The skin passed naturally
over the chest from one side to another, but was raised at one
part of the groove by a pulsatile swelling which occupied the
position of the right auricle. The clavicle and the two margins
of the sternum had no connections whatever, and below the groove
was a hard substance corresponding to the ensiform cartilage,
which, however, was very elastic, and allowed the patient, under
the influence of the pectoral muscles, when the upper extremity
was fixed, to open the groove to nearly the extent of three
inches, which was more than twice its natural width. By
approximating his arms he made the ends of his clavicles overlap.
When he coughed, the right lung suddenly protruded from the chest
through the groove and ascended a considerable distance above the
clavicle into the neck. Between the clavicles another pulsatile
swelling was easily felt but hardly seen, which was doubtless the
arch of the aorta, as by putting the fingers on it one could feel
a double shock, synchronous with distention and recoil of a
vessel or opening and closing of the semilunar valves.
Madden pictures (Figs. 134 and 135) a Swede of forty with
congenital absence of osseous structure in the middle line of the
sternum, leaving a fissure 5 3/8 X 1 3/16 X 2 inches, the longest
diameter being vertical.
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