File:Interstate medical journal (1909) (14780750531).jpg

Identifier: interstatemedica1619unse (find matches)
Title: Interstate medical journal
Year: 1909 (1900s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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ds from the fifth rib, is, of course, altogether above the fifthspace; the outer border of the rectus muscle of the abdomen passes upto the fifth cartilage, and limits the spot on its inner side; superficiallyto these parts the thick bundle of the great pectoral, which springsfrom the sixth cartilage, crosses above this spot, although a few thin INTRATHORACIC EFFUSIONS 559 fibres which arise from the sixth rib, and other which blend with theexternal oblique muscle of the abdomen or with the sheath of therectus, may pass over it; or the slender upper fasciculus of the obliquemuscle itself may cover it. Here, in fact, is a part of the chest wall,below the fifth rib and beneath the nipple relatively unprotected by theadjacent muscles. The internal intercostal muscle, the thin inter-costal fascia and the weakest portions of the great pectoral and theexternal oblique, together with the common fascia, are, beside the skin,the only coverings of the pleural sac in this situation. It is a very
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Fig. 4. This diagram shows the weak spot (*) in the chest wall; 011 the Oneside with the deep muscles bounding it, and on the other side covered by thesuperficial layer. weak part of the pleural boundary, and this is a valid reason whyspecial bulging and spontaneous perforation should occur preferentiallyin this region—that is, in the infra-mammilliary line in the fifth inter-space. It may also be remarked that this spot corresponds nearly withthe middle of the pleural cavity when that is much distended. An empyema may be regarded as a great pleural abscess, and, as weknow, abscesses often point opposite their center. It is further truethat the fifth intercostal space is wider than those below it, and itslimiting ribs being held to the sternum give firmness to its borders,conditions which may help the thinness of the chest wall here in de-termining the place of perforation. The spaces above are still widerand equally well supported by the ribs, and there is an inter-fascicularpart o

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