British medical journal . 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 imij
British medical journal . 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 percussion, should regard. Fig. 2.—Areas of iuapairment in phthisis. the apical and interscapular impairment in these cases agevidence of lung involvement at the top of the upper andlower lobes respectively on the right side. There are,however, on further examination, certain well-markeddifferences between these signs and those of true phthisis. Tulierculosis of Trnclico-Bronchial gland disease the apicalimpairment is less markedthan that in the interscapularregion; it may be apiireciablebeliind only, and tends to varyin its amount at different ex-aminations. The interscapular dullnessin gland disease spreads outfrom the middle line, and hasa well-deliued outer border ifpercussion is made from with-out inwards. Phthisis. In phthisis, on the otherhand, it is the apical impair-ment which is the most markedand fixed, the lower lobe beingsecondarily involved, and tliercmay be, as coufirmatory evi-dence, some slight impairmentor contraction of Kroeuigsarea of resonance at the leftapex als
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Keywords: ., bookcentury1800, bookdecade1850, booksubjectmedicine, bookyear185
