On the art of percussion : as applied to the diagnosis of thoracic and abdominal diseases / by John Hughes Bennett.
- John Hughes Bennett
- Date:
- [1842]
Licence: Public Domain Mark
Credit: On the art of percussion : as applied to the diagnosis of thoracic and abdominal diseases / by John Hughes Bennett. 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.
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![ON THE AHT OF I'KKCUSSfOX, nishod, 1 shall in this communication endeavour to give such short pi'uctical rules as may facilitate the progress of those who desire to perfect themselves in this most useful art. ^ In percussing, M. Piorry uses a circular ivory pleximeter, which he generally strikes with the tips of the first, second, and third fingers of the right hand, brought into a line, and pressed together by means of the thumb. The reiterated blows which it is necessary to give the pleximeter, during a careful examination of all the thoracic and abdominal organs, demand considerable physical exertion. This duty can scarcely be performed even by an expert percussor in less than half an hour; and if three or four patients are to be examined, it becomes very arduous. I have often seen M. Piorry himself much exhausted from the ex- ertions he has undergone in this way, from visiting a single ward. J3ut the learner undergoes still greater fatigue, from the nume- j'ous repetitions he is under the necessity of making before he is satisfied. The continual blows, also, on the tips of the fingers, (the nails being of course cut very short,) induce, at first, great pain and tenderness in them; and in my case, the skin surround- ing the root of the nails became so greatly swollen and inflamed, that I was, for a time, obliged to suspend all practical examination. Indeed, those who amuse themselves occasionally by merely tap- * None of tlie works on auscultation in the English language attach sufficient im- portance to percussion, and the authors appear practically unacquainted with the precision which it is possible to aiTive at by means of the pleximeter. Dr Forbes, for instance, when describing percussion, says,— By one well versed in direct per- cussion, an instrument will not often be needed ui the exploration of the chest, as his experience will enable him to evade most of the inconveniences attending the fonner. — Cyclop, of Prac. Med., vol. i., p. 220. This passage could only have been written by an individual little practised in the art of percussion. In the same article a considerable space is wasted in endeavouring to show tlie superior advantage of using the fingers of the left hand as a pleximeter, the back of the fingers being upper- most. Now, those who choose to use the fingers in this way will often find it more advantageous to Iieep the back of the finger in contact with the skin, as is practised by M. Louis. Dr Forbes also states, that witli the finger we can produce sounds as definite as by employing an ivory pleximeter. I have certainly heard MM. Louis, Bouillaud, Barth, and others, elicit very clear sounds by percussing on the index finger of the left hand, but deny that they could ever produce the clear sounds wliich may be done through the medium of an ivory pleximeter. Moreover, I have never seen any one accurately limit the size of axi organ by the mere use of the fin- gei-s, and am perfectly convinced, from the vagueness and looseness which characte- rise the whole of Dr Forbes's article on this subject, that he himself has never suc- ceeded ui doing it. Even Dr Williams, a much greater autliority, prefers the fin- gers. He says, Little need be said about ])leximetera, for they are not generally neeessai'y; M. Piorry much exaggerates the advantages to be derived from them.— Lihrarii of Medicine, vol. iii., p. 10. Such also appears to be the general opinion of the profession, and 1 have frequently heard it stated by practitioners, that they can do with their tingei-s all tliat M. Piorry or otliers can do with plexiinetci's. To such statements there is only one reply. Whenever a similar assertion is made to me, I invite the gentleman to make his appearance at the bed-side of the patient in some piilnie huttpital or elsewhere, and limit the dullness of the heart or some othei- organ. But, singulai' to say, none of the numerous invitations thus made have ever 1m on ac- cepted.](https://iiif.wellcomecollection.org/image/b21472294_0004.jp2/full/800%2C/0/default.jpg)
