. Physical diagnosis . again after striking, the clearer will be the noteobtained. (3) Let all the blows struck in any one part of the chest be uni-form in force. 1 Left-handed percussors will, of course, keep the right hand upon the chest and strikewith the left. 2 When percussing the right apex I prefer to strike upon the thumb (see Figs. 95 and 96)as it is almost impossible when standing directly in front of the patient to fit any of thefingers comfortably into the right supraclavicular fossa. 124 PHYSICAL DIAGNOSIS (4) Strike from the wrist and not from the elbow (see Figs. 97and 98). The
. Physical diagnosis . again after striking, the clearer will be the noteobtained. (3) Let all the blows struck in any one part of the chest be uni-form in force. 1 Left-handed percussors will, of course, keep the right hand upon the chest and strikewith the left. 2 When percussing the right apex I prefer to strike upon the thumb (see Figs. 95 and 96)as it is almost impossible when standing directly in front of the patient to fit any of thefingers comfortably into the right supraclavicular fossa. 124 PHYSICAL DIAGNOSIS (4) Strike from the wrist and not from the elbow (see Figs. 97and 98). The wrist must be held perfectly loose. (5) Keep the percussing finger bent at a right angle as in Fig. force to be used in percussion depends upon the purpose for which the percussion is used—that is, upon what organ we arepercussing—and also upon the thickness of the muscles coveringthat part of the chest. For example, it is necessary to percuss verystrongly when examining the back of a muscular man, where an. Fig. 99.—Proper Position of the Right Hand During Percussion. inch or two of muscle intervenes between the finger on which westrike and the lung from which we desire to elicit a sound. Overthe front of the chest and in the axillae the muscular covering ismuch thinner, and hence a lighter blow suffices. In children oremaciated patients, or in any case in which the muscular develop-ment is slight, percussion should be as light as is sufficient to elicit aclear sound. Heavy percussion is sometimes necessary but alwaysunsatisfactory, in that the sound which it elicits comes from a rela-tively large area of the chest and does not therefore give us infor-mation about the condition of any sharply localized area. If a car- PERCUSSION 125 penter, in tapping the wall to find the position of the studs, strikestoo hard, he will fail to find the beam, because the blow deliveredover the spot behind which the beam is situated is so forcible as tobring out the resonance of the
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