None
The hypoglossal nerve supplies motor fibers to the tongue and sends motor fibers to all the muscles attached to the hyoid bone with the exception of the digastric, middle constrictor of the pharynx, mylohyoid and stylohyoid. Uni-lateral hypoglossal paralysis is demonstrated by direct- ing the patient to protrude the tongue, when it will be ob- served to deviate toward the paralyzed side. There is or is not atrophy depending on whether the lesion causing the paralysis is supranuclear or infranuclear. In bi-lateral hypoglossal paraylsis the patient is unable to pro- trude the tongue. APPENDIX CASE HISTORY Case Number Date. PERSONAL DATA Name Address Sex Age Occupation Nativity Civil state Number of children. Pathologic labors Miscarriages FAMILY HISTORY Health of parents Age and cause of death Health and age of sisters _, Health and age of brothers Age and cause of death of sisters Age and cause of death of brothers Special history of tuberculosis, syphilis, epilepsy, insanity, gout, and diabetes in family PREVIOUS HISTORY User of tobacco, alcohol or narcotic drugs When and for what period Dates of treat- ment for same Venereal disease (gonorrhea and syphilis) Dates of treatment Diseases during childhood (Varicella, scarlatina, mumps, pertussis, diphtheria) Infectious diseases (Pneumonia, tuberculosis, diphtheria, otitis, cerebro-spinal meningitis, typhoid fever) Dates Complications Former attack of present complaint Date Mode of onset. Former injuries Residual deformities Recent loss of weight PRESENT ILLNESS Date and mode of onset Treatment Evolution of disease to date Subjective symptoms 469 470 PHYSICAL DIAGNOSIS PHYSICAL EXAMINATION Height ft. in. Weight 1 lbs. RESPIRATORY SYSTEM Inspection : Herpeslabialis State of alae nasi Cervical veins Contour of chest Clavicles Supra- and infraclavicular fossae Uni-lateral enlargement Uni-lateral retraction : Local bulging Local retraction Type of respiratory expansion (Costal or abdominal) Respiration sterterous, stridulous or jerky Dyspnea Inspiratory Expiratory Mixed Cyanosis : Cheyne-Stokes breathing Litten's Phenomenon Present Absent Expansion of thorax: General increase General decrease Uni-lateral increase Uni-lateral decrease Wavy breathing Palpation : Expansion of apices Expansion of bases Antero-posterior expansion Vocal fremitus: Normal Exaggerated Diminished Friction fremitus Ehonchal fremitus Tussile fremitus Suecussion fremitus Sense of resistance: Normal Increased Decreased Local tenderness Fluctuation Crepitation Local pulsations Percussion : Normal limits of resonance Increased resonance : Upward Downward Anteriorly over heart: Dullness or impaired resonance Sites Flatness Sites and dimensions Hyper-resonance Skodaic resonance Tympany Signs of cavity or excavation: Cracked-pot sound Wintrich change of sound Interrupted Wintrich change of sound Gerhardt's change of sound Friedreich's change of sound Amphoric resonance Grocco's sign Resistance Increased Decreased Auscultation : Breath sounds: Vesicular Increased Decreased Bronchial Site Increased Decreased Broncho-vesicular Site Amphoric Site CASE HISTORY 471 Cavernous Site Puerile Sites Prolonged expiration Cog-wheel breathing Vocal resonance Increased Diminished Bronchophony Pectoriloquy Whispering pectoriloquy Aegophony Absent respiratory and voice sounds Sites Rales Sibillant Sonorous Sites Crepitant Subcrepitant Mucous Sites Pleural friction Metallic tinkle Succussion sound Mensuration Cyrtometry of chest Examination of sputum CIRCULATORY SYSTEM Inspection: Precordial bulging Precordial retraction Abnormal pulsations Cardiac impulse: Site Extent Force Displacement Upward Upward and to left to left to left and downward to right Absent or invisible Systolic retraction (Broadbent's sign) Overfullness of jugulars (Kussmaul's sign) Diastolic collapse of jugulars (Friedreich's sign) Tortuous cutaneous veins Systolic jugular pulsations Hepatic pulsation Capillary pulse Palpation : Thrills Sites Time Pericardial friction Valve shock The pulse Condition of artery Rate Rhythm Volume Tension Omission Intermission Bi-lateral symmetry Dicrotism Percussion : Cardiac borders Increase to right To left To left and downwards General increase Vascular dullness Increased to right Auscultation: Heart sounds: General accentuation General diminution Accentuation first sound Accentuation second Reduplication first sound Reduplication second sound Endocardial murmurs Site P.M.I Line of transmission Time Quality Intensity Pericardial friction Pericardial succussion Flint murmur Venous hum Aortic murmurs Examination of the blood: Hemoglobin Leukocytes: Numerical Differential Erythrocytes Numerical Parasites Polychromatophilia Blood pressure Systolic pressure Diastolic pressure Pulse pressure 472 PHYSICAL DIAGNOSIS THE ABDOMEN Inspection : Distended veins Caput Medusae Diastasis. Visible peristalsis Tumor Pigmentation. Scars Umbilicus Hernia Palpation : Thickness of wall Tumor of wall Fluid wave. Fat wave Muscular rigidity Muscular spasm Tenderness Site SPECIAL ABDOMINAL ORGANS The Stomach: Position greater curvature Lesser curvature Gastrectasis Gastroptosis Visible peristalsis Pyloric tumor Hour-glass constriction Tenderness Succussion Transillumination Gastric contents: Free HC1 Combined HC1 Lactic Acid Blood The Intestines : Tenderness Tumor Impacted feces Gaseous distention Visible peristalsis Examination of feces Parasites Ova Blood Color Consistence Undigested food The Pancreas: Tenderness Tumor Cyst. Fat indigestion Cammidge Reaction The Liver and G all-Bladder : Enlargement Diminution. Ptosis Tenderness Systolic pulsation Consistence Fluctuation Nodules Reidel's lobe Gall-bladder tumor Gall-stone crepitus Peritoneal friction The Spleen: Enlargement Diminution Displacement Tumor Peritoneal friction , The Kidney: Tenderness Ptosis 1st degree 2nd degree 3rd degree Cystic Tumor. Urinalysis THE HEAD AND NECK The Head: Microcephalic Megalocephalic Rickets___ Hydrocephalus Cretinism Fontanelles: Depressed,. CASE HISTORY 473 Bulging Sutures Craneotabes Condition of hair: Color General loss Localized loss The face: Contour Pallor Cyanosis Jaundice Chloasma Spasm Scars Eruptions The eyes: Edema of lids Exophthalmos Enophthalmos Strabismus Hippus Nystagmus Argyll- Robertson pupil Ocular mobility The Lips: Pallor Cyanosis Epithelioma Chancre Fissures Parted lips The teeth: Premature decay Delayed dentition Hutchinson teeth Sordes The Gums: Spongy Lead line Copper line Red line Epulis Gingivitis The Tonsils: Chronic hypertrophy Tonsillitis Diphtheria Vincent 's angina The Ear: Deformity or injury Tophi Discharge The Neck: Cervical glands Thyroid Tracheal tug Sternomastoids Branchial cysts Torticollis