Diseases of the chest and the principles of physical diagnosis . it de pot fele) then is heard: (1) when air isforced through a stenotic opening as in the case of a superficial cavitycommunicating with a bronchus (vibrations of the tissues at the mouth ofthe cavity); (2) over the chest of a crying child (glottic vibrations); (3)occasionally over relaxed and infiltrated lung tissue. It is most markedif the examiners ear be close to the patients open mouth and duringexpiration. It is best heard over a superficial cavity near the pulmonaryapex, with tense but resilient walls and a stenotic outlet
Diseases of the chest and the principles of physical diagnosis . it de pot fele) then is heard: (1) when air isforced through a stenotic opening as in the case of a superficial cavitycommunicating with a bronchus (vibrations of the tissues at the mouth ofthe cavity); (2) over the chest of a crying child (glottic vibrations); (3)occasionally over relaxed and infiltrated lung tissue. It is most markedif the examiners ear be close to the patients open mouth and duringexpiration. It is best heard over a superficial cavity near the pulmonaryapex, with tense but resilient walls and a stenotic outlet. The sound THE HISTORY AND THE THEORY OF PERCUSSION 71 may be imitated by striking the loosely clasped hollowed palms of thehands together against the knee, or by suddenly percussing a perforatedrubber ball. All metallic sounds are best elicited if forcible staccato per-cussion is employed. Thus we find that: Rhythmic vibrations produce tympanitic sounds,Unrhythmic vibrations produce non-tympanitie unrhythmic vibrations produce Fig. 60.—The coin test. Summary.—1. Resonance is a long, low-pitched, non-musical note,heard on percussing normal lung, due to unrhythmic, more or less local-ized^vibrations. It may be imitated by percussing a loaf of fresh ,^is associated with a sense of resiliency. 2. Tympany is a long musical note of variable pitch, produced by per-cussing elastic, air-containing viscera. It is due to widespread rhythmicvibrations and may be heard over the stomach, intestines, over relaxedlung tissue, and over many cases of pulmonary cavitation and pneumo-thorax. It may be imitated by percussing a loaf of stale bread or towelfolded many times upon itself, or the inflated cheeks. 3. Dulness is a short, non-musical, invariably high-pitched sound,heard when percussing structures containing little or no air. It is due 72 THE EXAMINATION OF THE LUNGS
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