Clinical lectures on the principles and practice of medicine . of course, can be detected ; but, even then, the dulness is distin-guished from that of the liver by the diminished feeling of resistance. When the lung is emphysematous, or if air be present in the pleura,the sound becomes unusually tympanitic ; this tympanitic note on per-cussion, however, may exist under a variety of circumstances, which itis of great importance to be acquainted with. Thus, condensation frompneumonia at the posterior part of the lung, or partial pleurisy, by caus-ing the anterior portion of the organ to be over-
Clinical lectures on the principles and practice of medicine . of course, can be detected ; but, even then, the dulness is distin-guished from that of the liver by the diminished feeling of resistance. When the lung is emphysematous, or if air be present in the pleura,the sound becomes unusually tympanitic ; this tympanitic note on per-cussion, however, may exist under a variety of circumstances, which itis of great importance to be acquainted with. Thus, condensation frompneumonia at the posterior part of the lung, or partial pleurisy, by caus-ing the anterior portion of the organ to be over-distended with air, orcompressed and pushed forward, may give origin to this sound. Thesame occurs in chronic phthisis, over parts which were once dull, either Fig. 28. Phthisis—Atrophied heart and liver—Prolonged abstinence. 1, Atrophiedheart; 2, Infiltrated tubercle on left side ; 3, the same on right side with a cavity; 4,Atrophied liver; 5, Spleen; 6, unusual dulness over abdomen, from prolonged absti-nence.—(Piorry.) 56 EXAMINATION OF THE PATIENT. from large dry cavities filled with air, or from the emphysema whichaccompanies cicatrices and partial condensation of pulmonary texture. On percussing the chest with themouth open, there may frequentlybe elicited a sound, which Laennecfirst likened to gently striking acracked pot. It may be very closelyimitated by crossing the palms ofboth hands, so as to leave a hollowbetween them, and then striking theknuckles of the inferior handagainst the knee, so as to produce aclinking sound. I have produced itby percussing the chest in cases ofpleurisy, pneumonia, and phthisis;of congested, apoplectic, and emphy-sematous lungs, and even whenthese organs were quite healthy, if, asin young subjects, the ribs are veryelastic. The conditions which seemfavorable for the production of thissound are, 1st, A certain amount ofconfined air rendering the tissue ofthe lung tense; 2d, The sudden corn-Fig. 29. pression of this air by a solid bod
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Keywords: ., bookcentury1800, bookdecade1870, booksubjectmedicine, bookyear187
