Diseases of the chest, throat, and nasal cavities / by E. Fletcher Ingals.

  • Ingals, E. Fletcher (Ephraim Fletcher), 1848-1918.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the chest, throat, and nasal cavities / by E. Fletcher Ingals. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    region, between the ninth and eleventh ribs, dillness is obtained over the spleen, and for a short distance abont this dnll region resonance is rendered more or less tympanitic by the stomach and intestines. In the lower part of the left infra-scapular region, close to the spinal column, dulness is found over the kidney, and it occurs in a similar position, though a trifle lower, on the right side. In the axillary regions the resonance is often more marked than in the infra-clavicular. In the infra-axillary region the resonance is modified on the right side by the liver, and upon the left by the stomach and spleen. In this region the margin of the lung passes obliquely downward and backward from the anterior boundary near the sixth rib to the pos- terior near the tenth rib. On the right side, hepatic flatness is found below this line, and hepatic dulness a couple of inches higher. On the left side, below this line, we find tympanitic resonance in front over the stomach, and dulness posteriorly over the spleen. In this locality the pulmonary resonance is often modified by the stomach, as high as the fourth rib. The size of the spleen varies considerably, even in health. The area of dulness which it causes seldom exceeds two and one-half inches in height by about four inches in width; about half of this dull space is in the infra-scapular and half in the infra-axillary region. Exceptional.—In rare cases the spleen rises as high as the lower boundary of the axillary region, or the stomach may yield decided tympanitic resonance as high as the fourth rib. In the infra-scapular region, upon the right side in children, dulness is some, times very pronounced, due to the disproportionate size of the liver in early life. This is not infrequently mistaken for the consolidation of pneumonia. The percussion sounds in different regions of the chest are modified by age, sex, and various idiosyncrasies. In old age, the chest walls are less elastic than in middle life, and the lung has undergone some change which renders the sounds harder in quality and higher in pitch. In children, the lungs are very resonant, and the costal cartilages are elas- tic; consequently we obtain a low-pitched, intense vesicular sound. In men the percussion note over the upper portion of the chest is not usually so resonant as in women, but it is more distinct over the lower portions. It will be seen, from what has already been said, that there is notable dissimilarity of the percussion sounds on the two sides in the mammary regions, as also in the infra-mammary, infra-axillary, and infra-scapular regions. In all other portions of the chest the resonance is nearly identical on the two sides, but the slight normal disparity in the infra-clavicular regions is a point of great importance.