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.

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    to the sixth costal cartilage. The apex of this triangle is located at the margin of the sternum on a level with the fourth rib. The resonance of the mammary region is modified more or less by the thickness of the muscles in men and by the mammary glands in women. In the infra-mammary region, on the right side usually, there is nothing but the liver to afEect the percussion note, hence we have a eound termed flatness, like that obtained by percussing the thigh. If the colon be distended by gas, we obtain tympanitic resonance in the lower part of this region. In the left infra-mammary region flatness caused by the left lobe of the liver extends a couple of inches to the left of the median line. In the outer portion of this region we obtain a similar sound from the spleen, and between these two organs Ave elicit tympanitic resonance from the stomach. In the upper sternal region, as low as the level of the second costal cartilage, the sound is tubular, or, according to Flint, tympanitic. This is due to the presence of the trachea, the sounds of which are modified by the anterior borders of the lungs which are in apposition throughout this region. Below the level of the second ribs, on light percussion, pulmonary resonance may be heard, though modified by the timbre of the bone. But deep percussion gives dulness, resulting from the presence of the great blood-vessels. Over the lower sternal region, by light percussion, pulmonary reso- nance is obtained to the right of the median line, while on forcible per- cussion there is dulness. Left of the median line, the heart is super- ficial and yields flatness. At the inferior portion of this region, flatness is due to the left lobe of the liver. Over the scapula, the vesicular sound is indistinct from the thick- ness of the muscular tissue, but above the spine of the scapula_ it is much more marked than below, and in the upper part of this region it is quite cleaT. ^^L a In the inter-scapular regions the sounds are hard m quality and high pitched, because the chest walls are thick. There is,_ however m all cases some pulmonary resonance. The pitch is a trifle higher on the left side on account of the aorta. _ In the infra-scapular regions the vesicular resonance is wel defined, though not quite so clear as in the infra-clavicular region It extends downward to the tenth or eleventh rib. On the right side we find the lini of hepatic dulness at the eighth rib and the line o hepatic flatne s iTthe eleventh rib; but these vary from one to two inches during forci- O^tfleTt luif'the resonance is slightly modified near the spine by the newness of the liver. Below the tenth rib the -t-tmal cana f fi led with gas, causes a tympanitic sound. In the outer part of thia