A paper on the management of the shoulders, in examinations of the chest : including a new physical sign : read before the New York Academy of Medicine / by John W. Corson.

  • Corson, John W., 1816-1882.
Date:
1859
Catalogue details

Licence: Public Domain Mark

Credit: A paper on the management of the shoulders, in examinations of the chest : including a new physical sign : read before the New York Academy of Medicine / by John W. Corson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    TIL Elevating the shoulders{fig. 8) by crossing and grasping the a/rms tightly behind the head so as to hoist the scapula) to the highest point, and help uncover the lower part of the lungs at the back.—To be candid, this showy figure has seemed the least useful of all. Yet a refer- ence to the accompanying table of measurements, shows that by it we both separated and lifted the inferior angles of the sca- pulae to the greatest possible distance. And on examining them as thus twisted round, on the living subject, it will be seen that by this means there is considerable thinning of the latissimus dorsi and lower part of the trapezius muscles. There is a triangular space, just at the base of the lung posteriorly, where it really aids us in diag- nosis. We have tested this in a few cases of pneumonia and limited pleuritic effusion low down. Injustice, then, it should be placed fairly on the list. Sometimes in recovery from larger effusions it has enabled us here to trace downwards feeble returning respiration, the slowly receding dullness, or the leathery friction sounds of the drying membranes. In a recent case of pleurisy of three days' duration (No. 12 of the table of cases)—with a sharp stitch in the left side, a pulse of eighty- four, firm, and a respiration of thirty-two, a furred tongue, and some stiffness of the shoulder—by this .arrangement we deci- dedly emphasized a grazing sound from a spot the size of a dollar just above the diaphragm behind. IV. Depressing the shoulders (fig. 4) by bending forward, crossing arms, grasping at the loins, holding fast, and then unbending so as best to expose the apex of tlie limg behind.—In a large number of the most perplexing cases of phthisis, where there are no clear signs at the top of the lung in front, they may be found at the back. But they require careful search. If we press the flexible ear into the little uneven hollow above the spine of the scapulae, technically known as the supra-spinous fossa, or on the round inclined plane leading to it, and wait patiently till all is still, we shall often catch the harsh blowing, or fine fatty crackling of tubercles earlier than anywhere else. On this oblique irregular surface it is a little awkward to fit a