. Physical diagnosis . ce a lighter blow suffices. In children oremaciated patients, or in any case in which the muscular develop-ment is slight, percussion should be as light as is sufficient to elicit aclear sound. Heavy percussion is sometimes necessary but alwaysunsatisfactory, in that the sound which it elicits comes from a rela-tively large area of the chest and does not therefore give us infor-mation about the condition of any sharply localized area. If a car- PERCUSSION 125 penter, in tapping the wall to find the position of the studs, strikestoo hard, he will fail to find the beam, be
. Physical diagnosis . ce a lighter blow suffices. In children oremaciated patients, or in any case in which the muscular develop-ment is slight, percussion should be as light as is sufficient to elicit aclear sound. Heavy percussion is sometimes necessary but alwaysunsatisfactory, in that the sound which it elicits comes from a rela-tively large area of the chest and does not therefore give us infor-mation about the condition of any sharply localized area. If a car- PERCUSSION 125 penter, in tapping the wall to find the position of the studs, strikestoo hard, he will fail to find the beam, because the blow deliveredover the spot behind which the beam is situated is so forcible as tobring out the resonance of the hollow parts around. It is the samewith medical percussion. Heavy percussion is always may be necessary where the muscles are very thick, but its valueis then proportionately diminished. On the other hand, it is pos-sible to strike so lightly that no recognizable sound is elicited at. Fig. ioo.—Proper Position of the Patient During Percussion of the Back. all. The best percussion, therefore, is that which is just forcibleenough to elicit a clear sound without setting a large area of chestwall in vibration. The position of the patient above described applies to percus-sion of the front. When we desire to percuss the back, it is im-portant to get the scapulae out of the way as far as possible, sincewe cannot get an accurate idea of sounds transmitted through accomplish this, we put the patient in the position shown inFig. ioo, the arms crossed upon the chest and each hand upon theopposite shoulder. The patient should be made to bend forward;1 See also below, page 135, the lung reflex. 126 PHYSICAL DIAGNOSIS otherwise the left hand of the percussor will be uncomfortably bentbackward and his attention thereby distracted (see Fig. 101). When the axillae are to be percussed, the patient should put thehands upon the top of the head. (b) Au
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