Principles and practice of physical diagnosis / by John C. DaCosta ... ; with 225 original illustrations.

  • Da Costa, John C., jr., 1871-
Date:
1911
Catalogue details

Licence: Public Domain Mark

Credit: Principles and practice of physical diagnosis / by John C. DaCosta ... ; with 225 original illustrations. 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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    trunks, the trachea, esophagus, and thoracic duct, the thymus gland or its remnants, the bronchial and mediastinal glands, and the pneu- mogastric and phrenic nerves. It is convenient, for the sake of clear description, to divide the mediastinum into four arbitrary spaces,—superior, middle, anterior, and posterior,—upon whose anatomic differences the interpretation of mediastinal physical signs is to be based. The superior mediastinum lies above the pericardium, and is bounded anteriorly by the manubrium sterni, posteriorly by the bodies of the first four thoracic vertebrae, inferiorly by a line drawn obliquely from the lower border of the fourth thoracic vertebra to that of the manubrium, and laterally by the mediastinal pleurae. This section of the mediastinum contains the aortic arch, and the innomi- nate, left common carotid, and left subclavian arteries; the upper part of the superior vena cava and the innominate veins; the trachea, esophagus, and thoracic duct; the remains of the thymus gland and the superior mediastinal glands; and the phrenic, pneumogastric,' left recurrent laryngeal, and cardiac nerves. The middle mediastinum comprises the enlarged central portion corresponding to the pericardium and heart, in addition to which this space also contains the ascending aorta and its branches, the pul- monary artery, the lower part of the superior vena cava and the vena azygos major, the bronchial lymphatic glands, and the phrenic nerves with their accompanying vessels. The anterior mediastinum is a triangularly shaped space between the sternum and the pericardium, extending vertically from the lower border of the manubrium to the sixth or seventh costal cartilages. It incloses merely a group of lymphatic glands, the anterior medias- tinal, embedded in areolar tissue. The posterior mediastinum, which is virtually a downward exten- sion of the superior space, lies between the posterior surface of the pericardium and the spine, and corresponds to the bodies of the eight lower thoracic vertebras. The contents of this space are the de- scending thoracic aorta, the azygos veins, the esophagus, the thoracic duct, the pneumogastric nerves, and the posterior medias- tinal lymphatic glands. INSPECTION Inspection bears importantly upon the diagnosis of pulmonary diseases, the evidences of which are in some instances clearly shown by anomalies in the configuration of the chest and in the character of its respiratory movements. Cyanosis, edema, lymphadenitis, and enlargement of the superficial veins are additional signs, often-