Clinical medicine; a manual for the use of students and junior practitioners.

  • Bury, Judson Sykes.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Clinical medicine; a manual for the use of students and junior practitioners. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    2. Tracheal Resonance, or the so-called tympanitisch of Skoda, hence sometimes called Skodaic resonance. The note is short, the pitch raised, and the tone clear. It is heard— (i.) Over relaxed lung. (a.) In the neighbourhood of extensive infiltration of the lung, or of effusion into the pleura or pericardium. Thus in pneumonia of the lower lobe, or when there is effusion into the pleural cavity, a clear and sometimes quite a tubular or even amphoric sound may be obtained over the apex on the same side. (5.) Over a portion of lung which is only partially infiltrated, solid or liquid being mingled with air-containing tissue. Examples: the first and third stages of a croupous pneumonia, especially in children; oedema of the lung; catarrhal pneumonia. (2.) Over air spaces, (a.) Smooth-walled cavities, which are either close to the surface or are separated from it by dense solid tissue. Examples : bronchiectasis; tuberculosis. If the cavity communicates freely with a bronchus, the pitch rises when the mouth is open, falls when it is shut, (b.) When the bronchus or natural air spaces are directly connected with the surface by solid masses. Examples: pulmonary tumours; pneumonia of the upper lobes. (3.) Sometimes when the diaphragm is pushed up in consequence of abdominal distension, the increased clearness of the pulmonary re- sonance being probably due to relaxation of the lung-tissue. In other cases, however, the pulmonary resonance becomes impaired. This may be sometimes observed on the left front when the heart is enlarged and also raised by ascites. Here probably a portion of the left lung has, through collapse, become completely airless. Diminished Resonance.—The note is shorter, more muffled, and its pitch is usually raised. The various degrees in which the normal pulmonary resonance may be impaired or muffled are often spoken of as (1) slight impairment or slight dulness; (2) moderate impair- ment or moderate dulness; (3) absolute dulness. Diminished resonance is met with under the following conditions, passing from without inwards :— 1. In thickening of the superficial tissues, as from great muscular development, an excess of fat, or cedematous swelling. 2. When the ribs are strongly arched, as in kyphosis. A familiar instance is offered by percussing the back of a well-marked emphyse- matous thorax; the projecting angles of the ribs often give a mode- rately dull note, while the shallow depression over the infraspinous region furnishes increased or even tympanitic resonance. 3. When there are fluids or solid masses between the lung and the chest-wall. (a.) In hydrothorax or dropsy of the pleura the effusion is usually