A treatise on diseases of the chest and on mediate auscultation / by R.T.H. Laennec : translated from the latest French edition, with copious notes and a sketch of the author's life by John Forbes.

Date:
1834
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on diseases of the chest and on mediate auscultation / by R.T.H. Laennec : translated from the latest French edition, with copious notes and a sketch of the author's life by John Forbes. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    Fig. 4.—Piorry's Ple.ri meter {not connected with the Stethoscope.) a. Handles turned in the ivory. This little instrument is made of ivory, from an inch and a half to two inches in diameter, and ahout one-sixth of an inch in thickness. It may be made either circular or ovoid. N.B. All the instruments can be accurately constructed by any good turner 'from the foregoing descriptions. Dr. Williams recommends Grumbridge, turner, 42, Poland-street, Oxford-street, London, as the best manufacturer of stethoscopes. The best kind of wood for the purpose is fine pencil cedar. The principal nicety consists in making the bore por- fectly even and smooth. ADDITIONAL NOTES. The following- notes were, by an unfortunate oversight, omitted in their proper places ; and 1 deem it but a simple act of justice, due to the distinguished physician from whose work on the diseases of the heart they are extracted, to give them a place here. There is no British pathologist to whom auscultation, and more espe- cially that part of it which refers to diseases of the heart, is more indebted than to professor Elliotson. In recommending his work to the particular notice of the prac- titioner, I must be allowed to express a wish that it were presented to the profession in a more convenient and less expensive form than that in which it now exists. P. 172. A very striking and accurately described case of the disease termed Pulmonary Apoplexy, by Laennec, was published by Dr. Elliotson, in the Annals of Medicine and Surgery, in the year 1816, i. e. three years before the appearance of the Treatise on Mediate Auscultation. See a reprint of this case in Dr. Elliotson's Lectures on Diseases of the Heart, delivered before the Royal College of Physicians, p. 32. Lond. 1830, fol. P. 500. The following remark by Dr. Elliotson is in accordance with our own experience, and should be attended to in practice : we believe Dr. E. was the first who publicly announced the fact:— Laennec employed the stethoscope in its en- tire state, to examine the heart; and the presence of the plug is certainly advan- tageous in ascertaining the impulse. But tor observing the sounds of the heart, the instrument is much better without the plug. The excavation renders the sounds far more audible. Op. Cit. p. 16, note. P. 517. Dr. Elliotson mentions no less than four cases of the musical bellows sound, termed by him the cooing sound, and this physician was, 1 believe, the first who noticed this singular modification of the valvular murmur.—Op. Cit. p. 15. P. 521. Dr. Elliotson notices a fact of considerable practical importance, respect- ing the manifestation of the bellows-sound, namely, that it is very much affected by the posture of the patient, and very properly recommends the examination to be made both in the upright and horizontal position. He cites several cases in which the bellows sound existed only when the patient was in the recumbent posture, and gives it as the result of his experience that the morbid murmur which is coincident with the ventricular systole is increased, and that which accompanies the ventricular diastole is diminished by the recumb ent position. He also notices a very curious case of disease of the heart complicated with ascites, in which the valvular sound immediately ceased on the removal of the fluid by tapping, and returned with the re- accumulation of the dropsical fluid. Op. Cit. p. 18. P. 522. Another curious and important fact, first noticed by Dr. Elliotson, is recorded in the same lecture, (p. 15,) viz. the alteration of character in the same sound according to the part of the chest in which it is observed. In one case (he says) the sound was small and shrill (bruit de rdpe) at the centre of the sternum, but full and bass at the cartilages to the left, and of this nature, though fainter, all over the rest of the front of the chest, and all over the left half of the back. The
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