Transactions . andcentral tendon of the diaphragm, and the under-lying spleen, stomach, and left lobe of the liver,are much further lowered than the right bulge ofthe diaphragm and the liver. Where valvular disease exists, and the case is oflong standing, (Diagrams 24 and 25,) the left bulgeof the diaphragm and the liver are displaced to anextent nearly proportional to that of the left bulge. Protrusion of the Ribs.—The lower two-thirds ofthe sternum and the attaching costal cartilages oneach side of it, more especially the left, the xyphoidcartilage, and the sixth and seventh costal cartilage
Transactions . andcentral tendon of the diaphragm, and the under-lying spleen, stomach, and left lobe of the liver,are much further lowered than the right bulge ofthe diaphragm and the liver. Where valvular disease exists, and the case is oflong standing, (Diagrams 24 and 25,) the left bulgeof the diaphragm and the liver are displaced to anextent nearly proportional to that of the left bulge. Protrusion of the Ribs.—The lower two-thirds ofthe sternum and the attaching costal cartilages oneach side of it, more especially the left, the xyphoidcartilage, and the sixth and seventh costal cartilages,are all pushed forwards ; the whole of the lower leftribs are pushed outwards by the displacement ofthe apex. The adhesions of the heart lay hold ofthe costal walls as the heart enlarges, and draw OF THE INTERNAL ORGANS. 567 26.—UNIVERSAL PERICARDIAL ADHESIONS. Eliza Bliohton, aged ID; Universal Strong Girdling Pericar-dial Adhesions, preventing the Expansion of the Cavities iValves healthy; Heart 1. Right lung; 1. Left lung.—2. Ventricles 3. Right auricle 4. Vena cava.—5. Aorta.—6. Pulmonary artery 7. Liver.—8. Stomach 9. Spleen. Kidneys. Weight of Organs—Lungs, each, 11 ounces; heart, Q\ ditto; liver, 37 ditto;spleen, 6 ditto ; pancreas, 3 ditto; kidneys, each, 4 ditto. Symptoms Hearts region of superficial dulness, impulse, and sounds, normal. Pulse very feeble ; palpitation, dyspnoea, and anasarca ; lips blue. 568 ON CHANGES IN THE SITUATION those cartilages outwards to the left; the loweredge of the conjoined sixth, seventh, eighth, andhinth left costal cartilages, to the side of thexyphoid cartilage, is much raised, and these car-tilages and their attached ribs project to the leftside. (Diagrams 22, 23, 24, and L. 14.) Extent of the Hearts superficial dutness.—Theextent of the hearts superficial dulness is very great;its margin rises as high as the third costal cartilage,descends below the middle of the xyphoid cartilage,is about a ribs b
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