Retraction THE HANDS AND ARMS Nails : Pallor Cyanosis White spots Incurvation Capillary pulse Fingers: Tophi Nodes Clubbed fingers Enlarged joints Gangrene Manual deformities Tremor Wrist-drop Onychia Forearm: Rickets Pellagra Erythema multiforme Arm: Ruptured biceps Tumors Paralysis THE FOOT AND LOWER EXTREMITY Gangrene Foot-drop Edema Ulceration Joints. Babinski's reflex Knee-jerk THE NERVOUS SYSTEM Headache Vomiting Paralysis Choked disk Convulsions Disorders of sensation Disturbances of speech Disorders of organs of special sense Pain, tremor Station Gait Reflexes. Diagnosis Complications Prognosis Treatment Besult Discharged INDEX Abadie 's sign, 390 Abdomen, anatomical landmarks, 296 anatomy, clinical, 295 topographical, 303 auscultation, 329 color, 308, 309 contour of, 317 in ascites, 318 in enteroptosis, 323 in gastroptosis, 323 in meteor ism, 318 in obesity, 318 in pregnancy, 318 normal, 317 cutaneous flexion folds, 300 enlargement, asymmetric, 323 symmetric, 318 eruptions, 308 examination of, 295 in dorsal posture, 308 in knee-chest posture, 308, 341 in standing posture, 308 fat wave, 327 fluctuation, 326 fluid wave, 326 friction, 329 inspection, 308 mensuration, 331 movements, absence of, 315 respiratory, 47 muscular rigidity, 326 palpation, 324 percussion, 329 quadrants, 307 regions, 305 retraction, 323 scaphoid, 323 scars, 308 skin, 308 tortuous veins, 310 Abdominal aorta, anatomy, clinical, 300 aneurism, 331 cavity, 295 viscera, examination of, 332 Avail, 295, 325 Abscess, cervical, 416 metastatic in endocarditis, 266 of brain, 167 of liver, 358 of lung, 163 diagnosis, 165 Abscess of lung — Con'td. distinguished from bionchiectasis, 166 of the lobular pneumonia, 163. pathology, 163 physical signs, 164 empyema, 166 pulmonary gangrene, 166 peri-nephric, 370 post-pharyngeal, 407 psoas, 436 Absence of septa of heart, 293 Absent respiration, 87 Accoucheur's hand, 450 Acromegaly, facies of, 385 spade hand of, 422 Acute bronchitis, 100 (See Bronchi- tis, acute) endocarditis, 264 (Sec Endocarditis, acute) fibrinous pleurisy, 169 (See Pleu- risy, fibrinous, acute) myocarditis, 282 (See Myocarditis, acute) tuberculo-pneumonic phthisis, 132 broncho-pneumonic form, 132 diagnosis, 133 pathology, 132 physical sign, 132 pneumonic form, 132 Addison's disease, tongue of, 405 Adhesions, pleural, 172, 180, 182 pericardial, 259 Adventitious sounds, 89, 224 Aegophony, 89 (See Egophony) Ague-cake, 365 Alar thorax, 40 Albinism, pulmonary, 157 Allorhythniic pulse, 211 Alveoli, pulmonary, 23 Amblyopia, 450 Amphoric respiration, 86 in bronchiectasis, 105 in phthisis, 147 resonance, 78 Anesthesia, 444 Analgesia, 445 Anasarca, 38 Anatomy, clinical, of abdomen, 295 of aorta, 188 of bladder, 377 of bronchi, 19, 20, 29 of heart, 187 of intestine, small, 339 475 476 INDEX Anatomy, clinical — Cont 'd. of kidneys, 367 of liver and gall-bladder, 353 of lungs, 20, 28 of mediastinum, 17, 18 of pancreas, 348 of pericardium, 189 of pleura, 17, 27 of pleural cavity, 17 of pulmonary artery, 188 of stomach, 332 of thorax, 17 of trachea, 19, 29 of viscera, abdominal, 295 thoracic, 19 Aneurism, of aorta, abdominal, 331 thoracic, 194, 241 axillary artery, 213 brachial artery, 213 innominate artery, 213 Angina, Ludwig's, 416 Vincent's, 408 Angle, cardio-hepatic of Ebstein, 215 costal, 40 in chronic ulcerative phthisis, 40 in hypertrophic emphysema, 40 in rickets, 437 costo-vertebral, 370 of Louis, 31, 39, 40 as normal landmark of thorax, 31 Angulus ludovici, 31 Anosmia, 449 Anthracosis, 150 pathology, 150 Aorta, aneurism, 194, 241, 331 auscultation, 240 clinical anatomy, 188 pulsation, 194 surface marking, 192 Aortic arch, 189 area, 220 incompetence, 270 (See Aortic in- sufficiency) insufficiency, 270 aortic second sound in, 272 capillary pulse in, 271 Corrigan pulse in, 272 diagnosis, 272 Duroziez's sign in, 272 double murmur in> 275 pathology, 270 physical signs, 271 water-hammer pulse in, 272 roughening, 273, 275 stenosis, 273 button-hole deformity in, 273 diagnosis, 275 pathology, 273 physical signs, 274 pulse in, 275 relative, 273 value, clinical anatomy, 187 anatomic site, 192, 220 Ape hand, 425 Apex beat, 199 (See Impulse, cardi- ac) absence of, 201 displacements of, 199 extent of, 200 site of, 199 strength of, 201 Apical pneumonia, 118 Appendix, vermiform, clinical,- anat- omy, 343 palpation of, 346 Arc, reflex, 446 Arcus senilis, 393 Arch, costal, 33, 296 line of, 35 aortic, 189 Area, aortic, 220 auscultatory, of valves, 219 mitral, 220 pulmonary, 220 - tricuspid, 220 Argyll-Robertson pupil, 454 Argyria, 389, 406 Arm, atrophy, 430 contracture, 429 edema of, 428 examination of, 428 movements, 429 nodes, 428 paralysis, 428 rigidity, 429 spasm, 429 tumor, 428 Arrhythmia, 210 cardiac, 225 extra-systolic, 228 heart block, 228 intermittent, 226 respiratory, 227 simple, 226 Arterial murmurs, 240 diastolic, 240 in aorta, 240 in carotids, 241 in femorals, 241 in subclavians, 241 systolic, 240 pressure, estimation of, 244 pulse, 207 analysis of, 207 counting, 205 sphygmogram, 206 variations in, 206 technic of taking, 204 wall, 207 Artery, axillary, aneurism of, 213 brachial, aneurism of, 213 carotid, murmur of, 241 changes in, 207 coronary, 187 IXDKX 477 Artery — ('out M. epigastric, deep, 301 femoral, auscultation of, 241 double murmur in, 241 iliac, common, 300 external, 300 pulmonary, 188 surface marking, 102 size of, 207 subclavian, 211 murmur in, 241 Ascites, contour of abdomen in. 318 Aspiration pneumonia, 123 Astereognosis, 446 Asthnla, bronchial, 105 (See Bron- chial asthma) cardiac, 105 potter's, 153 renal, 105 Atelectasis, 154 acquired, 154 compression, 154 congenital, 154 diagnosis, 156 obstruction, 154 pathology, 154 physical signs, 154 Athetosis, 42(5 Atrophic emphysema, 100 (Set Em- physema, atrophic) Atrophy, of arm, 430 of heart, 199 of nails, 419 Auenbrugger *s sign, 256 Auricles of heart, 187 Auricular fibrillation, 22!) Auriculo-yentricular bundle. 226 Auscultation, 82 immediate, 82 mediate, 82 object of, 82 of abdomen, 329 of carotids, 241 of gall-bladder, 362 of intestine, small, 342 of jugulars, 241 of liver. 362 of lungs and bronchi. 82 of precordia, 219 of stomach, 339 of subclavians, 241 Auscultatory valve areas, 219 percussion, 68 of stomach, 338 Axillary line, anterior, 34 posterior, 34 region, 35 B Babinski 's sign, 447 Baccelli 'g sign — Cont 'd, in sero-fibrinous pleurisy, 175 Back, percussion of, 70 Barany tests, 460 Barrel chest, in Bell tympany, 81 Belt sign, Glenard's, Biermer's phenomenon, 80 Bladder, clinical anatomy of, .",77 examination of, 377 Blepharitis marginalia, 392 Blepharospasm, 390 Blood pressure, arterial, 242 definition, 242 diastolic, 251 estimation of, 244 ausculatory method, 249 palpatory method, 248 normal variations, 250 pathologic variations, 250 phases, 249 systolic, 244, 250 diminished, 250 increase. 