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

  • Elliotson, John, 1791-1868.
Date:
1844
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Licence: Public Domain Mark

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

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    bear 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 impos- sible, though never so much derided by the generality of men, and never so seem- ingly mad, foolish, and fantasiic;—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 beating of a man's heart; and 'tis common to hear the motion of the wind, to and fro, in the guts and odier small vessels. The stopping in the lungs is easily discovered by ihe wheezing. As to the motion of the parts one amongst another, [in order] to their becoming sensible, they require either that their motions be increased, or that the organ [of hearing] be made more nice and powerful, to sensate and distinguish them as they are; for the doing of both which, I think it not impossible but that, in many cases, there may be helps found.a Far be it from the defenders of auscultation and percussion to assert, that the diagnosis of thoracic diseases can never be doubtful. Skill in auscultation requires much application; and, even with the greatest, doubt will frequently exist. The stethoscope does not render the parietes of the chest transparent. Percussion and auscultation merely open a new set of symptoms to our notice; and, as diagnosis is certain in proportion to the number and nature of the facts on which it is founded, and the percussor and nuscultatnr, with all the same means of judging as his oppo- nents, possesses others in addition, he is better qualified to form an opinion; and, though he may sometimes-still regret his want of certainty, he knows that by shutting his ears,—by levelling himself with his opponents, he augments his un- certainty a hundred-fold.1' The alleged errors of those who practise auscultation, are no.arguments against it. Many tales of this description, like those of the errors of phrenologists, have, when traced to their origin, proved inaccurate, or even altogether destitute of truth; and eagerly to catch at them would betray a mind hoping that no fresh knowledge is to be attained. Persons, it must be remembered, who have no skill will pretend to it; and the skilful will sometimes give a hasty judgment; but, as in the case of Phrenology, nature is open to us all. Let us examine for ourselves—examine carefully and patiently;—not anxious to find auscultation a deception, but hoping to find the promise of new information fulfilled;—not unwilling to learn because we are no longer in statu pupillari ( in the rank of pupils);—not so high in our own estimation, as to feel indisposed to be taught by others;—not unphilosophical enough to have a hostile opinion upon a matter which observation must decide;— not guilty of the inconsistency of lamenting the imperfection of our art, and whining about its sad claim to the title of a conjectural art, while we are too indolent to investigate a method which professes to remove much of its uncertainty, is recom- mended by men of the greatest talent and the most intense application to the study of their profession, bears upon itself the stamp of probability, and the results of which are capable of being proved physically necessary.0 a Method of improving Natural Philosophy. Posthumous Works; Page 39. b Dr. Andral—who nowhere shows a disposition to overrate the value of auscultation, and is a highly-informed practical phvsician of the soundest judgment—says, in the preface to the second part of his Clinique Mcdicale,— Thanks especially to the wonderful dis- covery of Professor Laennec, the diagnosis of a great number of thoracic affections may be frequently established with as much accuracy as that of the least complicated luxation, or (he simplest fracture. There is a certain number of pneumonic inflammations, in which we are able to follow the different phases of the alteration of the lungs, and their return to the healthy state, with as strict precision as the eye externally follows the different periods of the cicatrization of a wound. There are affections of lhe heart, in which the nature of the organic lesion may be determined by the sense of hearing, almost as accurately as the state of a cutaneous tumour may be ascertained bv the eye, or the state of the neck of the womb by the touch. Clinical observation, however, meets with many cases in which diagnosis is very obscure; and others, in which the very nature of the affection is still a matter of dis- pute.1' « I said, upon another occasion, that the greatest discoveries have generally been at first