A treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them : comprising the author's view of the physiology of the heart's action and sounds, as demonstrated by his experiments on the motions and sounds in 1830, and on the sounds in 1834-5 / by J. Hope.

  • Hope, James, 1801-1841.
Date:
1839
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them : comprising the author's view of the physiology of the heart's action and sounds, as demonstrated by his experiments on the motions and sounds in 1830, and on the sounds in 1834-5 / by J. Hope. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    fingers or plessimeter firmly down, so as to condense the soft wall of the chest, and render it a better conductor of sound. Having just tried the experiment before several individuals placed at re- mote parts of a spacious room, I find that they readily distinguish the full, hollow tone of the middle lobe of the lung, the duller intonation of the lung overlapping the heart or liver, and the dead sound of the prsecordial region where the heart is in contact with the walls of the chest. Now, it is the object of cardiac percussion to ascertain the extent of this dead sound or dulness; because, as observation has demonstrated that it increases in proportion to the increased volume of the heart, and vice versa, it indicates with considerable nicety the actual dimensions of the organ. The mode of mani- pulation which I employ, is to place one finger over the decidedly dead part, and another over the slightly resonant edge of the lung, when, by striking the two fingers alternately, the arched line along which the organ lies in contact with the walls, may be traced with surprising accuracy, unless the subject be remarkable for obesity, which obscures the resonance. In females, the mamma may be pushed upwards, which generally leaves the dull portion sufficiently accessible. The extent of the dull portion in an average-sized adult with a well-proportioned heart, is represented by a circle of one and a half to two inches in diameter, supposing the individual to stand or lie without protruding the chest, and in a middling state of inspiration. When the heart is enlarged, as by hypertrophy, dilatation, fat, or even temporarily by congestion, the descent of the lungs being impeded, the dull portion increases and may attain the diameter of three, four, or, in extreme enlargement, even five inches. The centre of the dulness generally lies between the cartilages of the 5th and 6th ribs, but in great enlargement it lies lower, as be- tween the 6th and 7th ribs, because the organ is depressed by its own gravitation, except when held up by adhesion of the peri- cardium. In copious hydropericardium, I have known the dulness ascend under the sternum, in the conical form of the sac, as high as the level of the second rib; and I have repeatedly traced the gradual descent of the dulness in proportion as the fluid was absorbed.