236 DISEASES OF THE PARENCHYMA OP THE LUNG, 



tients, is a matter of the utmost importance in the treatment of the 

 disease. 



Physical Signs. Inspection of the chest reveals the existence of a 

 " phthisical habit " in many persons who suffer from phthisis, or who 

 are threatened by it. This term is used to signify that peculiar build 

 of the body indicative of a want of proper nutrition and development, 

 and which is found in persons who have been subjected to debilitating 

 influence capable of stunting the healthy growth of the system before 

 their bodies have become fully developed. The bones of such persons 

 are slender, their skin is tliin, their cheeks have a delicate redness, the 

 sclerotica is bluish, the subcutaneous connective tissue contains but 

 little fat. The muscles are ill-developed ; those of the neck allow the 

 thorax to sink, causing the neck to seem too long. The intercostal 

 muscles permit the ribs to spread widely apart, making the intercostal 

 spaces broader; the angle at which the ribs are attached to the ster- 

 num is acuter ; the entire chest is flatter, narrower, and longer than in 

 robust, muscular persons. The shoulders also are apt to sink forward, 

 and the inner edges of the scapulae are tipped up like wings. 



The diagnostic and prognostic significance of the phthisical habitus 

 has been a good deal underrated of late, and, no doubt, many persons 

 possessing such a conformation do live exempt from phthisis and attain 

 a good old age. But such a circumstance does not in the least conflict 

 with the belief that the phthisical habit is a valuable index of feeble- 

 ness and delicacy of constitution, hence of a tendency to consumption. 

 There is greater danger that a catarrh at the apex of the lung will in- 

 vade the air-vesicles in a patient of this kind, than in a muscular and 

 robust man. 



Depression of the supra and infra-clavicular fossae upon one 01 

 both sides, which, hitherto, has always played a great r6le in the 

 symptomatology of phthisis, is indicative neither of tuberculosis, nor 

 of caseous infiltration, nor of disorganization of the tissues ; but is 

 always and solely due to decrease in size of the apex of the lung, by 

 induration and shrinking. As this is the only process capable of caus- 

 ing depression of the thoracic wall, the symptom is rather a favorable 

 sign, indicating a comparative cure of the nutritive derangements which 

 are the chief causes of consumption. We are not warranted, therefore, 

 in forming a diagnosis of consumption, unless signs of an advancing 

 destruction of the lung be also present, besides the symptom in 

 question. 



Feebleness of the respiratory movement, when it corresponds to a 

 depressed point in the chest, is of similar import. In such a case the 

 contracted lung is impermeable to air, and cannot yield to the traction 

 of the inspiratory muscles. If the spot, which remains stationary upon 



