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

  • Gibson, George Alexander, 1854-1913.
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 University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    abnormal vibrations as those causing reduplication of the sounds of the heart, but render less distinct evidence of the vibrations producing murmurs. Cardiography has not yet been able to render any real service to clinical medicine, and no more need be said about it in this place. Percussion op the Heart. The percussion of the heart is divided into superficial and deep, according as it is desired to delimit the part of the organ uncovered by lung, or to find the precise size of the organ itself. The former is the superficial or absolute dulness, the latter the deep or relative dulness. Superficial Dulness. The superficial dulness is the part of the heart uncovered by lung, and lies witliin the notch in the left lung, and between it and the edge of the sternum. What has really to be done in defining the superficial dulness is to find the edge of the left lung. Percussion must be very light, as the edge of lung overlying the heart is very thin at its margin, and all trace of clearness in the sound must dis- appear before it is inferred that the margin of the lung is passed. Normally the superficial dulness extends from the fourth to the sixth left costal cartilage, and extends outwards to about the junction of the cartilages with the ribs. The part of the heart under the sternum which is uncovered by lung is not readily defined, and can only be made out by comparing the percussion sound on the sternum above and below it. The clinical value of the superficial dulness is not great, and many clinicians have entirely abandoned its investiga- tion. When, however, the heart is much enlarged, or when there is much pericardial effusion, the area of this dulness is extended as the organ approaches the chest wall and pushes the lung aside. On the other hand, when the volume of