Twentieth Century Practice - 1899 Author:Thomas Lathrop Stedman Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: ing of the right heart favors still greater pulmonary obstruction, and this iu turn adds to the burden of the right ventricle, thus completing the vicious circle... more ». The struggles of the ventricle become feebler and feebler, while the tension within its cavity constantly increases, as the blood presses into it from behind. At last there comes a moment when the overtaxed muscle cannot summon the energy for another contraction, and its action ceases in diastole. The steps which lead up to this result are in a great degree traceable by symptoms and physical signs. First of all, there are auscul- tatory and other signs of pulmonary obstruction; then come signs of general venous congestion. The distended right auricle may be traceable by percussion, or even may be seen pulsating at the right of the sternum. An increased area of cardiac dulness extending towards the xiphoid cartilage indicates the repletion of the right ventricle, and in spare subjects the labored beating of this may be felt by pressing the fingers under the costal cartilages. The superficial veins are seen to be unusually prominent, and the liver is enlarged. The spleen also is increased in size, and evidence of intestinal congestion may be afforded by copious diarrhoea. Proof of passive hyperaemia of the kidneys is found in lessened excretion and in albumiuuria. Thus all things combine to indicate a general preponderance of blood in the venous side of the circulation, the result which we should naturally expect from a retardation of the blood in the pulmonary vessels. Clinical Types. Bearing in mind that in a very large proportion of the community the potential cause of pneumonia is already present in the pueumo- cocci so often to be found in the air passages, it is easy to understand that a great variety of ...« less