. Medical diagnosis for the student and practitioner. and narrow epigastric angle. If the patient is thinthe neck is long and slender and the projecting scapulae give it its somewhatfanciful name. Of itself the possession of an alar chest or one of itsmodifications does not prove the existence of a tuberculosis but is rather one ofthe expressions of congenital asthenia which offers to the tubercle bacillusthe most favorable soil for its development. The most striking examples are seen in cases of advanced tuberculosis withextreme emaciation, yet the same skeletal type of chest may be observedi
. Medical diagnosis for the student and practitioner. and narrow epigastric angle. If the patient is thinthe neck is long and slender and the projecting scapulae give it its somewhatfanciful name. Of itself the possession of an alar chest or one of itsmodifications does not prove the existence of a tuberculosis but is rather one ofthe expressions of congenital asthenia which offers to the tubercle bacillusthe most favorable soil for its development. The most striking examples are seen in cases of advanced tuberculosis withextreme emaciation, yet the same skeletal type of chest may be observedin plump individuals. Various Deformities.—The rachitic chest is best exemplified by the pigeonbreast, and the transversely constricted thorax indicates the coincidence ofdeficient nutrition and some chronic obstruction to breathing in childhood,usually adenoids. The line of retraction is that of the diaphragmatic at-tachment indicating its close relation to imperfect chest expansion. ^RgT$SS£ * - jfl IM&S>~s-f-;.-.^ ^^ I*.. ?PSf -?^?. Fig. 99.—Pigeon breast (rickets). Fig. 100.—Funnel breast (trichterbrust).In this case congenital. A beading of the ribs at the chondro-costal articulations is well known asthe rickety rosary. Trichterbrust is of little importance in diagnosis, though an interestingand striking phenomenon. It is represented by a groove involving chieflythe median inferior portion of the chest deepening from above downward andcorresponding to the second portion of the sternum, the ensiform often point- THE EXAMINATION OF THE LUNGS AND PLEURAE 285 ing sharply forward. Usually congenital, it may be occupational in thosewho in early life have performed work necessitating continuous pressure overthis region. The thorax en bateau observed in certain cases of syringomyelia showsa deep anterior median groove of less limited vertical extent. Localized Changes in Outline.—These are of much more significance thangeneral deformities, and marked retraction of one s
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
