British medical journal . lts, especially in those Vvith thick dorsalmusculatuie. The Bight-sided Dullness of Gland —It is anincrease in size and in dullness of this area on the right sidewhich constitutes the sign I desire to bring to your normal impairment becomes more marked, beingof teu sufficient to be termed • dullness, and extends out twoor three inches from the middle line. The area extendsdownwards to the sixth, seventh, or even the eighthvertebral spine, while its outer limit, mapped by per-cussion from without inwards, forms a well-delined curvedline, though the
British medical journal . lts, especially in those Vvith thick dorsalmusculatuie. The Bight-sided Dullness of Gland —It is anincrease in size and in dullness of this area on the right sidewhich constitutes the sign I desire to bring to your normal impairment becomes more marked, beingof teu sufficient to be termed • dullness, and extends out twoor three inches from the middle line. The area extendsdownwards to the sixth, seventh, or even the eighthvertebral spine, while its outer limit, mapped by per-cussion from without inwards, forms a well-delined curvedline, though the note outside it is sometimes not so goodas that over corresponding parts of the opposite lung. Itis interesting and important that this clear outerlimit can be shown to undergo a distinct resi)iratoryfluctuation during deep breathing. There is also presentin nearly all cases slight impairment at the apex of thelung, both front and back, with some diminution of thearea of apical resonance as described by Kroenig. It is. Fig. -Arcas oi in tuberculosis oftracheo-broncbial tla-uda. this apical impairment that leads most of these cases,when found, to receive the diagnosis of phthisis inchildren. I have had many .such sent to mo at my chestliospital from surrounding schools with this diagnosis,proving that the signs are sufficiently coarse to be dis-coverable in a noisy school clinic, and that a need hasthus arisen for their true distinction is, indeed, of the highest importance; alung infiltration on the one liaud, a condition of serious imijort; on the other hand, a mere change of au- content,in all probability due to interference with certain linesof communication. It may, perhaps, be as well at this place to emphasizethe points in which the signs differ from those of apicalphthisis in children. It seems very natural, at tirst sight,that tbe clinician, especially if he places what I shouldlike to call a proper reliance on percussio
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Keywords: ., bookcentury1800, bookdecade1850, booksubjectmedicine, bookyear185
