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The author presents three refined methods of percussion of the head, requiring special apparatus. In two, electrical methods are used for producing and for intensifying the percussion sounds. By means of these methods the author has carried out an intensive investigation of the variations of sounds produced in both normal and pathologic cases. Variations in the percussion note obtained in normal skulls refer chiefly to regional differences in thickness. The thickness of the skull is greatest in the supra-orbital and mastoid regions, next over the interparietal suture. The note is dull in these regions. The most important pathologic state in which changes in the percussion sounds are produced is increased intracranial pressure. With the thinning of the skull in this condition, a tendency to tympany is noted. Similar results are produced likewise in hydrocephalus and senile osteoporosis. Impairment of percussion may be caused by processes producing bone thickening and by
Über die Schädelperkussion.. JAMA. 1932;99(21):1805. doi:10.1001/jama.1932.02740730069041