Hints and directions for the use of clinical clerks and students of clinical medicine.

  • Royal Infirmary (Aberdeen, Scotland)
Date:
[1866?]
Catalogue details

Licence: Public Domain Mark

Credit: Hints and directions for the use of clinical clerks and students of clinical medicine. Source: Wellcome Collection.

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    Memoranda.—Take the nipple as a superficial landmark. It generally is situated over the fourth rib, about three quarters of an inch external to its cartilage. The heart’s apex beats between the fifth and sixth ribs, about an inch inward, And two inches downward from the nipple. The place and extent of the heart’s impulse vary, however, a little with the position of the body. In health, the extent of transverse dulness is from two to two and a-half inches. The sounds of the aorta are to be studied at the right edge of the sternum in the second intercostal space. From there the stethoscope may be carried to the second costal car¬ tilage of the right side—“the aortic cartilage”—and down to the left edge of the sternum opposite the third intercostal space : that is, not far from the seat of the aortic valves. The pulmonary orifice lies very close to them, but the artery itself extends to the second costal cartilage on the left side—“ the pulmonic cartilage.” Its sound may therefore be isolated in the second intercostal space, near the left edge of the sternum. The mitral is listened to immediately above the beat of the apex. The sounds of the tricuspid, and of the right ventricle, may be sought for in the vicinity of, and somewhat above the ensiform cartilage. The outline and movements of the large arterial trunks are not visible to the eye in a state of health. In very emaciated persons, the pulsation of the aorta in the epigas¬ trium may be seen, however; and if the arch of that vessel lies unusually high, slight impulsive motion may be visible in thin people above the sternal notch. The carotid pulses can scarcely be seen, if the neck be tolerably provided with soft parts ; the same statement applies to the smaller arteries. Nares.—Discharges, sneezing, movements of alse in respiration. Larynx and Trachea —Voice natural or altered in quality, hoarse¬ ness, difficulty of speech, aphonia, &c. If affected, observe condition of epiglottis, ton¬ sils, pharynx, by means of a spatula—of larynx, by laryngoscope. Lungs.—Inspection. ►Size, shape, mobility, of the whole chest, and r Respira¬ tory ^ system.