Diseases of the chest and the principles of physical diagnosis . on and auscultation of the apex of the axilla will often revealphysical signs which may be sought in vain elsewhere. This is especially ^0 THE EXAMINATION OF THE LUNGS the case in the early stages of pneumonia, in pulmonary tuberculosis andin interlobar empyema. The accompanying illustration (Fig. 79)depicts the position in which the patients arm should be held for suchan examination. The muscles being retracted examination is facilitated. SPECIAL VARIETIES OF PERCUSSION Spinal Percussion.—Percussion of the spine wiiile not gener
Diseases of the chest and the principles of physical diagnosis . on and auscultation of the apex of the axilla will often revealphysical signs which may be sought in vain elsewhere. This is especially ^0 THE EXAMINATION OF THE LUNGS the case in the early stages of pneumonia, in pulmonary tuberculosis andin interlobar empyema. The accompanying illustration (Fig. 79)depicts the position in which the patients arm should be held for suchan examination. The muscles being retracted examination is facilitated. SPECIAL VARIETIES OF PERCUSSION Spinal Percussion.—Percussion of the spine wiiile not generally practised, is be-lieved by some physicians to have a value in the diagnosis of deep-seated aneurismsand tumors, mediastinal lymphadenitis, etc. There is normally dulness from the firstto the fourth dorsal vertebrse; and an osteal note extends thence to the last dorsal spine;the lumbar region yields an impaired note, and the sacral vertebrae, tympany. Wehave never been able to convince ourselves of the value of this method of examination<see Fig. 91).. Pjq_ 79_—Position of the patient while the axillary region is being examined. Threshold Percussion.—This is simply the lightest of light percus-sion. It must be done in an absolutely silent room. The pleximeter islaid lightly against the chest wall, only in the interspaces, the blow isdelivered upon the proximal end of the second or of the distal, phalanxwhich is bent at right angles to its fellow, and in a vertical direction uponthe chest (orthopercussion). If this is impossible, a stump of lead pencilmay be substituted. In other words, the pleximeter is not only small butvertically placed. The blow struck by the plexor is so light that onlyresonant tissues produce any audible sound; when dull tissues arestruck their note is below our auditory threshold (Fig. 80). METHODS AND RESULTS OF PERCUSSION 91 , The Coin —In performing this test silver coins are used, as theplexor and pleximeter respectively. Percussi
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