Clinical manual for the study of medical cases / edited by James Finlayson.

Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Clinical manual for the study of medical cases / edited by James Finlayson. Source: Wellcome Collection.

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    to be observed, especially in early adult life. The presence of clubbing of the finger ends, or of undue curvature of the nails; the red line on the gums, said to be more or less characteristic of tubercular disease; the peculiar momen- tary starting and elevation of the skin produced by a tap of the finger point over the costal cartilages, and de- scribed as myoidema; any undue, and especially any uni- lateral, flattening below the clavicles, or deformity elsewhere of the chest, and any inequality, or want of symmetry, in the respiratory movements; any rapid and too easy flushing of the face, and especially that limited flush of the cheek with pallid complexion generally, which denotes fever in an exhausted con- stitution • any or all of these may in particular cases be valuable indications of truly morbid emaciation.1 In infants and chil- 1 These subjects are referred to in detail under the sections on the Nails (p. 107), General signs of Pyrexia (p. 70), Gums (Chap, xi.), and in those deal- ing with the physical examination of the Chest (chap, xvi, part 1). Myoidema is the name first applied by Dr. Lawson Tait (Dublin Journal of Medical Science, vol. 52, p. 316) to a phenomenon observed long ago by Drs. Graves and Stokes (Dublin Hospital Reports, vol. 5, p. 70), as probably characteristic in some degree of phthisical emaciation, and as being found most frequently in incipient phthisis over the seat of the irritation—i.e., on the side first affected and in the supra-clavicular region. According to Dr. Tait, the sign attends especially the softening stage of tubercle. After each stroke of the ends of the fingers (say the first discoverers of this sign) a number of little tumours appeared, answering exactly to the number and situation of the points of the fingers, when they had struck the integuments of the chest. These having continued visible for a few moments, subsided, but could be again made to appear on repeating the percussion. [My observations, in very numerous instances, lead me to concur with the original description here given more closely than with the details of fact and of procedure in Dr. Lawson Tait's paper. In particular, I have found that the little tumours of Drs. Graves and Stokes, which are undoubtedly the more important part of myoidema, are produced more easily, and with far less risk of fallacy, when the percussion is made, not over a voluntary muscle at all, but over the anterior costal cartilages. The name therefore seems, in a certain sense, a misnomer, if it is intended thereby to suggest that the contraction of the fibrillar of voluntary muscle has anything to do with the more distinctive phenomena. The '' little tumours are quite evidently due to a temporary contraction of muscxilar fibres in the skin itself, similar in kind to those of the dartos on pinching the scrotum. I believe the phenomenon, thus inter- preted, to have some, but by no means a pathognomonic, significance.— W. T. G.]