LOCAL COXTKACTION OF YEIXS. 541 



normal. There is a systolic bruit over the pulmonaiy carti- 

 lage ; the heart's sounds are otlierwise normal. Pulse, 150, 

 M'hen the patient is standing. The left jugular vein pulsates 

 visibly, but only during expiration. During inspiration the 

 vein empties completely. There is no pulsation in the right 

 jugular, and that in tlie left is stopped by pressure above the 

 clavicle. It may be imitated in the right jugular by pressure 

 V ith the finger. There is no distinct venous hum. 



Margaret B. came to the hospital complaining of weakness 

 and nervousness. While in attendance, she began to suffer 

 from vomiting, and, a week or ten days after the vomiting com- 

 menced, she spat a little blood. Her nose also bled frequently 

 a,bout seven in the evening. There was no abnormal pulmonary, 

 or cardiac sound. On one occasion, a curious persistent con- 

 traction of the jugular vein was noticed at the i)lace where her 

 collar had pressed upon it.* 



In the case of Rosana 11., the pressure exerted by the aorta 

 on the left innominate vein was insufficient to produce the pul- 

 sation when the circulation was quiet, but it did so when it was 

 excited by emotion. In that of Elizabeth G., it w^as insufficient 

 to produce it when the thorax was dilated and the sternum 

 raised by inspiration, but did so when the thorax had collapsed 

 <and the sternum had fallen during expiration. In all of them 

 the peripheral vessels were dilated, so that the vein filled very 

 rapidly during compression, and but for this no appearance of 

 pulsation would have been produced. These few observations 

 may serve to direct attention to a cause of jugular pulsation 

 which, so far as I can find, is not generally recognised. 



There is another venous pulsation which is also omitted from 

 modern text-books, although it is to be found in the older 

 writers. This, however, is not a simulated, but a real, pulsa- 

 tion, occurring in the pulmonary veins, and in the vena cava. 

 Some time ago, Sir Joseph Fayrer and I foundf that occasionally 

 the pulmonary veins and the vena caA^a in rabbits might be 

 «een to pulsate rhythmically for a considerable time after the 

 auricles and ventricles had become perfectly still. In one 



* Compare antea ** Local conlraction of arteries," p. 178. 

 t Cf. p. 523. 



