Principles and practice of physical diagnosis / by John C. DaCosta ... ; with 225 original illustrations.

  • Da Costa, John C., jr., 1871-
Date:
1911
Catalogue details

Licence: Public Domain Mark

Credit: Principles and practice of physical diagnosis / by John C. DaCosta ... ; with 225 original illustrations. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    72/590 (page 62)
    A perfectly symmetric chest is rare, although conspicuous devia- tions from the normal contour are seldom met with, except in those who have acquired local muscular overdevelopment, usually as the result of their occupation or a similar cause. The one-sided chest fulness of the blacksmith and of the iron puddler and the drooping shoulder of the hod-carrier are familiar types of this sort of asymmetry. Aside from such influences, however, the right half of the chest is generally somewhat larger than the left half in right- handed persons, and there are few adults, even in perfect health, that do not show a moderate dextral inclination of the dorsal spine. In those who are left-handed the asymmetry is, of course, left sided. NORMAL LANDMARKS Study of the thoracic organs is facilitated by the use of the normal landmarks, bony and muscular, upon the walls of the chest, as well as by the aid of a number of arbitrary lines drawn upon its surface. Having detected a given sign, it is first oriented in a certain area of the thorax, and then more accurately localized by determining its precise relation to one of these fixed anatomic landmarks and to a surface line. For example: A systolic pulsation in the fifth left intercostal space, one-half inch to the right of the left midclavicular line, technically describes the situation of the normal apex-beat of the heart. The clavicles are conspicuous landmarks upon the anterior chest- wall: a moderate prominence of these bones is not incompatible with good health, and even bilateral deepening of the fossae above and below the collar-bones may exist, without the slightest implication of the pulmonary apices. Unilateral depression in one of these regions, on the contrary, is extremely significant of an apical lesion, especially if the sunken area expands laggingly and imperfectly during respira- tion. The sternal ends of the clavicles correspond to the level of the disc between the second and third thoracic vertebrae. The depressed area below the junction of the middle and outer thirds of the clavicle, between the pectoralis major and the deltoid muscles, is known as Mohrenheim's fossa (Fig. 21). Lloyd Jones has noted that in right-handed adults the right clavicle is tilted more than the left, that in the left-handed the left clavicle is tilted more than the right, and that in the ambidextrous the clavicles slope equally. The sternum, bounded above by the suprasternal notch and below by the pit of the stomach (scrobiculus cordis), is the seat of two important surface-markings: the angle of Louis (angulus