Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . clavicle with the scapula*and sternum alters the depressions above the clavicles,increasing their depth, the intercostal spaces are deep-ened. The shoulder blades are depressed and stand outfrom the ribs, giving the winged appearance (alar, orpterygoid). The movements on quiet breathing may be nearlynormal in frequency and extent, but on exertion orforced breathing expansion is less than normal, andthe movements become more rapid. This type may be simulated in marked emaciati
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . clavicle with the scapula*and sternum alters the depressions above the clavicles,increasing their depth, the intercostal spaces are deep-ened. The shoulder blades are depressed and stand outfrom the ribs, giving the winged appearance (alar, orpterygoid). The movements on quiet breathing may be nearlynormal in frequency and extent, but on exertion orforced breathing expansion is less than normal, andthe movements become more rapid. This type may be simulated in marked emaciation bydiminution in the soft parts which normally give the INSPECTION. 49 rounded contour to the upper portion of the chest. Lackof muscular development, or changes in the muscles ofrespiration, such as occur from long recumbence in bed,cause slight depressions of the bony thorax, due to feebleinspiratory efforts. Symmetrical depressions of thethorax in the above conditions are easily differentiatedfrom those dependent upon pathological intrathoracicconditions by noting that the normal contour of the bony Fig. Transverse section of a rachitic chest at level of sixth thoracic vertebrae. Circumference, 32% inches; right half, 16% inches; expansion, 2 inches. thorax is preserved, although there may be a slightflattening of the chest. This type of chest has also been called thePhthisical. In many cases of pulmonary tuberculosisthe flattening of the thorax is more apparent than real,being due to the marked emaciation and loss of muscle-tissue. Actual measurements in cases of pulmonarytuberculosis often show that both diameter are below 50 THE RESPIRATORY SYSTEM. the normal, but the antero-posterior not more so thanthe transverse. The diminution in the size of the bonythorax gives the chest a flattened look on account of theprominence of the shoulders, clavicle and scapula. Athorax flattened at the upper portion is of especialimport, as it occurs most frequently in connection wit
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