. A practical treatise on medical diagnosis for students and physicians . rom themedian line. The percussion-dulness is at the base of the chest andquite extensive. Arterial murmurs are not present. The pulsation is influ-enced by pressure and by respiratory movements. In mediastinal cancer we are aided by the discovery of enlargement ofthe glands in the axilla, neck, or elsewhere, or by a history of the growthin some other area. Aneurism must not be confounded with phthisis. The diseased vesselmay occlude a bronchus and cause collapse and bronchial dilatation; hem-orrhage may occur; bronchorr
. A practical treatise on medical diagnosis for students and physicians . rom themedian line. The percussion-dulness is at the base of the chest andquite extensive. Arterial murmurs are not present. The pulsation is influ-enced by pressure and by respiratory movements. In mediastinal cancer we are aided by the discovery of enlargement ofthe glands in the axilla, neck, or elsewhere, or by a history of the growthin some other area. Aneurism must not be confounded with phthisis. The diseased vesselmay occlude a bronchus and cause collapse and bronchial dilatation; hem-orrhage may occur; bronchorrhcea and cough always ensue. Fever isnot marked, which fact, with tracheal tugging, vascular physical signs,and the absence of tubercle bacilli, points to aneurism. X-ray Examination. By virtue of the large amount of blood andfibrin in an aneurism, the tumor is not pervious to the arrays, and in con- DISEASES OF THE MEDIASTINUM. 973 sequence is readily seen by fluoroscopic examination. Williams andothers have been very successful in recognizing an aneurism even when it. X-ray appearance in aneurism. (Pepper and Leonard.) could not be made out by physical signs. Such examination should beresorted to in all cases. (Fig. 356.) DISEASES OF THE MEDIASTINUM. Inflammation of the mediastinum may be limited to the glands or theconnective tissue, or may involve both. Moderate inflammation of the I glands, lymphadenitis, occurs in bronchitis and pneumonia, particularlyif bronchitis is of specific origin, as in measles or influenza. It is said I that such inflammation is of common occurrence in whooping-cough, andmay be the exciting cause of the paroxysms. DeMussy and Guiterashave found physical signs of enlargement, characterized by dulness in theupper part of the interscapular region, in cases of this disease and of in-fluenza. Other authorities, as Osier, dispute the possibility of this occur- 974 DISEASES OF THE HEART, BLOODVESSELS, AND MEDIASTINUM. rence, or at least of its recognitio
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