The signs of internal disease, with a brief consideration of the principal symptoms thereof . or fluid in-tervenes between the periphery of the lung and the parietal wall, asoccurs in pleuritic effusions, plastic pleuritic thickening, pneumo-thorax and in solid tumors the fremitus is decidedly lessened or istotally absent. In health the fremitus is most marked on the rightside just below the clavicle where it is stronger than in the corre- 54 PHYSICAL EXAMINATION spending left area, probably due to the anatomical fact that the rightbronchus is of larger caliber, is straighter and enters the lu
The signs of internal disease, with a brief consideration of the principal symptoms thereof . or fluid in-tervenes between the periphery of the lung and the parietal wall, asoccurs in pleuritic effusions, plastic pleuritic thickening, pneumo-thorax and in solid tumors the fremitus is decidedly lessened or istotally absent. In health the fremitus is most marked on the rightside just below the clavicle where it is stronger than in the corre- 54 PHYSICAL EXAMINATION spending left area, probably due to the anatomical fact that the rightbronchus is of larger caliber, is straighter and enters the lung on asomewhat higher level than its fellow. Posteriorly, in the right supra-scapular fossa the fremitus is greater than on the opposite side, forthe same reason. From this fact it may be deduced that if the tactilefremitus is well-marked and equal on the two sides in the areas named,then it is increased on the left side, and further evidences of diseaseshould be sought for at the left apex. If fremitus is weakened butequal on the two sides it would indicate diminution on the right Fig. 17—Differential palpation of apices of lungs. When the bronchial tubes are more or less occluded by the ad-herence of tenacious secretions or by stenosis, vibrations similar incharacter to the voice vibrations, produced by the passage of the airthrough the bronchi, are communicated to the hand. This is calledrhonchial fremitus. It is often present in bronchitis, and is particu-larly frequent in children suffering with the disease. The conditionsnecessary for its production are the same as those which produce therales heard on auscultation. Fremitus produced by coughing is called tussile. Advantage maysometimes be conveniently taken of crying spells in young childrento determine the presence or absence of crying and tussile fremitus. Friction fremitus results when two inflamed surfaces of thepleura are rubbed together, and is often present during the dry stageof pleurisy. More rarely it
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectdiagnos, bookyear1906
