Physical diagnosis of diseases of the chest / by Richard C. Cabot.

  • Cabot, Richard C. (Richard Clarke), 1868-1939.
Date:
1903
Catalogue details

Licence: Public Domain Mark

Credit: Physical diagnosis of diseases of the chest / by Richard C. Cabot. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    in which he is working. This is at first no easy matter, but can be accomplished with practice. (2) When the power to disregard external noises has been ac- quired, a still further selection must' be made among the sounds which come to the ear through the tubes of the stethoscope. Noises produced by friction of the chest piece of the stethoscope upon the skin are especially deceptive and may closely simulate a pleural or pericardial friction sound. It is well for the student to experiment upon the nature and extent of such skin rubs by deliberately moving the chest piece of the stethoscope upon the skin and listen- ing to the sounds so produced. Mistakes can be avoided in the majority of cases by holding the chest piece of the stethoscope very firmly against the chest. This can be easily done when the patient is in the recumbent position, but when the patient is sitting up it may be necessary to press so hard with the chest piece of the stethoscope as to throw the patient off his balance unless he is in some way supported; accordingly, it is my practice in many cases to put the left arm around and behind the patient so as to form a support, against which he can lean when the chest piece of the stethoscope is pressed strongly against his chest. When listening to the back of the chest, the manoeuvre is reversed. If the skin is very dry, the ribs are very prominent, or the chest is thickly covered with hair, it may be impossible to prevent the occur- rence of adventitious sounds due to friction of the chest piece upon the chest, no matter how firmly the instrument is held. In case of doubt, and in any case in which a diagnosis of pleural or pericardial friction is in question, the surface of the chest, at the point where we desire to listen, should be moistened and any hair that may be present thoroughly wetted with a sponge, so that it will lie flat upon the chest. Otherwise the friction of the hair under the chest piece of the stethoscope may simulate crepitant rales as closely as skin rubs simulate pleural friction. (3) The friction of the fingers of the auscultator upon the chest piece or on some other part of the stethoscope frequently gives rise to sounds closely resembling rales of one or another description. The nature of these sounds can be easily learned by intentionally moving the fingers upon the stethoscope. They are to be avoi led