Diseases of the chest and the principles of physical diagnosis . ess of thebronchial bifurcation (Figs. 47, 95, 104). {d) It is more intense in the interspaces (finger tips or ulnar surfaceof little finger used) than over the ribs. Fremitus is Pathologically Increased.—(a) Over pulmonary consolida-tion, because of better conduction of the vibrations from the bronchi(see Chap. III). (6) In cases of atelectasis, because the bronchi are nearer to the chestwall. (c) Over pulmonary cavities (as a rule) because of surrounding con-solidation. Increased fremitus is generally associated with bronchial
Diseases of the chest and the principles of physical diagnosis . ess of thebronchial bifurcation (Figs. 47, 95, 104). {d) It is more intense in the interspaces (finger tips or ulnar surfaceof little finger used) than over the ribs. Fremitus is Pathologically Increased.—(a) Over pulmonary consolida-tion, because of better conduction of the vibrations from the bronchi(see Chap. III). (6) In cases of atelectasis, because the bronchi are nearer to the chestwall. (c) Over pulmonary cavities (as a rule) because of surrounding con-solidation. Increased fremitus is generally associated with bronchial breathing andbronchophony. Of course, in a given case there may be factors workingat variance with one another as regards the production of bronchial 50 THE EXAMINATION OF THE LUNGS breathing, bronchophony and increased fremitus. While these threesigns are of the same diagnostic importance we must determine eachseparately. Fremitus is theoretically always diminished or absent over is little or no fremitus over the trachea, because air does not. transmit vibratory waves appreciable to the hand, and because there isno reinforcement by a resonator as in case of the thorax. But practi-cally we find fremitus in the majority of cases increased over cavities onaccount of (1) an overlying area of consolidated lung, (2) transmissionby well-organized fibroid walls, (3) general sense of increased fremitus COLUMBIA UNIVERSITY. 437 W. 59tH Street. UtW YORK CITY. PALPATION 51
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