Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
If the body be transfixed through any one of the intercostal spaces, the
instrument will surely wound some part of the lung. If the thorax be
pierced from any point whatever, provided the instrument be directed
towards a common centre, A, Plate 1, the lung will suffer lesion; for
the heart is, almost completely, in the healthy living body, enveloped
in the lungs. So true is it that all the costal region (the asternal as
well as the sternal) is a pulmonary enclosure, that any instrument which
pierces intercostal space must wound the lung.
As the sternal ribs degenerate into the "false" asternal or incomplete
ribs from before, obliquely backward down to the last dorsal vertebra,
so the thoracic space takes form. The lungs range through a much larger
space, therefore, posteriorly than they do anteriorly.
The form of the thorax, in relation to that of the abdomen, may be
learned from the fact that a gunshot, which shall enter a little below
N, Plate 1, and, after traversing the body transversely, shall pass out
at a corresponding point at the opposite side, would open the thorax and
the abdomen into a common cavity; for it would pierce the thorax at N,
the arching diaphragm at the level of M, and thereat enter the belly;
then it would enter the thorax again at P, and make exit below N,
opposite. If a cutting instrument were passed horizontally from before
backward, a little below M, it would first open the abdomen, then pierce
the arching diaphragm, and pass into the thorax, opposite the ninth or
eighth dorsal vertebra.
The outward form or superficies masks in some degree the form of the
interior. The width of the thorax above does not exceed the diameter
between the points I I, of Plate 1, or the points W W, of Plate 2. If we
make percussion directly from before backwards at any place external to
I, Plate 1, we do not render the lung vibrative. The diameters between I
I and N N, Plate 1, are not equal; and these measures will indicate the
form of the thorax in the living body, between the shoulders above and
the loins below.
The position of the heart in the thorax varies somewhat with several
bodies. The size of the heart, even in a state of perfect health, varies
also in subjects of corresponding ages, a condition which is often
mistaken for pathological. For the most part, its form occupies a space
ranging from two or three lines right of the right side of the sternum
to the middle of the shafts of the fifth and sixth ribs of the left
side. In general, the length of the osseous sternum gives the exact
perpendicular range of the heart, together with its great vessels.
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