Volume 7
A system of medicine / by many writers ; edited by Thomas Clifford Allbutt and Humphry Davy Rolleston.
- Date:
- 1905
Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Credit: A system of medicine / by many writers ; edited by Thomas Clifford Allbutt and Humphry Davy Rolleston. Source: Wellcome Collection.
Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.
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![The percussion-uotc on one side of the chest must Vje carefully compared with that on the other, and also the percussion-notes at various points of the same side must bo contrasted. A reference may be made to what has been called superficial and deep dulness. Where the lungs overlap a solid organ the ordinary dull area does not represent the size of the organ, but only that portion uncovered by tlie lungs. This is the area of superficial dulness, and it is obtained by light percussion. When strong or heavy percussion is employed it is sometimes possible to recognise a difference in the resonance where the solid organ underlies the lungs. The comparative dulness so obtained is what is called the deep dulness. The results, however, so obtained are not very trustworthy. A knowledge of the normal limits of thoracic dulness and resonance is most essential. In front there is resonance on the right side from the apex to the sixth rilj, where the liver dulness begins, and on the left side from the apex to the fourth costal cartilage, where the cardiac dulness commences. The limits of cardiac dulness are the mid-sternal line on the right, and on the left a line slightly concave outwards, extending from the sternal end of the fourth costal cartilage to the apex of the heart. To the left of the cardiac dulness the pulmonary resonance is continued downwards until it reaches the area of the stomach resonance. The thoracic portion of the latter, called 2’rauhe’s space, may be recognised by its different note and characters. Traube’s space is semilunar in sha]^, is about 31 inches wide, and extends along the anterior border of the costal margin as far to the left as the eighth or ninth rib. This space is diminished or obliterated when the lung is enlarged, as in hypertrophous emphysema, or when there is effusion into the left pleura, and it is enlarged when the lung is atrophied as in the atrophous or senile form of emphysema. Behind, the pulmonary resonance extends from the apex to the tenth or eleventh rib on both sides. In the right axillary region it extends as far as the eighth rib, and in the left as far as the ninth, ihe percussion-note is less resonant posteriorly, especially in the supra- and infra-spinous regions than in front. The thoracic percussion-note has more resonance when the parietes are thin, and there is little subcutaneous fat and poor muscular development, also when the lungs are over-expande as in emphysema. . ^ Grocco has pointed out that in cases of pleural effusion there may bo recoo'tiised a triangular area of dulness on percussion of the non-affected side'when the patient is examined in the standing or sitting po.sition.^ The apex of this triangle, which is close to the spine, is at the upper level of the effusion, and its base, which is seldom more than 2 or 3 inches, is below. The area disappears when the patient is examined lying on the affected side. Grocco’s triangle is not constmit, but its presence may sometimes help in the recognition of fluid effusions. In the case of large cavities, which contain both air and Hiiid, tne percussion-note is altered by a change in the patient’s position. W Hen the thorax is erect the area of resonance is less than when the patient is](https://iiif.wellcomecollection.org/image/b21295359_0007_0032.jp2/full/800%2C/0/default.jpg)
