. A practical treatise on medical diagnosis for students and physicians . end of complete expiration. Itmust further be said that palpation must be employed both with the tipsof the fingers and with the palm of the hand applied to the surface. By palpation the area and degree of pulsation are determined. If theaneurism is large or has perforated, the impulse is expansile and heavingin character. The sac may be soft and fluctuating, but usually presentsconsiderable resistance. In addition to the systolic impulse the diastolicshock is also felt. This is a most conclusive physical sign. A thrill
. A practical treatise on medical diagnosis for students and physicians . end of complete expiration. Itmust further be said that palpation must be employed both with the tipsof the fingers and with the palm of the hand applied to the surface. By palpation the area and degree of pulsation are determined. If theaneurism is large or has perforated, the impulse is expansile and heavingin character. The sac may be soft and fluctuating, but usually presentsconsiderable resistance. In addition to the systolic impulse the diastolicshock is also felt. This is a most conclusive physical sign. A thrill isfrequently present, systolic in time, usually due to dilatation of the arch ;at times, to sacculated aneurism. Without visible tumor, pulsation andthrill may be felt in the suprasternal notch, if the head is bent forward,so that the tissues are relaxed, and the fingers pushed down toward theaorta. When the aneurism is filled or filling with clot, the tumor maybe seen and felt, but no impulse will be transmitted to the hand, or thrillbe felt by the fingers. Fig. Aneurism of of absolute dulness, dark line. Area of relative dulness, broken line. (Original.) Pekcussiojst. Percussion furnishes the most reliable evidence of thepresence of an aneurism or aneurismal dilatation in cases in which theitumor is not too deep-seated or small in size. The dulness may be relativeonly. (See Cardiac Percussion.) The area of dulness is increased some-where in the course of the aorta. It may be observed projecting outwardat the right edge of the sternum when the ascending portion of the aortais the seat of disease, or over the entire upper part of the sternum extend-ing toward the left, when the transverse portion is diseased. It may beobserved as an extension of cardiac dulness upward in the second andihird interspaces. Sometimes dulness is detected in the scapular regions,oarticularly of the left side. The percussion-tone is flat, and there isynarked sense of resistance. Percu
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