tiple simultaneous method, in which two or more vital movements—for instance, of the heart, pulse, and respiration—are recorded at the same time, showing their exact relations to each other. The sphygmograph, in the compound form of Dr. Keyt (Fig. 5), with a chronographic
Fig. 6.
attachment, is a modern mechanical help in stethoscopy of great value, and has given important light on questions of physiology and pathology. It is an instrument of precision, of scientific interest and importance, and in difficult physical explorations the graphic method is found almost indispensable.
A few cases will now be given illustrative of practice in stethoscopy. A patient has the following symptoms: "Shortness of breath, smotherings, cough with little expectoration, pain of the side, varying from the sharp stitch to the dull and aching pain." The illness and distress are evident, and though the question of present relief is uppermost in the patient's mind, he has sufficient intelligence to demand and to comprehend the cause. From the symptoms given it may with about equally reasonable grounds be supposed that the trouble depends upon organic changes of the heart, its valves, or its pericardium; of the lungs or their pleuræ; or upon disturbances not directly connected with these organs at all, but arising from impressions transmitted through the reflex system of nerves; or it may be owing to a combination of two or more of these causes.
No amount of experience or tact will enable the physician to do more than to guess the diagnosis from these symptoms. He is unable to prescribe intelligently the needed means of relief and of the expected cure except by means of physical exploration of the chest. On inspection, increased frequency of breathing is observed: this is a suggestion only.
On applying the stethoscope the heart is found somewhat displaced, but perfectly healthy as regards its size, its valves, its membranous coverings—an important step by way of exclusion of certain possible conditions.
