thus making use of the ear, but to him is unquestionably due the glory of having systematised and developed this method of diagnosis, which, since his time, has been brought to a very high degree of refinement; so that it is not too much to say, that the skilled ear of a practised physician stands to him often entirely in the place of the eye.
To the uninitiated into the mysteries of medical practice this may appear somewhat hard to believe. Not a few of those who are sufficiently unfortunate to have to seek health artificially, look upon the adept’s proceedings far less with an eye of faith, than with a feeling of unmixed and scarcely repressible scorn; deeming them, indeed, little else than a pompous and affected way of hiding a consciousness of ignorance. To many, who have presented themselves in the full pride of apparently rude health for acceptance by an assurance office, the stethoscope has caused bitter feelings of disappointment and disgust; and deep, if not loud, have been their exclaimings against this destroyer of their hopes; until the sudden and unlooked-for realisation of its warnings has ended alike hopes and disappointment. And there are, even in these Jays, patients among the poorer classes who with difficulty divest themselves of the belief that the process of “sounding,” as they term it, is but a colloquy between the doctor and his familiar within; and who, were we living in the times when the black art was practised and witchcraft feared, would visit all the pains and penalties pronounced against their professors upon the practitioner who was sufficiently unfortunate to fail in effecting a cure.
It is not meant to be suggested that scepticism touching the revelations of the stethoscope is not often reasonable and justifiable enough on the part of the public. Too frequently, indeed, a false parade is made of a skill, of which the mere production and employment of a stethoscope is far from being a guarantee; too often the mode of manipulation is such as to cause annoyance and discomfort to the patient; and it is just possible that, besides ignorance, vanity or prejudice presiding at its employment, may be too ready to misread and distort its indications: and thus not seldom the unoffending stethoscope, which could not, if it would, speak other than the truth, and that without any effort or violence, is made to suffer for the sins of its misusers. Instances such as these are happily becoming daily rarer; and, meanwhile, nothing can hinder the stethoscope, or rather the method of investigation in regard to which it stands simply as a means to an end, from affording to the skilled and truth-seeking operator indications of priceless value.
This method has for its object, as before mentioned, to gather from the accurate reading of various normal and abnormal sounds, testimony as to the healthy or unhealthy condition of the parts within.
Not a little labour and study have been expended since Laennec’s time on this branch of medical practice; not a few patients have been examined, alive and dead: with the remarkable result that the class of diseases in question, from amongst those least understood, have come to be ranged with those best known and most easily recognised.
Cullen, writing in the year 1786, says of the inflammations affecting either the viscera of the chest, or the lining membrane of that cavity, “Neither do our diagnostics serve to ascertain the seat of the disease, nor does the difference in the seat of the disease exhibit any considerable variation of the state of things within, nor lead to any difference in the method of cure.”
A great change since the putting forth of this view, at once simple and comprehensive, has indeed taken place as regards the results of our diagnostics,—so far, at least, as they bear on our knowledge of many new forms of disease and their innumerable modifications. If we have hitherto failed to advance in a proportionate degree towards the art of curing them, it is simply that we have yet much to learn, and that we work with very imperfect means. Meanwhile it is certain that only upon accuracy of diagnosis can be founded principles of treatment with any pretension to a scientific basis.
This improved system of which we have been speaking consists essentially of two principal processes, technically known as “percussion” and “auscultation.” They may be otherwise described as the striking and listening processes. Each, while it yields indications distinct and of definite value, is incomplete without the other as regards any practical result to be obtained. There is also a third method, which was known to Hippocrates, called “succussion,” or the shaking process, by means of which the presence of fluid within the chest is sometimes demonstrated. The two former, however, are those with which wo need alone concern ourselves here.
Percussion was invented, in the year 1761, by a physician named Auenbrugger, a native of Graetz, in Styria. He wrote a treatise on the process, but failed to bring it much into repute; and it remained but little heeded until revived by Laennec.
There are two methods of practising per-