On rheumatic carditis / by Thomas B. Peacock.

  • Peacock, Thomas B. (Thomas Bevill), 1812-1882.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: On rheumatic carditis / by Thomas B. Peacock. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    cially in the vertical direction. The friction, however, generally disappears gradually, first below and then above at the upper part and right side of the prsecordial space. It may also, in some cases, be for a short time reproduced by making the patient draw a full breath or lean forwards, or in children, by making firm pressure on the chest with the stethoscope. This, however, can only occur when the fluid is small in quantity. When the friction-sound ceases to be heard, the heart's sounds may again become audible, and sometimes they are heard dis- tinctly and naturally, even when there is probably a consider- able amount of fluid. More generally, however, they are flat and imperfect, and when there is a large accumulation, much muffled or masked. When also there is much eff'u- sion, the area of dulness is very greatly extended, rising to the second or even to the first inter-cartilaginous space on the left of the sternum. The dull space has also a peculiar pyriform shape, being wider below and narrower at the upper part, and often there is a very obvious prominence in the prsecordial region. In some cases also, where there is a large accumulation, a wave- like pulsation can be perceived in several of the intercostal spaces. The rapidity with which the fluid is thrown out varies very much, so that in some cases the amount will be very large in a few hours, while in others the effusion will only very gradually increase. The duration of this stage is also very variable. The effused fluid is generally only slowly removed, but sometimes it dis- appears very quickly, so that in the course of a few days there may be a very rapid accumulation and equally rapid disappear- ance of fluid ; the quickness or slowness of the effusion and of the reabsorption being probably influenced by the greater or less intensity of the inflammation, and the larger or smaller proportion of fibrine contained in the effused fluid. Most generally, how- ever, the absorption is very gradual, the dulness on purcussion diminishing from above downwards ; and as the fluid disappears, the friction sound returns, being first heard at the upper part and right side of the dull space, and gradually falling to a lower level. The returning friction is generally of a harsher note than that which is first heard, and often towards the apex there is only a single systolic sound. The second friction may be only of short duration, or may be heard during a long period, and