. A practical treatise on medical diagnosis for students and physicians . arer than normal, or (d) of a different character from the normalsound. To the first group belong diminished or impaired resonance^didness, and flatness; to the second, hyper-resonance and tympany; andto the third, amphoric resonance, the cracked-pot sound, Williams trachealtone, the hell or anvil sound, Wintrichs jjhenomenon, interrupted Wintrichsphenomenon, Friedreichs phenomenon, Gerhardts phenomenon, and Bier-niers phenomenon. 484 PHYSICAL DIAGNOSIS OF DISEASES OF THE LUNG. It may be said in general that when a percu
. A practical treatise on medical diagnosis for students and physicians . arer than normal, or (d) of a different character from the normalsound. To the first group belong diminished or impaired resonance^didness, and flatness; to the second, hyper-resonance and tympany; andto the third, amphoric resonance, the cracked-pot sound, Williams trachealtone, the hell or anvil sound, Wintrichs jjhenomenon, interrupted Wintrichsphenomenon, Friedreichs phenomenon, Gerhardts phenomenon, and Bier-niers phenomenon. 484 PHYSICAL DIAGNOSIS OF DISEASES OF THE LUNG. It may be said in general that when a percussion-sound is produced inthe thorax ^vhich varies from the normal resonant tone, it indicates anabnormal physical condition. In percussing the chest, however, exactlycorresponding portions of the two sides must be compared. Change in tone may be general or local : (1) the areas over both lungsmay yield a different percussion-note from the normal (hilateral) ; (2) theohauge may be limited to one side (uyiUateral); or (3) it may be found insmall areas (local). Fig. Impaired Normal Normal Dulness ^ Flatness Changes in percussion-note. (Le Fevre.) Diminished or Impaired Resonance. The normal tone or resonance isimpaired or muffled in cases of beginning consolidation of the lung, inslight thickening of the pleura, and in small pleural effusions which over-lap the lung as a thin layer. It is the first change toward dulness. Itis particularly noted in the early stages of phthisis, when the lung usuallyis the seat of small areas of tuberculous infiltration at the apex. Dulness. The dull note signifies a relatively small amount of air inproportion to solid structure, the extent and the degree of dulness de- HYPER-EESONA NCE. 485 pending upon the proportion of solid to air-containing material. Moder-ate diilness is seen in tubercular disease, with moderate infiltration of thelung (see Fig. 158), and in small patches of catarrhal pneumonia, in pul-monary congestion and oedema, in p
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