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Updated: May 1, 2025
Clevenger points out that the intercostal veins, which carry blood almost horizontally backward to the azygos veins and which would run vertically upward in quadrupeds, possess valves. These are not only useless to man, but when he lies upon his back they are an actual hindrance to the free flow of the blood.
In this connection Young mentions a patient of sixty-five who in January, 1860, injured his right thumb and lost the last joint by swelling and necrosis. Chloroform was administered to excise a portion of the necrosed bone and death ensued. Recently, Dalton records a remarkable case of stab-wound of the pericardium with division of the intercostal artery, upon which he operated.
"They lay beneath the mighty ribs as in a cage, of which the intercostal spaces were a foot in width, and the bars of a strength to maintain the enormous pressure of that which had surrounded and entombed them; they lay in one close group, their naked limbs smeared with the stain of their prison a man, a woman, and a tiny child.
The razzle. A great scoop rewarded with a razzle. My achievements are taken too much us a matter of course. I don't assert myself enough. I am too modest. Say, I smell liquor. Who's got a bottle? Somebody took a cork out of a bottle. Who was it? Say, Will, have you got a bottle?" "Thought you said that your doctor told you not to drink." "He did; he said that I had intercostal rheumatism.
It entered the back near the left clavicle, beneath the scapula, close to the vertebrae between the intercostal spaces of the fifth and sixth ribs; grazing the pericardium it traversed the mediastinum, barely touching the oesophagus, and vena azygos, but completely severing the thoracic duct, and lodging in the xiphoid portion of the sternum.
Various explanations of the heart pang have been suggested, such as a spasm or cramp of the heart muscle, sudden interference with the heart's action, as adherent pericarditis, a sudden dilatation of the heart, an interference with the usual stimuli from auricle to ventricle and therefore a very irregular contraction, a sudden obstruction to the blood flow through a coronary artery, or a sudden spasm from irritation associated with some of the intercostal or more external chest muscles causing besides the pang a sense of constriction.
Here and there the fierce sun, from whose active persecution we had just escaped, searched for us through the woods, but its keen blade was dulled and turned aside by intercostal boughs, and its brightness dissipated in nebulous mists throughout the roofing of the dim, brown aisles around us.
The position assumed is that which will give the left chest the greatest unhampered expansion, as though he would relieve all pressure on the heart. Besides the feeling of constriction, even to some spasm, perhaps, of the intercostal muscles, respiration is slowed or very shallow, because of the reflex desire of the patient not to add to the pain by breathing.
From this time I devoted special attention to it every week, and, with the exception of a few months from the sale of the Times to Dr. Hopson and Cozine till the establishing of the Guide, I have been constantly engaged in editorial work. About the middle of January I was taken down with intercostal rheumatism and spinal trouble, and was very low for several months.
The murmur caused by this lesion is a systolic one, either accentuated in the second intercostal space at the right of the sternum, or perhaps heard loudest just to the left of the sternum in this region. The murmur is also transmitted up the arteries into the neck, and may at times be heard in the subclavian arteries. It may also be transmitted downward over the heart.
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