Tuberculosis : its nature, prevention and treatment with special reference to the open air treatment of phthisis / by Alfred Hillier.
- Date:
- 1900
Licence: In copyright
Credit: Tuberculosis : its nature, prevention and treatment with special reference to the open air treatment of phthisis / by Alfred Hillier. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
78/283 page 52
![Careful scrutiny of the apices, both from behind, in front, and above, during respiration may determine the presence of defective expansion of these parts, a most important early sign. The snpra-spinous and supra-clavicular regions may bo much depressed if a cavity exist in the upper lobe of the lung, and the scapula and clavicle be markedly prominent. Expansion is then much diminished. In chronic phthisis with much fibroid conti'action the intercostal s])aces are depressed, expansion during respiration almost absent, and the cardiac impulse displaced and diffused. The modification in the appearances of the chest walls is so marked in advanced stages of phthisis that one sometimes questions whether the so-calle<l “ typos” of chest said to be jiocnliarly favourable to phtliisis are not effects rather than causes. (2) Palpation.—Careful palpation of the apices, and comparison between other similar areas of the chest, in conjunction with inspection, ma}' determine a diminution of expansion and so point to commenc- ing disease, even though porcu.ssion is negative. To gauge the vocal fremitus the patient should utter, with a full, strong intonation, .such words as “ one, one, one,” or “ ninety - nine,” and a careful com- parison between the two sides of the chest be made. An increase of fremitus is caused by consolidation (tubercnlous or otherwise) and by vomicm when they freely communicate with a bronchus; but a pleuritic thickening or effusion may diminish or even oblit- erate it. The fremitus, it .should bo remembered, is normally greater on the right side. (.S) Percussion.—In the early stages percussion often fails to give positive evidence, but if it be per- formed lightly over the clavicles, especially after a](https://iiif.wellcomecollection.org/image/b21988614_0078.jp2/full/800%2C/0/default.jpg)
