. American practice of surgery ; a complete system of the science and art of surgery . va, the highestpoint in the central tendon, has a fixed position. The edges of this opening beinginextensible and continuous ^\ith the external coat of the vessel, the vein re-mains patulous throughout the respiratory act, and the blood is therefore suckedup through the cava into the thorax whenever the diaphragm contracts. Itis the contraction of the diaphragm, and not its descent, that is necessary foreffecting this result. Forbes further considers that it is by the traction of the THE DIAPHRAGM. AND SUBPH
. American practice of surgery ; a complete system of the science and art of surgery . va, the highestpoint in the central tendon, has a fixed position. The edges of this opening beinginextensible and continuous ^\ith the external coat of the vessel, the vein re-mains patulous throughout the respiratory act, and the blood is therefore suckedup through the cava into the thorax whenever the diaphragm contracts. Itis the contraction of the diaphragm, and not its descent, that is necessary foreffecting this result. Forbes further considers that it is by the traction of the THE DIAPHRAGM. AND SUBPHRENIC ABSCESS. 457 diaphragm through this fibrous structure that the closure of the ductus arterio-sus of the newly born infant is effected. This influence of the diaphragm upon the circulation is shown by the factthat the first effect of an injury inflicted upon this organ is experienced by theheart; and, in support of this, are adduced the cases of Deruginsky, Reeve, andothers, to be presented farther on. If one side of the diaphragm is lacerated or paralyzed, the heart is pushed. Fig. 187.—Superficial Layer of Diaphragm Stained with Silver Nitrate, etc., Showing the LatticeWork of Fibres Overhing the Lacuna. (W. G. MacCallum, in the Johns Hopkins Hospital Bulletin,May, ) over to the opposite side by the atmospheric pressure, the lateral fibrous scaffold-ing being no longer supported on the affected side. In bilateral paralysis, theheart is pushed backward. III. NEW-GROWTHS OF THE DIAPHRAGM. Almost no mention of tumors of the diaphragm is made in literature. Twocases of secondary sarcoma of this organ will be mentioned below\ It is notbeheved that sarcoma of the diaphragm is ever primary. Instances of lipomaof the organ are known, and this is not surprising since some fat naturally existsin the diaphragm. Enchondroma can easily encroach on it, as tumors of thisnature are of frequent occurrence on the costal arch. Cysts have been dis-covered on the diaphragm and their
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
