. A practical treatise on medical diagnosis for students and physicians . rresponding to the attachment of the diaphragm. The bow is fre-quently seen in intrathoracic obstruction. THE SHAPE AND SIZE OF THE CHEST. 461 The Subcutaneous Tissue and the Muscles. In disease: oedema or sub-cutaneous emphysema may occur in the conditions mentioned under gen-eral inspection. If there is too much fat over the surface of the chest,the muscles may be wanting in tone, thus preventing an estimation of therespiratory capacity. The Ribs. In disease: wasting of the fat and muscles is seen inphthisis, carcinoma
. A practical treatise on medical diagnosis for students and physicians . rresponding to the attachment of the diaphragm. The bow is fre-quently seen in intrathoracic obstruction. THE SHAPE AND SIZE OF THE CHEST. 461 The Subcutaneous Tissue and the Muscles. In disease: oedema or sub-cutaneous emphysema may occur in the conditions mentioned under gen-eral inspection. If there is too much fat over the surface of the chest,the muscles may be wanting in tone, thus preventing an estimation of therespiratory capacity. The Ribs. In disease: wasting of the fat and muscles is seen inphthisis, carcinoma, diabetes, muscular atrophy, and paralysis. The degreeof softness of the ribs can be diagnosticated in a measure by undue depres-sion of the ribs at the costocartilaginous articulations and at the baseof the chest (about the sixth rib) during the act of inspiration. It is anindication of rhachitis. Eigidity of the thorax, equal to the senile fixa-tion, occurs in some adults in middle life, and, as Roberts points out, inyoung subjects may be due to congenital Transverse section of healthy male adult chest. Semicircumference, right side, 16% inches;left side, 16% inches; expansion, 3% inches. (Ward 6, Philadelphia Hospital.) The Shape and Size of the Chest. An acquaintance with the normalshape and size is a necessary preliminary to an understanding of the altera-tions in disease. In Health. The shape of the chest is the shape of its transverse sec-tion, which depends upon the relations of the anteroposterior and thetransverse diameters. It is that of an ellipse, and has been described asreniform. (See Fig. 133.) The anteroposterior diameter is about one-fourthless than the transverse. In children the transverse section is more cir-cular, the anteroposterior and transverse diameters being almost equal.(See Fig. 134.) In health the chest should be symmetrical, the right side probably alittle larger than the left. The muscles of respiration should be welldeveloped, and t
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