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By mediate auscultation is meant, of course, the interrogation of the chest with the aid of the little instrument already referred to, an instrument which its originator thought hardly worth naming until various barbarous appellations were applied to it by others, after which Laennec decided to call it the stethoscope, a name which it has ever since retained.
The first work printed in this country on Auscultation, that wonderful art of discovering disease, which, as it were, puts a window in the breast, through which the vital organs can be seen, to all intents and purposes, was the manual published anonymously by "A Member of the Massachusetts Medical Society."
This means to put the forefinger of the left hand across the chest or back, and to give it a quick, sharp rap with two or three fingers. This experiment can be done by the student with only imperfect success, until practice brings some skill. Experiment 109. Borrow a stethoscope, and listen to the respiration over the chest on the right side. This is known as auscultation.
It is so rare to alight upon an interesting case in the country! Nothing but rheumatism and measles, measles and rheumatism, and never an autopsy, it is as monotonous as the treatment of fever and ague. I longed for the vast metropolitan hospitals, containing specimens of every shade of disease, and affording unlimited opportunities for auscultation.
All three of them agreed in stating that the case was one of advanced phthisis, complicated by nervous incidents which invested it with a peculiar character. Doctor Bonamy wagged his head as though to say that such an ensemble of testimony could leave no room for doubt. Forthwith, he subjected the patient to a prolonged auscultation. And he murmured: "I hear nothing I hear nothing."
We may determine the extent of the pleural exudate by auscultation. There is no evidence of respiratory sounds in that portion of the chest below the surface of the fluid. Dropsical swellings may occur on the under surface of the breast and abdomen. In subacute cases evidence of recovery is noted in from four to ten days. Acute pleurisy very often terminates fatally.
Among the most important measures in which he learns to acquire facility is that of auscultation. This useful process has come specially into vogue since the invention of the stethoscope in 1819 by Laennec, who derived valuable hints for it from the Hippocratic writings.
All three of them agreed in stating that the case was one of advanced phthisis, complicated by nervous incidents which invested it with a peculiar character. Doctor Bonamy wagged his head as though to say that such an /ensemble/ of testimony could leave no room for doubt. Forthwith, he subjected the patient to a prolonged auscultation. And he murmured: "I hear nothing I hear nothing."
They thus appeared to be taking her, together, for the moment, and almost for sociability, as prepared to proceed to gratuitous extremities; the upshot of which was in turn, that after much interrogation, auscultation, exploration, much noting of his own sequences and neglecting of hers, had duly kept up the vagueness, they might have struck themselves, or may at least strike us, as coming back from an undeterred but useless voyage to the north pole.
While the condition is best diagnosed by tracings taken simultaneously of the apex beat, jugular and radial, still the jugular tracing is almost conclusive in the absence of the auricular systolic wave. The radial tracing is exceedingly suggestive, and if there is also a careful auscultation of the heart, a presumptive diagnosis may be made.
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