Observations tending to elucidate the question, Is it possible to discover by anscultation which side of the heart is the diseased one, when hypertrophy or dilation, or both, exist on one side of the organ alone? / [Robert Spittal].

Spittal, Robert, 1804-1852.

Date:: 1835?]

Credit: Observations tending to elucidate the question, Is it possible to discover by anscultation which side of the heart is the diseased one, when hypertrophy or dilation, or both, exist on one side of the organ alone? / [Robert Spittal]. Source: Wellcome Collection.

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$regions by auscultation are caused by, and indicative of the condition of the right or left side of the heart ? The physiological action of the heart, according to Laennec,— 66 is only felt in the cardiac region ; that is, the space comprised between the cartilages of the fourth and seventh ribs, and under the lower end of the sternum. The motions of the left cavi¬ ties are chiefly perceptible in the former place; those of the right cavities in the latter. This is so much the case,” con¬ tinues he, “ that in disease of one side of the heart only, the pul¬ sation in these two situations gives quite different results.”*' Again, “ the impulse of the heart’s action is usually perceptible only over the region of the heart, or at most over the inferior half of the sternum” \ And farther on he observes, that “ the sounds heard at the end of the sternum are produced by the action of the right side of the heart; those between the carti¬ lages of the ribs by the left cavities. In a state of health the sound produced by the contractions of each side is the same; in certain states of disease, on the contrary, the sound of the two sides becomes quite dissimilar.” j Such are the decided statements of Laennec, contained in his unrivalled work on auscultation, in which, although more recent researches have detected occasional inaccuracies, still these have in no way diminished the admiration so justly due to that truly original and useful production. On the contrary, we are astonished at the accuracy with which so many new facts have been communicated to the world. Perhaps the most important error, as yet, or that ever will be discovered, in the work of Laennec, is that relating to the rhythm of the heart’s action, first observed by Professor Turner, and now almost generally admitted; and we take occasion to mention this inaccuracy, merely to show how errors of very great importance may be overlooked and perpetuated; while, at the same time, a little observation on the part of any one ac¬ customed to such researches might easily, in many instances, prove them to be without foundation. In the following observations, it is our intention to point out, if not an error in diagnosis, at least a hasty and rash induction from a few facts,—certainly from very insufficient data. We are not prepared to acquiesce in the statement so generally ad¬ mitted, that it is possible to distinguish by auscultation the movements and sounds of the different sides of the heart either in health or disease; and it does not appear difficult to show that this cannot always be done, and that there is a very great want of evidence from which to draw a satisfactory conclusion on the subject. * Laennec’s Treatise, by Forbes, p. 548. -j- Op. cit. p. 553. X Op. cit. p, o5o*$