The signs of internal disease, with a brief consideration of the principal symptoms thereof . Fig- 37—Extension of tuberculous lesion (Patton).^ Dark shade—primary le-sion; light shade—extension of primary lesion; X—secondary lesion of op-posite apex. most apparent anteriorly and the breathing excursion is lessened bothwith quiet breathing and during forced inspiration, when lack ofexpansion is striking. Expansile efforts may be painful. 150 PULMONARY TUBERCULOSIS OR CONSUMPTION Palpation shows increased fremitus except, as noted in first stage,where pleurisy has resulted in thickening. The sk
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The signs of internal disease, with a brief consideration of the principal symptoms thereof . Fig- 37—Extension of tuberculous lesion (Patton).^ Dark shade—primary le-sion; light shade—extension of primary lesion; X—secondary lesion of op-posite apex. most apparent anteriorly and the breathing excursion is lessened bothwith quiet breathing and during forced inspiration, when lack ofexpansion is striking. Expansile efforts may be painful. 150 PULMONARY TUBERCULOSIS OR CONSUMPTION Palpation shows increased fremitus except, as noted in first stage, where pleurisy has resulted in thickening. The skin is hot and dry. Percussion shows positive dullness over the affected areas, whichcontrasts markedly with the unaffected parts where the respiration isaugmented and the note preternatural^ clear. Both apices may be. Fig. 38—Showing relation of lobes to posterior chest wall, also extension oftuberculous lesion (Fatten). A Frimary lesion. B Extension of primarylesion. CC Secondary deposits. affected. The plexor finger notes increased resistance. Pain on per-cussion is often complained of. Hard, board-like tympany is notencountered in recent cases but is found in old chronic cases withextensive fibroid changes. Caseous consolidation, as noted underpneumonic phthisis, has a tubular or bronchial quality. Percussionshould be practised in the supraspinous fossiE and in the intrascapularregions, for reasons already given. In mu.scular and fleshy people notmuch information may be gained thereby, but in thin, and especially PULMONARY TUBERCULOSIS OR CONSUMPTION 151 in emaciated individuals, the returns are of great value. Myoidemais the name given to the local contraction and bulging of the muscles, when subject to irritation, such as occurs in direct percussion of thepectorals. It is encountered in thin,