A treatise on the diseases of the chest, and on mediate auscultation / by R.T.H. Laennec ... ; translated from the third French edition, with copious notes, a sketch of the author's life, and an extensive bibliography of the different diseases, by John Forbes ... ; to which are added the notes of Professor Andral, contained in the fourth and latest French edition, translated and accompanied with observations on cerebral auscultation, by John D. Fisher ... ; with plates.
- Laennec, R. T. H. (René Théophile Hyacinthe), 1781-1826. De l'auscultation médiate. English
- Date:
- 1838
Licence: Public Domain Mark
Credit: A treatise on the diseases of the chest, and on mediate auscultation / by R.T.H. Laennec ... ; translated from the third French edition, with copious notes, a sketch of the author's life, and an extensive bibliography of the different diseases, by John Forbes ... ; to which are added the notes of Professor Andral, contained in the fourth and latest French edition, translated and accompanied with observations on cerebral auscultation, by John D. Fisher ... ; with plates. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
![You shall know by this that the chest contains water and not pus, if in applying the ear during a certain time on the side, you occasionally attaches to .M. Piorry's method, especially in the hands of beginners. In 111** latter it Bometimes happens thai the loudness and Bharpness of the pri- mary sound arising from the contact of the two surfaces, arc bo considerable (particularly if the nail be used, which it ought never to be) as to drown, as il were, the secondary sound Resulting from the modifying influence of the subja- cent parts, from which modification it is thai wè form our judgment respecting the condition of those parts. When the fingers constitute the pleximeter, wc have little or none of this immediate v\<itt<r when the blow is given. In the percussion of the abdomen, possessed as it is ofsofl and yielding walla only, the pleximeter is absolutelj necessary to the production of the requisite degree of sound ; and it is yet further necessarj . in manj cases, in order t«t bring the superficial walls, by pressure, in contact with the subjacent parts. .Mediate; percussion alone may therefore be said to be applicable to tin: investigation of abdominal diseases. It is at least equally applicable with direct percussion to the chest ; and as it has decided advantages in some cases, and no other disad- vantage in any case than the necessity of having an additional instrument, it ought to take precedence of the original method of Avcnbrugger in the investi- gation of pectoral diseases only. An observation above stated by Laennec in the text, (p. 20,) that the indica- tions from percussion conveyed to the operator are much stronger than to the by- standers,.ought never to be overlooked in practice : the peculiar sensations in- dicative of the absence or presence of air in the subsequent parts, are often dis- tinctively appreciable as communicated through the percussing fingers, when the difference of sound is imperceptible. Different things have been used as pleximeters, and, among others, the horn cap which is now commonly affixed to the auricular extremity of the stethoscope M. Piorry objects to this on account of the liability of horn to warp, and also on account of the perforation in its centre. Dr. Williams, however, seems to consider this last as no objection, but recommends the inner surface of the cap to be lined with soft leather, to prevent the clacking noise produced by the impulsion of the fingers.—(Rational Exposition, p. 22.)—My own experience is against the use of the perforated pleximeter; exclusively of an objection I have to the cap of the stethoscope being so made as to be easily removed. In M. Piorry's Stethoscope, the ivory pleximeter is attached to its pectoral extremity, and indeed forms a necessary part of it. This arrangement is convenient, and is perfectly satisfactory as far as percussion is concerned ; but I have already objected to the whole instrument regarded as a stethoscope. See plate at the end.— Transi. In this clear and accurate notice of the différent sounds observed to arise from different points of the chest when percussed, it is remarkable that Laennec should have forgotten to mention the diminution of sound caused, in most cases, by the presence of the heart in the' left submammary region. Here a dull sound is heard, whicli in a healthy condition of the heart, occupies a space of ] £ or 2 inches square, as has been stated by M. M. Piorry and Bouillaud, and verified by my own observation. But it does not follow that the real size of the heart corresponds exactly to these dimensions : the measurement above stated, only shows the space where this organ is not covered by the lung. But in relation to this point there is a great difference in individuals—for it sometimes happens that an increase in the size of the heart will not extend the space of the dull sound in the precordial region. Sometimes it happens that instead of the nat- ural dullness of the thorax below the left breast, there is a very distinct sound: yet the heart, far from being diminished in volume, as would be conjectured, is much enlarged. This may be remarked daily in cases of pulmonary emphy- sema, where the dilatation or rupture of the vesicles exists in that portion of the lung which lies immediately beneath the cartilages of the left ribs. An enlargement of the heart or a dilatation of its cavities often accompanies this morbid stale of the lung, yel percussion of the precordial region will give no indication <»f tin l'art \part from tiiis pathological condition, a perfectly heal- thy lung may-, in various individuals, cover various portions of the heart, and](https://iiif.wellcomecollection.org/image/b21016756_0078.jp2/full/800%2C/0/default.jpg)