1, 250 venous, 251 Oliver's method <o' estimation of, 252 Bones, cranial, 380, 381 bosses, 381 craniotabes, 381 swelling. 381 tenderness. 381 Borborygmus, 342 Bradycardia, 210, 227 Stokes-Adams, 22s Branchial cyst, 41(5 fistula, 410 lb-east, funnel, 40 keel, 44 pigeon, 44 Breath, acetone. t00 foul, 400 uremic, 400 Breathing, 83 (See Respiration) Bronchi, clinical anatomy. 19, 22 diseases of, 100 stenosis, 108 surface markings. 29 Bronchial asthma, 105 Charcot-Leyden's crystals in, 107 Curschmann 's spirals in, 107 diagnosis, 107 eosinophils in, 106 pathology, 105 physical signs. Rothschild's sign, 138 thorax of, 38, 40, 138 valvular disease, 268 Chylothorax, 183 pathology, 183 physical signs, 183 Circulatory organs, clinical anatomy of, 187 examination of, 187 Cirrhosis of lung, 47, 129 (See Chronic interstitial pneumonia) after lobar pneumonia, 129 Claudication, intermittent, 436 Clavicles, as normal landmarks, 31 prominence of, 32, 40 Clavicular line, 35 Click, mucous, 143 Clonus, ankle, 447 patellar, 447 Clubbed fingers, 418, 422 Coal miner's disease, 150 Cog-wheel respiration, 87 Coin test, Gairdner's, 81 Collapse, diastolic, of jugulars, 196 pulmonary, 46, 155 Colon, ascending, 343 clinical anatomy, 343 descending, 345 palpation of, 345 transverse, 343 Color changes in skin of abdomen, 308, 309 Color-blindness, 450 Compensation of heart, 269 broken, 269 Compensatory emphysema, 46, 161 (See Emphysema compensa- tory) Complementary sinus, 28 Congenital heart disease, 293 (Sec Heart disease, congenital) Congestion, active, 110 collateral, 110 diagnosis, 111 hypostatic, 110 mechanical, 110 passive, 110 pathology, 110 physical signs, 111 pulmonary, 110 Conjunctiva, cyanosis, 392 examination of, 392 hemorrhage, 392 pallor, 392 yellowness, 392 Conjunctivitis, 392 Contour, abdominal, 317 Contracture, Dupuytren's, 425 of arm, 429 Contraction, local, of thorax, 47 uni-lateral, of thorax, 46 Convulsive tic, 390 Cook's sphygmomanometer, 243 Cor biloculare, 293 bovinum, 271, 287 triloculare, 293 villosum, 254 < lornea, opacity, 394 ulceration, 394 Corrigan button-hole orifice, 27:; Corrigan's disease, 270 Corset liver, 358 Costal angle, 40 arch, 33, 296 line of, 35 line, sixth, '■'>'> third, 35 respiration, 47 Costo-abdominal respiration, 47 ( losto-vertebral angle, 370 ( lough of aortic aneurism, 103 of pulmonary edema, 112 ( !racked-pot sound, 78 in bronchiectasis, 105 in phthisis, 142 in sero-fibrinous pleurisy. 171 Cranial nerves, examination of, 448 Craniotabes, 379, -".sl < Irepitant rale, 91 Crepitation, gall-stone, 362 Crepitus, 63, 163 ( 'retinisin, fades of, 380 head of, 380 < Irico-clavicular line, 34 Croupous pneumonia, lib" {Set Lobai pneumonia) Curschmann's spirals, 107 Curve. Kllis'. 170 Cyanosis ^2, 389, 396, 406, 417 Cycle, cardiac, 225 Cyrtometer, ;>t Cyrtometry, 94 Cyst, blood, W5 branchial, 416 echinococcus, 405 lingual, 405 Meibomian, 392 mucous, 405 of auricle, 384 respiratory, 47 Cysticercua cellulosae, 405 D Dactylitis, 422 Day-blindness, 450 Deafness, nerve. 459 middle ear, 459 Decubitus, in lobar pneumonia, 118 in sero-fibrinous pleurisy. of lung, 74 over mammae, 70 over scapulae, 70 over Traube's semilunar space, 174 para-vertebral, 76, 174 sternal, 70 uni-lateral, 74 vascular, 218 Duodenojejunal flexure, 339 Duodenum, clinical anatomy, 339 Dupuytren's contracture, 425 Duration, of percussion sound, 69 of pulse, 212 Duroziez 's sign, 272 in aortic insufficiency, 272 Dyspnea anemic, 52 cardiac, 52 expiratory, 52 hemic, 53 in acute bronchitis, 100 in atelectasis, 155 in bronchial asthma, 107 in broncho-pneumonia, 125 in chronic adhesive pleurisy, 182 in chronic bronchitis, 102 in emphysema, hypertrophic, 158 in phthisis, 138 in pulmonary congestion, 111 edema, 112 in sero-fibrinous pericarditis, 256 E Ear, congenital defects, 383 cyanosis, 384 cysts, 384 discharge from, 384 examination of, 383 hematoma, 384 keloid, 384 otomycosis, 384 tophi, 384 Ebstein's cardio-hepatic angle, 215 Echinococcus cyst of liver, 358 Edema of lungs, 111 diagnosis, 112 pathology, 111 physical signs, 112 of eyelids, 391 dullness of, 257 of thorax, general, 38 local, 38, 54, 181 Effects of valvular lesions, 269 Egophony, 89 in sero-fibrinous pleurisy, 175 Elbow, miner's, 430 Ellis' curve in sero-fibrinous pleurisy, 176 Embolic abscess of lung, 164 gangrene of lung, 166 Embryocardia, 228, 284 Emphysema, acute vesicular, 162 [NDEX 481 Emphysema, acute vesicular — Conl M pal bology, 102 physical signs, 163 atrophic, 160 diagnosis, 161 palhology, 160 physical signs, 160 chronic, 156 compensatory, 161 diagnosis, 162 pathology, 161 physical signs, KM diffuse, L56 hypertrophic, 156 diagnosis, 159 distinguished from chronic bron- chitis, 159 from sero -fibrinous pleurisy, 159 from pneumothorax, 159 Freund's theory of, 156 pathology, 156 physical signs, 158 thorax of, 40, 158 idiopathic, 156 interstitial, L62 pathology, 162 physical signs, 163 large-lunged, of Jenner, 156 pulmonary, 156 substantive, 156 Emphysematous crackling, 163 Empyema, 179 diagnosis, 182 local edema in, 38, L81 necessitatis, 38, 181 pathology, 179 physical signs, 18] pulsating, L81 Endocardial murmurs, 229 (See Mur- murs, endocardial) Endocarditis, acute, 264 diagnosis, 266 distinguished from typhoid fever, 267 pathology, 264 physical signs, 266 chronic, 267 infective, 2<i5 malignant, 265 mural, 264 pathology, 267 recurrent, 204 simple, 264 valvular, 264 Enophthalmos, 393 Ensiform cartilage, 33, 44, 296 Enterolith, 340 Enteroptosis, 323 abdominal contour in, 323 Epicardium, 188 Epigastric artery, deep, surface mark- ing, 301 region, 305 Epigastrium, bulging, 363 pulsation in, 271, 276 retraction of, 125, 155 Epilepsy, Jacksonian, 443 Epithelioma, of eyelid, 392 of lip, 398 Epithelium, respiratory, 22 Epistaxis, 395 Epulis, 401 Erlanger's sphygmomanometer, 244 Erythema nodosum, 428 Erythromelalgia, l-".2 Ewart 's sign, 257 Excrescences of cardiac valves, 265 verrucose, 265 Excursion, inspiratory, of tie. cerebellar, 442 festinating, 442 hemiplegic, 440 spastic, 440 steppage, 441 vertiginous, 442 Gall-bladder, clinical anatomy, 353 crepitations, 362 examination of, 353 inspection of, 355 palpation of, 358 surface marking, 358 Gallop-rhythm, 224, 284, 292 Gall-stone crepitation, 362 Ganglion, 425 Gangrene of lung, 166 after lobar pneumonia, 166 circumscribed, 166 diagnosis, 167 diffuse, 166 distinguished from pulmonary abscess, 167 pulmonary tuberculosis, 1 08 pathology, 166 physical signs, 167 Gastrectasis, 333 Gastroptosis, 335 abdominal contour in, 323 Geographical tongue, 404 Gerhardt's change