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Groux's case was in a person of forty-five, and the fissure had the vertical length of four inches. Hodgen of St. Louis reports a case in which there was exstrophy of the heart through the fissure. Slocum reports the occurrence of a sternal fissure 3 X 1 1/2 inches in an Irishman of twenty-five. Madden also cites the case of Abbott in an adult negress and a mother.
There is a case on record of a boy of fourteen who was shot in the right shoulder, the bullet entering through the right upper border of the trapezius, two inches from the acromion process. Those who examined him supposed the ball was lodged near the sternal end of the clavicle, four or five inches from where it entered. In about six weeks the boy was at his labors.
This will determine the fluidity and character of the exudate. If pus is found, a more radical surgical procedure than simple paracentesis must be done immediately. The point of puncture for aspiration most frequently chosen is in the fourth or fifth intercostal space, about an inch to the left of the sternal margin. Paracentesis is also often done in the region of the normal apex beat.
In the most exaggerated cases these fissures permit the exit of the heart, and as a general rule ectopies of the heart are thus caused. Pavy has given a most remarkable case of sternal fissure in a young man of twenty-five, a native of Hamburg. He exhibited himself in one medical clinic after another all over Europe, and was always viewed with the greatest interest.
The clavicle was fractured two inches from the acromial end, and the sternal end was driven high up into the muscles of the neck. The arm and hand were paralyzed, and the woman suffered great dyspnea. There was at first a grave emphysematous condition due to the laceration of several broken ribs. There was also suffusion and ecchymosis about the neck and shoulder.
This monster consisted of two females of about the same size, united from the sternal notch to the navel, having one cord and one placenta. It was stillborn. The diagnosis was made before operation by vaginal examination.
A curious mode of junction, probably the most interesting, as it admits of longer life in these monstrosities, is that of a simple cartilaginous band extending between two absolutely distinct and different individuals. The band is generally in the sternal region.
In the emu it accumulates all over the skin, but particularly on the rump, and between the shoulders, and round the sternal plate. To obtain the oil, we skinned those parts, and suspended them before a slow fire, and caught the oil in our frying pan; this was of a light yellowish colour, tasteless, and almost free from scent.
The apex of the heart is at a point about two inches below the left nipple and one inch to its sternal side. This point will be between the fifth and sixth ribs, and can generally be determined by feeling the apex beat. IV. Landmarks of a Few Arteries. The pulsation of the temporal artery can be felt in front of the ear, between the zygoma and the ear.
He began the interview by unbuttoning his waistcoat and asking me to listen at his fifth intercostal space, two inches from the left sternal line. I did so, and was shocked to hear a well-marked mitral regurgitant murmur. "It is of old standing," said he, "but of late I have had a puffiness about the ankles and some renal symptoms which show me that it is beginning to tell."
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