. Physical diagnosis . Fig. 40.—Funnel Breast. that of an adult, is far more nearly cylindrical; that is, the antero-posterior diameter is nearly as great as the lateral. The adultschest is distinctly flattened from before backward, although indi-vidual variations in this respect are considerable, as Woods Hutch-inson has shown. In childhood the commonest pathological modifications are due 62 PHYSICAL DIAGNOSIS. to adenoids or to rickets; in middle and later life to emphysema,phthisis, or old pleuritic disease (a) The Rachitic Chest The sternum generally projects (pigeon breast), but in someca
. Physical diagnosis . Fig. 40.—Funnel Breast. that of an adult, is far more nearly cylindrical; that is, the antero-posterior diameter is nearly as great as the lateral. The adultschest is distinctly flattened from before backward, although indi-vidual variations in this respect are considerable, as Woods Hutch-inson has shown. In childhood the commonest pathological modifications are due 62 PHYSICAL DIAGNOSIS. to adenoids or to rickets; in middle and later life to emphysema,phthisis, or old pleuritic disease (a) The Rachitic Chest The sternum generally projects (pigeon breast), but in somecases, especially when rickets is combined with adenoid hyper-trophy, there may be a depression at the root of the sternum re-sulting in the condition known as funnel breast1 (Figs. 40 and. Fig. 41.—Funnel Breast. 41). The sides of the chest are compressed laterally and slope into meet the sternum as the sides of a ship slope down to meetthe keel (pectus carinatuni) (Figs. 43 and 44). From the originof the ensiform cartilage a depression or groove is to be seen run-ning downward and outward to the axilla and correspondingnearly to the attachment of the diaphragm. This is sometimesspoken of as Harrisons groove. The lower margin of the ribs 1 In some cases this condition appears to be congenital. INSPECTION. 63 in front often flares out, owing to the enlargement of the liver andspleen below and the pull of the diaphragm above. Along the lineof the chondro-costal articulation there is to be felt, and sometimes
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