of sound, 80 in bronchiectasis, 105 in chronic ulcerative phthisis, 142 Gladiolus, 31 Gland, Blandin-Nuhn 's, 405 mammary, 32, 38, 39 as landmark of thorax, 32 hypertrophy of, 39 thyroid, 411 Glands, enlarged, inguinal, 314 cervical, 412, 413, 414 epitrochlear, 419 occipital, 413 INDEX 483 Glands, enlarged — Cont 'd parotid, 413 submaxillary, 413 supra-clavicular, 414 Glandular enlargement, .'514, 412 Glenard 's belt sign, 338 Globe, of eye, 392 position of, 393 Goiter, cystic, 411 exophthalmic, 412 Gout, toe of, 431 tophi of, 419 Grinder's rot, 153 Grocco 's sign, 70 in purulent pleurisy, 181 in sero-fibrinous pleurisy, 174 Groove, Earrison 's, 44 Gummata, pulmonary, 148 Gums, blue line, 401 examination of, 401 in diabetes, 401 in gingivitis, 401 in mercurial poisoning, 401 in pellagra, 401 in pyorrhea alveolaris, 401 in scorbutus, 401 in ulcerative stomatitis, 401 red line, 401 sponginess, 401 tumor, 401 Gurgling, in hour-glass stomach, 339 rales, 91 Gutta cadens, 185 11 Hair, color, 381 crepitus, 83 falling, circumscribed, 381 general, 381 Hand, accoucheur's, 425 ape, 425 claw, 424 examination of, 417 hemiplegic, 424 seal-fin, 425 shape, 422 spade, 422 tremor of, 425 Harelip, 400 Harrison 's sulcus, 44 Haygarth's nodosities, 4L'l Head bones, 380 cretinoid, 380 deviation, lateral, 382 examination, 379 fixation, 383 fontanelles, 380 hydro-cephalic, 380 movements, 383 position, 382 rachitic, 379 retraction, 382 shape, 379 Bead — Cont '<l size, 379 sutures, 380 Heart, apex of, 187 displacement, 199 site, 199 thrill at, 204 arrythmia, 225 atrophy, 199 auricles, 187 automaticitv, 225 base, 187, 190 pulsation at, 194 thrill at, 204 beat, myogenic, 220 neurogenic, 220 block, arrythmia, 228 borders, 187, 191 conductivity, 225 cycle, 22."> dilatation, 289 (See Dilatation, car- diac i disease, congenital, 293 diagnosis, 294 pathology, 293 physical signs, 294 dullness, area of, 21 4 decreased, 216 displaced, 216 increased, 210 extra -systole of, 228 failure cells, 110 flatness, area of. 260 myocarditis, 285 in lobar pneumonia, 120 in mitral insufficiency, 277 stenosis, 279 in pulmonary insufficiency, 279 484 INDEX Heart sounds — Cont'd in pulmonary stenosis, 280 in tricuspid insufficiency, 281 intensity of, 222 reduplication of, 222 second, 219 accentuation of, 222 enfeeblement of, 222 reduplication of, 223 surface marking, 190 valves, 187, 192 Heberden's nodes, 421 Hemeralopia, 450 Hemianopia, 452 Hemiatrophy, facial, 388 Hemicliorea, 443 Hemi-hypertrophy, facial, 389 Hemiplegia, 443 Hemo-pericardium, 261 pathology, 261 physical signs, 261 Hemoptysis, in phthisis, 141 in pulmonary syphilis, 150 Hemorrhage in phthisis, 136 Hemorrhagic infarction of lung, 112 Hemothorax, 183 pathology, 183 physical signs, 183 Hepatization, gray of lung, 117 red of lung, 117 Hepatoptosis, 361 Hernia, femoral, 436 umbilical, 313, 323 Herpes, labialis, 397 in lobar pneumonia, 118 Hippocratic fingers, 422 succussion sound, 92 Hippus, 454 Hissing respiration, 51 Holmgren test, 450 Hordeolum, 392 Hour-glass stomach, 339 Housemaid's knee, 435 Hum, venous, 241 Humming-top murmur, 241 Hutchinson's teeth, 401 Hydrocephalus, facies of, 385 Hydro-nephrosis, fluctuation in, 373 Hydro-pericardium, 261 pathology, 261 physical signs, 261 Hydro-pneumothorax, 184 (See Pneu- mothorax) Hydrops, pericardii, 261 Hydrothorax, 184 distinguished from sero-fibrinous pleurisy, 176 pathology, 184 physical signs, 184 Hypalgesia, 445 Hyperalgesia, 445 Hyperesthesia, 444 Hyperosmia, 449 Hyper-resonance, in compensatory em- physema, 77, 162 in hypertrophic emphysema, 77, 158 local, 77 pulmonary, 76 relaxation as cause, 77 Hypertrophic emphysema, 40, 156 (See Emphysema, hypertrophic) Hypertrophy, auricular left, 288 right, 288 cardiac, 285 concentric, 285 cor bovinum in, 287 diagnosis, 289 distinguished from cardiac dilata- tion, 289 from sero-fibrinous pericarditis, 289 eccentric, 274, 285 general, 287 physical signs, 287 prostatic, vesical distention in, 377 pulse in, 287 ventricular left, 287 right, 287 Hypesthesia, 444 Hypochondriac region, 35 Hypogastric region, 306 enlargement, 323 Ileo-cecal valve, clinical anatomy, 339 Ileum, clinical anatomy, 339 Iliac artery, common, 300 external, 300 region, 307 spine, anterior superior, 297 Illumination, direct, 38 oblique, 38 Immediate auscultation, 82 percussion, 65 Impaired resonance, 74 Impulse, cardiac, 199 absence, 201 displacement, downward, 199 to left, 200 to right, 200 upward, 199 extent. intertubereular, 304 mammary, 33 mid-axillary, 34 mid-clavicular, 33 mid-poupart, 304 mid-spinal, 34 mid-sternal, 33 nipple, 33 of transmission of murmurs, 231 scapular, 34 spinal, 35 • sternal, 33 sub-costal, 304 twelfth dorsal, 35 Linea alba, 298 nigra, 298 semilunaris, 298 Lineae albicantes, 308 transversa}, 299 Lips, chancre, 397 cyanosis, 396 enlargement, 397 epithelioma, 398 fissures, 397 herpes, 397 mucous patch, 397 pallor, 396 partid, 397 pendularis, lower, 397 rhagades, 397 Litten's phenomenon, 43 absence of, 50 Liver areas of dullness and flatness, 359 auscultation of, 362 clinical anatomy, 353 corset, 358 decreased size of, 361 downward displacement, 361 inspection of, 355 palpation of, 357 percussion, 359 pulsation, 195, 237, 276, 281, 290, 355 Eiedel's lobe, 358 surface marking, 354 tumors of, 359 distinguished from renal, 359 upward displacement, 361 Lobar pneumonia, 116 abscess of lungs after, 163 cirrhosis of lung after, 129 distinguished from acute bronchitis, 101 acute pneumonic phthisis, 121 broncho-pneumonia, 122 pulmonary congestion, 123 edema, 122 infarction, 122 sero-fibrinous pleurisy, 123 gangrene of lungs after, 166 heart sounds in, 120 Lobar pneumonia — Cont 'd. pathology, 116 pleurisy in, 117 pulse in, 119 purulent infiltration in, 163 rale indux in, 120 redux in, 120 roentgenogram, 98 sputum, 117 stage of engorgement, 116. gray hepatization, 117 red hepatization, 117 resolution, 163 Lobular pneumonia, 123 (See Bron- cho-pneumonia) Lordosis, 44 Lorenz, sign of, 138 Louis, angle of, 31, 39, 40 Ludwig's angina, 416 Lumbar region, 306 Lungs, abscess of, 157 albinism of, 157 auscultation of, 82 borders, 20, 28 bronchioles, 22 carcinoma of, 114 (See Pulmonary neoplasms) catarrhal pneumonia, 123 cavities, tympany in, 78 circulation, 23 circulatory disturbances, 110 cirrhosis of, 129 clinical anatomy, 20 collapse of, 46, 155 congestion of, 110 (See Pulmonary congestion) costal surfaces, 20 disease of, 116 dullness of, 74 dyspnea, 52 edema, 111 emphysema, 156 endothelioma of, 114 fibroid retraction of, 195 fissures of, 20, 28 fistula sound, 90, 93 flatness of, 76 gangrene of, 166 hepatization of, 117 hilus of, 20 infarction of, 112 (See Pulmonary infraction) infundibular of, 22 inspection