The signs of internal disease, with a brief consideration of the principal symptoms thereof . usness to strong well-marked, separated vibrations. In health the character of the voicematerially influences their strength, the vibrations being bettermarked in low-pitched, deep-voiced men than in higher voices;stronger in men generally than in women, and weakest in amount of tissue overlying the lungs influences this fremitus,and the vibrations are more appreciable in thin persons than in fat *The phenomenon is indiscriminately called by some writers tactile fremitusAnd vocal fremitus
The signs of internal disease, with a brief consideration of the principal symptoms thereof . usness to strong well-marked, separated vibrations. In health the character of the voicematerially influences their strength, the vibrations being bettermarked in low-pitched, deep-voiced men than in higher voices;stronger in men generally than in women, and weakest in amount of tissue overlying the lungs influences this fremitus,and the vibrations are more appreciable in thin persons than in fat *The phenomenon is indiscriminately called by some writers tactile fremitusAnd vocal fremitus. PHYSICAL EXaMINATION 53 ones. Any form of disease which increases the density of the pul-monary tissue or increases its conduction power augments the fremi-tus, provided that the bronchi are open, arid that the air columnfrom the larynx to the pulmonary tissue is uninterrupted. The sen-sation is due to vibration communicated to thfe thoracic walls, throughthe medium of the tissues, from the air in the trachea set in motionby the act of speaking. Hence, fremitus is increased in pneumonia. Fig. i6—Ulnar palpation. and tubercular deposits. On the other hand, conditions which sepa-rate the pulmonary tissues from the chest wall, or diseases accom-panied by a diminution of the normal pulmonary density, lessen thefremitus, or even obliterate it. Thus, when a layer of air or fluid in-tervenes between the periphery of the lung and the parietal wall, asoccurs in pleuritic effusions, plastic pleuritic thickening, pneumo-thorax and in solid tumors the fremitus is decidedly lessened or istotally absent. In health the fremitus is most marked on the rightside just below the clavicle where it is stronger than in the corre- 54 PHYSICAL EXAMINATION spending left area, probably due to the anatomical fact that the rightbronchus is of larger caliber, is straighter and enters the lung on asomewhat higher level than its fellow. Posteriorly, in the right supra-scapular fossa the fremitus is greate
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