540 ON PULSATION IN THE JUGULAR AND OTHER VEINS. 



in a similar manner, it also became very much distended. On 

 relaxing the pressure, it quickly emptied, and when I alternately 

 increased and diminislied the pressure, the alternate filling and 

 emptying produced an appearance of pulsation. If it was 

 compressed with the finger simultaneously with each beat of 

 the pulse, an exact imitation of the pulsation observed in the 

 left jugular was produced. It therefore appeared to me that 

 the pulsation in the left jugular was simply due to alternate 

 compression and relaxation of the innominate vein by the aorta, 

 during its dilatation and contraction at each beat of the heart. 

 Since my attention has been attracted to this unilateral jugular 

 pulsation, I have observed several cases of it. These have all 

 been females, and all have been more or less aniemic. Th& 

 following cases may serve as examples : — 



Kosana R, a^t. 22, cartridge maker, in following her occupa- 

 tion, stands in a close room. About twelve months ago she- 

 began to get very pale. She had no fright, but during the 

 course of the last year she has had much worry. The patient is- 

 markedly chlorotic ; menstruation is regular, but scanty ; the- 

 bowels are constipated ; tongue clean ; appetite rather poor. 

 There is an anaemic murmur over the pulmonary cartilage ; the 

 cardiac sounds are otherwise healthy. There is ap])arent pul- 

 sation in the left jugular vein, none in the right. When either 

 jugular is compressed, it fills very rapidly. On compressing 

 the right jugular with the finger at each beat of the pulse, 

 apparent pulsation is produced in it. On first beginning to- 

 auscultate, the pulsation in the left jugular was very distinct.. 

 The heart's action was somewhat excited. As the agitation 

 of the patient subsided, the pulsation in the left jugular 

 diminished, and finally disappeared. It did not return when 

 the patient walked across the room, but she could only be- 

 induced to do so slowly. 



Elizabeth G., a3t. 19, is also very pale. For nearly nine months 

 she has had a slight cough, and has been losing flesh. Her appetite- 

 is very poor ; the bowels are regular ; she has not menstruated 

 for the last three months. Percussion sounds are normaL 

 There is a slight click at the end of inspiration over the right 

 infraclavicular region. The breath sounds are otherwiso 



