Diseases of the chest, throat and nasal cavities : including physical diagnosis and diseases of the lungs, heart and aorta, laryngology and diseases of the pharynx, larynx, nose, thyroid gland, and œsophagus / by E. Fletcher Ingals.

  • Ingals, E. Fletcher (Ephraim Fletcher), 1848-1918.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the chest, throat and nasal cavities : including physical diagnosis and diseases of the lungs, heart and aorta, laryngology and diseases of the pharynx, larynx, nose, thyroid gland, and œsophagus / by E. Fletcher Ingals. Source: Wellcome Collection.

    187/710 (page 159)
    In this connection, it must be constantly borne in mind that mod- erate dulness is frequently a normal sign over the right apex and that other diseases than phthisis, as, for example, bronchitis and circum- scribed pneumonia, not infrequently cause temporary dulness m the infra-clavicular region, , ^ , . i v i Dulness over the left apex, even though shght, is always abnormal, iind when persistent, is nearly always a sign of phthisis. Marked dul- ness if persistent, has the same significance when found over the right apex This sign is sometimes found behind when it cannot be detected in front. It is frequently present in the supra-clavicular or clavicular region when it cannot be obtained below the clavicle. Exceptional.-ln the first stage of phthisis the resonance is sometimes vesiculo-tympanitic, on account of secondary circumscribed emphysema. Consolidation of the deeper portions of the lung may cause no dulness upon ordinary percussion if healthy lung tissue intervene between it and the surface. In forcible percussion a small amount of consolidation at the surface of the lung may be overlooked in consequence of the intense resonance from the deeper tissues. It should be remembered, in estimating the amount of phthisical con- fiolidation, that the degree of dulness and its area may be due to the temporary consolidation of circumscribed pneumonia. The extent of phthisical consolidation in such cases can only be ascertained after the inflammatory product has been absorbed. In the second stage of phthisis, dulness becomes very marked, and gradually extends over a wider area, owing to progressive pulmonary consolidation; up to this time, dulness is almost universally confined to one side. At the same time, tubular—or, according to Flint, tym- panitic—resonance may be caused by the bronchial tubes or the trachea, especially when percussion is made near the borders of the upper part of the sternum. Exceptional—la this, as in the first stage, vesiculo-tympanitic resonance may be obtained in rare instances. In the third stage, dulness is obtained over the affected lung, unless cavities of considerable size exist near the surface. In this case, reso- nance over a limited portion, surrounded by dulness and corresponding to the cavity, may be tympanitic, amphoric, or cracked-pot in char- acter. Sometimes early in the morning, dulness or flatness may be ob- tained over a cavity, owing to its being filled with secretions, which will give place, after free expectoration, to the signs of a vomica. In this stage, or in the latter part of the second stage, dulness nearly always appears at the apex of the opposite lung, where it can be detected by comparing the resonance over the diseased structure with that below the second or third rib. Among the early signs of this disease to be detected by auscultation