The Heart. 141 



tracted, such, for instance, as fibroid phthisis, etc. Abrams, 

 of San Francisco, in a paper illustrating, by means of 

 fluoroscopic drawings, the situation of the heart when 

 displaced upwards by dilitation of the stomach, showed 

 that, in extreme cases, it may be raised to such a degree 

 that the lower border corresponds to the level of the third 

 rib. He drew attention to a patch of dullness that could 

 be detected in the interscapular region, on the left side, 

 about the middle of the posterior border of the scapula, 

 when the heart was dislocated upwards by a dilated 

 stomach. He found that this dullness disappeared when 

 the patient leaned forwards and was then replaced by the 

 normal resonance of the lung, and he, therefore, concluded 

 that this dullness was due to compression of the lung by 

 the displaced heart. 



Lungs. On percussing from above downwards on 

 the right side and in the mammary line, the normal reso- 

 nant note of pulmonary tissue begins to change about the 

 upper border of the fifth rib, because of the underlying 

 liver "relative hepatic dullness." When the lower bor- 

 der of the sixth rib is reached this "relative" changes in- 

 to "absolute hepatic dullness," since here the liver is un- 

 covered by the lung, although it still has the pleura overly- 

 ing it, and this "absolute dullness" continues until the lower 

 limit of the chest is reached. On the left side, in the mam- 

 mary line, there is normal pulmonary resonance, from 

 above downwards, until the level of the sixth rib is reach- 

 ed, below which point, i.e., in the area of Traube's semi- 

 lunar space, the presence of the underlying stomach gives 

 a tympanitic note. On the right side, in the axillary line, 

 the normal resonance gradually lessens until about the 

 eighth rib when "absolute hepatic dullness" is reached. 

 This dullness ceases at the eleventh rib, to be replaced by 

 the tympanitic note of the intestine. In the left axillary 



