THE ANATOMIC EXPLANATION OF THE GREATER AMOUNT OF VOCAL FREMITUS AND VOCAL RESONANCE NORMALLY FOUND AT THE APEX OF THE RIGHT LUNG

GEORGE FETTEROLF
1909 Archives of Internal Medicine  
HISTORICAL Writers on physical diagnosis have for many years agreed that in the normal chest both vocal fremitus and vocal resonance are more marked on the right side than on the left. This phenomenon, according to Walshe,1 was first noted by Stokes, but the original statement I have been unable to find in the available published writings of Stokes. Skoda,2 in his classical work on auscultation and percussion, Markham's translation of which was published in 1854, states that"the voice of the
more » ... the voice of the same individual, whether his thoracic organs be healthy or unhealthy, is not heard equally loud at all parts of the thorax," but the concrete fact of the normal difference between the two sides evidently escaped him, as he makes no mention of it. Walshe,3 in 1860, states of fremitus :"As a general rule, the intensity of the fremitus is considerably greater on the right side of the chest than on the left, the greatest amount of this excess existing in the infraclavicular, infrascapular and interscapular regions.""T he fremitus is intensely marked over the larynx and trachea, stronger at the sternal than the humeral halves of the infraclavicular regions, generally faintly manifest on the right clavicle, and imperceptible at the top of the sternum.""In the great majority of cases it is stronger in recumbency than in the sitting position." Concerning vocal resonance the same writer4 says :"T he intensity and quality of this natural resonance are modified by certain circum-*From the Laboratory of
doi:10.1001/archinte.1909.00050120026002 fatcat:656iampaovfsdipp2b2dwyn3pi