1911 Encyclopædia Britannica/Auscultation

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15758431911 Encyclopædia Britannica, Volume 2 — Auscultation

AUSCULTATION (from Lat. auscultare, to listen), a term in medicine, applied to the method employed by physicians for determining, by the sense of hearing, the condition of certain internal organs. The ancient physicians appear to have practised a kind of auscultation, by which they were able to detect the presence of air or fluids in the cavities of the chest and abdomen. Still no general application of this method of investigation was resorted to, or was indeed possible, till the advance of the study of anatomy led to correct ideas regarding the locality, structure and uses of the various organs of the body, and the alterations produced in them by disease. In 1761 Leopold Auenbrugger (1722–1809), a Viennese physician, published his Inventum Novum, describing the art of percussion in reference more especially to diseases of the chest. This consisted in tapping with the fingers the surface of the body, so as to elicit sounds by which the comparative resonance of the subjacent parts or organs might be estimated. Auenbrugger’s method attracted but little attention till the French physician J. N. Corvisart (1755–1828) in 1808 demonstrated its great 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 oval piece of ivory (called a pleximeter, or stroke-measurer) may be used, with a small hammer; but one or more fingers of the left hand applied flat upon the part 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 ear alterations of resonance produced by disease. But percussion alone, however important in diagnosis, could manifestly convey only limited and imperfect information, for it could never indicate the nature or extent of functional disturbance.

In 1819 the distinguished French physician R. T. H. Laënnec (1781–1826) published his Traité de L’auscultation médiate, embodying the present methods of auscultatory examination, and venturing definite conclusions based on years of his own study. He also invented the stethoscope (στῆθος, the breast, and σκοπεῖν, to examine). Since then many men have widened the scope of auscultation, notably Skoda, Wintrich, A. Geigel, Th. Weber and Gerhardt. According to Laënnec the essential of a good stethoscope was its capability of intensifying the tone vibrations. But since his time the opinion of experts on this matter has somewhat changed, and there are now two definite schools. The first and older condemns the resonating stethoscope, maintaining that the tones are bound to be altered; the second and younger school warmly advocates its use. In America, more than elsewhere, there is a type of phonendoscope much used by the younger men, which has the advantage that it can be used when the older type of instrument fails, viz. when the patient is recumbent and too ill to be moved. By slipping it beneath the patient’s back a fairly accurate 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 stem of wood, hard rubber or metal, with an enlarged tip slightly funnel-shaped at one end, and an ear-plate with a hole in the middle, fastened perpendicularly to the other end. To enable the instrument to be more conveniently carried, the ear-plate can be unscrewed from the tube. The length of the stem of the instrument is of minor importance, but its bore should be as nearly as possible that of the entrance of the external ear. A flexible stethoscope in general use both in England and America transmits the sound from a funnel through tubes to the ears of the observer. This is the common form of a binaural resonating stethoscope. It is convenient and gives a loud tone, but is condemned by the older school, who say that the resonance is confusing, and that the slightest movement in handling gives rise to perplexing murmurs. Nevertheless, it is this form of instrument which has by far the greatest vogue. It is probable, however, that the most skilled physicians of all find a 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 heart, the 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 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 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 oesophagus and 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 evidence now accepted as absolutely diagnostic of that condition being the hearing of the foetal heart sounds.