. Medical diagnosis for the student and practitioner. enographic outline in mostinstances; though gross error is possible. (Repe-tition of figure 92 for added clearness.) If the superficial dulnesspasses to the right as a straight border or one concave and opening to theright, we may assume that the heart as a whole is displaced or that agreatly enlarged left ventricle is crowding over its fellow of the right side(v. Jagic). If its right percussion boundary is broken by a bulge to theright the change represents right ventricular enlargement. On the other hand, extension of the superficial area
. Medical diagnosis for the student and practitioner. enographic outline in mostinstances; though gross error is possible. (Repe-tition of figure 92 for added clearness.) If the superficial dulnesspasses to the right as a straight border or one concave and opening to theright, we may assume that the heart as a whole is displaced or that agreatly enlarged left ventricle is crowding over its fellow of the right side(v. Jagic). If its right percussion boundary is broken by a bulge to theright the change represents right ventricular enlargement. On the other hand, extension of the superficial area to the left alone orto the left and downward indicates left ventricular hypertrophy or dilatation,and if to the left and upward, an added left auricular enlargement. Casesin which decided right and left extension both are encountered are commonas the result of combined valvular lesions. In pericardial effusion it may be carried far beyond the right edge ofsternum as a parabolic curve, joining hepatic flatness below. THE EXAMINATION OF THE HEART 441. Area of Relative Dulness.—It has been so difficult formerly to accuratelyoutline the normal right heart that many modern diagnosticians still use theflat-finger method and the two arbitrary percussion areas shown in as representing the normal, and these serve fairly well to determineand measure any variation in the precordial area of ventricular orthopercussion method is far more accurate and greatly to be preferred.(See next page.) The most valuable information with relation to the right border lies, asstated, in the extension of the superficial cardiac area to the right beyond the median line as indicating right ventriculardilatation or hypertrophy or pericardialeffusion and the determination of anunduly wide extension of relative dulnessto the right, as determined by orthoper-cussion, threshold percussion or ausculta-tory percussion, indicating right auriculardilatation.* Value of the Sensation of Resistanc
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
