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AUSCULTATION (from Lat. auscultare, t...
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See also:AUSCULTATION (from See also:Lat. auscultare, to listen) , a See also:term in See also:medicine, applied to the method employed by physicians for determining, by the sense of See also:hearing, the See also:condition of certain See also:internal See also:organs. The See also:ancient physicians appear to have practised a See also:kind of auscultation, by which they were able to detect the presence of See also:air or fluids in the cavities of the See also:chest and See also:abdomen. Still no See also:general application of this method of investigation was resorted to, or was indeed possible, till the advance of the study of See also:anatomy led to correct ideas regarding the locality, structure and uses of the various organs of the See also:body, and the alterations produced in them by disease. In 1761 See also:Leopold Auenbrugger (1722–1809), a Viennese physician, published his Inventum Novum, describing the See also:art of percussion in reference more especially to diseases of the chest. This consisted in tapping with the fingers the See also:surface of the body, so as to elicit sounds by which the See also:comparative resonance of the subjacent parts or organs might be estimated. Auenbrugger's method attracted but little See also:attention till the See also:French physician J. N. Corvisart (1755–1828) in 18o8 demonstrated its See also:great See also:practical importance, and then its employment in the diagnosis of affections of the chest soon became general. Percussion was originally practised in the manner above mentioned (immediate percussion), but subsequently the method of mediate percussion was introduced by P. A. Piorry (1794–1879). It is accomplished by placing upon the spot to be examined some solid substance, upon which the percussion strokes are made with the fingers. For this purpose a thin See also:oval piece of See also:ivory (called a pleximeter, or stroke-measurer) may be used, with a small See also:hammer; but one or more fingers of the See also:left See also:hand applied See also:flat upon the See also:part See also:answer equally well, and this is the method which most physicians adopt. Percussion must be regarded as a necessary part of auscultation, particularly in relation to the examination of the chest; for the physician who has made himself acquainted with the normal condition of that part of the body in reference to percussion is thus able to recognize by the See also:ear alterations of resonance produced by disease. But percussion alone, however important in diagnosis, could manifestly convey only limited and imperfect See also:information, for it could never indicate the nature or extent of functional disturbance. In 1819 the distinguished French physician R. T. H. Laennec (1781–1826) published his Traite de l'auscultation mediate, embodying the See also:present methods of auscultatory examination, and venturing definite conclusions based on years of his own study. He also invented the See also:stethoscope (See also:ari Oos, the See also:breast, and o-coaeiv, to examine). Since then many men have widened the See also:scope of auscultation, notably Skoda, Wintrich, A. Geigel, Th. See also:Weber and See also:Gerhardt. According to Laennec the essential of a See also:good stethoscope was its capability of intensifying the tonevibrations. ' But since his See also:time the See also:opinion of experts on this See also:matter has somewhat changed, and there are now two definite See also:schools. The first and older condemns the resonating stethoscope, maintaining that the tones are See also:bound to be altered; the second and younger school warmly See also:advocates its use. In See also:America, more than elsewhere, there is a type of phonendoscope much used by the younger men, which has the See also:advantage that it can be used when the older type of See also:instrument fails, viz. when the patient is recumbent and too See also:ill to be moved. By slipping it beneath the patient's back a fairly accurate See also:idea of the breathing over the bases of the lungs behind can often be obtained. Stethoscopes have been made of many forms and materials. They usually consist of a hollow See also:stem of See also:wood, hard See also:rubber or See also:metal, with an enlarged tip slightly See also:funnel-shaped at one end, and an ear-See also:plate with a hole in the See also:middle, fastened perpendicularly to the other end. To enable the instrument to be more conveniently carried, the ear-plate can be unscrewed from the See also:tube. The length of the stem of the instrument is of See also:minor importance, but its See also:bore should be as nearly as possible that of the entrance of the See also:external ear. A flexible stethoscope in general use both in See also:England and America transmits the See also:sound from a funnel 'through tubes to the ears of the observer. This is the See also:common See also:form of a binaural resonating stethoscope. It is convenient and gives a loud See also:tone, but is condemned by the older school, who say that the resonance is confusing, and that the slightest See also:movement in handling gives rise to perplexing murmurs. Nevertheless, it is this form of instrument which has by far the greatest See also:vogue. It is probable, however, that the most skilled physicians of all find a See also:special use in each form, the monaural non-resonating type being more sensitive to high-pitched sounds, and of greater assistance in differentiating the sounds and murmurs of the See also:heart, the See also:ordinary binaural form being more useful in examining the lungs and other organs. In using the stethoscope, it must be applied very carefully, so that the edge of the funnel makes an air-tight connexion with the skin, and in the monaural form the ear must be but lightly applied to the ear-plate, not pressing heavily on the patient. The numerous diseases affecting the lungs can now be recognized and discriminated from each other with a precision which, but for auscultation and the stethoscope, would have been altogether unattainable. The same holds good in the See also:case of the heart, whose varied and often complex forms of disease can, by auscultation, be identified with striking accuracy. But in addition to these its See also:main uses, auscultation is found to render great assistance in the investigation of many obscure internal affections, such as aneurysms and certain diseases of the See also:oesophagus and See also:stomach. To- the accoucheur the stethoscope yields valuable aid in the detection of some forms of uterine tumours, and especially in the diagnosis of pregnancy—the only See also:evidence now accepted as absolutely diagnostic of that condition being the hearing of the foetal heart sounds. Additional information and CommentsThere are no comments yet for this article.
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