A text-book of medical diagnosis / by James M. Anders and L. Napoleon Boston ; with 418 illustrations in the text and 25 plates, 17 of them in colors.

  • Anders, James M. (James Meschter), 1854-1936.
Date:
1911
Catalogue details

Licence: In copyright

Credit: A text-book of medical diagnosis / by James M. Anders and L. Napoleon Boston ; with 418 illustrations in the text and 25 plates, 17 of them in colors. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    34/1276 (page 28)
    Neck: Length, circumference, thyroid gland. Note any tumor-masses, scars, eruptions, pulsations (whether venous or arterial). Esophagus: Swallowing, obstruction to passing sound. Thorax.—Lungs: Inspection: (a) The appearance of the external sur- face, evidence of emaciation, prominences, etc.; (b) the shape and size- (c) movements and degree of expansion (diseased side takes less part iri breathing); and {d) fluoroscopic study. Palpation: (a) The principal results of inspection are confirmed; (b) the tactile fremitus is elicited; this should be tested over every portion of the chest occupied by the lung; and (c) fluctuation may be detected, though rarely. Percussion: (a) Immediate percussion; (b) mediate percussion, which is divided under three subheads: (1) Finger percussion, (2) finger-pleximeter percussion; (3) human-pleximeter percussion. (For the technic of these methods see Diseases of the Lungs, page 53.) Note results of percussion with reference to pitch, volume, length or duration, and quality of sound. (It is to be recollected that when the vibrations are slow, the pitch is low and vice versa.) Cornparison of apices of the lungs; respiratory changes of the lung boundaries; inteipretation of sounds—normal resonance (with modifica- tions in health, according to age, the region percussed, and associated con- ditions), tympany, relative dullness; respiratory percussion (the patient holding the breath at full inspiration and full expiration); auscultatory percussion; palpatory percussion; amphoric resonance; special signs—bell tympany, cracked-pot sound, Wintrich's sign, Gerhardt's sign. Auscultation: Methods—(a) immediate, (6) mediate (for advantages of each method and technic see Diseases of the Lungs, page 61); modifica- tions of normal respiratory sounds (variations in vesicular breathing, bron- chovesicular, bronchial or tubular, cavernous, amphoric); changes in vocal resonance—diminished or increased (bronchophony, egophony, pectorilo- quy, amphoric whisper, etc.); adventitious sounds, rales (sibilant, sonorous, crepitant, subcrepitant, mucus, rattling sounds), friction rub. Heart: Inspection: Seat, quality and rhythm of apex-beat; abnormal pulsations elsewhere over chest-wall, especially over first and second inter- costal spaces; epigastric pulsation; cyanosis. Palpation: Seat, quality, and rhythm of impulse; presenge or absence of thrill. Percussion: Note area of cardiac dullness (effects of respiratory move- ments, effect of change of position). Auscultation: The mediate method to be preferred; note any modifica- tions of normal heart sounds—first and second; if adventitious sounds be audible, note their point of maximum intensity, rhythm, area of transmission and quality; auscultate—(a) mitral area, (b) tricuspid area, (c) aortic area, (d) pulmonary area, (e) over vessels of neck, (/) over body of heart., (g) effect of exercise, (h) effect of change of position. Pulse: (1) Condition of right and left radial artery (rigidity, tortuosity); (2) rate of pulse; (3) rhythm; (4) force; (5) tension; (6) size. Blood-pressure. Vascular System.—(1) Arteries; (2) veins; (3) capillaries; (4) lymph- atics. Liver and Gall-bladder.—Palpation and percussion (auscultation of gall-bladder if calculi are suspected). Spleen. Stomach and Bowels.—Inspection: Shape, depressions, and swellings.