Samuel Hart

“ While stethoscopy possesses an interest amounting to fascination, from its vital importance, from the numerous difficulties which can be overcome by reasonable diligence, and from the great degree of exactitude on the whole attainable, it still has its difficulties intrinsic and its difficulties of circumstance. ”

“ Thus the stethoscope heightens and places in relief our auditory perception of the movements and conditions of deep-seated vital organs, giving prominence to the lines and shades of a picture otherwise flat and indistinct. It will, of course, conduct all sounds communicated to it from without, thus making it necessary to avoid all frictional contact with the instrument, even of the lightest clothing; and the listener will steady it deftly by thumb and finger to escape confusion from a multiplicity of sounds. ”

“ If a small hollow needle be pressed through the chest-walls into the suspected region, the outpouring fluid will bring the needed relief and will verify the predictions of the ear by actual sight, weight, and measurement. This case is one of no uncommon occurrence, the treatment almost painless, and very satisfactory as to present relief and the prospect of permanent cure; the lung may expand to its normal size, and resume its functions healthfully. And the case is one requiring only the ordinary and easier means of diagnosis. ”

“ Although so admirably guarded against harm by the strong and elastic chest-walls, and against all inimical approach by that ever-vigilant sentinel, the epiglottis, they are, from the very nature of their functions, preeminently subject to danger from without as well as from within. The delicate mechanism of living lung-tissue can not be subjected to direct observation; the minute cells for containing air would be crushed by air admitted from without, and the heart arrested for a moment for inspection would never beat again ”

“ The sounds of respiration are also heard: the inflation of healthy air-cells, producing the vesicular murmur, is audible even to the unaided ear.
This direct application of the ear to the chest (called immediate auscultation) is preferred by some as having advantages over the mediate or instrumental method. The former is, however, open to some objections which are readily apparent, both as regards the subject and the examiner; while the stethoscopic method possesses numerous advantages, without the objections. ”

“ On the other hand it may be stated that, without multiplying illustrations, there are very numerous instances in which the subjective indications (symptoms) of organic disease are so prominent and the distress so urgent as to appear conclusive proof of imminent danger. A test of a few moments' time will make the correct diagnosis and furnish a comforting stethoscopic negative.
Disorders of the heart, although of less frequent occurrence than those of the lungs, are of equal importance and require the best skill of the examiner. ”

“ Difficulties from circumstances arise from disturbing voices or footsteps, or the roar and rattle of busy streets, and innumerable other sounds which may in part preoccupy the ear with their clangor. There are difficulties from disinclination on the part of the individual examined to offer the requisite time and facilities. There is too often incompetence on the part of the examiner; his sense of hearing as an auscultator may be defective, though not appreciable by any other test. ”

“ In fact, diseases of the lungs and heart far exceed those of any-other class in prevalence and fatality—consumption, so called, causing one fourth of the mortality between the ages of seventeen and thirty-five years—while diseases of the heart are of well-known formidable character, and raise the proportion of thoracic or pectoral diseases to a surprising ratio. ”

“ The whole of the left lung is found performing its functions healthfully. Nor is any disease found in the upper portion of the right lung; but, on searching the lower two thirds of this side, there is found an entire absence of all sounds of respiration; and, under percussion, no normal resonance due to the presence of spongy lung-tissue is heard—the sound is non-resonant, A partial resonance would be dullness ”

“ Difficulties exist to prevent the full popular benefit from stethoscopy, arising from the want of a better general knowledge of its claims and capabilities. Formerly, when the circulation of the blood and the functions of respiration were unknown and the arteries were supposed to be air-vessels, the materia medica was a wonderful list with which the physician made his round of experiments. ”

“ With the stethoscope suitably placed, a distinctly audible murmur will be detected. On observing the rhythmic succession of "first" and "second" sounds the murmur will be found to occur exactly with or in place of the latter, whose sudden click will at least be notably weakened. The murmur is found over the position of the semi-lunar valve and extending downward in a line toward the middle of the chest; it is slightly prolonged after the "second sound." No other murmurs are discovered. These are sufficient data for a diagnosis. ”

“ ONE fifth of the adult population of Christendom is suffering from chest or thoracic diseases of a degree varying from the insignificant to the most grave; while another fifth is living in constant fear of being or becoming their victims. ”

“ On firmly applying the ear to the walls of the chest of a person in health, certain sounds can be heard, varying in loudness and clearness with the quarter of the chest at which the ear is applied, and with the age or individual peculiarity of the person examined, or his state of action or repose. ”

“ The dullness is found to be better shown by light percussion than by more forcible strokes—an indication of the superficial situation of the changed tissue.
On again applying the stethoscope over the region, the natural vesicular quality of the inspiratory murmur is found to be changed to the broncho-vesicular murmur—indicating partial solidification of lung, which, if more complete, would give the bronchial or tubular sound. The pitch of its tone is raised, and it is "rough" or "harsh." A sound of expiration is also heard distinctly, while normally it is barely audible. ”

“ It will give its frequency and rhythm, its varying tension and strength, the condition of the heart and certain valves, with a delicacy and exactitude which, compared with the results obtainable by the most sensitive finger, are like the perfect work of photography compared with the attempts of the juvenile charcoal artist. ”

“ The acutest ear and the most practiced discernment are required in meeting the difficulties arising from complications of diseases, and the absence of those sounds and changes which are sufficiently distinct and characteristic—a condition to be expected in all earlier stages of pectoral troubles. ”

“ He may never have acquired the requisite degree of skill gained only by persevering practice, commencing with the normal conditions in healthy persons, thence through every class and grade of morbid states, until he has become the trustworthy adept, if not the technical expert. ”

“ A portion of one of his lungs is by some morbid process changed from its delicate, spongy structure to one which is more solid; the air-vesicles have been encroached upon by material which not only has interfered with their functions (though inappreciably to himself) , but which may prove a progressive and fatal invasion. ”

“ This case is one of a numerous and highly important class—an individual in fair health, without symptoms of any disease, is, by the stethoscopic ordeal, accounted a "bad risk," or is denied the advantages of assurance, and informed that some hygienic or curative course is essential for his safety. ”

“ Protected from friction and abrasion by the constantly renewed fluid within its strong membranous incasement, it expends an incredible amount of force in its incessant and exclusive work of propelling the blood. ”