. Physical diagnosis . of the underlying disease; for example, the presence of enlargedglands in the neck, especially if there are any scars, sinuses, or otherevidence that suppuration is going on or has formerly taken placein them, suggests the possibility of pulmonary tuberculosis or of anenlargement of the bronchial and mediastinal glands. In childrencervical adenitis is most often a sign of bad teeth, tonsillitis andhead lice. Again, malignant disease of the chest or abdomen is some- INSPECTION 93 times associated with the metastatic nodules over the clavicle (seeFig. 85), and a microscopi
. Physical diagnosis . of the underlying disease; for example, the presence of enlargedglands in the neck, especially if there are any scars, sinuses, or otherevidence that suppuration is going on or has formerly taken placein them, suggests the possibility of pulmonary tuberculosis or of anenlargement of the bronchial and mediastinal glands. In childrencervical adenitis is most often a sign of bad teeth, tonsillitis andhead lice. Again, malignant disease of the chest or abdomen is some- INSPECTION 93 times associated with the metastatic nodules over the clavicle (seeFig. 85), and a microscopic examination of them may thus revealthe nature of the intrathoracic disease to which they are large and matted masses of glands above the clavicle, whichhave never suppurated and have been painless and slow in theirgrowth, suggest the presence of similar deposits in the mediastinumas a part of the symptom complex known as Hodgkins presence of a goitre or enlargement of the thyroid gland may. Fig. 85.—Sarcoma of Sternum and Cervical Glands. (Curschmann.) account for a well-marked dyspnoea. Axillary adenitis means mostoften peripheral sepsis, next tuberculosis, then metastatic cancer,leucaemia and Hodgkins disease. Inguinal adenitis (suppurative) ismost often a result of gonorrhoea. If non-suppurative, it is usuallydue to sepsis in the leg, syphilis, leucaemia and Hodgkins diseaseand metastatic cancer. Syphilis produces general glandular enlargement; the posteriorcervical and the epitrochlear glands are often involved, but this isalso the case in many diseases other than syphilis. CHAPTER V. PALPATION AND THE STUDY OF THE PULSE. I. Palpation. The most important points to be determined by palpation—thatis, by laying the hand upon the surface of the chest—are: (i) The position and character of the apex beat of the heart. (2) The presence of a thrill (see below). (3) The vibrations of the spoken voice ( tactile fremitus). (4) The presence of pleurit
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