of, 37 ligament of, 20 lobes of, 20 lower borders, 28 lymphatics of, 25 mediastinal surfaces, 20 normal limits, 71 palpation of, 55 pancreatization, 148 percussion of, 65 INDEX 4-7 Lungs, percussion of — Cont'd. apices, 70 auscultatory, 68 palpatory, 68 respiratory excursion of, 74, 170 root of, 20 sarcoma of, 114 sclerosis of, 129 surface markings, 28 syphilis of, 148 tumors of, 114 tympany of, 78 Lymph nodes, bronchial, 25 mediastinal, 25 pulmonary, L'5 M Maerocheilia, 397 Microglossia, 401 Main-en-griffe, 424 Malignant endocarditis, 12* >-"> diagnosis, 2 HO physical signs, 266 Mai perforante, 431 Mammary gland, 32, 38, 39 as landmark of thorax, 32 hypertrophy of, 39 line', 33 region, 3.5 Manubrium stemi, 31 McRurney's point, 346 Med in stiu (i- pericarditis, 2.59 Mediastinum, anterior, 19 contents of, 19 middle, 18 contents of, 18 posterior, 18 contents of, 18 superior, 18 contents of, 18 tumors of, 19 Mediate auscultation, 82 percussion, 65 rules governing, 65 Megalonychosis, 419 Mensuration of abdomen, 331 thorax, 94 Metallic tinkle, 89, 01 Meteorism, abdominal contour in, 318 Mid-axillary line, 34 Mid-clavicular line, 33 Mid-poupart line, 304 Mid-spinal line, 34 Mid-sternal line, 33 Mill-stone maker 's phthisis, 153 Miner 's elbow, 430 Mitral area, 220 insufficiency. 27d diagnosis, 277 pathology, 270 physical signs. 270 pulmonary second sound in, 277 pulse in, 277 Mitral— Cont 'd. murmurs, 231 presystolic, 232 systolic, 233 stenosis, 277 button-hole orifice in, 278 diagnosis, 279 pathology of, 277 physical signs, 278 pulse in, 278 thrill in, 27S value, 187 Moist rales, 90, 91 Money-chink resonance. 78 Morvan's disease, 422 Movable kidney, .".7:; Mucous click, 14:; rales, 91 Multiple murmurs, 238 Murmurs, accidental, 238 aortic, 234 diastolic, 234 systolic, 234 arterial, 240 diastolic, 240 systolic, 241 caidio-respiratory, 2.".!1. 287 diastolic, 231 double in aortic insufficiency, 23.5 Duroziez's, 241. 272 endocardial, 229 characteristics of, 230 generation of. 22!' flint, 232, 2 7i'. _" functional. 238 relative incidence. 238 hemic, 238 humming top, 241 inorganic, 238 intensity of, 231 line of transmission, 231 mitral, 231 presystolic. 232 systolic. 233 monplegia, 442 multiple, 23S separation of. 238 nun's, 241 organic. 220 point of maximum intensity. 230 pulmonary, 237 diastolic. 23S systolic, 237 quality of, 231 safety-valve. 27(3. 277. ut' intestine, Large, 345 small, 340 of kidney, 370 of liver, 357 of precordia, 202 of spleen, 363 of stomach, 336 of thorax, 55 of ureter, 378 technic of, 55 ulnar, 5.1 Palpatory percussion, 68 Pancreas, clinical anatomy, 348 cyst of, 348 examination of, 348 tumor of, 351 Pancreatization of lung, 148 Paradoxical pulse, 211 in chronic adhesive pericarditis, 260 in chronic serofibrinous, peri- carditis, 257 Paralysis, abducent, 456 agitans, gait of, 442 propulsion in, 442 retropulsion in, 442 tremor of, 425 brachial, 428 bulbar, chronic, 397 Duchenne-Erb type, 428 facial, 458 flaccid, 442 glossodabiodaryngeal, 402 glosso-pharyngeal, 467 hypoglossal, 468 Klumpke tvpe, 428 of leg, 437 of palate, 407 of tongue, 407 pneumo-gastric, 4(57 pseudodivpei trophic muscular, 432 spastic, 442 spinal accessory, 468 trigeminal, 457 trochlear, 456 Paralytic thorax, 40 Paramyoclonus multiplex, 429 Parasternal line, 34 Paravertebral dullness, 76 Grocco's triangle of, 76, 174 Parenchymatous myocarditis, 282 Paresis, 442 Parietal pleura, 17 Paronychia, 419 Parotid gland enlargement. 413 Paroxysmal tachycardia, 227 Parosmia, 449 Patch, mucous, 406 smoker 's, 404 Patent ductus arteriosus. 294 foramen ovale, 293 Pause, compensatory, of heart, 226 Pectoriloquy, 88 whispering, 89 Pellagra, forearms in, 426 gum3 in, 401 tongue in, 405 Pelvis, 295 Percussion, cardiac, 215 deep, 68 finger, 65 force of, 68 immediate, 65 in intestinal obstruction. 341 instrument, 65 of abdomen, 321) of anterior chest wall, 70 of axillary region, 7<» of back, 70 of bladder, 377 of heart, 214 of intestine, small, 34] of kidney. 'Ml of liver, 359 of lungs, 70 of spleen, 366 of stomach. of thorax, 65, 70 palpatory, 68 sense of resistance in, 65, 7c sound, 69 attributes of, 69 dull, 76 duration, 69 flat, 76 hyper-resonant, 76 intensity, 69 pitch, 69 quality, 69 resonant, 70 special, 78 tympanitic, 78 Pericardial friction, 24(1 fremitus, 202 succussion, 240 Pericarditis, 253 adhesive, chronic, 259 Broadbent's sign in, 260 diagnosis, 261 Friedreich's sign in, 260 Kussmaul's sign in, 260 pathology, 259 physical signs, 260 external, 259 fibrinous, acute, 253 diagnosis, 255 distinguished from Corrigan 's disease, 255 pathology, 253 physical signs, 254 internal, 259 490 INDEX Pericarditis — Cont 'd. sero-fibrinous, 256 Auenbrugger 's sign in, 256 diagnosis, 258 distinguished from cardiac dila- tation, 258 distinguished from sero-fibrinous pleurisy, 258 Ewart's sign in, 257 milk spots in, 256 pathology, 256 physical signs, 256 Rotch's sign in, 257 sicca, 253 with effusion, 256 Pericardium, clinical anatomy, 189 diseases of, 256 Perihepatitic friction, 331 peritoneal function, 331, 367 Period, refractory of heart, 226 Perisplenitic friction, 331 Perisplenitis, peritoneal function in 330, 367 Peristalsis, visible, of intestine, 314 of stomach, 314, 335 Peritoneal friction, 331 in peritonitis, 331 Pes planus, 431 Pharynx, bulging, 407 eruptions, 407 examination of, 407 redness, 407 ulceration, 407 Phenomenon, Biermer's, 185 Litten's, 48 Phlegmasia, alba, dolens, 437 Phlegmon, ligneous, 416 woody, 416 Phthisical thorax, 32, 40, 138 Phthisis, broncho-pneumonic, acute, 132 chronic ulcerative, 133 (See Chron- ic ulcerative phthisis) fibroid, 144 (See Fibroid phthisis) mill-stone maker's, 153 pneumonic, acute, 132 stone-cutter's, 153 tuberculo-pneumonic, acute, 132 Physiologic venous pulse, 196 Pigeon breast, 44 cross-section of, 44 in rickets, 45 Pitch of percussion sound, 69 Pleura, diseases of, 169 parietal, 17 surface markings, 27 visceral, 17 Pleural adhesions, 172, 180, 182 cavity, clinical anatomy, 17 dropsy, 184 (See also Hydro- thorax) Pleural cavity — Cont 'd. effusion into, 171 friction, 90, 92, 170, 173 sinus, complementary, 28 Pleurisy, adhesive, chronic, 182 diagnosis, 183 pathology, 182 physical signs, 182 diaphragmatic, 177 diagnosis, 178 pathology, 177 physical signs, 177 fibrinous, acute, 169 distinguished from intercostal neuralgia, 171 distinguished from pleuro- dynia, 170 pathology, 169 physical signs, 170 purulent, Baccelli's sign in, 18 L diagnosis, 182 Grocco's sigh in, 181 pathology, 179 physical signs, 181 sero-fibrinous, 171 Baccelli's sign in, 175 diagnosis, 175 distinguished from hepatic tu- mor, 177 from hydrothorax, 176 from lobar pneumonia, 175 from pneumothorax, 177 from