Manual of Physical Diagnosis; For the Use of Students and Physicians (Paperback)

Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: eases, in diabetes and cerebral diseases and lesions. It is justly regarded as of grave import. Yet Cheyne-Stokes breathing continued over quite a long time has not infrequently been followed by recovery. PALPATION. After inspection and mensuration of the chest, palpation is usually practised. This is done by applying the palm of the hand or the fingers, as may best serve the purpose, to the chest-wall. The chief value of palpation lies in the fact that when the hand is thus closely applied, and the person " touched " speaks, a peculiar vibrating or trembling sensation is conveyed to the hand. This is known as vocal fremitus or tactile fremitus. This fremitus or thrill, representing the vibrations communicated to the air by the vocal cords, is conveyed to the walls of the air passages, from the larger to the smaller, until the ultimate structure of the lung is reached, whence it is conveyed to the chest-wall and hands. In health it is felt everywhere over the chest where lung-tissue reaches, but is more distinct where the chest-walls are thinnest, and especially in the, infraclavicular spaces. It is further often more plainly felt below the right clavicle than below the left, an important fact to be remembered in recognizing delicate shades of difference. This is usually explained by the tact that the right bronchus is shorter, larger, and enters the lung higher up and more horizontally than the left, whence a larger volume of air is contained in the right lung, especially in its upper portion. Hence strongervibrations are produced in speaking. For the same reason vocal fremitus is sometimes slightly more distinct posteriorly in the right half of the interscapular space and even below the angle of the right scapula. In the axillae the same difference may exist to a less dege...