Lessons in physical diagnosis / by Alfred L. Loomis.

  • Loomis, Alfred L. (Alfred Lebbeus), 1831-1895.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Lessons in physical diagnosis / by Alfred L. Loomis. Source: Wellcome Collection.

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    your examination is based. Now, the percussion sounds differ materially in a healthy thorax, according to the re- gion percussed. Taking the percussion note of the infra- clavicular region as the standard for pulmonary percus- sion, we find each of the other regions has its own V-ariations from it. In the right infra-mammary region you will get, by gentle percussion, the same note as in the infra-clavicular ; but forcible percussion, at and be- low the fourtn interspace, will raise the pitch and har- den the quality, owing to the presence of the liver be- hind the shelving border of the lung. Over the left infra-mammary region the pitch is similarly varied by the presence of the heart, until it reaches complete flat- ness at its inner border. The resonance of the right infra-mammary region has a harder quality, higher pitch, and shorter duration, from the presence of the liver immediately beneath. The left infra-mammai^y re- gion is similarly affected at its inner part by the left lobe of the liver, and at its outer border by the spleen, while the intermediate space gives a tympanitic resonance from the subjacent stomach. Over both clavicles you will get a mixed pulmonary and osseous resonance, while in the supra-sternal region the percussion sound has a distinctly tubular character. In the superior ster- nal region it has a bony tubular resonance down to the second rib ; below this, to the third rib, it is raised in pitch and hardened in quality. The dulness on percus- sion becomes complete in the next region, or inferior sternal, owing to the presence of the heart and great vessels, together with the left lobe of the liver. The Superior and Middle Axillary regions are ex- tremely resonant as far down as the fourth interspace ; the pitch is even lower than in the infra-clavicular re- gion, but below the fourth interspace the pitch rises, till