Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The aorta, C, Plates 1 and 2, is behind the upper half of the sternum,
from which it is separated by the pericardium, D, Plate 1, the thin edge
of the lung, and the mediastinal pleurae, U E, Plate 1, &c. If the heart
be injected from the abdominal aorta, the aortal arch will flatten
against the sternum. Pulmonary space would not be opened by a
penetrating instrument passed into the root of the neck in the median
line above the sternum, at L, Plate 1. But the apices of both lungs
would be wounded if the same instrument entered deeply on either side of
this median line at K K. An instrument which would pierce the sternum
opposite the insertion of the second, third, or fourth costal cartilage,
from H downwards, would transfix some part of the arch of the aorta, C,
Plate 1. The same instrument, if pushed horizontally backward through
the second, third, or fourth interspaces of the costal cartilages close
to the sternum, would wound, on the right of the sternal line, the vena
cava superior, G, Plate 1; on the left, the pulmonary artery, B, and
the descending thoracic aorta. In the healthy living body, the thoracic
sounds heard in percussion, or by means of the stethoscope, will vary
according to the locality operated upon, in consequence of the variable
thickness of those structures (muscular and osseous, &c.,) which invest
the thoracic walls. Uniformity of sound must, owing to these facts, be
as materially interrupted, as it certainly is, in consequence of the
variable contents of the cavity. The variability of the healthy thoracic
sounds will, therefore, be too often likely to be mistaken for that of
disease, if we forget to admit these facts, as instanced in the former
state. Considering the form of the thoracic space in reference to the
general form of the trunk of the living body, I see reason to doubt
whether the practitioner can by any boasted delicacy of manipulation,
detect an abnormal state of the pulmonary organs by percussion, or the
use of the stethoscope, applied at those regions which he terms
coracoid, scapulary, subclavian, &c., if the line of his examination be
directed from before backwards. The scapula, covered by thick carneous
masses, does not lie in the living body directly upon the
osseous-thorax, neither does the clavicle. As all antero-posterior
examination in reference to the lungs external to the points, I I,
between the shoulders cannot, in fact, concern the pulmonary organs, so
it cannot be diagnostic of their state either in health or disease. The
difficulties which oppose the practitioner's examination of the state of
the thoracic contents are already numerous enough, independent of those
which may arise from unanatomical investigation.
DESCRIPTION OF PLATES 1 & 2.
PLATE 1.
A. Right ventricle of the heart.
B. Origin of pulmonary artery.
C. Commencement of the systemic aorta, ascending part of aortic arch.
D. Pericardium investing the heart and the origins of the great
bloodvessels.
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