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The intensive study of tuberculosis by medical men particularly interested in this field has established statistically and otherwise that the apex of the lung is the point of predilection in early pulmonary involvement. A study of the physical signs which would make the early recognition of apical impairment possible is, therefore, of the highest importance. In 100 cases which I have closely observed, comparing the healthy with the affected side, I find that retraction, partial atrophy of the muscles and limited expansion are special diagnostic factors; my findings, I may say, also tally with those of Dr. Woods Hutchinson, namely, that the circumference is increased at the dorsoventral diameter between the ensiform cartilage and the angle of the scapula. Williams of Boston, in 1897, pointed to the interference in the respiratory activity of the diaphragm as an early sign of pulmonary tuberculosis. Various theories have been advanced as a reason
Fine MJ. LIMITED PULMONARY EXPANSION IN APICAL INVOLVEMENT: ITS ACCURATE MENSURATION WITH THE THORACIMETER, A NEW DEVICE. JAMA. 1916;LXVI(3):186. doi:10.1001/jama.1916.25810290001010
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