The principles and practice of medicine / [John Elliotson] ; edited by Nathaniel Rogers and Alexander Cooper Lee.

  • John Elliotson
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine / [John Elliotson] ; edited by Nathaniel Rogers and Alexander Cooper Lee. Source: Wellcome Collection.

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    nosis; and yet auscultation may furnish some symptoms so decisive as to silence him. Auscultation, however, can never justify us in the least neglect of the general symptoms and history of a disease. This would indeed he unplii- losophical; for the symptoms of auscultation, are hut one set among a number of others. But if it would be unphilosophical to neglect the general symptoms, it would he equally so to despise those which present themselves to the ear. If the functions of the heart and lungs are naturally performed with peculiar sounds, and if in diseases the sounds are altered, these deviations surely demand equal attention with those which are dis- cernible by the other senses. Surely the physician requires all his senses for the acquisition of knowledge; as much as other prosecutors of natural science. We employ our eyes to discern the countenance and general aspect of our patients; the changes of the pectoral, intestinal, and renal secretions; and alterations in the colour, size, and figure of various parts. We employ our touch to examine the pulse; and to ascertain the preter- natural presence of fluid, preternatural enlargement, diminution, or indura- tion. Our smell gives us information as to the depraved secretions of fever, as to suppuration, and as to gangrene. In diabetes, some have even re- course to the sense of taste. Nay, certain symptoms observable by the ear only, are always carefully dwelt upon. Borborygmi, for instance, enter into the definition of hysteria; and all the varieties of cough and wheezing are described. Why, then, should such sounds as are elicited by striking the chest, or require the ear to be brought either into contact with it, or into connexion with it by means of a solid medium, be despised? The celebrated Hook not only did not despise the ear as an inlet of knowledge, but looked forward to the invention of acoustic instruments, which would enable it to make important discoveries. Indeed, he almost prophesied the stethoscope. “ There may be a possibility ”, says he, “ of discovering the internal motions and actions of bodies by the sound they make. Who knows but that, as in a watch we may hear the beating of the balance, and the running of the wheels, and the striking of the hammers, and the grating of the teeth, and multitudes of other noises,—who knows, I say, but that it may he possible to discover the motions of the internal parts of bodies (whether animal, vegetable, or mineral) by the sound they make ;— that one may discover the works performed in the several offices and shops of a man’s body; and thereby discover what engine is out of order, what works are going on at several times, and lie still at others, and the like. I could proceed further; but methinks I could hardly forbear to blush, when I consider how the most part of men will look upon this. But yet, again, I have this encouragement;—not to think all these things utterly im- possible, though never so much derided by the generality of men, and never so seemingly mad, foolish, and fantastic;—that, as the thinking them impossible cannot much improve my knowledge, so the believing them possible may perhaps be an occasion for taking notice of such things as another would pass by without regard, as useless. And somewhat more of encouragement I have also from experience;—that I have been able to hear, very plainly, the heating of a man’s heart; and ’tis common to hear the motion of the wind, to and fro, in the guts and other small vessels. The stopping in the lungs is easily discovered by the wheezing. As to the motion of the parts one amongst another, bin order] to their becoming sensible, they require either that their motions be increased, or that the organ [Af hearing] be made more nice and powerful, to sensate and distin-
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