The Early Diagnosis of Tubercle

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The value of the test is diminished by the fact that in young children with short necks, but less often at later ages, such a movement may almost certainly cause pressure on venous trunks even in the absence of en- larged glands. It must be borne in mind, moreover, that a venous hum at the root of the neck is very com- monly found in healthy children in 66 per cent, of forty-eight boys examined by the writer on this point and in some cases is also audible over the manubrium. The presence or not... of this bruit must be noted before the head is extended.
Smith's murmur is very commonly obtained, as would be expected, in cases where enlargement of chest veins and jugulars is also present. A. G. Gibson found it in ten of fourteen such cases. It is of most sig- nificance in older children, among whom it is seldom present in health, and where it may indicate disease of pretracheo-bronchial or lateral tracheal glands, generally on the right side.
THE BACK OF THE THORAX Inspection Inspection may reveal the hairy back of scrofulosis (p.


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