A handbook of physical diagnosis of diseases of the organs of respiration and heart, and of aortic aneurism / by R.C.M. Page.

  • Richard Channing Moore Page
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of physical diagnosis of diseases of the organs of respiration and heart, and of aortic aneurism / by R.C.M. Page. 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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    the eleventh ribs on the axillary line, there is slight dullness mingled not infrequently with ventral tyiu- panicity. In the scax)u]ar and inter-scapular regions the resonance is interfered with by the intervening bone and muscles. 4. Auscultation.— In the left sub-clavicular, both axillary and sub-scapular regions, we hear the normal vesicular respiratory murmur. In the right sub-cla- vicular region we hear the normal vesiculo-bronchial respiratory murmur owing to proximity to the right primitive bronchus. Over the larynx, trachea and bronchi we hear the respiratory murmur characteristic of those organs. Over the liver and superficial area of cardiac dullness the respiratory murmur may be en- tirely absent unless transmitted there by the chest walls. The normal pectorophony (vocal resonance over the chest) is exaggerated in the right sub-clavicular region and is also more intense in the right inter-scap- ular and sub-scajpular regions than the left for the same reason that the fremitus is. From the foregoing observations we deduce the following differential summary of the physical signs as obtained in the right and left sub-clavicular re- gions in the healthy chest: (1) Inspection is chiefly negative. (2) Palpation gives exaggerated vocal frem- itus on the patient's right side. (3) Slight dullness on percussion in the patient's right side, the pitch being slightly raised. (4) Upon auscultation we find vesiculo-bronchial respiratory murmur and exagger- ated pectorophony (vocal resonance) on the patient's right side. In other words, we have in the right sub- clavicular region of the healthy chest all the signs of \