pulmonary neoplasm, 176 Grocco's sign in, 174 pathology, 171 physical signs, 172 uni-lateral bulging in, 172 visceral displacement in, 172 Pleuritis, sicca, 169 Pleuro-pericarditis, 259 Pleximeter, 65 Plexor, 65 Pneumonia, alba, of fetus, 148 apical, 118 catarrhal, 123 central, 118 croupous, 116 deglutition, 124 double, 118 interstitial, chronic, 129 lobar, 116 lobular, 123 massive, 118 migratory, 118 syphilitic, 148 Pneumonic phthisis, acute, 132 Pneumonokoniosis, 150 diagnosis, 153 pathology, 150 phthisis and, 153 physical signs, 153 INDEX 491 Pneumo-pericardium, 262 Pulmonary — Cont 'd. diagnosis, 263 neoplasms, 114 pathology, 262 diagnosis, 115 physical signs, 262 pathology, 114 Pneumothorax, 184 physical signs, 114 Biermer's phenomenon in L85 osteoarthropathy, 428, 432, 437 closed, 185 sound, accentuation of, 22:; coin test in, 185 weakening of, 223 diagnosis, 3 86 stenosis, 280 distinguished from hydrothorax diagnosis, 280 176 pathology, 280 from serofibrinous pleurisy, 176 physical signs, 280 gutto cadens in, 185 Pulsations, abnormal, areas of, 54, lung-fistula sound in, 186 64, 194 open, 185 at base of heart, 54, 64, 194 pathology, 184 of left lung, 54 physical signs, 185 of left sternal border, 195 succussion in, 186 of right sternal border, 194, 279 tympany in, 185 carotid, 287 Point, McBurney's, 346 diastolic, 195 Signorelli 's, 365 epigastric, 195, 276 Polypnea, 51 in episternal notch, 195 Portal vein, obstruction, 38 in neck, 276 caput medusae in, 38, •' 510 localized, of thorax, lA Post-dicrotic wave, 206 of jugular veins, 196, 237, 276, 280 Post-pharyngeal abscess, 407 of left axilla, 54 Potter's asthma, 153 of liver, 195, 237, 276, 281, 290, Poupart's ligaments, 297 355 Power, muscular, I 12 systolic, 195, 276 Precordia, bulging of, 194, 2 56 Pulse, allorrhytlunic, 210 retraction of, 194 analysis of, 207 Pregnancy, abdominal, contour in, arterial. 195 318 arterial changes in, 207 Pressure, arterial, 242 bilateral symmetry, 213 blood, 242 capillary, 201, 417 diastolic, 244, 251 centripetal venous, 198 systolic, 244, 250 Corrigan, 213 venous, 251 dicrotic, 212 instrumental estimation 251 duration of, 212 Oliver's method, 252 force of, 211 Presystolic murmur, mitral. 232 hyper-tension of, 212 tricuspid, 236 hypo-tension of, 212 thrill, 281 in aortic insufficiency, 272 Ptosis of eyelid, 391 in cardiac dilatation, 291 of intestine, 323 hypertrophy, 287 of stomach, 323 in chronic adhesive pericarditis, 260 Pubic spine, 297 myocarditis, 285 symphysis, 297 in mitral insufficiency, 277 Puerile respiration, 87 stenosis, 278 in bronchiectasis, 105 in pulmonary insufficiency, 279 in compensatory emphysema, 162 stenosis, 278 in pneumothorax,185 in sero-fibrinous pericarditis, 257 Pulmonary area, 220 in tricuspid insufficiency, 279 artery, clinical anatomy. 1SS stenosis, 280 infarction, 279 intermission of, 210 insufficiency, 279 paradoxical, 211 diagnosis, 279 pressure, 244, 251 pathology, 279 diminished, 250 physical signs, 279 increased, 250 murmur. 237 rate of, 207 diastolic, 23S disturbances of, 20S systolic, 237 rhythm of, 210 492 INDEX Pulse— Cont 'd. taking, technic of, 204 tension of, 212 venous, 196 volume of, 211 water-hammer, 213, 272 Pulsus alternans, 211 bigeminus, 211 celer, 212 deficiens, 210 durus, 212 intercidens, 211 intermittens, 211 magnus, 211 mollis, 212 paradoxus, 211, 257 parvus, 211 tardus, 212 trigeminus, 211 Pupil, Argyll-Robertson, 454 reflexes of, 453 Pupillary unrest, 454 Purulent infiltration, 163 pleurisy, 179 Putrid bronchitis, 102 Pyelonephrosis, fluctuation in, 373 Pylorus, clinical anatomy, 332 Pyo-pneumo-pericardium, 262 Pyo-pneumo-thorax, 184 Pyorrhea alveolaris, 401 Q Quality of murmurs, 231 of percussion sound, 69 R Rachitic rosary, 38, 43 thorax, 40 Radial sphygmogram, 206 Radiography, 95 Rales, 90 crepitant, 91 dry, 90 gurgling, 91 in acute bronchitis, 101 in bronchial asthma, 107 in broncho-pneumonia, 126 in chronic bronchitis, 103 pleurisy, 183 in emphysema, 159, 160, 162 in lobar pneumonia. 120 in phthisis, 133, 143, 148 in pulmonary congestion, 111 edema, 112 infarction, 113 in tracheal and bronchial stenosis, 109 indux, 91, 120 moist, 90 mucous, 91 redux, 91, 120 Rales — Cont 'd. sibilant, 90, 101, 103 sonorous, 90 subcrepitant, 91 Ranula, 405 Rate of pulse, 207 Raynaud's disease, 422 Rays, roentgen, 95 Reaction, pupillary, Wernicke 's, 452 Recession of thorax, expiratory, 47 Recurrent endocarditis, 264 Reflex accommodation, 454 arc, 446 light, 453 consensual, 454 oculo-cardiac, 393 patellar, 446 plantar, 447 tendo-Achilles, 447 Region, axillary, 35 epigastric, 305 hypochondriac, 35, 305 hypogastric, 306 infra-axillary, 35 infra-clavicular, 35 infra-scapular, 36 inter-scapular, 36 iliac, 307 lumbar, 306 mammary, 35 scapular, 36 sternal, 35 supra-clavicular, 35 supra-scapular, 36 umbilical, 305 Regurgitation, aortic, 270 mitral, 276 pulmonary, 279 tricuspid, 280 Reptilian heart, 293 Resistance, increase of, 64 sense of, 65, 70 Resonance, amphoric, 78 cracked-pot, 78 impaired, 74 money-chink, 78 osteal, 70 pulmonary, 70 diminished at apices, 71 diminution of anterior border, 60, 71 diminution of lower border, 74 160 extension of anterior border, 71 extension of lower border, 74 general decrease, 71, 159 increase, 71 increased at apices, 71 limits of, 71 variations in, 71 regional variations, 70 skodaic, 77 INDEX 4JJ3 Resonance — Cont 'd. vesicular, 70 vocal, 88 Bespiration, 47 absent, 87 amphoric, 86 bronchial, 85, 86 broncho-vesicular, 85, 86 cavernous, 65 Cheyne-Stokes, 52 cog-wheel, 87, 143 costal, 47 costo-abdominal, 47 frequency of, 47, 52 in acute fibrinous pleurisy, 170 peritonitis, 51 tuberculo-pneumonic phthisis, 133 in ascites, 51 in bronchial asthma, 51, 107 in bronchiectasis, 105 in broncho-pneumonia, 51 ui cerebral abscess, 51 hemorrhage, 51 tumor, 51 in chronic adhesive pleurisy, 183 bronchitis, 102 interstitial pneumonia, 131 in diabetes mellitus, 51 in edema of glottis, 51 in emphysema, 51, 159, 160, 162 in laryngeal stenosis, 51, 141 in laryngismus stridulus, 51 in lobar pneumonia, 51, 119 in meningitis, 51 in phthisis, 51, 143 in pleurisy with effusion, 172 in pulmonary congestion, 51 edema, 51 in tonsillar hypertrophy, 51 in tracheal stenosis, 51 in uremia, 51 movements of, 47 normal, 83 pathologic variations, 51, 86 phases of, 47 prolonged expiration, 40, 51, 87 puerile, 87, 105, 162, 185 rapid, 51 slow, 50 stertorous, 51 stridulous, 51 vesicular, 85, 86 Respiratory organs, disease of, 100 examination of, 37 Retraction, local of thorax, 47 uni-lateral of thorax, 46 Rhagades, 397 Rhonchal fremitus, 63 in acute bronchitis, 63, 101 in bronchial asthma, 63 in chronic bronchitis, 102 Rhonchal fremitus — Cont '<!. in phthisis, 63, 142 in pulmonary edema, 1 1 2 Rhonchi, 90 Rhythm, canter, 224, 292 gallop, 224, 284, 292 of pulse, 210 Ribs, as landmarks of thorax, 32 incurvation of, 44 method of counting 32 obliquity of, 40 overlapping of, 46 prominence of, 38, 40 Rickets, 44 bowing of tibiae in, 432 how-legs in, 437 epiphyseal swelling in, 428 funnel-chest in, 46 I [arrison 's sulcus in, 44 head of, 379 keel In-cast in, 44 knock-knees in, 437 rosary in. 38, 43 thorax of. 40 Riedel 's lobe, 358 Rigidity of abdominal wall, 326 of rectus, 326 Risus sardonicus, 390 Riva-Rocci sphygmomanometer, 2 16 Roentgenogram, 95 in aneurism, aortic, 99 in chronic Interstitial pneumonia, 98 in lobar pneumonia, 98 in mediastinal neoplasm, 98 in pleural thickening, 98 in pleurisy with effusion, 98 in pneumo-thorax, 98 in pulmonary neoplasm, 9S in sero-fibrinous pericarditis, 98 in tuberculosis, pulmonary, 96 of heart, 99 Roentgenography. 