Diseases of the chest and the principles of physical diagnosis . rregions. The supraclavicular fossae and the axillary apices must notbe overlooked. The bell of the stethoscope is placed firmly against the skin so as toexclude external sounds, but too great pressure is to be avoided, sinceit increases skin tension, diminishes elasticity and deadens sound. Con-siderable pressure maj- occasionally be necessary in order to bring thebell nearer to the source of the sound, as in the case of ausculting the 106 AUSCULTATION 107 fetal heart sounds, also at times to elicit pleural or pericardial fricti
Diseases of the chest and the principles of physical diagnosis . rregions. The supraclavicular fossae and the axillary apices must notbe overlooked. The bell of the stethoscope is placed firmly against the skin so as toexclude external sounds, but too great pressure is to be avoided, sinceit increases skin tension, diminishes elasticity and deadens sound. Con-siderable pressure maj- occasionally be necessary in order to bring thebell nearer to the source of the sound, as in the case of ausculting the 106 AUSCULTATION 107 fetal heart sounds, also at times to elicit pleural or pericardial frictionsounds by bringing the inflamed serous surfaces into more intimatecontact. Auscultation is sometimes rendered difficult by the presence ofcutaneous hair, edema or emphysema. In the first instance the cracklingof the hair may be obviated by shaving or by simply wetting the loud crackling sounds produced by subcutaneous emphysemarender auscultation of the intra-thoracic organs quite unreliable if notabsolutely impossible. Fig. 95.—Broncho-vesicular breath sounds are often due to stenosis of the upper airpassages. If the patients neck is sharply turned toward either side, if he has hypertrophiedtonsils, adenoids, etc., such sounds may be produced in normal lungs. They are to be differ-entiated from pathologic sounds bj^ the fact that: 1. The harshness is bilateral, is oftenaudible at a distance when the patient breathes deeply. 2. They may be greatly modifiedby opening the mouth. .3. They are [unassociated with other physical signs indicativeof pulmonary consolidation. The illustration shows a stenotic trachea due to enlargement of the thyroid the intimate contact of the right pulmonary apex with the trachea, in contrast to themarked separation of these structures on the left side. A, aorta; , descending aorta;, right subclavian artery; , right carotid artery; , left subclavian artery), l
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
