378.) hours, but even at times from one heart beat to another. Leaning for-ward or lying on the left
Diseases of the chest and the principles of physical diagnosis . ^ and intensitj not only in the course of a few. Fig. 215.—Peeic.\kdl^l effusion: the body being frozen in the recumbent posture andviews from behind. The heart is hypertrophied and dilated. Both lower pulmonarlobes are compressed, the left by the effusion, the right by the congested liver which hasbeen forced upward as the result of ascites (recumbent posture). The physical findingsare shown in Fig. 216. (Compare Figs. 175, 377, 378.) hours, but even at times from one heart beat to another. Leaning for-ward or lying on the left side tends to intensify the sound while the rightlateral decubitus often diminishes it. The pericardial friction may havea shuffling triple rhythm very similar to gallop rhj^hm. Pericardial Knock.—During the recent war much interest wasaroused by the pericardial knock,^ a choking ^sound heard over theprecordium in certain cases of penetrating chest wounds, in the neigh-borhood of the pericardium. This sound is sometimes audible not onl}^ IS. M Smith: Br. Med. Jour., .Jan. 19, 1918. 17 258 THE EXAMINATION
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