95 Roentgen rays, 95 Rogers' sphygmomanometer, 246 Rosary, rachitic, 38, 43 Rotch's sign, 257 Saddle nose, 394 Safety-valve murmur, 182 Sarcoma of lung, 114 Scaphoid abdomen, 323 Scapula, angle of, 32 as landmark of thorax, 32 winged, 40 Scapular line, 34 spinal, 35 region, 36 Scarpa's triangle, swelling in, 436 494 INDEX Scars of abdomen, 308 of neck, 416 of thorax, 38 Sclera, blue, 384 yellow, 394 Scleritis, 394 Sclerosis of lung, 129 Scoliosis, 44, 146 Scotoma, 451 absolute, 452 relative, 452 Scrobiculus cordis, 31, 35 Scybala, 340 Seal-fin hand, 425 Semilunar space of Traube, 332, 338 Sensation, muscular, 445 pain, 445 pressure, 445 stereognostic, 446 tactile, 444 temperature, 444 Septa, cardiac, 187 absence of, 293 interventricular, defects of, 293 Sero-fibrinous pericarditis, 256 pleurisy, 171 Shock, valve, 202, 278, 287 Sibilant rales, 91, 101, 103 Siderosis, 150 Sigmoid flexure, clinical anatomy, 343 palpation of, 348 Sign, Abadie's, 390 Auenbrugger 's, 256 Babinski's, 447 Baccelli's, 89, 175, 181 Biermer's, 80 Broadbent's, 198, 260 Duroziez's, 272 E wart's, 257 Friedreich's, 80, 142, 165, 196 Gerhardt's, 80, 105, 142, 165 Glenard's, 338 Grocco's, 76, 174, 181 Kernig's, 443 Kussmaul's, 260 Litten's, 48 Lorenz's, 138 Oliver's, 241 Prevost's, 456 Romberg's, 440 Rotch's, 257 Rothschild's, 138 Yon Graeffe's, 393 Williams', 95 Wintrich's, 79, 105, 142 Signorelli's point, 365 Simple endocarditis, 264 Sinus, complementary, 28 of Valsalva, 187 Sixth costal line, 35 Skiagraphy, 95 Skin, of abdomen, 308 colors of, 308, 309 eruptions of, 308 scars of, 308 of thorax, 38, 39 eruptions of, 38 pigmentation of, 38 Skodaic resonance, 77 in lobar pneumonia, 119 in sero-fibrinous pericarditis, 78 pleurisy, 174 Snoring respiration, 51 Sonorous rales, 90, 101, 103 Souffle, umbilical, 331 uterine, 331 Sound, aortic, accentuation of, 222, 285, 287 diminution of, 223 cracked-pot, 78, 105, 142, 174 falling-drop, 90, 91, 185 friction, pericardial, 239 perihepatitic, 331 perisplenitic, 331 peritoneal, 331 pleural, 90, 92, 170, 175 lung-fistula, 90, 93, 185 mitral, accentuation of, 222, 287 diminution of, 222, 279 percussion, 69 abnormal, 74 change of, Friedreich's, 80, 142, 165, 196 Gerhardt's, 80,. aarrowing of, 46, 140, 160 retraction of, 40, 51, 155 Traube \s semilunar, 332, 338 Spade-hand, 422 Spasm, brachial, 430 choreal, 390 facial, 391 habit, 390 lingual, 402 nodding, 383 of exophthalmic goiter, 390 professional, 426 tetanic, 390 Sphygmogram, arterial, 206 clinical significance, 206 variations in, 206 Sphygmomanometer, Cook's, 243 Erlanger's, 244 Faught's, 246 Janeway's, 245 Riva-Rocci's, 246 Rogers', 246 Stanton's, 243 Sphygmomanometry, auscultatory method, 249 palpatory method, 248 1 <'clmic, 246 Spine, iliac, 297 anterior superior, 297 Spiral's, Curschmann 's, 107 Splashing sounds, 92 Spleen, auscultation of, .".<i7 clinical anatomy of, 363 displacement of, 366 enlargement of, 364 examination of, 363 inspection of, 363 palpation of, 363 percussion of, 366 point, Signorelli 's, 365 surface marking, 363 tenderness of, 365 wandering, 366 Spots, cold, 444 heat, 444 milk, 256 Sputum, in bronchial asthma, 106 in bronchiectasis, 105 in broncho-pneumonia, 125 in chronic ulcerative phthisis, 141 in lobar pneumonia, 117 in pulmonary abscess, 165 edema, 112 gangrene, 167 Squint, 455 Stanton's sphygmomanometer, 243 Staphyloma, 394 Station, 440 Stenosis, aortic, 273 (See Aortic stenosis) Stenosis — Cont'd. mitral, 277 (See Mitral stenosis; of bronchi, 108 of trachea, 108 pulmonary, 280 (See Pulmonary stenosis; tricuspid, 281 (See Tricuspid sten- osis) Stereo-roentgenogram , 95 Stereo -roentgenography, 95 Sternal dullness, 70 line, 33 region, 35 Sterno-mastoids, prominence of, 409 Sternum, as landmark of thorax, 31 length of, 31 prominence of, 44 Stethophone, 82 Stethoscope, 82 binaural, 82 monaural, 82 selection of, 82 Stokes-Adams disease 228 Stomach, auscultation of, 339 auscultatory percussion of, •"••"•s clinical anatomy of, :;.",2 fundus of, 332 greater curvature of, '■'<■'•- hour-glass, 339 inflation of, 338 inspection of, 333 lesser curvature of, 332 orifice, cardiac. 332 pyloric, 332 palpation of, 336 percussion of, 338 peristalsis of, 335 pit of, 31 relations of, 332 succussion sounds of, 337 surfaces of. .",.".2 tumor of, 336 tympany of, ."..'Is decreased, 339 increased, 339 Stomatitis, catarrhal, 406 gangrenous, 406 ulcerative. 401 Stone-cutter 's phthisis, 153 Strabismus, 445 Stridulous respiration, 51 Subclavian artery, auscultation of, 241 murmur in, 241 Subcostal line, 304 Subcrepitant rale, 91 Subcutaneous nodules of forehead, 391 Submaxillarv lymph nodes, enlarged. 413 496 INDEX Succussion, fremitus, 63, 186 in pneumo-thorax, 63, 186 pulmonary cavity, 63 Hippocratic, 337 pericardial, 240 sound, 337 Sulcus, Harrison's, 44 Supra-clavicular fossa, 39 region, 35 recession of, 40 Supra-scapular fossa, 36 region, 36 Supra-sternal notch, 31, 35 Surgical kidney, 373 Sutures, open, 380 Symphysis pubis, 297 Syphilis, pulmonary, 148 acquired, 148 hereditary, 148 pathology, 148 physical signs, 149 Syphilitic broncho-pneumonia, 148 fibrosis of lung, 148 Systole, auricular, 196 ventricular, 244 Systolic jugular pulsation, 196, 280 murmurs, 231 aortic, 234 arterial, 240 mitral, 233 pulmonary, 237 tricuspid, 236 plateau, 207 pressure, 244 pulsation, epigastric, 195 retraction of thorax, 198 venous pulse, 197 Tachycardia, 210, 227 paroxysmal, 227 Talipes, equinus, 432 valgus, 432 varus, 432 Teeth, delayed, 400 early decay, 400 examination of, 400 grinding, 401 Hutchinson's, 401 loosening, 400 premature, 400 Tenderness of abdomen, 326 points of, 327 of thorax, 63 Tension of pulse, 212 Test, Barany's, 460 caloric, 462 Gairdner's, 81, 185 Holmgren, 450 pointing, 464 rotation, 463 Thermo-anesthesia, 445 Thermo-hyperesthesia, 