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June 8, 1912


JAMA. 1912;LVIII(23):1747. doi:10.1001/jama.1912.04260060096004

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It is well known that one of the effects of pulmonary tuberculosis is the production of a degenerative change in the musculature of the body, and that this effect is especially marked in the muscles of the upper part of the thorax. This degeneration is comparatively plainly indicated on the affected side. The physical change is shown especially by atrophy of the scapular muscles. We also have marked hyperirritability, fibrillation being one of the proofs of this condition. I can add that in addition to these signs, we have what appears to be a hypersensitive or painful spot. Very likely this spot is a manifestation of the degenerative changes referred to. It may be due to a reflex from the pneumogastric nerve through the spinal accessory nerve supplying the trapezius, or the third and fourth cervical nerves supplying the levator anguli scapulæ, as all these nerves either have common origins,

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