Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . eme cases, may overlap each other, especially in thelower portion. The ribs are. more oblique than nor-mally, giving that side of the chest a longer andnarrower appearance. The mamma is nearer the medianline; the top of the shoulder is lower than its fellow onthe opposite side; the scapula is nearer to the spinalcolumn, and the spinal column is curved, the con-vexity looking towards the opposite side. The move-ments of the affected side are diminished, restricted, ormay even
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . eme cases, may overlap each other, especially in thelower portion. The ribs are. more oblique than nor-mally, giving that side of the chest a longer andnarrower appearance. The mamma is nearer the medianline; the top of the shoulder is lower than its fellow onthe opposite side; the scapula is nearer to the spinalcolumn, and the spinal column is curved, the con-vexity looking towards the opposite side. The move-ments of the affected side are diminished, restricted, ormay even be absent. The supraclavicular fossa is deeperthan normal. INSPECTION. 55 Unilateral diminution in size may be due to (1)primary arrest of development, as occurs in infantilehemiplegia, etc., when the asymmetry is not limited tothe thorax alone, but generally over the entire lateralhalf of the body; and the affected side, although smallerthan the opposite, preserves its normal physiologicalfeatures. Unilateral diminution in size also occurs when thereis atrophy or loss of function of the muscles of normal Fig. Unilateral retraction of chest, consequent upon cirrhosis of left a girl of fourteen years. The figures indicate anteroposterior andtransverse diameters and semi-circumferences of right and left half ofchest. (Gee.) inspiration. In this condition retraction of the sidecan only occur when the condition has lasted for a longtime, and the unopposed traction or negative pressureof the lung has been sufficient to cause a gradual de-pression of the ribs. (2) Diseases oe the Pleura.—Marked retractionof the thorax occurs in diseases of the pleura, especiallyafter absorption of the fluid in pleurisy with effusion: 53 !TBE RESPIRATORY SYSTEM. when changes occur in the lung or in the pleurae whichprevent the lung thoroughly filling the thorax, as pul-monary collapse, fibrosis, chronic thickening of thepleura and adhesions of the two surfaces of the pleura. (3) Changes
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