Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . ted. (3) On the anterior portion of thechest, between the horizontal line and the line of flat-ness, percussion gives a peculiar tympanitic quality—Skodas resonance. (Figs. 36 and 38.) As the fluid increases in amount and the elasticity ofthe lung is satisfied, the fluid assumes a more horizontalline, and at last, when negative pressure has been re-placed by positive (which generally occurs when thefluid reaches the level of the third rib), the lung is com-pressed by the flui
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . ted. (3) On the anterior portion of thechest, between the horizontal line and the line of flat-ness, percussion gives a peculiar tympanitic quality—Skodas resonance. (Figs. 36 and 38.) As the fluid increases in amount and the elasticity ofthe lung is satisfied, the fluid assumes a more horizontalline, and at last, when negative pressure has been re-placed by positive (which generally occurs when thefluid reaches the level of the third rib), the lung is com-pressed by the fluid, and a small area of tympaniticpercussion may be detected anteriorly under the clavi-cles, close to the sternum, and in the supraspinous fossabehind. As the curved outline of the fluid depends upon theelasticity of the lung, a more nearly horizontal line, 228 THE RESPIRATORY SYSTEM. with a small amount of effusion, shows that there is lossof pulmonary elasticity or that the lung is preventedfrom retracting by adhesions, or that there is consolida-tion (probably tubercular) at the apex. The position of Fig. Lines 1, 2, 3, cur ye of small effusion. 4, 5, 6, 7, curved line of Ellis (letter of S).Dotted line from summit of curve to spine, upper limit of dulltriangle. the line of fluid does not change readily with change inposture of the patient. When the patient has longoccupied the recumbent posture, the line of Ellis is moreor less displaced by the fluid gravitating toward the most DISEASES OF RESPIRATORY TRACT. 229 dependent portion. The filling of one pleural sac causesdisplacement of the posterior mediastinum, giving adull area known as Groccos paravertebral triangle is an area of relative dullness anddiminution of respiratory murmur, found at the back of Fig. 37.
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