445 Thigh, edema of, 436 tumor of, 436 Third costal line, 35 Thomson's, 451 Thoracometry, 94 Thorax, abnormalities of expansion, 53 alar, 40 bi-lateral deformities of, 40 • clavicles as landmark of, 31 clinical anatomy of, 17 contour of, 39 diameter of, 39, 40, 43, 94, 158, 160 edema of, 38, 54 elongation of, 40 emphysematous, 40, 158 enlarged veins of, 38 eruptions of, 38 examination of, 37 expansion of, 53,-55, 94 flat, 40 fluctuation of, 64 funnel, 46 inlet, 31 • inspection of, 37 intercostal spaces as landmarks, 32 landmarks of, 29 local deformities of, 47 enlargement of, 47 retraction of, 47 localized pulsations, 54, 64, 194 mammary glands as landmarks, 32 mensuration of, 94 movements of, 94 musculature of, 38, 39 wasting of, 38, 40 nipples as landmarks, 32 normal, 39 cross-section of, 39 landmarks of, 29 of child, 39 cross-section of, 39 palpation of, 55 paralytic, 40 percussion of, 65 phthisical, 32, 40 pigeon, 44 cross-section of, 44 pigmentation of, 38 rachitic, 40 cross-section of, 43 regions of, 33 ribs as landmarks of, 32 scapulae as landmarks of, 32 scars of, 38 shortening of, 40 size of, 39 skin of, 38, 39 spine as landmark of, 32 INDEX 497 Thorax — Cont VI. sternum as landmark, 38 subcutaneous tissues of, 38 surface of, 38 systolic retraction of, 198 tenderness of, 63 uni-lateral contraction of, 46 deformities of, 46 enlargement of, 46 vibrations of, 58 Thrill, 203 at apex, 204, 275 aortic area, 204, 275 base of heart, 204 pulmonary area, 204 cardiac, 203 diastolic, 203 hemic, 203 in mitral stenosis, 278 over carotids, 20 \ presystolic, 203, 276 systolic, 203, 276 Thrush, 405 Thyroid gland, atrophy of, 412 enlargement, 411 fluctuation of, 411 murmur over, 411 thrill over, 411 Tic, convulsive, .".DO Tinkle, metallic, 89, 91 Tinnitus, 460 Toes, examination of, 431 gangrene of, 4.",1 in gout, 431 perforating ulcer of. 431 Tone, tracheal, Williams', 79 Tongue, atrophy, 401 color, 405 cysts, 405 examination of, 401 geographical, 404 hypertrophy, 401 acquired, 401 congenital, 401 indentations, 405 in pellagra, 405 leukoplakia, 404 movements, 402 paralysis, 402 size of, 401 smoker's patch, 404 spasm, 402 strawberry, 406 thrush, 405 tremor, 402 ulceration, 402 Tonsillitis, follicular, 407 Tonsils, enlargement of, 408 examination of, 407 inflammation of, 407 Tonsils — Cont 'd. pseudo-membrane on. 408 ulceration of. 4os Tophi, 384, 419 Torticollis, congenital, 409 rheumatic, ::^i! spasmodic, 409 Tortuosity of abdominal veins, 310 Toxemic dyspnea, 53 Tracheal tone, Williams, 79 tug, 241, (11 Trachea, clinical anatomy, 10 deflection of, 409 surface markings^ 29 Tracheo-bronchia] stenosis, 108 diagnosis, 1"0 pathology, Ins physical si^ns. 108 Traube's semilunar space. 332, :::;s decrease of, 339 dullness of. 257, 260 increase of, 131, 339 Tremor, convulsive. 44.". intention, 125, 44.". of tongue, 4 ( f i_> pill-rolling, 420. 44". Tricuspid insufficiency diagnosis, 281 pathology of, - physical si;_;ii>. 280 pulse in. 281 relative, 280 murmur, 236 presystolic, 236 systolic. 236 stenosis, 281 pathology of. 281 physical signs, 283 valve, is; anatomic site of. 220 auscultatory area of. 220 Tuberculo-pneumonic phthisis, acute 132 Tuberculosis, pulmonary, 132 (See Phthisis) Tug, tracheal, 241. 400 Tumor, intra-abdominal. 328 of stomach. 336 pulmonary. 114 Tussile. fremitus, 63 Twelfth dorsal line. 35 Tympanites, respiration in. 4S Tympany bell, SI gastric, 338 decrease of, 339 increase of, 339 in ascites. 323 in bronchiectatic cavities. 78, 104 in pneumo-thorax, 78 in pulmonary cavities. 7S on percussion, 78 498 INDEX r, u Ulcer, carcinomatous, 395, 404, 408 corneal, 394 of leg, 432 nasal, 395 perforating, of foot, 431 simple, 402 • syphilitic, 395, 403, 407 tuberculous, 395, 403, 407 Ulceration, peritonsillar, 408 Umbilical hernia, 313 notch, 353 region, 305 Umbilicus, eruptions of, 313 inflammation, 313 protrusion of, 313 retraction of, 313 Uni-lateral bulging of thorax, 46 contraction of thorax, 46 Unrest, pupillary, 454 Ureters, examination of, 378 palpation of, 378 surface marking, 378 tenderness of, 378 Uvula, elongation of, 407 Vagus neuritis, tachycardia in, 210 Valsalva, sinus of, 187 Valve aortic, 187 anatomic site, 220 auscultatory area, 220 areas, 219 ileo-cecal, 339 mitral, 187 anatomic site, 220 auscultatory area, 220 pulmonary, 188 anatomic site, 220 auscultatory area, 220 shock, 202, 278, 287 tricuspid, 187 anatomic site, 220 auscultatory area, 220 Valves, cardiac, 187 diseases of, 264 excrescences of, 265 of heart, 187 perforation of, 270 Valvular disease, chronic, 268 effects of, 269 incidence of, 269 Varicose veins, 432 Vascular dullness, 218 murmurs, 240 Vegetation, adenoid, 395 Vein, common iliac, surface marking, 302 external iliac, surface marking, 302 portal, obstruction, 38, 310 'L caput medusae in, 38, 310 BD- 79. Veins, cervical engorgement of, 256 distended, of thorax, 38, 310 fluid, 203, 229, 240 jugular, diastolic collapse, 196 pulsation of, 237 pulmonary, 189 varicose, 432 Vena cava, inferior, surface markings, 301 superior, 189 Venous hum, 241 murmurs, 241 pressure, 251 pulse, auricular, 196 centripetal, 198 negative, 196 physiologic, 196 positive, 197 presystolic, 196 systolic, 197 Ventricles, clinical anatomy, 187 Ventricular, diastole, 244 systole, 244 Vermiform, appendix, 343 palpation of, 346 Vertebra prominens, 32 Vertebrae, method of counting, 32 Vertigo, 460 Vesicular emphysema, acute, 162 resonance, 70 respiration, 86 Vincent's angina, 408 Viscera, abdominal, clinical anatomy, 295 examination of, 332 thoracic, clinical anatomy, 19, 187 Visceral pleura, 17, 20 Visceroptosis, abdominal contour in, 323 Vision, color, 450 field of, 451 Vocal fremitus, 58 absence of, 62 decrease of, 62 in atelectasis, 155 in chronic ulcerative phthisis, 62, 142 in emphysema, hypertrophic, 62, 158 in lobar pneumonia, 62, 119 in pneumo-thorax, 62, 185 in pulmonary cavity, 62 in sero-fibrinous pleurisy, 62, 173 in tuberculo-pneumonic phthisis, acute, 132 increase of, 62 normal variations, 58 resonance, 88 absent, 88 diminished, 88 in acute bronchitis, 101 INDEX 499 Vocal resonanci — Cont 'd. in ac^te fibrinous pleurisy, 170 in bronchial asthma, 107 in bronchiectasis, 105 in chronic bronchitis, 103 ulcerative phthisis, 143 in emphysema, 159 in pulmonary congestion, 111 edema, 112 in sero-fibrinous pleurisy, 175 increased, 88 modified, 89 Volume of pulse, 211 Von Graeffe's sign, 393 W Wall, abdominal, 295 edema, 326 palpation, 324 rigidity of, 326 suppuration, 326 thickness, estimation of, 324 arterial, 207 Wandering kidney, 373 spleen, 366 Water-hammer pulse, 213, -272 Wave, dicrotic, 206 fat, 327 fluid, 326 post-dicrotic, 206 Wernicke's reaction. 452 Whispering pectoriloquy. 