Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell.

Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    formed by standing behind the patient, when that is practicable, and putting the hands across the shoulders ; in the same way, for palpation of the apices posteriorly, the hands may be put across the shoulders from the front. The lower part of the thorax, both laterally and posteriorly, should always be palpated as well as the apices, and a note made of the movement iii these various situations. The conditions in which deficient expansion is present have been already mentioned under inspection, and need not therefore be repeated here. Pain on palpation is sometimes present, and may be even acute. It may be present either in the intercostal muscles, when it is usually rheumatic, or it may be confined to the nerves. It is also present before the appearance of the eruption in herpes zoster (shingles). In some cases of pleurisy pain is complained of on palpation, especially if considerable pressure be made on the part. Vocal Fremitus. — The physical explanation of vocal fremitus has been already considered. The factors which determine its intensity may be classed as follows :— (a.) The pitch of the voice : the lower the pitch the more marked the fremitus, and vice versa. This explains the fact that in women it is, as a rule, less marked than in men, the former having the higher pitched voices. Feeble voices are also badly conducted. (h.) The size of the tube (the bronchus), and therefore the size of the vibrating column of air within it. As a conse- quence vocal fremitus is usually better marked on the right than on the left side, the right bronchus being the larger. (c.) The distance of the part from the larynx—that is, from the point where the vibrations have their origin : the greater the distance the feebler the fremitus, and vice versa, so it is more marked over the upper part of the anterior aspect of the chest than the lower. (d.) The thickness of the chest wall : the thicker the chest the feebler the fremitus. A thick wall, whether due